PREGNANCY RISKS 1
A client asks, "Can my partner and I still engage in sexual intercourse while I am pregnant?" The nurse should tell the client: a) "Although your sexual desire may change, intercourse is safe during an uncomplicated pregnancy." b) "You should avoid having intercourse until you are at least 16 weeks pregnant." c) "Throughout the pregnancy, coitus interruptus is the preferred method for sexual activity." d) "Refrain from having sexual intercourse when you are in the last trimester."
"Although your sexual desire may change, intercourse is safe during an uncomplicated pregnancy." Generally, engaging in the usual pattern of sexual activity during pregnancy is safe as long as the client is comfortable and no complications arise. The client needs to be informed that some women find intercourse uncomfortable during the first and third trimesters, owing to the common discomforts of pregnancy. Numerous myths about engaging in sexual activity during pregnancy exist. However, coitus does not harm the fetus. Coitus interruptus is not considered the preferred method of sexual activity. Avoiding sexual activity until the 16th week of pregnancy is not necessary because coitus does not harm the fetus. During the third trimester, sexual intercourse is still considered safe. However, because of the increased size of the woman's abdomen, the couple should consider coital positions other than male superior position. Sexual intercourse would be contraindicated only if the woman experiences bleeding or ruptured membranes. Also, after 32 weeks' gestation, women with a history of preterm labor should be advised that coitus may lead to preterm labor due to the effects of prostaglandin production secondary to sexual intercourse. Stimulation of the breasts and nipples increases the body's production of oxytocin, which also can initiate labor.
A client asks how long she and her husband can safely continue sexual activity during pregnancy. How should the nurse respond? a) "As long as you wish, if the pregnancy is normal." b) "Until the end of the third trimester." c) "Until the end of the second trimester." d) "Until the end of the first trimester."
"As long as you wish, if the pregnancy is normal." During a normal pregnancy, the client and her partner need not discontinue sexual activity. If the client develops complications that could lead to preterm labor, she and her partner should consult with a health practitioner for advice on the safety of sexual activity.
A client is in the third trimester of pregnancy, and the husband tells the nurse that he is worried about his wife's increasing physical discomfort and overall health and safety. Which of the following nurse's responses to the husband is most appropriate? a) "Have you talked to any of your male friends who have had children already?" b) "This is not a common concern. Would you like to talk to a social worker? c) "Can you help me understand what aspect of her health and safety concerns you most?" d) "This is a completely normal concern, but your wife will be fine after the birth."
"Can you help me understand what aspect of her health and safety concerns you most?" While listening to the husband's concerns, the nurse determines that the developmental task at this stage in pregnancy is for him to feel increased concern for his partner as she becomes more uncomfortable toward the end of the pregnancy. It is a normal stage of development to exhibit increased focus on the health and safety of both the partner and unborn child. It would be inappropriate to suggest that the husband talk to his male friends or possibly a social worker. This may give the husband the impression that his concerns are abnormal or that the nurse is not interested in further exploring the concerns.
A client has come to the clinic for her first prenatal visit. The nurse should include which statement about using drugs safely during pregnancy in her teaching? a) "Consult with your health care provider before taking any medications." b) "Medications that are available over the counter are safe for you to use, even early on." c) "All medications are safe after you've reached the 5th month of pregnancy." d) "During the first 3 months, avoid all medications except ones ordered by your caregiver."
"Consult with your health care provider before taking any medications." Because all medications can be potentially harmful to the growing fetus, telling the client to consult with her health care provider before taking any medications is the best teaching. The client needs to understand that any medication taken at any time during pregnancy can be teratogenic.
A potentially pregnant 16-year-old client says that she has been "hooking up" with a boy she considers to be her boyfriend. Which response should the nurse make first? a) "All you have been doing with your boyfriend is hooking up?" b) "I think we need to talk about what is involved in sexual intercourse." c) "You mean you have had sexual intercourse?" d) "Describe what you mean by 'hooking up.'"
"Describe what you mean by 'hooking up.'" Because of the client's potential pregnancy, the nurse needs to determine exactly what the client means by the term "hooking up" by asking the client to describe what she has been doing in sexual encounters with her boyfriend. Asking the client if she means sexual intercourse or telling the client that they need to talk about sexual intercourse makes an assumption that may or may not be appropriate. The nurse needs to determine exactly what the client means by the terms used. Repeating the client's statement does not elicit the necessary information to interpret the client's statement. Additionally, this type of response assumes an understanding of what the client has said.
A client asks the nurse why taking folic acid is so important before and during pregnancy. The nurse should instruct the client that: a) "Eating foods with moderate amounts of folic acid helps regulate blood glucose levels." b) "Folic acid is needed to promote blood clotting and collagen formation in the newborn." c) "Folic acid consumption helps with the absorption of iron during pregnancy." d) "Folic acid is important in preventing neural tube defects in newborns and preventing anemia in mothers."
