Chapter 12 Nursing Management During Pregnancy

Chapter 12 Nursing management During Pregnancy 1. The nurse is assigned to clients who are having the following procedures: amniocentesis, fetal nonstress test, chorionic villus sampling, percutaneous umbilical blood sampling, and Doppler assessment of fetal heart rate. For which clients will the nurse ensure that signed informed consent has been given and is in the client's record? # Amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling § While the client ultimately consents to all procedures, some require signed documentation of consent within the clientÕs record. An informed consent is needed for an amniocentesis, chorionic villus sampling and a percutaneous umbilical blood sampling due to the invasive nature of the procedures. Both the fetal nonstress test and the Doppler assessment of the fetal heart rate are non-invasive procedures. 2. Which disease process would the nurse screen for under potential genetic disorders? # Cystic fibrosis § Screening of genetically linked disorders is important when obtaining a family history. Cystic fibrosis is a genetically linked disorder. Tuberculosis is an infectious disorder. Rheumatic fever stems from a streptococcus infection. Asthma is a hypersensitivity typically from an environmental allergy. 3. A client in her third trimester of pregnancy visits the health care center and asks why she is constipated. The nurse would include which most likely cause when responding to the client? # Pressure on intestine by the growing fetus § The nurse should explain that constipation often occurs during the third trimester because the growing fetus exerts pressure on the intestine. Engorgement of veins by the weight of the uterus causes varicosities. Pressure of the fetal head on the bladder increases the frequency of urination. Relaxation of the cardioesophageal sphincter causes heartburn. 4. A 28-year-old client who has just conceived arrives at a health care facility for her first prenatal visit to undergo a physical examination. Which intervention should the nurse perform to prepare the client for the physical examination? # Instruct the client to empty her bladder § When preparing the client for a physical examination, the nurse should instruct the client to empty her bladder; the nurse should then collect the urine sample so that it can be sent for laboratory tests to detect possibilities of a urinary tract infection. The client need not lie down, take deep breaths, or have the family present; however, it is important for the nurse to ensure that the client feels comfortable. 5. The health care provider has prescribed an over-the-counter antacid for a pregnant client in her first trimester who is having ongoing nausea, vomiting, and heartburn. Which instruction concerning the antacid should the nurse prioritize after noting the client is also prescribed a multivitamin supplement? # Take antacid 1 hour after the multivitamin § Antacids interfere with the uptake of the vitamin contents so the client should take the antacid 1 hour after taking the multivitamin. Caffeine should be avoided due to increases in blood pressure and diuretic effects. Antacids can be taken more often than solely at bedtime, and some clients need them after each meal. Antacids do not have to be taken with dairy products. The priority is to avoid allowing the antacid to cancel out the multivitamin. 6. Before beginning the initial prenatal examination, a nurse should instruct a client to complete what procedure before undressing? # Clean-catch urine § The first procedure a nurse should ask the client to do is obtain a clean-catch, midstream urine before undressing. Lab tests can be done after the examination is complete. At the first visit, the fetus is too small to be measured or have an ultrasound performed. 7. A client in her second trimester of pregnancy visits a health care facility. The client frequently engages in aerobic exercise and asks the nurse about doing so during her pregnancy. Which precaution should the nurse instruct the pregnant client to take when practicing aerobic exercises? # Maintain tolerable intensity of exercise § 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. 8. At 34 weeks' gestation a client is diagnosed with preeclampsia and sent home on bed rest. The nurse teaches the client to contact the provider immediately if she experiences which change? # Decreased fetal movement § Decreased fetal movement may indicate decreased fetal oxygenation as a result of hypertension. This is a risk to fetal well-being and the provider needs to be contacted. Decreased weight and increased urine output are signs that the body is mobilizing excessive fluid, and are normal findings. Change in appetite is unrelated to preeclampsia. 