OB Chapt 12 Nursing Management During Pregnancy

The Healthy People goal for US women to seek prenatal care during the first trimester is what percentage?

90 percent

Which of the following nursing interventions is appropriate when preparing a woman for an amniocentesis?

Be certain she knows that there is are risks of complication, such as premature labor, from amniocentesis

While assessing a client's breast during the third trimester, which of the following would the nurse expect to find?

Colostrum from the nipples

A pregnant client in her third trimester is diagnosed with supine hypotension syndrome. Which of the following would the nurse instruct the client to do?

Lie laterally, preferably on the left side

A client in her third trimester of pregnancy visits the healthcare center and asks why she is constipated. Which of the following would the nurse include as the most likely cause when responding to the client? a) Pressure on intestine by the growing fetus b) Pressure of fetal head on the bladder c) Engorgement of veins by the weight of the uterus d) Relaxation of cardioesophageal sphincter

Pressure on intestine by the growing fetus Correct Explanation: The nurse should explain that constipation often occurs during the third trimester because the growing fetus exerts pressure on the intestine. Engorgement of veins by the weight of the uterus causes varicosities. Pressure of the fetal head on the bladder increases the frequency of urination. Relaxation of the cardioesophageal sphincter causes heartburn.

A woman whose body mass index (BMI) is 32 has just learned that she is pregnant. Which of the following should the nurse advise her regarding her weight over the course of her entire pregnancy?

She should gain 11 to 20 lb

Which of these cardiac variations, if found in the client who is pregnant, should the nurse recognize as a normal finding in pregnancy?

Soft systolic murmur

At a prenatal appointment, a woman who is 3 months pregnant confides to you that she ingests starch because of a craving she has had since adolescence. She is now 26 years old. What would be your most appropriate response?

Suggest she have a hemoglobin assessment done because of the association between pica and iron-deficiency anemia.

A 24-year-old pregnant woman complains of excessive vaginal discharge. The discharge is not associated with a strong odor, itching, or irritation but she finds it messy and unpleasant. What do you advise her to do?

Use sanitary pads

As part of her physical examination of a pregnant client, the nurse examines the woman's breasts. Which of the following are healthy breast changes that indicate pregnancy? (Select all that apply.)

• Areolae darken • Overall breast size increases • Blue streaking of veins becomes prominent • Montgomery tubercles become prominent

A woman in her first trimester shares with the nurse that she has been experiencing terrible nausea when she gets up in the morning. Which of the following should the nurse advise her to do? (Select all that apply.)

• Eat some saltine crackers before rising in the morning • Suck on sourball candies • Delay breakfast until 10 or 11 AM • Try eating soups or vegetable drinks in the morning

The nurse should administer Rhogam (Rh immune globulin) to the pregnant woman who is Rho(D)-, after which of the following tests? a) NST (Non Stress Test) b) Biophysical Profile c) CST (Contraction Stress Test) d) Amniocentesis

Amniocentesis Correct Explanation: Amniocentesis is an invasive procedure whereby a needle inserted into amniotic sac to obtain a small amount of fluid. This places the pregnancy at risk for a woman with RhD-negative blood and she should receive RhoGam after the procedure. The CST,NST, and a biophysical profile are non-invasive tests.

What anatomic area should be examined when assessing Montgomery tubercles?

Breasts

During the physical exam at the first prenatal visit a speculum exam is performed. What sign of pregnancy does the practitioner look for during the speculum exam? a) Chadwick's sign b) Nagel's sign c) Goodell's sign d) Hagar's sign

Chadwick's sign Explanation: During the speculum examination, the practitioner obtains a Papanicolaou test or Pap smear (see Nursing Procedure 4-1 in Chap. 4), and notes signs of pregnancy, such as Chadwick's sign.

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 of the following symptoms is an indicator of true labor? a) Increase in fetal kick count b) Contractions beginning in the back and sweeping forward across the abdomen c) Intermittent backache stronger than usual d) Lightening (descent of the fetus into the pelvis)

Contractions beginning in the back and sweeping forward across the abdomen Correct Explanation: 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 pregnant patient is asking about medications, supplements, and vaccines. Which of the following would the nurse indicate as potentially teratogenic?

