Nursing management during pregnancy
Yvonne, 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 Yvonne about the potential effects of smoking in pregnancy?
"Babies of women who smoke tend to weigh significantly less than other infants." Correct Explanation: Smoking during pregnancy is linked with low birth weight but not cardiac anomalies, mental retardation, or nicotine dependence.
A pregnant woman has developed varicosities. Which of the following statements would suggest she needs additional health teaching?
"I wear knee-highs rather than pantyhose." Correct Explanation: Women with varicosities should not wear knee-high stockings as they put pressure on leg veins and reduce venous return
The nurse should administer Rhogam (Rh immune globulin) to the pregnant woman who is Rho(D)-, after which of the following tests?
Amniocentesis Correct Amniocentesis is an invasive procedure whereby a needle inserted into amniotic sac to obtain a small amount of fluid. This places the pregnancy at risk for a woman with RhD-negative blood and she should receive RhoGam after the procedure. The CST,NST, and a biophysical profile are non-invasive tests.
A woman in her first trimester is having trouble maintaining adequate nutrition because of nausea and vomiting. She also complains that her heartburn gets worse after eating so she avoids food even when she feels hungry. To help with her nutritional deficit, she is taking a multivitamin supplement. Which substance do you caution her to avoid within 1 hour of ingesting her multivitamin supplement?
An antacid Correct Explanation: Antacids interfere with the uptake of the vitamin contents. She needs to be encouraged to eat small frequent meals and notify the provider if she is losing weight. Caffeine should be avoided due to increases in blood pressure and diuretic effects. Acetaminophen should be taken only when the provider has approved it. Fatty foods are not healthy, and may make the morning sickness worse.
The blood tests for a primigravida client indicate that the client is Rh-negative and her partner is Rh-positive. What is an appropriate nursing intervention for this client?
Arrange for Rho immune globulin at 28 weeks' gestation Correct Explanation: The nurse should inform the client that Rh-negative mothers should receive Rho immune globulin at 28 weeks' gestation and with antepartum testing to prevent isoimmunization. Positive antibody screens need to be followed up to identify antibodies detected in the blood to prevent fetal complications. The nurse need not make arrangements for blood transfusions, inform the client about the possibility of a cesarean section, or prepare the client for the possibility of a spontaneous abortion.
A woman is 20 weeks pregnant. The nurse would expect to palpate the fundus at which of the following locations?
At the umbilicus Correct Explanation: At 20 weeks' gestation, the fundus can be palpated at the umbilicus. A fundus of 12 weeks' gestation is palpated at the symphysis pubis. At 16 weeks' gestation, the fundus is midway between the symphysis pubis and umbilicus. At 36 weeks' gestation, the fundus can be palpated just below the ensiform cartilage.
A woman in her third trimester complains to the nurse of significant back pain. The nurse questions the client carefully and records a detailed account of her back symptoms. What is the best rationale for the nurse evaluating the client's back symptoms with such care?
Back pain could be a sign of bladder or kidney infection Correct Explanation: 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. The other causes of back pain listed do not warrant as much immediate concern as the possibility of a bladder or kidney infection.
Which of the following nursing interventions is appropriate when preparing a woman for an amniocentesis?
Be certain she knows that there is are risks of complication, such as premature labor, from amniocentesis Correct Explanation: Amniocentesis carries a slight risk of beginning labor. The woman should not hold her breath because that depresses the diaphragm, shifts the contour of the uterus, and may shift the location of the placenta to the chosen needle insertion site. The bladder should be emptied to avoid accidental puncture
Ramona Silver, age 38, has one child with Tay-Sachs disease. She and her partner both carry the Tay-Sachs gene and did not intend to have more children, but she has just discovered that she is pregnant. She plans to have an abortion if tests show that the fetus has the Tay-Sachs gene. Which test will the primary care provider likely order?
Chorionic villus sampling Correct Explanation: CVS is a newer procedure and can provide information on fetal chromosomal studies similar to an amniocentesis, but earlier in pregnancy. The CVS is typically performed between 8 and 12 weeks gestation. Given the disease in question, she would be able to determine the course of the pregnancy early in gestation. Multiple marker screen tests are done later in the pregnancy, as is amniocentesis. Percutaneous umbilical blood sampling examines the blood, and is not the best source for chromosomal studies.
The nurse is describing pregnancy danger signs to a pregnant woman who is in her first trimester. Which of the following danger sign might occur at this point in her pregnancy?
Excessive vomiting Explanation: 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 the following findings is most worrisome in Melissa, a woman in her 26th week of pregnancy?
