prep u pregnancy
"Miscarriage is common in the first trimester. Nothing you did caused this." Spontaneous abortion is common in the first trimester of pregnancy. Approximately 25% to 50% of all pregnancies are nonviable and terminate spontaneously. Nearly all first-trimester miscarriages cannot be prevented, either by mother or clinician. It is important to reassure the client that she did not harm the pregnancy by running or any other activity. p. 785.
A client in her first trimester of pregnancy has experienced a spontaneous abortion. She states to the nurse, "It was my fault. I should have never gone running!" What is the best response by the nurse? "Miscarriage is common in the first trimester. Nothing you did caused this." "I know just how you feel. The same thing happened to a friend of mine." "It was nature's way of ridding your body of a defective fetus." "Don't worry. You can always have another baby."
"The safest medication to take for your headaches during your pregnancy would be acetaminophen (Tylenol)." The only medication that is approved for treatment of headaches in the first trimester of pregnancy is acetaminophen (Tylenol). p. 791
A client in her first trimester of pregnancy reports occasional headaches. She wants to know what she can take to alleviate the discomfort. What would be the best response by the nurse? "The safest medication to take for your headaches during your pregnancy would be acetaminophen (Tylenol)." "The safest medication to take for your headaches during your pregnancy would be Ibuprofen." "Wait until you reach your second trimester. You can take something to relieve headaches then." "You don't want to harm the baby by taking medications now, do you?"
RhoGam administration. Mothers with Rh negative blood are given RhoGAM at approximately 28 weeks' gestation or in cases of abdominal trauma or miscarriage. This is to prevent isoimmunization of the mother, which can endanger future pregnancies. Anemia may be treated with iron supplementation or iron-rich foods. Thalassemias may require referral to specialists because the condition poses some risks to the fetus. Patients with low-platelet levels are at risk for hemorrhage or disseminated intravascular coagulation and may not be candidates for epidurals. White blood cell (WBC) counts are usually elevated in pregnancy; they may be as high as 12,000/mm3 prenatally, and during labor they may rise as high as 30,000/mm3. WBCs in excess of these numbers suggest a potential infection. p. 805.
A client is 28 weeks pregnant when labwork is completed in the clinic. The client is Rh negative with a white blood cell count of 12,000 and normal platelet count. The nurse should plan for which treatment? 10 day course of antibiotics. RhoGam administration. Standard treatment for thalassemia. Infusion treatment for thrombocytopenia.
May 8 The rule estimates the expected date of delivery (EDD) by adding one year, subtracting three months, and adding seven days to the first day of a woman's last menstrual period (LMP).
A client reports that her last menstrual period was on August 1. Using Naegele's rule, what would the nurse anticipate as the client's due date? May 8 June 6 May 24 September 15
G4 P2022 Using the client's history, she has been pregnant four times (G4), had two term pregnancies (2), no preterm births (0), two spontaneous abortions (2), and two living children (2). Thus, the nurse would document this as G4, P2022. 790
A client reports that she has been pregnant four times, had two babies born at term, no preterm births, two spontaneous abortions, and has two living children. The nurse should document the client's gravida and para status as which of the following? G4 P2022 G4 P4220 G2 P4044 G2 P4202
"Usually, your doctor will recommend against starting brand new exercise programs while you're pregnant." Exercise is beneficial, but women should be cautioned not to start new forms of exercise during pregnancy 785.
A client who is in her first trimester states, "I've always been a fairly inactive person, but I'm determined to start going to exercise classes every day so my baby's as healthy as possible." How should the nurse respond to the client's statement? "Good for you. Regular physical activity tends to make labor and delivery go much smoother." "That's an excellent idea, and it really reduces your risk of developing high blood sugar during pregnancy." "Usually, your doctor will recommend against starting brand new exercise programs while you're pregnant." "You just need to remember to start exercising at a slow pace to avoid putting stress on your baby."
25 to 35 pounds. : Optimal weight gain during pregnancy depends on the client's height and weight. Recommended weight gain in pregnancy is as follows: Underweight client, 28-40 lb; normal weight client, 25-35 lb; overweight client, 15-25 lb; twin gestation, 35-45 lb. 797.
