Chapter 12, Nursing Care to Promote Fetal and Maternal Health

According to the Family and Medical Leave Act, a woman is guaranteed the right to how many weeks of unpaid, job-protected leave for the birth of a child?____ weeks

12

In the first trimester, sharp pains in the lower abdomen are common. They are not repetitive but often are associated with position changes or fetal movements. What are these indicative of? Growing pains Pyelonephritis Ectopic pregnancy Possible miscarriage

Growing pain

Which possible complication associated with back pain can lead to premature contractions? increased intracranial pressure leak of spinal fluid into the epidural space herniated disc bladder or kidney infection

bladder or kidney infection

Which vaccines are contraindicated during pregnancy since they may transmit a viral infection to the fetus? Select all that apply. measles mumps influenza rubella Tdap vaccine (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis)

rubella measles mumps

The pregnant client is discussing her dietary needs during pregnancy. Which statements indicate a correct understanding of the intake needed? Select all that apply. "I will need to nearly double my protein intake during pregnancy." "At least 8 glasses of water daily is needed to maintain hydration." "Sharp limitations in salt intake during pregnancy are important." "Taking in at least 1000 mg of calcium daily is important during pregnancy." "Taking my daily iron supplement is key to the health of my pregnancy."

"At least 8 glasses of water daily is needed to maintain hydration." "Taking in at least 1000 mg of calcium daily is important during pregnancy." "Taking my daily iron supplement is key to the health of my pregnancy."

A pregnant woman notices that sometimes her heartbeat is irregular when she is lying down resting on her back. The provider suspects she is experiencing low blood pressure. Which intervention would the health care provider suggest to the woman to prevent this from occurring? Select all that apply. "Try sleeping on your stomach with pillows to support your lower limbs." "Change positions slowly to allow pooled blood to reenter the circulation slowly." "Drink extra water before lying down for a rest." "Try sleeping and resting on your side with a small pillow between the knees." "This is a normal experience, and it will go away after birth."

"Change positions slowly to allow pooled blood to reenter the circulation slowly." "Try sleeping and resting on your side with a small pillow between the knees."

After teaching a woman about healthy lifestyle behaviors during pregnancy, the nurse determines that the teaching was successful based on which statement by the woman about traveling during pregnancy? Select all that apply. "When traveling, I should drink less fluid to void less frequently. " "Flying in the first trimester is not recommended. " "When traveling by car or plane, I need to get up every 1 to 2 hours to prevent clots in my legs." "There isn't any risk associated with air travel, other than being away from my primary provider." "I cannot drive a car with airbags after I reach 36 weeks. "

"When traveling by car or plane, I need to get up every 1 to 2 hours to prevent clots in my legs." "There isn't any risk associated with air travel, other than being away from my primary provider."

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

rest on the left side for at least 1 hour in the morning and afternoon

A 35-year-old client has been told to keep her pulse rate below 140 bpm during workouts because she is pregnant. This means that the client will be working roughly what percentage of the suggested pulse rate? 60% 65% 70% 75%

75%

When questioned about alcohol consumption at her first prenatal visit, a client says that she drinks occasionally. What should the nurse urge her to do? Abstain from alcohol completely during the remainder of her pregnancy. Drink no more than four alcoholic drinks per day. Drink only a glass or two of wine on occasion, but no more. Begin an alcohol treatment program immediately.

Abstain from alcohol completely during the remainder of her pregnancy.

As part of a 31-year-old client's prenatal care, the nurse is assessing immunization history. Which immunization is most relevant to ensuring a healthy fetus? rubella hepatitis A and B measles diphtheria, tetanus, and pertussis

rubella

Which change in the breasts should a nurse recognize as a normal change associated with pregnancy? Hypopigmentation of the areola and nipples Disappearance of superficial veins Expression of colostrum in the first trimester Tingling sensations and tenderness

Tingling sensations and tenderness

The use of what during pregnancy is potentially most harmful to the fetus? alcohol caffeine aspartame acesulfame-K

alcohol

During the initial assessment of a 22-year-old pregnant client, the nurse learns that the client usually smokes 2 packs of cigarettes per day. The nurse is planning an education session about lifestyle changes during pregnancy. Which goal would be the most realistic and individualized for this client during this initial clinic visit? The client stops smoking immediately for the health of the fetus. The client reduces her smoking by 50 percent by the next clinic visit. The client throws the cigarettes in the trash immediately. The client does some research on the harmful affects of cigarette smoking on the baby.

