Chapter 12: Nursing Management During Pregnancy (PrepU)

The nurse is assisting a primigravida on calculating the due date of her baby using Naegele rule. The most important information provided by the mother is: the ovulation date between her periods. the last day of her menstrual period. the date that intercourse occurred. the first day of the last menstrual period.

the first day of the last menstrual period. Naegele rule is calculated using the first day of the last menstrual period. From there, 7 days are added and then 3 months are subtracted. The ovulation date, intercourse date, or last day of the menstrual period are not needed.

The nurse is assessing a client at 30 weeks' gestation who reports increased constipation. Which suggestion should the nurse prioritize for this client? reducing iron supplement increasing fluid intake taking mineral oil increasing intake of meat

increasing fluid intake Increasing fluid content by drinking at least 8 glasses of noncaffeinated beverages helps relieve constipation in both pregnant and nonpregnant women. Reducing an iron supplement could lead to anemia; mineral oil can reduce absorption of fat-soluble vitamins. The client should add foods rich in fiber, which would include grains, vegetables, and fruits (instead of meat).

During a follow-up visit to the prenatal clinic, a pregnant client asks the nurse about using a hot tub to help with her backache. The nurse recommends against the use based on the understanding that what can occur? urinary incontinence fetal tachycardia membrane rupture rebound maternal hypothermia

fetal tachycardia Pregnant women should avoid hot tubs, saunas, whirlpools, and tanning beds. The heat may cause fetal tachycardia as well as raise the maternal temperature. Exposure to bacteria in hot tubs that have not been cleaned sufficiently is another reason to avoid them during pregnancy. Membrane rupture and urinary incontinence are not associated with hot tub use.

A nurse is educating a prenatal client at her second visit. The client is worried about "blotchy brown spots" on her forehead. The nurse reassures the client about this change by giving which appropriate response? "Apply over-the-counter bleach cream to the area once a day." "This discoloring could be permanent, and you could use makeup to cover it up." "Avoid sun because it will make the discoloring darker." "This discoloring could be the start of skin cancer. We can refer you to the primary care provider."

"Avoid sun because it will make the discoloring darker." Increased estrogen levels during pregnancy can cause pigmentation to increase. This discoloration is not harmful and will eventually fade; however, sunlight can make it darker. Bleaching is not an appropriate suggestion. The nurse should not tell the client that the discoloration is permanent or a sign of cancer.

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: 21 to 23 weeks' pregnant. 24 to 26 weeks' pregnant. 18 to 20 weeks' pregnant. 15 to 17 weeks' pregnant.

18 to 20 weeks' pregnant. There are no hard-and-fast rules as to how many ultrasounds a woman should have during her pregnancy; however, the first ultrasound is usually performed during the first trimester to confirm the pregnancy. A second scan may be performed at about 18 to 20 weeks' to look for congenital malformations. A third one may be done at around 34 weeks' to evaluate fetal size and verify placental position.

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 13 May 20 April 27 March 13

April 27 Naegele rule is to subtract 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 27.

The nurse discovers a soft systolic murmur when auscultating the heart of a client at 32 weeks' gestation. Which action would be most appropriate? Document this and continue to monitor the murmur at future visits. Inquire if the client has chest pain. Refer her for cardiac catheterization. Ask another nurse to assess the heart.

Document this and continue to monitor the murmur at future visits. Due to the increased blood volume that occurs with pregnancy, soft systolic murmurs may be heard and are considered normal.

The nurse is assessing a client at her first prenatal visit and reports her LMP started December 1. Which date will the nurse predict for the EDD? July 7 August 8 October 7 September 8

September 8 According to Naegele rule, the estimated date of birth is September 8. Add 7 days and subtract 3 months to the LMP to determine the estimated date of birth.

The nurse understands that the maternal uterus should be at what location at 20 weeks' gestation? at the level near the bottom of the sternum three finger-breadths above the umbilicus at the level of the symphysis pubis at the level of the umbilicus

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

What anatomic area should be examined when assessing Montgomery glands (Montgomery tubercles)? abdomen breasts perineum thorax

breasts Montgomery glands (Montgomery tubercles) are sebaceous glands on the areola of the breasts and are prominent during pregnancy.

