Ch 13 The Expectant Family: Needs and Care
25) A pregnant patient in the early stages of labor asks for assistance to sit in the whirlpool tub. What are the advantages of using this intervention for the laboring patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Increases relaxation 2. Increases pain threshold 3. Reduces postural hypotension 4. Promotes maternal-infant bonding 5. Reduces the need for pain medication
Answer: 1, 2, 5 Explanation: The benefits of using a whirlpool tub during labor include increased relaxation, increased pain threshold, and reduced need for pain medication. The whirlpool tub will not reduce postural hypotension. Breastfeeding promotes maternal-infant bonding. Page Ref: 265
24) The nurse is preparing material to present to a group of patients in the second trimester of their pregnancies. Which topics should the nurse include in this presentation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Clothing 2. Infant feeding 3. Fetal movement 4. Exercise and rest 5. Skin and breast care
Answer: 1, 2, 3, 5 Explanation: Topics appropriate to teach patients in the second trimester of pregnancy include clothing, infant feeding, fetal movement, and skin and breast care. Exercise and rest are topics to be reviewed during the first and third trimesters. Page Ref: 259
26) A patient in the first trimester of pregnancy is experiencing ptyalism. What should the nurse suggest to help this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Use chewing gum 2. Suck on hard candy 3. Snack on soda crackers 4. Use an astringent mouthwash 5. Brush the teeth with baking soda
Answer: 1, 2, 4 Explanation: Ptyalism is a rare discomfort of pregnancy in which excessive, often bitter, saliva is produced. Its cause has not been established. Effective treatments are limited, however using astringent mouthwashes, chewing gum, or sucking on hard candy may minimize the problem. Many women also choose to carry tissues or a small towel to spit into when necessary. Soda crackers and brushing the teeth with baking soda are not identified as helpful with ptyalism. Page Ref: 271
27) The nurse learns that a patient who is 8 weeks pregnant continues to smoke 10 cigarettes a day. In which order should the nurse provide a 5 to 15 minute intervention about smoking with this patient? 1. Ask about tobacco use 2. Advise to quit smoking 3. Assist in attempt to quit 4. Arrange for follow-up care 5. Assess willingness to quit
Answer: 1, 2, 5, 3, 4 Explanation: A C O G suggests that a 5- to 15-minute intervention with women who smoke fewer than 20 cigarettes a day is most effective. This program and other programs encourage healthcare providers to use the five As: ask about tobacco use; advise to quit smoking; assess willingness to quit; assist in attempt to quit; and arrange for follow-up care. Page Ref: 284
13) A 38-year-old client in her second trimester states a desire to begin an exercise program to decrease her fatigue. What is the most appropriate nursing response? A) "Fatigue should resolve in the second trimester, but walking daily might help." B) "Avoid a strenuous exercise regimen at your age. Drink coffee to combat fatigue." C) "Avoid an exercise regimen due to your pregnancy. Try to nap daily." D) "Fatigue will increase as pregnancy progresses, but running daily might help."
Answer: A Explanation: A) Even mild to moderate exercise is beneficial during pregnancy. Regular exercise-at least 30 minutes of moderate exercise daily or at least most days of the week-is preferred. B) The age of 38 is not too old to begin an exercise routine. Nurses should advise women of common sources of caffeine, including coffee, tea, colas, and chocolate and suggest they limit their caffeine intake to about 300 m g/day. C) Mild to moderate exercise is beneficial during pregnancy. Scheduling activities to allow for napping is helpful. D) Jogging or running is acceptable for women already conditioned to these activities, as long as they avoid exercising at maximum effort and overheating. Page Ref: 270
6) The primiparous client has told the nurse that she is afraid she will develop hemorrhoids during pregnancy because her mother did. Which statement would be best for the nurse to make? A) "It is not unusual for women to develop hemorrhoids during pregnancy." B) "Most women don't have any problem until after they've delivered." C) "If your mother had hemorrhoids, you will get them, too." D) "If you get hemorrhoids, you probably will need surgery to get rid of them."
