Chapter 10: The Expectant Family - Needs & Care
A Hispanic American client who is 26 weeks pregnant asks if her curandero, or folk healer, may accompany her to all future prenatal appointments. Which response by the nurse reflects respect for the client's cultural beliefs? a) "Yes, we will work as a team as much as possible in taking care of you." b) "National law prohibits the inclusion of anyone who is unlicensed to practice health care from giving health-related advice." c) "Because of the risks to your baby, we do not recommend that clients use alternative healthcare methods." d) "We prefer that only the father of the baby and your relatives accompany you to your prenatal visits."
A Explanation: 1. During pregnancy and birth, cultural and spiritual practices, including alternative healers and caregivers, should be incorporated into prenatal care as much as possible. 2. While certain disciplines require licensure and certification, numerous complementary and alternative healers provide health-related advice. 3. Cultural competence includes incorporating the client's cultural and spiritual beliefs into her care, while evaluating the potential negative health consequences of her healthcare beliefs. 4. The client is free to choose who accompanies her during prenatal visits.
The prenatal clinic nurse has presented information on prenatal class options to a couple pregnant for the first time. Which statement made by the couple indicates that additional information is necessary? Prenatal classes: a) Eliminate the risk of needing a vacuum extraction or cesarean birth. b) Help parents cope with the discomforts and unknowns of childbirth. c) Facilitate better communication between both partners. d) Encourage participants to write a list of their requests for labor and birth.
A Explanation: 1. This is false reassurance. There is no guarantee that an operative birth can be avoided, even if a couple attends prenatal classes. 2. This is one of the main goals of prenatal classes: learning skills to help get through the discomforts of childbirth. Participants also learn how the birthing process progresses. This does not imply that students of prenatal classes don't get epidurals. But participants will learn new skills that will facilitate the birthing process. 3. A secondary goal of prenatal classes is to facilitate communication between the pregnant woman and her partner. The primary goals are to inform participants of the birth process and teach them skills to cope with labor and birth. 4. One of the strategies used in prenatal classes is to have participants write a birth plan that lists their requests for how they want their birthing experience to be. But putting their desires down in writing is less important than learning about the birth process and learning skills to cope with labor and delivery.
The nurse is presenting a prenatal education class about the use of Lamaze during childbirth. Which concept should the nurse include in his teaching? a) Dissociative relaxation b) Partner-coached childbirth c) The extended McRoberts position d) Touch relaxation
A Explanation: 1. Dissociative relaxation, which is specific to Lamaze, promotes relaxation of uninvolved muscles while the uterus contracts, creating an active relaxation pattern. 2. Partner-coached childbirth is an element of the Bradley method. 3. The extended McRoberts position is a body-conditioning exercise that helps enable the woman to stretch her hamstring muscles. 4. Touch relaxation is a two-person relaxation technique in which the woman learns to release tension in the body areas that her partner touches.
A 23-year-old client is 10 weeks' gestation with her first pregnancy. She expresses worry over feeling no sexual desire for her husband and asks if this is normal. How should the nurse respond? a) "That sounds normal. In many cases, sexual desire decreases in the first trimester, but it increases again during the second trimester." b) "That's unusual. Usually, there are minimal changes in sexual desire throughout a healthy pregnancy." c) "That sounds normal. During the first trimester, sexual desire often decreases; however, by the third trimester, sexual desire is usually greater than before pregnancy." d) "That's unusual. Throughout a healthy pregnancy, sexual desire usually increases with each trimester."
A Explanation: 1. During the first trimester, factors such as fatigue, nausea, vomiting, and breast tenderness may decrease desire for sexual activity. During the second trimester, as these discomforts lessen and pelvic vascular congestion increases, the woman may experience greater sexual satisfaction than before pregnancy. 2. While each woman may be different, sexual desire often decreases during the first trimester, increases during the second trimester, and then decreases again during the third trimester. 3. While each woman may be different, sexual desire often decreases during the first trimester, increases during the second trimester, and then decreases again during the third trimester. 4. While each woman may be different, sexual desire often decreases during the first trimester, increases during the second trimester, and then decreases again during the third trimester.