"Folic acid is important in preventing neural tube defects in newborns and preventing anemia in mothers." Folic acid supplementation is recommended to prevent neural tube defects and anemia in pregnancy. Deficiencies increase the risk of hemorrhage during delivery as well as infection. The recommended dose prior to pregnancy is 400 mcg/day; while breast-feeding and during pregnancy, the recommended dosage is 600 to 800 mcg/day. Blood glucose levels are not regulated by the intake of folic acid. Vitamin C potentiates the absorption of iron and is also associated with blood clotting or collagen formation.
A client who's planning a pregnancy asks the nurse about ways to promote a healthy pregnancy. What is the nurse's best response? a) "Folic acid, 400 mcg, improves pregnancy outcomes by preventing certain complications." b) "You practice good health habits; just follow them and you'll be fine." c) "Pregnancy is a human process; you don't have to worry." d) "There is nothing you can do to have a healthy pregnancy; it's all up to nature."
"Folic acid, 400 mcg, improves pregnancy outcomes by preventing certain complications." When counseling a client who's planning to become pregnant, the nurse should discuss the role of folic acid in preventing neural tube defects. Telling the client not to worry ignores the client's needs. Practicing good health habits is an important topic to discuss with all clients, not just pregnant clients. Telling the client that a healthy pregnancy is up to nature is inaccurate.
An adolescent client with ruptured membranes is admitted to the hospital. A few hours after her arrival to the labor and birth unit, the client's parents call to inquire about her condition. How should the nurse respond? a) "For confidentiality reasons, I cannot give you any information." b) "She hasn't had her baby yet." c) "I'll call you when she gives birth." d) "You should be here at the hospital with her."
"For confidentiality reasons, I cannot give you any information." The nurse should respond by telling the parents that she cannot provide information about clients, including whether a person is even a client in the facility, due to confidentiality reasons. Giving out any information about the client's status is a breach of client confidentiality. Most states consider a pregnant teen to be emancipated as far as her pregnancy is concerned.
The nurse finds the client who has had an ileostomy crying. The client explains to the nurse, "I am upset because I know I will not be able to have children now that I have an ileostomy." Which response by the nurse is best? a) "I am sure you will adjust to this situation with time. Try not to be too upset." b) "Many women with ileostomies decide to adopt. . Perhaps you could consider that option?" c) "Having an ileostomy does not necessarily mean that you cannot bear children. Let us talk about your concerns." d) "I can understand your reasons for being upset. Having children must be important to you."
"Having an ileostomy does not necessarily mean that you cannot bear children. Let us talk about your concerns." The fact that the client has an ileostomy does not necessarily mean that she cannot get pregnant and bear children. It may be recommended, however, that the number of pregnancies be limited. Women of childbearing age should be encouraged to discuss their concerns with their health care provider (HCP). Discussing their concerns about sexual functioning and pregnancy will help decrease fears and anxiety. Empathizing or telling the woman that she can adopt does not address her concerns. Her current fears may be based on erroneous understanding. Telling the client that she will adjust to the situation ignores her concerns.
A first-time mother is in her second trimester, and prenatal screening has indicated the possibility of Down syndrome. While awaiting the results of amniocentesis, the patient acknowledges her great anxiety. Which of the patient's following statements indicates that she may be coping ineffectively with her anxiety? a) "I knew all along that something was going to go terribly wrong with my pregnancy." b) "I've had to rely a lot on my family and my friends from church these days." c) "I'm sad that there's a possibility of a problem with something that's been so joyful so far." d) "I phone my mom every day to debrief about what's on my mind."
"I knew all along that something was going to go terribly wrong with my pregnancy." Expressions of significant negativity and fatalism may be suggestive of ineffective coping with a stressor. Reliance on support persons and expressions of disappointment are likely appropriate responses to a stressor.
When evaluating a pregnant client's knowledge of symptoms to report immediately, which statement indicates to the nurse that the client understands the information given to her? a) "I'll report increased frequency of urination." b) "If I feel tired after resting, I should report it immediately." c) "If I have blurred or double vision, I should call the clinic immediately." d) "Nausea should be reported immediately."
"If I have blurred or double vision, I should call the clinic immediately." The client stating that she should contact the clinic if she experiences blurred or double vision indicates understanding of symptoms to report. Blurred or double vision may indicate hypertension or preeclampsia. Urinary frequency is a common problem during pregnancy caused by increased weight pressure on the bladder from the uterus. Clients generally experience fatigue and nausea during pregnancy. These symptoms don't need to be reported immediately.
A pregnant client asks how she can best prepare her 3-year-old son for the upcoming birth of a sibling. The nurse should make which suggestion? a) "Reprimand your son if he displays immature behavior." b) "Reassure your son that nothing is going to change." c) "Tell your son about the childbirth about 1 month before your due date." d) "Involve your son in planning and preparing for a sibling."
