Chapter 15: Pregnancy; O'Meara: Maternity, Newborn, and Women's Health; PREPU Level 5

The nurse has been given a basin containing a newly delivered placenta. Which action will the nurse complete next? a. Place in a bag and store in the refrigerator. b. Analyze for fragments. c. Send to the laboratory for testing. d. Remove all blood from the placenta.

b. Analyze for fragments. Hospital policies may vary slightly, but after delivery the placenta is analyzed for any fragments. If the placenta appears to have fragments missing, the uterus is assessed for retained fragments. After analysis, the nurse labels and places the placenta in the refrigerator for storage. The placenta is a vascular structure and is not drained of all blood.

Implantation generally occurs at which place on the uterus? a. the lower anterior surface b. the upper posterior surface c. directly over the cervical os d. directly over an opening to a fallopian tube

b. the upper posterior surface Implantation occurs most commonly on the upper posterior surface of the uterus. This position allows the fetus to deliver before the placenta.

The fluid-filled, inner membrane sac surrounding the fetus is which structure? a. amnion b. chorion c. endometrium d. decidua

a. amnion The fluid-filled, inner membrane sac surrounding the fetus is the amnion. The chorion is the outer membrane surrounding the fetus. The endometrium is the inner lining of the uterus. The decidua is the name used for the endometrium during pregnancy.

How many weeks into her pregnancy should a woman who is Rho(D)-negative be screened for antibodies and given Rho(D) immune globulin?

28 weeks For women who are Rh-negative, Rho(D) immune globulin is given at 28 weeks to prevent isoimmunization.

A pregnant client asks the nurse if the fetus can be tested for Down syndrome. Which statement by the nurse is most appropriate? a. "Yes, a chromosomal analysis can be done to assess for Down syndrome." b. "Of course. The primary health care provider can prescribe a DNA analysis for this." c. "You need to be sure you want to know this information before you think about being tested." d. "When you have ultrasounds done, they look for signs of Down syndrome."

a. "Yes, a chromosomal analysis can be done to assess for Down syndrome." Chromosomal analysis is part of the genetic testing for Down syndrome. The nurse would state this for the client to directly answer the client's question. A DNA analysis may be used in the detection of genetic diseases. The nurse should not avoid answering the client's question. While features of Down syndrome may be seen on ultrasound, the client asked if testing could be completed and the nurse should address this question.

A pregnant client is scheduled to undergo chorionic villus sampling (CVS) to rule out any birth defects. Ideally, when should this testing be completed? a. 10 to 12 weeks' gestation b. 7 to 9 weeks' gestation c. 5 to 6 weeks' gestation d. 4 to 5 weeks' gestation

a. 10 to 12 weeks' gestation Chorionic villus sampling (CVS) is typically performed between 10 to 12 weeks' gestation. Sometimes it may be offered up to 14 weeks. The test is not conducted before 10 weeks' gestation

A newly pregnant 41-year-old woman is requesting genetic testing of the baby. She is concerned that due to her age the baby has an increased risk for which condition? a. Down syndrome b. Patau syndrome c. cystic fibrosis d. muscular dystrophy

a. Down syndrome The risk of Down syndrome increases with advanced maternal age. According to the March of Dimes, the risk of having a baby with Down syndrome is about one in 1,340 for a woman at age 25; one in 940 at age 30; one in 353 at age 35; one in 85 at age 40; and one in 35 at age 45.

Which would be a normal finding by the nurse during a physical exam of a woman in her third trimester? a. Dyspnea b. Kyphosis c. Ptyalism d. Increased hematocrit

a. Dyspnea In the third trimester, a women experiences dyspnea from the uterus pushing up into the diaphragm. A pregnant woman will experience lordosis, not kyphosis. Ptyalism is excessive saliva production and is often seen in the first trimester of pregnancy. The hematocrit of a pregnant woman will decrease in the third trimester, not increase.

A client at 28 weeks' gestation is asking for a laxative for constipation. What action would the nurse recommend? a. Eat fiber-rich foods. b. Take a fiber-based laxative. c. Use a water-based enema. d. Insert a glycerin suppository.

a. Eat fiber-rich foods. Increasing dietary fiber is the best way to address constipation. Laxatives, suppositories, and enemas only provide temporary relief and may stimulate labor.

A pregnant client at 34 weeks' gestation reports a burning sensation in the lower esophagus. What action would the nurse recommend to increase her comfort? Select all that apply. a. Eat five to six small meals per day. b. Do not eat fried, fatty foods. c. Do not lie down immediately after eating. d. Eat a large amount of carbohydrates. e. Do not drink liquids with meals.

a. Eat five to six small meals per day. b. Do not eat fried, fatty foods. c. Do not lie down immediately after eating. The client is experiencing pyrosis. Eating small frequent meals, avoiding fried foods, and not laying down immediately after eating will minimize the discomfort. Large quantities of carbohydrates and not taking liquids with meals will not change the discomfort being experienced.