Regardless of the method of childbirth preparation, most childbirth classes: a) Present ways of alleviating fear. b) Teach imagery for relaxation. c) Use patterned, paced breathing techniques. d) Present the benefits of epidural anesthesia.
A Explanation: 1. The overall goal of prenatal classes is to decrease fear through increasing knowledge and teaching participants skills to help cope with labor. These skills include various relaxation methods and breathing techniques. 2. Not all classes teach imagery. 3. Not all classes use patterned, paced breathing. 4. Many couples will be able to avoid an epidural by using the techniques they learned in classes.
The nurse is presenting a prenatal class for couples beginning prenatal care. What information is most important for the nurse to include? a) You can have a certified nurse-midwife or a physician for your provider. b) You can give birth in either of two different types of rooms, each with different equipment. c) The birthing unit was remodeled and redecorated last year. d) Some of the providers recommend circumcision for the male child.
A Explanation: 1. This statement is the most important. The nurse should inform clients what their options are, including the types of providers available. 2. This statement is too vague to facilitate decision making by the couple. 3. This information does not help clients understand their options or make decisions. 4. Because not all clients will be having males, this statement is only helpful to those clients who give birth to males and see a provider who recommends circumcision. This statement is too narrowly focused to be helpful to all clients.
The nurse is caring for a client in the prenatal clinic. The client recently arrived in the United States as a refugee from a country in Africa. This is the first client from this cultural background with whom the nurse has worked. Which intervention is most appropriate in the care of this client? a) Ask the client about her expectations during the labor and birth b) Determine if the client has been tested for tuberculosis. c) Help the client into the paper dressing gown prior to her exam. d) Look for written handouts on prenatal care in the client's language.
A Explanation: 1. Women new to the United States will have little or no experience with the U.S. health care system. Culture heavily influences a client's behaviors and attitudes during pregnancy, labor, and birth, so determining what the client wants during her labor and birth will facilitate both a better experience for the family and a calmer situation for the health care team. 2. Although tuberculosis is pandemic in refugee camps, and testing for tuberculosis in new arrivals to the United States is important, this question is about prenatal care. Testing for tuberculosis is not related to prenatal care. 3. The client is probably unfamiliar with paper dressing gowns and will need some instruction (often through demonstration). But this is not the highest priority. It is more important to find out what the client expects to happen during her labor and birth. 4. Providing written handouts in the client's primary language is important. But a higher priority for prenatal care would be to assess what the client's expectations for labor and birth are.
The philosophy of the Coalition for Improving Maternity Services (CIMs) include which cornerstones of mother-friendly care? Select all that apply. a) Empowerment b) Autonomy c) Responsibility d) Beneficence e) Redundancy
A - B - C Explanation: 1. The cornerstones of mother-friendly care according to CIMs are empowerment, autonomy, responsibility, normalcy and do not harm. Beneficence and redundancy are not cornerstones of mother-friendly care. 2. The cornerstones of mother-friendly care according to CIMs are empowerment, autonomy, responsibility, normalcy and do not harm. Beneficence and redundancy are not cornerstones of mother-friendly care. 3. The cornerstones of mother-friendly care according to CIMs are empowerment, autonomy, responsibility, normalcy and do not harm. Beneficence and redundancy are not cornerstones of mother-friendly care. 4. The cornerstones of mother-friendly care according to CIMs are empowerment, autonomy, responsibility, normalcy and do not harm. Beneficence and redundancy are not cornerstones of mother-friendly care.5. The cornerstones of mother-friendly care according to CIMs are empowerment, autonomy, responsibility, normalcy and do not harm. Beneficence and redundancy are not cornerstones of mother-friendly care.