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? lower abdominal pressure swelling of extremities excessive vomiting dyspnea

excessive vomiting Excessive vomiting is a warning sign in the first trimester. Dyspnea, lower abdominal pressures, and swelling of face or extremities may occur late in pregnancy.

One vitamin has been identified as helping to prevent neural tube defects when consumed in adequate amounts before conception through the early weeks of pregnancy. Which vitamin is it? vitamin B6 niacin folic acid riboflavin

folic acid It is well established that daily supplements of folic acid taken prior to pregnancy decrease the risk of neural tube defects by as much as two thirds.

A nurse is caring for a pregnant client in her second trimester of pregnancy. The nurse educates the client to look for which danger sign of pregnancy needing immediate attention by the primary care provider? severe, persistent vomiting painful urination lower abdominal and shoulder pain vaginal bleeding

vaginal bleeding In a client's second trimester of pregnancy, the nurse should educate the client to look for vaginal bleeding as a danger sign of pregnancy needing immediate attention from the primary care provider. Generally, painful urination, severe/persistent vomiting, and lower abdominal and shoulder pain are the danger signs that the client has to monitor for during the first trimester of pregnancy.

When describing the role of a doula to a group of pregnant women, the nurse would include which information? The doula primarily focuses on providing continuous labor support. The doula is a professionally trained nurse hired to provide physical and emotional support. The doula can perform any necessary clinical procedures. The doula is capable of handling high-risk births and emergencies

The doula primarily focuses on providing continuous labor support. Doulas provide the woman with continuous support throughout labor. The doula is a laywoman trained to provide women and families with encouragement, emotional and physical support, and information through late pregnancy, labor, and birth. A doula does not perform any clinical procedures and is not trained to handle high-risk births and emergencies.

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 blood tests are definitive. Treatment can be started once the test results are back. A second set of screening tests can be obtained to confirm results.

Further testing will be required to confirm any diagnosis. Nursing management related to marker screening tests consists primarily of providing education about the tests. Remind the couple that a definitive diagnosis is not made without further tests such as an amniocentesis. The blood tests are not definitive but only strongly suggest the possibility of a defect. For some conditions there are no treatments. The couple may request a second set, but the health care provider will probably suggest proceeding with the more definitive methods to confirm the diagnosis.

The nurse is preparing to administer a prescribed medication to the pregnant client. Which order should the nurse question? folic acid penicillin rubella acetaminophen

rubella Most vaccines are contraindicated during pregnancy and are considered teratogenic, such as rubella. Penicillin and acetaminophen may be taken under provider supervision. Folic acid supplementation should be encouraged.

A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a 4-year-old child who was delivered at 38 weeks' gestation and tells the nurse that she does have a history of spontaneous abortion (miscarriage) within the first trimester. The nurse is correct to document the history as: G = 4, T = 2, P = 0, A = 0, L = 1 G = 1, T = 1, P = 1, A = 0, L = 1 G = 2, T = 0, P = 0, A = 0, L = 1 G = 3, T = 1, P = 0, A = 1, L = 1

G = 3, T = 1, P = 0, A = 1, L = 1 The GTPAL stands for Gravida -- number of pregnancies, which is 3 (current, 4-year-old, and miscarriage); Term -- only one pregnancy thus far carried to term; Preterm deliveries -- 0; Abortions (including miscarriages) -- 1; Living children -- 1. Do not be distracted by the twins. That is still one 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 will experience a heightened need for touch throughout my pregnancy." "I should substitute intercourse with nonsexual touch to avoid harming the fetus." "I will avoid having intercourse following the rupture of the membranes." "If I experience bleeding, I will abstain from vaginal intercourse."

"I should substitute intercourse with nonsexual touch to avoid harming the fetus." Sexual needs may be met through sexual intercourse with a partner as long as the pregnancy is healthy and there are no other risk factors, such as bleeding or rupture of membranes. Pregnancy is a time of a heightened need for touch, which may be met partially by sexual expression, but which can also be met through nonsexual touch, such as massage, caressing, or holding.

