Chapter12 PrepU
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?
Continue this as long as she enjoys it.
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 -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.
A nurse is providing education to a client who is 8 weeks' pregnant. The client stated she does not like milk. What is a source of calcium that the nurse can recommend to the client?
dark, leafy green vegetables
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." -Sexual needs may be met through sexual intercourse with a partner as long as the pregnancy is healthy and there are no other risk factors, such as bleeding or rupture of membranes. Pregnancy is a time of a heightened need for touch, which may be met partially by sexual expression, but which can also be met through nonsexual touch, such as massage, caressing, or holding.
A nurse is caring for a client who is 8 months pregnant. Which instruction is the nurse most likely to give her?
Rest on the left side for at least 1 hour in the morning and afternoon. -
Which pregnant woman should consult with her obstetric provider before continuing an exercise program?
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 woman is 20 weeks pregnant. The nurse would expect to palpate the fundus at which location?
at the umbilicus
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.
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?
"Babies of women who smoke tend to weigh significantly less than other infants."
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 - Some clients will not seek early prenatal care, especially if it is not their first pregnancy. The uterus expands to reach the height of the umbilicus by week 20. Before week 20 it is too low to be palpated, and after week 20 it may be beyond the umbilicus.
At 32 weeks' gestation a client with a BMI of 23 has gained 24 lb (11 kg). What is the nurse's recommendation for weight gain for the remainder of this pregnancy?
Continue to gain approximately 1 lb (.45 kg) per week during this pregnancy.
The client states that the first day of her last menstrual period is March 23. The nurse is most correct to calculate using Naegele rule that the estimated date of delivery is:
December 30 Using Naegele rule, since the first day of the client's last menstrual period is March 23, 7 days are added leading to the 30th. Subtracting 3 months from March is December. Thus, December 30 is the estimated date of delivery.
A client at 28 weeks' gestation is asking for a laxative for constipation. What action would the nurse recommend?
Eat fiber-rich foods.
The nursing instructor is explaining the nursing care that is given to a client during her pregnancy. The instructor determines the session is successful when the students correctly choose which method will be used to evaluate the effectiveness of the nursing care they will provide?
Verify that desired outcomes for identified goals have been met.
A woman who is 4 months pregnant notices frequent heart palpitations and leg cramps. She is anxious to learn how to alleviate these. Which nursing diagnosis would best apply to her?
Health-seeking behaviors related to ways to relieve discomforts of pregnancy
The nurse is caring for a neonate whose mother received no medical care for either of her pregnancies. When assessing the neonate's status, which would indicate a potential A, B, and O incompatibility?
Hemolytic anemia -Antibody screens are done to recognize women who may be at risk of developing antigen incompatibilities with fetal red blood cells. If the incompatibility develops, and is not addressed quickly, the neonate may develop hemolytic anemia as the mother's antibodies cross the placenta and attack the fetus's red blood cells. Hypothyroidism can affect the fetus's nervous system. Dehydration may lead to electrolyte deficiencies. Abnormal bleeding is less common due to the initiation of Vitamin K.
A client is preparing to leave the clinic after her first prenatal visit. What is important for the woman to do before she leaves the office?
Make a follow-up appointment.
The nurse performs a nonstress test (NST) on a client at 36 weeks' gestation. What criteria does the nurse look for on the tracing to determine that the NST is reactive?
Presence of 2 accelerations in 20 minutes -An NST is an assessment of fetal well-being. The criteria for a reactive NST is the presence of two accelerations in a 20-minute window. The presence of decelerations or contractions would require further evaluation of fetal status.
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 -Lead ingestion during pregnancy may lead to a newborn who is both cognitively and neurologically challenged. Formaldehyde exposure can lead to spontaneous abortions. Breathing air filled with pollutants (such as carbon monoxide) has been shown to lead to fetal growth restriction. The rubella virus' teratogenic effects on a fetus can be devastating, such as hearing impairment, cognitive and motor challenges, cataracts, and cardiac defects.
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?
"Every pregnant client is tested for these diseases; it doesn't necessarily suggest that the doctor suspects that you have them."
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." -The client should remain sitting for 1 to 3 hours after eating and avoid lying down within 3 hours of eating. Cutting out caffeine, chewing food slowly, and raising the head of the bed are helpful in reducing heartburn of pregnancy.
A gravida woman in her second trimester has shared that she still enjoys a glass of wine about once a week with dinner. What response by the nurse is most appropriate?
"There is no amount of alcohol consumption in pregnancy that is considered safe for the fetus."
