EAQ: adaptations to pregnancy

The nurse is caring for a pregnant client who reports constipation. Which instructions does the nurse give to the client about relieving constipation?

"Consume at least 28 g of fiber per day." Eat whole grains and fresh fruits." "Drink at least 50 ml/kg/day of fluids."

A pregnant client complains of constipation. While checking the client's history, the nurse learns that the client is taking oral iron supplements. What instruction does the nurse give the client to relieve constipation?

"Drink six to eight glasses of water every day."

What common complications are seen during the third trimester of pregnancy?

Constipation Urinary frequency Disturbance in sleep Difficulty breathing

A pregnant woman with a body mass index (BMI) of 22 asks the nurse how she should be gaining weight during pregnancy. The nurse's best response is to tell the woman that her pattern of weight gain should be approximately:

2 to 5 lbs during the first trimester, then a pound each week until the end of pregnancy.

What factors change significantly during pregnancy?

Albumin levels Hematocrit value Gastric secretions

The nurse who provides preconception care understands that it involves what?

Could include interventions to reduce substance use and abuse

Some men experience pregnancy-like symptoms, such as nausea, weight gain, and other physical symptoms. What is this phenomenon called?

Couvade syndrome

The nurse is teaching a pregnant client who complains of vomiting about the use of dry carbohydrate in the morning. The client asks the nurse, "My husband has similar problems. Will it be useful for my husband as well?" What can the nurse interpret that the husband has?

Couvade syndrome.

After reviewing the laboratory reports of a pregnant client with a history of depression, the nurse concludes that the client is at risk of postpartum depression. Which laboratory findings support the nurse's assumptions?

Decrease in thyroxine levels Increase in blood glucose levels

In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes what as the most important factor affecting pregnancy outcome?

Degree of glycemic control during pregnancy

Which behaviors would be exhibited during the letting go phase of maternal role adaptation?

Emergence of Family unit Sexual intimacy relationship continuing Defining one's individual roles

What is the role of the nurse while performing a research study on perinatal women?

Ensure that women are fully informed and aware of their rights.

The perinatal continuum of care begins with what?

Family planning and preconception care

While examining a pregnant client who is in the 38th week of gestation, the nurse finds a decrease in the fundal height. What is the reason for such a finding?

Fetal engagement

The nurse is teaching a pregnant client about body mechanics to decrease discomfort related to the lumbar curve of pregnancy. Which statement made by the client indicates the need for additional teaching?

I should adjust my car seat such that my knees are lower than my hips."

The nurse is providing exercise tips to an 18-week pregnant client. Which statement made by the client indicates the need for additional teaching?

I should lie on my back for 10 minutes after exercising."

Cardiovascular system changes occur during pregnancy. Which finding is considered normal for a woman in her second trimester?

Increased pulse rate

What hepatic changes are considered normal during pregnancy?

Increased serum albumin Increased serum alkaline phosphatase Increased serum cholesterol

A client in the second trimester of pregnancy reports constipation. What does the nurse explain to the client as the reason for this condition?

Iron supplements may cause constipation and darkened stool.

How many veins and arteries are present between the maternal and the fetal circulatory system by the 5th week of pregnancy?

One vein and two arteries

Which fetal complication is increased by maternal cigarette smoking?

Low-birth-weight baby

What are the metabolic changes associated with pregnancy?

Maternal production of insulin increases during the first trimester. Fasting blood glucose levels will decrease during the first trimester. There is enough glucose for the fetus during the second trimester.

The nurse is preparing a care plan for an obese pregnant client. Which pregnancy complications should be addressed when planning care?

Miscarriage Hypertension Gestational diabetes

Which physiologic change causes a postpartum increase in circulating blood volume?

Mobilization of extravascular fluid

Maternal physiologic changes in the puerperium enable the woman to cope with the blood loss that normally occurs during birth by increasing her circulating blood volume. What are the maternal physiologic changes?

