Prenatal Care Quiz

A woman is concerned about the safety of continuing coitus with her partner during pregnancy. Which suggestion should the nurse mention to her? Select all that apply. A. Coitus is generally not harmful to fetus B. Coitus is to be avoided after your membranes have ruptured C. Coitus can cause rupture of the membranes D. A non-monogamous sexual partner should wear a condom E. Partner oral-female genital contact due to risk of air embolism

A,B,D,E The nurse should reassure the client that coitus is generally not harmful to the fetus. Women whose membranes have ruptured or who have vaginal spotting should be advised against coitus until examined by their primary care provider to prevent possible infection. Advise caution also about partner oral-female genital contact, because accidental air embolism has been reported from this act during pregnancy as well as in the postpartal period from air entering open or fragile uterine arteries. Caution women with a nonmonogamous sexual partner that the partner needs to use a condom to prevent transmission of a sexually transmitted infection during pregnancy. Coitus does not initiate labor or cause rupture of the membranes.

A woman in her sixth month of pregnancy comes in for her first prenatal examination. She complains today of headache and abdominal pain of several months' duration. She appears somewhat hurried or nervous. What questions would the nurse ask next? A. Do you feel safe at home? B. Have you been eating properly and taking a prenatal vitamin?

A; All these questions are important when interviewing a pregnant woman. This picture may make you think of social problems such as domestic violence, substance abuse, or both. Asking more directed questions in these areas may be fruitful.

As part of a 31-year-old client's prenatal care, the nurse is assessing immunization history. Which immunization is most relevant to ensuring a healthy fetus? A. Rubella B. Hepatitis A and B

A; Maternal exposure to rubella during pregnancy poses a particular fetal risk that supersedes the significance of hepatitis, measles, diphtheria, tetanus, or pertussis.

A woman who is 26 weeks pregnant arrives for a follow-up visit. Which assessments, in addition to measuring fundal height and fetal heart rate, would the nurse expect to complete? Select all that apply. A. blood pressure B. weight C. blood glucose level D. urine testing

ABCD

A physically fit 30-year-old woman in her first trimester would like to continue exercising during pregnancy. She says she normally jogs, but has been thinking about taking up cycling. She also would like to know how much exercise she should get. Which instructions should the nurse give to the client? Select all that apply A. Try walking which is an excellent exercise option during pregnancy. B. Avoid taking up a new sport, such as cycling, during pregnancy. C. Avoid sports that involve body contact. D. Include warm-up and cool-down exercises. E. Exercise three times weekly for 30 consecutive minutes.

ABCDE

The nurse should administer Rho(D) immune globulin to the pregnant woman who is Rho(D)-, after which test?

Amniocentesis; Amniocentesis is an invasive procedure whereby a needle inserted into amniotic sac to obtain a small amount of fluid. This places the pregnancy at risk for a woman with RhD-negative blood, and she should receive RhoGam after the procedure. The CST, NST, and a biophysical profile are noninvasive tests.

What is the most effective way for a nurse to assess a woman's usual food intake during her pregnancy?

Ask her to describe her intake for the last 24hrs; A 24-hour food intake history is the best method to assess food intake in all individuals.

A nurse is educating a primigravida client about the expected changes during pregnancy. Which measure will provide anticipatory guidance about pregnancy? A. Inform health care provider if bleeding is more than just spotting. B. Avoid wearing high heels, especially during late pregnancy.

B The nurse should ask the client to avoid wearing high heels, especially during late pregnancy because the ligaments relax and the pregnant woman's center of gravity changes; thus, she may lose her balance. The nurse should ask the client to inform the healthcare provider if any bleeding, including a spot or two, occurs. The nurse should ask the pregnant woman to consume plenty of fiber and water to prevent constipation and hemorrhoids. If she wakes up feeling very hungry, it could help to eat starchy food, such as a baked potato, just before bedtime. If she eats sweets, she will probably have a rapid rise in blood sugar, followed by a sharp drop. Either of these changes can cause uncomfortable symptoms.

