Chapter 12: Nursing Management During Pregnancy

The nurse is assigned to clients who are having the following procedures: amniocentesis, fetal nonstress test, chorionic villus sampling, percutaneous umbilical blood sampling, and Doppler assessment of fetal heart rate. For which clients will the nurse ensure that signed informed consent has been given and is in the client's record?

Amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling

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 24 hours.

A client in her third trimester of pregnancy wishes to formula feed her baby. What instruction should the nurse provide?

Serve the formula at room temperature.

Which disease process would the nurse screen for under potential genetic disorders?

cystic fibrosis

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 signs and symptoms 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 pregnant woman has been diagnosed with pica since she eats lead paint chips for their sweetness. The nurse educating this woman should strongly encourage her to abandon this practice because it may have which consequence to the fetus?

neurological challenges

A young couple are very excited to discover they are pregnant and ask the nurse when to expect the baby. Based on a July 20 LMP, which day will the nurse predict for delivery?

April 27

A pregnant client reports frequent urination and tells the health care provider that she has stopped drinking water during the day since she cannot take many breaks during work. Which statement by the nurse is most appropriate at this time?

"Fluids are necessary so your blood volume can double, which is normal in pregnancy."

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

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

At 24 weeks' gestation a client is asked to drink a sweet orange solution and then wait an hour to have blood drawn. The client asks if this is the test to determine if she has diabetes. What is the best response by the nurse?

"This is a screening procedure. If your result is elevated you will be scheduled for a longer test to determine if you have gestational diabetes."

The nurse is assessing a client at her first prenatal visit and notes the fundal height is palpable at the level of the umbilicus. The nurse predicts the client is at which gestational age?

20 weeks

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

24 cm

During the physical examination at the first prenatal visit a speculum examination is performed and a bluish-colored cervix is noted. How will the nurse interpret this finding?

Chadwick sign

Which information is most important in order to decrease the risk of complications if the client decides to work until her due date?

Frequent rest periods

A 41-year-old pregnant woman and her husband are anxiously awaiting the results of various blood tests to evaluate the fetus for potential Down syndrome, neural tube defects, and spina bifida. Client education should include which information?

Further testing will be required to confirm any diagnosis.

The parents of a neonate born at 32 weeks' gestation ask about the purpose of the surfactant being given to the baby. What is the best response by the nurse?

Helps the lungs remain expanded after the initiation of breathing

A 28-year-old client who has just conceived arrives at a health care facility for her first prenatal visit to undergo a physical examination. Which intervention should the nurse perform to prepare the client for the physical examination?

Instruct the client to empty her bladder.

Why is a Papanicolaou test done at the first prenatal visit?

It identifies abnormal cervical cells.

A client who is uncertain when her LMP occurred is given an EDD of April 23 after the first ultrasound. Based on this information, the nurse determines the client's LMP was probably which day?

July 16

The health care provider has prescribed an over-the-counter antacid for a pregnant client in her first trimester who is having ongoing nausea, vomiting, and heartburn. Which instruction concerning the antacid should the nurse prioritize after noting the client is also prescribed a multivitamin supplement?

Take antacid 1 hour after the multivitamin.

The nurse discovers a new prescription for Rho(D) immune globulin for a client who is about to undergo a diagnostic procedure. The nurse will administer the Rho(D) immune globulin after which procedure?

amniocentesis

During pregnancy, the cardinal rule concerning 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

Which finding from a woman's initial prenatal assessment would be considered a possible complication of pregnancy that requires reporting to a primary care provider for management?

episodes of double vision

An adolescent at 8 weeks' gestation is at her first prenatal visit. During the health history interview, the nurse asks the client, "Are you afraid of anyone?" What is the nurse assessing with this question?

intimate partner violence

A nurse is conducting a class geared toward changes in early pregnancy and self-care items like perineal hygiene. A woman shares that she douches at least once a day since she has "so much discharge" from her vagina. Which response by the nurse is most appropriate at this time?

"During pregnancy, you should not douche because it can cause fluid to enter the cervix resulting in an infection."

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.

A nurse is educating a primigravida client about the expected changes during pregnancy. Which measure will provide anticipatory guidance about pregnancy?

Avoid wearing high heels, especially during late pregnancy.

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

Baseline data is collected.

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?