"Involve your son in planning and preparing for a sibling." Being involved in the pregnancy helps reinforce a child's position in the family and minimizes feelings of neglect and abandonment. Telling the child about the childbirth only 1 month before the due date wouldn't allow enough time to prepare him for the sibling and would prevent him from conceptualizing the passage of time. Reassuring him that nothing will change would be misleading; instead, the parents should discuss which aspects of family life will be changed by the upcoming birth and which will remain the same. Parents should reward mature behavior and ignore immature behavior.
A client is a gravida 2 para 1 and is currently 12 weeks gestation. She states that she drank beer throughout her last pregnancy. The client asks the nurse if it is okay to have a few drinks during this current pregnancy. Which of the following responses by the nurse would be most appropriate? a) "It is not safe to consume alcohol during pregnancy." b) "It is safer to consume wine than beer during pregnancy." c) "It is safe to consume 5 ounces or less of alcohol per week in the first trimester." d) "It is not safe to consume alcohol in the second and third trimesters, but the first is safe if consumed in moderation."
"It is not safe to consume alcohol during pregnancy." Complete abstinence from alcohol use during pregnancy is recommended. A safe level of alcohol consumption during pregnancy has not yet been established. Conclusive evidence surrounding the effects of either social or moderate drinking on the fetus, regardless of trimester or gestation, are not available. The best answer is to advise the pregnant women to abstain from all alcohol usage.
The nurse is caring for a primigravida at about 9 weeks' gestation. After explaining self-care measures for common discomforts of pregnancy, the nurse determines that the client understands the instructions when she says: a) "If I have a vaginal discharge, I should wear nylon underwear." b) "If I start to leak colostrum, I should cleanse my nipples with soap and water." c) "Nausea and vomiting can be decreased if I eat a few crackers before arising." d) "Leg cramps can be alleviated if I put an ice pack on the area."
"Nausea and vomiting can be decreased if I eat a few crackers before arising." Correct Explanation: Eating dry crackers before arising can assist in decreasing the common discomfort of nausea and vomiting. Avoiding strong food odors and eating a high-protein snack before bedtime can also help. Nipples should not be cleansed with soap. Cotton, not nylon, underwear should be worn if there is a vaginal discharge. The client should contact her health care provider for evaluation of the discharge. Leg cramps should be treated with heat, not ice. Adequate hydration and moderate physical activity, such as walking, can help decrease the incidence of leg cramps.
A client who's 4 weeks pregnant comes to the clinic for her first prenatal visit. When obtaining her health history, the nurse explores her use of drugs, alcohol, and cigarettes. Which client outcome identifies a safe level of alcohol intake for this client? a) "The client consumes no alcohol." b) "The client consumes no more than 2 oz (60 mL) of alcohol daily." c) "The client consumes no more than 4 oz (120 mL) of alcohol daily." d) "The client consumes 2 to 6 oz (60 to 180 mL) of alcohol daily, depending on body weight."
"The client consumes no alcohol." A safe level of alcohol intake during pregnancy hasn't been established. Therefore, authorities recommend that pregnant women abstain from alcohol entirely. Excessive alcohol intake has serious harmful effects on the fetus, especially between the 16th and 18th weeks of pregnancy. Affected neonates exhibit fetal alcohol syndrome, which includes microcephaly, growth restriction, short palpebral fissures, and maxillary hypoplasia. Alcohol intake may also affect the client's nutrition and may predispose her to complications in early pregnancy.
A client is 10 weeks pregnant and asks the nurse if feeling like she has to "go to the bathroom every 5 minutes" is normal. Which of the following is the best response? a) "You probably have a bladder infection and should contact your physician." b) "Bladder capacity normally increases throughout the pregnancy." c) "Women in early pregnancy are naturally preoccupied with their bodily functions." d) "The growing uterus puts pressure on the bladder, so urinary frequency is normal."
"The growing uterus puts pressure on the bladder, so urinary frequency is normal." The client is not exhibiting any signs or symptoms of bladder infection other than urinary frequency. Urinary frequency initially most likely results from increased bladder sensitivity and compression of the bladder from the enlarging uterus. This occurs particularly during the first trimester until the uterus rises from the pelvis, thus releasing pressure on the bladder. Women are not always preoccupied with their bodily functions in the first trimester, and bladder capacity and voiding sensations vary throughout the pregnancy.
A 30-year-old primiparous client at 34 weeks' gestation comes to the prenatal facility concerned about the reddish streaks she has increasingly developed on her breasts and abdomen. She asks what these skin changes are and whether they're permanent. What should the nurse tell her? a) "These streaks are called striae gravidarum, or stretch marks; they'll grow lighter after birth." b) "These streaks are called linea nigra; they'll fade after childbirth." c) "These streaks are called hemangiomas; they're permanent changes of pregnancy." d) "These streaks are called nevi; they'll fade after the postpartum period."