the client reduces her smoking by 50 percent by the next clinic visit

The maternal health nurse is caring for a pregnant client who reports breast tenderness. Which statement(s) will the nurse include when teaching the client about breast self-care? Select all that apply. "Wash your nipples with clear tap water and no soap." "Be sure to wear a firm, tight-fighting bra with wide straps." "Colostrum may appear in your second trimester." "Use a mild exfoliating soap and water to wash your nipples." "Be sure to wear a loose-fitting bra at night to ensure circulation."

"Colostrum may appear in your second trimester." "Wash your nipples with clear tap water and no soap."

Which pregnant woman should consult with her obstetric provider before continuing an exercise program? a 25-year-old G2P1 with history of heavy periods due to endometriosis a 40-year-old G1P0 who does 30 to 60 minutes of aerobic exercise a day a 33-year-old G5P1 with a history of cervical insufficiency a 17-year-old G1P0 who used oral contraceptive pills (OCPs) prior to becoming pregnant

a 33-year-old G5P1 with a history of cervical insufficiency

A woman with a history of genital lesions caused by herpes simplex virus (HSV) has been admitted to the labor unit at 39 weeks' gestation. She said she was given medicine prophylactically a few weeks ago to prevent lesions at the time of birth. Which medication is safe to give to a pregnant women with HSV? acyclovir benzathine penicillin chloroquine mefloquine

acyclovir

A woman in her first trimester of pregnancy has noted an increase in a thick, whitish vaginal discharge even though she showers daily. The woman shares this information with the clinic nurse, who provides some client education on the topic of leukorrhea. Which interventions should be addressed in this discussion? Select all that apply. Wear cotton underwear during the day. A perineal pad to absorb the discharge may help. Tampons are the most reliable product to control the flow during the day. It is normal for the discharge to change in color or odor. Many woman find douching to provide a feeling of cleanliness.

Wear cotton underwear during the day. A perineal pad to absorb the discharge may help.

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? Avoid medications. Eat a well-balanced diet. Maintain personal hygiene. Avoid intake of coffee.

avoid medications

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 the client about the potential effects of smoking in pregnancy? "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." "Smoking during pregnancy places your baby at an increased risk of intellectual disability." "Babies of women who smoke tend to weigh significantly less than other infants." "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."

babies of women who smoke tend to weigh significantly less than other infants

A nurse is teaching a group of primigravida women who are in their first trimester. One of the women asks the nurse about sexual activity during pregnancy. Which information would the nurse most likely incorporate into the response? Female orgasm on the EDC will cause labor to begin. Intercourse is not recommended before 36 weeks because it can induce labor. Women who have a partially dilated or effaced cervix at term must refrain from sexual activity. Because of pelvic congestion, women may experience increased clitoral sensitivity.

because of pelvic congestion women may experience increased clitoral sensitivity

A pregnant woman comes to the clinic for a follow-up appointment. The woman had an amniocentesis on her previous visit. The nurse reviews the results from the testing. Which result(s) would the nurse identify as problematic? Select all that apply. white flecks in clear fluid bilirubin positive lecithin-sphingomyelin (L/S) ratio greater than 2 negative phosphatidylglycerol glucose 35 mg/dL (1.94 mmol/L)

bilirubin positive negative phosphatidylglycerol

A client has consumed a large quantity of fish during pregnancy and expressed concern about the unborn child. What can mercury exposure during pregnancy cause? Brain and neurologic abnormalities in the fetus Stunted fetal growth Fetal malformations Abortion

brain and neurologic abnormalities in the fetus

An older female pregnant with her first child develops some pain in her legs associated with warmth to touch. Suspecting a blood clot, an ultrasound is prescribed and a peripheral venous thrombosis is diagnosed. Which intervention was likely prescribed for this woman? "Take your blood thinner the same time each day." "Buy and wear medical support hose every day." "Take a baby aspirin every morning and evening to prevent further clot formation." "If you sit at a desk, set a timer and get up and walk every 2 to 3 hours."