A woman presents to the clinic in the first trimester of pregnancy. She has three children living at home. One of them was born prematurely at 34 weeks. The other two were full-term at birth. She has a history of one miscarriage. How does the nurse record her obstetric history on the chart using the GTPAL format? A. G4 T2 P1 A1 L3 B. G5 T2 P1 A1 L3

B: One of the most common methods of recording the obstetric history is to use the acronym GTPAL. "G" stands for gravida, the total number of pregnancies including the current one. "T" stands for term, the number of pregnancies that ended at term (at or beyond 38 weeks' gestation); "P" is for preterm, the number of pregnancies that ended after 20 weeks and before the end of 37 weeks' gestation. "A" represents abortions, the number of pregnancies that ended before 20 weeks' gestation. "L" is for living, the number of children delivered who are alive at the time of history collection.

During the physical examination at the first prenatal visit a speculum examination is performed. What sign of pregnancy does the practitioner look for during the speculum examination? A. Chadwick's Sign B. Goodell's sign

B; During the speculum examination, the practitioner obtains a Papanicolaou test and notes signs of pregnancy, such as Chadwick's sign.

Why is the first prenatal visit usually the longest prenatal visit? A. Extensive Client teaching is done B. Baseline data s collected

B; The first prenatal visit is usually the longest because the baseline data to which all subsequent assessments are compared are obtained at this visit.

When assessing a woman at follow-up prenatal visits, the nurse would anticipate which procedure to be performed? A. Hemoglobin and Hematocrit B. Fundal Height Measurements

B; 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.

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? A. She should lose 5 to 10 lb B. She should gain 11 to 20 lb

B; Women whose weight falls into the obese BMI category (over 30 ), should aim to gain 11 lb to 20 lb; normal weight women (18.5-24.9) should aim to gain 25 lb to 35 lb; underweight women (BMI is less than 18.5) should aim to gain 28 lb to 40 lb; overweight women (BMI over 25-29.9), should aim to gain 15 lb to 25 lb.

Gestational diabetes occurs around the 24th week of gestation. When should every woman be screened for gestational diabetes?

Between 24-28 weeks gestation All women should be screened for gestational diabetes between 24 and 28 weeks of pregnancy.

By the time a woman is 36 weeks' gestation, where would the nurse expect to find the uterus?

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

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 4 weeks for the first 28 weeks, the every 2 weeks until 36 weeks and then weekly until birth; 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 client's maternal serum alpha-fetoprotein (MSAFP) level was unusually elevated at 17 weeks. The nurse suspects which condition?

Open Spinal Defects; Elevated MSAFP levels are associated with open neural tube defects. Fetal hypoxia would be noted with fetal heart rate tracings and via nonstress and contraction stress testing. MSAFP in conjunction with marker screening tests would be more reliable for detecting Down syndrome. Maternal hypertension would be noted via serial blood pressure monitoring.

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 instruction should the nurse give to the client?

Tub baths are fine unless you are unstable on your feet or are experiencing vaginal bleeding; Daily tub baths or showers are recommended. Women should not soak for long periods in extremely hot water or hot tubs, however, as heat exposure for a lengthy time could lead to hyperthermia in the fetus and birth defects, specifically esophageal atresia, omphalocele, and gastroschisis. As pregnancy advances, a woman may have difficulty maintaining her balance when getting in and out of a bathtub. If so, she should change to showering or sponge bathing for her own safety. If membranes rupture or vaginal bleeding is present, tub baths become contraindicated because there might be a danger of contamination of uterine contents. Soap is not a teratogen to the fetus.

A 38-year-old client has one child with Tay-Sachs disease. She and her partner both carry the Tay-Sachs gene and did not intend to have more children, but she has just discovered that she is pregnant. She plans to have an abortion if tests show that the fetus has the Tay-Sachs gene. Which test will the primary care provider likely prescribe? A. chorionic villus sampling B. amniocentesis

A: CVS is a newer procedure and can provide information on fetal chromosomal studies similar to an amniocentesis, but earlier in pregnancy. The CVS is typically performed between 8 and 12 weeks gestation. Given the disease in question, she would be able to determine the course of the pregnancy early in gestation. Multiple marker screen tests are done later in the pregnancy, as is amniocentesis. Percutaneous umbilical blood sampling examines the blood and is not the best source for chromosomal studies.

