MNB Chapter 7

A woman is in her early second trimester of pregnancy. The nurse would instruct the woman to return for a follow-up visit every: 1 week 2 weeks 3 weeks 4 weeks

4 weeks. Explanation: The recommended follow-up visit schedule is every 4 weeks up to 28 weeks, every 2 weeks from 29 to 36 weeks, and then every week from 37 weeks to birth.

The nurse is caring for several client's at the prenatal clinic. Which client would the nurse prepare for a rountine fetal ultrasound? A woman at 10 weeks' gestation who reports increased urination and fatigue A woman at 38 weeks' gestation having increased insomnia due to breathing discomfort A woman being seen to confirm pregnancy since her last menstral period was 6 weeks prior A woman at 20 weeks' gestation reporting increased nasal stuffiness

A woman at 20 weeks' gestation reporting increased nasal stuffiness Explanation: A rountine ultrasound to assess for fetal health is typically done at 16 to 20 weeks' gestation. The woman's concerns of nasal stuffiness are common during pregnancy and would not be the reason for the rountine ultrasound. An ultrasound to assess for fetal health is not done preconception or in the last trimester. Concerns about insomnia are not reasons to complete a routine ultrasound in the last trimester. If the woman has an accurate date for the last menstral period, a routine ultrasound is not performed so early in the pregnancy. Increased urination and fatigue are typical symptoms of pregnancy and would not be indications for a routine ultrasound.

The nurse is conducting a prenatal class for a group of primigravida clients. Which instruction will the nurse prioritize when teaching about breast care? Use hot water and a mild soap to keep the nipples clean. Wash the nipples with a deodorant soap to keep them clean and help toughen them. Use an antibacterial soap and cool water to keep the nipples clean. Wash the nipples with clean water only.

Wash the nipples with clean water only. Explanation: She should use only clean water to wash the nipples. The use of any soap will dry the nipples and can lead to cracking.

The nurse understands that the maternal uterus should be at what location at 20 weeks' gestation? at the level of the symphysis pubis at the level of the umbilicus at the level near the bottom of the sternum three finger-breadths above the umbilicus

at the level of the umbilicus Explanation: By 20 weeks' gestation, the uterus is at about the level of the umbilicus; by 36 weeks, it nears the bottom of the sternum.

A pregnant client at 26 weeks' gestation has arrived for a routine prenatal visit. Which assessments should the nurse prioritize? Select all that apply. blood pressure blood glucose level weight edema of the face and hands urine testing blood glucose level

blood pressure weight urine testing blood glucose level Explanation: Up to the 28th week of gestation, follow-up visits involve assessment of the client's blood pressure and weight, urine testing for protein and glucose, along with fundal height and fetal heart rate. Between weeks 24 and 28, a blood glucose level is obtained. Assessment for edema is typically done between 29 and 36 weeks' gestation; however, edema of the face and hands should be reported if noted sooner.

Before beginning the initial prenatal examination, a nurse should instruct a client to complete what procedure before undressing? ultrasound for fetal measurements initial blood tests clean catch urine measurement of fundal height

clean catch urine Explanation: The first procedure a nurse should ask the client to do is obtain a clean catch, midstream urine before undressing. Lab tests can be done after the examination is complete. At the first visit, the fetus is too small to be measured or ultrasound done.

The gravid woman at 8 weeks' gestation is scheduled for a transvaginal ultrasound. After teaching has been completed, which statements indicate understanding? Select all that apply. "A small wand shaped probe will be placed in my vagina." "I will have gel placed on my abdomen prior to starting the procedure." "I will need to drink fluids before the procedure." "I will be able to see my fetus's heart beating during the test." "I will need a catheter placed in my bladder to aid in the procedure."

"A small wand shaped probe will be placed in my vagina." "I will be able to see my fetus's heart beating during the test." Explanation: A transvaginal ultrasound can be used in pregnancy during the first trimester. It is not considered appropriate after that point. The transvaginal utrasound requires that a slender probe is placed in the vagina. It is able to determine if the pregnancy is viable. The fetal heart beat will present by this point in the pregnancy. A full bladder is not needed for the transvaginal ultrasound. There is no needed oral fluid intake for this procedure. There is no need for an indwelling cathether to be placed in the bladder for the transvaginal ultrasound.

A client at 32 weeks' gestation telephones the health care provider's office asking if omeprazole 20mg daily is safe to take as she is experiencing heartburn. When reviewing the over-the-counter medication, the nurse notes a Pregnancy category C listed. Which would be the nurse's first action? Respond that since it is over-the-counter, it is safe. Encourage the client to eat less spicy foods and avoid all medications. Offer to speak with the health care provider and then return her call. Instruct the client that due to the pregnancy category, this medication is not taken.

Offer to speak with the health care provider and then return her call. Explanation: Heartburn is a common occurrence in pregnancy; however, the nurse does not authorize medications without speaking with the health care provider first. Omeprazole, an over the counter medication, is Pregnancy category C indicating not enough human studies have been conducted. It would be up to the health care provider to determine acceptable usage.

The nurse is screening for potential exposure to toxoplasmosis. Which question is most appropriate? "Do you have old paint in the house?" "Do you use well water for drinking?" "Do you lock your medications in a cabinet:" "Do you have a cat in the house?"

"Do you have a cat in the house?" Explanation: Toxoplasmosis is caused by a protozoan that is passed from animals (such as cats) to humans via animal feces. If the woman contracts toxoplasmosis while she is pregnant, it can cause a miscarriage or fetal abnormalities.

The nurse is providing education regarding fetal kicks/movement to a 22 weeks primigravid in the family planning clinic. Which client statement indicates an understanding of the teaching? "I will need to feel and record that my baby moves every hour." "I will document fetal kicks/movement daily and they should be 10 every 2 hours." "I will monitor fetal movement at least for 20 minutes every week." "I will not be able to feel the fetus kick until 30 weeks gestation."

"I will document fetal kicks/movement daily and they should be 10 every 2 hours." Explanation: A healthy fetus moves and kicks regularly. Instruction to the first time mother includes onset of feeling the fetal kicks (16 to 20 weeks gestation) and understanding typical kick counts (10 kicks per 2 hours). Clients are encouraged to document each kick or change in position on a piece of paper. It is unrealistic to think the mother will record fetal movement and kicks each hour. Checking the kicks and movement should be completed daily not weekly.

Gynecologic health is an important part of a woman's health history. Which statement best illustrates the way to begin a menstrual history? "Discussing menstrual periods can be embarrassing. . ." "I'd like to ask you some questions about your menstrual periods." "I know you're probably uncomfortable talking about your health. . ." "I bet you have pain with menstrual periods."

"I'd like to ask you some questions about your menstrual periods." Explanation: Beginning any history with an open-ended question allows the woman the optimal opportunity to elaborate on her health concerns.

A gravid woman who is in her first trimester reports experiencing constipation. Which statement by the client indicates the need for further instruction? "Increasing my water intake will aid in reducing my constipation." "Taking gentle enemas no more frequently than once a week is acceptable." "Adding more vegetables to my diet will be helpful." "Exercise such as walking daily helps increase my bowel movements."

"Taking gentle enemas no more frequently than once a week is acceptable." Explanation: Constipation is a common source of concern for many women in pregnancy. It results from the slowing of intestinal peristasis and also as a side effect of iron administration. Steps such as increasing fluid intake, increasing dietary fiber, and exercising are beneficial in reducing constipation. Weekly enemas during the pregnancy is not advisible. Enemas can be habit forming and do not correct the causes of the constipation being experienced.

A client comes to the clinic for her usual prenatal check up. The nurse measures the fundal height at 24 cm. What is the estimated length of her gestation? 20 weeks 24 weeks 28 weeks 32 weeks

24 weeks Explanation: Fundal height is an approximation of the number of weeks of gestation. Between 20 to 32 weeks, SFH = gestation in weeks + or - 2 cm.

The nurse is measuring the fundal height of a woman who is at 28 weeks' gestation. Which measurement would the nurse expect? 12 cm 18 cm 28 cm 32 cm

28 cm Explanation: Fundal height should be approximately equal to the number of weeks' gestation. In this case, it would be 28 cm.

At which gestational age will the nurse no longer associate fundal height directly with week's gestation? 24 weeks 30 weeks 32 weeks 36 weeks

32 weeks Explanation: The nurse is correct to no longer anticipate that the client's fundal height will equal the gestation age of the fetus following 32 weeks' gestation. This is due to variances in fetal growth. Up until that point, fundal height is a good predictor of where growth should be.

The nurse is caring for a client in her second trimester who requires follow-up genetic testing after a common screening indicated a potential abnormality. What is the nurse's main role at this time? Facilitating the testing process Allowing the client to vent feelings Answering any questions regarding potential abnormalities Witnessing the signature of the genetic testing

Allowing the client to vent feelings Explanation: It is a difficult time for the client and family. The nurse's main role is to support the client and family and allow the client to vent any feelings. The nurse will also assist in answering any questions but much of this information comes from health care provider. Next, the nurse will facilitate the testing process and witness the signature as the testing requires informed consent.

Why is the first prenatal visit usually the longest prenatal visit? Laboratory tests are performed. Extensive client teaching is done. A pelvic exam with Papanicolau test is performed. Baseline data is collected.