Answer: A Explanation: A) Many pregnant women will develop hemorrhoids. Hemorrhoids are varicosities of the veins in the lower end of the rectum and anus. During pregnancy, the gravid uterus presses on the veins and interferes with venous circulation. As the pregnancy progresses, the straining that accompanies constipation can contribute to the development of hemorrhoids. B) It is not true that most women have no hemorrhoids until after the birth. Many women develop hemorrhoids during pregnancy. C) A family history does not automatically mean that a client will develop the condition. D) Hemorrhoids that occur in pregnancy or at birth usually become asymptomatic after the early postpartum period. Page Ref: 272
4) A Navajo client who is 36 weeks pregnant meets with a traditional healer as well as her physician. What does the nurse understand this to mean? A) The client is seeking spiritual direction. B) The client does not trust her physician. C) The client will not adapt well to mothering. D) The client is experiencing complications of pregnancy.
Answer: A Explanation: A) Navajo clients are aware of the mind-soul connection, and might try to follow certain practices to have a healthy pregnancy and birth. Practices could include focus on peace and positive thoughts as well as certain types of prayers and ceremonies. A traditional healer may assist them. B) Seeing a traditional healer does not indicate mistrust of the provider. C) Seeking a spiritual healer does not indicate the client's lack of parenting ability. D) Seeking a spiritual healer does not indicate any type of pathology or complications. Page Ref: 261
17) After teaching a pregnant client about the effects of smoking on pregnancy, the nurse knows that the client needs further education when she makes which statement? A) "I am at increased risk for preeclampsia." B) "I am at increased risk for preterm birth." C) "I am at increased risk for placenta previa." D) "I am at increased risk for abruptio placentae."
Answer: A Explanation: A) Smoking is not associated with increased risk for preeclampsia. B) Smoking is associated with increased risk for preterm birth. C) Smoking is associated with increased risk for placenta previa. D) Smoking is associated with increased risk for abruptio placentae. Page Ref: 284
23) What self-care measures would a nurse recommend for a client in her first trimester to reduce the discomfort of nausea and vomiting? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Avoid odors or causative factors. B) Have small but frequent meals. C) Drink carbonated beverages. D) Drink milk before arising in the morning. E) Eat highly seasoned food.
Answer: A, B, C Explanation: A) The nurse would recommend for a client in her first trimester to avoid odors and causative factors to reduce the discomfort of nausea and vomiting. B) The nurse would recommend for a client in her first trimester to have small but frequent meals to reduce the discomfort of nausea and vomiting. C) The nurse would recommend for a client in her first trimester to drink carbonated beverages to reduce the discomfort of nausea and vomiting. D) The nurse would recommend for a client in her first trimester to eat dry crackers or toast before arising in the morning to reduce the discomfort of nausea and vomiting. E) The nurse would recommend for a client in her first trimester to avoid greasy or highly seasoned foods to reduce the discomfort of nausea and vomiting. Page Ref: 275
3) The prenatal period should be used to expose the prospective parents to up-to-date, evidence-based information about which of the following topics? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Breastfeeding B) Pain relief C) Obstetric complications and procedures D) Toddler care E) Antepartum adjustment
Answer: A, B, C Explanation: A) The prenatal period should expose prospective parents to up-to-date, evidence-based information about breastfeeding. B) The prenatal period should expose prospective parents to up-to-date, evidence-based information about pain relief. C) The prenatal period should expose prospective parents to up-to-date, evidence-based information about obstetric complications and procedures. D) The prenatal period should expose prospective parents to up-to-date, evidence-based information about normal newborn care. E) The prenatal period should expose prospective parents to up-to-date, evidence-based information about postpartum adjustment. Page Ref: 267
10) Remedies for back pain in pregnancy that are supported by research evidence and may safely be taught to any pregnant woman by the nurse include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Pelvic tilt B) Water aerobics C) Sit-ups D) Proper body mechanics E) Good posture is important because it allows more room for the stomach to function.
Answer: A, B, D, E Explanation: A) The pelvic tilt can help restore proper body alignment and relieve back pain. B) Exercise is an effective treatment for lower back pain. Exercise in water seems to provide benefits while being physically comfortable for expectant mothers. C) Sit-ups require back-lying. Because of the pressure of the enlarging uterus on the vena cava, the woman should not lie flat on her back after about the fourth month. D) The use of proper posture and good body mechanics throughout pregnancy is important. E) Good posture is important because it allows more room for the stomach to function. Page Ref: 273
2) The nurse is preparing a class for expectant fathers. Which information should the nurse include? A) Siblings adjust readily to the new baby. B) Sexual activity is safe for normal pregnancy. C) The expectant mother decides the feeding method. D) Fathers are expected to be involved in labor and birth.