A client is 6 weeks' pregnant. The client reports being nauseated every morning. Which measure will the nurse suggest the client use to help relieve nausea? a. Take two aspirin on arising. b. Delay toothbrushing until noon. c. Eat several dry crackers before getting out of bed. d. Take a teaspoon of baking soda before breakfast.

a. Eat several dry crackers before getting out of bed. The traditional solution for preventing nausea is for the pregnant client to keep dry crackers, such as saltines, by the bedside and eat a few before rising because increasing carbohydrate intake seems to relieve nausea better than any other nutrition remedy. The client can then eat a light breakfast or delay breakfast until 10 or 11 AM, which is past the time nausea seems to persist. Aspirin is irritating to the stomach and should not be taken. Delaying toothbrushing does not affect nausea. A teaspoon of baking soda should not be suggested, because this could adversely affect the client's electrolyte status.

A nursing instructor is explaining the stages of fetal development to a group of nursing students. The instructor determines the session is successful after the students correctly choose which time period as representing the pre-embryonic stage? a. From fertilization to the end of the second week after fertilization b. Approximately 2 weeks after fertilization to the end of the eighth week c. Approximately 9 weeks after fertilization to birth d. Approximately 6 weeks after fertilization to the end of 8 weeks

a. From fertilization to the end of the second week after fertilization The pre-embryonic stage begins at fertilization and lasts through the end of the second week after fertilization. The embryonic stage begins approximately 2 weeks after fertilization and ends at the conclusion of the eighth week after fertilization. The fetal stage begins at 9 weeks after fertilization and ends at birth. There is no distinct stage recognized approximately 6 to 8 weeks after fertilization. This is part of the embryonic stage period.

A client at 38 weeks' gestation is diagnosed with placental insufficiency. Which prescription from the health care provider will the nurse anticipate? a. Prepare the client for an induction of labor. b. Discharge the client home with daily nonstress testing. c. Assess the client's blood pressure every 2 hours. d. Administer one dose of betamethasone.

a. Prepare the client for an induction of labor. Placental insufficiency is a serious complication where the placenta no longer works properly to provide nutrition and oxygen to the fetus, nor remove waste products from the fetus. Because this client's fetus is at full term, the nurse would anticipate an induction of labor or a cesarean birth. The client is not stable enough to be sent home for monitoring. Hypertension can be a cause of placental insufficiency; however, at this point in the pregnancy, birth is the best option. Betamethasone is a steroid given to clients to hasten preterm fetal lung development. This client is at term and does not need betamethasone.

A client comes to the clinic with concerns about her pregnancy. She is in her first trimester and is now experiencing moderate abdominal pain on the right side. What would be the nurse's first action? a. Recommend an abdominal ultrasound to the doctor since this may be ectopic pregnancy. b. Reassure the mother that this is normal as the baby is implanting into the uterus. c. Obtain a detailed 24-hour intake to determine if the pain is related to what she has eaten. d. Encourage her to ambulate since gas pains are common in early pregnancy.

a. Recommend an abdominal ultrasound to the doctor since this may be ectopic pregnancy. The nurse should recognize that abdominal pain is not normal during pregnancy and warrants investigation since ectopic pregnancy is a distinct possibility. An abdominal ultrasound would be best practice for this complaint. Dismissing her reports as normal is not a wise choice.

The nurse teaches a sedentary pregnant client with a BMI of 35 about the importance of healthy lifestyle during pregnancy. Which goal would be appropriate for this client? a. Walk for 30 minutes 5 days a week. b. Adhere to a weight reduction diet. c. Participate in a daily aerobic dance program. d. Begin lifting weights for 30 minutes per day.

a. Walk for 30 minutes 5 days a week. For a sedentary client a walking program is an appropriate goal. Dieting/weight reduction is never recommended during pregnancy. A daily aerobic or weight lifting program are not appropriate goals for a sedentary client with a high BMI.

A woman in early pregnancy asks the nurse why she has palmar erythema. The nurse's reply would be based on the principle that palmar erythema is most likely caused by which of the following? a. an increased estrogen level b. an allergy to fetal protein c. reduced serum protein d. chorionic gonadotropin hormone secretion

a. an increased estrogen level The cause of palmar erythema during early pregnancy is unknown but is attributed to the increasing estrogen level.

A nurse is assessing a client's nutritional intake during pregnancy. What method will the nurse use to accomplish this? a. enacting a 24-hour nutrition recall b. weighing the client c. calculating the client's body mass index (BMI) d. having the client describe food cravings

a. enacting a 24-hour nutrition recall Nutritional status is an important assessment when caring for a pregnant client. Although all of the answers refer to interventions that the nurse should include in the assessment, the 24-hour nutrition recall is the best single method for assessing the client's nutritional intake. Depending upon the pre-pregnancy weight or BMI of the client, they may not be an indicator of current nutritional status. Food cravings are part of the nutritional recall.

