Part2 7&16
You advise a pregnant woman to reduce her fluid intake with meals. Which condition is the woman trying to relieve or prevent?
heartburn
Working with pregnant teenagers as a special population requires the nurse to have knowledge of adolescent development. Which of the following is crucial for a positive pregnancy and outcome for the mother and fetus?
support network
The nurse is helping an indigent HIV-positive pregnant patient set up a postdelivery care plan for her baby. What is an appropriate question/statement during that discussion?
"HIV can be passed to the baby from breast-feeding so it's important that you give the baby formula. Formula's pretty expensive so I'll give you some information for places you can contact if you ever need some help getting it."
The first time you see a woman during pregnancy, her fundal height is palpable at the level of her umbilicus. This measurement is typical of what gestational age?
20 weeks
Fourteen-year-old Ann and her parents have presented at the obstetrician's office in the second trimester, the teen had been hiding the pregnancy. The nurse is helping them develop a plan of care. What is the best thing she can say to the clearly angry parents?
"I know you must be very upset and angry about Ann's pregnancy but because she's still an adolescent herself, she'll need your guidance in making nutritional and health choices that will be good for the baby and for herself."
A 32-year-old woman with epilepsy is having an annual checkup at her primary care physician's office. While the nurse is taking her blood pressure prior to the doctor's examination, the patient tells the nurse that she is thinking about getting pregnant and asks the nurse's advice. What is an appropriate answer for the nurse to give?
"I'll let the doctor know so you can discuss your medications with her. In the meantime, I'll give you a list of folate-rich foods you can add to your diet.
A nurse you know is 5 weeks pregnant. She works on a unit where chemotherapy is administered. Which of the following statements would make you believe she needs additional health teaching about avoiding teratogens during pregnancy?
"Latex gloves irritate my hands, so I don't use them."
A woman's baby is HIV positive at birth. She asks the nurse if this means the baby will develop AIDS. Which of the following statements would be the nurse's best answer?
"The antibodies may be those transferred across the placenta; the baby may not develop AIDS."
A 43-year-old, physically fit, healthy woman who is newly married tells the nurse that she and her husband would like to have a child. What is an appropriate first response?
"Well, I'm sure you know there are some risks involved so it's helpful that you've been taking such good care of yourself."
A pregnant single mom living alone tells the nurse she is considering getting a cat for her two year old daughter. Which is the best response by the nurse?
"You should wait until after you give birth to obtain the cat for your daughter."
The Healthy People 2010 goal for US women to seek prenatal care during the first trimester is what percentage?
90 percent
In working with a pregnant woman who now weighs 55 kg and has developed gestational diabetes mellitus, how much should the nurse recommend that the patient eat? Approximately
900 kcals of carbohydrates, 330 kcals of protein, and 415 kcals of fat each day in three meals and three snacks
A postpartum mother has the following lab data recorded: a negative rubella titer. What is the appropriate nursing intervention?
Administer rubella vaccine before discharge.
A woman with a long history of controlled asthma has just had her first antenatal visit for her fourth child. She is late for a meeting and says she knows what to do. What is the best action the nurse can take?
Acknowledge her need to leave but ask her to demonstrate the use of her inhaler and her peak flow meter before she goes; make any necessary corrections to her technique. Remind her to take her regular medications.
What advice should the nurse provide to a pregnant patient who admits to continuing to drink alcohol 1 to 2 times a week?
Alcohol should not be consumed during pregnancy
Charlene McCoy, who has several children already, reports for a first prenatal visit. She seems preoccupied and withdrawn, and she makes consistently negative remarks about the pregnancy. Reviewing her records, you note that she is receiving a serotonin reuptake inhibitor. What should you do?