Answer: B Explanation: A) Siblings often have difficulty adapting to the arrival of a new baby. Parents who are unprepared for the older child's feelings of anger, jealousy, and rejection may respond inappropriately in their confusion and surprise. B) In a healthy pregnancy, there is no medical reason to limit sexual activity. C) Often, the father wants input in deciding on the feeding method. D) In some cultures, the father is not present at birth. The nurse should recognize the importance of birth practices that are part of a family's tradition and honor these practices when possible. Page Ref: 259
20) The pregnant client has asked the nurse what kinds of medications cause birth defects. Which statement would best answer this question? A) "Birth defects are very rare. Don't worry; your doctor will watch for problems." B) "To be safe, don't take any medication without talking to your doctor." C) "Too much vitamin C is one of the most common issues." D) "Almost all medications will cause birth defects in the first trimester."
Answer: B Explanation: A) The nurse should avoid giving a "don't worry" answer to ensure therapeutic communication, but it is appropriate to instruct the client to check with her caregiver about medications. B) The nurse should remind the client of the need to check with her caregiver about medications. If a woman has taken a drug in category D or X, she should be informed of the risks associated with that drug and of alternatives. C) Vitamin C is cited as a category A drug, as long as its use does not exceed the recommended dietary allowance. It has demonstrated no associated fetal risk. D) Not all medications are teratogenic. Page Ref: 283
5) A Chinese woman who is 12 weeks pregnant reports to the nurse that ginseng and bamboo leaves help reduce her anxiety. How should the nurse respond to this client? A) Advise the client to give up the bamboo leaves but to continue taking ginseng. B) Advise the client to discuss all herbal remedies with the provider. C) Tell the client that the provider thinks the remedies have no scientific foundation. D) Assess where the client obtains her remedy, and investigate the source.
Answer: B Explanation: A) The nurse should find out what medications and home remedies the client is using, and counsel the client regarding overall effects. B) The nurse should advise the client to discuss all medications (including herbal supplements) with the health care provider. C) It is not appropriate to tell the client that the provider thinks the remedies have no scientific foundation. D) It is outside the nurse's scope to assess the source of the herbs. Page Ref: 261
15) A pregnant client who swims 3-5 times per week asks the nurse whether she should stop this activity. What is the appropriate nursing response? A) "You should decrease the number of times you swim per week." B) "Continuing your exercise program would be beneficial." C) "You should discontinue your exercise program immediately." D) "You should consider a less strenuous type of exercise."
Answer: B Explanation: A) There is no need to decrease the number of times the client swims per week, because mild to moderate exercise is beneficial during pregnancy. B) Mild to moderate exercise is beneficial during pregnancy. Regular exercise-at least 30 minutes of moderate exercise daily or at least most days of the week-is preferred. C) Non-weight-bearing exercises, such as swimming or cycling, are recommended because they decrease the risk of injury and provide fitness with comfort. D) A moderate, rhythmic exercise routine involving large muscle groups such as swimming, cycling, or brisk walking is best. Page Ref: 278
21) Absolute contraindications to exercise while pregnant include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Abruptio placentae B) Placenta previa after 26 weeks' gestation C) Preeclampsia-eclampsia D) Cervical insufficiency (cerclage) E) Intrauterine growth restriction (I U G R)
Answer: B, C, D Explanation: A) Abruptio placentae is not an absolute contraindication to exercise. B) Placenta previa after 26 weeks' gestation is an absolute contraindication to exercise. C) Preeclampsia-eclampsia is an absolute contraindication to exercise. D) Cervical insufficiency (cerclage) is an absolute contraindication to exercise. E) Intrauterine growth restriction (I U G R) is not an absolute contraindication to exercise. Page Ref: 278
14) The pregnant client in her second trimester states, "I didn't know my breasts would become so large. How do I find a good bra?" The best answer for the nurse to give would be which of the following? A) "Avoid cotton fabrics and get an underwire bra; they fit everyone best." B) "Just buy a bra one cup size bigger than usual, and it will fit." C) "Look for wide straps and cups big enough for all of your breast tissue." D) "There isn't much you can do for comfort. Try not wearing a bra at all."
