Antepartum Period

The nurse performs a routine prenatal assessment on a client at 35 weeks' gestation and finds vital signs: blood pressure 138/88 mm Hg, pulse 82/min, respirations 18/min, temperature 99.1° F (37.3° C). Which statement is most appropriate for the nurse to make at this time?

"Your blood pressure is slightly high. I will check it again before you leave."

A client at 39 weeks' gestation comes to the labor and delivery suite. The client states the membranes ruptured 12 hours ago. What priority assessment will the nurse perform?

Assess fetal heart rate (FHR).

Which recommendation would be most helpful to suggest to a primigravid client at 37 weeks' gestation who has leg cramps?

Straighten the knees and flex the toes toward the chin.

A nurse is caring for a 16-year-old pregnant adolescent. The client is taking an iron supplement. What should this client drink to increase the absorption of iron?

a glass of orange juice

A pregnant client and her partner come to preregister at the hospital and take a tour of the labor and delivery suite. The mother has a detailed birth plan she wants honored while in labor. How should the nurse best respond to this information?

The nurses taking care of you will do their best to respect your wishes."

The team on an antepartum unit consists of two registered nurses (RN), one licensed vocational nurse (LVN), and one nursing assistant. Which one of the following clients would be appropriate to assign to the LVN?

a client with gestational hypertension

At 32 weeks' gestation, a client is admitted to the facility with a diagnosis of gestational hypertension. Based on this diagnosis, the nurse expects the assessment to reveal:

3+ edema in the lower extremities.

While assessing a multigravid client at 10 weeks' gestation, the nurse notes a purplish color to the vagina and cervix. The nurse documents this as what finding?

A purplish blue discoloration of the vagina and cervix is termed Chadwick's sign; it is caused by increased vascularity of the vagina during pregnancy and is considered a probable sign of pregnancy. Goodell's sign, also considered a probable sign of pregnancy, refers to a softening of the cervix during pregnancy. Hegar's sign, also a probable sign of pregnancy, refers to a softening of the lower uterine segment. Melasma, the mask of pregnancy, refers to the pigmentation of the skin on the face during pregnancy. Melasma is considered a presumptive sign of pregnancy.

A client who is 16 weeks pregnant reports many mood swings. Which statement accurately describes estrogen and progesterone levels during this client's stage of pregnancy?

Both estrogen and progesterone levels are rising.

The nurse is facilitating a childbirth education class with a group of parents. On the first day of class, the nurse finds that none of the clients is a first-time parent. Which of the following would be a teaching strategy to best assist the clients?

Complete a needs assessment about what the parents are interested in learning.

A 40-year-old primigravid client with AB-positive blood visits the outpatient clinic for an amniocentesis at 16 weeks' gestation. The nurse determines that the most likely reason for the client's amniocentesis is to determine if the fetus has which problem?

Down syndrome

A pregnant client arrives in the emergency department and states, "My baby is coming." The nurse sees a portion of the umbilical cord protruding from the vagina. What should the nurse do first?

Hold pressure on the fetal head.

A primigravid client with class II heart disease who is visiting the clinic at 8 weeks' gestation tells the nurse that she has been maintaining a low-sodium, 1,800-calorie diet. Which instruction should the nurse give the client?

Increase caloric intake to 2,200 calories daily to promote fetal growth.

At an initial prenatal visit the client tells the nurse that her last menstrual period started on April 14th. Using Naegele's rule, the nurse determines the woman's estimated due date is when?

January 21 Naegele's rule is a mathematical equation that uses a woman's last menstrual period (LMP) to estimate a pregnant client's dues date. The formula is LMP + 7 days ? 3 months. Here the LMP is:April 14th + 7 days = April 21st; April 21st ? 3 months = January 21st.

A client, 7 months pregnant, is admitted to the unit with abdominal pain and bright red vaginal bleeding. Which action should the nurse take?

Place the client on her left side and start supplemental oxygen, as ordered.

A 19-year-old primigravid client is being discharged home after hospitalization for hyperemesis gravidarum and is being referred to home health care. The nurse should develop a discharge plan that includes which interventions? Select all that apply.

Refer client to a nutritionist for the following day. Ensure that the client has a prescription for an antiemetic. Encourage return to normal routine when client feels ready. Discuss plan of care and discharge instructions with client.