Continuous labor support facilitates the birth process. What other things does labor support help to do? Select all that apply. a) reduces medical intervention b) increases the mother's memory of the birth c) reduces anxiety in the newborn d) strengthens bonding e) increases newborn APGAR scoring
A - B - D Explanation: 1. Continuous labor support facilitates the birth process, reduces medical intervention, increases the mother's memory of the birth, and strengthens bonding between the mother and neonate. Continuous labor support does not reduce the anxiety of the newborn or increase the newborn APGAR score. 2. Continuous labor support facilitates the birth process, reduces medical intervention, increases the mother's memory of the birth, and strengthens bonding between the mother and neonate. Continuous labor support does not reduce the anxiety of the newborn or increase the newborn APGAR score. 3. Continuous labor support facilitates the birth process, reduces medical intervention, increases the mother's memory of the birth, and strengthens bonding between the mother and neonate. Continuous labor support does not reduce the anxiety of the newborn or increase the newborn APGAR score. 4. Continuous labor support facilitates the birth process, reduces medical intervention, increases the mother's memory of the birth, and strengthens bonding between the mother and neonate. Continuous labor support does not reduce the anxiety of the newborn or increase the newborn APGAR score. 5. Continuous labor support facilitates the birth process, reduces medical intervention, increases the mother's memory of the birth, and strengthens bonding between the mother and neonate. Continuous labor support does not reduce the anxiety of the newborn or increase the newborn APGAR score.
A Chinese woman who is 16 weeks pregnant reports to the nurse that ginseng and bamboo leaves help to reduce her anxiety. How should the nurse respond to this client? a) Advise the client to avoid the use of all herbs. b) Assess the amount and frequency with which the client is using the remedy. c) Tell the client that her remedies have no scientific foundation. d) Assess where the client obtains her remedy, and investigate the source.
B Explanation: 1. Because some herbs have negative effects on pregnancy, using a reliable reference to determine the actions of the herbs can educate both the nurse and the client. 2. Use of herbs is a common alternative healthcare practice for many women. Pregnant women are often taught "secret family recipes" for avoiding or minimizing the discomforts of pregnancy. It is appropriate to assess the amount and frequency of the client's use of the herbs. 3. Some remedies do have scientific foundation, so it is not appropriate to instruct the client that none do. 4. It is outside the nurse's scope to assess the source of the herbs.
The nurse is planning a "train the trainer" class for labor and delivery nurses learning to teach prenatal classes. Which statement indicates that teaching has been effective? a) "Women like to be in a semi-sitting position when giving birth." b) "Teaching alternatives available at our hospital facilitates decision making." c) "I will explain that bright lights in the room are best for moms and babies." d) "Patients should be taught not to make noise during labor or birth."
B Explanation: 1. No one position for birth is favored by all women. Prenatal classes should teach about alternatives and help strengthen the mind-body connection of patients. 2. This is a true statement. To be respectful and facilitate autonomy, prenatal classes should teach about alternatives and help strengthen the mind-body connection of patients. 3. Subdued lighting and soft music are options that are easy to implement and help personalize a family's birth experience. 4. Vocalization during labor and birth should be encouraged, if that is what the patient wants to do. It is not appropriate to expect all laboring patients to want the same things or to behave in the same ways.
A 32-year-old primipara who is 8 weeks' gestation asks you if she should expect any respiratory changes as her pregnancy progresses. What should the nurse tell her? a) "By the third trimester, you will no longer feel as though you're short of breath." b) "If you develop shortness of breath, it should improve in the last few weeks of your pregnancy, as lightening occurs." c) "Shortness of breath is an abnormal finding during any stage of pregnancy, and it's considered a serious complication." d) "You may experience shortness of breath due to stretching of the round ligament."
B Explanation: 1. Shortness of breath occurs as the uterus rises into the abdomen and causes pressure on the diaphragm. This problem worsens in the last trimester. 2. The primigravida experiences considerable relief from shortness of breath in the last few weeks of pregnancy, when lightening occurs and the fetus and uterus move down in the pelvis. 3. Because of decreased vital capacity from pressure of the enlarging uterus on the diaphragm, shortness of breath is a common problem of pregnancy. 4. Round ligament stretching causes a "grabbing" sensation in the lower abdomen and inguinal area.
The nurse is preparing a class for expectant fathers. Which information should the nurse include? a) Siblings adjust readily to the new baby. b) Sexual activity is safe for normal pregnancy. c) The expectant mother decides the feeding method. d) Fathers are expected to be involved in labor and birth.