A client who is of normal weight just learned that she is 10 weeks pregnant. The client asks the nurse about weight gain during pregnancy. The nurse should instruct the client that the recommended weight gain is 20 to 25 pounds. 15 to 20 pounds. 25 to 35 pounds. 35 to 45 pounds.
Mastitis Localized redness, pain, and warmth are findings of mastitis, which is an inflammation of breast tissue. Cellulitis is severe inflammation of dermal and subcutaneous layers of the skin. Venous congestion is noted by the prominence of the veins of the breast. Nipple inversion is not characterized by pain, redness, and warmth. Hyperpigmentation is a normal finding and involves a darkening of the nipples and areolae. 795
A client who is pregnant presents to the health care clinic with reports of left breast pain, redness, and warmth. The nurse recognizes these as signs of which abnormal finding of pregnancy? Nipple inversion Mastitis Venous congestion Hyperpigmentation
Ptyalism Ptyalism, or excessive salivation, may occur in the first trimester. Constipation is a common problem during pregnancy, especially in clients who take iron supplements, and hemorrhoids may develop because of the pressure on the venous structures from straining to have a bowel movement. Gastric ulcers may cause bleeding and would be a reason for taking iron supplements. Pica, a craving for or ingestion of nonnutritional substances such as dirt or clay, is seen in all socioeconomic classes and cultures. Pica can be a major concern if the craving interferes with proper nutrition during pregnancy. p. 785.
A nurse assesses a 23-year-old primigravida client in her first trimester. The client reports problems with excessive salivation. Which of the following conditions should the nurse document in this client? Hemorrhoids Gastric ulcer Ptyalism Pica
Chloasma The nurse should document the darkening of the skin on the client's face as chloasma, or the facial "mask of pregnancy." Linea nigra is a dark line extending from the umbilicus to the mons pubis. Spider nevi are tiny, red angiomas occurring on the face, neck, chest, arms, and legs, and may occur because of elevated estrogen levels. Palmar erythema is a pinkish color on the palms of the hands. 799
A nurse assesses a primigravida client and observes darkening of the skin on the client's face. How should the nurse document this pigmentation? Chloasma Linea nigra Spider nevi Palmar erythema
At the xiphoid process 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 and 12 weeks' gestation. At 16 weeks' gestation, the fundus should reach halfway between the symphysis pubis and the umbilicus. With a full-term pregnancy (such as at 40 weeks' gestation), the fundus should reach the xiphoid process. p. 802.
A nurse at the health care facility assesses a client in the 40th 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 xiphoid process At the level of the umbilicus
Risk for Unstable Blood Glucose Level Based on the information provided, the nurse could make the diagnosis of Risk for Unstable Blood Glucose Level related to high carbohydrate intake and gestational diabetes. There are no indications of increased risk for urinary incontinence, constipation, or infection, as these are not associated with gestational diabetes or carbohydrate intake. 793.
A nurse is talking with a client in her second trimester of pregnancy who has just been diagnosed with gestational diabetes. The nurse asks the client about her typical diet. The client says that she likes to drink a lot of sodas and eat bread and pasta. Which of the following nursing diagnoses can the nurse make at this time?
If proper hydration and nutrition are not maintained, the client may be at risk for hyperemesis gravidarum. 794
A pregnant client at 12 weeks' gestation visits the clinic and tells the nurse that she has been vomiting severely for the past 5 days. The nurse should refer the client to a physician for possible peptic ulcer. hyperemesis gravidarum. fetal anomalies. viral infection.
"Nosebleeds are common in pregnancy and caused by capillary rupture from increased progesterone." During pregnancy, capillaries with lax walls proliferate from increased production of progesterone by the placenta. Epistaxis (nosebleeds) are a common result. p. 800.
A pregnant client comes in for a routine visit and tells the nurse that she is concerned with the frequent nosebleeds that she is experiencing. What should the nurse inform her about these nosebleeds? "Nosebleeds can indicate a more serious problem with the pregnancy." "We should be concerned with damage to your liver and your clotting factors being dysfunctional." "Nosebleeds are common in pregnancy and caused by capillary rupture from increased progesterone." "This can occur when you have a cold or the flu during pregnancy."