9. The nurse is educating the client at 12 weeks' gestation regarding the best types of exercise throughout pregnancy. Which activities should the nurse encourage? # Stretching and breathing exercises such as yoga § It is important to exercise during pregnancy. One excellent type of exercise includes yoga, which reduces stress and increases relaxation. Yoga also gently stretches muscles and can increase muscle tone. Contact and high-impact sports are not appropriate for the pregnant mother. Hot areas such as a jacuzzi, hot tub, and sauna are also inappropriate. 10. Nausea and vomiting are common reports during pregnancy. What nutritional action can be used to lessen nausea and vomiting? # Limiting intake of heavy, greasy foods § Nausea and vomiting can be lessened by limiting intake of fatty and greasy foods and eating small frequent meals every 2 to 3 hours. Other interventions include eating carbohydrate foods such as dry crackers, Melba toast, dry cereal, or hard candy before getting out of bed in the morning. Avoid drinking liquids with meals; avoid coffee, tea, and spicy foods; and eliminate individual food intolerances. Drinking liquids, increasing fluid intake, and limiting carbohydrate intake does not lessen nausea and vomiting. 11. A woman in her second trimester of pregnancy is beginning to experience more headaches. In addition to suggesting holding an ice pack to the forehead, the health care provider recommends which medication to provide some relief from the pain? # Acetaminophen § Resting with an ice pack on the forehead and taking a usual adult dose of acetaminophen usually furnishes adequate relief. Compounds with ibuprofen (class C drugs) are not usually recommended because they cause premature closure of the ductus arteriosus in the fetus. Additionally, they have been found to contribute to fetal renal damage, low amniotic fluid, and fetal intracranial hemorrhage. Aspirin and naproxen are also not recommended to take during pregnancy. 12. The nurse is assisting a primigravida on calculating the due date of her baby using Naegele rule. The most important information provided by the mother is: # The first day of the last menstrual period § Naegele rule is calculated using the first day of the last menstrual period. From there, 7 days are added and then 3 months are subtracted. The ovulation date, intercourse date, or last day of the menstrual period are not needed. 13. A pregnant client at full-term gestation calls the nurse to report contractions every 6 to 7 minutes that are getting stronger. The membranes are intact. The client lives 45 minutes away from the hospital and had a 4-hour labor with the previous birth. What will the nurse advise? # Come to the hospital now for assessment § Generally, clients are advised to come to the hospital once contractions are 5 minutes apart, but because this client has a history of fast (4 hour) labor and lives 45 minutes away from the hospital, the client should be advised to come to the hospital now. Membranes may rupture at any point in labor and should not dictate the timing of hospital admission. Bloody show is a normal finding in labor, but it does not determine the stage of labor or when the client should come to the hospital. 14. The nurse assesses a 20-week gestational client at a routine prenatal visit. What will the nurse predict the fundal height to be on this client experiencing an uneventful pregnancy? # 20 cm § Between weeks 18 and 32 the fundal height in centimeters should match the gestational age of the pregnancy. At 20 weeks' the fundal height should be at the umbilicus. A fundal height smaller than expected can indicate that the original dates were miscalculated, oligohydramnios, or that the fetus is smaller than expected. If the fundal height is larger than expected this can indicate multiple gestation, the original dates were miscalculated, polyhydramnios, or a molar pregnancy. 15. A pregnant woman who had stress incontinence during a previous pregnancy asks the nurse what could be done to manage this in her current pregnancy. What should the nurse recommend to the client? # Kegel exercises § Women can relieve stress incontinence to some degree by strengthening the perineal muscles through Kegel exercises. 16. A client in the first trimester reports having nausea and vomiting, especially in the morning. Which instruction would be most appropriate to help prevent or reduce the clientÕs compliant? # Eat dry crackers or toast before rising § The nurse should recommend the client eat dry crackers or toast before rising to prevent nausea and vomiting in the morning. Drinking plenty of fluids at bedtime could cause nocturia. Foods such as cheese should be avoided to prevent constipation. Spicy foods could cause heartburn. 17. The nurse is advising a pregnant woman during her first prenatal visit regarding the frequency of future visits. Which schedule is recommended for prenatal care? # Once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth § The best health for mother and baby results when the mother has her first visit before the end of the first trimester (before the end of week 13) and then has regular visits until after she has delivered the baby. The usual timing for visits is about once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth. 18. A 31-year-old client at 28 weeks' gestation reports frequent low back pain and ankle edema by the end of the day. Which suggestion should the nurse prioritize for this client? # Rest when possible with feet elevated at or above the heart. § Resting in the recumbent position helps alleviate stress on the back, and elevating the legs will help relieve the edema. Soaking the feet or lying on the right side will not alleviate the edema. Sitting semi-Fowler is not enough to alleviate the edema. 