Rubella vaccine

There is a strong correlation between poor oral health and preterm birth. a) False b) True

True

A pregnant client complains to the nurse of shortness of breath when sleeping. The nurse informs the client that this is normal and occurs because the growing fetus puts pressure on the diaphragm. Which measure should the nurse suggest to help alleviate this problem? a) Use extra pillows b) Avoid spicy food c) Avoid overeating d) Lie on a firmer mattress

Use extra pillows Correct Explanation: The nurse should instruct the client to use extra pillows at night to keep her more upright. The nurse can instruct the client to use a firmer mattress if the client is experiencing backache. The nurse can ask the client to avoid overeating and ingesting spicy food in case the client is experiencing heartburn.

One function of the nurse when dealing with a pregnant client is to teach self-care during pregnancy. One of the topics that the nurse provides teaching about is breast care. What does the nurse teach the client about keeping the breasts clean? a) Use hot water and a mild soap to keep the nipples clean b) Wash the nipples with clean water only c) Use a mild soap and cool water to keep the nipples clean d) Wash the nipples with a deodorant soap to keep them clean and help toughen them

Wash the nipples with clean water only Explanation: She should use only clean water to wash the nipples. Soap dries the nipples and can lead to cracking.

A pregnant client in her second trimester informs the nurse that she needs to travel by air the following week. Which of the following precautions should the nurse instruct the client to take during the flight? a) Wear low-heeled shoes b) Wear cotton clothes c) Wear a padded bra d) Wear support hose

Wear support hose Correct Explanation: 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.

Yvonne, 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 Yvonne about the potential effects of smoking in pregnancy? a) "Smoking during pregnancy places your baby at an increased risk of mental retardation." b) "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." c) "Babies of women who smoke tend to weigh significantly less than other infants." d) "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."

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

In light of the high incidence of some illnesses in women, which of the following questions is most important to include in a review of systems for a pregnant woman? a) "Do you have a peptic ulcer?" b) "Have you had any neurologic diseases?" c) "Have you had any urinary tract infections?" d) "Have you ever had a heart attack?"

"Have you had any urinary tract infections?" Correct Explanation: Urinary tract infections occur at a greater incidence in pregnant women than in others because stasis of urine occurs because of pressure on the ureters; the trace of glucose often present in urine helps bacteria grow.

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

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

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

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

After teaching the pregnant woman about ways to minimize flatulence and bloating during pregnancy, which statement indicates the need for additional teaching? a) "I'll try to drink more fluids to help move things along." b) "I'll switch to chewing gum instead of using mints." c) "I'll increase my time spent on walking each day." d) "I'll stay away from foods like cabbage and brussels sprouts."

"I'll switch to chewing gum instead of using mints." Correct Explanation: Eating mints can help reduce flatulence; chewing gum increases the amount of air that is swallowed, increasing gas build-up. Increasing fluid intake helps to reduce flatus. Gas-forming foods such as beans, cabbage, and onions should be avoided. Increasing physical exercise, such as walking, aids in reducing flatus.

A nurse you know is 5 weeks pregnant. She works on a unit where chemotherapy is administered. Which of the following statements would make you believe she needs additional health teaching about avoiding teratogens during pregnancy? a) "Latex gloves irritate my hands, so I don't use them." b) "I find giving emotional support taxing." c) "I care for about five clients a day." d) "I never accompany clients to the x-ray department."

"Latex gloves irritate my hands, so I don't use them." Correct Explanation: Working with chemotherapeutic agents is not recommended during pregnancy. This is an identified environmental hazard and she needs to discuss this with the provider and find information on the specific chemotherapeutic agents with which she works. The number of clients seen per day is inconsequential. It is advisable to avoid x-rays when pregnant. Emotionally draining activities may be harmful, but they are not teratogenic.

A client who is 32 weeks gestation tells the nurse that she has been experiencing shortness of breath when walking up the steps at home. She is concerned that something is wrong. What is the nurse's best response? a) "Oxygen requirements are increasing in your body because the fetus is growing" b) "You only have a few more weeks until you deliver and then you will breathe fine again" c) "The enlarging uterus pushes against your diaphragm and this makes breathing shallow" d) "Don't worry about this because it is a normal change that occurs with pregnancy"

"The enlarging uterus pushes against your diaphragm and this makes breathing shallow" Correct Explanation: Increasing levels of progesterone cause relaxation of ligaments and joints. This allows the rib cage to flares to accommodate the enlarging uterus. As the uterus enlarges, it pushes up against the diaphragm. This changes respirations from abdominal to costal and the woman feels short of breath. The nurse should never demean a client's symptoms. Oxygen requirements do increase during pregnancy but this not the reason for the woman's shortness of breath.