B Explanation: 1. Siblings often have difficulty adapting to the arrival of a new baby. Regression is often seen in siblings' behaviors. 2. During a normal pregnancy, sexual activity is safe for both mother and baby. 3. Often, the father wants input into the feeding method. 4. In some cultures, labor and birth are only for women, and it is inappropriate for fathers to be involved with the labor and birth.
The pregnant client has asked the nurse what kinds of medications cause birth defects. Which statement would best answer this question? a) "Birth defects are very rare. Don't worry; your doctor will watch for problems." b) "To be safe, don't take any medication without talking to your doctor." c) "Too much vitamin C is one of the most common issues but is avoidable." d) "Almost all medications will cause birth defects in the first trimester."
B Explanation: 1. The nurse should avoid a "don't worry" answer to ensure therapeutic communication, but it is appropriate to instruct the client to talk to the doctor about medications. 2. Teratogens are substances that can cause birth defects. Alcohol is one example, as are warfarin (Coumadin) and isotretinoin (Roaccutane). The greatest risk is during the first trimester, but not all medications are teratogenic. Those medications with clear evidence of teratogenicity are classified in pregnancy category X and should be avoided when conception is being attempted and during the first trimester. 3. Vitamin C can cause rebound scurvy but is not teratogenic. 4. Not all medications are teratogenic.
A pregnant client who swims 3 to 5 times per week asks the nurse if she should stop this activity. What is the appropriate nursing response? a) "You should decrease the number of times you swim per week." b) "You should continue your exercise program because it would be beneficial." c) "You should discontinue your exercise program immediately." d) "You should increase the number of times you swim per week."
B Explanation: 1. Thirty minutes of moderate-intensity exercise daily is recommended for pregnant women, but even mild exercise is helpful. Women who exercise regularly have better muscle tone, self-image, bowel function, energy levels, sleep, and postpartum recovery than do those who are sedentary. 2. Thirty minutes of moderate-intensity exercise daily is recommended for pregnant women, but even mild exercise is helpful. Women who exercise regularly have better muscle tone, self- image, bowel function, energy levels, sleep, and postpartum recovery than do those who are sedentary. 3. Thirty minutes of moderate-intensity exercise daily is recommended for pregnant women, but even mild exercise is helpful. Women who exercise regularly have better muscle tone, self- image, bowel function, energy levels, sleep, and postpartum recovery than do those who are sedentary. 4. Thirty minutes of moderate-intensity exercise daily is recommended for pregnant women, but even mild exercise is helpful. Women who exercise regularly have better muscle tone, self- image, bowel function, energy levels, sleep, and postpartum recovery than do those who are sedentary.
The nurse assesses her patient to have mild anxiety concerning the birth process. The patient states that she is not interested in Lamaze classes because she is single and does not want to have natural childbirth. The nurse's best response would be: a) "Lamaze classes promise painless childbirth. If you learn their methods, your pain is minimal." b) "Lamaze classes can teach you relaxation methods and also the benefits and risks of pain- relief methods. This assists you in making the best decision for you." c) "You are very nervous. I think these classes would be best for you." d) "Lamaze classes are geared toward couples. You might want to find a different class."
B Explanation: 1. This choice is inappropriate because even with Lamaze, there could be some pain. 2. Lamaze teaches relaxation methods by utilizing patterned breathing. Those who are able to use the method require little if any anesthesia during delivery. The other choices are inappropriate. 3. Telling a patient that she is nervous is not a reason to take the class. It would be better to encourage the patient to take the class so she will be knowledgeable on the birth experience and it could reduce any anxiety she may have about the experience. 4. Lamaze classes are geared toward teaching about the breathing and relaxation during childbirth and often have single parents or non-couple participants.
An expectant couple desires to determine compatibility with a care provider. They ask the nurse for assistance. Which of the following questions should the nurse encourage the couple to ask first? a) "Can my children attend the birth?" b) "If I have a cesarean birth, can my husband attend?" c) "What is your philosophy of birth?" d) "What percentage of your patients have episiotomies?"
C Explanation: 1. Children's attendance is a complement to the provider's philosophy. 2. A husband's presence for a cesarean birth is a complement to the provider's philosophy. 3. A thorough understanding of the provider's philosophy is essential to determining compatibility. 4. Episiotomy percentages are a complement to the provider's philosophy.