During pregnancy most nutritional needs can be consumed in adequate amounts through the diet. Which nutrient is the exception to this statement? a. iron b. calcium c. sodium d. vitamin D

a. iron Although most nutrients are needed in greater amounts during pregnancy, most women who are at low nutritional risk can meet their nutrient needs throughout pregnancy from food alone. A notable exception is iron. Folic acid is another possible exception. As previously noted, fortified foods or supplements containing 600 micrograms of folic acid are recommended during pregnancy. A woman at low nutritional risk can meet the needs for calcium, sodium, and vitamin D in her diet.

A young woman with scoliosis has just learned that she is pregnant. Several years ago, she had stainless-steel rods surgically implanted on both sides of her vertebrae to strengthen and straighten her spine. However, her pelvis is unaffected by the condition. What does the nurse anticipate in this woman's pregnancy? a. potential for greater than usual back pain b. cesarean birth c. increased risk of miscarriage d. increased risk of fetal trauma

a. potential for greater than usual back pain Surgical correction of scoliosis (lateral curvature of the spine) involves implanting stainless-steel rods on both sides of the vertebrae to strengthen and straighten the spine. Such rod implantations do not interfere with pregnancy; a woman may notice more than usual back pain, however, from increased tension on back muscles. If a woman's pelvis is distorted due to scoliosis, a cesarean birth may be scheduled to ensure a safe birth, but this is not required in this scenario. Vaginal birth, if permitted, requires the same management as for any woman. With the improved management of scoliosis, the high maternal and perinatal risks associated with the disorder reported in earlier literature no longer exist.

During the initial prenatal visit, the nurse performs what assessment to guide teaching about nutrition during pregnancy? a. prepregnancy BMI b. current weight c. height and bone structure d. hemoglobin level

a. prepregnancy BMI Weight gain goal during pregnancy is based on the client's prepregnant BMI. Current weight and height are part of the BMI calculation. Hemoglobin level only provides information about iron stores, not overall nutritional status.

The nurse is planning a seminar that focuses on the 2030 National Health Goals during pregnancy for clients who are in the first trimester of pregnancy. Which information should the nurse include in this seminar? Select all that apply. a. refusing alcohol b. importance to stop smoking c. maintaining health appointments d. seeking alternative care approaches e. abstaining from drugs and substances

a. refusing alcohol b. importance to stop smoking c. maintaining health appointments e. abstaining from drugs and substances The 2030 National Health Goals for pregnancy include objectives to abstain from social and binge alcohol intake, avoid smoking, receive prenatal care, and abstain from illicit drugs. Seeking alternative care approaches is not a 2020 National Health Goal for pregnancy.

A woman in the third trimester of her first pregnancy expresses fear about the birth canal being wide enough for her to push the baby through it during labor. She is a petite person, and the baby seems so large. She asks the nurse how this will be possible. To help alleviate the client's fears, the nurse should mention the role of the hormone that softens the cervix and collagen in the joints, which allows dilation and enlargement of the birth canal. This hormone is which of the following? a. relaxin b. progesterone c. estrogen d. human placental lactogen

a. relaxin Relaxin, secreted by the corpus luteum of the ovary as well as the placenta, is responsible for helping to inhibit uterine activity and to soften the cervix and the collagen in joints. Softening of the cervix allows for dilatation at birth; softening of collagen allows for laxness in the lower spine and so helps enlarge the birth canal. The effect of estrogen is to cause breast and uterine enlargement. Progesterone has a major role in maintaining the endometrium, inhibiting uterine contractility, and aiding in the development of the breasts for lactation. Human placental lactogen (hPL), also known as human chorionic somatomammotropin, serves as an antagonist to insulin, making insulin less effective, thereby allowing more glucose to become available for fetal growth.

The nursing instructor is teaching students about normal changes of pregnancy. The instructor talks about diastasis recti. What is the instructor presenting? a. separation of the muscles of the abdominal wall b. raising of the uterus into the abdomen c. relaxation of the kidneys d. movement of the bladder to the rear of the pelvis behind the uterus

a. separation of the muscles of the abdominal wall By 20 weeks' gestation, muscles of the abdominal wall may begin to separate (diastasis recti) and not return to normal approximation until several weeks after childbirth. The term diastasis recti does not refer to the raising of the uterus into the abdomen, relaxation of the kidneys, or movement of the bladder.

A pregnant client reports chewing on ice throughout the day. Which laboratory value would the nurse evaluate? a. serum iron level b. serum potassium level c. serum glucose level d. serum sodium level

a. serum iron level Pregnant clients who crave ice often have an iron deficiency. A low serum iron level needs to be checked. The client's electrolyte values are not associated with cravings for ice.

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? a. "By this time, the fundus should drop down lower because the baby is moving towards the pelvic inlet." b. "At 36 weeks' gestation, the fundus is in the normal expected location." c. "To be honest, the fundus should be lower since you have gained minimal weight." d. "Just get prepared, the fundus might actually get a little higher until a few days before you go into labor."

b. "At 36 weeks' gestation, the fundus is in the normal expected location." The fundus grows to reach the umbilicus at 20 to 22 weeks and the xiphoid process of the sternum at 36 weeks. Therefore, this fundus is in the normal, expected location. After 36 weeks' gestation, lightening occurs and the fundus will drop ~4 cm below the xiphoid process. Once the fundus reaches the xiphoid process, it cannot go higher without severely compromising maternal respiratory efforts.