"These streaks are called striae gravidarum, or stretch marks; they'll grow lighter after birth." The client's weight gain and enlarging uterus, combined with the action of adrenocorticosteroids, lead to stretching of the underlying connective tissue of the skin, creating striae gravidarum in the second and third trimesters. Better known as stretch marks, these streaks develop most often in skin covering the breasts, abdomen, buttocks, and thighs. After delivery, they typically grow lighter. Linea nigra is a dark line that extends from the umbilicus or above to the mons pubis. In the primigravid client, this line develops at approximately the third month of pregnancy. In the multigravid client, linea nigra typically appears before the third month. Tiny bright hemangiomas may occur during pregnancy as a result of estrogen release. They're called vascular spiders because of the branching pattern that extends from each spot. Nevi are circumscribed, benign proliferations of pigment-producing cells in the skin.
A pregnant client at about 29 weeks' gestation asks the nurse "What can I do about this dark brown line running down my stomach?" When teaching the client about this brown line, the nurse should tell the client: a) "This is a linea nigra that will fade after the baby is born." b) "This is a mask of pregnancy that will remain dark after birth." c) "These are stretch marks that will turn a silvery color after birth." d) "This is a normal finding known as Chadwick's sign."
"This is a linea nigra that will fade after the baby is born." This dark brown line is a darkened pigmentation termed linea nigra. The pigmentation will fade after birth. Chadwick's sign is a bluish hue of the cervix and vagina. It is considered a normal pregnancy finding. The mask of pregnancy, called chloasma, appears as darkened areas of pigmentation on the cheeks and across the nose. It usually lightens and disappears after pregnancy. Stretch marks are reddish or purplish in color and result from the skin stretching due to the growing fetus. After birth, the marks typically become silvery white in appearance.
A client who is 37 weeks pregnant comes to the clinic for a prenatal checkup. To assess the client's preparation for parenting, the nurse might ask which question? a) "What changes have you made at home to get ready for the baby?" b) "Can you tell me about the meals you typically eat each day?" c) "Have you begun prenatal classes?" d) "Are you planning to have epidural anesthesia?"
"What changes have you made at home to get ready for the baby?" During the third trimester, the pregnant client typically perceives the fetus as a separate being. To verify that this has occurred, the nurse should ask whether she has made appropriate changes at home such as obtaining infant supplies and equipment. The type of anesthesia planned doesn't reflect the client's preparation for parenting. The client should have begun prenatal classes earlier in the pregnancy. The nurse should have obtained dietary information during the first trimester to give the client time to make any necessary changes.
A 20-year-old primigravid client tells the nurse that her mother had a friend who died from hemorrhage about 10 years ago during a vaginal birth. Which response would be most helpful? a) "What is it that concerns you about pregnancy, labor, and childbirth?" b) "Today's modern technology has resulted in a low maternal mortality rate." c) "In North America, mothers seldom die in childbirth." d) "Do not concern yourself with things that happened in the past."
"What is it that concerns you about pregnancy, labor, and childbirth?" The client is verbalizing concerns about death during childbirth, thus providing the nurse with an opportunity to gather additional data. Asking the client about these concerns would be most helpful to determine the client's knowledge base and to provide the nurse with the opportunity to answer any questions and clarify any misconceptions. Although the maternal mortality rate is low in the United States and Canada, maternal deaths do occur, even with modern technology. Leading causes of maternal mortality in the United States and Canada include embolism, pregnancy-induced hypertension, hemorrhage, ectopic pregnancy, and infection. Telling the client not to concern herself about what has happened in the past is not useful. It only serves to discount the client's concerns and block further therapeutic communication. Also, postponing or ignoring the client's need for a discussion about complications of pregnancy may further increase the client's anxiety.
After teaching a primigravid client at 10 weeks' gestation about the recommendations for exercise during pregnancy, which client statement indicates successful teaching? a) "While we are on vacation next month, I can continue to scuba dive." b) "Even though I am pregnant, I can learn to ski next month." c) "Sitting in a hot tub after exercise will help me to relax." d) "While pregnant, I should avoid contact sports."
"While pregnant, I should avoid contact sports." The client understands the instructions when she says she should avoid contact sports because they may result in injury to the client and the fetus. Learning to ski while pregnant is not recommended because injury may occur. Scuba diving should be avoided because depth pressures could cause fetal damage. Hot tubs should be avoided during the first trimester because sitting in them can result in fetal hyperthermia and fetal hypoxia. Mild exercises, such as walking, can help strengthen the muscles and prevent some discomforts such as backache.
