Nursing Management During Pregnancy

In light of the high incidence of some illnesses in women, which of the following questions is most important to include in a review of systems for a pregnant woman?

"Have you had any urinary tract infections?"

A pregnant woman at her first prenatal visit asks the nurse if it is safe to have sex during her pregnancy. Which of the following patient statements alerts the nurse to the need for further teaching?

"I should substitute intercourse with nonsexual touch to avoid harming the fetus."

A pregnant woman has developed varicosities. Which of the following statements would suggest she needs additional health teaching?

"I wear knee-highs rather than pantyhose."

After teaching the pregnant woman about ways to minimize flatulence and bloating during pregnancy, which statement indicates the need for additional teaching?

"I'll switch to chewing gum instead of using mints."

A client who is 32 weeks gestation tells the nurse that she has been experiencing shortness of breath when walking up the steps at home. She is concerned that something is wrong. What is the nurse's best response?

"The enlarging uterus pushes against your diaphragm and this makes breathing shallow"

The nurse assesses the uterine fundus and finds it to be halfway between the symphysis pubis and the umbilicus. The nurse would determine that this corresponds to how many gestational weeks?

16

The first time you see a woman during pregnancy, her fundal height is palpable at the level of her umbilicus. This measurement is typical of what gestational age?

20 weeks

A pregnant woman comes to the clinic for a visit. This is her third pregnancy. She had a miscarriage at 12 weeks and gave birth to a son, now 3 years old, at 32 weeks. Using the GTPAL system, the nurse would document this woman's obstetric history as:

30111

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

4 weeks

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

4, 1, 1, 1, 1

The Healthy People goal for US women to seek prenatal care during the first trimester is what percentage?

90 percent

The nurse should administer Rhogam (Rh immune globulin) to the pregnant woman who is Rho(D)-, after which of the following tests?

Amniocentesis

Which of the following nursing interventions is appropriate when preparing a woman for an amniocentesis?

Be certain she knows that there is are risks of complication, such as premature labor, from amniocentesis

You meet a family at the prenatal clinic. What is the most effective way to assess the woman's usual food intake during her pregnancy?

Ask her to describe her intake for the last 24 hours.

During pregnancy the cardinal rule regarding 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?

Asthma

What instruction should a nurse offer to a pregnant client or a client who wishes to become pregnant to help her avoid exposure to teratogenic substances?

Avoid medications

A woman in her third trimester complains to the nurse of significant back pain. The nurse questions the client carefully and records a detailed account of her back symptoms. What is the best rationale for the nurse evaluating the client's back symptoms with such care?

Back pain could be a sign of bladder or kidney infection

Why is the first prenatal visit usually the longest prenatal visit?

Baseline data is collected

What anatomic area should be examined when assessing Montgomery tubercles?

Breasts

While assessing a client's breast during the third trimester, which of the following would the nurse expect to find?

Colostrum from the nipples

A woman who is 3 months pregnant enjoys a slow, long walk daily. Which of the following would be most appropriate for her concerning this for the remainder of her pregnancy?

Continue this as long as she enjoys it.

A woman calls the prenatal clinic and says that she thinks she might be in labor. She shares her symptoms over the phone with the nurse and asks what to do. The nurse determines that she is likely in true labor and that she should head to the hospital. Which of the following symptoms is an indicator of true labor?

Contractions beginning in the back and sweeping forward across the abdomen

The nurse discovers a soft systolic murmur when auscultating the heart of a client at 32 weeks' gestation. Which action would be most appropriate?

Document this and continue to follow at future visits.

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

Doula

A client in the first trimester complains to the nurse of nausea and vomiting, especially in the morning. Which instruction would be most appropriate to help prevent or reduce the client's compliant?

Eat dry crackers or toast before rising

The nurse is describing pregnancy danger signs to a pregnant woman who is in her first trimester. Which of the following danger sign might occur at this point in her pregnancy?

Excessive vomiting

Which of the following findings is most worrisome in Melissa, a woman in her 26th week of pregnancy?

Facial edema

When providing preconception care to a client, which medication would the nurse identify as being safe to continue during pregnancy?

Famotidine

A woman relates to the nurse that she understands that dietary fat is bad for her and that she should avoid it during pregnancy. How should the nurse respond?

Fats are essential during pregnancy, and vegetable oils are a good source

Martha is pregnant and arrives for her second prenatal appointment. Her previous pregnancy ended at 19 weeks and she has 3-year-old twins born at 30 weeks gestation. How will you document her "G" and "L" for her records?

G3 L2

A multigravida client is pregnant for the third time. Her previous two pregnancies ended in an abortion in the first and third month of pregnancy. How will the nurse classify her pregnancy history?

G3 P0020

A client has been confirmed to be pregnant. She gives a history of two previous full-term normal pregnancies. How will the nurse classify the client's pregnancy history?