19. A nurse is providing education to a client who is 8 weeks' pregnant. The client stated she does not like milk. What is a source of calcium that the nurse can recommend to the client? # Dark, leafy green vegetables § Dark leafy green vegetables are a source of calcium. Red and orange vegetables contain a variety of vitamins, bread and rice contain carbohydrates, and meat and fish contain protein, but none of these foods are a good source of calcium. 20. The nurse is reviewing rubella antibody testing results (above) for a pregnant client at 8 weeks' gestation. What action does the nurse anticipate based on these results? # Administer the measles-mumps-rubella (MMR) vaccine postpartum. § A rubella IgG antibody index of 0.7 to 1.0 (7 to 10 international units/ml) is equivocal and an additional dose of measles-mumps-rubella (MMR) vaccine is indicated in order to develop sufficient immunity to rubella. The MMR vaccine is a live vaccine and cannot be given in pregnancy. It should be administered postpartum. Breastfeeding is not a contraindication to live vaccine administration; the MMR vaccination does not need to be deferred until after weaning. 21. 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 historytaking process? Select all that apply. # To prepare a plan of care that suits the clientÕs lifestyle # To develop a trusting relationship with the client # To prepare a plan of care for the pregnancy § 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 clientÕs 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 clientÕs partnerÕs 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. 22. Utilize the GTPAL system to classify a woman who is currently 18 weeks pregnant. This is her 4th pregnancy. She gave birth to one baby vaginally at 26 weeks who died, experienced a miscarriage, and has one living child who was delivered at 38 weeks gestation. # 4, 1, 1, 1, 1 § The GTPAL system is used to classifying pregnancy status. G = gravida, T= term, P = preterm, A = number of abortions, L= number of living children. 23. A woman is 20 weeks pregnant. The nurse would expect to palpate the fundus at which location? # At the umbilicus § At 20 weeks, 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. 24. During pregnancy, the cardinal rule concerning medications and herbal remedies is that all drugs cross the placenta and have a potential impact on the fetus. What is one disease where treatment must continue during pregnancy? # Asthma § Treatment (including medications) for certain diseases and conditions must continue during pregnancy. Examples include epilepsy, asthma, diabetes, and depression. 25. The nurse teaches a sedentary pregnant client with a BMI of 35 about the importance of healthy lifestyle during pregnancy. Which goal would be appropriate for this client? # Walk for 30 minutes 5 days a week § For a sedentary client a walking program is an appropriate goal. Dieting/weight reduction is never recommended during pregnancy. A daily aerobic or weight lifting program are not appropriate goals for a sedentary client with a high BMI. 26. The nurse is reinforcing health care provider education on the technique for an amniocentesis. Which piece of equipment will the nurse have ready? # Ultrasound equipment § First, the health care provider identifies a pocket of amniotic fluid using an ultrasound machine. A scalpel is not used in the procedure. A urine culture is not obtained prior to the procedure nor is a Foley catheter inserted. 27. When providing preconception care to a client, which instruction will the nurse to provide about medications during pregnancy? # ÒYou need to talk with your health care provider about using all prescription, over-thecounter, and herbal medications.Ó § Medication use is common during pregnancy, with prevalence estimates generally exceeding 65% and increasing over the years. Pregnant women use a wide variety of both prescription and over-the-counter medications for both pregnancy-related conditions and conditions unrelated to pregnancy conditions. Little is known about the effects of taking most medications during pregnancy. It is best for pregnant women to not take any medications during their pregnancy. At the very least, they should be encouraged to discuss with the health care provider their current medications and any herbal remedies they take so that they can learn about any potential risks should they continue to take them during pregnancy. A common concern of many pregnant women involves the use of over-the-counter medications and herbal agents. Many women consider these products benign simply because they are available without a prescription. Although herbal medications are commonly thought of as ÒnaturalÓ alternatives to other medicines, they can be just as potent as some prescription medications. The nurse should encourage pregnant women to check with their health care providers before taking anything. 