OB Chapter 11

The nurse is counseling a young woman who has just entered her second trimester, after an uneventful first trimester. She tells the nurse, "It still doesn't seem real. It's just hard to believe that I will really have a baby." Which future events should the nurse point out that will help the young woman come to believe it is real? Select all that apply.

Seeing an ultrasound image of the baby Feeling the baby kick

In assessing the dietary intake over the last 24 hours of a pregnant client, which food would be most concerning to the nurse?

Smoked salmon and bagels

The community nurse is preparing a presentation for a health fair illustrating successful pregnancies. Which component should the nurse prioritize as the most critical to ensure a positive psychological experience with the pregnancy by the mother?

Social Support

During late pregnancy, the nurse teaches a pregnant woman to lay on her left side to avoid what condition?

Supine hypotension syndrome

During the first few months of pregnancy, estrogen stimulates uterine growth.

TRUE

Fundal height is not a reliable indicator of gestational weeks after 36 weeks' gestation.

TRUE

The influence of progesterone leads to decreased peristalsis in the pregnant woman.

TRUE

During a physical exam, the physician notates that the pregnant client has a positive Chadwick sign. What client findings would be noted for this symptom?

The cervix has a bluish, purple discoloration.

The nurse is assessing a pregnant client at her 20-week visit. Which breast assessment should the nurse anticipate documenting?

Darkened breast areolae

A 28-year-old client in her first trimester of pregnancy reports conflicting feelings. She expresses feeling proud and excited about her pregnancy while at the same time feeling fearful and anxious of its implications. Which action should the nurse do next?

Inform the client this is a normal response to pregnancy that many women experience.

A client at 39 weeks' gestation calls the OB triage and questions the nurse concerning a bloody mucus discharge noted in the toilet after an OB office visit several hours earlier. What is the best response from the triage nurse?

"A one time discharge of bloody mucus in the toilet might have been your mucus plug."

During pregnancy, one of progesterone's actions is to allow sodium to be "wasted" or lost in the urine. The nurse would expect to see which hormone increased to help counteract this loss?

aldosterone

The nurse is caring for a client at 8 weeks' gestation who states, "I did not plan for this right now and I am not happy or excited about this pregnancy. I am not sure what to do." Which response by the nurse is best?

"Many women feel this way during the first trimester."

Which statement by a pregnant client would validate that she understood the nurse's teaching regarding the risk of venous stasis during pregnancy?

"My clotting times and bleeding times will be unchanged during this pregnancy even though I am at higher risk of clots in my leg vein."

A client is about 16 weeks' pregnant and is concerned because she feels her "abdomen" contracting. She calls the primary care provider's office and speaks to the nurse. What is the nurse's most appropriate response to this client's concern?

"What you are feeling are called Braxton Hicks contractions. They are considered practice contractions during pregnancy."

A woman's prepregnant weight is within the normal range. During her second trimester, the nurse would determine that the woman is gaining the appropriate amount of weight when her weight increases by which amount per week

1 lb (0.45 kg)

Which interventions would a pregnant client be taught regarding dietary restrictions during pregnancy? Select all that apply.

1. Discard foods that have been left out at room temperature for more than 2 hours. 2. Wash raw fruits and vegetables with hot water and a mild soap. 3. Do not drink raw or unpasteurized milk.

A urinalysis is done on a client in her third trimester. Which result would be considered abnormal?

2+ Protein in urine

A mother comes in with her 17-year-old daughter to find out why she has not had a menstrual cycle for a few months. Examination confirms the daughter is pregnant with a fundal height of approximately 24 cm. The nurse interprets this finding as indicating that the daughter is approximately how many weeks pregnant?

24

A client in her first trimester is concerned about how weight gain will affect her appearance and questions the nurse concerning dietary restrictions. How much weight gain should the nurse point out will be safe for this client with a low BMI?

28 to 40 pounds (13 to 18 kilograms)

The recommended amount of weight gain during pregnancy is 25 to ____ pounds

35

Before becoming pregnant, a woman's heart rate averaged 72 beats per minute. The woman is now 15 weeks' pregnant. The nurse would expect this woman's heart rate to be approximately:

85 beats per minute.