Answer: C Explanation: A) Cotton is comfortable during pregnancy when perspiration increases, because it does not retain heat and moisture. B) The client should be fitted for a well-fitting, supportive bra of an appropriate size. C) The nurse should instruct the client to get a bra that fits with straps that are wide and do not stretch, and a cup that holds all breast tissue comfortably. D) One can obtain a bra that fits and is comfortable. It is not necessary to be uncomfortable. Page Ref: 276
8) The nurse is teaching an early pregnancy class for clients in the first trimester of pregnancy. Which statement by a client requires immediate intervention by the nurse? A) "When my nausea is bad, I will drink some ginger tea." B) "The fatigue I am experiencing will improve in the second trimester." C) "It is normal for my vaginal discharge to be green." D) "I will urinate less often during the middle of my pregnancy."
Answer: C Explanation: A) Ginger helps nausea, and is safe for use during pregnancy. B) First-trimester fatigue is common; fatigue usually improves during the second trimester. C) Increased whitish vaginal discharge, called leukorrhea, is common in pregnancy. Green discharge is not a normal finding, and indicates a vaginal infection. D) Urinary frequency, a common discomfort of pregnancy, occurs early in pregnancy and again during the third trimester because of the pressure of the enlarging uterus on the bladder. Page Ref: 271
7) Which statement, if made by a pregnant client, would indicate that she understands health promotion during pregnancy? A) "I lie down after eating to relieve heartburn." B) "I try to limit my fluid intake to 3 or 4 glasses each day." C) "I elevate my legs while sitting at my desk." D) "I am avoiding exercise to stay well rested."
Answer: C Explanation: A) Heartburn is gastroesophageal reflux, and will be exacerbated by lying down. B) At least 8-10 glasses of fluids should be consumed each day to maintain the increased blood volume of pregnancy. C) Elevating the legs can help decrease lower leg edema. D) Regular mild to moderate exercise has many benefits for pregnant women. Page Ref: 271
12) The nurse in a prenatal clinic finds that four clients have called with complaints related to their pregnancies. Which call should the nurse return first? A) Pregnant woman at 7 weeks' gestation reporting nasal stuffiness B) Pregnant woman at 38 weeks' gestation experiencing rectal itching and hemorrhoids C) Pregnant woman at 15 weeks' gestation with nausea and vomiting and a 15-pound weight loss D) Pregnant woman at 32 weeks' gestation treating constipation with prune juice
Answer: C Explanation: A) Nasal stuffiness is common in the first trimester as a result of increased estrogen. B) Hemorrhoids are common during pregnancy and often cause itching. C) The nurse should return this call first because this patient is the highest priority. A 15-pound weight loss is not an expected finding. Although some nausea is common, the woman who suffers from extreme nausea coupled with vomiting requires further assessment. D) Constipation during the third trimester is a common finding. Increased fluid and fiber from food sources are most effective in relieving constipation. Page Ref: 269
19) The prenatal client in her third trimester tells the clinic nurse that she works 8 hours a day as a cashier and stands when at work. What response by the nurse is best? A) "No problem. Your baby will be fine." B) "Do you get regular breaks for eating?" C) "Your risk of poor pregnancy outcomes may be higher." D) "Standing might increase ankle swelling."