Usually after 12 weeks, when the placenta starts managing the production of progesterone, morning sickness ends." By 12 weeks' gestation, the placenta has grown sufficiently to take over production of progesterone and the corpus luteum is absorbed. Most women who have morning sickness start feeling better once the placenta takes over. 785
A pregnant client states, "I am only 6 weeks pregnant, but the morning sickness is awful. When is it going to stop?" What is the best response by the nurse? "Usually after 12 weeks, when the placenta starts managing the production of progesterone, morning sickness ends." "You will probably have some morning sickness throughout your entire pregnancy." "This is part of being pregnant for some women. You have to expect that this is going to happen." "This is going to occur for the first 16 weeks, while estrogen stores are depleted."
Give the mother antibiotics 4 hours prior to delivery. Protection of the infant results when antibiotics are administered 4 hours prior to delivery. Women who are positive for Group B are encouraged to notify their providers early in labor. 791
A pregnant client tests positive for Group B Streptococcus. The nurse understands that what intervention is necessary to protect the infant?
Tay-Sachs disease. Certain inherited disorders occur more often in particular ethnic groups such as Tay-Sachs disease in the Ashkenazi Jewish population. 790
A pregnant client visits the clinic for the first time. The client tells the nurse that this is her first pregnancy and that she and her husband are Ashkenazi Jews and immigrated to the United States from Israel. The nurse should encourage the client to be tested for cystic fibrosis. cerebral palsy. Tay-Sachs disease. sickle cell anemia.
preeclampsia Clinical manifestations of preeclampsia include significantly increased hypertension, persistant headache, malaise, sudden edema, especially of the face, and proteinuria 1+ or greater. Hypoglycemia is characterized by hunger, shakiness, dizziness, sweating, blurred and/or double vision, and confusion. Clinical manifestations of pyelonephritis may include fever, malaise, flank pain, polyuria, urgency, dysuria, and hematuria. Clinical manifestations of iron deficiency anemia may include pale skin, shortness of breath, extreme fatigue, weakness, dizziness, tachycardia, headache, irritability, and restless legs syndrome. p. 797.
A primigravida presents to the clinic with headache and proteinuria. The nurse obtains a blood pressure of 180/110 and suspects the patient is suffering from: preeclampsia iron deficiency pyelonephritis hypoglycemia
Braxton Hicks contractions Braxton Hicks contractions prepare the body for labor. They are usually irregular in frequency and duration, with fewer than five contractions in 1 hour. They are also short (< 30 seconds) but may be painful. These contractions may begin as early as the second trimester, especially for patients who have had babies before, but are more common in the third trimester. They often resolve with position changes, a hot shower, hydration, or relaxation. They are to be differentiated from preterm labor contractions, which are regular, do not resolve with comfort measures, occur more frequently than four contractions in 1 hour, get longer and stronger over time, and result in cervical change. The triage nurse must be able to distinguish between Braxton Hicks and preterm labor contractions. The client is not exhibiting symptoms of preeclampsia or preterm labor.
A woman comes to the clinic complaining of irregular contractions lasting less than 30 seconds and occurring no more frequently than 5 times in 1 hour. She is afraid of losing the pregnancy. She is at 26 weeks of gestation with her first child. What is most likely happening to this woman? Preeclampsia Braxton Hicks contractions Possible miscarriage Preterm labor
Tubal pregnancy Lower quadrant pain in a young woman could represent any of these possibilities. A positive HCG test and left, not right-sided, pain make appendicitis less likely. Presence of an extrauterine mass makes threatened abortion less likely. 784
A woman has a positive pregnancy test and comes to the nurse with left lower quadrant pain. Bimanual examination reveals a tender mass. Which of the following is suspected? Ovarian cyst Tubal pregnancy Threatened abortion Appendicitis
To promote the formation of surfactant in the fetal lungs A key task of the third trimester is maturation of the fetal lungs. Growth factors in amniotic fluid promote growth and differentiation of lung tissue. With normal amniotic fluid volume, functionality of the lungs depends on their ability to form surfactant, which prevents collapse of the alveoli upon expiration. If a fetus must be delivered between 28 and 34 weeks, a glucocorticosteroid injection is given to the mother to promote the formation of surfactant.
A woman is only 30 weeks pregnant, but the physician determines that the fetus must be delivered for the safety of the mother. The physician orders a glucocorticosteroid injection to be given. Why does the physician order this injection? To stimulate the mother's heart rate To promote the formation of surfactant in the fetal lungs To help the mother breathe better while in labor To stimulate the fetal heart rate
The egg never leaves the fallopian tube Ectopic pregnancy occurs when the egg never leaves the fallopian tube. Signs of this potentially life-threatening condition include lower abdominal pain on one side and spotting of blood. Confirmation of ectopic pregnancy is considered an obstetric emergency requiring hospitalization and termination of the pregnancy to save the mother's life. The other options are distracters to the question.