A 20-year-old married client with a positive pregnancy test states, "Is it really true? I can not believe I am going to have a baby!" Which response by the nurse would be most appropriate at this time? a) "What concerns you about this pregnancy?" b) "Would you like some booklets on the pregnancy experience?" c) "Yes it is true. How does that make you feel?" d) "You should be delighted that you are pregnant."
"Yes it is true. How does that make you feel?" This client is expressing a feeling of surprise about having a baby. Therefore, the nurse's best response would be to confirm the pregnancy, which is something that the client already suspects, and then ascertain how the client is feeling now that the suspicion is confirmed. Studies have shown that a common reaction to pregnancy is summarized as ambivalence or "someday, but not now." Such feelings are normal and are experienced by many women early in pregnancy. Offering a pamphlet on pregnancy does not respond to the client's feelings. Telling the client that she should be delighted ignores, rather than addresses, the client's feelings. Also, doing so imposes the nurse's opinion on the client. Ambivalence is a common reaction to pregnancy. Telling the client that she should be delighted may lead to feelings of guilt. Asking about the client's concerns is premature until the nurse determines the client's overall feelings about the pregnancy.
A nurse is caring for a pregnant client who is a strict vegetarian. What type of diet should the client follow? a) A diet rich in protein b) A diet rich in sodium c) A diet lower in calcium and iron d) A diet rich in fat
A diet rich in protein A vegetarian diet can be inadequate in protein, the need for which increases during pregnancy. Therefore, a diet rich in plant proteins will help. Calcium and iron needs to be higher in a vegan diet and also during pregnancy. Diets high in sodium or fat are not needed during pregnancy.
On her second visit to the prenatal facility, a client states, "I guess I really am pregnant. I've missed two periods now." Based on this statement, the nurse determines that the client has accomplished which psychological task of pregnancy? a) Identifying the fetus as a separate being b) Preparing to relinquish the neonate through labor c) Accepting the biological fact of pregnancy d) Assuming caretaking responsibility for the neonate
A. Accepting the biological fact of pregnancy The first maternal psychological task of pregnancy is to accept the pregnancy as a biological fact. If the client doesn't accept that she's pregnant, she's unlikely to seek prenatal care. B. Identifying the fetus as a separate being usually occurs after the client feels fetal movements. C. Assuming caretaking responsibility for the neonate should occur during the postpartum period. D. Preparing to relinquish the neonate through labor normally occurs during the third trimester.
A nurse is conducting a prenatal class for expectant parents. What is one topic that should be addressed to promote safety in the developing fetus? a) the stages of labor with possible complications b) infant hygiene and feeding c) alcohol consumption and smoking d) the role of the father in proper prenatal care
Alcohol consumption and smoking Safety considerations for the neonate and infant begin with an awareness of behaviors that may harm the developing fetus. Risks to the fetus include excess alcohol consumption and smoking.
During her first prenatal visit, a client expresses concern about gaining weight. What is the nurse's first action? a) Be alert for a possible eating problem and do a further in-depth assessment. b) Ask her to come back to the clinic every 2 weeks for a weight check. c) Report the client's concerns to her caregiver. d) Ask the client how she feels about gaining weight and provide instructions about expected weight gain and diet.
Ask the client how she feels about gaining weight and provide instructions about expected weight gain and diet. Weight gain during pregnancy is a normal concern for most women. The nurse must first teach the client about normal weight gain and diet in pregnancy, then assess the client's response to that information. Although it's important for the nurse to determine whether the client has complicating problems such as an eating disorder, doing so wouldn't be the nurse's first action. Reporting the client's concern about weight gain to the health care provider isn't necessary at this time. A weight check every 2 weeks also is unnecessary.
A 24-year-old nulligravid client with a history of irregular menstrual cycles visits the clinic because she suspects that she is "about 6 weeks pregnant." An ultrasound is scheduled in 2 weeks. The nurse should instruct the client that this test will be done to: a) assess maternal pelvic adequacy. b) identify the gender of the fetus. c) determine a multifetal pregnancy. d) assess gestational age.
Assess gestational age. In the first trimester, ultrasound scanning typically is prescribed to determine the gestational age. This is especially important for a client with a history of irregular menstrual cycles to establish an accurate birth date. There is no reason at this point in pregnancy to determine whether twins are present. This might be indicated if the fundal height were larger than the gestational age may indicate. Identifying the gender of the fetus is not a reason for an ultrasound examination unless there is a history of sex-linked genetic disorders. Pelvic adequacy can be determined by physical examination. If the client has a borderline pelvis, an ultrasound scan cannot confirm this. Pelvimetry can be done, but it is not performed as frequently as it once was.
A nurse is assessing a pregnant woman in the clinic. In the course of the assessment, the nurse learns that this woman smokes one pack of cigarettes per day. The first step the nurse should take to help the woman stop smoking is to: a) assess the client's readiness to stop. b) provide the client with the telephone number of a formal smoking cessation program. c) suggest that the client reduce the daily number of cigarettes smoked by one-half. d) help the client develop a plan to stop.
