The Pregnant Client Receiving Prenatal Care - LIPPINCOTT's11th

Question 1

The Pregnant Client Receiving Prenatal Care

28. A primigravid client at 16 weeks’ gestation has had an amniocentesis and has received
    teaching concerning signs and symptoms to report. Which statement indicates that the client needs
    further teaching?
29. “I need to call if I start to leak fluid from my vagina.”
30. “If I start bleeding, I will need to call back.”
31. “If my baby does not move, I need to call my health care provider.”
32. “If I start running a fever, I should let the office know.”

Answer 1

28. 3. At 16 weeks’ gestation, a primipara will not feel the baby moving. Quickening occurs
       between 18 and 20 weeks’ gestation for a primipara and between 16 and 18 weeks’ gestation for a
       multipara. Leaking fluid from the vagina should not occur until labor begins and may indicate a
       rupture of the membranes. Bleeding and a fever are complications that warrant further evaluation and
       should be reported at any time during the pregnancy.CN: Health promotion and maintenance; CL: Evaluate

Question 2

29. During a visit to the prenatal clinic, a pregnant client at 32 weeks’ gestation has heartburn.
    The client needs further instruction when she says she must do what?
30. Avoid highly seasoned foods.
31. Avoid lying down right after eating.
32. Eat small, frequent meals.
33. Consume liquids only between meals.

Answer 2

29. 4. Consuming most liquids between meals rather than at the same time as eating is an excellent
       strategy to deter nausea and vomiting in pregnancy but does not relieve heartburn. During the third
       trimester, progesterone causes relaxation of the sphincter and the pressure of the fetus against the
       stomach increases the potential of heartburn. Avoiding highly seasoned foods, remaining in an upright
       position after eating, and eating small, frequent meals are strategies to prevent heartburn.
       CN: Physiological adaptation; CL: Evaluate

Question 3

30. The nurse is teaching a new prenatal client about her iron deficiency anemia during
    pregnancy. Which statement indicates that the client needs further instruction about her anemia?
31. “I will need to take iron supplements now.”
32. “I may have anemia because my family is of Asian descent.”
33. “I am considered anemic if my hemoglobin is below 11 g/dL (110 g/L).”
34. “The anemia increases the workload on my heart.”

Answer 3

30. 2. Iron deficiency anemia is caused by insufficient iron stores in the body, poor iron content in
       the diet of the pregnant woman, or both. Other thalassemias and sickle cell anemia, rather than iron
       deficiency anemia, can be associated with ethnicity but occur primarily in clients of African or
       Mediterranean origin. Because red blood cells increase by about 50% during pregnancy, many clients
       will need to take supplemental iron to avoid iron deficiency anemia. A pregnant client is considered
       anemic when the hemoglobin is below 11 mg/dL (110 g/dL). In most types of anemia, the heart must
       pump more often and harder to deliver oxygen to cells.
       CN: Reduction of risk potential; CL: Evaluate

Question 4

31. Following a positive pregnancy test, a client begins discussing the changes that will occur in
    the next several months with the nurse. The nurse should include which of the following information
    about changes the client can anticipate in the first trimester?
32. Differentiating the self from the fetus.
33. Enjoying the role of nurturer.
34. Preparing for the reality of parenthood.
35. Experiencing ambivalence about pregnancy.

Answer 4

31. 4. Many women in their first trimester feel ambivalent about being pregnant because of the
       significant life changes that occur for most women who have a child. Ambivalence can be expressed
       as a list of positive and negative consequences of having a child, consideration of financial and social
       implications, and possible career changes. During the second trimester, the infant becomes a separate
       individual to the mother. The mother will begin to enjoy the role of nurturer postpartum. During the
       third trimester, the mother begins to prepare for parenthood and all of the tasks that parenthood
       includes.

CN: Health promotion and maintenance; CL: Apply

Question 5

32. An antenatal primigravid client has just been informed that she is carrying twins. The plan of
    care includes educating the client concerning factors that put her at risk for problems during the
    pregnancy. The nurse realizes the client needs further instruction when she indicates carrying twins
    puts her at risk for which of the following?
33. Preterm labor.
34. Twin-to-twin transfusion.
35. Anemia.
36. Group B Streptococcus.

Answer 5

32. 4. Group B Streptococcus is a risk factor for all pregnant women and is not limited to those
       carrying twins. The multiple gestation client is at risk for preterm labor because uterine distention, a
       major factor initiating preterm labor, is more likely with a twin gestation. The normal uterus is only
       able to distend to a certain point and when that point is reached, labor may be initiated. Twin-to-twin
       transfusion drains blood from one twin to the second and is a problem that may occur with multiple
       gestation. The donor twin may become growth restricted and can have oligohydramnios while the
       recipient twin may become polycythemic with polyhydramnios and develop heart failure. Anemia is a
       common problem with multiple gestation clients. The mother is commonly unable to consume enough
       protein, calcium, and iron to supply her needs and those of the fetuses. A maternal hemoglobin level
       below 11 mg/dL (110 g/L) is considered anemic.
       CN: Physiological adaptation; CL: Evaluate

Question 6

33. A 30-year-old multigravid client has missed three periods and now visits the prenatal clinic
    because she assumes she is pregnant. She is experiencing enlargement of her abdomen, a positive
    pregnancy test, and changes in the pigmentation on her face and abdomen. These assessment findings
    reflect this woman is experiencing a cluster of which signs of pregnancy?
34. Positive.
35. Probable.3. Presumptive.
36. Diagnostic.

Answer 6

33. 2. The plan of care should reflect that this woman is experiencing probable signs of
       pregnancy. She may be pregnant but the signs and symptoms may have another etiology. An enlarging
       abdomen and a positive pregnancy test may also be caused by tumors, hydatidiform mole, or other
       disease processes as well as pregnancy. Changes in the pigmentation of the face may also be caused
       by oral contraceptive use. Positive signs of pregnancy are considered diagnostic and include evident
       fetal heartbeat, fetal movement felt by a trained examiner, and visualization of the fetus with
       ultrasound confirmation. Presumptive signs are subjective and can have another etiology. These signs
       and symptoms include lack of menses, nausea, vomiting, fatigue, urinary frequency, and breastchanges. The word “diagnostic” is not used to describe the condition of pregnancy.
       CN: Physiological adaptation; CL: Analyze

Question 7

34. An antenatal client receives education concerning medications that are safe to use during
    pregnancy. The nurse evaluates the client’s understanding of the instructions and determines that she
    needs further information when she states which of the following?
35. “If I am constipated, magnesium hydroxide (Milk of Magnesia) is okay but mineral oil is not.”
36. “If I have heartburn, it is safe to use chewable calcium carbonate (Tums).”
37. “I can take acetaminophen (Tylenol) if I have a headache.”
38. “If I need to have a bowel movement, sennosides (Ex-Lax) are preferred.”

Answer 7

34. 4. Ex-Lax is considered too abrasive to use during pregnancy. In most instances, a Fleet
       enema will be given before Ex-Lax. Medications for constipation that are considered safe during
       pregnancy include compounds that produce bulk, such as Metamucil and Citrucel. Colace, Dulcolax,
       and Milk of Magnesia can also be used. Mineral oil prevents the absorption of vitamins and minerals
       within the GI tract. The strategies for heartburn are considered safe and Tylenol may be used as an
       over-the-counter analgesic.
       CN: Pharmacological and parenteral therapies; CL: Evaluate

Question 8

35. When preparing a 20-year-old client who reports missing one menstrual period and suspects
    that she is pregnant for a radioimmunoassay pregnancy test, the nurse should tell the client which of
    the following about this test?
36. It has a high degree of accuracy within 1 week after ovulation.
37. It is identical in nature to an over-the-counter home pregnancy test.
38. A positive result is considered a presumptive sign of pregnancy.
39. A urine sample is needed to obtain quicker results.

Answer 8

35. 1. The radioimmunoassay pregnancy test, which uses an antiserum with specificity for the b-
       subunit of human chorionic gonadotropin (hCG) in blood plasma, is highly accurate within 1 week
       after ovulation. The test is performed in a laboratory. Over-the-counter or home pregnancy tests are
       performed on urine and use the hemagglutination inhibition method. Radioimmunoassay tests usually
       use blood serum. A positive pregnancy test is considered a probable sign of pregnancy. Certain
       conditions other than pregnancy, such as choriocarcinoma, can cause increased hCG levels.
       CN: Reduction of risk potential; CL: Appl

Question 9

36. After instructing a female client about the radioimmunoassay pregnancy test, the nurse
    determines that the client understands the instructions when the client states that which of the
    following hormones is evaluated by this test?
37. Prolactin.
38. Follicle-stimulating hormone.
39. Luteinizing hormone.
40. Human chorionic gonadotropin (hCG)

Answer 9

36. 4. The hormone analyzed in most pregnancy tests is hCG. In the pregnant woman, trace
       amounts of hCG appear in the serum as early as 24 to 48 hours after implantation owing to the
       trophoblast production of this hormone. Prolactin, follicle-stimulating hormone, and luteinizing
       hormone are not used to detect pregnancy. Prolactin is the hormone secreted by the pituitary gland to
       prepare the breasts for lactation. Follicle-stimulating hormone is involved in follicle maturation
       during the menstrual cycle. Luteinizing hormone is responsible for stimulating ovulation.
       CN: Reduction of risk potential; CL: Evaluate

Question 10

37. Using Nägele’s rule for a client whose last normal menstrual period began on May 10, the
    nurse determines that the client’s estimated date of childbirth would be which of the following?
38. January 13.
39. January 17.
40. February 13.
41. February 17.

Answer 10

37. 4. When using Nägele’s rule to determine the estimated date of childbirth, the nurse would
       count back 3 calendar months from the first day of the last menstrual period and add 7 days. This
       means the client’s estimated date is February 17.
       CN: Health promotion and maintenance; CL: Apply

Question 11

38. After instructing a primigravid client about the functions of the placenta, the nurse determines
    that the client needs additional teaching when she says that which of the following hormones is
    produced by the placenta?
39. Estrogen.
40. Progesterone.
41. Human chorionic gonadotropin (hCG).
42. Testosterone.