The nurse is providing care for a pregnant client who has been given the necessary requisitions for laboratory work by the primary care provider. The client notices that the lab tests include testing for HIV and other sexually transmitted infections, and expresses alarm, stating, "I don't understand why the doctor would suspect that I've got these diseases." What is the nurse's most therapeutic statement? a. "Unfortunately, these infections have the potential to harm the fetus. It's important that the doctor identifies them early in your pregnancy." b. "Every pregnant client is tested for these diseases; it doesn't necessarily suggest that the doctor suspects that you have them." c. "Pregnancy is a major change, so every member of the care team makes sure that your health is assessed carefully." d. "Sexually transmitted infections are much more common than most people believe."

b. "Every pregnant client is tested for these diseases; it doesn't necessarily suggest that the doctor suspects that you have them." The nurse should reassure the client that these lab tests are ordered for all clients, not only those who are at high risk for sexually transmitted infections. Making general statements about the incidence of sexually transmitted infections or the need for thorough care does not address the client's expressed concern.

During a physical assessment, the nurse palpates a pregnant client's fundus at the level of the umbilicus. What statement should the nurse make to the client about this assessment finding? a. "You are at 12 weeks of your pregnancy." b. "You are at 20 weeks of your pregnancy." c. "You are at 36 weeks of your pregnancy." d. "You can go into labor at any time now."

b. "You are at 20 weeks of your pregnancy." As a fetus grows, the uterus expands to accommodate its size. Typical fundal measurements are over the symphysis pubis at 12 weeks, at the umbilicus at 20 weeks, and at the xiphoid process at 36 weeks. The client will not be going into labor very soon.

The nurse is reviewing client data following a regular monthly appointment at 6 months' gestation. Which fundal height requires no further intervention? a. 18 cm b. 24 cm c. 30 cm d. 32 cm

b. 24 cm An anticipated fundal height for 24 weeks' gestation (6 months) is 24 cm. Between 18 and 32 weeks' gestation, the fundal height in centimeters should match the gestational age. All of the other measurements would require further intervention.

What advice should the nurse provide to a pregnant client who admits to continuing to drink alcohol 1 to 2 times a week? a. She should avoid alcohol in the first trimester. b. Alcohol should not be consumed during pregnancy. c. The affects of alcohol on the fetus are not fully understood. d. She may have an occasional drink after the first trimester.

b. Alcohol should not be consumed during pregnancy. There is no safe amount of alcohol to consume during pregnancy. If the client refuses or has a problem, alert the health care provider for the appropriate referral.

After a routine examination, a client tells the nurse that she plans to use a home pregnancy test to determine if she is pregnant. What should the nurse's response be to this client's plan? a. Use a diluted urine specimen. b. Arrange for prenatal care if the test is positive. c. Wait until after two missed menstrual periods. d. Refrain from eating for 4 hours before testing.

b. Arrange for prenatal care if the test is positive. After a positive pregnancy test, the first step should be to arrange for prenatal care. This is the response that the nurse should make to the client. The urine is not usually diluted for a home pregnancy test. The client should not wait for 2 months before determining if she is pregnant. Eating does not impact the results of the home pregnancy test.

The nurse is preparing to assess the nutritional status of a client who is 8 weeks pregnant. What is the most effective way for the nurse to assess the client's food intake thus far in the pregnancy? a. Assess skin status for hydration and color. b. Ask the client to describe total intake for a week. c. Assess a list that the client describes as a good diet. d. Ask the client to describe intake for the last 24 hours.

b. Ask the client to describe intake for the last 24 hours. The best method for assessing a woman's nutritional intake during pregnancy is to ask the client to list all the food eaten within the past 24 hours, starting with waking up until going to sleep. This method of history-taking yields much more accurate information than asking a client how often a specific food is eaten. Assessing skin status may provide more information about hydration than nutritional status. Assessing a total intake for a week would be too extreme for the client to recall. Assessing the client from a list of foods does not identify what the client has most recently eaten.

The nurse will be assisting a client during an amniocentesis. Which nursing intervention should the nurse prioritize? a. Caution about the opioid premedication. b. Be certain she is aware of potential complications. c. Ensure she understands the need for 2 days of bed rest. d. Expect test results within 1 week.

b. Be certain she is aware of potential complications. The client should be aware of the potential complications and risks, and should sign an informed consent. Opioids are contraindicated for pregnant woman due to side effects. She should maintain bed rest for the remainder of the day, with light housework the following day and a return to normal activities on the third day. It may take 2 or 3 weeks before the test results come back from the laboratory.

The nurse is assessing a client at 12 weeks' gestation who reports enjoying her usual slow, long daily walk. The nurse should point out which recommendation to this client? a. Reduce walking to half a block daily. b. Continue this as long as she enjoys it. c. Stop and rest every block. d. Engage in aerobics for greater benefits.

b. Continue this as long as she enjoys it. Walking is an excellent exercise during pregnancy because it is low impact and increases venous circulation. Exercise should be maintained as long as it is comfortable, but intensity should not increase over what is normally performed.