A 17-year-old client arrives for an annual examination and reports no changes since the last exam; however, the nurse assesses a positive Chadwick sign, slightly enlarged uterus, and subsequent positive urine pregnancy test. Which task should the nurse prioritize to assist this client who is denying any possibility that she is pregnant?

Accepting the pregnancy

A pregnant client in her third trimester, lying supine on the examination table, suddenly grows very short of breath and dizzy. Concerned, she asks the nurse what is happening. Which response should the nurse prioritize?

Blood is trapped in the vena cava in a supine position.

During an exam, the nurse notes that the blood pressure of a client at 22 weeks' gestation is lower, and her heart rate is 12 beats per minute higher than at her last visit. How should the nurse interpret these findings?

Both findings are normal at this point of the pregnancy.

A client presents to the clinic because she thinks she may be pregnant. On examination, the nurse notes that the client's cervix and vaginal mucosa appear a bluish-purple color. The nurse interprets this finding as which sign?

Chadwick sign

The nurse cares for a pregnant client at the first prenatal visit and reviews expected changes that will occur during pregnancy. Which information will the nurse include in the education?

During pregnancy blood volume can increase by at least 40%.

Elevated hCG levels are a positive sign of pregnancy.

FALSE

Presumptive signs of pregnancy are a positive indicator of pregnancy.

FALSE

A client arrives to the clinic very excited and reporting a positive home pregnancy test. The nurse cautions that the home pregnancy test is considered a probable sign and will assess the client for which sign to confirm pregnancy?

Fetal movement felt by examiner

A client in her 39th week of gestation arrives at the maternity clinic stating that earlier in her pregnancy, she experienced shortness of breath. However, for the past few days, she has been able to breathe easily, but she has also begun to experience increased urinary frequency. A nurse is assigned to perform the physical examination of the client. Which observation is most likely?

Fundal height has dropped since the last recording.

A 28-year-old client states that she has not had her menstrual period for the past 3 months and suspects she is pregnant. Which should the nurse do next?

Have the client take a pregnancy test.

A 22-year-old client comes to the walk-in clinic complaining of fatigue, breast heaviness and extreme tenderness, and a clear vaginal discharge. What question would the nurse ask this client?

Have you been sexually active in the past 2 months?

A pregnant mother may experience constipation and the increased pressure in the veins below the uterus can lead to development of what problem?

Hemorrhoids

A woman comes to the clinic and tells the nurse, "I think I might be pregnant." After completing the history and physical exam, the nurse obtains a blood specimen for pregnancy testing. When explaining this test to the client, which hormone would the nurse identify as being measured by this test?

Human chorionic gonadotropin

The nurse is teaching the pregnant woman about nutrition for herself and her baby. Which statement by the woman indicates that the teaching was effective?

I will need to take iron supplementation throughout my pregnancy even if I am not anemic."

A student nurse is preparing for a presentation that will illustrate the various physiologic changes in the woman's body during pregnancy. Which cardiovascular changes up through the 26th week should the student point out?

Increased pulse rate and decreased blood pressure

What would the nurse recommend to a pregnant client at 35 weeks' gestation who reports irregular contractions and lower backache?

Lie down and rest and see if the contractions stop and pain subsides.

The nurse is explaining the latest laboratory results to a pregnant client who is in her third trimester. After letting the client know she is anemic, which heme iron-rich foods should the nurse encourage her to add to her diet?

Meats

A client in her second trimester of pregnancy reports discomfort during sexual activity. Which instruction should a nurse provide?

Modify sexual positions to increase comfort.

he ___________ is a unique endocrine gland with the ability to form protein and steroid hormones.

Placenta

The partner of a pregnant client in her first trimester asks the nurse about the client's behavior recently, stating that she is very moody, seems happy one moment and is crying the next and all she wants to talk about is herself. What response would correctly address these concerns?

Pregnant women often experience mood swings and self-centeredness but this is normal.

What effect does progesterone have on normal gallbladder function?

Progesterone interferes with gallbladder contraction, leading to stasis of bile.