When measuring the diagonal conjugate of a woman's pelvis, the distance between which anatomic landmarks would be used?

Anterior surface of the sacral prominence and the anterior surface of the symphysis pubis The diagonal conjugate measures the distance between the anterior surface of the sacral prominence and the anterior surface of the inferior margin of the symphysis pubis, or the anterior-posterior diameter of the pelvic inlet.

A client asks the nurse to compute her expected date of birth. Based on the fact that her last menstrual flow began on July 20, her date would be:

April 27; Nagele's rule is to count backward 3 months and add 7 days from the first day of the last menstrual period to determine an expected due date, making the client's due date April 27th.

In light of the high incidence of some illnesses in women, which question is most important to include in a review of systems for a pregnant woman? A. "Have you ever had a heart attack?" B. "Have you had any urinary tract infections?"

B; Urinary tract infections occur at a greater incidence in pregnant women than in others because stasis of urine occurs because of pressure on the ureters; the trace of glucose often present in urine helps bacteria grow.

Leah is 28 weeks pregnant. To prepare her for discomforts that occur during the final trimester of pregnancy, what would the nurse teach her about?

Experiencing increased shortness of breath and dyspnea before lightening; As the fetus grows inside the mother, there is more pressure on the diaphragm and more difficulty breathing, and episodes of dyspnea may occur. This tends to decrease with lightening, when the fetus drops. Eating a well balanced diet, oral hygiene, and exercise should be done throughout the entire pregnancy.

A pregnant woman experiences frequent leg cramps. Which measure would the nurse include in her teaching plan to provide her with relief?

Extending her knee and dorsiflexing her foot; Dorsiflexing the foot with the knee extended is an effective method for relieving cramps in the calf muscle, the most frequently affected muscle.

Which finding is most worrisome in a client in her 26th week of pregnancy?

Facial Edema; Generalized hair loss, hyperpigmented maxillary rash (chloasma), and nosebleeds are usually benign and common in pregnancy. Facial edema after the 24th week of gestation may indicate gestational hypertension.

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; Omega-3 fatty acids, particularly linoleic acid, are fats that are essential for new cell growth but cannot be manufactured by the body. Vegetable oils such as safflower, corn, olive, peanut, and cottonseed, fatty fish, omega-3 infused eggs, and omega-3 infused spreads are all good sources. Pregnant women should ingest between 200 and 300 mg daily. Because some fish may be contaminated by mercury, alert women that the American Pregnancy Association (APA) recommends that marlin, orange roughy, tilefish, swordfish, shark, king mackerel, and bigeye and ahi tuna should be avoided during pregnancy.

As part of her first prenatal visit, the nurse is taking a pregnant woman's obstetric history. She has an 18-month-old daughter who was born 2 days after her estimated date of birth and a 3-year-old son who was born at 35 weeks' gestation. Before her son was born, she lost two pregnancies: one at 12 weeks and the other at 21 weeks. Using the GTPAL method, how would the nurse record this history?

G5 T1 P2 A1 L2 5 pregnancies, 1 between 38-42 weeks, 2 between 20-37 weeks, 1 abortion at 12 weeks, 2 current living, 1 still in uterus.

Based on the incidence of disease in women, which assessment of lower extremities would be most important to make in a pregnant woman?

Presence of varicosities; During pregnancy, women are prone to develop varicosities because of uterine pressure on lower-extremity veins.

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.

Several laboratory tests are performed during the first prenatal visit. What is one of those lab tests?

hepatitis screen; 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. In most cases, rubeola titer, prolactin levels and magnesium levels are not examined

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 soft systolic murmur is common in pregnancy secondary to the increased blood volume. The other findings are not normal and require further assessment by the nurse.