A nurse is caring for a woman at 8 weeks' gestation who is having nausea and vomiting, typically in the morning. Which nursing instruction would be most helpful? a. Awaken 30 minutes prior to the normal waking time to begin eating. b. Keep dry crackers at the bedside and eat before rising. c. Eat a bland breakfast in the morning, for example toast and tea. d. Prepare food for others first and then prepare your own.

b. Keep dry crackers at the bedside and eat before rising. The nurse should monitor the client for nausea and vomiting, which impacts the client's nutritional status. The sensation of nausea typically occurs upon rising in the morning. It is helpful to instruct the client to keep dry crackers at the bedside. Eating breakfast about 1-2 hours after waking up may be helpful. Bland breakfasts may be helpful but the timing is most important. Preparing food for others may make the client feel nauseated, which would make the client not want to eat.

The nurse is praising an adolescent for seeking health care as soon as the adolescent found out about being pregnant. Which nursing intervention is the priority for this client in the first trimester of pregnancy? a. Schedule the client for a screening glucose tolerance test. b. Make sure the client receives nutritional counseling and reinforce the teaching. c. Teach the client about needing 8 to 10 hours of sleep each night. d. Instruct on fetal development throughout the pregnancy.

b. Make sure the client receives nutritional counseling and reinforce the teaching. There are many important nursing interventions for an adolescent who is pregnant. Nutritional counseling must be emphasized as part of prenatal care for adolescent clients because adolescents already have higher nutritional demands due to their growth status. Nutrition is also a priority due to the fetus' development. Adolescents are not at increased risk for developing gestational diabetes, so the client does not need a glucose tolerance test at this time. Adolescents do need 8 to 10 hours of sleep per night, but this is not the priority education over nutrition education. Instruction on fetal development at the first visit may be overwhelming and is not the priority at this time.

During a routine prenatal visit, a pregnant woman reports a white, thick, vaginal discharge. She denies any itching or irritation. Which action would the nurse take next? a. Notify the health care provider of a possible infection. b. Tell the woman that this is entirely normal. c. Advise the woman about the need to culture the discharge. d. Check the discharge for evidence of ruptured membranes.

b. Tell the woman that this is entirely normal. Vaginal secretions increase during pregnancy and this is considered normal leukorrhea based on the woman's report that she is not experiencing any itching or irritation. There is no evidence indicating the need to notify the health care provider, check for rupture of membranes, or advise her about the need for a culture.

The nurse is assessing a pregnant client in her third trimester who is reporting a first-time occurrence of constipation. When asked why this is happening, what is the best response from the nurse? a. There is not enough fiber in your diet. b. The intestines are displaced by the growing fetus. c. This shouldn't be happening. d. hCG is delaying peristalsis.

b. The intestines are displaced by the growing fetus. The growing fetus is displacing the intestines and interfering with peristalsis, delaying the passage of fecal matter and resulting in constipation. This is common and expected; however, the client should take measures to prevent hemorrhoids that can occur as the result of the pressure and straining. Progesterone, not hCG, can delay gastric emptying and decrease peristalsis.

The nurse is preparing to administer a prescribed medication to the pregnant client. Which order should the nurse question? a. penicillin b. rubella c. acetaminophen d. folic acid

b. rubella Most vaccines are contraindicated during pregnancy and are considered teratogenic, such as rubella. Penicillin and acetaminophen may be taken under provider supervision. Folic acid supplementation should be encouraged.

A woman in her second trimester comes for a follow-up visit and says to the nurse, "I feel like I'm on an emotional roller-coaster." Which response by the nurse would be most appropriate? a. "How often has this been happening to you?" b. "Maybe you need some medication to level things out." c. "Mood swings are completely normal during pregnancy." d. "Have you been experiencing any thoughts of harming yourself?"

c. "Mood swings are completely normal during pregnancy." Emotional lability is characteristic throughout most pregnancies. One moment a woman can feel great joy, and within a short time she can feel shock and disbelief. Frequently, pregnant women will start to cry without any apparent cause. Some women feel as though they are riding an "emotional roller-coaster." These extremes in emotion can make it difficult for partners and family members to communicate with the pregnant woman without placing blame on themselves for their mood changes. Clear explanations about how common mood swings are during pregnancy are essential.

A pregnant client at 32 weeks' gestation remarks during a routine prenatal visit, "Sex is becoming difficult for us." Which would be the best response by the nurse? a. "If you and your partner are having problems, maybe decreasing the frequency of sex would be helpful." b. "Intercourse this late in pregnancy can be difficult. Do you think that abstaining is possible?" c. "Sex during pregnancy is a common concern. What do you mean by difficult?" d. "You should expect to have discomfort with sex because of the pregnancy. Discuss this with your obstetrician."

c. "Sex during pregnancy is a common concern. What do you mean by difficult?" Frank discussion about how sexual feelings and behaviors may change during pregnancy can help prevent and alleviate problems. The nurse should seek more information from the pregnant client regarding the difficulties that are encountered. Decreasing the frequency of sex or telling the client to abstain until after the birth does not address the cause of the difficulty. Discomfort should not be an issue, and if present should be investigated.