Alert the RN or primary care provider
Mrs. Smith asks you to compute her expected date of birth. Based on the fact that her last menstrual flow began on July 20, her date would be
April 27
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
With advanced maternal age there are increased risks for a fetus to have chromosomal or genetic defects. There is an increased risk of a fetus with trisomy 21, trisomy 18 and trisomy 13 and therefore the mother might be offered fetal genetic screening. Which of the following might be offered during the first trimester to the mother to determine if the fetus has a chromosomal abnormality?
Chorionic villus sampling
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
Between her regularly scheduled visits, a woman in her first trimester of pregnancy who is taking iron supplements for anemia calls the nurse at her obstetrician's office complaining of constipation. She reports that she has never had this problem before and asks for some advice about how to get relief. What is the best advice the nurse can give her?
Continue taking iron supplements but increase fluids and high-fiber foods; exercise more.
A woman who is 3 months pregnant enjoys a slow, long walk daily. Which of the following would be most appropriate for her concerning this for the remainder of her pregnancy?
Continue this as long as she enjoys it.
Nursing care for women diagnosed with gestational diabetes includes which of the following?
Encourage blood glucose control
A woman with cardiac disease is 32 weeks gestation and alerts the nurse she has been having spells of light-headedness and dizziness every few days. The nurse provides which of the following interventions as an option to the patient?
Decrease activity and rest more often.
A patient in the OB clinic is complaining of being awakened by leg cramps while sleeping. Select the appropriate nursing intervention.
Dorsiflex the foot while extending her leg during the cramp
Mary Jones's maternal serum alpha-fetoprotein (MSAFP) screening results show that her MSAFP levels are high. What is the best response by the nurse?
Further test are required based on the results
Martha is pregnant and arrives for her second prenatal appointment. Her previous pregnancy ended at 19 weeks and she has 3-year-old twins born at 30 weeks gestation. How will you document her "G" and "L" for her records?
G3 L2
As part of her first prenatal visit, you are taking a pregnant woman's obstetric history. She has an 18-month-old daughter who was delivered 2 days after her estimated date of delivery and a 3-year-old son who was born at 35 weeks' gestation. Before her son was born, she lost two pregnancies: one at 12 weeks and the other at 21 weeks. Using the GTPAL method, how would you record this history?
G5 T1 P2 A1 L2
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
If constipation is a problem for a woman during pregnancy, which of the following measures would be best to recommend?
Increasing fluid intake
If a pregnant woman's estimated date of delivery (EDD) is April 23, what was the first day of her last menstrual period (LMP), according to Nagele's rule?
July 16
A woman with Class II heart disease is in the third trimester of her pregnancy. She's been taking good care of herself and has had little difficulty, but to be on the safe side the obstetrician has ordered bed rest for her for the final month. For her own and the baby's safety, in what position should the nurse advise the patient to sleep?
Lie in a semirecumbent position.
When providing education to a teenage prenatal class, the nurse states that infants born to teenage mothers are more likely to have which of the following?
Low-birth weight
A woman develops gestational diabetes. Which of the following self-assessments should the woman be instructed to make daily?
Measure serum for glucose level by a finger prick.
A pregnant woman comes in for a routine third-trimester exam, which included a pelvic exam. She calls several hours later, very worried, to report a small amount of bleeding. What should you tell her?
Not to worry but to report any heavy increase in bleeding
A 21-year old patient arrives at the prenatal clinical at 12 weeks gestation and has a positive STI. Which of the following should the nurse be aware of that would indicate the patient is at high-risk for non-compliance with treatment for the STI?
Noted to have history of substance abuse
When discussing rest and sleep with a pregnant woman, which of the following positions would you suggest that she use for napping?
On her side with the weight of the uterus on the bed
The nurse explains to a pregnant client that she will need to take iron during her pregnancy after being diagnosed with iron-deficiency anemia. The nurse suggests that absorption of the supplemental iron can be increased by taking it with which of the following?
Orange juice
A patient is 8 weeks gestation and is a type 1 diabetic. The health care provider has classified this patient as a high-risk pregnancy. To which of the following providers will the health provider send this patient?
