Chp 7 OB Pregn
A woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability is called what? 1 Primipara 2 Primigravida 3 Multipara 4 Nulligravida
1 A primipara is a woman who has completed one pregnancy with a viable fetus. Gravida is a pregnant woman; para comes from parity, meaning a viable fetus; primi means first; multi means many; and null means none. A primigravida is a woman pregnant for the first time. A multipara is a woman who has completed two or more pregnancies with a viable fetus. A nulligravida is a woman who has never been pregnant.
The nurse is assessing the transvaginal ultrasound report of a pregnant patient. After assessment, the nurse instructs the patient to avoid air travel. What will this instruction prevent? 1 Preterm labor in the patient 2 Supine hypotension 3 Peripartum hemorrhage 4 Gestational hypertension
1 Transvaginal ultrasound is performed to determine the cervical length of a pregnant patient. When the cervical length is found to be short, the patient is at risk of preterm labor, and patients at risk of preterm labor are advised to avoid air travel. To prevent supine hypotension, the pregnant patient should be instructed on maintaining side-lying or semisitting postures. Avoiding air travel does not prevent supine hypotension. Peripartum hemorrhage occurs during delivery and cannot be prevented by avoiding air travel. Gestational hypertension is a pregnancy complication that is not affected by air travel.
A pregnant woman demonstrates understanding of the nurse's instructions regarding relief of leg cramps if she does what? 1 Wiggles and points her toes during the cramp 2 Applies cold compresses to the affected leg 3 Extends her leg and dorsiflexes her foot during the cramp 4 Avoids weight bearing on the affected leg during the cramp
1 Extending the leg and dorsiflexing the foot is the appropriate relief measure for a leg cramp. Pointing toes can aggravate rather than relieve the cramp. Application of heat is recommended. Bearing weight on the affected leg can help relieve the leg cramp, so it should not be avoided.
A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse would be most concerned regarding what this woman consumes during and after tennis matches. Which is the most important? 1 Several glasses of fluid 2 Extra protein sources, such as peanut butter 3 Salty foods to replace lost sodium 4 Easily digested sources of carbohydrate
1 If no medical or obstetric problems contraindicate physical activity, pregnant women should get 30 minutes of moderate physical exercise daily. Liberal amounts of fluid should be consumed before, during, and after exercise, because dehydration can trigger premature labor. Also the woman's calorie intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise. All pregnant women should consume the necessary amount of protein in their diet, regardless of level of activity. Many pregnant women of this gestation tend to retain fluid. This may contribute to hypertension and swelling. An adequate fluid intake prior to and after exercise should be sufficient. The woman's calorie and carbohydrate intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise.
The nurse teaching a preconception class explains to the group that which are potential problems related to pregnancy after 35 years of age. Select all that apply. 1 Hypertension 2 Cesarean birth 3 Placenta previa 4 Prolonged labor 5 Gestational diabetes 6 Abnormal fetal presentation
1,2,3,4,5 Potential problems related to pregnancy after 35 years of age include hypertension, cesarean birth, placenta previa, prolonged labor, and gestational diabetes. Abnormal fetal presentation is a potential problem related to multiparity.
Which statement about multifetal pregnancy is accurate? Select all that apply. 1 The expectant mother often develops anemia because the fetuses have a greater demand for iron. 2 Twin pregnancies come to term with the same frequency as single pregnancies. 3 The mother should be counseled to increase her nutritional intake and gain more weight. 4 Backache and varicose veins are often more pronounced. 5 There is always a history of fertility drugs.
1,3,4 Twin pregnancies often end prematurely. Serious efforts should be made to bring the pregnancy to term. A woman with a multifetal pregnancy often develops anemia due to the increased demands of two fetuses. This should be monitored closely throughout her pregnancy. The client may need nutrition counseling to ensure that she gains more weight than what is needed for a singleton birth. The considerable uterine distention is likely to cause backache and leg varicosities. Maternal support hose should be recommended. A history of fertility drugs is sometimes, but not always, a cause of multifetal pregnancy.