Facial edema Correct Explanation: 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.
When providing preconception care to a client, which medication would the nurse identify as being safe to continue during pregnancy?
Famotidine Correct Explanation: Famotidine is a category B drug that has been used frequently during pregnancy and does not appear to cause major birth defects or other fetal problems. Accutane and warfarin are category X drugs and should never be taken during pregnancy. Lithium is a category D drug with clear health risks for the fetus and should be avoided during pregnancy.
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 Correct Explanation: 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.
Leah is 28 weeks pregnant. In preparing for discomforts that occur during the final trimester of pregnancy, you would teach her about?
Increased shortness of breath and dyspnea before lightening Correct Explanation: As the fetus grows inside the mother, there is more pressure on the diaphragm and more difficulty breathing, and episodes of dyspnea may occur. This tends to decrease with lightening, when the fetus drops. Eating a well balanced diet, oral hygiene, and exercise should be done throughout the entire pregnancy.
Which of the following nursing interventions should the nurse perform when assessing fetal well-being through abdominal ultrasonography in a client?
Instruct the client to refrain from emptying her bladder. Explanation: When assessing fetal well-being through abdominal ultrasonography, the nurse should instruct the client to refrain from emptying her bladder. The nurse must ensure that abdominal ultrasonography is conducted on a full bladder and should inform the client that she is likely to feel cold, not hot, initially in the test. The nurse should obtain the client's vital records and instruct the client to report the occurrence of fever when the client has to undergo amniocentesis, not ultrasonography
A woman complains of constant redness and itching of her palms early in her pregnancy. She fears that she is suffering an allergic reaction and asks the nurse whether this is normal. Which of the following should the nurse mention?
It is caused by increased estrogen levels and should disappear in time Correct Explanation: Palmar erythema, or palmar pruritus, occurs in early pregnancy and is probably caused by increased estrogen levels. Constant redness or itching of the palms can make a woman believe she has developed an allergy. Explain that this type of itching in early pregnancy is normal. She may find lotion to be soothing. As soon as a woman's body adjusts to the increased level of estrogen, the erythema and pruritus disappear. This condition is not a sign of fatigue or high blood pressure
A client in her second trimester of pregnancy visits a healthcare facility. The client frequently engages in aerobic exercise and asks the nurse about doing so during her pregnancy. Which of the following precautions should the nurse instruct the pregnant client to take when practicing aerobic exercises?
Maintain tolerable intensity of exercise Correct Explanation: 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.
You advise your pregnant patient to keep a small high-carbohydrate snack on the bedside table. This advice is given to ameliorate which condition?
Nausea and vomiting Correct Explanation: Women will commonly experience nausea and vomiting upon awakening first thing in the morning. Patients who experience this should be encouraged to have small snacks at their bedside for eating prior to moving from the bed. Heartburn is a result of pressure and hormone action. Faintness is due to pressure on the vena cava, not blood sugar. GI transit time is not affected
A nurse is caring for a client in her second trimester of pregnancy. During a regular follow-up visit, the client complains of varicosities of the legs. Which of the following instructions should the nurse provide to help the client alleviate varicosities of the legs?
Refrain from crossing legs when sitting for long periods. Correct Explanation: To help the client alleviate varicosities of the legs, the nurse should instruct the client to refrain from crossing her legs when sitting for long periods. The nurse should instruct the client to avoid standing, not sitting, in one position for long periods of time. The nurse should instruct the client to wear support stockings to promote better circulation, though the client should stay away from constrictive stockings and socks. Applying heating pads on the extremities is not reported to alleviate varicosities of the legs.
A client in her third trimester of pregnancy wishes to use the method of feeding formula to her baby?
Serve the formula at room temperature. Correct Explanation: The nurse should instruct the client to serve the formula to her infant at room temperature. The nurse should instruct the client to follow the directions on the package when mixing the powder because different formulas may have different instructions. The infant should be fed every 3 to 4 hours, not every 8 hours. The nurse should specifically instruct the client to avoid refrigerating the formula for subsequent feedings. Any leftover formula should be discarded
An adolescent who is pregnant asks you which of the following sports would be safe for her to learn during pregnancy. Which of the following activities would you suggest as safe?
Swimming Explanation: Sports that require balance (bicycling, skiing) become difficult during pregnancy. Jogging can be difficult because of lax knee cartilage.