A client reports occasional headaches. She wants to know what she can take to alleviate the discomfort. What would be the best response by the nurse? a) "The safest medication to take for your headaches during your pregnancy would be acetaminophen (Tylenol)." b) "The safest medication to take for your headaches during your pregnancy would be Ibuprofen." c) "Wait until you reach your third trimester. You can take something to relieve headaches then." d) "You don't want to harm the baby by taking medications now, do you?"

"The safest medication to take for your headaches during your pregnancy would be acetaminophen (Tylenol)." Correct Explanation: The medication that is approved for treatment of headaches is acetaminophen (Tylenol).

The nurse is measuring the fundal height of a woman who is at 28 weeks' gestation. Which measurement would the nurse expect? a) 12 cm b) 32 cm c) 28 cm d) 18 cm

28 cm Correct Explanation: Fundal height should be approximately equal to the number of weeks' gestation. In this case, it would be 28 cm.

A pregnant woman comes to the clinic for a visit. This is her third pregnancy. She had a miscarriage at 12 weeks and gave birth to a son, now 3 years old, at 32 weeks. Using the GTPAL system, the nurse would document this woman's obstetric history as:

30111

A woman is in her early second trimester of pregnancy. The nurse would instruct the woman to return for a follow-up visit every: a) 3 weeks b) 2 weeks c) 1 week d) 4 weeks

4 weeks Correct Explanation: The recommended follow-up visit schedule is every 4 weeks up to 28 weeks, every 2 weeks from 29 to 36 weeks, and then every week from 37 weeks to birth.

Utilize the GTPAL system to classify a woman who is currently 18 weeks pregnant. This is her 4th pregnancy. She delivered one baby vaginally at 26 weeks who died, experienced a miscarriage, and has one living child who was delivered at 38 weeks gestation. a) 3, 2, 1, 2, 1 b) 3, 2, 1, 1, 1 c) 4, 1, 1, 1, 1 d) 4, 2, 2, 1, 1

4, 1, 1, 1, 1 Correct Explanation: The GTPAL system is used to classifying pregnancy status. G = gravida, T= term, P = preterm, A = number of abortions, L= number of living children.

A nurse is assessing a client's nutritional intake during pregnancy. What is the best method for accomplishing this? a) Having the client describe her food cravings b) A 24-hour nutrition recall c) Calculating the client's BMI d) Weighing the client

A 24-hour nutrition recall Correct Explanation: Although all of the answers refer to interventions that the nurse should include in her assessment, the 24-hour nutrition recall is the best single method for assessing her nutritional intake.

A woman in her first trimester is having trouble maintaining adequate nutrition because of nausea and vomiting. She also complains that her heartburn gets worse after eating so she avoids food even when she feels hungry. To help with her nutritional deficit, she is taking a multivitamin supplement. Which substance do you caution her to avoid within 1 hour of ingesting her multivitamin supplement? a) An antacid b) Acetaminophen c) Fatty or fried foods d) Coffee or other caffeinated beverages

An antacid Correct Explanation: Antacids interfere with the uptake of the vitamin contents. She needs to be encouraged to eat small frequent meals and notify the provider if she is losing weight. Caffeine should be avoided due to increases in blood pressure and diuretic effects. Acetaminophen should be taken only when the provider has approved it. Fatty foods are not healthy, and may make the morning sickness worse.

You meet a family at the prenatal clinic. What is the most effective way to assess the woman's usual food intake during her pregnancy? a) Ask her to describe her intake for the last 24 hours. b) Assess her skin for hydration and color. c) Assess a list she makes describing a good diet. d) Ask her to describe her total intake for a week.

Ask her to describe her intake for the last 24 hours. Explanation: A 24-hour food intake history is the best method to assess food intake in all individuals.

During pregnancy the cardinal rule regarding taking medications and herbal remedies is that all drugs cross the placenta and have a potential impact on the fetus. What is one disease where treatment must continue during pregnancy?

