Nursing Mn 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? excessive vomiting swelling of extremities dyspnea lower abdominal pressure

A 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. Hyperemesis gravidarum usually occurs during the first trimester of pregnancy due to high human chorionic gonadotropin (hCG) levels. Hyperemesis gravidarum is persistent nausea and vomiting with weight loss due to inability to ingest food or fluid, which leads to dehydration.

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 sterile urine cup Foley catheter sterile field with scalpel

A First, the health care provider identifies a pocket of amniotic fluid using an ultrasound machine. A scalpel is not used in the procedure. A urine culture is not obtained prior to the procedure nor is a Foley catheter inserted.

The nurse is discussing nutritional supplementation with a 27-year-old pregnant client. Which element would the nurse encourage as essential in preventing neural tube defects? folic acid calcium iron iodine

A Folic acid supplementation is essential during the first trimester to prevent neural tube defects. Iron deficiency leads to anemia, which causes preterm birth and low-birth-weight infants. Iron, calcium, and iodine supplementation are necessary during pregnancy, but the lack of these does not cause neural tube defects in the fetus.

The nurse teaches a sedentary pregnant client with a BMI of 35 about the importance of healthy lifestyle during pregnancy. Which goal would be appropriate for this client? Walk for 30 minutes 5 days a week. Participate in a daily aerobic dance program. Adhere to a weight reduction diet. Begin lifting weights for 30 minutes per day.

A For a sedentary client a walking program is an appropriate goal. Dieting/weight reduction is never recommended during pregnancy. A daily aerobic or weight lifting program are not appropriate goals for a sedentary client with a high BMI.

A multigravida client is pregnant for the third time. Her previous two pregnancies ended in an abortion in the first and third month of pregnancy. How will the nurse classify her pregnancy history? G3 P0020 G2 P1020 G2 P0020 G3 P0021

A Gravida (G) is the total number of pregnancies she has had, including the present one. Therefore she is G3 and not G2. Para (P), the outcome of her pregnancies, is further classified by the FPAL system as follows: F = Full term: number of babies born at 37 or more weeks of gestation, which is 0 and not 1 in this case. P = Preterm: number of babies born between 20 and 37 weeks of gestation, which is 0 in this case. A = Abortions: total number of spontaneous and elective abortions, which is 2 in this case. L = Living children, as of today. She has no living children; therefore, it is 0 and not 1.

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. The steroids will increase the baby's muscle mass. The steroids will help to slow the development of infection. The steroids will create a layer of fat to help with temperature regulation.

A Steroids given to the mother before birth help to speed up the development of the fetal lungs. The use of prenatal steroids has decreased the mortality rate in preterm infants. Prenatal steroids do not increase muscle mass or amount of fat tissue to aid in temperature regulation. Prenatal steroids do not have an impact on the development of sepsis in either the mother or neonate.

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 Promotes clearing mucus from the respiratory tract Helps maintain a rhythmic breathing pattern Assists with ciliary body maturation in the upper airways

A Surfactant keeps the alveolar surfaces from sticking together, allowing the lungs to expand and making it easier for the neonate to breathe. Surfactant does not remove mucus or mature the upper airway. It does not effect the breathing pattern, just the effort needed to expand the alveoli.

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: decreased birth weight in neonates. increased risk of spontaneous abortion (miscarriage). increased risk of stillbirth. increased risk of placental abruption (abruptio placentae).

A 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.

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. Reduce the amount of exercise. Begin a new exercise regimen.

A 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.

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? lower abdominal and shoulder pain vaginal bleeding severe, persistent vomiting painful urination

B 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.

At the first prenatal visit of all clients who come to the clinic appropriate blood screenings are obtained. The nurse realizes that a hemoglobin A1C above which level is concerning for diabetes and warrants further testing? 5.0% 6.5% 6.0% 5.5%

B A hemoglobin A1C level of at least 6.5% is concerning for overt diabetes, and further testing should be conducted to ensure the client does not have diabetes. If glucose testing is not diagnostic of overt diabetes, the woman should be tested for gestational diabetes from 24 to 28 weeks' gestation with a 75-gm oral glucose tolerance test.

