Chapter 12
A teenager arrives in the emergency department in active labor having no prenatal care. Upon examination in L & D, the nurse notices a cluster of pinpoint vesicles with a red base on her vulva which the teenager asks the nurse to not touch "her rash" because it hurts when touched. At this point, which intervention should the nurse perform next?
Report this finding to the health care provider immediately so he or she can plan the birth route.
The nurse is caring for a client who is at 37 weeks' gestation and has a biophysical profile of 9. Which nursing action is best?
Schedule a health care provider appointment for one week.
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?
Mercury attacks the nervous tissue.
Why is the first prenatal visit usually the longest prenatal visit?
Baseline data is collected
The nurse is assessing a primipara's fundal height at 36 weeks' gestation and notes the fundus is now located at the xiphoid process of the sternum. The client asks if this is normal. Which response to the client would be best?
"At 36 weeks' gestation, the fundus is in the normal expected location."
A nurse is teaching a client who is 30 weeks pregnant about ways to deal with heartburn. The nurse determines a need for additional teaching based on which client statement?
"I should lie down for 1/2 hour after eating."
A pregnant client presents for her first prenatal visit. She informs the nurse that she had an ectopic pregnancy 3 years ago. She ask the nurse if this would happen this time. Which response by the nurse would be best?
"Your statistical risk of another tubal pregnancy is increased."
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 prophylaxically 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
The use of what during pregnancy is potentially most harmful to the fetus?
Alcohol
The nurse discovers a new prescription for RhoGAM for a client who is about to undergo a diagnostic procedure. The nurse will administer the RhoGAM after which procedure?
Amniocentesis
A young couple are very excited to discover they are pregnant and ask the nurse when to expect the baby. Based on a July 20 LMP, which day will the nurse predict for delivery?
April 27
The nurse is describing pregnancy danger signs to a pregnant woman who is in her first trimester. Which danger sign might occur at this point in her pregnancy?
Excessive vomiting
A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a 4-year-old child who was delivered at 38 weeks' gestation and tells the nurse that she does have a history of a miscarriage within the first trimester. The nurse is correct to document the history as
G = 3, T = 1, P = 0, A = 1, L = 1
A multigravida client is pregnant for the third time. Her previous two pregnancies ended in an abortion in the first and third month of pregnancy. How will the nurse classify her pregnancy history?
G3 P0020
A pregnant client arrives for her first prenatal appointment. She reports her previous pregnancy ended at 19 weeks, and she has 3-year-old twins born at 30 weeks' gestation. How will the nurse document this in her records?
G3 T0 P1 A1 L2
A client has been confirmed to be pregnant. She gives a history of two previous full-term normal pregnancies. How will the nurse classify the client's pregnancy history?
G3, P2
The nurse is assessing a client at 14 weeks' gestation at a routine prenatal visit and notes the fundal height is at the umbilicus. The nurse will most likely interpret this finding to indicate which situation?
Intrauterine growth retardation
Why is a Papanicolau test done at the first prenatal visit?
It identifies abnormal cervical cells.
A client in her second trimester of pregnancy visits a health care facility. The client frequently engages in aerobic exercise and asks the nurse about doing so during her pregnancy. Which precaution should the nurse instruct the pregnant client to take when practicing aerobic exercises?
Maintain tolerable intensity of exercise.
A client at 29-weeks gestation tells the nurse she is experiencing aches in her hips and joints. What would the nurse do next?
Tell the client these are normal findings during pregnancy
The client is 32 weeks pregnant and has been referred for biophysical profile (BPP) after a nonreassuring nonstress test (NST). Which statement made by the client indicates that the nurse's explanation of the procedure was effective?
The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume.
Which pregnant woman should consult with her obstetric provider before continuing an exercise program?
a 33-year-old G5 P1 with a history of incompetent cervix
When measuring the diagonal conjugate of a woman's pelvis, the distance between which anatomic landmarks would be used?
anterior surface of the sacral prominence and the anterior surface of the symphysis pubis
Which possible complication associated with back pain can lead to premature contractions?
bladder or kidney infection
A pregnant client wishes to know if sexual intercourse would be safe during her pregnancy. Which of the following should the nurse confirm before educating the client regarding sexual behavior during pregnancy?
client does not have an incompetent cervix
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:
decreased birth weight in neonates.