A young woman comes to the ED with lower abdominal pain on the right side and has been spotting blood for 2 days. She is diagnosed with an ectopic pregnancy, which is an obstetric emergency. An ectopic pregnancy is when what occurs? The placenta grows over the implanted egg The egg implants in the uterus but detaches shortly after The egg never leaves the ovary The egg never leaves the fallopian tube
Pica Pica, a craving for or ingestion of nonnutritional substances such as dirt or clay, is seen in all socioeconomic classes and cultures. Pica can be a major concern if the craving interferes with proper nutrition during pregnancy. Ptyalism, excessive salivation, may occur in the first trimester. Chloasma is a darkening of the skin on the face, known as the facial "mask of pregnancy." Polyhydramnios is an excess of amniotic fluid in the uterus. p. 793.
In assessing a client who is in her second trimester, a nurse observes that the client is underweight and anemic from lack of dietary iron. The nurse suspects malnutrition and asks the client about her diet and eating habits. The client confesses that she has been craving and eating clay recently. The nurse recognizes this condition as which of the following? Polyhydramnios Ptyalism Pica Chloasma
Arrange for Rho immune globulin at 28 weeks' gestation 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. p. 805.
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 Prepare the client for the possibility of a spontaneous abortion Arrange for Rho immune globulin at 28 weeks' gestation Inform the client about the possibility of a cesarean section
Arrange for Rho immunoglobulin at 28 weeks' gestation The nurse should inform the client that Rh-negative mothers should receive Rho immunoglobulin at 28 weeks' gestation and with antepartum testing to prevent isoimmunization if the partner's blood type is unknown. 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. 805
The blood tests for a primigravida client indicate that the client is Rh-negative and her partner's blood type is unknown. What is an appropriate nursing intervention for this client? Arrange for Rho immunoglobulin at 28 weeks' gestation Make necessary arrangements for blood transfusion Inform the client about the possibility of a cesarean section Prepare the client for the possibility of a spontaneous abortion
Quickening The fluttering sensation that can be confused with gas is called "quickening." In the 2 weeks leading up to the 20-week mark, she may feel "flutters" that she may confuse with gas. Lightening is the descent of the presenting part of the fetus into the pelvis. Placenta previa is the implantation of the placenta so that it covers part or all of the cervical os. Linea nigra is a hyperpigmented line that appears on the maternal abdomen between the symphysis pubis and top of the fundus. p. 786.
The client at 18 weeks' gestation states, "I feel a fluttering sensation, kind of like gas." The nurse understands that the client is describing what occurrence? Linea nigra Quickening Placenta previa Lightening
is normal for some women in the second and third trimesters. : Breast changes noted by many women include expression of colostrum in the second and third trimester.
The nurse is caring for a client who is 24 weeks pregnant. The client tells the nurse that she has been secreting colostrum for the past few days. The nurse should instruct the client that colostrum secretion
Refer the client due to possible intrauterine growth retardation. Uterine size should approximately equal the number of weeks of gestation. Measurements smaller than expected may indicate intrauterine growth retardation. Nutrition may contribute to this problem, but a referral is the first priority. This assessment finding is not congruent with gestational diabetes.801
The nurse is completing the assessment of a client who is 26 weeks' pregnant. Assessment reveals a fundal height of 21 cm. How should the nurse follow up this assessment finding? Obtain a 24-hour food recall. Order a repeat ultrasound due to possible multiple gestation. Refer the client due to possible intrauterine growth retardation. Have the client reassessed for gestational diabetes.
Elevated blood pressure Hydatiform mole pregnancy is associated with elevated blood pressure at 9 to 11 weeks. Hydatiform mole pregnancy is not related to thrombophlebitis, anemia, or cardiac dysrhythmias. Thrombophlebitis may occur in the pregnant woman on bed rest due to the hypercoagulable state. Anemia may result from inadequate nutrition prior to pregnancy. Cardiac dysrhythmias may occur in pregnant clients with a history of heart disease.