Which of these cardiac variations, if found in the client who is pregnant, should the nurse recognize as a normal finding in pregnancy? Premature ventricular contractions S4 (atrial gallop) Soft systolic murmur Split S1S2

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.

A nurse at the health care facility assesses a client at 20 weeks' 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 level of the umbilicus halfway between the symphysis pubis and the umbilicus at the xiphoid process at the top of the symphysis pubis

at the level of the umbilicus 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 to 12 weeks' gestation. At 16 weeks' gestation, the fundus should reach halfway between the symphysis pubis and the umbilicus. With a full-term pregnancy, the fundus should reach the xiphoid process.

A woman calls the prenatal clinic and says that she thinks she might be in labor. She shares her symptoms over the phone with the nurse and asks what to do. The nurse determines that she is likely in true labor and that she should head to the hospital. Which symptom is an indicator of true labor? contractions beginning in the back and sweeping forward across the abdomen intermittent backache stronger than usual increase in fetal kick count lightening (descent of the fetus into the pelvis)

contractions beginning in the back and sweeping forward across the abdomen True labor contractions usually begin in the back and sweep forward across the abdomen similar to tightening of a rubber band. They gradually increase in frequency and intensity over a period of hours. Lightening and intermittent backache are preliminary signs of labor but do not indicate true labor. Increase in fetal kick count does not indicate true labor.

The nurse is conducting the first prenatal assessment on a newly pregnant client. She shares with the nurse that she has 3 children, 2 born at full-term and one at 34 weeks' gestation. Her last pregnancy ended in a miscarriage. How should the nurse document this client's obstetrical history? G4 T3 P0 A1 L3 G4 T2 P1 A1 L3 G5 T2 P1 A1 L3 G3 T2 P1 A1 L3

G5 T2 P1 A1 L3 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 to include miscarriage. "L" is for living, the number of children delivered who are alive at the time of history collection. . For this client, G5 = current pregnancy (1) + children (3) + miscarriage (1); T2 = children born at 38+ weeks (2); P1 = children born between 20 and 37 weeks (1); A1 = abortion (0) + miscarriage (1); L3 = number of living children at time of assessment (3).

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." "To be honest, the fundus should be lower since you have gained minimal weight." "Just get prepared, the fundus might actually get a little higher until a few days before you go into labor." "By this time, the fundus should drop down lower because the baby is moving towards the pelvic inlet."

"At 36 weeks' gestation, the fundus is in the normal expected location." The fundus grows to reach the umbilicus at 20 to 22 weeks and the xiphoid process of the sternum at 36 weeks. Therefore, this fundus is in the normal, expected location. After 36 weeks' gestation, lightening occurs and the fundus will drop ~4 cm below the xiphoid process. Once the fundus reaches the xiphoid process, it cannot go higher without severely compromising maternal respiratory efforts.

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? "I only work four hours a day so I don't get exposed too much." "I have an assistant helping me now to handle the chemicals." "The gloves they provide irritate my hands, so I don't use them." "There hasn't been a chemical spill in three years."

"The gloves they provide irritate my hands, so I don't use them." There are various chemicals which are recognized for their teratogenic effects and must be avoided during pregnancy. The nurse should find out which chemicals the client is exposed to and determine the risk factor. The greatest danger is the client handling chemicals without a barrier protection such as gloves. The other issues may also be dangers depending on the chemicals and the environment in which the client is working and should also be evaluated.

When providing preconception care to a client, which instruction will the nurse to provide about medications during pregnancy? "You need to avoid all prescription, over-the-counter, and herbal medications when you are pregnant." "It is safe for you to take over-the-counter medications." "You need to talk with your health care provider about using all prescription, over-the-counter, and herbal medications." "You should switch to herbal remedies because they are safer to use than other types medicines."