Assess the client's readiness to stop. Before planning any intervention with a client who smokes, it's essential to determine whether or not the client is willing or ready to stop smoking. Commonly, a pregnant client will agree to stop for the duration of the pregnancy, which gives the nurse an opportunity to work with the client over time to help with permanent smoking cessation.
A client calls to schedule a pregnancy test. The nurse knows that most pregnancy tests measure which hormone? a) Human chorionic gonadotropin (hCG) b) Estradiol c) Human placental lactogen d) Human chorionic thyrotropin
B. Human chorionic gonadotropin (hCG) Widely used pregnancy tests detect hCG in the blood and urine by immunologic tests specific for the beta subunit of hCG. Human placental lactogen, human chorionic thyrotropin, and estradiol are hormones produced by the placenta; however, they aren't used to detect pregnancy.
A client who is pregnant with her second child comes to the clinic complaining of a pulling and tightening sensation over her pubic bone every 15 minutes. She reports no vaginal fluid leakage. Because she has just entered her 36th week of pregnancy, she is apprehensive about her symptoms. Vaginal examination discloses a closed, thick, posterior cervix. These findings suggest that the client is experiencing: a) Braxton Hicks contractions. b) fetal distress. c) true labor contractions. d) back labor.
Braxton Hicks contractions. Braxton Hicks contractions cause pulling or tightening sensations, primarily over the pubic bone. Although these contractions may occur throughout pregnancy, they're most noticeable during the last 6 weeks of gestation in primigravid clients and the last 3 to 4 months in multiparous clients. Back labor refers to labor pain that typically starts in the back. Fetal distress doesn't cause contractions, although it may cause sharp abdominal pain. Decreased or absent fetal movements, green-tinged or yellowish green-tinged fluid, or port-wine-colored fluid may also indicate fetal distress. Pain from true labor contractions typically starts in the back and moves to the front of the fundus as a band of pressure that peaks and subsides in a regular pattern.
A 28-year-old multigravida at 32 weeks' gestation is admitted to the hospital because of vaginal bleeding. Which action should the nurse do first? a) Check fetal heart rate and maternal blood pressure. b) Perform a sterile vaginal examination. c) Witness a consent for immediate cesarean birth. d) Administer a cleansing enema.
Check fetal heart rate and maternal blood pressure. When a client is admitted with bleeding in the third trimester of pregnancy, the nurse should first assess fetal heart rate and maternal blood pressure to establish a baseline and evaluate fetal and maternal well-being. Vaginal examination is contraindicated for this client until the cause of the vaginal bleeding has been identified. For example, if the bleeding is due to abruptio placenta, a vaginal exam may cause further placental separation leading to excessive vaginal bleeding, thus placing the client at risk for hemorrhage. Any rectal manipulation, such as rectal examination or administration of an enema, is contraindicated for this client until the cause of the vaginal bleeding has been identified. For example, if the bleeding is due to abruptio placenta, an enema may cause further placental dislodgment leading to excessive vaginal bleeding and subsequently possible hemorrhage. At this point, a cesarean birth has not been planned, so witnessing a consent is not warranted.
A client, approximately 11 weeks pregnant, and her husband are seen in the antepartal clinic. The client's husband tells the nurse that he has been experiencing nausea and vomiting and fatigue along with his wife. The nurse interprets these findings as suggesting that the client's husband is experiencing which complication? a) pica b) Couvade syndrome c) mittelschmerz d) ptyalism
Couvade syndrome Couvade syndrome refers to the situation in which the expectant father experiences some of the discomforts of pregnancy along with the pregnant woman as a means of identifying with the pregnancy. Ptyalism is the term for excessive salivation. Mittelschmerz is the lower abdominal discomfort felt by some women during ovulation. Pica refers to an oral craving for substances such as clay or starch that some pregnant clients experience.
Which recommendation would be the most appropriate preventive measure to suggest to a primigravid client at 30 weeks' gestation who is experiencing occasional heartburn? a) Drink several cups of regular tea throughout the day. b) Take a pinch of baking soda with water before meals. c) Eat smaller and more frequent meals during the day. d) Decrease fluid intake to four glasses daily.
Eat smaller and more frequent meals during the day. Eating smaller and more frequent meals may help prevent heartburn because acid production is decreased and stomach displacement is reduced. Heartburn can occur at any time during pregnancy. Contributing factors include stress, tension, worry, fatigue, caffeine, and smoking. Certain spicy foods (e.g., tacos) may trigger heartburn in the pregnant client. The client should be advised to avoid sodium bicarbonate antacids (e.g., Alka-Seltzer), baking soda, Bicitra or sodium citrate, and fatty foods, which are high in sodium and can contribute to fluid retention. Increasing, not decreasing, fluid intake may help to relieve heartburn by diluting gastric juices. Caffeinated products such as coffee or tea can stimulate acid formation in the stomach, further contributing to heartburn.