Answer: C Explanation: A) Standing more than 3 hours a day increases the risk of preterm labor. To be therapeutic in communication, avoid false reassurance. B) Although breaks for eating are important for pregnant employees, it is more important to tell the client about the increased risks associated with standing more than 3 hours a day. C) Pregnant women who are employed in jobs that require prolonged standing (more than 3 hours) may be at risk for poor pregnancy outcomes. D) Although this is true, it is less important than teaching the client about the risks of preterm labor from standing more than 3 hours a day. Page Ref: 277
16) The nurse is presenting a class of important "dos and don'ts" during pregnancy, including travel considerations. What method of travel does the nurse recommend as most appropriate for a client in her 25th week of pregnancy? A) Automobile B) Airplane C) Train D) None; this client should not travel
Answer: C Explanation: A) Travel by automobile can be especially fatiguing, aggravating many of the discomforts of pregnancy. The pregnant woman needs frequent opportunities to get out of the car and walk. B) Occasional flying is considered safe in the absence of any obstetric or medical complications. However, those women who have medical or obstetric complications, such as poorly controlled diabetes, sickle cell disease, or preeclampsia, and those women with placental abnormalities or who are at risk for preterm birth are advised to avoid flying during pregnancy. Before flying, the pregnant woman should check with her particular airline to see if it has any travel restrictions. C) As pregnancy progresses, travel by train is generally recommended for long distances. D) If medical or pregnancy complications are not present, there are no restrictions on travel. Pregnant women should avoid travel if there is a history of bleeding or preeclampsia, or if multiple births are anticipated. Page Ref: 259
9) The nurse assessing a pregnant African American woman in the first trimester understands that a cultural practice is which of the following? A) Use of herbs like dandelion during pregnancy to increase lactation B) Drinking ginseng tea for faintness C) Eating clay to supply dietary minerals D) Consulting a spiritual advisor to ensure a healthy pregnancy and birth
Answer: C Explanation: A) Use of dandelion is a practice of American Indians. B) Asian women who are pregnant often drink ginseng tea. C) African American pregnant women may be guided by their extended family into common practices such as geophagia, the ingestion of dirt or clay, which is believed to alleviate mineral deficiencies. D) Consulting a spiritual advisor is common among Navajo and many other Native American cultures. Page Ref: 262
18) Which of the following drugs and drug categories can cause multiple fetal central nervous system (C N S), facial, and cardiovascular anomalies? A) Category C: Zidovudine B) Category B: Penicillin C) Category X: Isotretinoin D) Category A: Vitamin C
Answer: C Explanation: A) Zidovudine does not cause multiple fetal central nervous system (C N S), facial, and cardiovascular anomalies. B) Penicillin does not cause multiple fetal central nervous system (C N S), facial, and cardiovascular anomalies. C) Isotretinoin (Accutane), the acne medication, can cause multiple central nervous system (C N S), facial, and cardiovascular anomalies. D) Vitamin C does not cause multiple fetal central nervous system (C N S), facial, and cardiovascular anomalies. Page Ref: 283
22) Intercourse is contraindicated if the pregnancy is vulnerable because of which diagnosis? A) Gestational diabetes B) Cervical insufficiency (cerclage) C) Abruptio placentae D) Placenta previa
Answer: D Explanation: A) Intercourse is not contraindicated if the pregnancy is vulnerable because of the diagnosis of gestational diabetes. B) Intercourse is not contraindicated if the pregnancy is vulnerable because of the diagnosis of cervical insufficiency (cerclage). C) Intercourse is not contraindicated if the pregnancy is vulnerable because of the diagnosis of abruptio placentae. D) Intercourse is contraindicated if the pregnancy is vulnerable because of the diagnosis of threatened spontaneous abortion, placenta previa, or the risk of preterm labor. Page Ref: 281
11) A client in her third trimester of pregnancy reports frequent leg cramps. What strategy would be most appropriate for the nurse to suggest? A) Point the toes of the affected leg B) Increase intake of protein-rich foods C) Limit activity for several days D) Flex the foot to stretch the calf
Answer: D Explanation: A) Leg cramps are exacerbated by pointing the toes. B) Leg cramps often result from an imbalance in the calcium-phosphorus ratio, not from a lack of protein-rich foods. C) Leg cramps are not caused by excess activity. D) The nurse should advise the client to practice dorsiflexion of her feet to stretch the affected muscle. Page Ref: 273
1) The nurse is caring for a pregnant client. The client's husband has come to the prenatal visit. Which question is best for the nurse to use to assess the father's adaptation to the pregnancy? A) "What kind of work do you do?" B) "What furniture have you gotten for the baby?" C) "How moody has your wife been lately?" D) "How are you feeling about becoming a father?"
Answer: D Explanation: A) What kind of work the husband does is not an indicator of his adaptation to the pregnancy. B) What furniture has been obtained is not an indicator of the father's adaptation to the pregnancy. C) The husband's perceptions of his wife's moodiness are not an indicator of the father's adaptation to the pregnancy. D) A husband's adaptation to pregnancy includes his feelings about impending fatherhood. Page Ref: 259
