Ch. 12 nursing mgmt during pregnancy

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?

"Have you had any urinary tract infections?" 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.

Gestational diabetes occurs around the 24th week of gestation. When should every woman be screened for gestational diabetes?

Between 24 and 28 weeks' gestation All women should be screened for gestational diabetes between 24 and 28 weeks of pregnancy.

A patient in the OB clinic is complaining of being awakened by leg cramps while sleeping. Select the appropriate nursing intervention.

Dorsiflex the foot while extending her leg during the cramp Plantar flexion can make cramps worse, dorsiflexion while extending the leg can relieve the cramp; excess fluid and lack of supplementation with vitamins or minerals may worsen cramps. Performing planar flexion exercise does not prevent the cramp. Increasing fluids may help, but has never proven to eliminate cramping.

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 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.

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

Facial edema Generalized hair loss, hyperpigmented maxillary rash (chloasma), and nosebleeds are usually benign and common in pregnancy. Facial edema after the 24th week of gestation may indicate gestational hypertension

Mary Jones's maternal serum alpha-fetoprotein (MSAFP) screening results show that her MSAFP levels are high. What is the best response by the nurse?

Further test are required based on the results Alpha-fetoprotein is a protein manufactured by the fetus. The woman's blood contains small amounts of this protein during pregnancy. The blood test is run between 16 and 20 weeks' gestation, an abnormal level indicates a need for further testing to determine the risks her fetus may face

A woman presents to the clinic in the first trimester of pregnancy. She has three children living at home. One of them was born prematurely at 34 weeks. The other two were full-term at birth. She has a history of one miscarriage. How do you record her obstetric history on the chart using the GTPAL format?

G5 T2 P1 A1 L3 One of the most common methods of recording the obstetric history is to use the acronym GTPAL. "G" stands for gravida, the total number of pregnancies. "T" stands for term, the number of pregnancies that ended at term (at or beyond 38 weeks' gestation); "P" is for pre-term, the number of pregnancies that ended after 20 weeks and before the end of 37 weeks' gestation. "A" represents abortions, the number of pregnancies that ended before 20 weeks' gestation. "L" is for living, the number of children delivered who are alive at the time of history collection.

By the time a woman is 36 weeks' gestation, where would the nurse expect to find the uterus?

Near the bottom of the sternum By 20 weeks' gestation, the uterus is at about the umbilicus; by 36 weeks, it nears the bottom of the sternum.

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?

Not to worry but to report any heavy increase in bleeding 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.

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?

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

A client in her third trimester of pregnancy wishes to use the method of feeding formula to her baby. What instruction should the nurse provide?

Serve the formula at room temperature The nurse should instruct the client to serve the formula to her infant at room temperature. The nurse should instruct the client to follow the directions on the package when mixing the powder because different formulas may have different instructions. The infant should be fed every 3 to 4 hours, not every 8 hours. The nurse should specifically instruct the client to avoid refrigerating the formula for subsequent feedings. Any leftover formula should be discarded.

Blood mixed with mucus seeping from the vagina in the late third trimester is abnormal and should be reported to the physician immediately.

false As the cervix softens and ripens, the mucus plug that filled the cervical canal during pregnancy is expelled. The exposed cervical capillaries seep blood as a result of pressure exerted by the fetus. This blood, mixed with mucus, takes on a pink tinge and is referred to as "show" or "bloody show." Women need to be aware of this event so they do not think they are bleeding abnormally.

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?

• Areolae darken • Overall breast size increases • Blue streaking of veins becomes prominent • Montgomery tubercles become prominent Healthy breast changes that occur during pregnancy include the areolae darkening, overall breast size increasing, blue streaking of veins becoming prominent, and Montgomery tubercles becoming prominent. Breasts tend to become firmer in consistency during pregnancy, not softer. Hard, painless lumps indicate possible tumors, which are not normal, healthy breast changes

A client wants to know if she can engage in intercourse during pregnancy. Which of the following should the nurse confirm to ensure that sexual intercourse or orgasm is not contraindicated in the client? Select all that apply.

• Client does not face a risk of threatened abortion • Client is not at risk for pre-term labor To confirm that intercourse or orgasm is not contraindicated in the pregnant client, the nurse should ensure that the client does not have placenta previa, and the client is not at risk for pre-term labor or a threatened abortion. Breast tenderness and dependent edema are not contraindications for sexual intercourse in a pregnant client. Breast tenderness generally occurs in the first trimester of pregnancy. Dependent edema is a common vascular problem occurring during pregnancy.