During each prenatal checkup, a nurse obtains a client's weight and blood pressure and measures fundal height. What is another essential part of each prenatal checkup? a) Determining the client's Rh factor b) Measuring the client's hemoglobin (Hb) level c) Evaluating the client for edema d) Obtaining pelvic measurements
Evaluating the client for edema During each prenatal checkup, the nurse should evaluate the client for edema, a possible sign of gestational hypertension. If edema exists, the nurse should assess for high blood pressure and proteinuria — other signs of gestational hypertension. Hb is measured during the first prenatal visit and again at 24 to 28 weeks' gestation and at 36 weeks' gestation. The pelvis is measured and the Rh factor is determined during the first prenatal visit.
A 32-year-old primigravida at 39 weeks' gestation is admitted to the hospital in active labor. While the nurse performs Leopold's maneuvers, the client asks why these maneuvers are being done. The nurse explains that the major purpose of these maneuvers is to determine which factor? a) estimated gestational age b) fetal presentation c) intensity of contractions d) fetal size
Fetal presentation Leopold's maneuvers, four techniques of abdominal palpation performed between contractions and after the client empties her bladder, assist in identifying fetal presentation and position. Leopold's maneuvers are often performed before initial auscultation of the fetal heart rate. In certain situations, the maneuvers can determine deviations, such as multifetal pregnancy or a large fetus. However, this condition is usually confirmed through ultrasound procedures. Leopold's maneuvers are not used to determine estimated gestational age. Estimated gestational age is determined by ultrasound. Leopold's maneuvers do not determine contraction intensity because they are performed between contractions. Rather, contraction intensity is determined by palpation and electronic uterine monitoring.
A pregnant woman does not have funds to purchase adequate, nutritious food. She works part time at a low-wage job and has two other children. The nurse can refer the client to which type of assistance? a) neighbors who can provide food b) food bank c) home-delivered meals d) the pregnant woman's employer
Food bank The best option is a food bank; the nurse can guide the client to choose optimally nutritious foods. Home-delivered meals are expensive. Neighbors are unlikely to sustain providing sufficient food. The employer is not responsible for providing food.
A client has her first prenatal visit at 15 weeks' gestation. Which finding requires further investigation? a) Urine negative for protein b) Blood pressure of 124/72 mm Hg c) Fundal height of 18 cm d) Weight of 144 lb (65.kg)
Fundal height of 18 cm Fundal height (in centimeters) should equal the number of weeks' gestation. This client should have a fundal height of 15 to 16 cm. The blood pressure, urine, and weight findings are within normal limits for this client.
Which of the following topics for the patient education of a pregnant woman should the nurse prioritize in an effort to promote healthy fetal development? a) Stress management b) Physical activity c) Infection prevention d) Nutrition
Nutrition During pregnancy, adequate maternal nutrition is essential for normal growth and development of the fetus. While infection, exercise, and stress management are all valid and relevant subjects to address, the importance of maternal nutrition is paramount.
A primigravid client at 36 weeks' gestation tells the nurse that she has been experiencing insomnia for the past 2 weeks. Which suggestion would be most helpful? a) Practice relaxation techniques before bedtime. b) Drink a small glass of wine with dinner. c) Drink a cup of hot chocolate before bedtime. d) Exercise for 30 minutes just before bedtime.
Practice relaxation techniques before bedtime. Insomnia in the later part of pregnancy is not uncommon because the client has difficulty getting into a position of comfort. This is further compounded by frequent nocturia. The best suggestion would be to advise the client to practice relaxation techniques before bedtime. The client should avoid caffeine products such as chocolate and coffee before going to bed because caffeine is a stimulant. Alcohol consumption, regardless of the type or amount, should be avoided. Exercise is advised during the day, but it should be avoided before bedtime because exercise can stimulate the client and decrease the client's ability to fall asleep.
Assessment of a pregnant client reveals that she feels very anxious because of a lack of knowledge about giving birth. The client is in her second trimester. Which intervention by the nurse is most appropriate for this client? a) Provide her with written information about the birthing process. b) Have a more experienced pregnant woman assist her. c) Provide her with the information and teach her the skills she'll need to understand and cope during birth. d) Do nothing in hopes that she'll begin coping as the pregnancy progresses.
Provide her with the information and teach her the skills she'll need to understand and cope during birth. Because the client is in her second trimester, the nurse has ample time to establish a trusting relationship with her and to teach her in a style that fits her needs. Written information would be effective only in conjunction with teaching sessions. Introducing her to another pregnant client may be helpful, but the nurse still needs to teach the client about giving birth. Doing nothing won't address the client's needs.