Baseline data is collected. Explanation: The first prenatal visit is usually the longest because the baseline data to which all subsequent assessments are compared are obtained at this visit.

Which strategies is the nurse correct to utilize when attempting to awaken a potentially sleeping fetus? Select all that apply. Clap near the mother's abdomen Place hands on the abdomen to move the fetus Use vibroacoustic stimulation Provide the mother a cold beverage Lay the mother on the left side

Clap near the mother's abdomen Provide the mother a cold beverage Place hands on the abdomen to move the fetus Use vibroacoustic stimulation Explanation: The nurse is correct to arouse the fetus in a variety of ways. The nurse can use audio stimulation such as clapping near the abdomen or using vibroacoustic stimulation. Providing the mother a cold beverage can also arouse the fetus. Feeling the mother's abdomen for the location of the fetus and moving the body parts can also cause the fetus to move and/or kick. Simply laying the mother on her side may cause a shift in the fetus but is not always enough to arouse the fetus.

The client at her 32 week gestation appointment expresses concern regarding lower extremity edema and bulging leg veins. Which suggestions by the nurse are helpful? Select all that apply. Limit fluid intake to 1 liter daily. Complete moderate exercise daily. Wear compression stockings. Keep legs below the level of the heart. Avoid sudden position changes.

Complete moderate exercise daily. Wear compression stockings. Explanation: Suggestions of exercising and wearing compression stockings are most helpful to the client with lower extremity edema and varicose veins. It is also helpful to have frequent rest periods with the legs elevated above the heart. Fluid intake is not to be limited. Avoiding sudden position changes helps prevent round ligament pain.

Which disease process would the nurse screen for under potential genetic disorders? Tuberculosis Rheumatic fever Cystic fibrosis Asthma

Cystic fibrosis Explanation: Screening of genetically linked disorders is important when obtaining a family history. Cystic fibrosis is a genetically linked disorder. Tuberculosis is an infectious disorder. Rheumatic fever stems from a streptococcus infection. Asthma is a hypersensitivity typically from an environmental allergy.

A nurse is conducting a program about the importance of prenatal care for a group of women in a community health clinic. Which information would the nurse include when describing the purpose of prenatal care? Select all that apply. Establish a baseline of present health. Determine the gestational age of the fetus. Monitor for fetal development and maternal well-being. Maximize the risk of possible complications. Identify women at risk for complications. Increase the business of the clinic.

Establish a baseline of present health. Determine the gestational age of the fetus. Monitor for fetal development and maternal well-being. Identify women at risk for complications. Explanation: The purposes of prenatal care are to establish a baseline of present health; determine the gestational age of the fetus; monitor fetal development and maternal well-being; identify women at risk for complications and minimize the risk of possible complications; and provide time for education about pregnancy, lactation, and newborn care. It is not done to help a clinic financially.

A woman who was diagnosed as having experienced a missed abortion at 10 weeks' gestation. When reviewing the client's medical records which finding would most likely be noted? Gradually increasing uterine contractions. Bright red vaginal bleeding consistently over the past 2 weeks. Feeling diminished signs of pregnancy such as breast tenderness and nausea. Passage of small amounts of tissue from the vagina. Excessive nausea and vomiting.

Feeling diminished signs of pregnancy such as breast tenderness and nausea. Explanation: A missed abortion results when the products of conception die in utero but are not expelled. The woman may experience a diminishing of pregnancy signs and symptoms as the hormonal levels begin to decline. There is no heavy or consistent vaginal bleeding. There is no cramping.

Which information is most important in order to decrease the risk of complications if the client decides to work until her due date? Eat light meals Adequate sleep Flat shoes Frequent rest periods

Frequent rest periods Explanation: It is common to have a client work until she goes into labor providing she has had a low risk pregnancy. Frequent rest periods are stressed, if possible, as the client progresses throughout the work day. The other options are good suggestions for any client at the end of pregnancy.

A pregnant woman comes to the clinic for a prenatal visit for her third pregnancy. She reveals she had a previous miscarriage at 12 weeks and her 3-year-old son was born at 32 weeks. How should the nurse document this woman's obstetric history? G3, T1, P0, A2, L1 G3, T0, P1, A1, L1 G2, T1, P2, A1, L2 G2, T0, P1, A1, L1

G3, T0, P1, A1, L1 Explanation: The woman's obstetric history would be documented as G3, T0, P1, A1, L1. G (gravida) = 3 (past and current pregnancy), T (term pregnancies) = 0, P (number of preterm pregnancies) = 1, A (number of pregnancies ending before 20 weeks viability to include miscarriage) = 1, and L (number of living children) = 1.

A nurse is classifying the pregnancy history of a woman who has had five pregnancies: three full-term, one preterm, and one abortion. How would the nurse document this information on the patient chart? G4 P3115 G5 P3114 G5 P3115 G5 P1135

G5 P3114 Explanation: G = gravida or the total number of pregnancies, which in this case equals five. P = para is the outcome of the pregnancies in the following order: full term, preterm, abortions, and living as of today. In this case, P3114.

The nurse is caring for a client having a contraction stress test. Once placing the client on the fetal monitor, it is noted that she is not currently having any Braxton Hicks contractions. If the client does not want medication to initiate contractions, which is then best to suggest? Ambulation in the hall Laying on the left side Inducing through nipple stimulation Have the client eat a spicy meal

Inducing through nipple stimulation Explanation: A contraction stress test monitors the fetal response to contractions. There are 3 ways to produce contractions for the contraction stress test. It is easily completed during Braxton Hicks contractions as they can provide sufficient information regarding fetus status. Next, the mother can stimulate oxytocin release by nipple stimulation. Lastly, the medication pitocin can produce contractions.

The nurse is assessing a woman who is pregnant for the first time. Which of the following terms applies to this client? primigravida primipara nulligravida multipara

Primigravida Explanation: Gravida refers to a woman who is or has been pregnant. Primigravida refers to a woman who is pregnant for the first time, which is the case in this scenario. Multigravida refers to a woman who has been pregnant previously. Nulligravida refers to a woman who has never been and is not currently pregnant. Para refers to the number of pregnancies that have reached viability, regardless of whether the infants were born alive. Primipara refers to a woman who has given birth to one child past age of viability.

When explaining what will occur during the first prenatal visit physical examination, a pregnant client asks why a Papanicolaou test is being done at this time. What should the nurse respond to the client? It helps to date the pregnancy. It detects if uterine cancer is present. It predicts whether cervical cancer will occur. It detects cancer cells of the cervix, vulva, or vagina.

It detects cancer cells of the cervix, vulva, or vagina. Explanation: A Papanicolau test is taken from the endocervix at a first prenatal visit to be certain a precancerous or cancerous condition of the uterine cervix, vulva, or vagina is not present. A Papanicolau test is not used to date a pregnancy, detect uterine cancer, or predict if cervical cancer will occur.

A client is preparing to leave the clinic after her first prenatal visit. What is important for the woman to do before she leaves the office? Choose a hospital for birth. Choose a name for the baby. Make a follow-up appointment. Sign up for a Lamaze class.

Make a follow-up appointment. Explanation: Before leaving an initial prenatal appointment the woman should schedule a follow-up appointment. Establishing a pattern of regular appointments is crucial to providing effective prenatal care. Naming the baby, choosing a hospital, and signing up for a Lamaze class are not normally done this early in the pregnancy.

The nurse is assessing a client at 14 weeks' gestation at a routine prenatal visit and notes the fundal height is at the umbilicus. The nurse will most likely interpret this finding to indicate which situation? Intrauterine growth retardation Multiple fetal pregnancy Deficient amniotic fluid Urinary retention

Multiple fetal pregnancy Explanation: The fundus typically is at the level of the umbilicus at 20 weeks' gestation. Therefore the fundal height is greater than that which is expected, suggesting possible multiple gestation, polyhydramnios, fetal anomalies, or macrosomia. Smaller than expected measurements would suggest intrauterine growth retardation or possibly inadequate amount of amniotic fluid. Urinary retention would displace the uterus.

A woman reports that her last menstrual period (LMP) occurred February 1, 2017. Using the Naegele rule, what would be her estimated date of delivery (EDD)? November 8, 2018 November 8, 2017 October 1, 2018 October 1, 2017

November 8, 2017 Explanation: To determine the due date using Naegele rule, add 7 days to the date of the first day of the LMP, and then subtract 3 months.

During the initial prenatal visit, a client indicates that she frequently experiences stress incontinence. Which of the following should the nurse recommend to the client to help relieve this condition? Perform Kegel exercises Reduce intake of fluids Perform monthly perineal self-examination Increase intake of water

Perform Kegel exercises Explanation: As part of any woman's gynecologic history, assess for the possibility of stress incontinence (incontinence of urine on laughing, coughing, deep inspiration, jogging, or running). Women can relieve stress incontinence to some degree by strengthening perineal muscles with the use of Kegel exercises. Perineal self-examination is inspecting the external genitalia monthly for signs of infection or lesions. Reduction of fluid intake should not be encouraged, as this could lead to dehydration; increasing intake of water would not relieve stress incontinence, but rather would more likely make it worse, due to the bladder being even more distended with the increased volume of fluid.