"You need to talk with your health care provider about using all prescription, over-the-counter, and herbal medications." Medication use is common during pregnancy, with prevalence estimates generally exceeding 65% and increasing over the years. Pregnant women use a wide variety of both prescription and over-the-counter medications for both pregnancy-related conditions and conditions unrelated to pregnancy conditions. Little is known about the effects of taking most medications during pregnancy. It is best for pregnant women to not take any medications during their pregnancy. At the very least, they should be encouraged to discuss with the health care provider their current medications and any herbal remedies they take so that they can learn about any potential risks should they continue to take them during pregnancy. A common concern of many pregnant women involves the use of over-the-counter medications and herbal agents. Many women consider these products benign simply because they are available without a prescription. Although herbal medications are commonly thought of as "natural" alternatives to other medicines, they can be just as potent as some prescription medications. The nurse should encourage pregnant women to check with their health care providers before taking anything.

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 3 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth once every 4 weeks for the first 28 weeks, then every 3 weeks until 36 weeks, and then every 2 weeks until the birth once every 4 weeks for the first 36 weeks, then weekly until the birth once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth

once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the 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 in the first trimester reports having nausea and vomiting, especially in the morning. Which instruction would be most appropriate to help prevent or reduce the client's compliant? Eat dry crackers or toast before rising. Avoid eating spicy food. Avoid foods such as cheese. Drink plenty of fluids at bedtime.

Eat dry crackers or toast before rising. The nurse should recommend the client eat dry crackers or toast before rising to prevent nausea and vomiting in the morning. Drinking plenty of fluids at bedtime could cause nocturia. Foods such as cheese should be avoided to prevent constipation. Spicy foods could cause heartburn.

A woman who is 4 months pregnant notices frequent heart palpitations and leg cramps. She is anxious to learn how to alleviate these. Which nursing diagnosis would best apply to her? Pain related to severe complications of pregnancy Risk for ineffective breathing pattern related to pressure of the growing uterus Impaired urinary elimination related to inability to excrete creatine from her muscles Health-seeking behaviors related to ways to relieve discomforts of pregnancy

Health-seeking behaviors related to ways to relieve discomforts of pregnancy Health-seeking behaviors is a diagnosis used to describe clients who are actively interested in learning ways to improve their health.

A nurse is caring for a client who is 8 months pregnant. Which instruction is the nurse most likely to give her? Apply lanolin ointment to the nipple and areola to prevent cracking. Perform nipple exercises and stimulation on a regular basis. Take a hot water bath or shower daily to maintain hygiene. Rest on the left side for at least 1 hour in the morning and afternoon.

Rest on the left side for at least 1 hour in the morning and afternoon. During the last months of pregnancy, the nurse should instruct the woman to rest on her left side for at least 1 hour in the morning and afternoon. This position relieves fetal pressure on the renal veins, helps the kidneys excrete fluid, and increases flow of oxygenated blood to the fetus. The body's oil and sweat glands are more active than usual during pregnancy. Thus, a daily warm bath or shower is important, rather than a hot bath, which may produce hyperthermia. Nipple exercises and stimulation should not be done, especially in the third trimester, when they can cause uterine contractions and premature labor. Lanolin ointment may damage the areola and nipple. It has not been shown to be effective in preventing sore and cracked nipples. Lanolin is also a common allergen and may contain insecticide residuals such as DDT.

The client is 32 weeks' pregnant and has been referred for a biophysical profile (BPP) after a nonreassuring nonstress test (NST). Which statement made by the client indicates that the nurse's explanation of the procedure was effective? The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume. The BPP is a blood test to detect placental problems. The BPP is a diagnostic procedure whereby a needle is inserted into the amniotic sac to obtain fluid. The BPP is a screening for neural tube defects.

The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume. A biophysical profile uses a combination of factors to determine fetal well-being based upon five fetal biophysical variables. An NST is done to measure FHR acceleration. Then an ultrasound is done to measure breathing, body movements, tone, and amniotic fluid volume. Each variable receives a score from 0 to 2 for a maximum score of 10. A score of 6 or less indicates altered fetal well-being and indicates a need for further assessment. A needle is not involved with the BPP. The BPP does not detect placental problems, and the BPP is not a screening for neural tube defects.