Answer 11

38. 4. The placenta does not produce testosterone. Human placental lactogen, hCG, estrogen, and
       progesterone are hormones produced by the placenta during pregnancy. The hormone hCG stimulates
       the synthesis of estrogen and progesterone early in the pregnancy until the placenta can assume this
       role. Estrogen results in uterine and breast enlargement. Progesterone aids in maintaining the
       endometrium, inhibiting uterine contractility, and developing the breasts for lactation. The placenta
       also produces some nutrients for the embryo and exchanges oxygen, nutrients, and waste products
       through the chorionic villi.
       CN: Health promotion and maintenance; CL: Evaluate

Question 12

39. The nurse assesses a woman at 24 weeks’ gestation and is unable to find the fetal heart beat.
    The fetal heart beat was heard at the client’s last visit 4 weeks ago. According to priority, the nurse
    should do the following tasks in which order?
40. Call the health care provider.
41. Explain that the fetal heart beat could not be found at this time.3. Obtain different equipment and recheck.
42. Ask the client if the baby is or has been moving.

Answer 12

39.4,3,2,1. While initially continuing to attempt to find the fetal heart beat, the nurse can ask the
client if the baby has been moving. This will give a quick idea of status. The next step would be to
obtain different equipment and attempt to find the fetal heart beat again. A simple statement of fact that
the nurse cannot find the heartbeat and is taking steps to rule out equipment error is appropriate.
Calling the health care provider would be the last step after it is determined that the baby does not
have a heartbeat.CN: Reduction of risk potential; CL: Synthesize

Question 13

40. A primiparous client at 10 weeks’ gestation questions the nurse about the need for an
    ultrasound. She states “I don’t have health insurance and I can’t afford it. I feel fine, so why should I
    have the test?” The nurse should incorporate which statements as the underlying reason for
    performing the ultrasound now? Select all that apply.
41. “We must view the gross anatomy of the fetus.”
42. “We need to determine gestational age.”
43. “We want to view the heart beating to determine that the fetus is viable.”
44. “We must determine fetal position.”
45. “We must determine that there is a sufficient nutrient supply for the fetus.”

Answer 13

40.1,2. Although ultrasounds are not considered part of routine care, the ultrasound is able to
confirm the pregnancy, identify the major anatomic features of the fetus and possible abnormalities,
and determine the gestational age by measuring crown-to-rump length of the embryo during the first
trimester. At this time, the ultrasound cannot confirm that the fetus is viable. The ultrasound will
provide information about fetal position; however, this information would be more important later in
the pregnancy, not during the first trimester. The ultrasound would provide no information about
nutrient supply for the fetus.
CN: Health promotion and maintenance; CL: Analyze

Question 14

41. A 20-year-old married client with a positive pregnancy test states, “Is it really true? I can’t
    believe I’m going to have a baby!” Which of the following responses by the nurse would be most
    appropriate at this time?
42. “Would you like some booklets on the pregnancy experience?”
43. “Yes it is true. How does that make you feel?”
44. “You should be delighted that you are pregnant.”
45. “Weren’t you and your husband trying to have a baby?”

Answer 14

41. 2. 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 the client if she and her husband were trying to have a baby is a
       “yes-no” question and is not helpful. In addition, it ignores the client’s underlying feelings.
       CN: Psychosocial integrity; CL: Synthesize

Question 15

42. A newly diagnosed pregnant client tells the nurse, “If I’m going to have all of these
    discomforts, I’m not sure I want to be pregnant!” The nurse interprets the client’s statement as an
    indication of which of the following?
43. Fear of pregnancy outcome.
44. Rejection of the pregnancy.
45. Normal ambivalence.
46. Inability to care for the newborn.

Answer 15

42. 3. Women normally experience ambivalence when pregnancy is confirmed, even if the
       pregnancy was planned. Although the client’s culture may play a role in openly accepting the
       pregnancy, most new mothers who have been ambivalent initially accept the reality by the end of the
       first trimester. Ambivalence also may be expressed throughout the pregnancy; this is believed to be
       related to the amount of physical discomfort. The nurse should become concerned and perhaps contact
       a social worker if the client expresses ambivalence in the third trimester. The client’s statement
       reflects ambivalence, not fear. There is no evidence to suggest or imply that the client is rejecting the
       fetus. The client’s statement reflects ambivalence about the pregnancy, not her ability to care for the
       newborn.
       CN: Psychosocial integrity; CL: Analyze

Question 16

43. 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 of the following?
44. Ptyalism.
45. Mittelschmerz.
46. Couvade syndrome.
47. Pica.

Answer 16

43. 3. 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.
       CN: Psychosocial integrity; CL: Analyze

Question 17

44. A primigravid client asks the nurse if she can continue to have a glass of wine with dinnerduring her pregnancy. Which of the following would be the nurse’s best response?
45. “The effects of alcohol on a fetus during pregnancy are unknown.”
46. “You should limit your consumption to beer and wine.”
47. “You should abstain from drinking alcoholic beverages.”
48. “You may have 1 drink of 2 oz of alcohol per day.”

Answer 17

44. 3. Maternal alcohol use may result in fetal alcohol syndrome, marked by mild to moderate
       mental retardation, physical growth retardation, central nervous system disorders, and feeding
       difficulties. Because there is no definitive answer as to how much alcohol can be safely consumed by
       a pregnant woman, it is recommended that pregnant clients be taught to abstain from drinking alcohol
       during pregnancy. Smoking and other medications also may affect the fetus.CN: Reduction of risk potential; CL: Apply

Question 18

45. Examination of a primigravid client having increased vaginal secretions since becoming
    pregnant reveals clear, highly acidic vaginal secretions. The client denies any perineal itching or
    burning. The nurse interprets these findings as a response related to which of the following?
46. A decrease in vaginal glycogen stores.
47. Development of a sexually transmitted disease.
48. Prevention of expulsion of the cervical mucus plug.
49. Control of the growth of pathologic bacteria.

Answer 18

45. 4. An increase in clear, highly acidic vaginal secretions is a normal finding during pregnancy
       that aids in controlling the growth of pathologic bacteria. Vaginal secretions increase because of the
       influence of estrogen secretion and increased vaginal and cervical vascularity. The highly acidic
       nature of the vaginal secretions is caused by the action of Lactobacillus acidophilus, which increases
       the lactic acid content of the secretions. The increased acidity helps to make the vagina resistant to
       bacterial growth. During pregnancy, estrogen secretion fosters a glycogen-rich environment.
       Unfortunately, this glycogen-rich, acidic environment fosters the development of yeast (Candida
       albicans) infections, manifested by itching, burning, and a cheese-like vaginal discharge. If the client
       had a sexually transmitted disease, most likely she would have additional symptoms, such as lesions
       in the genital area or changes in color, consistency, or odor of the vaginal secretions. An increase in
       vaginal secretions does not help prevent expulsion of the mucus plug. The mucus plug is held in place
       by the cervix until the cervix becomes ripe.
       CN: Health promotion and maintenance; CL: Analyze

Question 19

46. When measuring the fundal height of a primigravid client at 20 weeks’ gestation, the nurse
    will locate the fundal height at which of the following points?
47. Halfway between the client’s symphysis pubis and umbilicus.
48. At about the level of the client’s umbilicus.
49. Between the client’s umbilicus and xiphoid process.
50. Near the client’s xiphoid process and compressing the diaphragm.

Answer 19

46. 2. Measurement of the client’s fundal height is a gross estimate of fetal gestational age. At 20
       weeks’ gestation, the fundal height should be at about the level of the client’s umbilicus. The fundus
       typically is over the symphysis pubis at 12 weeks. A fundal height measurement between these two
       areas would suggest a fetus with a gestational age between 12 and 20 weeks. The fundal height
       increases approximately 1 cm/week after 20 weeks’ gestation. The fundus typically reaches the
       xiphoid process at approximately 36 weeks’ gestation. A fundal height between the umbilicus and the
       xiphoid process would suggest a fetus with a gestational age between 20 and 36 weeks. The fundus
       then commonly returns to about 4 cm below the xiphoid owing to lightening at 40 weeks.
       Additionally, pressure on the diaphragm occurs late in pregnancy. Therefore, a fundal height
       measurement near the xiphoid process with diaphragmatic compression suggests a fetus near the
       gestational age of 36 weeks or older.
       CN: Health promotion and maintenance; CL: Apply

Question 20

47. A primigravida at 8 weeks’ gestation tells the nurse that she wants an amniocentesis because
    there is a history of Hemophilia A in her family. The nurse informs the client that she will need to
    wait until she is at 15 weeks’ gestation for the amniocentesis. Which of the following provides the
    most appropriate rationale for the nurse’s statement regarding amniocentesis at 15 weeks’ gestation?
48. Fetal development needs to be complete before testing.
49. The volume of amniotic fluid needed for testing will be available by 15 weeks.
50. Cells indicating hemophilia A are not produced until 15 weeks’ gestation.
51. Fetal anomalies are associated with amniocentesis prior to 15 weeks’ gestation.

Answer 20

47. 2. The volume of fluid needed for amniocentesis is 15 mL and this is usually available at 15
       weeks’ gestation. Fetal development continues throughout the prenatal period. Cells necessary for
       testing for Hemophilia A are available during the entire pregnancy but are not accessible by
       amniocentesis until 12 weeks’ gestation. Anomalies are not associated with amniocentesis testing.
       CN: Reduction of risk potential; CL: Apply

Question 21

48. After instructing a primigravid client about desired weight gain during pregnancy, the nurse
    determines that the teaching has been successful when the client states which of the following?
49. “A total weight gain of approximately 20 lb (9 kg) is recommended.”
50. “A weight gain of 6.6 lb (3 kg) in the second and third trimesters is considered normal.”
51. “A weight gain of about 12 lb (5.5 kg) every trimester is recommended.”
52. “Although it varies, a gain of 25 to 35 lb (11.4 to 14.5 kg) is about average.”