Asthma

The nurse understands that the maternal uterus should be at what location at 20 weeks' gestation? a) At the level of the symphysis pubis b) At the level near the bottom of the sternum c) At the level of the umbilicus d) Three finger-breadths above the umbilicus

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

A nurse at the healthcare facility assesses a client in the 20 week of 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? a) Halfway between the symphysis pubis and the umbilicus b) At the top of the symphysis pubis c) At the level of the umbilicus d) At the xiphoid process

At the level of the umbilicus Correct Explanation: In the 20 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 is 20 weeks pregnant. The nurse would expect to palpate the fundus at which of the following locations? a) Just below the ensiform cartilage b) Between the symphysis and umbilicus c) Symphysis pubis d) At the umbilicus

At the umbilicus Correct Explanation: At 20 weeks' gestation, 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.

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? a) Avoid medications b) Avoid intake of coffee c) Eat a well-balanced diet d) Maintain personal hygiene

Avoid medications Correct Explanation: The nurse should instruct a client who is pregnant or one who wants to conceive to avoid medications to enable the client to 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.

A woman in her third trimester complains to the nurse of significant back pain. The nurse questions the client carefully and records a detailed account of her back symptoms. What is the best rationale for the nurse evaluating the client's back symptoms with such care? a) Back pain could be a sign of bladder or kidney infection b) Back pain could be a result of improper lifting c) Back pain could be a sign of degenerated discs d) Back pain could be a result of a soft mattress

Back pain could be a sign of bladder or kidney infection Correct Explanation: Obtaining a detailed account of a woman's back symptoms is crucial because back pain can be an initial sign of a bladder or kidney infection. The other causes of back pain listed do not warrant as much immediate concern as the possibility of a bladder or kidney infection

Why is the first prenatal visit usually the longest prenatal visit? a) Extensive patient teaching is done b) Lab tests are performed c) Baseline data is collected d) A pelvic exam with Pap smear is performed

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

A woman who is 3 months pregnant enjoys a slow, long walk daily. Which of the following would be most appropriate for her concerning this for the remainder of her pregnancy? a) Reduce walking to half a block daily. b) Stop and rest every block. c) Engage in aerobics for greater benefits. d) Continue this as long as she enjoys it.

Continue this as long as she enjoys it. Correct Explanation: 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.

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: a) Increased risk of placenta abruptio b) Increased risk of spontaneous abortion c) Increased risk of stillbirth d) Decreased birth weight in neonates

Decreased birth weight in neonates Correct Explanation: The nurse should inform the client that children born of mothers who use nicotine will have a decreased birth weight. Spontaneous abortion is associated with caffeine use. Increased risks of stillbirth and placenta abruptio are associated with mothers addicted to cocaine.

A woman in early pregnancy is concerned because she is nauseated every morning. Which of the following would be the best measure to help relieve this? a) Take a teaspoon of baking soda before breakfast. b) Delay breakfast until midmorning. c) Delay toothbrushing until noon. d) Take two aspirin on arising.

Delay breakfast until midmorning. Explanation: The cause of morning sickness is unknown. Delaying eating until the nausea passes can be helpful. Aspirin is irritating to the stomach and would increase symptoms.

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 follow at future visits.

A client in her second trimester of pregnancy has developed varicose veins and experiences leg cramps. Which of the following suggestions would be most appropriate? a) Increase intake of folic acid b) Elevate legs while sitting c) Increase intake of calcium d) Perform aerobic exercises

Elevate legs while sitting Correct Explanation: 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.

Which of the following findings from a woman's initial prenatal assessment would be considered a possible complication of pregnancy that requires reporting to a physician for management? a) Nasal congestion and swollen nasal membranes b) Episodes of double vision c) Palpitations when lying on her back d) Increased lumbar curvature

Episodes of double vision Correct Explanation: Difficulty with vision can occur from cerebral edema or is a symptom of hypertension of pregnancy.

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

Excessive vomiting

Which of the following findings is most worrisome in Melissa, a woman in her 26th week of pregnancy?

Facial edema

When providing preconception care to a client, which medication would the nurse identify as being safe to continue during pregnancy? a) Warfarin b) Lithium c) Accutane d) Famotidine

Famotidine Correct Explanation: Famotidine is a category B drug that has been used frequently during pregnancy and does not appear to cause major birth defects or other fetal problems. Accutane and warfarin are category X drugs and should never be taken during pregnancy. Lithium is a category D drug with clear health risks for the fetus and should be avoided during pregnancy.