A gravida woman in her second trimester has shared that she still enjoys a glass of wine about once a week with dinner. What response by the nurse is most appropriate? "As long as you do not increase the amount of alcohol you are drinking there is little risk." "There is no amount of alcohol consumption in pregnancy that is considered safe for the fetus." "Now that you have reached the second trimester you are at a reduced risk for causing complications to your fetus." "The best thing for you to do is to reduce the amount of alcohol you are drinking."

B Alcohol ingestion during the pregnancy is considered unsafe at all points in the pregnancy. Alcohol can impact the fetus during each of trimester of pregnancy. There are no exact amounts of alcohol that can be ingested safely. Alcohol impacts each pregnancy and fetus differently. The best course of action is to share the dangers with the woman.

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? nasal congestion and swollen nasal membranes episodes of double vision palpitations when lying on her back increased lumbar curvature

B Difficulty with vision can occur from cerebral edema or is a symptom of hypertension of pregnancy.

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

B 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.

The nurse is teaching a pregnant client some nonpharmacologic ways to handle common situations encountered during pregnancy. The nurse determines the session is successful when the client correctly chooses which condition that can be minimized if she avoids drinking fluids with her meals? blood clots heartburn nosebleeds constipation

B Filling the stomach with heavy food and fluid can cause overfill and place pressure on the stomach, increasing gastric reflux. Avoid excess fluids with meals and eat small frequent meals to avoid heartburn. Nosebleeds result from increased estrogen. Blood clots can result from sitting still for too long. Constipation can result from increased progesterone.

A woman who is 4 months pregnant has pyrosis. Which suggestion would the nurse give her? Try to include complex carbohydrates in meals. Eat small meals and do not lie down after meals. Take 30 ml of milk of magnesia after every meal. Increase vitamin intake by adding more citrus fruit.

B Pyrosis, or heartburn, occurs in pregnancy because the uterine pressure against the stomach causes regurgitation into the esophagus. Eating small meals and remaining upright limits the possibility of regurgitation.

A client at 34 weeks' gestation reports difficulty sleeping at night. What will the nurse recommend? Eat a large evening meal to prevent hunger during the night. Try relaxation exercises at bedtime. Use an over-the-counter sleep aid. Avoid napping to improve quality of nighttime sleep.

B Relaxation or mindfulness exercises may help with falling asleep. Large meals may increase heartburn in late pregnancy, which can interfere with sleep due to discomfort; therefore, large meals are not recommended. Napping or an afternoon rest period may be required to ensure adequate rest and sleep. An over-the-counter sleep aid should not be recommended without further consultation.

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 = 3, T = 1, P = 0, A = 1, L = 1 G = 1, T = 1, P = 1, A = 0, L = 1 G = 2, T = 0, P = 0, A = 0, L = 1

B 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 (either elective or miscarriage) -- 1; Living children -- 1. Do not be distracted by the twins. That is still one pregnancy.

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? Goodell sign Naegele sign Chadwick sign Hegar sign

C Because of increased pelvic congestion during pregnancy, the cervix and vaginal mucosa will have a bluish coloration, which is called Chadwick sign. A softened cervix is called Goodell sign, and the uterine isthmus being softened is called Hegar sign. Naegele rule is used to calculate the expected date of delivery (EDD).

A pregnant client tells the nurse that she has a 2-year-old child at home who was born at 38 weeks; she had a miscarriage at 9 weeks; and she gave birth to a set of twins at 34 weeks. Which documentation would be appropriate for the nurse? gravida 3, para 4 gravida 2, para 1 gravida 4, para 2 gravida 2, para 4

C Gravida (G) indicates the number of pregnancies. When a nurse calculates the GP of a pregnant client, the current pregnancy counts as one, the twin pregnancy counts as one, and the previous pregnancies count as two for a gravida of 4. Para (P) indicates the number of pregnancies that result in birth at a viable gestational age. The birth of multiples count as one. Thus, this client has a 2-year-old and one set of twins, for a para of 2.