The nurse is collecting a urine specimen from a pregnant patient during a prenatal visit. For what will the nurse test this patient's urine? Select all that apply. Protein Glucose Bacteria White blood cells Drug levels

Protein Glucose Bacteria White blood cells Explanation: Urine is tested for proteinuria, glycosuria, nitrites, and pyuria. All of these can be done by means of test strips. The nurse will not test the patient's urine for drug levels as part of a routine prenatal visit.

When describing perinatal education to a pregnant woman and her partner, the nurse emphasizes which goal as the primary one? Equip a couple with the knowledge to experience a pain-free birth. Provide knowledge and skills to actively participate in birth and parenting. Eliminate anxiety so that they can have an uncomplicated birth. Empower the couple to totally control the birth process.

Provide knowledge and skills to actively participate in birth and parenting. Explanation: The primary focus of perinatal education is to provide information and support to clients and their families to foster a more active role in the upcoming birth. It also includes preparation for breastfeeding, infant care, transition to new parenting roles, relationships skills, family health promotion, and sexuality. Some methods of birth education focus on pain-free birth. Information provided in birth education classes helps to minimize anxiety and provide the couple with control over the situation, but elimination of anxiety or total control is unrealistic.

The nurse is documenting subjective and objective data changes from a client at 34 weeks' gestation. Which would the nurse report immediately to the health care provider? Select all that apply. Difficulty sleeping Feeling faint Bleeding gums Frequent nosebleeds Scant spotting on underwear Sharp abdominal pain

Scant spotting on underwear Sharp abdominal pain Explanation: The nurse is correct to report to the health care provider any signs of vaginal bleeding and sharp abdominal pain as these could indicate an emergency. Normal common discomforts of pregnancy include difficulty sleeping due to the increased size of the abdomen, feeling faint due to postural hypotension, bleeding gums and nosebleeds due to hormonal and drying effects of pregnancy. While it is common to have sharp round ligament pain from the increasing pregnancy, it is usually on the right side and must be further examined.

The nurse is caring for a client who is at 37 weeks' gestation and has a biophysical profile of 9. Which nursing action is best? Notify the health care provider immediately. Schedule a health care provider appointment for one week. Tell the client to report to the hospital for a nonstress test. Prepare all records as the client will be admitted for a cesarean section.

Schedule a health care provider appointment for one week. Explanation: A biophysical profile of 9 is a good score indicating fetal well-being. The nurse would schedule this client for her weekly health care provider appointment. There is no need to immediately notify the health care provider, have the client report to the hospital nor prepare the records for a cesarean section indicating the fetus needs to be delivered.

Which of the following would you advise a woman about breast self-examination during pregnancy? There is no reason to continue this during pregnancy. Self-exams are nonproductive during pregnancy. She should choose a date each month to do this. She should do it weekly, because she no longer has menstrual periods.

She should choose a date each month to do this. Explanation: Nonpregnant women use their menstrual period as a reminder to do a self-exam. Without this reminder, pregnant women need to use another system, such as a certain day each month.

The client is 32 weeks pregnant and has been referred for biophysical profile (BPP) after a nonreassuring nonstress test (NST). Which statement made by the client indicates that the nurse's explanation of the procedure was effective? The BPP is a diagnostic procedure whereby a needle is inserted into the amniotic sac to obtain fluid. The BPP is a blood test to detect placental problems. The BPP is a screening for neural tube defects. The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume.

The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume. Explanation: A biophysical profile uses a combination of factors to determine fetal well-being based upon five fetal biophysical variables. An NST is done to measure FHR acceleration. Then an ultrasound is done to measure breathing, body movements, tone, and amniotic fluid volume. Each variable receives a score from 0 to 2 for a maximum score of 10. A score of 6 or less indicates altered fetal well-being and indicates a need for further assessment. A needle is not involved with the BPP. The BPP does not detect placental problems, and the BPP is not a screening for neural tube defects.

The nursing instructor is explaining the nursing care that is given to a client during her pregnancy. The instructor determines the session is successful when the students correctly choose which method will be used to evaluate the effectiveness of the nursing care they will provide? Ask the client to respond to a preprinted survey about nursing care. Interview the client on her first postpartum visit about the nursing care she have received. Identify the nursing diagnoses for the specific client. Verify that desired outcomes for identified goals have been met.

Verify that desired outcomes for identified goals have been met Explanation: Evaluating the effectiveness of nursing care given during pregnancy is to look at the nursing diagnosis for the specific client, identify the goals and their desired outcomes for each diagnosis, and see if the desired outcomes are achieved. This may involve using a preprinted survey and interviewing the client. The nursing diagnoses should be established at the beginning to help guide the care for each individual client.

A pregnant woman reports her last child was born by cesarean birth. She questions if she will be required to have a cesarean birth for this current pregnancy. What information should be provided? Select all that apply. The reason for the previous cesarean birth will aid in determining if a repeated cesarean birth will be performed. It is safe for women who have had a cesarean birth to have a vaginal birth if that is what she chooses. If the cesarean birth was due to pelvic size a repeated cesarean birth is likely indicated. If the previous cesarean birth was due to fetal distress a repeated cesarean birth will be needed. The type of incision into the uterus in the previous cesarean birth will be a factor for consideration.

The reason for the previous cesarean birth will aid in determining if a repeated cesarean birth will be performed. The type of incision into the uterus in the previous cesarean birth will be a factor for consideration. If the cesarean birth was due to pelvic size a repeated cesarean birth is likely indicated. Explanation: A woman who gives birth by cesarean may be a candidate for a future birth vaginally. The determination about the method of birth for a future birth will be based upon a series of factors. The underlying reason for the cesarean birth has a large impact. If the woman had an operative birth due to small pelvic size, structural deformities or contractures, a repeated cesarean birth will likely be indicated. This is because the problems will still be present in the next pregnancy. The type of incision on the uterus is also an important factor. If the uterine incision was a classical incision, a repeated cesarean is indicated. The classic incision places the uterus at a high risk for rupture. If the cesarean birth was due to fetal distress, the woman may be a candidate for a vaginal birth after cesarean birth.

A petite pregnant client is concerned that she will be unable to deliver vaginally due to her small size. Which procedure should the nurse point out will help to confirm the manual measurements obtained of her pelvis and provide information which will help determine the best method of delivery for her? Ultrasonography Papanicolau test Measurement of her height and weight Vaginal examination

Ultrasonography Explanation: Manual measurements of the pelvis are usually obtained within the first few months of pregnancy to determine the adequacy of the pelvis; however, some of the measurements are only estimates. The use of ultrasonography helps to obtain pelvimetry, which eliminates the guess work and gives the necessary information to determine the size of the pelvis. Just because an individual is petite does not mean her pelvis is not of adequate size to safely deliver a full-term fetus. The vaginal examination would not give the actual measurements. The Papanicolau test and measurement of the client's height and weight would not provide any information of the client's pelvic measurements.

During pregnancy the cardinal rule regarding on taking medications and herbal remedies is that all drugs cross the placenta and have a potential impact on the fetus. What is one disease where treatment must continue during pregnancy? gout asthma gastritis cholelithiasis

asthma Explanation: Treatment, including medications, for certain diseases and conditions must continue during pregnancy. Examples include epilepsy, asthma, diabetes, and depression.

A primapara woman, 30 weeks' gestation, has no family support and frequently calls the health care provider's office with questions. Which report by the woman would alert the nurse that she may be having a complication related to the pregnancy and needs to come to the clinic today for further assessment? having a hard time having bowel movements and feeling like anal area is swollen experiencing some shortness of breath after walking up five flights of stairs having some discharge from nipples that has never happened before feeling of achy, cramping in vaginal area accompanied by bleeding that has saturated 1 pad/hour

feeling of achy, cramping in vaginal area accompanied by bleeding that has saturated 1 pad/hour Explanation: A woman should report vaginal bleeding, no matter how slight, because some of the serious bleeding complications of pregnancy begin with only slight spotting. Constipation followed by hemorrhoid development is common with pregnancy. Walking up stairs during the third trimester does produce some shortness of breath. It is normal to have some colostrum, or pre-milk, discharge during pregnancy.

The nurse is preparing the client for the routine laboratory tests which will be obtained at the first prenatal visit. Which test will the nurse prioritize at this visit? prolactin levels hepatitis screen magnesium level rubeola titer

hepatitis screen Explanation: The woman will undergo tests for hepatitis B, HIV, syphilis, gonorrhea, and chlamydia. Each of these infections can cause serious fetal problems unless they are treated. Rubella is more concerning than rubeola and a titer may be completed to assess the woman's immunity to rubella. Other blood tests will include a complete blood count to evaluate anemia, blood type and antibody screen, and possibly thyroid screen to evaluate for hypothyroidism.

By the time a woman is 36 weeks' gestation, where would the nurse expect to find the uterus? at the umbilicus halfway between the umbilicus and bottom edge of the ribcage near the bottom of the sternum under the edge of the ribcage

near the bottom of the sternum Explanation: By 20 weeks' gestation, the uterus is at about the umbilicus; by 36 weeks, it nears the bottom of the sternum.

What is the term that refers to a woman who has never been pregnant? parity gravida nulligravida multigravida

nulligravida Explanation: Gravida refers to the number of pregnancies the woman has had (regardless of the outcome). For example, a woman who has had one pregnancy is a gravida 1, whereas a woman who has had five pregnancies is a gravida 5. A woman who has never been pregnant is a nulligravida, whereas a woman who has had more than one pregnancy is a multigravida.