A woman relates to the nurse that she understands that dietary fat is bad for her and that she should avoid it during pregnancy. How should the nurse respond? a) Fats are essential during pregnancy, and fish such as marlin and orange roughy are good sources b) Fats should be avoided during pregnancy c) Fats are not essential during pregnancy and thus are optional d) Fats are essential during pregnancy, and vegetable oils are a good source

Fats are essential during pregnancy, and vegetable oils are a good source Correct Explanation: Omega-3 fatty acids, particularly linoleic acid, are fats that are essential for new cell growth but cannot be manufactured by the body. Vegetable oils such as safflower, corn, olive, peanut, and cottonseed, fatty fish, omega-3 infused eggs and omega-3 infused spreads are all good sources. Pregnant women should ingest 200 and 300 mg daily. Because some fish may be contaminated by mercury, alert women that The American Pregnancy Association (APA) recommends marlin, orange roughy, tilefish, swordfish, shark, king mackerel, and bigeye and ahi tuna should be avoided during pregnancy.

Martha is pregnant and arrives for her second prenatal appointment. Her previous pregnancy ended at 19 weeks and she has 3-year-old twins born at 30 weeks gestation. How will you document her "G" and "L" for her records? a) G2 L2 b) G3 L0 c) G3 L2 d) G2 L0

G3 L2 Correct Explanation: She has had 2 prior pregnancies and is pregnant now, total "G" = 3; she has twins from a prior pregnancy and one lost child for a total "L" = 2.

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? a) G3 P0021 b) G2 P1020 c) G3 P0020 d) G2 P0020

G3 P0020 Correct Explanation: 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 has been confirmed to be pregnant. She gives a history of two previous full-term normal pregnancies. How will the nurse classify the client's pregnancy history? a) G3, P0 b) G2, P1 c) G3, P2 d) G2, P3

G3, P2 Correct Explanation: Gravida (G) is the total number of pregnancies the client has had, including the present one, and para (P) is the number of babies born at 20 or more weeks of gestation. Since she gives a history of two previous normal deliveries, she is P2 and not P0, P1, or P3. Because she has had a total of three pregnancies including the present one, she is G3 and not G2.

A nurse is classifying the pregnancy history of a woman who has had five pregnancies: three full-term, one preterm, and one abortion. How would the nurse document this information on the patient chart? a) G5 P1135 b) G4 P3115 c) G5 P3114 d) G5 P3115

G5 P3114 Correct Explanation: G = gravida or the total number of pregnancies, which in this case equals five. P = para is the outcome of the pregnancies in the following order: full term, preterm, abortions, and living as of today. In this case, P3114.

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

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

You advise a pregnant woman to reduce her fluid intake with meals. Which condition is the woman trying to relieve or prevent? a) Nosebleeds b) Blood clots c) Constipation d) Heartburn

Heartburn Correct Explanation: Filling the stomach with heavy food and fluid can 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 nurse assesses a 32-year-old primigravida client with twin gestation in her second trimester. The client reports constipation from iron supplements. Which condition should the nurse assess for in this client as a result of the constipation? a) Hemorrhoids b) Gastric ulcer c) Ptyalism d) Thrombophlebitis

Hemorrhoids Correct Explanation: The nurse should assess this client for hemorrhoids. Constipation, is a common problem during pregnancy, especially in clients who take iron supplements and hemorrhoids may develop because of the pressure on the venous structures from straining to have a bowel movement. Gastric ulcers may cause bleeding and would be a reason for taking iron supplements. Clients who are placed on bedrest during pregnancy are at a very high risk for development of thrombophlebitis. Ptyalism or excessive salivation may occur in the first trimester.