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. urinary frequency in the third trimester headache with visual changes in the third trimester lower abdominal pain with shoulder pain in the first trimester nausea with vomiting during the first trimester sudden leakage of fluid during the second trimester backache during the second trimester

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 Danger signs and symptoms that need to be reported immediately include headache with visual changes in the third trimester; sudden leakage of fluid in the second trimester; and lower abdominal pain accompanied by shoulder pain in the first trimester. Urinary frequency in the third trimester, nausea and vomiting during the first trimester, and backache during the second trimester are common discomforts of pregnancy.

A client comes to the clinic for her usual prenatal check up. The nurse measures the fundal height at 24 cm. What is the estimated length of her gestation? 24 weeks 20 weeks 28 weeks 32 weeks

24 weeks Fundal height is an approximation of the number of weeks of gestation. Between 20 to 32 weeks, SFH = gestation in weeks + or - 2 cm.

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. Travel no more than 120 miles daily. Limit trips away from home, greater than 200 miles. Sit in the back seat with feet elevated.

Stop and walk every 2 hours. Walking increases venous return and reduces the possibility of thrombophlebitis, a risk for pregnant women who sit for extended periods of time. Limiting mileage, sitting in the back with the feet elevated, and limiting trips may help, but they are not enough to prevent phlebitis.

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? "Just wait until late pregnancy when the baby's head is settled into the inlet of the pelvis." "I can write you a note to give to your supervisor if that will help relieve some stress." "Maybe it would be better to stop drinking caffeinated beverages/coffee instead of water." "Fluids are necessary so your blood volume can double, which is normal in pregnancy."

"Fluids are necessary so your blood volume can double, which is normal in pregnancy." Women should not restrict their fluid intake to diminish frequency of urination because fluids are necessary to allow blood volume to double. Decreasing daily caffeine intake because of the risks caffeine poses for low birth weight may have the added benefit of reducing urinary frequency. Most importantly, a woman needs to understand that voiding more frequently is a normal pregnancy finding. The sensation of frequency will probably return after lightening (the settling of the fetal head into the inlet of the pelvis at pregnancy's end). A note for the supervisor is inappropriate in the workplace.

A nurse is teaching a client who is 30 weeks' pregnant about ways to deal with pyrosis (heartburn). The nurse determines a need for additional teaching based on which client statement? "I should chew my food slowly." "I need to cut out caffeine." "I should lie down for 1/2 hour after eating." "I need to raise the head of my bed about 15 to 30 degrees."

"I should lie down for 1/2 hour after eating." The client should remain sitting for 1 to 3 hours after eating and avoid lying down within 3 hours of eating. Cutting out caffeine, chewing food slowly, and raising the head of the bed are helpful in reducing pyrosis (heartburn) of pregnancy.

A client in her second trimester of pregnancy has developed varicose veins and experiences leg cramps. Which suggestion would be most appropriate? Increase intake of folic acid. Increase intake of calcium. Elevate legs while sitting. Perform aerobic exercises.

Elevate legs while sitting. The nurse should encourage the client to elevate her legs while sitting; this will prevent pooling and engorgement of veins in the lower extremities. Aerobic exercises do not help in preventing varicose veins. Folic acid intake is recommended in the first trimester to prevent congenital abnormalities. Increasing the intake of calcium helps in strengthening bones.

The nurse is educating the client at 12 weeks' gestation regarding the best types of exercise throughout pregnancy. Which activities should the nurse encourage? High-impact movements enabling less time in the activity All activities that the client does in a prepregnant state Relaxing activities such as hot baths and jacuzzis Stretching and breathing exercises such as yoga

Stretching and breathing exercises such as yoga It is important to exercise during pregnancy. One excellent type of exercise includes yoga, which reduces stress and increases relaxation. Yoga also gently stretches muscles and can increase muscle tone. Contact and high-impact sports are not appropriate for the pregnant mother. Hot areas such as a jacuzzi, hot tub, and sauna are also inappropriate.

Which vaccines are contraindicated during pregnancy since they may transmit a viral infection to the fetus? Select all that apply. mumps influenza Tdap vaccine (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) measles rubella

mumps measles rubella Live virus vaccines, such as measles, HPV, mumps, rubella, and poliomyelitis (Sabin type), are contraindicated during pregnancy because they may transmit a viral infection to a fetus. Women are advised to be vaccinated against influenza before/during pregnancy. Tetanus is also treated the same in pregnant women as in others by Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) injection.