A pregnant client calls the nurse at 22 weeks gestation to report that she is experiencing some edema of her face and hands, with puffiness in her eyelids in the morning. What is the priorityaction by the nurse?

Refer the client to her physician.

A client at 36 weeks' gestation, begins to exhibit signs of labor after an eclamptic seizure. The nurse should assess the client for:

abruptio placentae

The nurse is assessing a 39-year-old client during her 32-week prenatal checkup. The client has attended regular prenatal checkups throughout the pregnancy. Which assessment data is a priority for the nurse to complete?

blood pressure

The health care provider prescribes clomiphene citrate for a woman who has been having difficulty getting pregnant. When teaching the client about this drug, the nurse should discuss what potential adverse effects?

chance of multiple gestation.

After a prenatal class one week, a group of concerned mothers approach the nurse to tell her that one of the nurse facilitators has been sharing their personal stories with other parents outside the group. Which value within the American Nurses Association (Canadian Nurses' Association) Code of Ethics is the nurse violating?

confidentiality

For the client who is receiving intravenous magnesium sulfate for severe preeclampsia, which assessment findings would alert the nurse to suspect hypermagnesemia?

decreased deep tendon reflexes

Which medication is considered safe during pregnancy?

insulin

A multipara at 16 weeks' gestation is diagnosed as having a fetus with probable anencephaly. The client is from a conservative faith and has decided to continue the pregnancy and donate the neonatal organs after the death of the neonate. What should the nurse do?

Explore his or her own feelings about the issues of anencephaly and organ donation.

A nulligravid client with gestational diabetes tells the nurse that she had a reactive nonstress test 3 days ago and asks, "What does that mean?" The nurse explains that a reactive nonstress test indicates which of the following about the fetus?

Fetal well-being at this point in the pregnancy.

A client at 36 weeks' gestation, begins to exhibit signs of labor after an eclamptic seizure. The nurse should assess the client for:

abruptio placentae After an eclamptic seizure, the client is at risk for abruptio placentae due to severe vasoconstriction resulting in hemorrhage into the decidua basalis. Abruptio placentae is manifested by a board-like abdomen and an abnormal fetal heart rate tracing. Transverse lie or shoulder presentation, placenta accreta, and uterine atony are not related to eclampsia. Causes of a transverse lie may include relaxation of the abdominal wall secondary to grand multiparity, preterm fetus, placenta previa, abnormal uterus, contracted pelvis, and excessive amniotic fluid. Placenta accreta, a rare phenomenon, refers to a condition in which the placenta abnormally adheres to the uterine lining. Uterine atony, or relaxed uterus, may occur after childbirth, leading to postpartum hemorrhage.

A primigravid client visits the clinic for a routine examination at 35 weeks' gestation. The client's blood pressure is near the baseline of 120/74 mm Hg with no proteinuria or evidence of facial edema. The client asks the nurse, "What should I take if I get an occasional headache after looking at my computer at work all day?" Which over-the-counter medicine does the nurse consider to be safest for occasional use by a pregnant client with no known risks?

acetaminophen The nurse should instruct the client that symptoms from an occasional headache due to eye strain or continuous work at a computer can be relieved by acetaminophen. Although this drug causes prostaglandin inhibition, this effect is rapidly reversed and cleared with no apparent harmful effects in pregnancy. If the headaches become more frequent or severe, the client should be instructed to contact her health care provider (HCP) immediately. Aspirin should be avoided during pregnancy because it inhibits prostaglandin synthesis. It also decreases uterine contractility and may delay the onset of labor or prolong pregnancy and labor. Aspirin decreases platelet aggregation, possibly increasing the risk of bleeding. Ibuprofen and naproxen can lead to premature closure of the fetal ductus arteriosus and decreased amniotic fluid with prolonged use. They may also prolong pregnancy or labor because of their antiprostaglandin effects.

A client at 24 weeks gestation comes to the clinic for a prenatal check-up and reports that she has been "seeing double." The nurse checks the urine and determines that there is 3+ proteinuria. What does the nurse determine is the potential priority problem?

gestational hypertension

A primigravid client at 8 weeks' gestation tells the nurse that since having had sexual relations with a new partner 2 weeks ago, she has noticed flu-like symptoms, enlarged lymph nodes, and clusters of vesicles on her vagina. The nurse refers the client to a primary health care provider because the nurse suspects which sexually transmitted infection?

herpes genitalis The client is reporting symptoms typically associated with herpes genitalis. Some women have no symptoms of gonorrhea. Others may experience vaginal itching and a thick, purulent vaginal discharge. C. trachomatis infection in women is commonly asymptomatic, but symptoms may include a yellowish discharge and painful urination. The first symptom of syphilis is a painless chancre.