At 24 weeks' gestation a client is asked to drink a sweet orange solution and then wait an hour to have blood drawn. The client asks if this is the test to determine if she has diabetes. What is the best response by the nurse?
"This is a screening procedure. If your result is elevated you will be scheduled for a longer test to determine if you have gestational diabetes."
During the interview portion of her first prenatal visit, a woman reports she thinks she may have a vaginal infection. When questioned, she reports the discharge is thick, greenish-yellow, and she is very uncomfortable. She reports she thinks it is "yeast." How should the nurse reply?
"Yeast is usually a thick, cheesy, white discharge so we will need to evaluate it during the pelvic exam."
When providing preconception care to a client, which instruction would be most important for the nurse to provide about medications during pregnancy?
"You need to talk with your provider about using medications."
A primigravida at her 12-week prenatal visit expresses concern that she hasn't felt her baby move yet. What is the best response from the nurse?
"You usually cannot feel them until approximately 16 to 20 weeks." -The first fetal movements felt by the pregnant woman are usually felt between 16 and 20 weeks gestation. Thirteen weeks is too early (fetus is too small), and movements cannot be felt even if the woman lies down and concentrates on them, although the woman should start feeling movements within the next few weeks.
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 - The diagonal conjugate, usually 12.5 cm or greater, indicates the anteroposterior diameter of the pelvic inlet. The diagonal conjugate is the most useful measurement for estimating pelvic size because a misfit with the fetal head occurs if it is too small.
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 -The GTPAL system is used to classifying pregnancy status. G = gravida, T= term, P = preterm, A = number of abortions, L= number of living children.
A client in the third trimester of pregnancy has to travel a long distance by car. The client is anxious about the effect the travel may have on her pregnancy. Which instruction should the nurse provide to promote easy and safe travel for the client?
Always wear a three-point seat belt.
The nurse discovers a new prescription for Rho(D) immune globulin for a client who is about to undergo a diagnostic procedure. The nurse will administer the Rho(D) immune globulin after which procedure?
Amniocentesis -Amniocentesis is an invasive procedure whereby a needle is inserted into the amniotic sac to obtain a small amount of fluid. This places the pregnancy at risk for a woman with Rh(D)-negative blood, since the puncture can allow the seepage of blood and amniotic fluid into the woman's system. She should receive Rho(D) immune globulin after the procedure to protect her and future babies. The CST, NST, and a biophysical profile are noninvasive tests.
The nurse is assigned to clients who are having the following procedures: amniocentesis, fetal nonstress test, chorionic villus sampling, percutaneous umbilical blood sampling, and Doppler assessment of fetal heart rate. For which clients will the nurse ensure that signed informed consent has been given and is in the client's record?
Amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling - While the client ultimately consents to all procedures, some require signed documentation of consent within the client's record. An informed consent is needed for an amniocentesis, chorionic villus sampling and a percutaneous umbilical blood sampling due to the invasive nature of the procedures. Both the fetal nonstress test and the Doppler assessment of the fetal heart rate are non-invasive procedures.
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 -Naegele rule is to subtract 3 months and add 7 days from the first day of the last menstrual period to determine an expected due date, making the client's due date April 27.
What is the most effective way for a nurse to assess a woman's usual food intake during her pregnancy?
Ask her to describe her intake for the last 24 hours.
At the first prenatal visit, the client reports her LMP was November 16, 2019. The nurse determines the estimated due date to be:
August 23, 2020. - There are several methods to determine the EDB. Nagele's rule can be used, which involves subtracting 3 months and then adding 7 days to the first day of the LMP. Then correct the year by adding 1 where necessary. Another method is to add 7 days and then add 9 months and add 1 to the year where needed. Thus the client reports her LMP was Nov 16, 2019, subtract 3 months (August), add 7 days (23), and add 1 year (2020). This client's EDB is August 23, 2020.
A client in her third month of pregnancy arrives at the health care facility for a regular follow-up visit. The client reports discomfort due to increased urinary frequency. Which instruction should the nurse offer the client to reduce the client's discomfort?
Avoid consumption of caffeinated drinks. To reduce the client's urinary frequency, the nurse should instruct the client to avoid consuming caffeinated drinks, since caffeine stimulates voiding patterns. The nurse instructs the client to drink fluids between meals rather than with meals if the client complains of nausea and vomiting. The nurse instructs the client to avoid an empty stomach at all times, to prevent fatigue. The nurse also instructs the client to munch on dry crackers or toast early in the morning before arising if the client experiences nausea and vomiting; this would not help the client experiencing urinary frequency.