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? heartburn slowed GI transit time nausea and vomiting faintness

nausea and vomiting Women will commonly experience nausea and vomiting upon awakening first thing in the morning. Clients who experience this should be encouraged to have small snacks at their bedside for eating prior to moving from the bed. Heartburn is a result of pressure and hormone action. Faintness is due to pressure on the vena cava, not blood sugar. GI transit time is not affected.

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 spontaneous abortion fetal growth restriction cataracts

neurological challenges Lead ingestion during pregnancy may lead to a newborn who is both cognitively and neurologically challenged. Formaldehyde exposure can lead to spontaneous abortions. Breathing air filled with pollutants (such as carbon monoxide) has been shown to lead to fetal growth restriction. The rubella virus' teratogenic effects on a fetus can be devastating, such as hearing impairment, cognitive and motor challenges, cataracts, and cardiac defects.

A pregnant client reports difficulty sleeping well. Which suggestion for sleeping should the nurse prioritize to assist this client? on her stomach with a pillow under her breasts on her side with the weight of the uterus on the bed on her back with a pillow under her head on her back with a pillow under her knees and hips

on her side with the weight of the uterus on the bed Resting on the side prevents pressure from the uterus against the vena cava and therefore allows blood to return to the uterus. Other positions may be more uncomfortable or may exacerbate the problems associated with pressure on the vena cava.

Which two tests are generally performed on urine at a prenatal visit? protein and glucose occult blood and protein pH and glucose protein and sodium

protein and glucose Protein is assessed to help detect hypertension of pregnancy; glucose is assessed to help detect gestational diabetes.

The diagonal conjugate of a pregnant woman's pelvis is measured. Which measurement would the nurse interpret as presenting a potential problem? 13.5 cm 12.5 cm 13.0 cm 12.0 cm

12.0 cm The diagonal conjugate, usually 12.5 cm or greater, indicates the anteroposterior diameter of the pelvic inlet. The diagonal conjugate is the most useful measurement for estimating pelvic size because a misfit with the fetal head occurs if it is too small.

The nurse is reviewing client data following a regular monthly appointment at 6 months' gestation. Which fundal height requires no further intervention? 30 cm 32 cm 24 cm 18 cm

24 cm An anticipated fundal height for 24 weeks' gestation (6 months) is 24 cm. Between 18 and 32 weeks' gestation, the fundal height in centimeters should match the gestational age. All of the other measurements would require further intervention.

A client in her third month of pregnancy arrives at the health care facility for a regular follow-up visit. The client reports discomfort due to increased urinary frequency. Which instruction should the nurse offer the client to reduce the client's discomfort? Munch on dry crackers and toast in the early morning. Avoid an empty stomach at all times. Drink fluids with meals rather than between meals. Avoid consumption of caffeinated drinks.

Avoid consumption of caffeinated drinks. To reduce the client's urinary frequency, the nurse should instruct the client to avoid consuming caffeinated drinks, since caffeine stimulates voiding patterns. The nurse instructs the client to drink fluids between meals rather than with meals if the client complains of nausea and vomiting. The nurse instructs the client to avoid an empty stomach at all times, to prevent fatigue. The nurse also instructs the client to munch on dry crackers or toast early in the morning before arising if the client experiences nausea and vomiting; this would not help the client experiencing urinary frequency.

What instruction should a nurse offer to a pregnant client or a client who wishes to become pregnant to help her avoid exposure to teratogenic substances? Maintain personal hygiene. Avoid intake of coffee. Avoid medications. Eat a well-balanced diet.

Avoid medications. The nurse should instruct a client who is pregnant or one who wants to conceive to avoid medications and thus avoid exposure to any kind of teratogenic substance. Eating a well-balanced diet and maintaining personal hygiene, though important during pregnancy, will not prevent a client's exposure to teratogenic substances. Coffee is not a teratogenic substance, so the client need not avoid coffee. However, coffee is not recommended during pregnancy because it may increase the risk of spontaneous abortion (miscarriage).