Which two tests are generally performed on urine at a prenatal visit? protein and sodium pH and glucose occult blood and protein protein and glucose

protein and glucose Explanation: Protein is assessed to help detect hypertension of pregnancy; glucose is assessed to help detect gestational diabetes.

The nurse is reviewing all of the documentation on determining estimated date of delivery. Which objective data is included? Select all that apply. sonogram CT Scan fundal height last day of menstrual period calculating Naegele rule Pelvic exam findings

sonogram fundal height calculating Naegele rule Explanation: The following provide objective data on the estimated date of delivery (EDD). The sonogram (a gold standard) provides detailed fetal measurements confirming the gestational age. The fundal height provides growth data, and Nagele rule calculates the estimated date of delivery using the first day of the last menstrual period. A CT scan is not ordered. Pelvic exam findings provide data that the client is pregnant and can also provide data that true labor has begun.

The nurse is assisting a primigravid on calculating the due date of her baby using Naegele's rule. The most important information provided by the mother is: the first day of the last menstrual period. the ovulation date between her periods. the date that intercourse occurred. the last day of her menstrual period.

the first day of the last menstrual period. Explanation: Naegele rule is calculated using the first day of the last menstrual period. From there, 7 days are added and then 3 months are subtracted. The ovulation date, intercourse date nor last day of the menstrual period is needed.

A 24-year-old childcare worker comes to the clinic for her first prenatal visit. She cannot remember when her last period was but thinks it was between 2 and 5 months ago. When she began gaining weight and feeling "odd" she did a home pregnancy test, which was positive. She states she felt fetal movements about 1 week ago. She has had no nausea, vomiting, fatigue, or fevers. Past medical history is remarkable for irregular periods. She has been dating the same man for 1 year and says they did not use condoms. Examination reveals an overweight young woman who appears her stated age. Head, eyes, ears, nose, throat, neck, thyroid, cardiac, and pulmonary examinations are unremarkable. The client's abdomen is nontender with normal bowel sounds, and the gravid uterus is palpated to the level of the umbilicus. Fetal tones are easily found with Doptone; with the fetoscope a faint heart rate of 140 is audible. By speculum examination the cervix is bluish; by bimanual examination the cervix is soft. Papanicolau test, cultures, and blood work are pending. The nurse gives the client her due date and how far along she is based on clinical findings. An obstetric ultrasound to confirm her dates is ordered. Based only on the clinical examination findings, how many weeks pregnant did the nurse tell this client she was? 6 to 8 weeks 12 to 14 weeks 18 to 20 weeks 24 to 26 weeks

18 to 20 weeks Explanation: Fetal tones can be easily found with Doptone and faintly auscultated with the fetoscope. The uterus is usually at the level of the umbilicus at 20 weeks. First-time mothers usually do not feel fetal movement until 20 to 24 weeks.

The nurse assesses a 20-week gestational client at a routine prenatal visit. What will the nurse predict the fundal height to be on this client experiencing an uneventful pregnancy? 24 cm 12 cm 16 cm 20 cm

20 cm Explanation: Between weeks 18 and 32 the fundal height in centimeters should match the gestational age of the pregnancy. At 20 weeks' the fundal height should be at the umbilicus. A fundal height smaller than expected can indicate that the original dates were miscalculated, oligohydramnios, or that the fetus is smaller than expected. If the fundal height is larger than expected this can indicate multiple gestation, the original dates were miscalculated, polyhydramnios, or a molar pregnancy.

The nurse is reviewing client data following a regular monthly appointment at 6 months' gestation. Which fundal height requires no further intervention? 18 cm 24 cm 30 cm 32 cm

24 cm Explanation: An anticipated fundal height for 24 weeks' gestation (6 months) is 24 cm. Between 18 and 32 weeks gestation, the fundal height in centimeters should match the gestational age. All of the other measurements would require further intervention.

Utilize the GTPAL system to classify a woman who is currently 18 weeks pregnant. This is her 4th pregnancy. She gave birth to one baby vaginally at 26 weeks who died, experienced a miscarriage, and has one living child who was delivered at 38 weeks gestation. 3, 2, 1, 2, 1 4, 2, 2, 1, 1 3, 2, 1, 1, 1 4, 1, 1, 1, 1

4, 1, 1, 1, 1 Explanation: The GTPAL system is used to classifying pregnancy status. G = gravida, T= term, P = preterm, A = number of abortions, L= number of living children.

A nurse is assessing a pregnant client. Which of the following would the nurse document as an abnormal finding in a pregnancy? Lordosis Pedal edema Linea nigra Visual changes

Visual changes Explanation: Visual changes are not seen in a normal pregnancy. They are only seen in the case of pregnancy-induced hypertension. Lordosis, pedal edema, and linea nigra are changes seen in a normal pregnancy.

Some women contract with other women to provide support during pregnancy and birth, to provide emotional support during labor and birth, and to aid in establishing breastfeeding. What is the name of the woman who is contracted? partera doula midwife pregnancy aide

doula Explanation: The woman may contract with a doula to provide support for labor and birth and help with establishing breastfeeding. A doula can also provide support for the postpartum period.

When assessing a woman at follow-up prenatal visits, the nurse would anticipate which procedure to be performed? hemoglobin and hematocrit urine for culture fetal ultrasound fundal height measurement

fundal height measurement Explanation: On every follow-up visit, fundal height measurements are performed to evaluate fetal growth and gestation. Hemoglobin and hematocrit, as part of a complete blood count, would be done on the initial visit and then repeated if the woman's status indicates a need for doing so. Urine is checked for protein, glucose, ketones, and nitrites. A culture would be done if there are signs and symptoms of an infection. Fetal ultrasound can be done at any time during the prenatal period, but it is not done at every visit.

The nurse is advising a pregnant woman during her first prenatal visit regarding the frequency of future visits. Which schedule is recommended for prenatal care? once every 3 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth once every 4 weeks for the first 28 weeks, then every 3 weeks until 36 weeks, and then every 2 weeks until the birth once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth once every 4 weeks for the first 36 weeks, then weekly until the birth

once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth Explanation: The best health for mother and baby results when the mother has her first visit before the end of the first trimester (before the end of week 13) and then has regular visits until after she has delivered the baby. The usual timing for visits is about once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth.

A pregnant client is excited that she is beginning to feel her baby move within her. The nurse explains that these first fetal movements are known as: amenorrhea. lactation. lordosis quickening

quickening. Explanation: The first fetal movements that the pregnant woman feels are called quickening and usually occur between 18 and 20 weeks of gestation. Amenorrhea is the absence of menstruation and is one of the first indications of pregnancy. Lactation is the production of breast milk in preparation for breastfeeding. Lordosis is the inward curve of the lower back, which becomes exaggerated during pregnancy.

During a nonstress test, when monitoring the fetal heart rate, the nurse notes that when the expectant mother reports fetal movement, the heart rate increases 15 beats or more above the baseline. The nurse interprets this as: variable decelerations. fetal tachycardia. a nonreactive pattern. reactive pattern.

reactive pattern Explanation: A reactive nonstress test indicates fetal activity, as evidenced by acceleration of the fetal heart rate by at least 15 bpm for at least 15 seconds within a 20-minute recording period. If this does not occur, the test is considered nonreactive. An increase in the fetal heart rate does not indicate variable decelerations. Fetal tachycardia would be noted as a heart rate greater than 160 bpm.

A patient at 6 weeks' gestation asks if she can listen to the fetal heart sounds. The nurse informs the patient that fetal heart sounds cannot be heard with a Doppler until when? 8 weeks 10 to 12 weeks 18 to 20 weeks 24 weeks

10 to 12 weeks Explanation: Fetal heart sounds can be heard through a Doppler at 10 to 12 weeks and through a regular stethoscope at 18 to 20 weeks.

The nurse is providing care for a pregnant client who has been given the necessary requisitions for laboratory work by the primary care provider. The client notices that the lab tests include testing for HIV and other sexually transmitted infections, and expresses alarm, stating, "I don't understand why the doctor would suspect that I've got these diseases." What is the nurse's most therapeutic statement? "Unfortunately, these infections have the potential to harm the fetus. It's important that the doctor identifies them early in your pregnancy." "Every pregnant client is tested for these diseases; it doesn't necessarily suggest that the doctor suspects that you have them." "Pregnancy is a major change, so every member of the care team makes sure that your health is assessed carefully." "Sexually transmitted infections are much more common than most people believe."

"Every pregnant client is tested for these diseases; it doesn't necessarily suggest that the doctor suspects that you have them." Explanation: The nurse should reassure the client that these lab tests are ordered for all clients, not only those who are at high risk for sexually transmitted infections. Making general statements about the incidence of sexually transmitted infections or the need for thorough care does not address the client's expressed concern.

The nurse is assessing a client's risk for sexually transmitted infections. Which statement by the client would be cause for concern? "I am not sure if I want to keep the baby. It is a hard decision." "I am unsure who the father of the baby is. I will be raising it alone." "I needed RhoGAM after my last pregnancy. Will I need it again?" "I only want my family to see the baby after it is born."