Mobilization of extravascular water stored during pregnancy. Loss of placental endocrine function, which removes the stimulus for vasodilation. Elimination of uteroplacental circulation, which reduces the size of the maternal vascular bed by 10% to 15%.

What type of cultural concern is the most likely deterrent to many women seeking prenatal care?

Modesty

In understanding and guiding a woman through her acceptance of pregnancy, a maternity nurse should be aware of what?

Mood swings most likely are the result of worries about finances and a changed lifestyle, as well as profound hormonal changes.

A pregnant client after 20 weeks of gestation reports painless bright red vaginal bleeding. Upon assessment the nurse finds that the client's vital signs are normal. Which condition does the nurse suspect in the patient?

Placenta previa

The primary health care provider finds that a pregnant client has low hematocrit values but does not consider the woman anemic. Why is the pregnant woman with low hemaotocrit values not considered anemic?

Plasma volume expands rapidly during pregnancy.

After reviewing the medical reports of a client, the nurse finds that the client has multifetal gestation. What could be the most likely complication associated with this?

Postpartum hemorrhage (PPH)

What are some common maternal and fetal indications for antepartum testing?

Preeclampsia Previous stillbirth Fetal growth restriction Premature rupture of membranes

A client who is planning for a pregnancy and has type 1 diabetes mellitus is seeking preconception care. On which aspect does the nurse primarily focus while planning preconception care for the client?

Prevention of fetal malformations

What nursing interventions will help a woman reorder her relationships as she adapts to pregnancy?

Promoting sexual expression between the pregnant woman with her partner Promoting communication between the pregnant woman and her mother

The nurse is assessing a client with hyperemesis gravidarum during the early stages of pregnancy. Which nonpharmacologic measure is appropriate to alleviate the discomforts associated with nausea and vomiting?

Providing environment that is free from odors

The nurse instructs a pregnant client to wear a supportive bra. How would this intervention benefit the client?

Reduction of pressure on the ulnar nerve

What action does the nurse take to provide perinatal care that is based on information gained through research and clinical trials?

Refer to evidence-based practice.

The nurse is reviewing the lab reports of a client who is 10 weeks pregnant and has a family history of diabetes mellitus. The nurse finds that the client's 1-hour glucose tolerance test is normal. What does the nurse advise the client?

Repeat the test at 28 weeks

Although remarkable developments have occurred in reproductive medicine, assisted reproductive therapies are associated with a number of legal and ethical issues. Nurses can provide accurate information about the risks and benefits of treatment alternatives so couples can make informed decisions about their choice of treatment. Which issues would need to be addressed by an infertile couple before treatment?

Risk of multiple gestation Whether or how to disclose the facts of conception to offspring Freezing embryos for later use Stress management techniques and couple counseling

The nurse is assessing a client at 30 weeks of pregnancy with poorly controlled pregestational diabetes. The client has come for the antenatal visit on a Monday. When should the nurse ask the client to come next?

Same week on a Thursday

A client reveals the first day of the last menstrual period (LMP) as November 25, 2014. After an assessment, the nurse confirms that the client is pregnant. What will be the estimated date of birth (EDB)?

September 1, 2015

A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse would be most concerned regarding what this woman consumes during and after tennis matches. Which is the most important?

Several glasses of fluid

Which behavior indicates that a woman is "seeking safe passage" for herself and her infant?

She keeps all prenatal appointments.

The nurse is teaching student nurses about acid-base values in the arterial blood of pregnant women. Which statement made by a student nurse indicates the need for additional teaching?

Sodium bicarbonate levels increase during pregnancy."

The nurse is providing care for a client with twins during labor. The nurse instructs the client to avoid lying flat on the back. Which condition does the nurse aim to prevent in the client during labor?

Supine hypotension

A client in the first trimester of pregnancy reports feelings of ambivalence. How does the nurse react to this finding?

The nurse understands it as a normal response during pregnancy.

The nurse is caring for a 3-month pregnant woman who reports, "I always feel very thirsty." What does the nurse infer from the patient's statement?