In order to help pregnant women effectively manage pain during labor and delivery, which strategies are most commonly taught during childbirth education classes? Select all that apply. 1 Touch 2 Hot bath 3 Ambulation 4 Position changes 5 Progressive relaxation 6 Neuromuscular disassociation
1,3,4,5,6 Touch, ambulation, position changes, progressive relaxation, and neuromuscular disassociation increase comfort, decrease muscle fatigue, reduce tension that increases pain perception, and decrease pain tolerance, conserve energy, decrease oxygen use, and enhance other pain relief methods. A hot bath is not recommended as a pain management strategy for a pregnant woman in labor. The heat may be dangerous because it may lower the woman's blood pressure causing dizziness or fainting and may be dangerous for the fetus, especially if membranes have ruptured.
A patient in the first trimester of pregnancy tells the nurse, "I urinate frequently and am not able to hold urine even for a short time." What would the nurse suggest to ease the patient's discomfort? 1 "Eat dry carbohydrates." 2 "Perform Kegel exercises." 3 "Apply local heat or ice." 4 "Get back rubs regularly
2 During the first trimester of pregnancy, patients may have various discomforts such as urgent urination. Kegel exercises help strengthen the pelvic floor muscles and thus are helpful decreasing urinary urgency. Dry carbohydrates are included in the diet to suppress vomiting in pregnant women, but they have no effect on urinary urgency. Headache is also a common discomfort in a pregnant patient. Massage and hot and cold application help relieve this pain. Backache during pregnancy can be eased by giving back rubs to a pregnant patient.
A woman delivered twin babies at the 36th week of her first pregnancy. How does the nurse record gravidity and parity of the patient? 1 Gravida 1, para 0 2 Gravida 1, para 1 3 Gravida 2, para 1 4 Gravida 3, para 2
2 Gravidity indicates the total number of pregnancies that the woman has had, including the present one. Parity indicates the number of pregnancies that have reached 20 weeks of gestation. Because the woman had twins at 36 weeks in her first pregnancy, the nurse should record this information as gravida 1, para 1. If the woman had been pregnant for the first time (primigravida) and has not carried a pregnancy to 20 weeks, then it would be documented as gravida 1, para 0. The nurse should document it as gravida 2, para 1 if the woman has one living child and is pregnant with the second one. If the woman gave birth at 36 weeks during her third pregnancy, then it is documented as gravida 3, para 2.
The nurse is assessing a pregnant patient who is in the second trimester. The patient tells the nurse, "My body shook for a while when I was sitting on my couch." What laboratory parameter would the nurse monitor? 1 Blood glucose levels 2 Blood pressure 3 Complete blood cell count 4 Electroencephalogram (EEG)
2 The pregnant patient may experience mild convulsions caused by elevated blood pressure. Therefore, the nurse should monitor the patient's blood pressure. Fluctuations in blood glucose levels may cause hyperglycemia or hypoglycemia during pregnancy; these fluctuations do not cause seizures. The complete blood cell count is used to determine the presence of infection and anemia. These conditions are not known to cause seizures. EEG is used to determine brain functioning in clients with chronic seizures. It is not necessary in this case. The assumption here is that "shook" qualifies as a seizure but this is unclear. A patient can have high or low blood sugar and this could lead to "tremors" and/or "shaking" type behavior.
The nurse instructs a pregnant patient to avoid sitting for a long time and to wear loose-fitting pants. Which pregnancy discomfort is the nurse trying to ease? 1 Constipation 2 Varicose veins 3 Supine hypotension 4 Urinary tract infections
2 Varicose veins are observed in pregnant patients usually in the second or third trimesters. Prolonged sitting increases the blood pressure in the leg veins, causing varicose veins. Patients who spend more time sitting (e.g., at a desk job) have a high risk of developing varicose veins. Similarly, wearing tight-fitting pants can also affect the venous return and cause stasis of the blood in the veins. Constipation is another regularly observed complication during pregnancy. Increased intake of fiber and water is helpful to relieve constipation. Supine hypotension is caused when the abdominal contents compress the inferior vena cava in the supine position. This can be relieved by changing positions when sleeping. Urinary tract infections can be prevented during pregnancy by increasing the intake of water and by emptying the bladder regularly.
A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. What is her gravidity and parity using the GTPAL system? 1 3-0-1-0-1 2 3-1-0-1-0 3 3-1-2-0-1 4 3-0-2-0-1
2 G-P-TA-L 3-1-0-1-0 Using the GPTAL system, this woman's gravidity and parity information is calculated as follows: G: Total number of times the woman has been pregnant (she is pregnant for the third time); T: Number of pregnancies carried to term (she has one stillborn); P: Number of pregnancies that resulted in a preterm birth (she has none); A: Abortions or miscarriages before the period of viability (she has had one); L: Number of children born who are currently living (she has no living children).