Answer 21

48. 4. The National Academy of Sciences Institute of Medicine and Health Canada recommend
       that women gain 25 to 35 lb (11.5 to 14.5 kg) during pregnancy. The pattern of weight gain is as
       important as the total amount of weight gained. Underweight women and women carrying twins
       should have a greater weight gain. Typically, women should gain 3.5 lb (1.6 kg) during the first
       trimester and then 1 lb (0.45 kg)/week during the remainder of the pregnancy (24 weeks) for a total of
       about 27 to 28 lb (12.2 to 12.7 kg). A weight gain of only 6.6 lb (3 kg) in the second and third
       trimesters is not normal because the client should be gaining about 1 lb (0.45 kg)/week, or 12 lb (5.4
       kg) during the second and third trimesters. Gaining 12 lb (5.4 kg) during each trimester would total 36
       lb (16.2 kg), which is slightly more than the recommended weight gain. In addition, nausea and
       vomiting during the first trimester can contribute to a lack of appetite and smaller weight gain during
       this trimester.CN: Health promotion and maintenance; CL: Evaluate

Question 22

49. When developing a teaching plan for a client who is 8 weeks pregnant, which of the
    following foods would the nurse suggest to meet the client’s need for increased folic acid?
50. Spinach.
51. Bananas.
52. Seafood.
53. Yogurt.

Answer 22

49. 1. Green, leafy vegetables, such as asparagus, spinach, brussel sprouts, and broccoli, are rich
       sources of folic acid. The pregnant woman needs to eat foods high in folic acid to prevent folic acid
       deficits, which may result in neural tube defects in the newborn. A well-balanced diet must include
       whole grains, dairy products, and fresh fruits; however, bananas are rich in potassium, seafood is rich
       in iodine, and yogurt is rich in calcium, not folic acid.
       CN: Reduction of risk potential; CL: Apply

Question 23

50. The nurse instructs a primigravid client about the importance of sufficient vitamin A in her
    diet. The nurse knows that the instructions have been effective when the client indicates that she
    should include which of the following in her diet?
51. Buttermilk and cheese.2. Strawberries and broccoli.
52. Egg yolks and squash.
53. Oranges and tomatoes.

Answer 23

50. 3. Egg yolks and squash and other yellow vegetables are rich sources of vitamin A. Pregnant
       women should avoid megadoses of vitamin A because fetal malformations may occur. Buttermilk and
       cheese are good sources of calcium. Strawberries, broccoli, citrus fruits (such as oranges), and
       tomatoes are good sources of vitamin C, not vitamin A.
       CN: Basic care and comfort; CL: Evaluate

Question 24

51. The nurse is discussing dietary concerns with pregnant teens. Which of the following choices
    are convenient for teens yet nutritious for both the mother and fetus? Select all that apply.
52. Milkshake or yogurt with fresh fruit or granola bar.
53. Chicken nuggets with tater tots.
54. Cheese pizza with spinach and mushroom topping.
55. Peanut butter with crackers and a juice drink.
56. Buttery light popcorn with diet cola.
57. Cheeseburger with tomato, lettuce, pickle, ketchup, and baked potato.

Answer 24

51.1,3,4. Dairy products, fresh fruit, vegetables, and foods high in protein (like cheese and peanut
butter) are excellent choices. Fried foods, such as chicken nuggets and tater tots, and foods such as
cheeseburgers and buttered popcorn are high in fat; carbonated drinks such as diet colas, and foods
such as pickles and ketchup contain large amounts of sodium. These foods can lead to an increase in
ankle edema and promote weight gain from empty calories.
CN: Health promotion and maintenance; CL: Apply

Question 25

52. An antenatal client is discussing her anemia with the nurse in the prenatal clinic. After a discussion about sources of iron to be incorporated into her daily meals, the nurse knows the client needs further instruction when she responds with which of the following? 1. “I can meet two goals when I drink milk, lots of iron and meeting my calcium needs at the same time.” 2. “Drinking coffee, tea, and sodas decreases the absorption of iron.” 3. “I can increase the absorption of iron by drinking orange juice when I eat.” 4. “Cream of wheat and molasses are excellent sources of iron.”

Answer 25

52. 1. Milk contains a large amount of calcium but contains no iron. Coffee, tea, and caffeinated soft drinks inhibit the absorption of iron. The vitamin C found in orange juice enhances the absorption of iron. Cream of wheat (1 cup/10 mg iron) and molasses (1 tbsp/3.0 mg iron) are considered excellent sources of iron as they contain the indicated amounts of iron. CN: Physiological adaptation; CL: Evaluate

Question 26

53. The nurse instructs a primigravid client to increase her intake of foods high in magnesium because of its role with which of the following? 1. Prevention of demineralization of the mother's bones. 2. Synthesis of proteins, nucleic acids, and fats. 3. Amino acid metabolism. 4. Synthesis of neural pathways in the fetus.

Answer 26

53. 2. Magnesium aids in the synthesis of protein, nucleic acids, proteins, and fats. It is important for cell growth and neuromuscular function. Magnesium also activates the enzymes for metabolism of protein and energy. Calcium prevents demineralization of the mother's bones. Vitamin B 6 is important for amino acid metabolism. Folic acid assists in the development of neural pathways in the fetus. CN: Basic care and comfort; CL: Apply

Question 27

54. When caring for a primigravid client at 9 weeks' gestation who immigrated to North America from Vietnam 1 year ago, the nurse would assess the client's diet for a deficiency of which of the following? 1. Calcium. 2. Vitamin E. 3. Vitamin C. 4. Iodine.

Answer 27

54. 1. The diet for Vietnamese clients typically consists of small portions of meat and ample amounts of rice. Fresh milk may not have been readily available in Vietnam, and many Asian clients are lactose intolerant. Therefore, the nurse would need to assess the client's diet for deficiencies of calcium and possibly iron. Traditionally, Southeast Asian diets have an abundance of dark green leafy vegetables, such as mustard greens and bok choy, which contain adequate amounts of vitamin E and vitamin C. Seafood, which contains iodine, is usually adequate in the diets of Southeast Asian women. CN: Reduction of risk potential; CL: Analyze

Question 28

55. Which of the following statements by a primigravid client scheduled for chorionic villi sampling indicates effective teaching about the procedure? 1. “A fiberoptic fetoscope will be inserted through a small incision into my uterus.” 2. “I can't have anything to eat or drink after midnight on the day of the procedure.” 3. “The procedure involves the insertion of a thin catheter into my uterus.” 4. “I need to drink 32 to 40 oz (960 to 1,200 mL) of fluid 1 to 2 hours before the procedure.”

Answer 28

55. 3. Chorionic villi sampling, which can be performed between 8 and 10 weeks' gestation, involves the insertion of a thin catheter into the vagina and uterus to obtain a sample of the chorionic cells. It is a useful diagnostic test to determine trisomy 13, translocations, fragile X syndrome, and trisomy 18. Fetoscopy is performed with a small fiberoptic fetoscope inserted through a smallincision into the client's uterus to inspect the fetus for gross abnormalities. There are no food or fluid restrictions necessary before chorionic villi sampling. Ideally, the client should empty the bladder before this procedure. A full bladder would be needed if the client were scheduled to have an ultrasound examination. CN: Reduction of risk potential; CL: Evaluate

Question 29

56. A 34-year-old multiparous client at 16 weeks' gestation who received regular prenatal care for all of her previous pregnancies tells the nurse that she has already felt the baby move. The nurse interprets this as which of the following? 1. The possibility that the client is carrying twins.2. Unusual because most multiparous clients do not experience quickening until 30 weeks' gestation. 3. Evidence that the client's estimated date of childbirth is probably off by a few weeks. 4. Normal because multiparous clients can experience quickening between 14 and 20 weeks' gestation.

Answer 29

56. 4. Although most multiparous women experience quickening at about 171⁄2 weeks' gestation, some women may perceive it between 14 and 20 weeks' gestation because they have been pregnant before and know what to expect. Detecting movement early does not suggest a twin pregnancy. If the multiparous client does not experience quickening by 20 weeks' gestation, further investigation is warranted, because the fetus may have died, the client has a hydatidiform mole, or the pregnancy dating is incorrect. There is no evidence that the client's expected date of birth is erroneous. CN: Health promotion and maintenance; CL: Analyze