The patient has increased loss of water from the body.

The nurse is caring for a client who is in the third trimester of pregnancy. The client reports pain in the pelvic joints. What does the nurse recognize as the cause of the pain?

There is relaxation of the pelvic joints.

An expectant father confides in the nurse that his pregnant wife, 10 weeks of gestation, is driving him crazy. "One minute she seems happy, and the next minute she is crying over nothing at all. Is there something wrong with her?" What is the nurse's best response?

This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant."

Which TORCH infection could be contracted by the infant because the mother owned a cat?

Toxoplasmosis

Which suggestion about weight gain is an accurate recommendation?

Underweight women should gain 12.5 to 18 kg. Obese women should gain at least 7 kg. Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale. The desirable weight gain during pregnancy varies among women.

Which of the following statements about the prevalence of perinatal mental health problems is true?

Up to a quarter of pregnant women will experience some aspect of depression during their pregnancy. Income status plays a significant role in the presentation of perinatal mental health problems. Between 30 and 50 billion dollars accounts for productivity and direct medical costs related to depression in women.

The nursing instructor is teaching a group of students about preconception counseling and care. The student nurse asks the nurse about interventions that can decrease the incidence of spina bifida in the fetus. Which answer does the nurse give to the student? The patient:

includes a daily intake of 600 mcg of folic acid during pregnancy.

A nurse providing care for the antepartum woman should understand that the contraction stress test (CST):

is considered negative if no late decelerations are observed with the contractions.

A pregnant client is unable to curtail her alcohol abuse. Which nursing intervention could be performed to reduce complications in the fetus?

suggest that the client take a multivitamin supplement.

A student nurse is teaching a group of pregnant women about sibling adaptation. Which statement by one of the clients indicates a need for additional teaching?

"Exclude the child during infant feeding times."

Which information does the nurse include in preconception counselling for a client with Marfan syndrome, who also presents with an aortic root diameter of more than 6 cm?

"There is an increased chance of maternal mortality." "The newborn child may develop Marfan syndrome." "You may not be able to deliver the child vaginally."

A client with hypothyroidism asks the nurse if it is safe to take thyroid medication during pregnancy. What response should the nurse give to the client?

"Thyroid medications do not affect the fetus and they should be taken according to prescription."

The nurse is teaching a group of nursing students about the respiratory changes that take place during pregnancy. Which statement by a student indicates a need for additional teaching?

"Tidal volume decreases by 33%."

The nurse is teaching a group of pregnant women about safety during pregnancy. Which statement made by a client indicates the need for additional teaching?

"We should avoid travelling to high-altitude regions above 8,000 feet."

A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of exercise on the fetus. The nurse should inform her:

"You may find that around the seventh month of your pregnancy, you need to modify your exercise to walking."

The GTPAL (gravidity, term, preterm, abortions, and living children) of a patient is 3-1-2-1-3. What does the nurse infer about the client's obstetric history from this?

3 pregnancies with 1 miscarriage, 2 preterm birth and 3 living children.

A client had an abortion in her first pregnancy, gave birth at 39 weeks gestation during the second pregnancy, and gave birth to twins at 36 weeks gestation in her third pregnancy. How does the nurse denote the obstetric history of the patient in the GTPAL (gravidity, term, preterm, abortions, living children) system?

3-1-1-1-3

Which of these are perinatal mood disorders (PMDs)?

Anxiety Depression Postpartum psychosis Obsessive-compulsive disorder Posttraumatic stress disorder (PTSD)

The nurse is caring for a client who is 16 weeks pregnant who wants to quit smoking. The nurse implements the Five A's for cessation of smoking with the client. What are the Five A's implemented for smoking cessation?

Ask, assess, advise, assist, and arrange follow-up.

A client who is in the first trimester of pregnancy reports frequent nausea. Which nursing interventions would help relieve the symptoms of nausea in this client?