The nurse should frequently monitor a client at 8 weeks' gestation who has a history of hydatidiform molar pregnancy (gestational trophoblastic disease) for which problem over the next 3 to 4 weeks? Iron Calcium Anemia Thrombophlebitis Elevated blood pressure Folic acid Magnesium Cardiac dysrhythmias
"Small glands on your areola have enlarged in preparation for breastfeeding." The Montgomery tubercles are sebaceous glands on the areola that enlarge during pregnancy. They produce an oily secretion that lubricates and protects the nipple, especially important for breastfeeding women. While the response "You don't have anything to worry about; these are normal for pregnancy." is correct, it does not inform the prenatal woman about the reason of this change in her breasts.
The prenatal client expresses concern about the appearance of raised bumps on her areola. What is the best response by the nurse? "I suspect you are having an allergic response to the prenatal vitamins." "These are not expected with pregnancy; you should be tested for breast cancer." "You don't have anything to worry about; these are normal for pregnancy." "Small glands on your areola have enlarged in preparation for breastfeeding."
uman chorionic gonadotropin (hCG) The outer layer of the developing embryo produces human chorionic gonadotropin (hCG). Both urine and blood pregnancy tests measure levels of this hormone, whose presence validates the existence of a pregnancy and initiates a feedback loop that preserves the corpus luteum for longer than the normal 14 days. Neither estrogen, aldosterone, or progesterone are measured to validate the existence of pregnancy. p. 785.
Urine and blood pregnancy tests measure the level of which hormone to validate the existence of pregnancy? Estrogen Aldosterone Human chorionic gonadotropin (hCG) Progesterone
Breasts Montgomery tubercles are sebaceous glands on the areola of the breasts and are prominent during pregnancy. p. 800.
What anatomic area should be examined when assessing Montgomery tubercles? Perineum Thorax Abdomen Breasts
Slit-like appearance A slit-like appearance to the cervix is seen in women with a previous vaginal delivery. The trauma of a vaginal birth may produce a tear or laceration. When the laceration heals it leaves a slit-like appearance to the cervix. A small amount of whitish discharge, called leukorrhea, is normal. Chadwick's sign is a bluish discoloration of the cervix seen in pregnancy. Nabothian cysts are retention cysts on the surface of the cervix that are normal in women after childbirth. p803
What cervical change should a nurse recognize as indicating that a woman has delivered a fetus vaginally? Presence of leukorrhea Chadwick's sign Nabothian cysts Slit-like appearance
"I have to call my doctor to switch me from lithium to another drug for my bipolar disorder." It is very important for women to avoid teratogens during the first-trimester period (weeks 2 to 8 after conception), because all major fetal organs are formed. Lithium, tetracycline, alcohol, and exposure to radiation all are considered teratogens. The only statement that reflects an understanding is Option D.
Which statement by the pregnant woman shows an understanding that she should avoid teratogens in the first trimester?
pregnancy-induced hypertension. After 20 weeks, increased BP (>140/90) may be associated with pregnancy-induced hypertension.
While assessing a pregnant client at 36 weeks' gestation, the nurse observes that the client's face is edematous and she has 3+ reflexes with mild clonus. The nurse should refer the client to a physician for possible hydatidiform mole. multiple gestation. pregnancy-induced hypertension. hyperthyroidism.
fade to a white or silvery color.
While assessing the abdomen of a pregnant client, the nurse observes striae gravidarum. The nurse should instruct the client that after delivery, the striae gravidarum will
10 weeks. : A fetal Doppler ultrasound device can be used after 10-12 weeks' gestation to hear the fetal heartbeat.
While caring for a pregnant client at 8 weeks' gestation, the client asks the nurse, "When can you hear the baby's heartbeat?" The nurse should instruct the client that when a Doppler device is used, the earliest time when the fetal heart rate can be heard is the gestational age of 22 weeks. 14 weeks. 18 weeks. 10 weeks.
Untreated gonorrhea can delay the progression of an egg to the uterus, resulting in an ectopic pregnancy. No or delayed treatment of gonorrhea and chlamydia can cause inflammation of the fallopian tube and result in scarring, which can delay the progression of the egg to the uterus. The result can be ectopic pregnancy.
Why is it important for the nurse to inquire about the client's history of sexually transmitted diseases before the client attempts to conceive?