Perinatologist
A woman is pregnant and has asthma. Her physician has told her to continue taking prednisone during pregnancy, but she is concerned the drug may be teratogenic. What advice would be best to give her regarding this?
Prednisone is considered safe in the doses prescribed by her physician.
Ms. Wells is a 17-year-old primigravida at 37 weeks gestation, her blood sugar has not been well controlled. She is discussing her delivery options for the infant. The provider suspects the infant has macrosomia. Which of the following should the nurse anticipate?
Prepare for amniocentesis and assessment of fetal lung maturity.
Which of the following is recommended to prevent transmission of HIV to a newborn if the mother has AIDS?
Prepare for cesarean delivery.
A woman accustomed to daily exercise complains late in her second trimester of pregnancy that she is experiencing "terrible" heartburn at night. What would you advise her to do?
Put 6-inch blocks under the head of her bed
A patient, 31 years old, at 28 weeks gestation with her second pregnancy is in the clinic for a prenatal check-up. She informs you of frequent low back pain and ankle edema by the end of the day. What interventions should you suggest to relieve these discomforts?
Rest when possible with feet elevated at or above the heart.
The pregnant patient is asking about medications, supplements, and vaccines. Which of the following would the nurse indicate as potentially teratogenic?
Rubella vaccine
During prenatal care for the pregnant woman with class II heart disease, the nurse should be aware the most at risk time for this patient is during which of the following times of her pregnancy?
Second trimester
The first day of the patient's last menstrual period was December 1. Based on Naegle's rule, the nurse determines which of the following is the estimated date of birth.
September 8
A woman who has sickle cell anemia asks you if her infant will develop sickle cell disease. The nurse would base the answer on which of the following?
Sickle cell anemia is recessively inherited.
A pregnant woman is planning on taking a vacation that involves extensive travel by automobile. Which of the following guidelines should you give her?
Stop and walk every few hours
A non-stress test is performed on a pregnant woman. The nurse informs the client the test was reactive. Which of the following statements by the patient indicates understanding of the test results?
The fetal heart rate increases with activity and indicates fetal well-being.
Which of the following scenarios should the nurse follow up on as a potential indication of intimate partner violence?
The partner of a pregnant woman attends each of her appointments. The partner is friendly and outgoing. Each time the nurse asks the patient a question, the partner answers. While the partner speaks, the patient looks at her lap.
A woman 8 weeks pregnant questions if she can have an amniocentesis at this time for genetic screening. The nurse should respond how to the patient?
There is not an adequate amount of amniotic fluid at this time
While the nurse is weighing a pregnant woman at a regularly scheduled OB visit, the patient complains of vaginal itching, a great deal of foamy yellow-green discharge, and pain during intercourse. She says this is her first pregnancy and she didn't know this was what happened. What can the nurse tell her?
This is not normal for pregnancy; the doctor might test her for trichomoniasis. If it is trichomoniasis, she can be treated with an oral dose of metronidazole. Remind the patient that she should call immediately if she has any symptoms that don't seem normal to her.
A 24-year-old pregnant woman complains of excessive vaginal discharge. The discharge is not associated with a strong odor, itching, or irritation but she finds it messy and unpleasant. What do you advise her to do?
Use sanitary pads
The nurse should administer Rhogam (Rh immune globulin) to the pregnant woman who is Rho(D)-, after which of the following tests?
amniocentesis
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
A woman with a positive history of genital herpes is in active labor. She has small pin-point vesicles in the perineum area. Her membranes are ruptured, she is dilated 5cm, effaced 70%. The nurse should anticipate what type of delivery?
cesarean
When educating a pregestational patient on how to control her blood sugar, the nurse knows there are three main facets to glycemic control: diet, exercise and _______. Which of the following is the third facet?
insulin
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
The nurse is providing education to women who had diabetes prior to pregnancy. The nurse is discussing pregnancy-related complications from diabetes. Which of the following is a potential complication?
polyhydramnios