"I am unsure who the father of the baby is. I will be raising it alone." Explanation: While many individuals have complex social issues, if a client states that she is unsure of the father of the baby, it is understood that she has had recent, multiple sex partners. Sex with multiple partners places the client and fetus at risk for a sexually transmitted infection. Not wanting to keep the baby, needing RhoGAM and having social issues does not place the client at risk for sexually transmitted infections.

A pregnant woman is flying across the country to visit her family. After teaching the woman about traveling during pregnancy, which statement indicates that the teaching was successful? "I'll sit in a window seat so I can focus on the sky to help relax me." "I won't drink too much fluid so I don't have to urinate so often." "I'll get up and walk around the airplane about every 2 hours." "I'll do some upper arm stretches while sitting in my seat."

"I'll get up and walk around the airplane about every 2 hours." Explanation: When traveling by airplane, the woman should get up and walk about the plane every 2 hours to promote circulation. An aisle seat is recommended so that she can have easy access to the aisle. Drinking water throughout the flight is encouraged to maintain hydration. Calf-tensing exercises are important to improve circulation to the lower extremities.

A nurse is educating a pregnant client about obtaining a blood sample for an alpha-fetoprotein (AFP) level. Which response by the client indicates that the health teaching was successful? "If my AFP level is high, it could mean there is a problem with my baby's spinal cord." "If my AFP level is negative, it means the baby has no birth defects." "If my AFP level is low, then I won't need to follow up." "If there is a need to get my AFP level tested, a blood sample will be obtained around 11 weeks."

"If my AFP level is high, it could mean there is a problem with my baby's spinal cord." Explanation: An elevated AFP level in a pregnant client could indicate the presence of some type of spinal cord defect. Testing is usually performed around 16 to 18 weeks' gestation and requires follow-up. Because the AFP is a screening tool, the test may need to be repeated. An AFP test alone cannot guarantee that there are no other birth defects. Any level that is abnormal should be followed up.

The nurse manager of a prenatal clinic has implemented interventions to individualize the prenatal care experience. Which patient statement indicates that the nurse's efforts have been successful? "It was so nice to not have to wait long in the waiting room." "I really hate having my weight and blood pressure measured around other people." "Why does everyone push breastfeeding and natural childbirth? What about what I want?" "I thought you would have more reading material on labor and delivery in the waiting room."

"It was so nice to not have to wait long in the waiting room." Explanation: Strategies to individualize prenatal care include trying to schedule appointments so there won't be a long wait time, providing privacy for weight and blood pressure assessments, educating on care options and encouraging participating in decisions about care, and providing materials on pregnancy in the waiting room.

The nurse teaches a pregnant patient the manifestations associated with complications while pregnant. Which statement indicates that additional patient teaching is needed? "Pain with urination is expected during pregnancy." "I should call the doctor if I have any vaginal bleeding." "A sudden rush of fluid means that my membranes ruptured. "I should not worry if I vomit once a day for the first 12 weeks."

"Pain with urination is expected during pregnancy." Explanation: Pain on urination is a symptom of a urinary infection, potentially serious because these are associated with preterm birth. This statement indicates that additional patient teaching is needed. The patient should call the doctor with any vaginal bleeding. A sudden rush of fluid indicates the membranes have ruptured. Once a day vomiting is not uncommon during the first trimester of pregnancy.

A gravid woman in her second trimester has shared that she still enjoys a glass of wine about once a week with dinner. What response by the nurse is most appropriate? "Now that you have reached the second trimester you are at a reduced risk for causing complications to your fetus." "The best thing for you to do is to reduce the amount of alcohol you are drinking." "There is no amount of alcohol consumption in pregnancy that is considered safe for the fetus." "As long as you do not increase the amount of alcohol you are drinking there is little risk." "The best thing for you to do is to reduce the amount of alcohol you are drinking."

"There is no amount of alcohol consumption in pregnancy that is considered safe for the fetus." Explanation: Alcohol ingestion during the pregancy is considered unsafe at all points in the pregnancy. Alcohol can impact the fetus during each of trimester of pregnancy. There are no exact amounts of alcohol that can be ingested safely. Alcohol impacts each pregnancy and fetus differently. The best course of action is to share the dangers with the woman.

During the interview portion of her first prenatal visit, a woman reports she thinks she may have a vaginal infection. When questioned, she reports the discharge is thick, greenish-yellow, and she is very uncomfortable. She reports she thinks it is "yeast." How should the nurse reply? "Yeast is usually a thick, cheesy, white discharge so we will need to evaluate it during the pelvic exam." "You have a sexually transmitted disease." "You are describing gonorrhea." "You may have chlamydia so we will need to perform a pelvic exam."

"Yeast is usually a thick, cheesy, white discharge so we will need to evaluate it during the pelvic exam." Explanation: Yeast is normally a thick, cheesy discharge. Greenish-yellow discharge is associated with gonorrhea.

During the interview portion of her first prenatal visit, a woman reports she thinks she may have a vaginal infection. When questioned, she reports the discharge is thick, greenish-yellow, and she is very uncomfortable. She reports she thinks it is "yeast." How should the nurse reply? "You have a sexually transmitted disease." "Yeast is usually a thick, cheesy, white discharge so we will need to evaluate it during the pelvic exam." "You are describing gonorrhea." "You may have chlamydia so we will need to perform a pelvic exam."

"Yeast is usually a thick, cheesy, white discharge so we will need to evaluate it during the pelvic exam." Explanation: Yeast is normally a thick, cheesy discharge. Greenish-yellow discharge is associated with gonorrhea.

A nurse is providing care to a pregnant woman. To promote optimal outcomes, the nurse would engage in which activity? Select all that apply. Individualized assessment Assistance with social coordination Counseling Authoritarian decision making Teaching

Individualized assessment Counseling Teaching Explanation: Nurses contribute to the success of prenatal care through individualized assessment, counseling, and educating. Assistance with social coordination and authoritarian decision making are not associated with successful prenatal care.

A primigravida client has presented for her first prenatal visit and is concerned about the potential weight gain and the struggle to lose the weight after the baby's birth. How much weight should the nurse recommend this client with a normal BMI gain during her pregnancy to ensure a healthy fetus? 15 to 20 lbs 20 to 25 lbs 30 to 35 lbs 10 to 15 lbs

30 to 35 lbs Explanation: The nurse should convey that weight gain is healthy and that the client with a normal BMI should gain 30 to 35 lb (13.6 to 15.8 kg) to ensure a healthy fetus.

The nurse is caring for a client who is having a high risk pregnancy and requires genetic studies. Which procedures will the nurse anticipate? Select all that apply. Amniocentesis Maternal serum alpha-fetoprotein screening Chorionic villus sampling Percutaneous umbilical blood sampling Ultrasonography

Amniocentesis Chorionic villus sampling Percutaneous umbilical blood sampling Explanation: The nurse is most correct to anticipate either an amniocentesis or chorionic villus sampling as the primary tests for genetic testing. Percutaneous umbilical blood sampling can also be used to determine genetically linked blood diseases such as von Willebrand disease. Maternal serum alpha-fetoprotein screen is completed to screen for neural tube defects. Ultrasonography is a noninvasive procedure showing fetal images and movement.

The nurse is assigned to clients who are having the following procedures: <br />Amniocentesis<br />Fetal nonstress test<br />Chorionic villus sampling<br />Percutaneous umbilical blood sampling<br />Doppler assessment of fetal heart rate<br />For which clients will the nurse ensure that the informed consent is on the chart? Fetal nonstress test, Doppler assessment of fetal heart rate Amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling Amniocentesis, chorionic villus sampling, fetal nonstress test Amniocentesis, percutaneous umbilical blood sampling, Doppler assessment of fetal heart rate

Amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling Explanation: While the client ultimately consents to all procedures, some require signed documentation of consent within the client's record. An informed consent is needed for an amniocentesis, chorionic villus sampling and a percutaneous umbilical blood sampling due to the invasive nature of the procedures. Both the fetal nonstress test and the Doppler assessment of the fetal heart rate are non-invasive procedures.

A client at 16 weeks' gestation is scheduled for prenatal testing. Which of the following would the nurse anticipate as the most likely screening test for congenital anomalies based on the current age of this pregnancy? Cardocentesis. Amniocentesis. Nuchal translucency testing. Chorionic villi sampling.

Amniocentesis. Explanation: Amniocentesis to screen for congenital anomalies can be done starting at 14 weeks' gestation. This procedure carries risks of spontaneous abortion, infection, and placental abruption. Cardocentesis is used less commonly to determine blood disorders. Chorionic villi sampling is performed at 8

The blood tests for a primigravida client indicate that the client is Rh-negative and her partner is Rh-positive. What is an appropriate nursing intervention for this client? Make necessary arrangements for blood transfusion. Arrange for Rho immune globulin at 28 weeks' gestation. Inform the client about the possibility of a cesarean section. Prepare the client for the possibility of a spontaneous abortion.

Arrange for Rho immune globulin at 28 weeks' gestation. Explanation: The nurse should inform the client that Rh-negative mothers should receive Rho immune globulin at 28 weeks' gestation and with antepartum testing to prevent isoimmunization. Positive antibody screens need to be followed up to identify antibodies detected in the blood to prevent fetal complications. The nurse need not make arrangements for blood transfusions, inform the client about the possibility of a cesarean section, or prepare the client for the possibility of a spontaneous abortion.