Question 30

``` 57. Which diagnostic test would be the most important to have for a primigravid client in the second trimester of her pregnancy? 1. Culdocentesis. 2. Chorionic villus sampling. 3. Ultrasound testing. 4. α-fetoprotein (AFP) testing. ```

Answer 30

57. 4. AFP testing is usually performed between the 15th and 18th weeks of gestation. Abnormally high levels found in maternal serum may be indicative of neural tube defects such as anencephaly and spina bifida. Low levels may indicate trisomy 21 (Down syndrome). Culdocentesis is used to confirm a tubal pregnancy. Chorionic villus sampling is done as early as 10 weeks' gestation to detect anomalies. Ultrasound testing may be done in the first trimester to determine fetal viability and in the third trimester to determine pelvic adequacy and fetal or placental position. CN: Reduction of risk potential; CL: Apply

Question 31

58. A 17-year-old gravid client presents for her regularly scheduled 26-week prenatal visit. She appears disheveled, is wearing ill-fitting clothes, and does not make eye contact with the nurse. Which items should the nurse discuss with the client? Select all that apply. 1. Intimate partner violence. 2. Substance abuse. 3. Depression. 4. Glucose tolerance screening test. 5. HCG (Human chorionic gonadotropin) levels.

Answer 31

58.1,2,3,4. Anyone could be a victim of intimate partner violence. Health care workers should routinely assess women for intimate partner violence. Pregnant teens have increased risk for not finishing school, smoking, and substance abuse. It is possible that the client is depressed and her appearance and lack of eye contact are symptoms of her depression. The nurse expects the glucose tolerance screening test to be prescribed between 24 and 28 weeks' gestation to screen for gestational diabetes. HCG levels can identify the presence of a pregnancy or give information about an abnormal pregnancy. It would not be done at this time in a normal pregnancy. CN: Health promotion and maintenance; CL: Apply

Question 32

59. When performing Leopold's maneuvers, which of the following would the nurse ask the client to do to ensure optimal comfort and accuracy? 1. Breathe deeply for 1 minute. 2. Empty her bladder. 3. Drink a full glass of water. 4. Lie on her left side.

Answer 32

59. 2. Leopold's maneuvers involve abdominal palpation. The client should empty her bladder before the nurse palpates the abdomen. Doing so increases the client's comfort and makes palpation more accurate. Although breathing deeply may help to relax the client, it has no effect on the accuracy of the results of Leopold's maneuvers. The client does not need to drink a full glass of water before the examination. The client should be lying in a supine position with the head slightly elevated for greater comfort and with the knees drawn up slightly. CN: Health promotion and maintenance; CL: Apply

Question 33

60. The nurse performed Leopold's maneuvers and determined that the fetal position is LOA. Identify the area where the nurse would place the Doppler to most easily hear fetal heart sounds.

Answer 33

60.Because the fetus is determined to be in an LOA, a vertex position, the convex portion of the fetus lying closest to the uterine wall would be located in the lower left quadrant of the abdomen. Placing the Doppler ultrasound over that area would produce the loudest fetal heart sounds. CN: Management of care; CL: Apply

Question 34

61. The nurse is assessing fetal position for a 32-year-old client in her 8th month of pregnancy. As shown below, the fetal position can be described as which of the following? 1. Left occipital transverse. 2. Left occipital anterior. 3. Right occipital transverse. 4. Right occipital anterior

Answer 34

61.1. In left occipital transverse lie, the occiput faces the woman's left hip. In left occipital anterior lie, the occiput faces the left anterior segment of the woman's pelvis. In right occipital transverse lie, the occiput faces the woman's right hip. In right occipital anterior lie, the occiput faces the right anterior segment of the woman's pelvis. CN: Physiological adaptation; CL: Apply

Question 35

62. Which of the following statements by the nurse would be most appropriate when responding to a primigravid client who asks, “What should I do about this brown discoloration across my nose and cheeks?” 1. “This usually disappears after childbirth.” 2. “It is a sign of skin melanoma.” 3. “The discoloration is due to dilated capillaries.” 4. “It will fade if you use a prescribed cream.”

Answer 35

62. 1. Discoloration on the face that commonly appears during pregnancy, called chloasma (mask of pregnancy), usually fades postpartum and is of no clinical significance. The client who is bothered by her appearance may be able to decrease its prominence with ordinary makeup. Chloasma is not a sign of skin melanoma. It is not caused by dilated capillaries. Rather, it results from increased secretion of melanocyte-stimulating hormones caused by estrogen and progesterone secretion. No treatment is necessary for this condition. CN: Health promotion and maintenance; CL: Apply

Question 36

63. A 36-year-old primigravid client at 22 weeks' gestation without any complications to date is being seen in the clinic for a routine visit. The nurse should assess the client's fundal height to: 1. Determine the level of uterine activity. 2. Identify the need for increased weight gain. 3. Assess the location of the placenta. 4. Estimate the fetal growth.

Answer 36

63. 4. Assessment of fundal height is a gross estimate of fetal growth. By 20 weeks' gestation, the height of the fundus should be at the level of the umbilicus, after which it should increase 1 cm for each week of gestation until approximately 36 weeks' gestation. Fundal height that is significantly different from that implied by the estimated gestational age warrants further evaluation (eg, ultrasound examination) because it possibly indicates multiple pregnancy or fetal growth retardation. Fundal height estimation will not determine uterine activity or a need for increased weight gain. Ultrasound examination, not fundal height estimation, will locate the placenta. CN: Health promotion and maintenance; CL: Apply

Question 37

64. After the nurse reviews the primary health care provider's explanation of amniocentesis with a multigravid client, which of the following indicates that the client understands a serious risk of the procedure? 1. Premature rupture of the membranes. 2. Possible premature labor. 3. Fetal limb malformations. 4. Fetal organ malformations.

Answer 37

64. 2. One of the primary risks of amniocentesis is stimulation of the uterus and subsequent preterm labor. Other risks include hemorrhage from penetration of the placenta, infection of the amniotic fluid, and puncture of the fetus. There is little risk for rupture of the membranes, fetal limbmalformations, or fetal organ malformations, if a practitioner skilled in using ultrasound performs the procedure. Fetal limb malformations have been associated with percutaneous umbilical blood sampling. CN: Reduction of risk potential; CL: Evaluate

Question 38

65. A primigravid client at 28 weeks' gestation tells the nurse that she and her husband wish to drive to visit relatives who live several hours away. Which of the following recommendations by the nurse would be best? 1. “Try to avoid traveling anywhere in the car during your third trimester.” 2. “Limit the time you spend in the car to a maximum of 4 to 5 hours.” 3. “Taking the trip is okay if you stop every 1 to 2 hours and walk.” 4. “Avoid wearing your seat belt in the car to prevent injury to the fetus.”

Answer 38

65. 3. The client traveling by automobile should be advised to take intermittent breaks of 10 to 15 minutes, including walking, every 1 to 2 hours to stimulate the circulation, which becomes sluggish during long periods of sitting. Automobile travel is not contraindicated during pregnancy unless the client develops complications. There is no set maximum number of hours allowed. The pregnant client should always wear a seat belt when traveling by automobile. The client should be aware of the nearest health care facility in the city to which she is traveling. CN: Reduction of risk potential; CL: Apply

Question 39

66. The nurse is teaching a woman who is 18 weeks pregnant about seat belt safety. Identify the area that indicates that the client understands where the lap portion of the seat belt should be placed.

Answer 39

66.Seat belt safety is important for pregnant women because proper use reduces maternal mortality in car accidents. Both lap and shoulder belts are to be used. The lap portion of the belt is placed snugly but comfortably to fit under the abdominal bulge. Wearing the lap belt over the abdomen could increase the risk of uterine rupture and fetal complications due to belt tightening as the woman is propelled forward during an automobile accident. The shoulder belt is placed snugly across the shoulder, chest, and upper abdomen. CN: Safety and infection control; CL: Apply

Question 40

67. Which of the following recommendations would be most helpful to suggest to a primigravid client at 37 weeks' gestation who has leg cramps? 1. Change positions frequently throughout the day. 2. Alternately flex and extend the legs. 3. Straighten the knee and flex the toes toward the chin. 4. Lie prone in bed with the legs elevated.

Answer 40

67. 3. Leg cramps are thought to result from excessive amounts of phosphorus absorbed from milk products. Straightening the knee and flexing the toes toward the chin is an effective measure to relieve leg cramps. Also, decreasing milk intake and supplementing with calcium lactate may help to reduce the cramping. Keeping the legs warm and elevating them are good preventive measures. Changing positions frequently aids venous return but is not helpful in relieving leg cramps. Alternately flexingand extending the legs will not help to relieve the leg cramp. Lying prone in the bed is a difficult position for a client at 37 weeks' gestation to achieve and maintain because of the increase in abdominal size and therefore is not considered helpful. CN: Basic care and comfort; CL: Synthesize

Question 41

68. Which of the following recommendations would be the most appropriate preventive measure to suggest to a primigravid client at 30 weeks' gestation who is experiencing occasional heartburn? 1. Eat smaller and more frequent meals during the day. 2. Take a pinch of baking soda with water before meals. 3. Decrease fluid intake to four glasses daily. 4. Drink several cups of regular tea throughout the day.

Answer 41

68. 1. 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 (eg, tacos) may trigger heartburn in the pregnant client. The client should be advised to avoid sodium bicarbonate antacids (eg, 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. CN: Basic care and comfort; CL: Synthesize

Question 42

69. A nurse eating lunch at a restaurant sees a pregnant woman showing signs of airway obstruction. When the nurse asks the woman if she needs help, the woman nods her head yes. Indicate the area where the nurse's fist should be placed to effectively administer thrusts to clear the foreign body from the airway.

Answer 42

69.The fist is placed against the middle of the woman's sternum, with backward thrusts until the foreign body is expelled. The pressure from the backward thrusts causes compression of the ribs, further adding to the chest and lung pressure, thereby forcing the foreign body to move upward. CN: Safety and infection control; CL: Apply

Question 43

70. When performing Leopold's maneuvers on a primigravid client at 22 weeks' gestation, the nurse performs the first maneuver to do which of the following? 1. Locate the fetal back and spine. 2. Determine what is in the fundus. 3. Determine whether the fetal head is at the pelvic inlet. 4. Identify the degree of fetal descent and flexion.

Answer 43

70. 2. In the first maneuver, which is done with the nurse facing the client's head, both hands are used to palpate and determine which fetal body part (eg, the head or buttocks) is in the fundus. This first maneuver helps to determine the presenting part of the fetus. In the second maneuver, also done with the nurse facing the client's head, the palms of both hands are used to palpate the sides of the uterus and determine the location of the fetal back and spine. In the third maneuver, one hand gently grasps the lower portion of the abdomen just above the symphysis pubis to determine whether the fetal head is at the pelvic inlet. The fourth maneuver, done with the nurse facing the client's feet,determines the degree of fetal descent and flexion into the pelvis. CN: Health promotion and maintenance; CL: Apply