A young woman in her first trimester confesses to the nurse when questioned that she is probably not consuming enough calories. The nurse should explain to this client that deficient nutrition can hinder the baby's growth, which at this point in her pregnancy is primarily via an increase in the number of cells formed. This type of growth is known as which of the following? a) Hyperplasia b) Hypercholesterolemia c) Hyperemesis gravidarum d) Hypertrophy

Hyperplasia Correct Explanation: Early in pregnancy, fetal growth occurs largely by an increase in the number of cells formed (hyperplasia); late in pregnancy it occurs mainly by enlargement of existing cells (hypertrophy). This means a fetus deprived of adequate nutrition early in pregnancy could be small for gestational age because of an inadequate number of cells formed in the body. Hypercholesterolemia is a condition of high blood cholesterol levels. Hyperemesis gravidarum is nausea and vomiting of pregnancy prolonged past week 16 of pregnancy or so severe dehydration, ketonuria, and significant weight loss occur within the first 12 weeks of pregnancy.

Leah is 28 weeks pregnant. In preparing for discomforts that occur during the final trimester of pregnancy, you would teach her about? a) Eating a well-balanced diet to prevent anemia b) Increased shortness of breath and dyspnea before lightening c) Avoid exercise to prevent varicosities d) Good oral hygiene to decrease ptyalism

Increased shortness of breath and dyspnea before lightening Correct Explanation: As the fetus grows inside the mother, there is more pressure on the diaphragm and more difficulty breathing, and episodes of dyspnea may occur. This tends to decrease with lightening, when the fetus drops. Eating a well balanced diet, oral hygiene, and exercise should be done throughout the entire pregnancy.

Why is a Papanicolaou smear done at the first prenatal visit? a) It helps to date the pregnancy. b) It identifies abnormal cervical cells. c) It detects if uterine cancer is present. d) It predicts whether cervical cancer will occur.

It identifies abnormal cervical cells. Correct Explanation: A Pap smear is a test for cervical cancer. Should abnormal cells be present, the woman may need to make a decision about her priorities of therapy for cervical disease or continuing the pregnancy.

A woman complains of constant redness and itching of her palms early in her pregnancy. She fears that she is suffering an allergic reaction and asks the nurse whether this is normal. Which of the following should the nurse mention? a) It is caused by increased estrogen levels and should disappear in time b) It is a sign of fatigue; she should get more rest c) It is a sign of high blood pressure; she should start an anti-hypertensive drug d) It is likely an allergic reaction to a lotion, which should be avoided during pregnancy

It is caused by increased estrogen levels and should disappear in time Correct Explanation: Palmar erythema, or palmar pruritus, occurs in early pregnancy and is probably caused by increased estrogen levels. Constant redness or itching of the palms can make a woman believe she has developed an allergy. Explain that this type of itching in early pregnancy is normal. She may find lotion to be soothing. As soon as a woman's body adjusts to the increased level of estrogen, the erythema and pruritus disappear. This condition is not a sign of fatigue or high blood pressure.

If a pregnant woman's estimated date of delivery (EDD) is April 23, what was the first day of her last menstrual period (LMP), according to Nagele's rule? a) July 16 b) July 19 c) July 23 d) July 13

July 16 Correct Explanation: According to Nagele's rule, the last menstrual period was July 16th. Take the LMP and add 7 days and subtract 3 months; if finding the LMP from the EDD, subtract 7 days and add 3 months.

A client in her second trimester of pregnancy visits a healthcare facility. The client frequently engages in aerobic exercise and asks the nurse about doing so during her pregnancy. Which of the following precautions should the nurse instruct the pregnant client to take when practicing aerobic exercises? a) Wear support hose when exercising b) Maintain tolerable intensity of exercise c) Reduce the amount of exercise d) Begin a new exercise regimen

Maintain tolerable intensity of exercise Correct Explanation: 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 counsels a pregnant woman regarding her recommended daily allowance of calories. She advises her to obtain her carbohydrate calories from complex carbohydrates rather than simple carbohydrates. What is the best rationale for this guidance? a) More consistent regulation of glucose and insulin b) Greater fatty acid content c) Faster digestion of complex than simple carbohydrates d) Provision of a greater amount of calories per gram

More consistent regulation of glucose and insulin Correct Explanation: Advise women to obtain their carbohydrate calories from complex carbohydrates (cereals and grains) rather than simple carbohydrates (sugar and fruits) because complex carbohydrates are more slowly digested. Doing so will help regulate glucose and insulin levels more consistently. All carbohydrates contain roughly the same amount of calories per gram (4 kcal/g). Carbohydrates of any kind are not a significant source of fatty acids.