During the initial prenatal visit, a client indicates that she frequently experiences stress incontinence. Which of the following should the nurse recommend to the client to help relieve this condition? Reduce intake of fluids Perform Kegel exercises Perform monthly perineal self-examination Increase intake of water

Ask the woman to perform Kegel exercises Explanation: As part of any woman's gynecologic history, assess for the possibility of stress incontinence (incontinence of urine on laughing, coughing, deep inspiration, jogging, or running). Women can relieve stress incontinence to some degree by strengthening perineal muscles with the use of Kegel exercises. Perineal self-examination is inspecting the external genitalia monthly for signs of infection or lesions. Reduction of fluid intake should not be encouraged, as this could lead to dehydration; increasing intake of water would not relieve stress incontinence, but rather would more likely make it worse, due to the bladder being even more distended with the increased volume of fluid.

A nurse is preparing to perform a physical examination of a pregnant woman at her first prenatal visit. Which of the following actions should the nurse perform before beginning the physical examination? Ask the woman to void for a clean-catch urine specimen Have the woman perform a breast self-examination Have the woman perform a perineal self-examination Ask the woman to perform Kegel exercises

Ask the woman to void for a clean-catch urine specimen Explanation: Ask a woman to void for a clean-catch urine specimen before the physical examination as this will provide a urine specimen for either immediate dipstick or laboratory testing of bacteria, protein, glucose, and ketone determinations, or these can be immediately tested by dipstick analysis. In addition, an empty bladder makes the pelvic examination more comfortable and, by reducing bladder size, allows for easier identification of pelvic organs. There is no need for the woman to perform a breast self-examination, perineal self-examination, or Kegel exercises before the physical examination.

In which situation is the nurse correct to document a reactive nonstress test? Select all that apply. At least 2 accelerations of the fetal heart rate The mother noting fetal movement and/or fetal kicks Decelerations in the fetal heart rate every 15 minutes Variability noted in the fetal monitor strip A lack of fetal movement over a 20 minute period

At least 2 accelerations of the fetal heart rate Variability noted in the fetal monitor strip The mother noting fetal movement and/or fetal kicks Explanation: It is a reassuring factor to have a reactive nonstress test. A reactive test shows at least 2 accelerations of the fetal heart rate, variability of the heart rate noted in the monitor strip and the mother notes (which should be seen on the monitor strip as well) the fetus moving and/or kicking. Decelerations and a lack of fetal movement are concerning and will need to have further follow-up.

A nurse is assessing a client who has come to the office to find out if she is pregnant after a home pregnancy test was positive. The nurse will record the client's last menstrual period in which component of her medical record? Chief concern/complaint Demographic data History of past illnesses/surgeries Review of systems

Chief concern/complaint Explanation: The chief concern/complaint is the reason the woman has come to the health care setting, in this instance, the fact she is or thinks she is pregnant. Among other things, this section of the health history should include the date of her last menstrual period, whether it was normal for her and whether she has used a home test pregnancy kit. Demographic data usually obtained include name, age, address, telephone number, e-mail address, religion, ethnicity, type and place of employment, and health insurance information. Questions about a woman's past medical history are important because a past condition can become active during or immediately following pregnancy. The review of systems looks at each body system for potential diseases which could present complications or concerns during the pregnancy. It also identifies any current conditions the client may have which could change routine care to accommodate specific needs.

A woman has come to the clinic for her first prenatal visit. Which method would be the most effective way for the nurse to initiate data gathering for a health history? Conduct an interview in a private room to obtain her health history. Ask her to complete a written questionnaire concerning her past and present status. Wait until she is in the examining room and prepared for her physical examination. Ask her some basic questions in the waiting room before taking her to the examining room.

Conduct an interview in a private room to obtain her health history. Explanation: Health interviewing is always conducted best in a quiet, private setting before examination procedures begin.

As part of the assessment of a client's health history during the first prenatal visit, the nurse is having the client complete a 24-hour recall to establish what and how much the woman is eating. In which section of the health history should the nurse record this information? Day history/social profile Demographic data History of past illnesses Chief concern

Day history/social profile Explanation: The day history/social profile contains information about a woman's current nutrition, elimination, sleep, recreation, and interpersonal interactions. This information can be elicited best by asking a woman to describe what her typical day is like. The chief concern is the reason the woman has come to the health care setting—in this instance, the fact she is or thinks she is pregnant. Among other things, this section of the health history should include the date of her last menstrual period, whether it was normal for her and whether she has used a home test pregnancy kit. Demographic data usually obtained include name, age, address, telephone number, e-mail address, religion, ethnicity, type and place of employment, and health insurance information. Questions about a woman's past medical history are important because a past condition can become active during or immediately following pregnancy.

The client states that the first day of her last menstrual period is March 23. The nurse is most correct to calculate using Naegele rule that the estimated date of delivery is: January 30 December 30 December 16 November 23

December 30 Explanation: Using Naegele rule, since the first day of the client's last menstrual period is March 23, 7 days are added leading to the 30th. Subtracting 3 months from March is December. Thus, December 30 is the estimated date of delivery.

The nurse is preparing a care plan for a primigravida client and her partner who are excited about her pregnancy and ask lots of questions on various subjects. Which nursing diagnosis should the nurse prioritize for this client and her partner in this care plan? Health-seeking behaviors Fear related to lack of knowledge Risk of injury Deficient knowledge

Deficient knowledge Explanation: The most appropriate nursing diagnosis in this case would be "deficient knowledge." This can entail various topics to include nutrition, exercise, testing, and even the sex of the baby. The other choices are also potential nursing diagnoses but would involve other types of activities. The couple is not displaying fear but are seeking information that will help them be successful with their pregnancy.

While conducting the first prenatal health history visit, the nurse learns that a pregnant patient is taking various herbal remedies and over-the-counter medications for minor ailments. Which nursing diagnosis should the nurse identify as being appropriate for the patient at this time? Risk for injury to fetus related to lifestyle choices Deficient knowledge regarding exposure to teratogens during pregnancy Health-seeking behaviors related to guidelines for nutrition and activity during pregnancy Health-seeking behaviors related to strong cultural desire to have a healthy child

Deficient knowledge regarding exposure to teratogens during pregnancy Explanation: The patient is taking herbal remedies and over-the-counter medications, many of which can be teratogenic to the developing fetus. This is the most appropriate nursing diagnosis for the nurse to select for this assessment finding. There is no enough information to determine if the fetus is at risk because of the patient's lifestyle choices. The patient has not asked for specific information so health-seeking behavior diagnoses would not be appropriate for the patient at this time.

The health care provider is concerned about a client's fetus having appropriate blood flow through the fetal vessels. Which diagnostic test does the nurse anticipate to confirm a diagnosis? Transabdominal ultrasound Maternal serum alpha-fetoprotein screening Doppler study Amniocentesis

Doppler study Explanation: The Doppler flow study is best for identification of blood flow. It places a transducer on the client's abdomen and allows the sonographer to assess blood flow through fetal vessels and in the fetal aorta, brain and heart. A transabdominal ultrasound is commonly used to determine gestational age, observe the fetus and diagnose complications of pregnancy. Amniocentesis is commonly used to identify chromosomal or genetic abnormalities. The maternal serum alpha-fetoprotein screening is used to determine neural tube defects.

A pregnant client at 18 weeks' gestation has arrived for her routine prenatal visit. Which assessment findings should the nurse prepare to document at this time? Select all that apply. Fundal height of approximately 18 cm Insomnia Braxton Hicks contractions Quickening Leg cramps

Fundal height of approximately 18 cm Quickening Explanation: Between 18 and 30 weeks' gestation, fundal height in centimeters is approximately the same as the number of weeks' gestation. In this case, the client is 18 weeks pregnant, so fundal height should measure approximately 18 cm. Quickening, which is typically described as light fluttering and is usually felt between 16 and 22 weeks' gestation, is caused by fetal movement. Insomnia, Braxton Hicks contractions, and leg cramps are common during the third trimester.

A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a 4-year-old child who was delivered at 38 weeks' gestation and tells the nurse that she does have a history of a miscarriage within the first trimester. The nurse is correct to document the history as: G = 4, T = 2, P = 0, A = 0, L = 1 G = 3, T = 1, P = 0, A = 1, L = 1 G = 1, T = 1, P = 1, A = 0, L = 1 G = 2, T = 0, P = 0, A = 0, L = 1

G = 3, T = 1, P = 0, A = 1, L = 1 Explanation: The GTPAL stands for Gravida -- number of pregnancies, which is 3 (current, 4 year old and miscarriage); Term -- only one pregnancy thus far carried to term; Preterm deliveries -- 0; Abortions (including miscarriages) -- 1; Living children -- 1. All other options are incorrect. Do not be distracted by the twins. That is still one pregnancy.