During labor, a client greatly relies on her partner for support. They previously attended childbirth education classes, and now he's working with her on comfort measures. Which nursing diagnosis is appropriate for this couple? a) Compromised family coping related to labor b) Readiness for enhanced family coping related to participation in pregnancy and delivery c) Powerlessness related to pain d) Ineffective role performance related to involvement with the pregnancy
Readiness for enhanced family coping related to participation in pregnancy and delivery The client and her partner are working together for a common goal. He's offering support, and they're sharing the experience of childbirth, making Readiness for enhanced family coping related to participation in pregnancy and delivery an appropriate nursing diagnosis. Compromised family coping related to labor, Powerlessness related to pain, and Ineffective role performance related to involvement with the pregnancy suggest that the couple have a problem that isn't indicated in the question.
Which factor promotes a positive parent-neonate relationship? a) Readiness for the pregnancy b) Grandparent support c) Unplanned pregnancy d) Complicated pregnancy
Readiness for the pregnancy Readiness for pregnancy, a healthy and uncomplicated pregnancy, and parental maturity are factors that promote a positive parent-neonate relationship. Extended family is important to the social development of the neonate but doesn't affect the parent-neonate relationship.
An 18-year-old pregnant woman tells the nurse that she is concerned that she may not be able to take care of herself during her pregnancy. She states that she is not sure what prenatal care is available, or if she should access it. The nurse should recognize that the client: a) may not be fit to take care of a child. b) may not take care of herself. c) should be referred to community resources available for pregnant women. d) needs to take up a second job.
Should be referred to community resources available for pregnant women. The client needs to know that many freely available resources exist, and the nurse should help her to find such resources. It doesn't necessarily mean that the client has no interest in caring for herself or her child.
A nurse is assessing a neonate born 1 day ago to a client who smoked one pack of cigarettes daily during pregnancy. Which finding is most common in neonates whose mothers smoked during pregnancy? a) Postterm birth b) Large size for gestational age c) Appropriate size for gestational age d) Small size for gestational age
Small size for gestational age Neonates of women who smoked during pregnancy are small for gestational age for two reasons: Nicotine causes vasoconstriction, which reduces blood flow and thus nutrient transfer to the fetus, and smokers are at greater risk for poor nutrition. These neonates are more likely to be preterm than postterm because smoking causes maternal vasoconstriction, decreases placental perfusion, and induces uterine contractions. Large size for gestational age results from increased nutrient transfer to the fetus such as in a neonate who receives excessive glucose from a mother with diabetes mellitus.
Drugs known to cause birth defects are called a) Nosocomial b) Umbilical cross c) Teratogenic d) Pregnancy sensitivity
Teratogenic
A nurse obtains the antepartum history of a client who is 6 weeks pregnant. Which finding is a concern? a) The client's participation in low-impact aerobics three times per week. b) The client's consumption of six to eight cans of beer on weekends. c) The client's practice of taking a multivitamin supplement daily. d) The client's consumption of four to six small meals daily.
The client's consumption of six to eight cans of beer on weekends. Consuming any amount or type of alcohol isn't recommended during pregnancy because it increases the risk of fetal alcohol syndrome or fetal alcohol effect. The nurse should teach the client about these risks. If the client is accustomed to moderate exercise, she may continue to engage in low-impact aerobics during pregnancy. Eating frequent, small meals helps maintain the client's energy level by keeping the blood glucose level relatively constant. Taking a multivitamin supplement daily and eating a balanced diet are recommended during pregnancy.
A 36-year-old female client has been diagnosed with hemorrhoids. Which factor in the client's history would most likely be a primary cause of her hemorrhoids? a) her job as a schoolteacher b) varicosities in her legs c) three vaginal delivery pregnancies d) her age
Three vaginal delivery pregnancies Hemorrhoids are associated with prolonged sitting or standing, portal hypertension, chronic constipation, and prolonged increased intra-abdominal pressure, as associated with pregnancy and the strain of vaginal child birth. Her job as a schoolteacher does not require prolonged sitting or standing. Age and leg varicosities are not related to the development of hemorrhoids.
The nurse is providing instruction to a woman who is 18 weeks pregnant. Which findings are expected at this time? Select all that apply. a) Quickening b) Fundal height of approximately 18 cm c) Leg cramps d) Braxton-Hicks contractions e) Insomnia
• Fundal height of approximately 18 cm • Quickening Between 18 and 30 weeks' gestation, fundal height in centimeters is approximately the same as the number of weeks' gestation. In this case, the client is 18 weeks pregnant, so fundal height should measure approximately 18 cm. Quickening, which is typically described as light fluttering and is usually felt between 16 and 22 weeks' gestation, is caused by fetal movement. Insomnia, Braxton-Hicks contractions, and leg cramps are common during the third trimester.