When teaching a group of pregnant adolescent clients about reproduction and conception, the nurse is correct when stating that fertilization occurs:

in the first third of the fallopian tube.

A primigravid client at 32 weeks' gestation with ruptured membranes is prescribed to receive betamethasone 12 mg intramuscularly for two doses 24 hours apart. When teaching the client about the medication, what should the nurse include as the purpose of this drug?

to accelerate fetal lung maturity

After the nurse instructs a pregnant client about swimming and bathing during pregnancy, which client statement indicates the need for additional teaching?

"I can relax in a hot tub for about 20 minutes."

During a routine prenatal visit, a pregnant client reports constipation, and the nurse teaches her how to relieve it. Which statement indicates the client's understanding of the nurse's instructions?

"I'll increase my intake of unrefined grains."

Which statements made by a pregnant woman in the first trimester are consistent with this stage of pregnancy? Select all that apply.

"My husband told his friends we'll have to give up the convertible for a minivan." "Oh my, how did this happen? I don't need this now." "I wonder how it will feel to buy maternity clothes and be fat."

A 22-year-old primigravida approaches the nurse during the prenatal clinic and states that her partner is saying hurtful comments about her weight gain. What is the most appropriate response from the nurse?"Tell me how you are feeling about your partner's comments."

"Tell me how you are feeling about your partner's comments." This response allows the client to express her feelings so the nurse can assist her. Asking the client how much she has gained or how she feels about her changing shape implies that the nurse is making an assumption that the client has gained weight, which may appear to the client as though the nurse is not supportive. While appropriate weight gain during pregnancy is important, making that statement does not provide the opportunity for the client to express her feelings.

A client who is 2 months' pregnant has become more introverted, stopping most social activities. What action would the nurse take upon learning this information?

Assess the client for depression using an approved depression screening tool.

A pregnant client with diabetes mellitus is at risk for having a large-for-gestational-age neonate because:

insulin acts as a growth hormone on the fetus. Insulin acts as a growth hormone on the fetus. Therefore, pregnant clients with diabetes must maintain good glucose control. Large babies are prone to complications and may have to be delivered by cesarean birth. Neither excess sugar nor excess insulin reduces placental functioning. A high-calorie diet helps control the mother's disease and doesn't contribute to neonatal size.

An adolescent primigravid client at 26 weeks' gestation has gained 25 lb (11.34 kg) since becoming pregnant. Which of the following is the recommended amount of weight gain during the third trimester?

1 lb (0.45 kg) per week.

A pregnant mother who has brought her toddler to the clinic for a check-up asks the nurse how she can keep her next baby from becoming obese. The mother plans to bottle-feed her next child. Which information should the nurse include in the teaching plan to help the mother avoid overnourishing her infant?

recognizing clues indicating that a baby is full

A primigravid client with diabetes at 38 weeks' gestation asks the nurse why she had a fetal acoustic stimulation during her last nonstress test. Which should the nurse include as the rationale for this test?

to startle and awaken the fetus Fetal acoustic stimulation involves the use of an instrument that emits sound levels of approximately 80 dB at a frequency of 80 Hz. The sharp sound startles and awakens the fetus and is used with nonstress testing as a method to evaluate fetal well-being. A fetoscope or Doppler stethoscope is used to listen to the fetal heart rate. Nipple stimulation or intravenous oxytocin is used to stimulate contractions. Ultrasound testing is used to determine amniotic fluid volume.

After teaching a pregnant client about potential complications of amniocentesis that must be reported immediately, the nurse determines that the client understands the instruction when she says that she will report which problem?

vaginal bleeding

A nurse is obtaining a prenatal history from a client who's 8 weeks pregnant. To help determine whether the client is at risk for a TORCH infection, the nurse should ask which question?

"Do you have any cats at home?"

In 6 months, a client is expecting a second child. During the psychosocial assessment, the client says to the nurse, "I've been through this before. Why are you asking me these questions?" What is the nurse's best response?