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

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

Part of the initial prenatal assessment should include the client's immunization history. The nurse informs the client to avoid which type of vaccines while she is pregnant? bacterial vaccine toxoid vaccine live virus vaccine inactivated virus vaccine

C Routine immunizations are not usually indicated during pregnancy. However, no evidence exists of risk from vaccinating pregnant women with inactivated virus or bacterial vaccines or toxoids. A number of other vaccines have not been adequately studied. Advise pregnant women to avoid live virus vaccines (MMR and varicella) and to avoid becoming pregnant within one month of having received one of these vaccines because of the theoretical risk of transmission to the fetus.

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? "By this time, the fundus should drop down lower because the baby is moving towards the pelvic inlet." "Just get prepared, the fundus might actually get a little higher until a few days before you go into labor." "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."

C 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.

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 low-heeled shoes. Wear a padded bra. Wear support hose. Wear cotton clothes.

C The nurse should instruct the client to wear support hose while traveling by air. The nurse should also instruct the client to periodically exercise the legs and ankles, and walk in the aisles if possible. Wearing low-heeled shoes, cotton clothes, or a padded bra will have no effect on the client during the flight.

The nurse is completing the initial assessment at the prenatal visit of a pregnant client. Which question should the nurse prioritize when completing the review of systems? "Have you had any neurologic diseases?" "Do you have a peptic ulcer?" "Have you ever had a heart attack?" "Have you had any urinary tract infections?"

D It is important to ensure the woman does not have any current infections as they can all contribute to adverse effects in the pregnancy. Any conditions the woman has had in the past may recur or be exacerbated during pregnancy. It is also possible for the woman to currently have a low-grade infection and not be aware of it. A urine culture may be required to ensure the woman does not currently have an infection. UTIs can contribute to premature labor.

The nurse is assisting a pregnant client who underwent a nonstress test that was ruled reactive. Which factor will the nurse point out when questioned by the client about the results? The results indicate a stress test is needed for further evaluation. There is no evidence of congenital anomalies or deformities. The fetus is developing at a fast rate but doing fine. The fetal heart rate increases with activity and indicates fetal well-being.

D A nonstress test is a noninvasive way to monitor fetal well-being. A reactive NST is a positive sign the fetus is tolerating pregnancy well by demonstrating heart rate increase with activity, and this indicates fetal well-being. This test is not used to determine congenital anomalies or deformities. It does not determine the speed by which fetus is developing. Further evaluation would be necessary if the results were nonreactive.

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? naproxen aspirin products ibuprofen acetaminophen

D Resting with an ice pack on the forehead and taking a usual adult dose of acetaminophen usually furnishes adequate relief. Compounds with ibuprofen (class C drugs) are not usually recommended because they cause premature closure of the ductus arteriosus in the fetus. Additionally, they have been found to contribute to fetal renal damage, low amniotic fluid, and fetal intracranial hemorrhage. Aspirin and naproxen are also not recommended to take during pregnancy.

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, 2, 2, 1, 1 3, 2, 1, 2, 1 3, 2, 1, 1, 1 4, 1, 1, 1, 1

D The GTPAL system is used to classifying pregnancy status. G = gravida, T= term, P = preterm, A = number of abortions, L= number of living children.

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

D 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.

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? Activate the air bag in the car. Use a lap belt that crosses over the uterus. Apply a padded shoulder strap properly. Always wear a three-point seat belt.

D To promote easy and safe travel for the client, the nurse should instruct the client to always wear a three-point seat belt to prevent ejection or serious injury from collision. The nurse should instruct the client to deactivate the air bag if possible. The nurse should instruct the client to apply a nonpadded shoulder strap properly, ensuring that it crosses between the breasts and over the upper abdomen, above the uterus. The nurse should instruct the client to use a lap belt that crosses over the pelvis below—not over—the uterus.

A woman is 20 weeks pregnant. The nurse would expect to palpate the fundus at which location? just below the ensiform cartilage between the symphysis and umbilicus symphysis pubis at the umbilicus

D At 20 weeks, the fundus can be palpated at the umbilicus. A fundus of 12 weeks' gestation is palpated at the symphysis pubis. At 16 weeks' gestation, the fundus is midway between the symphysis pubis and umbilicus. At 36 weeks' gestation, the fundus can be palpated just below the ensiform cartilage. 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.