The nurse is documenting a non-pregnant client's obstetric history. The client informed the nurse she has 4 children living at home. She birthed one child at 34 weeks' gestation, one child at 37 weeks' gestation, one at 38 weeks' gestation, and one at 39 weeks' gestation. The client has had one abortion. Using the GTPAL format, how will the nurse document the client's obstetric history? G5, T2, P1, A1, L3 G4, T3, P0, A1, L3 G5, T2, P2, A1, L4 G4, T3, P1, A1, L4

G5, T2, P2, A1, L4 Explanation: "G" stands for gravida, the total number of pregnancies (5). "T" stands for term, the number of pregnancies that ended at term (at or beyond 38 weeks' gestation)(2). "P" is for preterm, the number of pregnancies that ended after 20 weeks' gestation (2). "A" is for abortions, either spontaneous or induced (1). "L" is for living, the number of children delivered who are alive at the time of history collection (4).

During a routine prenatal visit, a client at 36 weeks' gestation states she has difficulty breathing and feels like her pulse rate is really fast. The nurse finds her pulse to be 100 beats per minute (increased from baseline readings of 70 to 74 beats per minute) and irregular, with bilateral crackles in the lower lung bases. The nurse would develop a plan of care identifying interventions to promote which area as the priority? Tissue perfusion Gas exchange Activity Anxiety

Gas exchange Explanation: Typically, heart rate increases by approximately 10 to 15 beats per minute during pregnancy and the lungs should be clear. Dyspnea may occur during the third trimester as the enlarging uterus presses on the diaphragm. However, the findings described indicate that the woman is experiencing impaired gas exchange. There is no evidence to support problems with tissue perfusion, activity, or anxiety.

The nurse is educating a woman about the importance of folic acid before conception and during pregnancy, to prevent neural tube defects in the fetus. The client plans to take prenatal vitamins and minerals. What food source would the nurse recommend to add to the womans diet? Oily fish such as salmon Yogurt and low-fat milk Green leafy vegatables Green and iced tea

Green leafy vegatables Explanation: Green leafy vegetables are a good source of folic acid. In the past, green tea was thought to interfere with the absorption of folic acid; however, studies do not support this. The women would be advised to avoid green and iced tea due to the caffeine content. Yogurt, low-fat milk and oily fish are not known to be high in folic acid.

Which medical pair is the highest concern if reported during a pregnant client's medical history? Heart disease and diabetes Asthma and environmental allergies Irritable bowel syndrome and nausea Sinus congestion and bronchitis

Heart disease and diabetes Explanation: The highest concern is heart disease and diabetes. Due to the increase in circulating blood volume, the heart has significantly more workload. Diabetes must be closely regulated, as a high glucose can have an impact on the status of the fetus. All of the other options are important to discuss with the health care provider but not of highest concern.

The nurse is caring for a neonate whose mother received no medical care for either of her pregnancies. When assessing the neonate's status, which would indicate a potential A, B, and O incompatibility? Hypothyroidism Electrolyte deficiencies Hemolytic anemia Abnormal bleeding

Hemolytic anemia Explanation: Antibody screens are done to recognize women who may be at risk of developing antigen incompatibilities with fetal red blood cells. If the incompatibility develops, and is not addressed quickly, the neonate may develop hemolytic anemia as the mother's antibodies cross the placenta and attack the fetus's red blood cells. Hypothyroidism can affect the fetus's nervous system. Dehydration may lead to electrolyte deficiencies. Abnormal bleeding is less common due to the initiation of Vitamin K.

A gravid client is talking with the nurse about the excessive nausea and vomiting she has been experiencing throughout the day. She asks why this is happening to her and what she can do to reduce the nausea. What information should be included in the nurse's response? Select all that apply. The levels of estrogen normally seen in pregnancy are associated with nausea and vomiting. Limiting fluid intake during the morning and evening hours has been shown to reduce nausea in pregnancy. The changes in progesterone in pregnancy are associated with high levels of nausea in pregnancy. Ingesting small frequent meals in pregnancy is helpful to manage nausea. Eating a high carbohydrate snack before getting out of bed may be helpful.

Ingesting small frequent meals in pregnancy is helpful to manage nausea. Eating a high carbohydrate snack before getting out of bed may be helpful. Explanation: Nausea and vomiting in pregnancy is associated with elevated human chorionic gonadotropin (hCG) levels. Progesterone and estrogen levels are elevated in pregnancy but the normal levels associated with pregnancy are not linked to an increased occurance of nausea and vomiting. Unusually elevated hormone levels, however, are associated with increased incidents of nausea and vomiting. Eating small frequent meals instead of large bulky meals can assist with the nausea. Ingesting a high carbohydrate snack such as crackers before arising from bed in the morning is also associated with reduced levels of nausea.

Why is a Papanicolau test done at the first prenatal visit? It helps to date the pregnancy. It predicts whether cervical cancer will occur. It identifies abnormal cervical cells. It detects if uterine cancer is present.

It identifies abnormal cervical cells. Explanation: A Papanicolau test is a test for cervical cancer. Should abnormal cells be present, the woman may need to make a decision about her priorities of therapy for cervical disease or continuing the pregnancy.

The nurse is caring for a client having chorionic villus sampling using the transcervical approach. When preparing the client for the procedure, in which position is the client placed? Supine position Recumbent position Sims position Lithotomy position

Lithotomy position Explanation: The lithotomy position with the legs in stirrups is the best position to access the cervical region. The other options make it difficult, if not impossible, to access.

A woman reports that her LMP occurred on January 10, 2017. Using Naegele rule, what is her due date? October 17, 2017 October 10, 2017 October 7, 2017 October 11, 2017

October 17, 2017 Explanation: To determine the due date using Naegele rule, add seven days to the date of the first day of the LMP, then subtract three months.

The nurse is conducting an assessment of a pregnant client at a routine second trimester prenatal visit. Which lower extremity assessment should the nurse prioritize? Lateral movement of the kneecap Presence of varicosities Diameter of the calf muscle Blanching and refilling of toenails

Presence of varicosities Explanation: During pregnancy, women are prone to develop varicosities because of uterine pressure on lower-extremity veins. Evaluating the diameter of the calf would be important if a deep vein thrombosis was suspected. Capillary refill of the toenails would be a routine evaluation. Lateral movement of the kneecap would not be a priority.

The pregnant mother and her partner ask the nurse why the health care provider chose a chorionic villus sampling (CVS) procedure over an amniocentesis. The nurse is correct to highlight which benefits of CVS over amniocentesis. Select all that apply. Less cost Quicker results Less procedural discomfort Able to be completed earlier in pregnancy Less potential complications

Quicker results Able to be completed earlier in pregnancy Explanation: Chorionic villus sampling is a procedure similar to amniocentesis that provides chromosomal studies of fetal cells. CVS can be completed earlier in pregnancy with the results returning earlier, in 7 to 10 days. Cost factors are similar. Both procedures may have some associated discomfort.

Which client immunization titer is most important to assess and document in the prenatal record of the pregnant woman? Polio Rubella Rotavirus Diphtheria

Rubella Explanation: Rubella (German measles) is an infection caused by the rubella virus. The virus causes a rash and mild symptoms in children but can be teratogenic to a fetus. A rubella titer determines if the mother is immune to the virus. If the mother is not immune, the mother will receive a rubella immunization immediately after delivery. Diphtheria and polio are infant vaccines but not as teratogenic to the fetus. Rotavirus is a gastrointestinal virus typically mild in adults.

At the conclusion of a prenatal assessment, the nurse determines that a client is at risk during the pregnancy. Which data from the client's past illness history does the nurse use to make this decision? Select all that apply. Seizure disorder Previous cesarean birth Hypertension for 10 years History of abnormal Papanicolau test Previous treatment for gonorrhea

Seizure disorder Hypertension for 10 years Previous treatment for gonorrhea Explanation: Past illness history criteria that place a patient at risk during pregnancy include a seizure disorder, a chronic disease such as hypertension, and sexually transmitted infections. A previous cesarean birth and a history of abnormal Papanicolau testing are criteria for the obstetrical history that can place the client at risk during pregnancy.

The nurse is educating the client at 12 weeks' gestation regarding the best types of exercise throughout pregnancy. Which activities should the nurse encourage? All activities that the client does in a prepregnant state High impact movements enabling less time in the activity Relaxing activities such as those including hot baths and jacuzzis Stretching and breathing exercises such as yoga

Stretching and breathing exercises such as yoga Explanation: It is important to exercise during pregnancy. One excellent type of exercise includes yoga, which reduces stress and increases relaxation. Yoga also gently stretches muscles and can increase muscle tone. Contact and high impact sports are not appropriate for the pregnant mother. Hot areas such as in a jacuzzi, hot tub and sauna are also inappropriate.

A 20-year-old woman you see in a prenatal clinic has an accessory nipple. Which of the following teaching points would be most important to make with her? The tendency for accessory nipples is familial. Such growths fade with menopause. Bleeding from such growths is not uncommon. Such growths deepen in color during pregnancy.

Such growths deepen in color during pregnancy. Explanation: Pigment changes can be expected during pregnancy. Alerting women to this can decrease anxiety.

While triaging messages from the answering machine from clients with the following symptoms, which client would obtain the first visit of the day? The client at 37 weeks' gestation experiencing shortness of breath The client at 11 weeks' gestation experiencing abdominal cramping The client at 24 weeks' gestation experiencing frequent heartburn The client at 6 weeks' gestation experiencing nausea and vomiting

The client at 11 weeks' gestation experiencing abdominal cramping Explanation: The nurse is correct to have the client with the most acute symptom to have the earliest appointment. The client with the most acute symptom is the client in the first trimester experiencing abdominal cramping. The other clients are experiencing common discomforts of pregnancy.