The nurse-midwife is performing a pelvic examination on a client who came to her following a positive home pregnancy test. The nurse checks the woman's cervix for the probable sign of pregnancy known as Goodell sign. Which description illustrates this alteration? a. The cervix looks blue or purple when examined. b. The lower uterine segment softens. c. The fundus enlarges. d. The cervix softens.

d. The cervix softens. At about the 8th week of gestation, the cervix softens, a probable sign known as Goodell sign. The cervix also looks blue or purple when examined; this is Chadwick sign, and may occur as early as the 6th week of pregnancy. At about 6 weeks, the lower uterine segment softens, a probable sign called Hegar sign. A softening of the uterine fundus, where the embryo has implanted, also occurs by about the 7th week, and the fundus enlarges by the 8th week.

Which teaching strategy would be most appropriate when educating a primipara about the changes that will occur during her pregnancy? a. Supply the client with a popular book on pregnancy and assign readings to prepare for upcoming visits. b. Encourage the client to write down questions and those topics will be the information presented during clinic visits. c. Be selective about the information provided and include those points most relevant to this particular client. d. The nurse asks the client if he or she can answer any questions so that the client controls the education.

c. Be selective about the information provided and include those points most relevant to this particular client. A client's receptiveness to instruction is key for the nurse. Regardless of how excited and pleased a woman is about being pregnant, she can assimilate only so much information at one time. It is important for the nurse to be selective about the health information provided and to include those points most relevant to the individual woman. Assigning homework is unrealistic and may not address information this particular client needs at the moment. Asking a client what she wants to know is important; however, a first-time pregnant woman will need to know normal versus abnormal signs/symptoms throughout the pregnancy and when to notify the clinic.

During an exam, the nurse notes that the blood pressure of a client at 22 weeks' gestation is lower, and her heart rate is 12 beats per minute higher than at her last visit. How should the nurse interpret these findings? a. The heart rate increase may indicate that the client is experiencing cardiac overload. b. The blood pressure should be higher since the cardiac volume is increased. c. Both findings are normal at this point of the pregnancy. d. Combined, both of these findings are very concerning and warrant further investigation.

c. Both findings are normal at this point of the pregnancy. A pregnant woman will normally experience a decrease in her blood pressure during the second trimester. An increase in the heart rate of 10 to 15 beats per minute on average is also normal, due to the increased blood volume and increased workload of other organ systems. Hormonal changes cause the blood vessels to dilate, leading to a lowering of blood pressure.

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? a. Begin a new exercise regimen. b. Wear support hose when exercising. c. Maintain tolerable intensity of exercise. d. Reduce the amount of exercise.

c. Maintain tolerable intensity of exercise. Women accustomed to exercise before pregnancy are instructed to maintain a tolerable intensity of exercise. They are instructed not to begin a new exercise regimen. A nurse does not tell the client to wear a support hose when exercising or to reduce the amount of exercises.

The nurse is assessing a pregnant client at 12 weeks' gestation and the client reports some new bumps on the dark part of her nipples. What is the best response from the nurse when questioned by the client as to what they are? a. normal bumps of pregnancy; they do nothing b. might be sign of cancer; need to speak with health care provider c. Montgomery glands (Montgomery tubercles); secrete lubricant for the nipples d. striae, stretching of the breast tissue

c. Montgomery glands (Montgomery tubercles); secrete lubricant for the nipples All women have Montgomery glands (Montgomery tubercles). They become more prominent during pregnancy and help to prepare the nipples for breastfeeding. The bumps are not specific to pregnancy and are not a sign of cancer. They are not the result of stretching.

A primigravid client states that she has heard that her nipples will leak milk during the pregnancy and is concerned of embarrassment if this should happen while she is at work. Which nursing suggestion is best? a. Have a change of clothing available in case the milk leakage happens. b. Limit fluid intake to prevent the production of milk prior to childbirth. c. Purchase a padded supportive bra to wear under your clothing. d. Place tape on your nipples to prevent nipple leakage while at work.

c. Purchase a padded supportive bra to wear under your clothing. The breasts prepare for breastfeeding even before birth of the infant. At about the 16th week of pregnancy, colostrum secretion begins in the breasts. The best suggestion is to wear a padded, supportive bra that can absorb the leakage without it coming through the clothing. Having a change of clothes does not prevent the problem, and it may be noticeable that clothing has been changed. Limiting fluid intake is not suggested. The pregnant woman needs to remain hydrated. Placing tape on the nipples may harm the nipples and, although accepted in a few cultures, is discouraged.