28. A pregnant client in her second trimester informs the nurse that she needs to travel by air the following week. Which precaution should the nurse instruct the client to take during the flight? # Wear support hose § The nurse should instruct the client to wear support hose while traveling by air. The nurse should also instruct the client to periodically exercise the legs and ankles, and walk in the aisles if possible. Wearing low-heeled shoes, cotton clothes, or a padded bra will have no effect on the client during the flight. 29. A pregnant client is planning a vacation to a different state and questions the nurse concerning precautions. Which suggestion should the nurse prioritize for this client who will be traveling by automobile? # Stop and walk every 2 hours § Walking increases venous return and reduces the possibility of thrombophlebitis, a risk for pregnant women who sit for extended periods of time. Limiting mileage, sitting in the back with the feet elevated, and limiting trips may help, but they are not enough to prevent phlebitis. 30. A woman is concerned that orgasm will be harmful during pregnancy. Which statement is factual? # Some women experience orgasm intensely during pregnancy. § Because of pelvic congestion, orgasm may be achieved more readily by pregnant women than non-pregnant women. 31. A client in the third trimester of pregnancy has to travel a long distance by car. The client is anxious about the effect the travel may have on her pregnancy. Which instruction should the nurse provide to promote easy and safe travel for the client? # Always wear a three-point seat belt § To promote easy and safe travel for the client, the nurse should instruct the client to always wear a three-point seat belt to prevent ejection or serious injury from collision. The nurse should instruct the client to deactivate the air bag if possible. The nurse should instruct the client to apply a nonpadded shoulder strap properly, ensuring that it crosses between the breasts and over the upper abdomen, above the uterus. The nurse should instruct the client to use a lap belt that crosses over the pelvis belowÑnot overÑthe uterus. 32. At 32 weeksÕ gestation a client with a BMI of 23 has gained 24 lb (11 kg). What is the nurseÕs recommendation for weight gain for the remainder of this pregnancy? # Continue to gain approximately 1 lb (.45 kg) per week during this pregnancy. § Expected weight gain is 1.5 lb (0.68 kg) per month in the first trimester and 1 lb (.45 kg) per week for the second and third trimester. This client needs to continue to gain 1 lb (.45 kg) per week. Restricting weight gain near the end of pregnancy can negatively impact fetal growth. 33. During the physical examination at the first prenatal visit a speculum examination is performed and a bluish-colored cervix is noted. How will the nurse interpret this finding? # Chadwick sign § Because of increased pelvic congestion during pregnancy, the cervix and vaginal mucosa will have a bluish coloration, which is called Chadwick sign. A softened cervix is called Goodell sign, and the uterine isthmus being softened is called Hegar sign. Naegele rule is used to calculate the expected date of delivery (EDD) 34. A pregnant client arrives for her first prenatal appointment. She reports her previous pregnancy ended at 19 weeks, and she has 3-year-old twins born at 30 weeks' gestation. How will the nurse document this in her records? # G3 T0 P1 A1 L2 § G indicates the total number of pregnancies (2 prior, now pregnant = 3); T indicates term deliveries at or beyond 38 weeks' gestation (none = 0); P is for preterm deliveries (at 20 to 37 weeks = 1; multiple fetus delivery are scored as 1); A is for abortions or pregnancies ending before 20 weeks' gestation (1); and L refers to living children which is 2. Thus, G3 T0 P1 A1 L2 is what the nurse should note in the client's record. 35. When describing the role of a doula to a group of pregnant women, the nurse would include which information? # The doula primarily focuses on providing continuous labor support § Doulas provide the woman with continuous support throughout labor. The doula is a laywoman trained to provide women and families with encouragement, emotional and physical support, and information through late pregnancy, labor, and birth. A doula does not perform any clinical procedures and is not trained to handle high-risk births and emergencies 36. The nurse understands that the maternal uterus should be at what location at 20 weeks' gestation? # At the level of the umbilicus § By 20 weeks' gestation, the uterus is at about the level of the umbilicus; by 36 weeks, it nears the bottom of the sternum. 37.