The nurse is caring for a client with a G=5, T=0, P=3, A=1, L=3 obstetric history. The nurse is most correct to state which interpretation? The client has had uncomplicated pregnancies. The client has had difficulty becoming pregnant. The client has had difficulty reaching full term. The client has had multiple elective abortions.

The client has had difficulty reaching full term. Explanation: When interpreting the obstetric history, it is noted that the client has had three preterm pregnancies and that her children are living. The client also had one abortion, whether elective or a miscarriage. Thus, the interpretation most accurate is that the client has had difficulty reaching a full-term pregnancy. The client has had pregnancy complications. There is no evidence that the client has had difficulty becoming pregnant nor had multiple abortions.

The nurse is planning a class for nurses learning to teach early prenatal classes. Which statement indicates that teaching has been effective? Early prenatal care is needed for a healthy newborn. The goal of early prenatal care is to optimize the health of the woman and the fetus. Early prenatal care is meant to obtain laboratory work and teach the woman regarding danger signs early in the pregnancy. The first prenatal visit should be as soon as the woman misses her period.

The goal of early prenatal care is to optimize the health of the woman and the fetus. Explanation: Early prenatal classes or first trimester classes include early gestational changes, self care, fetal development and environmental dangers for the fetus, sexuality, birth settings and types of providers, nutrition, rest, exercise, relief measures for discomforts, coping with stress, psychological changes for both woman and her partner, getting the pregnancy off to a good start, availability of prenatal and genetic screening, risk factors for preterm labor and other pregnancy-related conditions, and how to recognize symptoms and what to do if they occur. Although all the answers are essentially correct, optimizing the health of the woman and fetus is the best answer.

The nurse recieves a call from a concerned client, who is 39 weeks' gestation, indicating the woman has "blood tinged mucous seeping from the vagina." What does the nurse understand about this? The woman should rest on her left side and drink water. This is known as "bloody show" and is a normal finding at this time. The woman has likely been overly active, and should be evaluated for complications. This is known as Braxton Hicks contractions and is not a concern at this time.

This is known as "bloody show" and is a normal finding at this time. Explanation: In preparation for birth, the mucous plug that filled the cervical canal is expelled. The mucous is blood tinged. The "bloody show" is normal at this time. This "bloody show" is not caused by increaed activity. The nurse would not recommend left side lying position unless the woman were experiencing preterm cramping. Braxton Hicks are known as false labor.

The nurse manager is orienting a new nurse in a clinic at the local prison. Which statements should the nurse manager include regarding the care of incarcerated pregnant clients? Select all that apply. Incarcerated pregnant women need to be screened for the use of tobacco, drugs, and alcohol. The food served by the corrections facility may need to be adjusted for the pregnancy. Comprehensive prenatal care will be provided by the correctional facility health care team. The nurse should discuss contraception as part of prenatal care. Incarcerated pregnant women need to be screened for sexually transmitted infections, including HIV. Women who are incarcerated are more likely to have a high-risk pregnancy .

The nurse should discuss contraception as part of prenatal care. Women who are incarcerated are more likely to have a high-risk pregnancy . The food served by the corrections facility may need to be adjusted for the pregnancy. Incarcerated pregnant women need to be screened for the use of tobacco, drugs, and alcohol. Incarcerated pregnant women need to be screened for sexually transmitted infections, including HIV. Explanation: All of these are true, with the exception that comprehensive prenatal care is not provided by the correctional facility health care team. On-site medical staff, including nurses and other health care providers, often do not provide any prenatal care or provide only limited prenatal care, with ultrasounds and management of high-risk pregnancies occurring off-site. Care provided outside of the correctional facility is arranged in coordination with prison officers and on-site staff. Women who are incarcerated are more likely to have a high-risk pregnancy due to a higher incidence of current and past trauma, drug or alcohol use disorder, chronic illness, infections, smoking, and poor prenatal care and a lower socioeconomic status. As when caring for other pregnant women, the nurse regularly screens incarcerated pregnant women for sexually transmitted infections, including HIV, and the use of tobacco, drugs, and alcohol. The food made available by the corrections facility may need to be adjusted to exclude food that is unpasteurized as well as cold cuts or undercooked meat, which may contain pathogens dangerous in pregnancy. As with all pregnant women, the nurse should discuss contraception as part of prenatal care. Women are up to 15 times more likely to start contraception if it is offered during incarceration instead of delayed until it can be obtained in the community after release. Approximately half of incarcerated women become pregnant within 3 months of release from prison, making the provision of contraception prior to release particularly important.

A nurse in an obstetric clinic is preparing the staff for a prenatal appointment with an incarcerated pregnant woman. What does the nurse explain is the main difference when an incarcerated client comes to the clinic? The woman will receive limited prenatal care. The woman will have follow up appointments at the prison. There is no difference when incarcerated women come to the clinic. There will be correction officers with the woman throughout her appointment. The woman will be handcuffed and wearing shackles during her appointment.

There will be correction officers with the woman throughout her appointment. Explanation: Care considerations and provision of care are the same as for the nonincarcerated population. During a visit with an off-site provider, the corrections officer may be asked to leave the room during the course of the visit to maintain patient privacy. The presence of the officer may be required, however, in situations in which the lack of presence may pose a danger to the healthcare staff or the examination space available offers a flight risk. In some cases the officer may be required to maintain direct visual contact of the inmate at all times. Correctional facility medical staff, including nurses and other healthcare providers, often do not provide any prenatal care or provide only limited prenatal care, with ultrasounds and management of high-risk pregnancies occurring off-site. Typically the woman will not be handcuffed or shackled unless she is a danger to others.

A nurse is reviewing the obstetric history of a pregnant woman who has come to the clinic for a visit. The history reveals that the woman is "gravida 3, para 2". Which interpretation by the nurse would be appropriate? Three previous pregnancies and two children born at term Two previous pregnancies, two children born at term, and currently pregnant Two previous preterm births and three miscarriages Three previous pregnancies and two preterm births

Two previous pregnancies, two children born at term, and currently pregnant Explanation: A woman who has had two previous pregnancies, given birth to two term children, and is pregnant again is gravida 3, para 2.

A nurse at the health care facility assesses a client in the 20th week of gestation. The client is healthy and progressing well, without any sign of complications. Where should the nurse expect to measure the fundal height in this client? at the top of the symphysis pubis halfway between the symphysis pubis and the umbilicus at the level of the umbilicus at the xiphoid process

at the level of the umbilicus Explanation: In the 20th week of gestation, the nurse should expect to find the fundus at the level of the umbilicus. The nurse should palpate at the top of the symphysis pubis between 10 to 12 weeks' gestation. At 16 weeks' gestation, the fundus should reach halfway between the symphysis pubis and the umbilicus. With a full-term pregnancy, the fundus should reach the xiphoid process.

A pregnant client tells the nurse that she has a 2-year-old child at home who was born at 38 weeks; she had a miscarriage at 9 weeks; and she gave birth to a set of twins at 34 weeks. Which documentation would be appropriate for the nurse? gravida 2, para 1 gravida 4, para 2 gravida 5, para 4 gravida 5, para 4

gravida 4, para 2 Explanation: Gravida (G) indicates the number of pregnancies. When a nurse calculates the GTPA of a pregnant client, the current pregnancy counts and the three other pregnancies count for a total of four pregnancies. Para (P) indicates the number of pregnancies carried to viable gestational age. This client has had two viable pregnancies so far.

A nurse is documenting the obstetric history for a pregnant woman who has previously given birth to two infants at term and had one abortion at 12 weeks' gestation. How would the nurse document this information? gravida 3, para 2 gravida 3, para 3 gravida 4, para 2 gravida 4, para 3

gravida 4, para 2 Explanation: Gravida refers to the total number of pregnancies (including current), para to the number of births. The abortion would be noted as an "A" if using the full "GTPAL."

A nurse is taking a history during a client's first prenatal visit. Which assessment finding would alert the nurse to the need for further assessment? history of exercising twice a week history of diabetes for 4 years history of occasional use of OTC pain relievers maternal age of 28 years

history of diabetes for 4 years Explanation: A diagnosis of diabetes in a pregnant client increases risk for both the client and the infant during pregnancy and requires close monitoring and follow up. This client's age, exercise history, and history of occasional OTC pain reliever use do not increase pregnancy risk.

An adolescent who is 8 weeks' pregnant is at her first perinatal visit. During the health history interview, the nurse asks the client, "Are you afraid of anyone?" What is the nurse assessing with this question? mood mental status social history intimate partner violence

intimate partner violence Explanation: Pregnant women, especially adolescents, are at increased risk for intimate partner violence. The nurse needs to ask enough questions to be certain that the woman is not experiencing physical, sexual, or emotional intimate partnership violence.

A nursing student correctly identifies which action to be the best way to prevent complications of pregnancy? limiting work hours receiving prenatal care getting adequate rest each night eating a diet high in protein

receiving prenatal care Explanation: Prenatal care is essential for ensuing the overall health of newborns and their mothers. Prenatal care is a major strategy for helping to reduce complications of pregnancy. Limiting work hours is not necessary. Eating a diet high in protein and getting adequate rest (although helpful) will not prevent complications during pregnancy.