Question 44

71. A primigravid adolescent client at approximately 15 weeks' gestation who is visiting the prenatal clinic with her mother is to undergo alpha-fetoprotein (AFP) screening. When developing the teaching plan for this client, the nurse should include which of the following? 1. Ultrasonography usually accompanies AFP testing. 2. Results are usually very accurate until 20 weeks' gestation. 3. A clean-catch midstream urine specimen is needed. 4. Increased levels of AFP are associated with neural tube defects.

Answer 44

71. 4. Increased AFP levels are associated with neural tube defects, such as spina bifida, anencephaly, and encephalocele. Ultrasonography is used to confirm a neural tube defect only when AFP levels are increased. Because AFP levels are usually highest at 15 to 18 weeks' gestation, this is the optimum time for testing. Performing the test after this time leads to inaccurate results. The client's blood, not urine, is used for the sample. CN: Reduction of risk potential; CL: Create

Question 45

72. Which of the following statements best identifies the rationale for why the nurse reinforces the need for continued prenatal care throughout the pregnancy with an adolescent primigravid client? 1. Pregnant adolescents are at high risk for pregnancy-induced hypertension. 2. Gestational diabetes during pregnancy commonly develops in adolescents. 3. Adolescents need additional instruction related to common discomforts. 4. The father of the baby is rarely involved in the pregnancy.

Answer 45

72. 1. Prenatal care is commonly the most critical factor influencing pregnancy outcome. This is especially true for adolescents, because the most significant medical complication in pregnant adolescents is pregnancy-induced hypertension. Continued prenatal care helps to allow for early detection and prompt intervention should the complication arise. Other risks for adolescents include low-birth-weight infant, preterm labor, iron-deficiency anemia, and cephalopelvic disproportion. Gestational diabetes can occur with any pregnancy regardless of the age of the mother. Generally, all first-time mothers need instruction related to discomforts. Adolescent mothers have better nutrition when they attend group classes and are subject to peer pressure. No evidence demonstrates that most adolescents lack support systems. Fathers may abandon mothers at any time during the pregnancy; other fathers, regardless of age, are supportive throughout the pregnancy. CN: Health promotion and maintenance; CL: Apply

Question 46

73. Which of the following would be included in the teaching plan about pregnancy-related breast changes for a primigravid client? 1. Growth of the milk ducts is greatest during the first 8 weeks of gestation. 2. Enlargement of the breasts indicates adequate levels of progesterone. 3. Colostrum is usually secreted by about the 16th week of gestation. 4. Darkening of the areola occurs during the last month of pregnancy.

Answer 46

73. 3. Colostrum is usually secreted by about the 16th week of gestation in preparation for breast- feeding. Growth of the milk ducts is greatest in the last trimester, not in the first 8 weeks of gestation. Enlargement of the breasts is usually caused by estrogen, not progesterone. Darkening of the areola can occur as early as the sixth week of gestation. CN: Health promotion and maintenance; CL: Create

Question 47

74. A primigravid client at 32 weeks' gestation is enrolled in a breast-feeding class. Which of the following statements indicate that the client understands the breast-feeding education? Select all that apply. 1. “My milk supply will be adequate since I have increased a whole bra size during pregnancy.”2. “I can hold my baby several different ways during feedings.” 3. “If my infant latches on properly, I won't develop mastitis.” 4. “If I breast-feed, my uterus will return to prepregnancy size more quickly.” 5. “Breast milk can be expressed and stored at room temperature since it is natural.” 6. “I need to feed my baby when I see feeding cues and not wait until she is crying.”

Answer 47

74.2,4,6. Understanding of breast-feeding education is demonstrated by statements involving knowledge of the several positions available for comfortable breast-feeding, oxytocin release from the pituitary leading to a let-down reflex and uterine contractions for involution, and feeding cues helpful in successful breast-feeding (because waiting until the infant is hungry and crying is stressful). Breast size does not ensure successful breast-feeding. Mastitis is an infectious process and is not influenced by latching on. Breast milk needs to be stored in the refrigerator or freezer to decrease the risk of bacterial growth. CN: Basic care and comfort; CL: Evaluate

Question 48

75. When planning a class for primigravid clients about the common discomforts of pregnancy, which of the following physiologic changes of pregnancy should the nurse include in the teaching plan? 1. The temperature decreases slightly early in pregnancy. 2. Cardiac output increases by 25% to 50% during pregnancy. 3. The circulating fibrinogen level decreases as much as 50% during pregnancy. 4. The anterior pituitary gland secretes oxytocin late in pregnancy.

Answer 48

75. 2. During pregnancy, the circulatory system undergoes tremendous changes. Cardiac output increases by 25% to 50%, and circulatory blood volume increases by about 30%. The client may experience transient hypotension and dizziness with sudden position changes. Early in pregnancy there is a slight increase in the temperature, and clients may attribute this to a sinus infection or a cold. The client may feel warm, but this sensation is transient. The level of circulating fibrinogen increases as much as 50% during pregnancy, probably because of increased estrogen. Any calf tenderness should be reported, because it may indicate a clot. Late in pregnancy, the posterior pituitary gland secretes oxytocin. The client may experience painful Braxton Hicks contractions or early labor symptoms.CN: Health promotion and maintenance; CL: Create

Question 49

76. When teaching a primigravid client at 24 weeks' gestation about the diagnostic tests to determine fetal well-being, which of the following should the nurse include? 1. A fetal biophysical profile involves assessments of breathing movements, body movements, tone, amniotic fluid volume, and fetal heart rate reactivity. 2. A reactive nonstress test is an ominous sign and requires further evaluation with fetal echocardiography. 3. Contraction stress testing, performed on most pregnant women, can be initiated as early as 16 weeks' gestation. 4. Percutaneous umbilical blood sampling uses a needle inserted through the vagina to obtain a sample.

Answer 49

76. 1. The fetal biophysical profile includes fetal breathing movements, fetal body movements, tone, amniotic fluid volume, and fetal heart rate reactivity. A reactive nonstress test is a sign of fetal well-being and does not require further evaluation. A nonreactive nonstress test requires further evaluation. A contraction stress test or oxytocin challenge test should be performed only on women who are at risk for fetal distress during labor. The contraction stress test is rarely performed before 28 weeks' gestation because of the possibility of initiating labor. Percutaneous umbilical cord sampling requires the insertion of a needle through the abdomen to obtain a fetal blood sample. CN: Reduction of risk potential; CL: Apply

Question 50

77. The antenatal clinic nurse is educating a gestational diabetic soon after diagnosis. Outcome evaluation for this client session will include which of the following? Select all that apply. 1. The client states the need to maintain blood glucose levels between 70 and 110 mg/dL (3.9 to 6.2 mmol/L). 2. The client describes her planned walking program while pregnant. 3. The client will strive to maintain a hemoglobin A1C of less than 6% (0.06). 4. The client verbalizes the need to maintain a dietary intake of less than 1,500 cal/day to prevent hyperglycemia. 5. The client will continue her prenatal vitamins, iron, and folic acid.

Answer 50

77.1,2,3,5. The gestational diabetic needs to maintain blood glucose levels as close to “normal” as the nondiabetic pregnant woman. Walking is an excellent form of exercise for anyone and works well for pregnant diabetics as it burns calories, accelerates the heart rate, and as a result maintains the blood sugar at a lower level. During pregnancy continuously high blood glucose levels measured by a hemoglobin A1C of greater than 6 mg/dL (60 g/L) carry risks for the dyad. The suggested diet for a gestational diabetic is 1,800 to 2,400 cal/day to avoid the body breaking down maternal fat to maintain blood glucose levels. Continuing prenatal vitamins, iron, and folic acid (800 mcg/day) are general nutritional recommendations for pregnancy. CN: Reduction of risk; CL: Evaluate

Question 51

78. When teaching a primigravid client how to do Kegel exercises, the nurse explains that the expected outcome of these exercises is to: 1. Prevent vulvar edema. 2. Alleviate lower back discomfort. 3. Strengthen the perineal muscles. 4. Strengthen the abdominal muscles.

Answer 51

78. 3. The purpose of Kegel exercises is to strengthen the perineal muscles in preparation for the labor process. These movements strengthen the pubococcygeal muscle, which surrounds the urinary meatus and vagina. No evidence is available to support the idea that these exercises prevent vulvar edema, alleviate lower back discomfort, or strengthen the abdominal muscles. CN: Basic care and comfort; CL: Apply

Question 52

79. During a routine clinic visit, a 25-year-old multigravid client who initiated prenatal care at 10 weeks' gestation and is now in her third trimester states, “I've been having strange dreams about the baby. Last week I dreamed he was covered with hair.” The nurse should tell the mother: 1. “Dreams like the ones that you describe are very unusual. Please tell me more about them.” 2. “Commonly when a mother has these dreams, she is trying to cope with becoming a parent.” 3. “Dreams about the baby late in pregnancy usually mean that labor is about to begin soon.”4. “It's not uncommon to have dreams about the baby, particularly in the third trimester.”

Answer 52

79. 4. During the third trimester, it is not uncommon for clients to have dreams or fantasies about the baby. Sometimes the dreams are about infants who are malformed or, in this example, covered with hair. There is no evidence to suggest that the client is trying to cope with becoming a parent. Having dreams about the baby does not mean that labor will begin soon. CN: Psychosocial integrity; CL: Synthesize

Question 53

80. A primigravid client at 36 weeks' gestation tells the nurse that she has been experiencing insomnia for the past 2 weeks. Which of the following suggestions would be most helpful? 1. Practice relaxation techniques before bedtime. 2. Drink a cup of hot chocolate before bedtime. 3. Drink a small glass of wine with dinner. 4. Exercise for 30 minutes just before bedtime.

Answer 53

80. 1. 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. CN: Basic care and comfort; CL: Apply

Question 54

81. Which of the following client statements indicates a need for additional teaching about self- care during pregnancy? 1. “I should use nonskid pads when I take a shower or bath.” 2. “I should avoid using soap on my nipples to prevent drying.” 3. “I should sit in a hot tub for 20 minutes to relax after working.” 4. “I should avoid douching even if my vaginal secretions increase.”

Answer 54

81. 3. The client needs further instruction when she says it is permissible to sit in a hot tub for 20 minutes to relax after working. Hot tubs and saunas should be avoided, particularly in the first trimester, because their use can lead to maternal hyperthermia, which is associated with fetal anomalies such as central nervous system defects. The client should use nonskid pads in the shower or bath to avoid slipping because the client's center of gravity has shifted and she may fall. The clientshould avoid using soap on the nipples to prevent removal of the natural protective oils. Douching is not recommended for pregnant women because it can destroy the normal flora and increase the client's risk of infection. CN: Health promotion and maintenance; CL: Evaluate

Question 55