Which finding is most worrisome in a client in her 26th week of pregnancy?
facial edema - Generalized hair loss, hyperpigmented maxillary rash (chloasma), and nosebleeds are usually benign and common in pregnancy. Facial edema after the 24th week of gestation may indicate gestational hypertension.
A pregnant client tells the nurse that she has a 2-year-old child at home who was born at 38 weeks; she had a miscarriage at 9 weeks; and she gave birth to a set of twins at 34 weeks. Which documentation would be appropriate for the nurse?
gravida 3, para 4
Which possible complication associated with back pain can lead to premature contractions?
bladder or kidney infection - Obtaining a detailed account of a woman's back symptoms is crucial because back pain can be an initial sign of a bladder or kidney infection. Increased ICP, spinal fluid leak, and a herniated disc are usually not associated with back pain during a normal pregnancy.
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. - The nurse should inform the client that children born of mothers who use nicotine will have a decreased birth weight. Spontaneous abortion (miscarriage) is associated with caffeine use. Increased risks of stillbirth and placental abruption (abruptio placentae) are associated with mothers addicted to cocaine.
Which finding from a woman's initial prenatal assessment would be considered a possible complication of pregnancy that requires reporting to a primary care provider for management?
episodes of double vision -Difficulty with vision can occur from cerebral edema or is a symptom of hypertension of pregnancy.
A common report during pregnancy is heartburn. What should the nurse recommend to decrease the discomfort of heartburn?
Eat small, frequent meals.
A client in her second trimester arrives at a health care facility for a follow-up visit. During the exam, the client reports constipation. Which instruction should the nurse offer to help alleviate constipation?
Ensure adequate hydration and bulk in the diet.
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?
Use extra pillows.
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?
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.
At 34 weeks' gestation a client is diagnosed with preeclampsia and sent home on bed rest. The nurse teaches the client to contact the provider immediately if she experiences which change?
Decreased fetal movement -Decreased fetal movement may indicate decreased fetal oxygenation as a result of hypertension. This is a risk to fetal well-being and the provider needs to be contacted. Decreased weight and increased urine output are signs that the body is mobilizing excessive fluid, and are normal findings. Change in appetite is unrelated to preeclampsia.
The nurse is meeting with a client at 28 weeks' gestation. To prepare her for the final trimester, which factor should the nurse prioritize in the teaching session?
Decreasing shortness of breath
A woman in early pregnancy is concerned because she is nauseated every morning. Which measure would be best to help relieve this?
Delay breakfast until mid-morning. -The cause of morning sickness is unknown. Delaying eating until the nausea passes can be helpful. Aspirin is irritating to the stomach and would increase symptoms.
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.
Do not lie down immediately after eating. Eat five to six small meals per day. Do not eat fried, fatty foods.
The nurse discovers a soft systolic murmur when auscultating the heart of a client at 32 weeks' gestation. Which action would be most appropriate?
Document this and continue to monitor the murmur at future visits. - Due to the increased blood volume that occurs with pregnancy, soft systolic murmurs may be heard and are considered normal.
A 41-year-old pregnant woman and her husband are anxiously awaiting the results of various blood tests to evaluate the fetus for potential Down syndrome, neural tube defects, and spina bifida. Client education should include which information?
Further testing will be required to confirm any diagnosis. - Nursing management related to marker screening tests consists primarily of providing education about the tests. Remind the couple that a definitive diagnosis is not made without further tests such as an amniocentesis. The blood tests are not definitive but only strongly suggest the possibility of a defect. For some conditions there are no treatments. The couple may request a second set, but the health care provider will probably suggest proceeding with the more definitive methods to confirm the diagnosis.
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 spontaneous abortion (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 - Gravida (G) is the total number of pregnancies she has had, including the present one. Therefore she is G3 and not G2. Para (P), the outcome of her pregnancies, is further classified by the FPAL system as follows: F = Full term: number of babies born at 37 or more weeks of gestation, which is 0 and not 1 in this case. P = Preterm: number of babies born between 20 and 37 weeks of gestation, which is 0 in this case. A = Abortions: total number of spontaneous and elective abortions, which is 2 in this case. L = Living children, as of today. She has no living children; therefore, it is 0 and not 1.
Why is a Papanicolaou test done at the first prenatal visit?
It identifies abnormal cervical cells.
A woman reports that her last menstrual period (LMP) occurred February 1, 2017. Using the Naegele rule, what would be her estimated date of delivery (EDD)?
November 8, 2017 - To determine the due date using Naegele rule, add 7 days to the date of the first day of the LMP, and then subtract 3 months.