"Each pregnancy has a unique psychosocial meaning." With each pregnancy, the client explores a new aspect of the mother role and must reformulate the self-image as a pregnant woman and a mother. The other options don't address the client's feelings. No evidence suggests that a second pregnancy requires more adjustment. Couvade symptoms occur in the father, not the mother.

The nurse is teaching a new prenatal client about her iron-deficiency anemia during pregnancy. Which statement indicates that the client needs further instruction about her anemia?

"I may have anemia because my family is of Asian descent."

Which client statement indicates a need for additional teaching about self-care during pregnancy?

"I should sit in a hot tub for 20 minutes to relax after working."

A pregnant client is seeking information from the nurse about a home birth with registered midwives. Which of the following statements lets the nurse know that the client has considered the risks and benefits of using a midwife? Select all that apply.

"I will develop a list of questions to use in interviewing potential midwives." "I understand the complications that could occur in a home birth setting." "I realize that I may need to be transferred to a hospital if complications develop."

After instruction of a primigravid client at 8 weeks' gestation about measures to overcome early morning nausea and vomiting, which client statement indicates the need for additional teaching?

"I will eat two large meals daily with frequent protein snacks."

A client who tells the nurse that she would like to use the basal body temperature method for family planning receives instructions about the method. Which client statement indicates to the nurse that the teaching has been successful?

"It's important to take my temperature at about the same time every morning before arising." The client using the basal body temperature method should take her temperature for 5 minutes at the same time every morning on awakening, before arising or starting any activity. Doing so prevents other factors, such as eating or moving, from possibly influencing body temperature. The temperature reading should be recorded on a graph.In some women, a slight drop in body temperature occurs just before ovulation. However, a woman cannot determine exactly when ovulation occurs until it has actually happened. Typically, ovulation occurs when the slight drop in body temperature is followed by temperature rise. This temperature rise is maintained for the remainder of the menstrual cycle.Taking the basal body temperature at times other than on awakening, such as before bedtime, may result in inaccurate readings because the client's temperature may be affected by numerous factors, causing fluctuations.Basal body temperature can be an effective fertility management method if the client is motivated and able to perform the procedure correctly. Unfortunately it is one of the least reliable methods. Generally clients who choose this method do not wish to use other chemical or barrier methods for a variety of reasons.

A nurse determines that a client is in false labor. After obtaining discharge orders, the nurse provides discharge teaching to the client. Which instruction is most appropriate at this time?

"Return to the facility if fever occurs." The nurse should instruct a client in false labor to return to the health care facility if she develops signs or symptoms of infection, such as a fever; if her membranes rupture; if vaginal bleeding occurs; or if her contractions become more intense. The nurse should suggest warm milk or herbal tea, which promote relaxation and rest, instead of coffee or caffeinated tea. Taking a warm tub bath or shower — not applying cold compresses — helps relieve discomfort. A semi-upright position with pillows placed under the client's knees promotes rest.

A client is a long-distance runner and is 8 weeks pregnant with her first baby. The client tells the nurse that she would like to continue running throughout the pregnancy and asks the nurse if there are any safety risks. Which response by the nurse correctly identifies musculoskeletal changes in pregnancy that may be a safety risk to the client?

"The joints of the pelvis relax."

A client who is 37 weeks pregnant comes to the clinic for a prenatal checkup. Which question will the nurse ask to assess the client's preparation for parenting?

"What changes have you made at home to get ready for the baby?"

A client has just expelled a hydatidiform mole. She's visibly upset over the loss and wants to know when she can try to become pregnant again. How should the nurse respond?

"You must wait at least 1 year before becoming pregnant again." Clients who develop a hydatidiform mole must be instructed to wait at least 1 year before attempting another pregnancy, despite testing that shows they have returned to normal. A hydatidiform mole is a precursor to cancer, so the client must be monitored carefully for 1 year by an experienced health care provider. Discussing this situation at a later time or checking with the physician to give the client something to relax does nothing to address the client's immediate concerns. Advising the client to wait until all tests are normal is a vague response and provides the client with little information.

During a health-teaching session, a pregnant client asks the nurse how soon the fertilized ovum becomes implanted in the endometrium. Which answer should the nurse supply?

7 days after fertilization

A client who's 2 months pregnant complains of urinary frequency and says she gets up several times at night to go to the bathroom. She denies other urinary symptoms. How should the nurse intervene?