You advise your pregnant patient to keep a small high-carbohydrate snack on the bedside table. This advice is given to ameliorate which condition? a) Faintness b) Heartburn c) Slowed GI transit time d) Nausea and vomiting

Nausea and vomiting Correct Explanation: Women will commonly experience nausea and vomiting upon awakening first thing in the morning. Patients 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 comes in for a routine third-trimester exam, which included a pelvic exam. She calls several hours later, very worried, to report a small amount of bleeding. What should you tell her? a) That the bleeding, called Chadwick's sign, is a normal part of pregnancy b) That her cervical mucous plug may have been expelled c) Not to worry but to report any heavy increase in bleeding d) To return right away

Not to worry but to report any heavy increase in bleeding Explanation: During the third trimester, if the provider completes a vaginal exam it can be normal to have a small amount of spotting. If the bleeding becomes active or increases the patient needs to be seen ASAP. Chadwick's sign is a change of color in the vaginal area. The loss of the mucus plug would lead to a much greater amount of blood.

The nurse is advising a pregnant woman during her first prenatal visit regarding the frequency of future visits. Which of the following is the recommended schedule for prenatal care?

Once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth.

A pregnant client is excited that she is beginning to feel her baby move within her. The nurse explains that these first fetal movements are known as which of the following? a) Amenorrhea b) Lordosis c) Quickening d) Lactation

Quickening Correct Explanation: The first fetal movements that the pregnant woman feels are called quickening and usually occur between 18 and 20 weeks of gestation. Amenorrhea is the absence of menstruation and is one of the first indications of pregnancy. Lactation is the production of breast milk in preparation for breastfeeding. Lordosis is the inward curve of the lower back, which becomes exaggerated during pregnancy.

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

Rest on the left side for at least 1 hour in the morning and afternoon. Correct Explanation: 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.

As part of a 31-year-old client's prenatal care, the nurse is assessing immunization history. Which of the following immunizations is most relevant to ensuring a healthy fetus? a) Measles b) Rubella c) Diphtheria, tetanus, and pertussis d) Hepatitis A and B

Rubella Explanation: Maternal exposure to rubella during pregnancy poses a particular fetal risk that supersedes the significance of hepatitis, measles, diphtheria, tetanus, or pertussis.

The first day of the patient's last menstrual period was December 1. Based on Naegle's rule, the nurse determines which of the following is the estimated date of birth. a) October 7 b) August 8 c) September 8 d) July 7

September 8 Correct Explanation: Acording to Naegle's rule, the estimated date of birth is September 8th. Add 7 days and minus 3 months to the last LMP to determine the estimated date of delivery or birth.

A woman has heard that hypotension can be a problem during pregnancy, but she is not sure what it is or what causes it. The nurse explains that it is simply a temporary bout of low blood pressure due to impaired blood return to the heart. It is commonly caused by sleeping in a position that causes compression of the vena cava blood vessel. To avoid this condition, which of the following should the nurse mention? a) Sleep flat on your back b) Sleep face down c) Sleep on your side d) Sleep with your feet elevated

Sleep on your side Correct Explanation: Supine hypotension is a symptom that occurs when a woman lies on her back and the uterus presses on the vena cava, impairing blood return to her heart. A woman experiences an irregular heart rate and a feeling of apprehension. To relieve the problem is simple: if a woman turns or is turned onto her side, pressure is removed from the vena cava, blood flow is restored, and the symptoms quickly fade. To prevent the syndrome, advise pregnant women to always rest or sleep on their side, not their back. Sleeping face down is not advised, and sleeping with the feet elevated would not prevent compression of the vena cava.

A woman is concerned that orgasm will be harmful during pregnancy. Which of the following statements is most factual? a) Most women do not experience orgasm during pregnancy. b) Venous congestion in the pelvis makes orgasm painful. c) Orgasm during pregnancy is potentially harmful. d) Some women experience orgasm intensely during pregnancy.

Some women experience orgasm intensely during pregnancy. Correct Explanation: Because of pelvic congestion, orgasm may be achieved more readily by pregnant women than nonpregnant women.