buy and wear medical support hose every day

While assessing a client's breast during the third trimester, which finding would the nurse expect? breasts becoming soft colostrum from the nipples pink-colored nipples pain in the nipple area

colostrum from the nipples

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 symptom is an indicator of true labor? contractions beginning in the back and sweeping forward across the abdomen lightening (descent of the fetus into the pelvis) intermittent backache stronger than usual increase in fetal kick count

contractions beginning in the back and sweeping forward across the abdomen

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: increased risk of spontaneous abortion (miscarriage). decreased birth weight in neonates. increased risk of stillbirth. increased risk of placental abruption (abruptio placentae).

decreased birth weight in neonates

A primigravida who is 40 weeks' pregnant thinks she may be in labor. She calls the nurse and reports that she has had 10 contractions in the last hour. She says that they are mildly painful and last 45 seconds. What is the best response from the nurse? "Did your water break? Do you feel the baby moving?" "You should wait 1 hour, and then come to the hospital." "You need to come in right away because you live 20 minutes away." "Wait until your water breaks, and then come into the hospital." "Wait 1 hour and see how the contractions change, and then call back."

did your water break? do you feel the baby moving?

A nurse is conducting a class geared toward changes in early pregnancy and self-care items like perineal hygiene. A woman shares that she douches at least once a day since she has "so much discharge" from her vagina. Which response by the nurse is most appropriate at this time? "Douching will definitely keep your vagina clean." "If you prepare your own douching solution, be sure to boil the water to kill bacteria." "During pregnancy, you should not douche because it can cause fluid to enter the cervix resulting in an infection." "Let's discuss this with your health care provider before you continue douching."

during pregnancy you should not douche because it can cause fluid to enter the cervix resulting in an infection

The nurse is teaching a pregnant client in her last trimester about interventions to help reduce risks of complications during pregnancy. Which of the following are recommended guidelines? Take a daily shower, but avoid a tub bath because this could harm the fetus. If planning to breastfeed, bathe as normal using soap and water on the nipples. During the last month, rest on the left side for at least an hour, morning and afternoon. Sleep on your back to avoid supine hypotension syndrome.

during the last month rest on the left side for at least an hour morning and afternoon

A client in her second trimester of pregnancy has developed varicose veins and experiences leg cramps. Which suggestion would be most appropriate? Perform aerobic exercises. Increase intake of folic acid. Increase intake of calcium. Elevate legs while sitting.

elevate legs while sitting

During the initial clinic visit for a primiparous woman, the nurse reviews the topic of constipation during pregnancy when the woman interjects that she has been "straining forcefully" almost on a daily basis. The nurse offers some measures that may help to prevent the occurrence of which complication? anemia related to bleeding around anal opening explosive diarrhea with water and electrolyte loss due to excess laxative use nutritional deficits related to anorexia caused by bowel sluggishness hemorrhoid development that may eventually need surgical repair

hemorrhoid development that may eventually need surgical repair

A nurse is assessing a pregnant woman in her last trimester. Which question would be most appropriate to use to gather information about weight gain and fluid retention? "What's your usual dietary intake for a typical week?" "What size maternity clothes are you wearing now?" "How puffy does your face look by the end of a day?" "How swollen do your ankles appear before you go to bed?

how swollen do your ankles appear before you go to bed

A pregnant woman at her first prenatal visit asks the nurse if it is safe to have sex during her pregnancy. Which client statement alerts the nurse to the need for further teaching? "I should substitute intercourse with nonsexual touch to avoid harming the fetus." "I will experience a heightened need for touch throughout my pregnancy." "If I experience bleeding, I will abstain from vaginal intercourse." "I will avoid having intercourse following the rupture of the membranes."

i should substitute intercourse with nonseuxal toutch to avoid harming the fetus

A nurse is giving a prenatal class on teratogens that have an affinity for specific body tissues. Which teratogen is accurately paired with the specific body tissue affected? Lead attacks the joints. Mercury attacks the nervous tissue. Tetracycline attacks the muscles. Thalidomide attacks the lungs.

mercury attacks the nervous system

A pregnant woman has been diagnosed with pica since she eats lead paint chips for their sweetness. The nurse educating this woman should strongly encourage her to abandon this practice because it may have which consequence to the fetus? neurological challenges cataracts fetal growth restriction spontaneous abortion

neurological challenges

Which occupation may expose a fetus to environmental hazards? Select all that apply. nurse anesthetist working in a busy oral surgeon's office accountant short-order cook for a busy deli nurse working for a pulmonologist who administers inhalation ribavirin routinely to the client population carpenter

nurse anesthetist working in a busy oral surgeon's office short-order cook for a busy deli nurse working for a pulmonologist who administers inhalation ribavirin routinely to the client population