A 31-year-old client at 28 weeks' gestation reports frequent low back pain and ankle edema by the end of the day. Which suggestion should the nurse prioritize for this client?
Rest when possible with feet elevated at or above the heart. -Resting in the recumbent position helps alleviate stress on the back, and elevating the legs will help relieve the edema. Soaking the feet or lying on the right side will not alleviate the edema. Sitting semi-Fowler's is not enough to alleviate the edema.
The health care provider has prescribed an over-the-counter antacid for a pregnant client in her first trimester who is having ongoing nausea, vomiting, and heartburn. Which instruction concerning the antacid should the nurse prioritize after noting the client is also prescribed a multivitamin supplement?
Take antacid 1 hour after the multivitamin. Antacids interfere with the uptake of the vitamin contents so the client should take the antacid 1 hour after taking the multivitamin. Caffeine should be avoided due to increases in blood pressure and diuretic effects. Antacids can be taken more often than solely at bedtime, and some clients need them after each meal. Antacids do not have to be taken with dairy products. The priority is to avoid allowing the antacid to cancel out the multivitamin.
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. -A biophysical profile uses a combination of factors to determine fetal well-being based upon five fetal biophysical variables. An NST is done to measure FHR acceleration. Then an ultrasound is done to measure breathing, body movements, tone, and amniotic fluid volume. Each variable receives a score from 0 to 2 for a maximum score of 10. A score of 6 or less indicates altered fetal well-being and indicates a need for further assessment. A needle is not involved with the BPP. The BPP does not detect placental problems, and the BPP is not a screening for neural tube defects.
When describing the role of a doula to a group of pregnant women, the nurse would include which information?
The doula primarily focuses on providing continuous labor support.
A nurse in an obstetric clinic is preparing the staff for a prenatal appointment with an incarcerated pregnant woman. What does the nurse explain is the main difference when an incarcerated client comes to the clinic?
There will be correction officers with the woman throughout her appointment.
The nurse receives a call from a concerned client, who is 39 weeks' gestation, indicating the woman has "blood-tinged mucus seeping from the vagina." What does the nurse understand about this?
This is known as "bloody show" and is a normal finding at this time.
The nurse is preparing the client for the routine laboratory tests that will be obtained at the first prenatal visit. Which test will the nurse prioritize at this visit?
hepatitis screen - The woman will undergo tests for hepatitis B, HIV, syphilis, gonorrhea, and chlamydia. Each of these infections can cause serious fetal problems unless they are treated. Rubella is more concerning than rubeola and a titer may be completed to assess the woman's immunity to rubella. Other blood tests will include a complete blood count to evaluate anemia, blood type and antibody screen, and possibly thyroid screen to evaluate for hypothyroidism.
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?
potential for greater than usual back pain
During the initial prenatal visit, the nurse performs what assessment to guide teaching about nutrition during pregnancy?
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.
A nurse is providing care to a pregnant client who is 9 weeks gestation. The client reports that her breasts have become quite tender. She says, "I know my breasts are going to get bigger, but I didn't think that it would be uncomfortable." The nurse offers suggestions to address this discomfort, based on the understanding that this change is the result of which hormones? Select all that apply.
progesterone estrogen
A pregnant client reports chewing on ice throughout the day. Which laboratory value would the nurse evaluate?
serum iron level
Untreated hyperemesis can lead to preterm birth. What is the cause of the preterm birth?
severe dehydration resulting in hypoperfusion of the placenta - With severe dehydration there is hypoperfusion to the placenta, and preterm labor may be initiated. Ketonuria impacts the fetus' neurologic development but does not initiate preterm labor. Medications used to control nausea and vomiting do not induce labor.
During the initial history and physical of a 30-year-old primipara 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.
snorting cocaine once or twice a month smoking 2 packs of cigarettes a day drinking alcoholic beverages 3 times a week
The nurse is assisting a primigravid on calculating the due date of her baby using Naegele's rule. The most important information provided by the mother is:
the first day of the last menstrual period.
In preparing for a preconception class, the nurse plans to include a discussion of potential risk factors. Which risk factor would be most important to include?
the use of OTC drugs with teratogens
A nurse is caring for a pregnant client in her second trimester of pregnancy. The nurse educates the client to look for which danger sign of pregnancy needing immediate attention by the primary care provider?
vaginal bleeding - In a client's second trimester of pregnancy, the nurse should educate the client to look for vaginal bleeding as a danger sign of pregnancy needing immediate attention from the primary care provider. Generally, painful urination, severe/ persistent vomiting, and lower abdominal and shoulder pain are the danger signs that the client has to monitor for during the first trimester of pregnancy.