Assessing if the client is well hydrated Assessing the client's weight gain pattern during pregnancy Reviewing measures already taken for the prevention of morning sickness

When does human chorionic gonadotropin (hCG) reach its maximum levels in a pregnant woman?

Between 50 to 70 days into the pregnancy

Which factors affect the process of labor and birth?

Birth canal Contractions Fetus and placenta

Which findings obtained during clinical evaluation of a pregnant client help determine the gestational age of the fetus?

Current fundal height First fetal heart tones heard Current week of gestation

The nurse is teaching student nurses about changes in blood coagulation and fibrinolytic activity in pregnant women. Which information does the nurse include about coagulation in pregnant women?

Fibrinogen levels increase during pregnancy. Prothrombin time decreases during pregnancy. Partial thromboplastin time decreases during pregnancy.

What are some strategies for preventing postpartum depression?

Don't place unrealistic expectations on yourself; no mother is perfect! Share knowledge about postpartum emotional problems with close family and friends. Sleep as much as possible; make a promise to yourself to try to sleep when the baby sleeps. At least once each day or every other day, purposely relax for 15 minutes: deep-breathing, meditating, taking a hot bath.

Which findings could be considered a barrier to a pregnant woman seeking prenatal care?

Economic cost of healthcare Client's cultural beliefs do not include prenatal care as being valued. Client had a bad experience the last time she went to a doctor for care.

A client is in the 21st week of her third pregnancy. The client's first pregnancy ended in fetal death in the 24th week of pregnancy, and the second one was terminated during the third month of gestation. How does the nurse denote the obstetric history of this patient?

Gravida 3 para 2

Which sign of pregnancy may manifest as an increase of urinary frequency in the client?

Hegar sign

The hormonal reports of a pregnant female reveal increased estrogen levels in the body. Which related signs would the nurse find in the patient?

Mucoid discharge from the cervix Heaviness in the patient's breast Well-defined pink blotches on the palm

The nurse is assessing the fetal heart rate in a pregnant client. The nurse finds asynchronous fetal heartbeats during auscultation. In which condition would this finding be considered normal?

Multifetal pregnancy

The nurse is assessing a client who is 7 months pregnant. The nurse observes that there are increased chest movements and decreased abdominal movements while breathing. How does the nurse interpret this finding?

Normal finding during pregnancy.

A client in the first trimester of pregnancy tells the nurse, "I urinate frequently and am not able to hold urine even for a short time." What would the nurse suggest to ease the client's discomfort?

Perform Kegel exercises."

During an interaction with a pregnant client, the nurse learns that the client accepts the biologic fact of pregnancy, and views the expectant child as part of herself. Which phase of the mother-child relationship is the client experiencing?

Phase 1

Which statement about multifetal pregnancy is accurate?

The expectant mother often develops anemia because the fetuses have a greater demand for iron. The mother should be counseled to increase her nutritional intake and gain more weight. Backache and varicose veins are often more pronounced.

After performing the Leopold's maneuver on a client at 38 weeks of pregnancy, the nurse concludes that the client will require external cephalic version for having a vaginal delivery. What was the finding during assessment?

The fetus is in the breech presentation.

What are some safety measures to take while pregnant?

Use correct body mechanics. Take rest periods; reschedule daily activities to meet rest and relaxation needs. Avoid environmental teratogens, such as cleaning agents, paints, sprays, herbicides, and pesticides. Use safety features on tools and vehicles (e.g., safety seat belts, shoulder harnesses, headrests, goggles, helmets) as specified.

The nurse is caring for a pregnant client who reports constipation. What does the nurse suspect is causing the client's constipation?

Uterine distention Iron supplementation Decreased intake of fluids Increased progesterone levels

The nurse instructs a pregnant client to avoid sitting for a long time and to wear loose-fitting pants. Which pregnancy discomfort is the nurse trying to ease?

Varicose veins

To reassure and educate pregnant women about changes in their blood pressure, maternity nurses should be aware that:

compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the latter stage of term pregnancy.