A woman who is pregnant for the first time has arrived to the labor department thinking she was in labor only to be diagnosed with Braxton Hicks contractions and sent home. Prior to leaving the unit, the woman asks, "How will I know when it is 'true' labor?" Which signs/symptoms should the woman associate with true labor? Select all that apply. pain in back that wraps across the abdomen and increases in frequency and intensity leakage of white to yellow discharge from the nipples pink-tinged blood and mucus mixture on underwear sudden gush of clear fluid coming from the vagina urine leakage after coughing or sneezing

pain in back that wraps across the abdomen and increases in frequency and intensity pink-tinged blood and mucus mixture on underwear sudden gush of clear fluid coming from the vagina

When counseling a client about exercise in pregnancy, which statement is correct? "After the first trimester, exercise must be avoided." "Plan to exercise a minimum of 3 times a week for 30 minutes." "For most women, extreme exercise in pregnancy is completely safe." "Walking should be limited to 30 minutes at a time because it can induce labor."

plan to exercise a minimum of 3 times a week for 30 minutes

A client at 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? "You only have a few more weeks until the birth and then you will breathe fine again." "The enlarging uterus pushes against your diaphragm and this makes breathing shallow." "Oxygen requirements are increasing in your body because the fetus is growing." "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

A pregnant 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? "You don't want to harm the baby by taking medications now, do you?" "Wait until you reach your third trimester. You can take something to relieve headaches then." "The safest medication to take for your headaches during your pregnancy would be acetaminophen." "The safest medication to take for your headaches during your pregnancy would be ibuprofen."

the safest medication to take for your headaches during your pregnancy would be acetaminophen

A client at 32 weeks' gestation is admitted to labor and delivery with vaginal bleeding and contractions. The physician orders a course of two steroid injections. The client asks why she needs steroids. What is the best explanation by the nurse? The steroids speed up the development of the lungs. The steroids will help to slow the development of infection. The steroids will increase the baby's muscle mass. The steroids will create a layer of fat to help with temperature regulation.

the steroids will speed up the development of the lungs

A pregnant woman asks the nurse about using herbal remedies while she is pregnant. The nurse recommends that the woman talk with her health care provider about their use based on which understanding? They are not rated with regard to safety during pregnancy. They can create nutritional deficiencies in the mother and fetus. They are known to cause teratogenic effects in the fetus. They have been proven to cause early labor.

they are not rate with regard to safety during pregnancy

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 instruction should the nurse give to the client? Tub baths are fine unless you are unstable on your feet or are experiencing vaginal bleeding. Avoid tub baths at all times during pregnancy, as they may be dangerous for the fetus. Long soaks in very hot water are encouraged during pregnancy to promote relaxation. 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

A client in her third trimester reports to the nurse 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? Avoid overeating. Lie on a firmer mattress. Use extra pillows. Avoid spicy food.

use extra pillows

A pregnant woman in her first trimester comes to the clinic for a visit. Which statement would lead the nurse to suspect that the woman is experiencing a complication of pregnancy that requires additional follow up? "I'm so tired. As soon as I get home from work, I go to bed. I used to go to bed at 10:00 pm and now I have to go to bed at 8:00 pm." "When I get up in the morning, I feel good, but throughout the day, my palms get red and itchy." "When I first urinate in the morning, I notice a burning sensation, but then as I'm constantly going throughout the day, it goes away." "Last night, I woke up in the middle of the night with this intense leg pain that subsided after a few seconds. Today, my leg still feels sore."

when i first urinate in the morning I notice a burning sensation but then as im constantly going throughout the day it goes away

Following an initial prenatal visit, a woman's rubella titer results were less than 1:8. On her next visit, the woman asks what this test result means. Which is the best answer to this woman's question about her rubella titer results? "You have immunity against rubella." "You recently were infected with rubella." "You were exposed to someone with rubella." "You are susceptible to a rubella viral invasion."

you are susceptible to a rubella viral invasion