Why is the first prenatal visit usually the longest prenatal visit? Extensive client teaching is done. Laboratory tests are performed. Baseline data is collected. A pelvic exam with Papanicolaou test is performed.

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

The nurse will be assisting a client during an amniocentesis. Which nursing intervention should the nurse prioritize? Caution about the narcotic premedication. Be certain she is aware of potential complications. Expect test results within 1 week. Ensure she understands the need for 2 days of bed rest.

Be certain she is aware of potential complications. The client should be aware of the potential complications and risks, and should sign an informed consent. Narcotics are contraindicated for pregnant woman due to side effects. She should maintain bed rest for the remainder of the day, with light housework the following day and a return to normal activities on the third day. It may take 2 or 3 weeks before the test results come back from the laboratory.

The nurse is assessing a client at 12 weeks' gestation who reports enjoying her usual slow, long daily walk. The nurse should point out which recommendation to this client? Continue this as long as she enjoys it. Engage in aerobics for greater benefits. Stop and rest every block. Reduce walking to half a block daily.

Continue this as long as she enjoys it. Walking is an excellent exercise during pregnancy because it is low impact and increases venous circulation. Exercise should be maintained as long as it is comfortable, but intensity should not increase over what is normally performed.

The client states that the first day of her last menstrual period is March 23. The nurse is most correct to calculate using Naegele rule that the estimated date of delivery is: December 16 December 30 November 23 January 30

December 30 Using Naegele rule, since the first day of the client's last menstrual period is March 23, 7 days are added leading to the 30th. Subtracting 3 months from March is December. Thus, December 30 is the estimated date of delivery.

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. Wear support hose when exercising. Begin a new exercise regimen. Reduce the amount of exercise.

Maintain tolerable intensity of exercise. Women accustomed to exercise before pregnancy are instructed to maintain a tolerable intensity of exercise. They are instructed not to begin a new exercise regimen. A nurse does not tell the client to wear a support hose when exercising or to reduce the amount of exercises.

While assessing a client's breast during the third trimester, which finding would the nurse expect? breasts becoming soft pink-colored nipples pain in the nipple area colostrum from the nipples

colostrum from the nipples During the third trimester, the nipples express colostrum. Areolae and nipples appear enlarged with darker pigmentation during the third trimester. The nurse assesses for the softness of the breast, color, and pain in the nipple area in nursing mothers.

When preparing a class for a group of pregnant women about nicotine use during pregnancy, the nurse describes the major risks associated with nicotine use, including: increased risk of placental abruption (abruptio placentae). increased risk of spontaneous abortion (miscarriage). increased risk of stillbirth. decreased birth weight in neonates.

decreased birth weight in neonates. The nurse should inform the client that children born of mothers who use nicotine will have a decreased birth weight. Spontaneous abortion (miscarriage) is associated with caffeine use. Increased risks of stillbirth and placental abruption (abruptio placentae) are associated with mothers addicted to cocaine.

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? partera pregnancy aide midwife doula

doula The pregnant woman may hire a doula to provide support for labor and birth and help with establishing breastfeeding. A doula can also provide support for the postpartum period.

The nurse is screening for potential exposure to toxoplasmosis. Which question is most appropriate? "Do you lock your medications in a cabinet:" "Do you have a cat in the house?" "Do you have old paint in the house?" "Do you use well water for drinking?"

"Do you have a cat in the house?" Toxoplasmosis is caused by a protozoan that is passed from animals (such as cats) to humans via animal feces. If the woman contracts toxoplasmosis while she is pregnant, it can cause a miscarriage or fetal abnormalities.

A potential complication for the mother and fetus is Rh incompatibility; therefore, assessment should include blood typing. If the mother is Rh negative, her antibody titer should be evaluated. If treatment with Rho(D) immune globulin is indicated, the nurse would expect to administer it at which time? only at birth at 32 weeks at 28 weeks at 36 weeks

at 28 weeks If indicated, Rho(D) immune globulin should be given at 28 weeks for prophylaxis and again following birth if the infant is Rh+.

A pregnant woman has developed varicosities. Which statement would suggest she needs additional health teaching? "I dorsiflex my feet and ankles frequently." "I wear knee-highs rather than pantyhose." "I'll try not to stand for long periods." "I maintain a high fluid intake."