A pregnant woman is planning on taking a vacation that involves extensive travel by automobile. Which of the following guidelines should you give her? a) Limit trips away from home, great than 200 miles b) Stop and walk every few hours c) Sit in the back seat with feet elevated d) Travel no more than 120 miles daily

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

A primigravida client has come to the clinic for a prenatal checkup. What teaching topics would help to promote a healthy pregnancy for this client? a) More frequent tooth brushing is recommended to prevent caries related to ptyalism. b) Douching is recommended to decrease the risk of vaginal infections. c) Applying lanolin ointment to the breasts is recommended to prevent cracked nipples. d) Swimming in a pool is a recommended exercise during pregnancy.

Swimming in a pool is a recommended exercise during pregnancy. Correct Explanation: Swimming in a pool is good exercise for a pregnant woman. However, swimming in a lake can be harmful because of the danger of infection, especially in the latter months. Douching can increase the risk of vaginal infections. Increased salivation or ptyalism, seen in some women during pregnancy, does not cause tooth decay and necessitate more frequent brushing. Lanolin ointments may damage the areola and nipple and have not been shown to be effective in preventing sore and cracked nipples.

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

The doula primarily focuses on providing continuous labor support. Correct Explanation: 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 pregnant woman states that she would like to take a tub bath but has heard from her aunt that this could be dangerous to the baby. Which of the following instructions should the nurse give to the patient? a) Avoid tub baths at all times during pregnancy, as they may be dangerous for the fetus b) Tub baths are fine unless you are unstable on your feet or are experiencing vaginal bleeding c) Long soaks in very hot water are encouraged during pregnancy to promote relaxation d) Tub baths are fine, but avoid using soap, as this may prove a teratogen to the fetus

Tub baths are fine unless you are unstable on your feet or are experiencing vaginal bleeding Correct Explanation: Daily tub baths or showers are recommended. Women should not soak for long periods in extremely hot water or hot tubs, however, as heat exposure for a lengthy time could lead to hyperthermia in the fetus and birth defects, specifically esophageal atresia, omphalocele, and gastroschisis. As pregnancy advances, a woman may have difficulty maintaining her balance when getting in and out of a bathtub. If so, she should change to showering or sponge bathing for her own safety. If membranes rupture or vaginal bleeding is present, tub baths become contraindicated because there might be a danger of contamination of uterine contents. Soap is not a teratogen to the fetus.

A client in her second trimester of pregnancy arrives at a health care facility complaining of heartburn. What instructions should the nurse offer to help the client deal with heartburn? Select all that apply. a) Avoid overeating b) Limit consumption of food before bedtime c) Sleep in a semi-Fowler's position d) Avoid use of antacids e) Consume lots of liquids before bedtime

• Avoid overeating • Limit consumption of food before bedtime • Sleep in a semi-Fowler's position Correct Explanation: When caring for a pregnant client with heartburn, the nurse should instruct the client to limit consuming foods before bedtime. The nurse should also instruct the client to sleep in a semi-Fowler's position and to avoid overeating. The nurse need not instruct the client to avoid the use of antacids. On the contrary, antacids are known to be useful for heartburn even during pregnancy, so the nurse need not instruct the client to avoid them. The nurse should not instruct the client to consume lots of fluids before bedtime. Along with food, even fluids should be limited before bedtime.

Which of the following are purposes for prenatal care? (Select all that apply.) a) Increase the business of the clinic. b) Maximize the risk of possible complications. c) Establish a baseline of present health. d) Determine the gestational age of the fetus. e) Identify women at risk for complications. f) Monitor for fetal development and maternal well-being.

• Establish a baseline of present health. • Determine the gestational age of the fetus. • Identify women at risk for complications. • Monitor for fetal development and maternal well-being. Correct Explanation: The purposes of prenatal care are to establish a baseline of present health; determine the gestational age of the fetus; monitor fetal development and maternal well-being; identify women at risk for complications and minimize the risk of possible complications; and provide time for education about pregnancy, lactation, and newborn care. It is not done to help a clinic financially.

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 of the following would the nurse include? Select all that apply. a) Backache during the second trimester b) Nausea with vomiting during the first trimester c) Lower abdominal pain with shoulder pain in the first trimester d) Sudden leakage of fluid during the second trimester e) Headache with visual changes in the third trimester f) Urinary frequency in the third trimester

• Lower abdominal pain with shoulder pain in the first trimester • Sudden leakage of fluid during the second trimester • Headache with visual changes in the third trimester Correct Explanation: Danger signs and symptoms that need to be reported immediately include headache with visual changes and 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.