The pregnant client who is at 21 weeks' gestation and is planning a vacation with her family. She asks the nurse which method of travel would be recommended for her to use. How should the nurse respond? "The safest method of travel is to: a) "Take an automobile." b) "Fly on an airplane." c) "Travel by train." d) "Not travel this late in pregnancy."
C Explanation: 1. Automobile travel does not allow for frequent enough movement. 2. Airplane travel does not allow for frequent enough movement. 3. In the latter half of pregnancy, frequent movement is recommended for pregnant women, both to increase comfort and to decrease venous pooling, which can lead to thrombophlebitis. The train allows the most movement for the traveling pregnant woman. 4. It is not necessary to cease travel altogether.
17) The prenatal client in her third trimester tells the clinic nurse that she works eight hours a day as a cashier and stands when at work. What response by the nurse is best? a) "No problem. Your baby will be fine." b) "Do you get regular breaks for eating?" c) "Your risk of preterm labor is higher." d) "Standing might increase ankle swelling."
C Explanation: 1. Standing more than five hours a day increases the risk of preterm labor. To be therapeutic in communication, avoid false reassurance. 2. Although breaks for eating, drinking, and toileting are important for pregnant employees, it is more important to tell the client about the increased risk of preterm labor. 3. Pregnant women who stand for more than five times a day have an increased risk of preterm labor. Because preterm labor can put the infant's life at risk, this statement would be the highest priority. 4. Although this is true, it is less important than teaching the client about the risks of preterm labor when standing more than five hours a day.
A 29-year-old woman who is pregnant with her first child asks the nurse which childbirth preparation class is most highly recommended for couples. Which nursing response is best? a) "For couples, the International Childbirth Education Association (ICEA) recommends the Bradley method, which is a partner-coached childbirth." b) "Lamaze would be the ideal choice of preparation for you and your husband." c) "Ideally, you can learn about each method, and then choose the one that's best for you." d) "Any of the methods will work well, as long as you and your husband do not deviate from the instructions related to that specific method."
C Explanation: 1. The International Childbirth Education Association (ICEA) does not advocate a particular method of childbirth preparation but rather promotes a philosophy of "freedom of choice based on knowledge of alternatives." 2. Education regarding the various childbirth preparation classes should be provided, and the woman should choose the option she deems best. 3. Education regarding the various childbirth preparation classes should be provided, and the woman should choose the option she deems best. 4. International Childbirth Education Association (ICEA) educators often teach a combination of techniques designed to meet individual needs and assist the partner in supporting the woman during labor and birth.
The client in her first trimester of pregnancy is experiencing nausea. To promote self-care, the nurse should help the pregnant client understand that the nausea might be relieved by: a) Eating spicy foods b) Not eating until two hours after rising c) Eating small, frequent meals d) avoiding carbonated beverages
C Explanation: 1. The nausea of pregnancy can be exacerbated by ketosis, fatigue, and certain foods, such as those containing caffeine or spices. 2. Eating dry carbohydrates prior to rising each day can help to prevent or decrease the severity of the nausea. 3. Avoiding severe hunger by eating small, frequent meals throughout the day can help to prevent or decrease the severity of the nausea. 4. Carbonated beverages might be helpful in decreasing nausea.
A couple would like their 5-year-old to attend the birth. Which statement by the nurse would assist in the family's plan to include their 5-year-old in the birth? a) "You should let your child stay home because you will be focusing on the birth." b) "Children under 12 are not allowed to be present at the birth." c) "You should bring someone who will tend to any specific needs of your child." d) "Bring some toys to keep your child occupied."
C Explanation: 1. A sibling should have his own support person whose primary responsibility is to take care of the child's needs so that the child will have support if anxiety develops over the birth process, and the mother can concentrate on the labor and birth. 2. Children are allowed to be present at births. 3. A sibling should have his own support person whose primary responsibility is to take care of the child's needs so that the child will have support if anxiety develops over the birth process, and the mother can concentrate on the labor and birth. 4. Preparing the child on what to expect is beneficial. Toys will not sustain a 5-year-old's attention for an extended time period.