When providing preconception care to a client, the nurse would identify which medication as being safe to continue during pregnancy?
famotidine
A nurse is taking a history during a client's first prenatal visit. Which assessment finding would alert the nurse to the need for further assessment?
history of diabetes for 4 years
At 16 weeks' gestation, a client is vomiting 3 to 5 times per day. The nurse will assess the client for the development of which condition?
hypokalemic alkalosis
By the time a woman is 36 weeks' gestation, where would the nurse expect to find the uterus?
near the bottom of the sternum
To control an elevated cholesterol level, the nurse would teach the client to include which type of fish in the diet? Select all that apply.
salmon trout
Untreated hyperemesis can lead to preterm birth. What is the cause of the preterm birth?
severe dehydration resulting in hypoperfusion of the placenta
During the initial obstetrical clinic visit, the nurse shares with a client that several blood studies will be drawn. What screening is performed for Black women because of the ethnically inherited nature of the disease?
sickle-cell trait or disease
During the initial history and physical of a 30-year-old primapara client, the nurse has identified some teratogens the fetus is being exposed to at this phase of the pregnancy. Which lifestyle data could result in teratogenic exposure to the fetus? Select all that apply.
smoking 2 packs of cigarettes a day drinking alcoholic beverages 3 times a week snorting cocaine once or twice a month
Which of these cardiac variations, if found in the client who is pregnant, should the nurse recognize as a normal finding in pregnancy?
soft systolic murmur
A nurse is educating a pregnant client about obtaining a blood sample for an alpha-fetoprotein (AFP) level. Which response by the client indicates that the health teaching was successful?
"If my AFP level is high, it could mean there is a problem with my baby's spinal cord."
The diagonal conjugate of a pregnant woman's pelvis is measured. Which measurement would the nurse interpret as presenting a potential problem?
12.0 cm
A client who is in her first trimester is anxious to have an ultrasound at each visit. The nurse explains that it is not necessary and schedules a second ultrasound to be performed when she is about:
18 to 20 weeks pregnant.
The nurse is assessing a client at her first prenatal visit and notes the fundal height is palpable at the level of the umbilicus. The nurse predicts the client is at which gestational age?
20 weeks
The nurse is reviewing client data following a regular monthly appointment at 6 months' gestation. Which fundal height requires no further intervention?
24 cm
A potential complication for the mother and fetus is Rh incompatibility; therefore, assessment should include blood typing. If the mother is Rh negative, her antibody titer should be evaluated. If treatment with Rho(D) immune globulin is indicated, the nurse would expect to administer it at which time?
28 weeks
A woman is in her early second trimester of pregnancy. The nurse would instruct the woman to return for a follow-up visit every:
4 weeks
Utilize the GTPAL system to classify a woman who is currently 18 weeks pregnant. This is her 4th pregnancy. She gave birth to one baby vaginally at 26 weeks who died, experienced a miscarriage, and has one living child who was delivered at 38 weeks gestation.
4, 1, 1, 1, 1
At the first prenatal visit of all clients who come to the clinic appropriate blood screenings are obtained. The nurse realizes that a hemoglobin A1c above which level is concerning for diabetes and warrants further testing?
6.5%
A nurse at the health care facility assesses a client in the 20th week of gestation. The client is healthy and progressing well, without any sign of complications. Where should the nurse expect to measure the fundal height in this client?
At the level of the umbilicus
A nurse is educating a prenatal client at her second visit. The client is worried about "blotchy brown spots" on her forehead. The nurse reassures the client about this change by giving which appropriate response?
Avoid sun because it will make the discoloring darker.
A nurse is teaching a group of primigravida woman 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?
Because of pelvic congestion, women may experience increased clitoral sensitivity.
A 25-year-old client at 27 weeks' gestation reports waking up with leg cramps. Which suggestion should the nurse point out to the client to help relieve this discomfort?
Dorsiflex the foot while extending her leg during the cramp.
As part of the first prenatal visit, the nurse is assessing a pregnant woman's obstetrical history, which includes an 18-month-old daughter, born 2 days after her estimated date of birth; a 3-year-old son born at 35 weeks' gestation; and two lost pregnancies, one at 12 weeks and one at 21 weeks. How should the nurse document this history?
G5 T1 P2 A1 L2
The nurse is assisting a pregnant client who has just underwent a nonstress test that was ruled reactive. Which factor will the nurse point out when questioned by the client about the results?
The fetal heart rate increases with activity and indicates fetal well-being.
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.
A petite pregnant client is concerned that she will be unable to deliver vaginally due to her small size. Which procedure should the nurse point out will help to confirm the manual measurements obtained of her pelvis and provide information which will help determine the best method of delivery for her?
Ultrasonography
The nurse is conducting a prenatal class for a group of primigravida clients. Which instruction will the nurse prioritize when teaching about breast care?
Wash the nipples with clean water only.
When developing a plan of care, the nurse needs to make which assessments for a pregnant client with a BMI of 18.3? Select all that apply.
assess for maternal fatigue assess for preterm labor assess for poor fetal growth
The nurse understands that the maternal uterus should be at what location at 20 weeks' gestation?
at the level of the umbilicus
A nurse is documenting the obstetric history for a pregnant woman who has previously given birth to two infants at term and had one abortion at 12 weeks' gestation. How would the nurse document this information?
gravida 4, para 2
The nurse is preparing a teaching plan for a pregnant woman about the signs and symptoms to be reported immediately to her health care provider. Which signs and symptoms would the nurse include? Select all that apply.
headache with visual changes in the third trimester sudden leakage of fluid during the second trimester lower abdominal pain with shoulder pain in the first trimester
The nurse is reviewing the charts of a group of clients. Which client's weight gain should the nurse be concerned about?
the client who gained 8 lb (4 kg) in the first trimester