Explain that urinary frequency is expected during the first trimester. Urinary frequency is expected during the first trimester as the growing uterus exerts pressure on the client's bladder. Although the client should increase fluid intake during pregnancy, she should avoid drinking fluids after 6 p.m. to reduce the need to get up at night. Because urinary frequency is a normal discomfort of pregnancy and the client has no other signs or symptoms of UTI, referral to a urologist is unnecessary. Urinary frequency, dysuria, and voiding of small amounts of urine indicate UTI.

A multigravid client at 34 weeks' gestation who is leaking amniotic fluid has just been hospitalized with a diagnosis of preterm premature rupture of membranes and preterm labor. The client's contractions are 20 minutes apart, lasting 20 to 30 seconds. Her cervix is dilated to 2 cm. The nurse reviews prescriptions (see chart). Which prescription should the nurse initiate first?

Initiate fetal and contraction monitoring. The nurse should initiate fetal and contraction monitoring for this client upon arrival to the unit. This gives the nurse data regarding changes in fetal and maternal contraction status before completing the other prescriptions. Next, the betamethasone would be given to begin the maturation process for the fetal lungs. The nurse should then start an intravenous infusion to provide a line for immediate intravenous access, if needed, and provide hydration for the client. The nurse should obtain the urine specimen prior to administering any antibiotic therapy, if prescribed.

A client has meconium-stained amniotic fluid. Fetal scalp sampling indicates a blood pH of 7.12; fetal bradycardia is present. Based on these findings, the nurse should take which action?

Prepare for cesarean birth.

A client treated with terbutaline for premature labor is ready for discharge. Which instruction should the nurse include in the discharge teaching plan?

Report a heart rate greater than 120 beats/minute to the health care provider.

A multigravid client who stands for long periods while working in a factory visits the prenatal clinic at 35 weeks' gestation, stating, "The varicose veins in my legs have really been bothering me lately." Which instruction would be most helpful?

Take frequent rest periods with the legs elevated above the hips.

The nurse is performing a health history for a client in her first trimester of pregnancy who lives alone with two cats. What education should the nurse provide so that the client can protect herself from illness?

The client should wear disposable gloves to clean the litter box and wash hands with soap and warm water after cat litter exposure.

Lower back pain is a common concern among pregnant clients. Which comfort measure should a nurse include in the teaching plan for a pregnant client?

Use an ergonomically correct desk chair.

A client is at 24 weeks' gestation. The nurse is reviewing the report of laboratory tests. The nurse should report which of these results to the health care provider?

VDRL The nurse reports the results of the VDRL to the HCP. The pregnant client must be treated for syphilis to prevent perinatal transmission of the disease. The rubella titer and blood sugar values are within normal range. The blood type is not a significant factor in this situation.

A pregnant woman states that she frequently ingests laundry starch. The nurse should assess the client for which condition?

anemia

A client is Rh(D)-negative and D-negative and hasn't formed Rh antibodies. When should the client receive RHO(D) immune globulin (RhoGAM) to prevent isoimmunization?

at about 28 weeks' gestation and again within 72 hours after birth

Following a positive pregnancy test, a client begins discussing the changes that will occur in the next several months with the nurse. The nurse should include which information about a change the client can anticipate in the first trimester?

experiencing ambivalence about pregnancy

Before surgery to remove an ectopic pregnancy and the fallopian tube, which sign or symptom would alert the nurse to the possibility of tubal rupture?

falling hematocrit and hemoglobin levels

When the nurse is assessing a 34-year-old multigravid client at 34 weeks' gestation experiencing moderate vaginal bleeding, which symptom would most likely alert the nurse that placenta previa is present?

painless vaginal bleeding

A 16-year-old unmarried client visiting the prenatal clinic at 32 weeks' gestation and currently weighing 140 lb (63.5 kg) is being closely monitored for early signs of preeclampsia. The client is 5 feet, 2 inch (158 cm) tall and weighed 120 lb (54.4 kg) before the pregnancy. Which factor would be most important to assess?

proteinuria

A 32-year-old multigravida returns to the clinic for a routine prenatal visit at 36 weeks' gestation. The assessments during this visit include: blood pressure 140/90 mm Hg; pulse 80 beats/min; respiratory rate 16 breaths/min. What further information should the nurse obtain to determine if this client is becoming preeclamptic?

proteinuria