While assisting the primary health care provider, the nurse documents the subjective symptoms of pregnancy in a patient. Which subjective symptom does the nurse record based on the patient's statement? 1 Vaginal changes 2 Urinary frequency 3 Breast enlargement 4 Abdominal enlargement
2 Subjective symptoms are symptoms that can be reported by the patient. Subjective symptoms of pregnancy include urinary frequency, nausea and vomiting, and fatigue. Vaginal changes, breast enlargement, and abdominal enlargement are objective signs, which can be observed.
Which of the following would be included in a birth plan for an expectant mother? Select all that apply. 1 Tracking of the onset of progressive, regular contractions 2 The presence of birth companions such as the partner 3 Preferred position for labor and for birth 4 Medical interventions 5 Discussion of any fears about labor
2,3,4 The birth plan should include the woman's or couple's preferences related to presence of birth companions such as the partner, preferred position for labor and birth, and medical interventions. The birth plan does not include the tracking of the onset of progressive, regular contractions or discussion of any fears about labo
What is the expected delivery date for a pregnant woman whose first day of her last menstrual period was April 20, 2014? 1 December 27, 2014 2 January 20, 2015 3 January 27, 2015 4 February 7, 2016
3 According to Nagele's rule, the expected date of delivery is calculated by adding 7 days and 9 months to the first day of the last menstrual period. Because the patient's last menstrual period was April 20, 2014, the expected date of delivery would be April 20, 2014 + 9 months + 7 days = January 27, 2015.
A patient is in the 21st week of her third pregnancy. The patient's first pregnancy ended in fetal death in the 24th week of pregnancy, and the second one was terminated during the third month of gestation. How does the nurse denote the obstetric history of this patient? 1 Gravida 1 para 1 2 Gravida 2 para 2 3 Gravida 3 para 2 4 Gravida 2 para 1
3 Gravidity and parity information is obtained during history-taking interviews. The term gravidity indicates the number of pregnancies. The term parity indicates the number of pregnancies in which the fetus reached 20 weeks of gestation (the fetus may have been alive or stillborn). In this case, the patient had a total of three pregnancies, denoted by gravida 3. Among the three pregnancies, two of them reached 20 weeks of gestation, denoted by para 2. Gravida 1 para 1 would indicate that the patient had one pregnancy, which completed 20 weeks of gestation. Gravida 2 para 2 indicates that the patient had two pregnancies, and both fetuses completed 20 weeks of gestation. Gravida 2 para 1 indicates that the patient had two pregnancies, and only one fetus reached 20 weeks of gestation.
The nurse reviews the obstetric history of a pregnant woman and notes the GTPAL (gravidity, term, preterm, abortions, living children) for the woman is "1-0-1-0-1." What does the nurse infer from this? 1 The woman was pregnant twice, gave birth at the 35th week, and the baby survived. 2 The woman was pregnant once and gave birth to twins at the 36th week of pregnancy. 3 The woman was pregnant once, gave birth at the 35th week, and the baby survived. 4 The woman was pregnant twice and had miscarriage at 10 weeks during second pregnancy.
3 If the woman was pregnant only (gravidity-1), gave birth at week 35 (term-0), had one preterm delivery (preterm-1), had no abortions (abortion-0), and the baby survived (living children-1), then the GTPAL should be "1-0-1-0-1." If the woman was pregnant twice, gave birth at the 35th week during both pregnancies, and both babies survived, then the GTPAL would be "2-0-2-0-2." If the woman was pregnant once, gave birth to twins at the 36th week, then the GTPAL would be "1-0-2-0-2." The GTPAL would be "2-1-0-1-1" if the woman was pregnant twice, had one term pregnancy, but the second pregnancy ended in miscarriage at 10 weeks.
A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of exercise on the fetus. The nurse should inform her: 1 "You don't need to modify your exercising any time during your pregnancy." 2 "Stop exercising, because it will harm the fetus." 3 "You may find that around the seventh month of your pregnancy, you need to modify your exercise to walking." 4 "Jogging is too hard on your joints; switch to walking now."
