Chapter 8 Flashcards
While auscultating fetal heart tones, a client who is at 37 weeks’ gestation and is in the supine position is experiencing dizziness, lightheadedness, and clammy skin. Which nursing action is the most appropriate?
Place a wedge beneath the client’s right hip.
A client with a normal prepregnancy weight asks why she has been told to gain 25 to 35 pounds during her pregnancy, but her underweight friend was told to gain 28 to 40 pounds. What should the nurse explain as being the recommended weight gain during pregnancy?
More than 25 to 35 pounds for an underweight woman
The nurse is reviewing the assessment findings of a client who is at 35 weeks’ gestation. Which data suggest the need for further investigation?
Glycosuria
A client in the prenatal clinic believes she is pregnant because she has not menstruated for 3 months, and her breasts are getting bigger. What response by the nurse is best?
“Lack of menses can be caused by many things. We need to do a pregnancy test.”
The nurse has completed a presentation for newly pregnant women about the changes of pregnancy. Which participant’s statement reflects accurate comprehension of the information?
“A positive Goodell sign is a probable change of pregnancy.”
A client who is experiencing her first pregnancy has just completed the initial prenatal examination with a certified nurse–midwife. Which statement indicates that the client has a correct understanding of her condition?
“Because we heard the baby’s heartbeat, I am undoubtedly pregnant.”
An adolescent client reports that her period is late but that her home pregnancy test is negative. Which response is most appropriate?
“You might be pregnant, but it might be too early for your home test to be accurate.”
A 28-year-old client who is pregnant with her first child reports increased dental caries (cavities) since becoming pregnant. How should the nurse explain the likely cause for this change?
“It may be necessary to pay extra attention to dental care while you’re pregnant, especially if you’re vomiting frequently.”
A client at 30 weeks’ gestation is tearful at the time of her follow-up visit. She tells the prenatal clinic nurse that she is excited to finally become a mother and that she has been thinking about what kind of parent she will be. However, she is upset because her mother has told her that she does not want to be a grandmother because she does not feel old enough. Meanwhile, the client’s husband has said that the pregnancy does not feel real to him yet and that he will become excited when the baby is actually here. What is the most likely explanation for what is happening within this family?
Family members are adjusting to the role change at their own pace.
The partner of a pregnant client at 16 weeks’ gestation accompanies her to the clinic. The partner tells you that the baby just does not seem real to him, and he is having a hard time relating to his partner’s fatigue and food aversions. Which statement would be best for the nurse to make?
“Many men feel this way. Feeling the baby move will help make it real.”
A 20-year-old client who is at 10 weeks’ gestation confides that the pregnancy was unplanned and is unsure about continuing it or sharing news about it with her partner. How should the nurse respond to this client?
“It’s common to feel ambiguous about pregnancy in the first trimester.”
During an interview the nurse asks the partner of a woman in the second trimester of pregnancy what changes they have noticed during the pregnancy. Which answer would indicate a typical response to pregnancy?
“She daydreams about what kind of parent she is going to be.”
The mother of a client who is 14 weeks pregnant is uncertain about how to be a good grandmother to this baby due to working full time and being so busy. How should the nurse respond in this situation?
“How do you envision your role as grandmother?”
A client in labor is a Lebanese immigrant, and she explains that in the Muslim faith, the baby’s name is selected after delivery, as it is God’s will whether or not the baby will be born. Which nursing response is appropriate?
“Thank you for explaining that to me. By sharing your cultural beliefs with me, you are helping me to provide you with the best possible care.”
The nurse is presenting an in-service to nursing staff regarding the provision of culturally competent client care. Which statement should the nurse include in the presentation?
“Developed countries are becoming increasingly more ethnically diverse.”