The nurse is obtaining a fetal nonstress test and having difficulty maintaining the fetal heart rate. What nursing action is most helpful? a. Switch to a fetal Doppler. b. Reposition the client on the left side. c. Recline the client backward. d. Offer the client a cold beverage.

c. Recline the client backward. The nurse has obtained the fetal heart rate but is having difficulty maintaining a strong signal. It is most helpful to recline the client to stretch the abdomen. This position gives more area to search for the fetal heart rate and obtain a stronger signal. It also can move the fetus. A handheld Doppler has less ability to receive the heart rate. Repositioning the client on the left side and offering a cold beverage may make the fetus more active but will not help to obtain a consistent heart rate.

A pregnant woman tends not to eat for long periods of time because of her busy work schedule. What process safeguards her fetus from becoming hypoglycemic during this time? a. The brain is too undeveloped to use glucose. b. Women naturally ingest complex carbohydrates to last for long periods during pregnancy. c. Somatomammotropin helps to regulate glucose levels. d. Fetal oxygen interferes with the metabolism of glucose and prolongs its action.

c. Somatomammotropin helps to regulate glucose levels. Somatomammotropin makes insulin "less effective" than normal, thus decreasing its ability to produce hypoglycemia.

When describing the role of a doula to a group of pregnant women, the nurse would include which information? a. The doula is a professionally trained nurse hired to provide physical and emotional support. b. The doula can perform any necessary clinical procedures. c. The doula primarily focuses on providing continuous labor support. d. The doula is capable of handling high-risk births and emergencies.

c. The doula primarily focuses on providing continuous labor support. Doulas provide the woman with continuous support throughout labor. The doula is a laywoman trained to provide women and families with encouragement, emotional and physical support, and information through late pregnancy, labor, and birth. A doula does not perform any clinical procedures and is not trained to handle high-risk births and emergencies.

A nurse is leading a discussion in a prenatal class for a group of primigravida clients. Which factor would the nurse include when explaining the changes that are expected to occur in the uterus during the pregnancy? a. Uterine growth occurs because of an increase in the number of cells in the uterus. b. The uterus moves into the abdomen by the second month of pregnancy. c. The uterus changes from a pear-shaped organ to an oval one. d. The uterus reaches its maximum height in the abdomen at 39 weeks.

c. The uterus changes from a pear-shaped organ to an oval one. The uterus starts as a pear-shaped organ and becomes oval as length increases over width. Uterine growth is primarily related to an increase in size of the myometrial cells. The uterus remains in the pelvic cavity for the first 3 months, after which it progressively ascends into the abdomen. The uterus reaches its highest level at the xiphoid process at approximately 36 weeks. Between 38 to 40 weeks, fundal height drops as the fetus begins to descend and engage into the pelvis.

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

c. a 33-year-old G5P1 with a history of cervical insufficiency Women who know they have cervical insufficiency or have had cerclage to correct this should consult with their obstetric provider before beginning or continuing an exercise program. The other pregnant females can continue their exercise programs with the routine precautions outlined.

A nurse at the health care facility assesses a client at 20 weeks' 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? a. at the top of the symphysis pubis b. halfway between the symphysis pubis and the umbilicus c. at the level of the umbilicus d. at the xiphoid process

c. at the level of the umbilicus In the 20th week of gestation, the nurse should expect to find the fundus at the level of the umbilicus. The nurse should palpate at the top of the symphysis pubis between 10 to 12 weeks' gestation. At 16 weeks' gestation, the fundus should reach halfway between the symphysis pubis and the umbilicus. With a full-term pregnancy, the fundus should reach the xiphoid process.

An 18-year-old pregnant woman asks the nurse why she has to have a routine alpha-fetoprotein serum level drawn. The nurse explains that this: a. is a screening test for placental function. b. tests the ability of her heart to accommodate the pregnancy. c. may reveal chromosomal abnormalities. d. measures the fetal liver function.

c. may reveal chromosomal abnormalities. An alpha-fetoprotein analysis is a cost-effective screening test to detect chromosomal and open-body-cavity disorders.

A client in her third trimester reports sleeping poorly: sleeping on her back results in lightheadedness and dizziness and lying on her side results in no sleep. Which suggestion for sleeping should the nurse prioritize for this client? a. without a pillow b. with a pillow under her shoulders c. with a pillow under her right hip d. with a pillow under both hips

c. with a pillow under her right hip Pregnancy places strain on the cardiovascular system with increased fluid in the lungs and heart. The use of one pillow under the right hip will help displace the uterus and fetus off the major blood vessels, allowing the circulation to flow appropriately and provide relief to the client. When the woman lies flat on her back the uterus and contents can compress the vena cava and aorta and reduce blood flow, resulting in the light-headedness and dizzy spells. Removal of the pillow would not alter the effects on the vena cava. A pillow under the shoulders would hurt the neck, and a pillow under both hips would exacerbate the light-headedness.

The nurse is screening for potential exposure to toxoplasmosis. Which question is most appropriate? a. "Do you have old paint in the house?" b. "Do you use well water for drinking?" c. "Do you lock your medications in a cabinet:" d. "Do you have a cat in the house?"

d. "Do you have a cat in the house?" Toxoplasmosis is caused by a protozoan that is passed from animals (such as cats) to humans via animal feces. If the woman contracts toxoplasmosis while she is pregnant, it can cause a miscarriage or fetal abnormalities.