3 Typically, running should be replaced with walking around the seventh month of pregnancy. The nurse should inform the woman that she may need to reduce her exercise level as the pregnancy progresses. Physical activity promotes a feeling of well-being in pregnant women. It improves circulation, promotes relaxation and rest, and counteracts boredom. Simple measures should be initiated to prevent injuries, such as warm-up and stretching exercises to prepare the joints for more strenuous exercise.
A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. What is her gravidity and parity using the GTPAL system? 1 2-0-0-1-1 2 2-1-0-1-0 3 3-1-0-1-0 4 3-0-1-1-0
3 Using the GTPAL system outlined in the question stem, this woman's gravidity and parity information is calculated as follows: G: Total number of times the woman has been pregnant (she is pregnant for the third time). T: Number of pregnancies carried to term (she has had only one pregnancy that resulted in a fetus at term). P: Number of pregnancies that resulted in a preterm birth (none). A: Abortions or miscarriages before the period of viability (she has had one). L: Number of children born who are currently living (she has no living children). 3-1-0-1-0 is the correct calculation of this woman's gravidity and parity.
What question does the nurse ask when assessing the socioeconomic status of a pregnant patient? 1 "What prescription medications do you take?" 2 "Do you have any factories around your house?" 3 "Do you have any medical insurance?" 4 "Are there any diseases that run in your family?"
3 When the nurse is assessing a patient's socioeconomic status, the nurse should determine if the patient has health insurance. Lack of health insurance may mean the patient does not have a job to pay for insurance nor the income to pay for it privately. This may impact the patient's prenatal care if she cannot afford services. When the nurse asks about the family's medical history, this falls under the patient's personal history. The nurse asks about the community in which the patient lives when assessing the patients environment. Medications can affect the fetus in a pregnant patient. Therefore, the nurse should ask about the medications taken by the patient when assessing the patient's health status.
The nurse is assisting the primary health care provider during a pelvic examination of a pregnant patient. What does the nurse assess while performing a pelvic examination? 1 Size of the uterus 2 Height of the fundus 3 The patient's knowledge of Kegel exercises 4 Tone of pelvic musculature
3 Whenever a pelvic examination is being performed for a pregnant patient, it is important to assess her knowledge of Kegel exercises, which help maintain the tone of pelvic musculature. The size of the uterus, the height of the fundus, and the tone of pelvic musculature are assessed by the primary health care provider during a pelvic examination.
Which findings obtained during clinical evaluation of a pregnant patient help determine the gestational age of the fetus? Select all that apply. 1 Previous cesarean section 2 Types of contraception used 3 Current fundal height 4 First fetal heart tones heard 5 Current week of gestation
3,4,5 The current fundal height, first uterine evaluation, first fetal heart tones heard, and current week of gestation help determine the gestational age of the fetus. The fundal height increases as the fetus grows, and the fundal measurement can be used to determine the gestational age. Previous cesarean section may not have a bearing on the current pregnancy and its gestational age. Information on types of contraception used may not help in determining the gestational age.
How often should a low-risk pregnant patient see her health care team before she reaches 28 weeks? 1 Every week 2 Every 2 weeks 3 Every 3 weeks 4 Every 4 weeks
4 A low-risk pregnant patient should see her health care team every 4 weeks until she reaches 28 weeks pregnant. As long as she remains low-risk, she will not see her health care team every week until she reaches 36 weeks. From 28 weeks to 36 weeks, she will be assessed every 2 weeks. Every 3 weeks is more often than necessary for a low-risk patient before 28 weeks.
The nurse is providing exercise tips to an 18-week pregnant patient. Which statement made by the patient indicates the need for additional teaching? 1 "I should exercise regularly for 30 minutes at a time." 2 "I should decrease weight-bearing exercises." 3 "I should take my pulse every 15 minutes while exercising." 4 "I should lie on my back for 10 minutes after exercising.
4 After the fourth month of pregnancy, the patient should not be encouraged to lie on her back. This position may cause supine hypotension due to the fetus compressing the main maternal vessels. Exercising regularly for 30 minutes at a time improves muscles and increases stamina. Weight-bearing exercises should be decreased to prevent joint injury. The patient should concentrate on non-weight-bearing activities to prevent these complications. The patient should take her pulse every 10 to 15 minutes to avoid risk of cardiovascular complications.