The Pregnant Client in Childbirth Preparation Classes 82. The nurse is developing a teaching plan for a client entering the third trimester of her pregnancy. The nurse should include which of the following in the plan? Select all that apply. 1. Differentiating the fetus from the self. 2. Ambivalence concerning pregnancy. 3. Experimenting with mothering roles. 4. Realignment of roles and tasks. 5. Trying various caregiver roles. 6. Concern about labor and birth.

Answer 55

82.3,4,5,6. During the third trimester of pregnancy, the woman experiments with maternal and caregiver roles and may make plans for changes in employment, managing household tasks, and/or childcare. The woman is also concerned about safety and passage through labor and birth. Other psychological tasks include preparation of the nursery, being tired of the pregnancy, and being introspective. A woman will begin to see herself as someone different from the fetus in the second trimester. Additionally, the mother may fantasize about the infant during the second trimester and be concerned about her changing body image. She may experience ambivalence about pregnancy in the first trimester. CN: Psychosocial integrity; CL: Create

Question 56

83. A new antenatal G 6, P 4, Ab 1 client attends her first prenatal visit with her partner. The nurse is assessing this couple's psychological response to the pregnancy. Which of the following requires the most immediate follow-up? 1. The couple is concerned with financial changes this pregnancy causes. 2. The couple expresses ambivalence about the current pregnancy. 3. The father of the baby states that the pregnancy has changed the mother's focus. 4. The father of the baby is irritated that the mother is not like she was before pregnancy.

Answer 56

83. 4. Pregnancy creates changes in the mother and father. Being considerate, accepting changes, and being supportive of the current situation are considered acceptable responses by the father, rather than feeling irritation about these changes. Expressing concern with the financial changes pregnancy and an expanded family include is normal. The first trimester involves the client and family feeling ambivalent about pregnancy and moving toward acceptance of the changes associated with pregnancy. Maternal acceptance of the pregnancy and a subsequent change in her focus are normal occurrences. CN: Health promotion and maintenance; CL: Analyze

Question 57

84. When preparing a prenatal class about endocrine changes that normally occur during pregnancy, the nurse should include information about which of the following subjects? 1. Human placental lactogen maintains the corpus luteum. 2. Progesterone is responsible for hyperpigmentation and vascular skin changes. 3. Estrogen relaxes smooth muscle in the respiratory tract. 4. The thyroid enlarges with an increase in basal metabolic rate.

Answer 57

84. 4. Thyroid enlargement and increased basal body metabolism are common occurrences during pregnancy. Human placental lactogen enhances milk production. Estrogen is responsible for hyperpigmentation and vascular skin changes. Progesterone relaxes smooth muscle in the respiratory tract. CN: Health promotion and maintenance; CL: Create

Question 58

85. When developing a series of parent classes on fetal development, which of the following should the nurse include as being developed by the end of the third month (9 to 12 weeks)? 1. External genitalia. 2. Myelinization of nerves. 3. Brown fat stores. 4. Air ducts and alveoli.

Answer 58

85. 1. Although sex is not easily discerned at 9 to 12 weeks, external genitalia are developed at this period of fetal development. Myelinization of the nerves begins at about 20 weeks' gestation. Brown fat stores develop at approximately 21 to 24 weeks. Air ducts and alveoli develop later in the gestational period, at approximately 25 to 28 weeks. CN: Health promotion and maintenance; CL: Apply

Question 59

86. A primigravid client attending parenthood classes tells the nurse that there is a history of twins in her family. What should the nurse tell the client? 1. Monozygotic twins result from fertilization of two ova by different sperm. 2. Monozygotic twins occur by chance regardless of race or heredity. 3. Dizygotic twins are usually of the same sex. 4. Dizygotic twins occur more often in primigravid than in multigravid clients.

Answer 59

86. 2. Monozygotic twinning is independent of race, age, parity, or heredity. Monozygotic twins result from the fertilization of one ovum by two different sperm. Dizygotic twinning occurs with the fertilization of more than one ovum during conception. Dizygotic twins may be of the same sex or different sexes. Dizygotic twinning is correlated with increased parity, becoming pregnant within 1 month after stopping oral contraception, and infertility treatments. A primigravid client is less likely to conceive dizygotic twins. CN: Health promotion and maintenance; CL: Apply

Question 60

87. During a 2-hour childbirth preparation class focusing on the labor and birth process for primigravid clients, the nurse is describing the maneuvers that the fetus goes through during the labor process when the head is the presenting part. In which order do these maneuvers occur? 1. Engagement2. Flexion 3. Descent 4. Internal rotation

Answer 60

1. Engagement 3. Descent 2. Flexion 4. Internal rotation Engagement refers to the fetus' entering the true pelvis and occurs before descent in primiparas and concurrently in multiparous women. If the head is the presenting part, the normal maneuvers during labor and birth are (in order): descent, flexion, internal rotation, extension, external rotation, and expulsion. These maneuvers are called the cardinal movements. They occur as the fetal head passes through the maternal pelvis during the normal labor process. CN: Health promotion and maintenance; CL: Apply

Question 61

88. A primigravid client in a preparation for parenting class asks how much blood is lost during an uncomplicated birth. The nurse should tell the woman: 1. “The maximum blood loss considered within normal limits is 500 mL.” 2. “The minimum blood loss considered within normal limits is 1,000 mL.” 3. “Blood loss during childbirth is rarely estimated unless there is a hemorrhage.” 4. “It would be very unusual if you lost more than 100 mL of blood during childbirth.”

Answer 61

88. 1. In a normal birth and for the first 24 hours postpartum, a total blood loss not exceeding 500 mL is considered normal. Blood loss during childbirth is almost always estimated because it provides a valuable indicator for possible hemorrhage. A blood loss of 1,000 mL is considered hemorrhage. CN: Health promotion and maintenance; CL: Apply

Question 62

89. Which of the following statements by a primigravid client about the amniotic fluid and sac indicates the need for further teaching? 1. “The amniotic fluid helps to dilate the cervix once labor begins.” 2. “Fetal nutrients are provided by the amniotic fluid.” 3. “Amniotic fluid provides a cushion against impact of the maternal abdomen.” 4. “The fetus is kept at a stable temperature by the amniotic fluid and sac.”

Answer 62

89. 2. Although the amniotic fluid promotes normal prenatal development by allowing symmetric development, it does not provide the fetus with nutrients. Rather, nutrients are provided by the placenta. The amniotic fluid does help dilate the cervix once labor begins by pressure and gravity forces. The amniotic fluid helps to protect the fetus from injury by cushioning against impact of the maternal abdomen and allows room and buoyancy for fetal movement. The amniotic fluid and sac keep the fetus at a stable temperature by maintaining a neutral thermal environment. CN: Health promotion and maintenance; CL: Evaluate

Question 63

90. During a childbirth preparation class, a primigravid client at 36 weeks' gestation tells the nurse, “My lower back has really been bothering me lately.” Which of the following exercises suggested by the nurse would be most helpful? 1. Pelvic rocking. 2. Deep breathing. 3. Tailor sitting. 4. Squatting.

Answer 63

90. 1. Pelvic rocking helps to relieve backache during pregnancy and early labor by making the spine more flexible. Deep breathing exercises assist with relaxation and pain relief during labor. Tailor sitting and squatting help stretch the perineal muscles in preparation for labor. CN: Health promotion and maintenance; CL: Analyze

Question 64

91. A client is experiencing pain during the first stage of labor. What should the nurse instruct the client to do to manage her pain? Select all that apply. 1. Walk in the hospital room. 2. Use slow chest breathing. 3. Request pain medication on a regular basis. 4. Lightly massage her abdomen. 5. Sip ice water.

Answer 64

91.1,2,4. Pain during the first stage of labor is primarily caused by hypoxia of the uterine and cervical muscle cells during contraction, stretching of the lower uterine segment, dilatation of the cervix and perineum, and pressure on adjacent structures. Ambulating will assist in increasing circulation of blood to the area and relaxing the muscles. Slow chest breathing is appropriate during the first stage of labor to promote increased oxygenation as well as relaxation. The woman or her coach can lightly massage the abdomen (effleurage) while using slow chest breathing. Chest breathing and massaging increase oxygenation and relaxation of uterine muscles. Pain medication is not used during the first stage of labor because most medications will slow labor; anesthesia may be considered during the second stage of labor. Sipping ice water, while helpful for maintaining hydration, will not be useful as a pain management strategy. CN: Health promotion and maintenance; CL: Synthesize

Question 65

92. During a preparation for parenting class, one of the participants asks the nurse, “How will I know if I am really in labor?” The nurse should tell the participant which of the following about true labor contractions? 1. “Walking around helps to decrease true contractions.”2. “True labor contractions may disappear with ambulation, rest, or sleep.” 3. “The duration and frequency of true labor contractions remain the same.” 4. “True labor contractions are felt first in the lower back, then the abdomen.”

Answer 65

92. 4. With true labor, the contractions are felt first in the lower back and then the abdomen. Theygradually increase in frequency and duration and do not disappear with ambulation, rest, or sleep. In true labor, the cervix dilates and effaces. Walking tends to increase true contractions. False labor contractions disappear with ambulation, rest, or sleep. False labor contractions commonly remain the same in duration and frequency. Clients who are experiencing false labor may have pain, even though the contractions are not very effective. CN: Health promotion and maintenance; CL: Apply

Question 66

93. After instructing participants in a childbirth education class about methods for coping with discomforts in the first stage of labor, the nurse determines that one of the pregnant clients needs further instruction when she says that she has been practicing which of the following? 1. Biofeedback. 2. Effleurage. 3. Guided imagery. 4. Pelvic tilt exercises.

Answer 66

93. 4. Pelvic tilt exercises are useful to alleviate backache during pregnancy and labor but are not useful for the pain from contractions. Biofeedback (a conscious effort to control the response to pain), effleurage (light uterine massage), and guided imagery (focusing on a pleasant scene) are appropriate pain relief techniques to practice before labor begins. Various breathing exercises also can help to alleviate the discomfort from contraction pain. CN: Health promotion and maintenance; CL: Evaluate

Question 67

94. After a preparation for parenting class session, a pregnant client tells the nurse that she has had some yellow-gray frothy vaginal discharge and local itching. The nurse's best action is to advise the client to do which of the following? 1. Use an over-the-counter cream for yeast infections. 2. Schedule an appointment at the clinic for an examination. 3. Administer a vinegar douche under low pressure. 4. Prepare for preterm labor and birth.

Answer 67