"I wear knee-highs rather than pantyhose." Women with varicosities should not wear knee-high stockings as they put pressure on leg veins and reduce venous return.

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 T2 P2 A0 L1 G3 T0 P1 A1 L2 G2 T2 P1 A0 L2 G2 T1 P1 A1 L1

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.

In preparing for a preconception class, the nurse plans to include a discussion of potential risk factors. Which risk factor would be most important to include? family history of pregnancy complications the importance of healthy lifestyle the use of OTC drugs with teratogens importance of taking adequate vitamin and mineral supplements

the use of OTC drugs with teratogens Risk factors for adverse pregnancy have been demonstrated by statistics gathered for smoking during pregnancy, consuming alcohol during pregnancy, not taking adequate folic acid supplements during pregnancy, being obese, taking prescription or OTC drugs that are known teratogens, and having a preexisting condition that can negatively affect pregnancy if unmanaged.

A 27-year-old client is in the first trimester of an unplanned pregnancy. She acknowledges that it would be best if she were to quit smoking now that she is pregnant, but states that it would be too difficult given her 13 pack-year history and circle of friends who also smoke. She asks the nurse, "Why exactly is it so important for me to quit? I know lots of smokers who have happy, healthy babies." What can the nurse tell the client about the potential effects of smoking in pregnancy? "Smoking is unhealthy for anyone's heart, but your baby faces an especially high risk of heart trouble if you smoke while you're pregnant." "Smoking during pregnancy places your baby at an increased risk of intellectual disability." "Babies of women who smoke tend to weigh significantly less than other infants." "Smoking during pregnancy means that your child will be born with a dependence on nicotine and will have to endure a period of withdrawal in his or her first days of life."

"Babies of women who smoke tend to weigh significantly less than other infants." Smoking during pregnancy is linked with low birth weight but not cardiac anomalies, intellectual disability, or nicotine dependence.

A pregnant woman comes to the clinic for a prenatal visit for her third pregnancy. She reveals she had a previous miscarriage at 12 weeks and her 3-year-old son was born at 32 weeks. How should the nurse document this woman's obstetric history? G3, T1, P0, A2, L1 G2, T0, P1, A1, L1 G3, T0, P1, A1, L1 G2, T1, P2, A1, L2

G3, T0, P1, A1, L1 The woman's obstetric history would be documented as G3, T0, P1, A1, L1. G (gravida) = 3 (past and current pregnancy), T (term pregnancies) = 0, P (number of preterm pregnancies) = 1, A (number of pregnancies ending before 20 weeks viability to include miscarriage) = 1, and L (number of living children) = 1.

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? 24 weeks 20 weeks 18 weeks 22 weeks

20 weeks Some clients will not seek early prenatal care, especially if it is not their first pregnancy. The uterus expands to reach the height of the umbilicus by week 20. Before week 20 it is too low to be palpated, and after week 20 it may be beyond the umbilicus.

A pregnant adolescent asks the nurse which sport would be safe for her to learn during pregnancy. Which activity would the nurse suggest as safe? skiing bicycling swimming jogging

swimming Sports that require balance (bicycling, skiing) become difficult during pregnancy. Jogging can be difficult because of lax knee cartilage. Swimming would be a safe activity to partake in during pregnancy.

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? "Let's discuss this with your health care provider before you continue douching." "Douching will definitely keep your vagina clean." "If you prepare your own douching solution, be sure to boil the water to kill bacteria." "During pregnancy, you should not douche because it can cause fluid to enter the cervix resulting in an infection."

"During pregnancy, you should not douche because it can cause fluid to enter the cervix resulting in an infection." Even if vaginal discharge seems excessive, douching is contraindicated because the force of the irrigating fluid could cause the solution to enter the cervix, leading to a uterine infection. In addition, douching alters the pH of the vagina, leading to an increased risk of vaginal bacterial growth. Stating that douching will keep the client clean does not provide the client with the information she needs. Boiling water for a douche will not prevent development of infection. The nurse is capable of responding to the client directly without referring the client to the health care provider.