A client in her 29th week of gestation reports dizziness and clamminess when assuming a supine position. During the assessment, the nurse observes there is a marked decrease in the client's blood pressure. Which intervention should the nurse implement to help alleviate this client's condition? a. Keep the client's legs slightly elevated. b. Place the client in an orthopneic position. c. Keep the head of the client's bed slightly elevated. d. Place the client in the left lateral position.

d. Place the client in the left lateral position. The symptoms experienced by the client indicate supine hypotension syndrome. When the pregnant woman assumes a supine position, the expanding uterus exerts pressure on the inferior vena. The nurse should place the client in the left lateral position to correct this syndrome and optimize cardiac output and uterine perfusion. Elevating the client's legs, placing the client in an orthopneic position, or keeping the head of the bed elevated will not help alleviate the client's condition.

A primigravid client arrives at the health clinic smelling like they had been recently smoking a cigarette. Upon assessing the client for tobacco use, the client states, "I know people who smoked during their pregnancy and their babies were fine." When assisting the client to understand the most concerning impact of smoking on the fetus, the nurse is correct to state which? a. Smoking during pregnancy impacts the heart valves of the fetus. b. Smoking during pregnancy damages the fetal lungs. c. Smoking during pregnancy causes a lower intelligence level of the fetus. d. Smoking during pregnancy limits the supply of blood to the fetus.

d. Smoking during pregnancy limits the supply of blood to the fetus. The nurse is correct to provide instruction and guidance on the effects of smoking during pregnancy. It is most important for the client to understand that smoking during pregnancy limits the blood supply to the fetus due to the vasoconstrictive effects of the nicotine. This may result in a stillborn or low-birth-weight newborn. In addition, the placenta may be less effective due to the effect of tar in the system, again limiting blood supply. The heart and lungs of the fetus may be impacted primarily by the poor circulatory effect. Depending upon the ability of oxygen to get to the fetal brain, cognitive impairment may also be identified due to the circulatory effect.

The nurse provides instructions to a client with hyperemesis gravidarum. Which outcome indicates that teaching has been effective? a. The client has vomiting episodes only in the morning. b. The client is able to tolerate soft foods after episodes of vomiting. c. The client is able to ingest clear liquids between episodes of vomiting. d. The client is able to ingest a regular diet after progressing through clear liquids and soft foods.

d. The client is able to ingest a regular diet after progressing through clear liquids and soft foods. The pregnant client with hyperemesis gravidarum may be hospitalized and treated with intravenous fluids. If there is no vomiting after the first 24 hours of oral restriction, small amounts of clear fluid can be started, and the woman discharged home. If able to take clear fluid without vomiting, small quantities of dry toast, crackers, or cereal can be added every 2 or 3 hours, then the woman may be gradually advanced to a soft diet and then to a regular diet. If vomiting returns at any point, enteral or total parenteral nutrition may be prescribed to ensure she receives adequate nutrition. Vomiting episodes in the morning or tolerating clear liquids or soft foods between vomiting episodes indicates that teaching has not been effective.

A nursing student is explaining to a newly pregnant woman what happens during each stage of fetal development. At which stage does the nurse inform the woman that the lungs are fully shaped? a. end of 4 weeks b. end of 8 weeks c. end of 12 weeks d. end of 16 weeks

d. end of 16 weeks At the end of 16 weeks, the lungs are fully shaped, fetus swallows amniotic fluid, skeletal structure is identifiable, downy lanugo hair is present on the body, and sex can be determined using ultrasound.

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? a. dyspnea b. lower abdominal pressure c. swelling of extremities d. excessive vomiting

d. 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 these cardiac variations, if found in the client who is pregnant, should the nurse recognize as a normal finding in pregnancy? a. split S1S2 b. premature ventricular contractions c. S4 (atrial gallop) d. soft systolic murmur

d. soft systolic murmur A soft systolic murmur is common in pregnancy secondary to increased blood volume. The other findings are not normal and require further assessment by the nurse.

A woman has a positive pregnancy test and comes to the nurse with left lower quadrant pain. Bimanual examination reveals a tender mass. Which of the following is suspected? a. threatened abortion b. appendicitis c. ovarian cyst d. tubal pregnancy

d. tubal pregnancy Lower quadrant pain in a young woman could represent any of these possibilities. A positive HCG test and left, not right-sided, pain make appendicitis less likely. Presence of an extrauterine mass makes threatened abortion less likely.

The nurse teaches a primigravida client that lightening occurs about 2 weeks before the onset of labor. What will the mother likely experience at that time? a. dysuria b. dyspnea c. constipation d. urinary frequency

d. urinary frequency Lightening refers to the descent of the fetal head into the pelvis and engagement. With this descent, pressure on the diaphragm decreases, easing breathing, but pressure on the bladder increases, leading to urinary frequency. Dysuria might indicate a urinary tract infection. Constipation may occur throughout pregnancy due to decreased peristalsis, but it is unrelated to lightening.