G3, P2

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?

G5 P3114 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.

Leah is 28 weeks pregnant. In preparing for discomforts that occur during the final trimester of pregnancy, you would teach her about?

Increased shortness of breath and dyspnea before lightening

A pregnant client in her third trimester is diagnosed with supine hypotension syndrome. Which of the following would the nurse instruct the client to do?

Lie laterally, preferably on the left side

A client in her second trimester of pregnancy visits a healthcare facility. The client frequently engages in aerobic exercise and asks the nurse about doing so during her pregnancy. Which of the following precautions should the nurse instruct the pregnant client to take when practicing aerobic exercises?

Maintain tolerable intensity of exercise

A nurse counsels a pregnant woman regarding her recommended daily allowance of calories. She advises her to obtain her carbohydrate calories from complex carbohydrates rather than simple carbohydrates. What is the best rationale for this guidance?

More consistent regulation of glucose and insulin

The nurse is advising a pregnant woman during her first prenatal visit regarding the frequency of future visits. Which of the following is the recommended schedule for prenatal care?

Once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth.

A client in her third trimester of pregnancy visits the healthcare center and asks why she is constipated. Which of the following would the nurse include as the most likely cause when responding to the client?

Pressure on intestine by the growing fetus

A nurse is caring for a client who is 8 months pregnant. Which instruction is the nurse most likely to give her?

Rest on the left side for at least 1 hour in the morning and afternoon.

The pregnant patient is asking about medications, supplements, and vaccines. Which of the following would the nurse indicate as potentially teratogenic?

Rubella vaccine

A woman whose body mass index (BMI) is 32 has just learned that she is pregnant. Which of the following should the nurse advise her regarding her weight over the course of her entire pregnancy?

She should gain 11 to 20 lb

Which of these cardiac variations, if found in the client who is pregnant, should the nurse recognize as a normal finding in pregnancy?

Soft systolic murmur

A pregnant woman is planning on taking a vacation that involves extensive travel by automobile. Which of the following guidelines should you give her?

Stop and walk every few hours

At a prenatal appointment, a woman who is 3 months pregnant confides to you that she ingests starch because of a craving she has had since adolescence. She is now 26 years old. What would be your most appropriate response?

Suggest she have a hemoglobin assessment done because of the association between pica and iron-deficiency anemia.

A primigravida client has come to the clinic for a prenatal checkup. What teaching topics would help to promote a healthy pregnancy for this client?

Swimming in a pool is a recommended exercise during pregnancy.

When describing the role of a doula to a group of pregnant women, which of the following would the nurse include?

The doula primarily focuses on providing continuous labor support.

A pregnant woman states that she would like to take a tub bath but has heard from her aunt that this could be dangerous to the baby. Which of the following instructions should the nurse give to the patient?

Tub baths are fine unless you are unstable on your feet or are experiencing vaginal bleeding

A client in her third trimester complains to the nurse of shortness of breath when sleeping. The nurse informs the client that this is normal and occurs because the growing fetus puts pressure on the diaphragm. Which measure should the nurse suggest to help alleviate this problem?

Use extra pillows

A 24-year-old pregnant woman complains of excessive vaginal discharge. The discharge is not associated with a strong odor, itching, or irritation but she finds it messy and unpleasant. What do you advise her to do?

Use sanitary pads

A pregnant client in her second trimester informs the nurse that she needs to travel by air the following week. Which of the following precautions should the nurse instruct the client to take during the flight?

Wear support hose

As part of her physical examination of a pregnant client, the nurse examines the woman's breasts. Which of the following are healthy breast changes that indicate pregnancy? (Select all that apply.)

• Areolae darken • Overall breast size increases • Blue streaking of veins becomes prominent • Montgomery tubercles become prominent

Which of the following are purposes for prenatal care? (Select all that apply.)

• Determine the gestational age of the fetus. • Monitor for fetal development and maternal well-being. • Identify women at risk for complications. • Establish a baseline of present health.

A woman in her first trimester shares with the nurse that she has been experiencing terrible nausea when she gets up in the morning. Which of the following should the nurse advise her to do? (Select all that apply.)

• Eat some saltine crackers before rising in the morning • Suck on sourball candies • Delay breakfast until 10 or 11 AM • Try eating soups or vegetable drinks in the morning

The nurse is preparing a teaching plan for a pregnant woman about the signs and symptoms to be reported immediately to her health care provider. Which of the following would the nurse include? Select all that apply.

• Headache with visual changes in the third trimester • Sudden leakage of fluid during the second trimester • Lower abdominal pain with shoulder pain in the first trimester

A client in her second trimester of pregnancy arrives at a health care facility complaining of heartburn. What instructions should the nurse offer to help the client deal with heartburn? Select all that apply.

• Limit consumption of food before bedtime • Sleep in a semi-Fowler's position • Avoid overeating