A pregnant client at 24 weeks' gestation calls the clinic crying after a prenatal visit, where she had a pelvic exam. She states that she noticed blood on the tissue when she wiped after voiding. What initial statement by the nurse would explain this finding?

The cervix is very vascular during pregnancy, so spotting after a pelvic exam is not unusual.

The nurse-midwife is performing a pelvic examination on a client who came to her following a positive home pregnancy test. The nurse checks the woman's cervix for the probable sign of pregnancy known as Goodell sign. Which description illustrates this alteration?

The cervix softens.

The nurse is teaching a prenatal class about preparing for their expanding families. What is helpful advice from the nurse?

The hormones of pregnancy may cause anxiety or depression postpartum."

The nurse is assessing a pregnant client in her third trimester who is reporting a first-time occurrence of constipation. When asked why this is happening, what is the best response from the nurse?

The intestines are displaced by the growing fetus.

Pregnant women commonly experience the emotional response of __________ during the first trimester of pregnancy.

ambivalence

The nurse has just informed a client that her pregnancy test is positive and she will need further assessment to determine the complete status of the situation. Which initial emotional response does the nurse expect the client to exhibit?

ambivalence

During a prenatal visit, the nurse inspects the skin of the client's abdomen. Which would the nurse identify as an abnormal finding?

bruising

What is the major concern for a lactose intolerant woman who is pregnant?

calcium deficiency

A client who has just given a blood sample for pregnancy testing in the health care provider's office asks the nurse what method of confirming pregnancy is the most accurate. The nurse explains the difference between presumptive symptoms, probable signs, and positive signs. What should the nurse mention as an example of a positive sign, which may be used to diagnose pregnancy?

visualization of the fetus by ultrasound

Which assessment finding in the pregnant woman at 12 weeks' gestation should the nurse find most concerning? The inability to:

detect fetal heart sounds with a Doppler.

Which effect would the nurse identify as a normal physiologic change in the renal system due to pregnancy?

dilation of the renal pelvis

A woman is 10 weeks' pregnant and tells the nurse that this pregnancy was unplanned and she has no real family support. The nurse's most therapeutic response would be to:

encourage her to identify someone that she can talk to and share the pregnancy experience.

A 28-year-old primigravida client with diabetes mellitus, in her first trimester, comes to the health care clinic for a routine visit. The client reports frequent episodes of sweating, giddiness, and confusion. What should the nurse tell the client about these experiences?

increased secretion of insulin occurs in the first trimester

When caring for a newborn, the nurse observes that the neonate has developed white patches on the mucus membranes of the mouth. Which condition is the newborn most likely experiencing?

oral candidiasis (thrush)

The nurse is preparing to teach a community class to a group of first-time parents. Which information should the nurse include concerning what the pregnant woman's partner may experience as a normal response?

physical symptoms similar to the mother

The compulsive ingestion of nonfood substances is termed ________.

pica

Oxytocin, responsible for uterine contractions, is released from the ________ pituitary gland.

posterior

A client's menstrual period is two weeks late. She has been feeling tired and has had episodes of nausea in the morning. What classification of pregnancy symptoms is this client experiencing?

presumptive

A new mother voices concerns about breastfeeding her infant. The nurse would explain to the mother the two hormones that control lactation and letdown are:

prolactin and oxytocin.

The client at 18 weeks' gestation states, "I feel a fluttering sensation, kind of like gas." The nurse understands that the client is describing what occurrence?

quickening

A client in her 10th week of gestation arrives at the maternity clinic reporting morning sickness. The nurse needs to inform the client about the body system adaptations during pregnancy. Which factors correspond to the morning sickness period during pregnancy? Select all that apply

reduced stomach acidity elevated human chorionic gonadotropin (hCG) increased estrogen level

A woman in the third trimester of her first pregnancy expresses fear about the birth canal being wide enough for her to push the baby through it during labor. She is a petite person, and the baby seems so large. She asks the nurse how this will be possible. To help alleviate the client's fears, the nurse should mention the role of the hormone that softens the cervix and collagen in the joints, which allows dilation (dilatation) and enlargement of the birth canal. What is this hormone?

relaxin