The nurse is assisting an expectant couple in developing a birth plan. Which of the following instructions would the nurse include in the teaching plan? a) The birth plan includes only patient choices and does not take into account standard choices of the healthcare provider. b) The birth plan allows the patient to make choices about the birth process; however, these choices cannot be altered. c) The birth plan is a legally binding contract between the patient and the healthcare provider. d) The birth plan is a communication tool between the patient and the healthcare provider.
D 1. The birth plan is used as a tool for communication among the expectant parents, the healthcare provider, and the healthcare professionals at the birth setting. 2. The written plan identifies options that are available; thus, it can be altered. 3. It is not a legal document. 4. The birth plan is used as a tool for communication among the expectant parents, the healthcare provider, and the healthcare professionals at the birth setting.
A client who is at 10 weeks' gestation tells her nurse, "I'm making too much saliva, and I spit on people every time I talk! What's wrong with me?" How should the nurse respond? a) "Let's schedule you for a doctor's appointment, because excessive salivation can signal a complication of pregnancy." b) "That's called ptyalism, and it's usually caused by increased salt intake during the second trimester." c) "You should avoid astringent mouthwashes and chewing gum." d) "Excess salivation commonly occurs during the first trimester, although the cause is unknown."
D Explanation: 1. Excess salivation, also called ptyalism, is a normal occurrence in women during the first trimester. 2. Ptyalism, which is excess production of saliva, usually occurs during the first trimester and the cause is unknown. 3. Astringent mouthwashes, chewing gum, and sucking hard candy may help relieve the bitter taste that often accompanies ptyalism. 4. Ptyalism, which is excess production of saliva, commonly occurs during the first trimester and the cause is unknown.
The patient who experienced an emergency cesarean birth with her first child expresses anxiety about her upcoming birth. How can the nurse teaching the patient's prenatal classes help decrease her anxiety? a) Encourage muscle tightening with each contraction. b) Explain that patterned breathing increases anxiety and should be avoided. c) Instruct the patient to hire a therapeutic massage therapist for labor. d) Practice progressive relaxation and encourage her to use the technique in labor.
D Explanation: 1. Relaxation, not muscle tightening, should be encouraged. Some relaxation techniques teach patients to tighten and then release muscles to learn the difference between tension and relaxation, but the key is to be as relaxed as possible during contractions. 2. Patterned breathing techniques decrease, not increase, anxiety. Practice of patterned breathing prior to the onset of labor facilitates their use during labor. 3. Although some patients would enjoy a massage therapist during their labor, not all patients enjoy massage, and not all patients have the resources to hire this type of professional for their labor. 4. Progressive relaxation (and all relaxation techniques), when practiced prior to labor, is a valuable tool to facilitate relaxation and therefore decrease anxiety during labor.
The nurse is caring for a pregnant client. The client's husband has come to the prenatal visit. Which question is best for the nurse to use to assess the adaptation to pregnancy by the father-to- be? a) "What kind of work do you do?" b) "What furniture have you gotten for the baby?" c) "How moody has your wife been lately?" d) "How are you feeling about becoming a father?"
D Explanation: 1. What kind of work the husband does is not an indicator of his adaptation. 2. What furniture has been obtained is not an indicator of his adaptation. 3. The husband's perception of his wife's moodiness is not an indicator of his adaptation. 4. The adaptation of a husband to pregnancy includes his feelings about impending fatherhood.
A client in her third trimester of pregnancy reports frequent leg cramps. What strategy would be most appropriate for the nurse to suggest? a) Point the toes of the affected leg b) Increase intake of protein-rich foods c) Limit activity for several days d) Flex the foot to stretch the calf
D Explanation: 1. Pointing the toes will exacerbate leg cramps. 2. Protein intake does not affect leg cramps. 3. Limiting activity is not appropriate. 4. Leg cramps are a common problem in pregnancy, resulting from an imbalance in the calcium- phosphorus ratio; pressure on nerves or decreased circulation in the legs from the enlarged uterus; or fatigue. Dorsiflexing the foot will stretch the calf muscles and will help relieve the cramps.