Deficient knowledge

During the initial assessment of a 22-year-old pregnant client, the nurse learns that the client usually smokes 2 packs of cigarettes per day. The nurse is planning an education session about lifestyle changes during pregnancy. Which goal would be the most realistic and individualized for this client during this initial clinic visit?

The client reduces her smoking by 50 percent by the next clinic visit.

A client at 32 weeks' gestation is admitted to labor and delivery with vaginal bleeding and contractions. The physician orders a course of two steroid injections. The client asks why she needs steroids. What is the best explanation by the nurse?

The steroids speed up the development of the lungs.

A nurse is providing education to a client who is 8 weeks' pregnant. The client stated she does not like milk. What is a source of calcium that the nurse can recommend to the client?

dark, leafy green vegetables

The nurse is meeting with a client at 28 weeks' gestation. To prepare her for the final trimester, which factor should the nurse prioritize in the teaching session?

decreasing shortness of breath

At 32 weeks' gestation a client with a BMI of 23 has gained 24 lb (11 kg). What is the nurse's recommendation for weight gain for the remainder of this pregnancy?

Continue to gain approximately 1 lb (.45 kg) per week during this pregnancy.

The nurse is leading a preconception education session at the community center. A participant asks: "I heard you shouldn't eat unpasteurized milk or cheese while pregnant. Is that true?" The nurse respond that these foods should be avoided because they may be contaminated with which substance that is harmful during pregnancy? Select all that apply.

Listeria Salmonella E. Coli

A pregnant client is planning a vacation to a different state and questions the nurse concerning precautions. Which suggestion should the nurse prioritize for this client who will be traveling by automobile?

Stop and walk every 2 hours.

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

Wear support hose.

A young woman with scoliosis has just learned that she is pregnant. Several years ago, she had stainless-steel rods surgically implanted on both sides of her vertebrae to strengthen and straighten her spine. However, her pelvis is unaffected by the condition. What does the nurse anticipate in this woman's pregnancy?

potential for greater than usual back pain

A client in her third trimester of pregnancy visits the health care center and asks why she is constipated. The nurse would include which most likely cause when responding to the client?

pressure on intestine by the growing fetus

After teaching a pregnant woman how to perform fetal movement (kick) counts, the nurse determines that the teaching was successful when the client makes which statement?

"I'll sit comfortably in a recliner or lie on my side when I do the counts."

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

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

During a routine prenatal visit, the woman complains about lack of sleep due to "the baby having a dance party at night which keeps me awake with all the kicking." Which nursing diagnosis would be most appropriate for the nurse to document?

disturbed sleep pattern related to frequent movement of fetus at night

The nurse is assessing a client's risk for sexually transmitted infections. Which statement by the client would be cause for concern?

"I am unsure who the father of the baby is. I will be raising it alone."

The nurse is assessing a primipara's fundal height at 36 weeks' gestation and notes the fundus is now located at the xiphoid process of the sternum. The client asks if this is normal. Which response to the client would be best?

"At 36 weeks' gestation, the fundus is in the normal expected location."

Following an initial prenatal visit, a woman's rubella titer results were less than 1:8. On her next visit, the woman asks what this test result means. Which is the best answer to this woman's question about her rubella titer results?

"you are susceptible to a rubella viral invasion."

The diagonal conjugate of a pregnant woman's pelvis is measured. Which measurement would the nurse interpret as presenting a potential problem?

12.0 cm

A client who is in her first trimester is anxious to have an ultrasound at each visit. The nurse explains that it is not necessary and schedules a second ultrasound to be performed when she is about:

18 to 20 weeks' pregnant.

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.

4, 1, 1, 1, 1

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.

Chorionic villus sampling Percutaneous umbilical blood sampling Amniocentesis

The client at 32 weeks' gestation expresses concern regarding lower extremity edema and bulging leg veins. Which suggestions by the nurse are helpful? Select all that apply.

Complete moderate exercise daily. Wear compression stockings.

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.

A client at 27 weeks' gestation still walks daily but reports "terrible" heartburn at night. Which action should the nurse point out will best address this situation?

Elevate the head of the bed.

At 28 weeks' gestation, the client has gained 7.5 lb (3.4 kg) since the last visit. What assessments would the nurse complete next? Select all that apply.

Inspect hands for edema. Measure blood glucose level. Examine for excessive amniotic fluid.