94. 2. Increased vaginal discharge is normal during pregnancy, but yellow-gray frothy discharge with local itching is associated with infection (e.g., Trichomonas vaginalis). The client's symptoms must be further assessed by a health professional because the client needs treatment for this condition. T. vaginalis infection is commonly treated with metronidazole (Flagyl). However, this drug is not used in the first trimester. In the first trimester, the typical treatment is topical clotrimazole. Although a yeast infection is associated with vaginal itching, the vaginal discharge is cheese-like. Furthermore, because the client may have a serious vaginal infection, over-the-counter medications are not advised until the client has been evaluated. Douching is not recommended during pregnancy because it would predispose the client to an ascending infection. The client is not exhibiting signs and symptoms of preterm labor, such as contractions or leaking fluid. And although the client's problems are suggestive of a T. vaginalis infection, which can lead to preterm labor and premature rupture of the membranes, further evaluation is needed to confirm the cause of the infection. CN: Health promotion and maintenance; CL: Synthesize

Question 68

95. The topic of physiologic changes that occur during pregnancy is to be included in a parenting class for primigravid clients who are in their first half of pregnancy. Which of the following topics would be important for the nurse to include in the teaching plan? 1. Decreased plasma volume. 2. Increased risk for urinary tract infections. 3. Increased peripheral vascular resistance. 4. Increased hemoglobin levels.

Answer 68

95. 2. During pregnancy, urinary tract infections are more common because of urinary stasis. Clients need instructions about increasing fluid volume intake. Plasma volume increases during pregnancy. The increase in plasma volume is more pronounced and occurs earlier than the increase in red blood cell mass, possibly resulting in physiologic anemia. Peripheral vascular resistance decreases during pregnancy, providing a relatively stable blood pressure. Hemoglobin levels decrease during pregnancy even though there is an increase in blood volume. CN: Health promotion and maintenance; CL: Apply

Question 69

The Pregnant Client with Risk Factors 96. A multigravid client at 32 weeks' gestation has experienced hemolytic disease of the newborn in a previous pregnancy. The nurse should prepare the client for frequent antibody titer evaluations obtained from which of the following? 1. Placental blood. 2. Amniotic fluid. 3. Fetal blood. 4. Maternal blood.

Answer 69

96. 4. For the Rh-negative client who may be pregnant with an Rh-positive fetus, an indirect Coombs test measures antibodies in the maternal blood. Titers should be performed monthly during the first and second trimesters and biweekly during the third trimester and the week before the due date. CN: Health promotion and maintenance; CL: Apply

Question 70

97. A client with a past medical history of ventricular septal defect repaired in infancy is seen at the prenatal clinic. She has dyspnea with exertion and is very tired. Her vital signs are 98, 80, 20, BP 116/72. She has +2 pedal edema and clear breath sounds. As the nurse plans this client's care, which of the following is her cardiac functional classification? 1. Class I. 2. Class II. 3. Class III. 4. Class IV.

Answer 70

97. 2. According to both the New York Heart Association and the Canadian Cardiovascular Society, this client would fit under Class II because she is symptomatic with increased activity (dyspnea with exertion). Class II clients have cardiac disease and a slight limitation in physical activity. When physical activity occurs, the client may experience angina, difficulty breathing,palpations, and fatigue. All of the client's other symptoms are within normal limits. CN: Management of care; CL: Analyze

Question 71

98. A primigravid client has completed her first prenatal visit and blood work. Her laboratory test for the hepatitis B surface antigen (HBsAg) is positive. The nurse can advise the client that the plan of care for this newborn will include which of the following? Select all that apply. 1. Hepatitis B immune globulin at birth. 2. Series of three hepatitis B vaccinations per recommended schedule. 3. Hepatitis B screening when born. 4. Isolation of infant during hospitalization. 5. Universal precautions for mother and infant. 6. Contraindication for breast-feeding.

Answer 71

98.1,2,5. The test result indicates that the mother has an active hepatitis infection and is a carrier. Hepatitis B immune globulin at birth provides the infant with passive immunity against hepatitis B and serves as a prophylactic treatment. Additionally, the infant will be started on the vaccine series of three injections. The infant should not be screened or isolated because the infant is already hepatitis B positive. As with all clients, universal precautions should be used and are sufficient to prevent transmission of the virus. Women who are positive for hepatitis B surface antigen are able to breast- feed. CN: Management of care; CL: Create

Question 72

99. A woman with asthma controlled through the consistent use of medication is now pregnant for the first time. Which of the following client statements concerning asthma during pregnancy indicates the need for further instruction? 1. “I need to continue taking my asthma medication as prescribed.” 2. “It is my goal to prevent or limit asthma attacks.” 3. “During an asthma attack, oxygen needs continue to be high for mother and fetus.” 4. “Bronchodilators should be used only when necessary because of the risk they present to the fetus.

Answer 72

99. 4. Asthma medications and bronchodilators should be continued during pregnancy as prescribed before the pregnancy began. The medications do not cause harm to the mother or fetus. Regular use of asthma medication will usually prevent asthma attacks. Prevention and limitation of an asthma attack is the goal of care for a client who is or is not pregnant and is the appropriate care strategy. During an asthma attack, oxygen needs continue as with any pregnant client but the airways are edematous, decreasing perfusion. Asthma exacerbations during pregnancy may occur as a result of infrequent use of medication rather than as a result of the pregnancy. CN: Pharmacological and parenteral therapies; CL: Evaluate

Question 73

100. A woman at 22 weeks' gestation has right upper quadrant pain radiating to her back. She rates the pain as 9 on a scale of 1 to 10 and says that it has occurred 2 times in the last week for about 4 hours at a time. She does not associate the pain with food. Which of the following nursing measures is the highest priority for this client? 1. Educate the client concerning changes occurring in the gallbladder as a result of pregnancy. 2. Refer the client to her health care provider for evaluation and treatment of the pain. 3. Discuss nutritional strategies to decrease the possibility of heartburn. 4. Support the client's use of acetaminophen (Tylenol) to relieve pain.

Answer 73

100. 2. The nurse seeing this client should refer her to a health care provider for further evaluation of the pain. This referral would allow a more definitive diagnosis and medical interventions that may include surgery. Referral would occur because of her high pain rating as well as the other symptoms, which suggest gallbladder disease. During pregnancy, the gallbladder is under the influence of progesterone, which is a smooth muscle relaxant. Because bile does not move through the system as quickly during pregnancy, bile stasis and gallstone formation can occur. Although education should be a continuous strategy, with pain at this level, a brief explanation is most appropriate. Major emphasis should be placed on determining the cause and treating the pain. It is not appropriate for the nurse to diagnose pain at this level as heartburn. Discussing nutritional strategies to prevent heartburn are appropriate during pregnancy, but not in this situation. Tylenol is an acceptable medication to take during pregnancy but should not be used on a regular basis as it can mask other problems. CN: Management of care; CL: Synthesize

Question 74

101. A client in the triage area who is at 19 weeks' gestation states that she has not felt her baby move in the past week and no fetal heart tones are found. While evaluating this client, the nurse identifies her as being at the highest risk for developing which problem? 1. Abruptio placentae. 2. Placenta previa. 3. Disseminated intravascular coagulation. 4. Threatened abortion.

Answer 74

101. 3. A fetus that has died and is retained in utero places the mother at risk for disseminated intravascular coagulation (DIC) because the clotting factors within the maternal system are consumed when the nonviable fetus is retained. The longer the fetus is retained in utero, the greater the risk of DIC. This client has no risk factors, history, or signs and symptoms that put her at risk for either abruptio placentae or placenta previa, such as sharp pain and “woody,” firm consistency of the abdomen (abruption) or painless bright red vaginal bleeding (previa). There is no evidence that she is threatening to abort as she has no cramping or vaginal bleeding. CN: Management of care; CL: Analyze

Question 75

102. A 40-year-old client at 8 weeks' gestation has a 3-year-old child with Down syndrome. The nurse is discussing amniocentesis and chorionic villus sampling as genetic screening methods for the expected baby. The nurse is confident that the teaching has been understood when the client states which of the following? 1. “Each test identifies a different part of the infant's genetic makeup.” 2. “Chorionic villus sampling can be performed earlier in pregnancy.” 3. “The test results take the same length of time to be completed.” 4. “Amniocentesis is a more dangerous procedure for the fetus.”

Answer 75

102. 2. Chorionic villus sampling (CVS) can be performed from approximately 8 to 12 weeks' gestation, while amniocentesis cannot be performed until between 11 weeks' gestation and the end of the pregnancy. Eleven weeks' gestation is the earliest possible time within the pregnancy to obtain asufficient amount of amniotic fluid to sample. Because CVS take a piece of membrane surrounding the infant, this procedure can be completed earlier in the pregnancy. Amniocentesis and chorionic villus sampling identify the genetic makeup of the fetus in its entirety, rather than a portion of it. Laboratory analysis of chorionic villus sampling takes less time to complete. Both procedures place the fetus at risk and postprocedure teaching asks the client to report the same complicating events (bleeding, cramping, fever, and fluid leakage from the vagina). CN: Management of care; CL: Evaluate

Question 76

103. After conducting a presentation to a group of adolescent parents on the topic of adolescent pregnancy, the nurse determines that one of the parents needs further instruction when the parent says that adolescents are at greater risk for which of the following? 1. Denial of the pregnancy. 2. Low-birth-weight infant. 3. Cephalopelvic disproportion. 4. Congenital anomalies.

Answer 76

103. 4. Additional teaching is needed when the parent says that adolescents are at greater risk for congenital anomalies. Although adolescents are at greater risk for denial of the pregnancy, lack of prenatal care, low-birth-weight infant, cephalopelvic disproportion, anemia, and nutritional deficits and have a higher maternal mortality rate, studies reveal that congenital anomalies are not more common in adolescent pregnancies. CN: Health promotion and maintenance; CL: Evaluate

Question 77

104. A dilatation and curettage (D&C) is scheduled for a primigravid client admitted to the hospital at 10 weeks' gestation with abdominal cramping, bright red vaginal spotting, and passage of some of the products of conception. The nurse should assess the client further for the expression of which of the following feelings? 1. Ambivalence. 2. Anxiety. 3. Fear. 4. Guilt.

Answer 77

104. 4. With a spontaneous abortion, many clients and their partners feel an acute sense of loss. Their grieving commonly includes feelings of guilt, which may be expressed as wondering whether the woman could have done something to prevent the loss. Anger, sadness, and disappointment are also common emotions after a pregnancy loss. Ambivalence, anxiety, and fear are not common emotions after a spontaneous abortion. CN: Psychosocial integrity; CL: Analyze

Question 78

105. When providing care to the client who has undergone a dilatation and curettage (D&C) after a spontaneous abortion, the nurse administers hydroxyzine as prescribed. Which of the following is an expected outcome? 1. Absence of nausea. 2. Minimized pain. 3. Decreased uterine cramping. 4. Improved uterine contractility.

Answer 78