A pregnant client in her second trimester visits a healthcare center. She informs the nurse that at times she experiences difficulty breathing. Which of the following would the nurse identify as the most likely cause of the client's complaint
The nurse should consider the pressure caused by the growing fetus on the diaphragm as the most likely cause of the client's problem. Displacement of the stomach by the growing fetus causes heartburn in the pregnant client. Pressure on the pelvic area by the growing fetus causes dependent edema. Pressure on the rectal vein by the growing fetus causes hemorrhoids.
A nurse is caring for a pregnant client in her second trimester of pregnancy. The nurse educates the client to look for which of the following danger signs of pregnancy needing immediate attention by the physician.
Vaginal bleeding Correct Explanation: 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 physician. 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.
Which of the following are purposes for prenatal care? (Select all that apply.)
• Monitor for fetal development and maternal well-being. • Determine the gestational age of the fetus. • Identify women at risk for complications. • Establish a baseline of present health. Correct Explanation: The purposes of prenatal care are to establish a baseline of present health; determine the gestational age of the fetus; monitor fetal development and maternal well-being; identify women at risk for complications and minimize the risk of possible complications; and provide time for education about pregnancy, lactation, and newborn care. It is not done to help a clinic financially
As part of her physical examination of a pregnant client, the nurse examines the woman's breasts. Which of the following are healthy breast changes that indicate pregnancy? (Select all that apply.)
• Overall breast size increases • Areolae darken • Montgomery tubercles become prominent • Blue streaking of veins becomes prominent Correct Explanation: Healthy breast changes that occur during pregnancy include the areolae darkening, overall breast size increasing, blue streaking of veins becoming prominent, and Montgomery tubercles becoming prominent. Breasts tend to become firmer in consistency during pregnancy, not softer. Hard, painless lumps indicate possible tumors, which are not normal, healthy breast changes.
The nurse is preparing a teaching plan for a pregnant woman about the signs and symptoms to be reported immediately to her health care provider. Which of the following would the nurse include? Select all that apply.
• Sudden leakage of fluid during the second trimester • Headache with visual changes in the third trimester • Lower abdominal pain with shoulder pain in the first trimester Correct Explanation: Danger signs and symptoms that need to be reported immediately include headache with visual changes and sudden leakage of fluid in the second trimester, and lower abdominal pain accompanied by shoulder pain in the first trimester. Urinary frequency in the third trimester, nausea and vomiting during the first trimester, and backache during the second trimester are common discomforts of pregnancy.
A pregnant client has come to a health care provider for her first prenatal visit. The nurse needs to document useful information about the past health history. What are goals of the nurse in the history-taking process? Select all that apply.
• To prepare a plan of care that suits the client's lifestyle • To develop a trusting relationship with the client • To prepare a plan of care for the pregnancy Explanation: When documenting a comprehensive health history while caring for a client, it is important for the nurse to prepare a care plan that suits the client's lifestyle, to develop a trusting relationship with the client, and to prepare a plan of care for the pregnancy. The nurse does not need to assess the client's partner's sexual health during the history-taking process or urge the client to achieve an optimal body weight. Achieving optimal body weight before conception helps the client to achieve a positive impact on the pregnancy.
What instruction should a nurse offer to a pregnant client or a client who wishes to become pregnant to help her avoid exposure to teratogenic substances?
Avoid medications Correct Explanation: The nurse should instruct a client who is pregnant or one who wants to conceive to avoid medications to enable the client to avoid exposure to any kind of teratogenic substance. Eating a well-balanced diet and maintaining personal hygiene, though important during pregnancy, will not prevent a client's exposure to teratogenic substances. Coffee is not a teratogenic substance so the client need not avoid coffee. However, coffee is not recommended during pregnancy because it may increase the risk of spontaneous abortion.
A pregnant woman states that she would like to take a tub bath but has heard from her aunt that this could be dangerous to the baby. Which of the following instructions should the nurse give to the patient?
Daily tub baths or showers are recommended. Women should not soak for long periods in extremely hot water or hot tubs, however, as heat exposure for a lengthy time could lead to hyperthermia in the fetus and birth defects, specifically esophageal atresia, omphalocele, and gastroschisis. As pregnancy advances, a woman may have difficulty maintaining her balance when getting in and out of a bathtub. If so, she should change to showering or sponge bathing for her own safety. If membranes rupture or vaginal bleeding is present, tub baths become contraindicated because there might be a danger of contamination of uterine contents. Soap is not a teratogen to the fetus.
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 Correct Explanation: The nurse should inform the client that children born of mothers who use nicotine will have a decreased birth weight. Spontaneous abortion is associated with caffeine use. Increased risks of stillbirth and placenta abruptio are associated with mothers addicted to cocaine