When caring for a client with lactose intolerance, the nurse would be aware of which potential problem during pregnancy?

inadequate calcium for skeletal growth

The nurse is concerned that a client is not obtaining enough folic acid. Which test would the nurse anticipate being used to evaluate the fetus for potential neural tube defects?

maternal serum alpha-fetoprotein analysis

Which vaccines are contraindicated during pregnancy since they may transmit a viral infection to the fetus? Select all that apply.

measles mumps rubella

A nurse is educating a pregnant client about physical changes that can occur in pregnancy. Which conditions are associated with physical changes in pregnancy? Select all that apply.

nasal stuffiness and sinus problems thoracic breathing instead of abdominal breathing swollen and tender gums

A nurse is conducting a class with group of pregnant women who are all in their first trimester of pregnancy. During the class, the women are discussing the various discomforts that they are experiencing. The nurse would expect to hear reports about which discomforts? Select all that apply.

nausea urinary frequency breast tenderness

The nurse advises a pregnant client to keep a small high-carbohydrate, low-fat snack at the bedside. The nurse should point out this will assist with which condition?

nausea and vomiting

A pregnant client reports difficulty sleeping well. Which suggestion for sleeping should the nurse prioritize to assist this client?

on her side with the weight of the uterus on the bed

What areas of teaching would the nurse cover during the preconception visit? Select all that apply.

refraining from alcohol intake eating nutrient-dense foods

The nurse is preparing to administer a prescribed medication to the pregnant client. Which order should the nurse question?

rubella

The nurse is reinforcing health care provider education on the technique for an amniocentesis. Which piece of equipment will the nurse have ready?

ultrasound equipment

The nurse is assessing a client at her first prenatal visit and notes that she is exposed to various chemicals at her place of employment. Which statement by the client would indicate she needs additional health education to protect her and her fetus?

"The gloves they provide irritate my hands, so I don't use them."

The nurse is caring for several clients at the prenatal clinic. Which client would the nurse prepare for a routine fetal ultrasound?

A woman at 20 weeks' gestation reporting increased nasal stuffiness; Explanation: A routine ultrasound to assess for fetal health is typically done at 16 to 20 weeks' gestation. Of the clients presented, only the client at 20 weeks' gestation is in the correct time frame.

A pregnant client reports occasional headaches. She wants to know what she can take to alleviate the discomfort. What would be the best response by the nurse?

Acetaminophen is considered relatively safe to take for your headaches during your pregnancy."

A hospitalized client with hyperemesis gravidarum has been tolerating small amounts of clear fluids for the past 6 hours. What is the next step in the plan of care?

Add small quantities of dry toast every 2 to 3 hours.

A client in the third trimester of pregnancy has to travel a long distance by car. The client is anxious about the effect the travel may have on her pregnancy. Which instruction should the nurse provide to promote easy and safe travel for the client?

Always wear a three-point seat belt.

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. Identify women at risk for complications.

A pregnant client arrives for her first prenatal appointment. She reports her previous pregnancy ended at 19 weeks, and she has 3-year-old twins born at 30 weeks' gestation. How will the nurse document this in her records?

G3 T0 P1 A1 L2; G indicates the total number of pregnancies (2 prior, now pregnant = 3); T indicates term deliveries at or beyond 38 weeks' gestation (none = 0); P is for preterm deliveries (at 20 to 37 weeks = 1; multiple fetus delivery are scored as 1); A is for abortions or pregnancies ending before 20 weeks' gestation (1); and L refers to living children which is 2. Thus, G3 T0 P1 A1 L2 is what the nurse should note in the client's record.

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

Maintain tolerable intensity of exercise.

The nurse is reviewing an employer's guidelines to support pregnant employees. When reviewing the information, which guideline requires further follow-up and education by the nurse?

Promote overtime shifts to save money for parental leave.

The nurse is educating the client at 12 weeks' gestation regarding the best types of exercise throughout pregnancy. Which activities should the nurse encourage?

Stretching and breathing exercises such as yoga

A client at 29 weeks' gestation tells the nurse she is experiencing aches in her hips and joints. What would the nurse do next?

Tell the client these are normal findings during pregnancy.

A woman in her second trimester of pregnancy is beginning to experience more headaches. In addition to suggesting holding an ice pack to the forehead, the health care provider recommends which medication to provide some relief from the pain?

acetaminophen

While assessing a client's breast during the third trimester, which finding would the nurse expect?

colostrum from the nipples

Some pregnant women hire a trained professional 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 takes this role?

doula

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

excessive vomiting

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, then every 2 weeks until 36 weeks, and then weekly until the birth