The nurse is teaching a woman who is 37 weeks pregnant about breastfeeding. Which statement made by the patient indicates effective teaching by the nurse? 1 "I will prepare my nipples for breastfeeding by rubbing a washcloth on them in the shower." 2 "Formula is healthier for the baby than breastfeeding." 3 "Breastfeeding is natural and very easy for any woman to do." 4 "These are three reputable lactation support services I can use."
4 It is important for a nurse to offer breastfeeding support resources to all new mothers interested in breastfeeding. It is common for questions or issues to arise during the breastfeeding relationship, and it is important for the mother to know when and how to get support. There is no need to prepare the nipples or breasts for breastfeeding. Breastfeeding is considered healthier than formula for both the infant and the mother. Breastfeeding is natural, but women often face challenges while doing so.
The nurse is caring for a patient who is 9 weeks pregnant with her second child. What is the priority information that the nurse should include in the patient teaching? 1 Signs of preeclampsia or eclampsia 2 What to expect during labor and delivery 3 How to prepare the older child for a new sibling 4 How to prevent exposure to teratogens or other hazards
4 It is important for the nurse to provide information that is relevant to the current needs of the patient. A woman in the first trimester of pregnancy needs information about limiting exposure to harmful chemicals, foods, or other potential hazards to protect the developing fetus. Information about the signs of preeclampsia, what to expect during labor and delivery, and how to prepare an older child for a new sibling are concerns that are better addressed during the last trimester of pregnancy.
What does a nurse advise the woman who wants to have a nurse-midwife provide obstetric care? 1 "You will have to give birth at home." 2 "You must see an obstetrician as well as the midwife during pregnancy." 3 "You will not be able to have epidural analgesia for labor pain." 4 "You must be having a low-risk pregnancy."
4 Midwives usually see low-risk obstetric patients. Care is often noninterventional, with active involvement from the woman and her family. Nurse-midwives must refer clients to physicians for complications. Most nurse-midwife births are managed in hospitals or birth centers; a few may be managed in the home. Nurse-midwives may practice with physicians or independently with an arrangement for physician backup. They must refer patients to physicians for complications. Care in a midwifery model is noninterventional, and the woman and family usually are encouraged to be active participants in the care. This does not imply that medications for pain control are prohibited.
The nurse is teaching a group of pregnant women about safety during pregnancy. Which statement made by a patient indicates the need for additional teaching? 1 "We should wear seatbelts in the car." 2 "We should wear gloves while handling chemicals." 3 "We should schedule our daily activities to promote rest and relaxation." 4 "We should avoid travelling to high-altitude regions above 8000 feet."
4 Pregnant women should follow safety steps to avoid complications. Pregnant women should avoid traveling to high-altitude regions above 12,000 feet. Seat belts should be used to ensure safety while traveling. It is necessary for the pregnant women to wear gloves while handling chemicals to avoid the toxic effects of the chemicals. Daily activities should be rescheduled to promote rest and relaxation.
A pregnant patient in the third trimester reports urinary frequency. What is the best nursing intervention for reducing frequency of urination in the patient? 1 Advise the patient to limit her fluid intake. 2 Encourage the patient to wear a perineal pad. 3 Advise the patient to empty her bladder regularly. 4 Encourage the patient to perform Kegel exercises.
4 Kegel exercises involve deliberate contraction and relaxation of the pubococcygeus muscle. Practicing Kegel (pelvic muscle) exercises during pregnancy results in fewer complaints of urinary incontinence. Limiting the patient's fluid intake may cause dehydration. Fluid intake should be limited only during the night. Wearing a perineal pad reduces discomfort associated with urinary frequency but does not affect the frequency of urination. Regularly emptying the bladder does not reduce urinary frequency.
The nurse is assessing a pregnant patient. The nurse finds that the patient's estimated date of birth (EDB) is December 2, 2015. What would be the patient's first day of the last menstrual period (LMP)? 1 February 25, 2015 2 March 25, 2015 3 February 2, 2015 4 March 2, 2014
Nägele's rule estimates the birth date by adding 7 days to the patient's LMP and counting forward by 9 months, so the patient's LMP is estimated by subtracting 7 days and 9 months from the EDB. Thus, the patient's LMP would be February 25, 2015. If the patient LMP is March 25, 2015, the EDB would be January 2, 2015. If the patient's LMP is February 2, 2015, then the EDB would be November 9, 2015. If the patient's LMP is March 2, 2014, then the EDB would be December 9, 2014.