105. 1. Hydroxyzine has a tranquilizing effect and also decreases nausea and vomiting. It does not decrease fluid retention, reduce pain, decrease uterine cramping, or promote uterine contractility. One of the adverse effects of the medication is sleepiness. Ibuprofen may decrease pain from uterine cramping. Oxytocin may be used to increase uterine contractility. CN: Pharmacological and parenteral therapies; CL: Evaluate

Question 79

106. On entering the room of a client who has undergone a dilatation and curettage (D&C) for a spontaneous abortion, the nurse finds the client crying. Which of the following comments by the nurse would be most appropriate? 1. “Are you having a great deal of uterine pain?” 2. “Commonly spontaneous abortion means a defective embryo.” 3. “I'm truly sorry you lost your baby.”4. “You should try to get pregnant again as soon as possible.”

Answer 79

106. 3. The death of a fetus at any time during pregnancy is a tragedy for most parents. After a spontaneous abortion, the client and family members can be expected to suffer from grief for several months or longer. When offering support, a simple statement such as “I'm truly sorry you lost your baby” is most appropriate. Therapeutic communication techniques help the client and family understand the meaning of the loss, move less stressfully through the grief process, and share feelings. Asking the client whether she is experiencing a great deal of uterine pain is inappropriate because this is a “yes-no” question and doesn't allow the client to express her feelings. Saying that the embryo was defective is inappropriate because this may lead the client to think that she contributed to the fetus's demise. This is not the appropriate time to discuss embryonic or fetal malformations. However, the nurse should explain to the client that this situation was not her fault. Telling the client that she should get pregnant again as soon as possible is not therapeutic and discounts the feelings of the expectant mother who had already begun to bond with the fetus. CN: Psychosocial integrity; CL: Apply

Question 80

107. Rho (D) immune globulin (RhoGAM) is prescribed for a client before she is discharged after a spontaneous abortion. The nurse instructs the client that this drug is used to prevent which of the following? 1. Development of a future Rh-positive fetus. 2. An antibody response to Rh-negative blood. 3. A future pregnancy resulting in abortion. 4. Development of Rh-positive antibodies.

Answer 80

107. 4. Rh sensitization can be prevented by Rho(D) immune globulin, which clears the maternal circulation of Rh-positive cells before sensitization can occur, thereby blocking maternal antibody production to Rh-positive cells. Administration of this drug will not prevent future Rh-positive fetuses, nor will it prevent future abortions. An antibody response will not occur to Rh-negative cells. Rh-negative mothers do not develop sensitivities if the fetus is also Rh negative.CN: Pharmacological and parenteral therapies; CL: Apply

Question 81

108. A multigravid client who stands for long periods while working in a factory visits the prenatal clinic at 35 weeks' gestation, stating, “The varicose veins in my legs have really been bothering me lately.” Which of the following instructions would be helpful? 1. Perform slow contraction and relaxation of the feet and ankles twice daily. 2. Take frequent rest periods with the legs elevated above the hips. 3. Avoid support hose that reach above the leg varicosities. 4. Take a leave of absence from your job to avoid prolonged standing

Answer 81

108. 2. The client with leg varicosities should take frequent rest periods with the legs elevated above the hips to promote venous circulation. The client should avoid constrictive clothing, but support hose that reach above the varicosities may help alleviate the pain. Contracting and relaxing the feet and ankles twice daily is not helpful because it does not promote circulation. Taking a leave of absence from work may not be possible because of economic reasons. The client should try to rest with her legs elevated or walk around for a few minutes every 2 hours while on the job. CN: Reduction of risk potential; CL: Synthesize

Question 82

109. A primigravid client at 8 weeks' gestation tells the nurse that since having had sexual relations with a new partner 2 weeks ago, she has noticed flu-like symptoms, enlarged lymph nodes, and clusters of vesicles on her vagina. The nurse refers the client to a primary health care provider because the nurse suspects which of the following sexually transmitted diseases? 1. Gonorrhea. 2. Chlamydia trachomatis infection. 3. Syphilis. 4. Herpes genitalis.

Answer 82

109. 4. The client is reporting symptoms typically associated with herpes genitalis. Some women have no symptoms of gonorrhea. Others may experience vaginal itching and a thick, purulent vaginal discharge. C. trachomatis infection in women is commonly asymptomatic, but symptoms may include a yellowish discharge and painful urination. The first symptom of syphilis is a painless chancre. CN: Physiological adaptation; CL: Apply

Question 83

110. While caring for a 24-year-old primigravid client scheduled for emergency surgery because of a probable ectopic pregnancy, the nurse should: 1. Prepare to witness an informed consent for surgery. 2. Assess the client for massive external bleeding. 3. Explain that the fallopian tube can be salvaged. 4. Monitor the client for uterine contractions.

Answer 83

110. 1. The client may need surgery to remove a ruptured fallopian tube where the pregnancy has occurred, and the nurse is usually responsible for witnessing the signature on the informed consent. Typically, if bleeding is occurring, it is internal and there is only scant vaginal bleeding with no discoloration. The nurse cannot determine whether the fallopian tube can be salvaged; this can be accomplished only during surgery. If the tube has ruptured, it must be removed. If the tube has not ruptured, a linear salpingostomy may be done to salvage the tube for future pregnancies. With an ectopic pregnancy, although the client is experiencing abdominal pain, she is not having uterine contractions. CN: Physiological adaptation; CL: Synthesize

Question 84

Managing Care Quality and Safety 111. The nurse is reviewing results for clients who are having antenatal testing. The assessment data from which client warrants prompt notification of the health care provider and a further plan of care? 1. Primigravida who reports fetal movement 6 times in 2 hours. 2. Multigravida who had a positive oxytocin challenge test. 3. Primigravida whose infant has a biophysical profile of 9. 4. Multigravida whose infant has a reactive nonstress test.

Answer 84

111. 2. Late decelerations during an oxytocin challenge test indicate that the infant is not receiving enough oxygen during contractions and is exhibiting signs of utero-placental insufficiency. This client would need further medical intervention. Fetal movement 6 times in 2 hours is adequate in a healthy fetus and a biophysical profile of 9 indicates that the risk of fetal asphyxia is rare. A reactive nonstress test informs the health care provider that the fetus has 2 fetal heart rate accelerations of 15 beats per minute above baseline and lasting for 15 seconds within a 20-minute period, which is a normal result and an indication of fetal well-being. CN: Management of care; CL: Evaluate

Question 85

112. A client asks the nurse why taking folic acid is so important before and during pregnancy. The nurse should instruct the client that: 1. “Folic acid is important in preventing neural tube defects in newborns and preventing anemia in mothers.” 2. “Eating foods with moderate amounts of folic acid helps regulate blood glucose levels.” 3. “Folic acid consumption helps with the absorption of iron during pregnancy.” 4. “Folic acid is needed to promote blood clotting and collagen formation in the newborn.”

Answer 85

112. 1. Folic acid supplementation is recommended to prevent neural tube defects and anemia in pregnancy. Deficiencies increase the risk of hemorrhage during birth as well as infection. The recommended dose prior to pregnancy is 400 mcg/day; while breast-feeding and during pregnancy, the recommended dosage is 500 to 600 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. CN: Reduction of risk potential; CL: Apply

Question 86

113. A nurse is assigned to the obstetrical triage area. When beginning the assignment, the nurse is given a report about four clients waiting to be seen. Place the clients in the order in which the nurse should see them. 1. A primigravid client at 10 weeks' gestation stating she is not feeling well with nausea and vomiting, urinary frequency, and fatigue. 2. A multiparous client at 32 weeks' gestation asking for assistance with finding a new primary health care provider. 3. A single mother at 4 months postpartum fearful of shaking her baby when he cries. 4. An antenatal client at 16 weeks' gestation who has occasional sharp pain on her left side radiating from her symphysis to her fundus.

Answer 86

3. A single mother at 4 months postpartum fearful of shaking her baby when he cries.4. An antenatal client at 16 weeks' gestation who has occasional sharp pain on her left side radiating from her symphysis to her fundus. 1. A primigravid client at 10 weeks' gestation stating she is not feeling well with nausea and vomiting, urinary frequency, and fatigue. 2. A multiparous client at 32 weeks' gestation asking for assistance with finding a new primary health care provider The first client to be seen should be the postpartum mother who is fearful of shaking her infant. Postpartum depression is a disorder that may occur during the first year postpartum but peaks at 4 weeks postpartum, prior to menses, or upon weaning. As a single mother, this client may not have support, a large factor putting women at risk. Other factors accentuating risk include prior depressive or bipolar illness and self-dissatisfaction. Second, the nurse should see the 16-week antenatal client, who is likely experiencing round ligament syndrome. At this point in the pregnancy, the uterus is stretching into the abdomen causing this type of pain. The pain is on the wrong side to be attributed to appendicitis or gallbladder disease. Nursing interventions to ease the pain include a heating pad or bringing the legs toward the abdomen. The nurse should next see the primigravid client who states she is not feeling well because she is exhibiting signs and symptoms of discomfort experienced by most women in the first trimester. The multiparous client at 32 weeks' gestation is the lowest priority as she is physically well, while the other clients have physical and psychological problems. In most emergency department situations, she may not be seen by medical or nursing staff but would be given the names of health care providers in the reception area. CN: Management of care; CL: Synthesize

Question 87

114. A client at a prenatal clinic has missed two appointments. The client calls the nurse to report that she has difficulty with consistent transportation. The nurse should refer the client to: 1. The clinic charge nurse. 2. The primary care provider. 3. The clinic social worker. 4. Her health insurance plan.

Answer 87

114. 3. The social worker is available to assist the client in finding services within the community to meet client needs. The charge nurse of the clinic or a primary care provider would be able to refer the client to the social worker. The client's insurance company deals with payments for health care and would most likely refer the client back to the local setting to find resources for transportation. CN: Management of care; CL: Apply

Question 88

115. The nurse is working in an ambulatory obstetrics setting. What are emphasized client safety procedures for this setting? Select all that apply. 1. Handwashing or antiseptic use when entering and leaving a room. 2. Use of two client identifiers when initiating contact with a client. 3. Document and use all known abbreviations. 4. Conduct preprocedure verification asking for client name and procedure to be performed. 5. Prevent infection by isolating anyone with nausea and vomiting.

Answer 88

115.1,2,4. The same safety policies apply to both inpatient and outpatient settings and are adapted to the individual specialty. Handwashing and use of two patient identifiers are standard procedures. Abbreviations that are used for inpatient are also used for outpatient as the same mistakes can occur in either setting with confusion in spelling or interpretation of letters and numbers. Preprocedure verification with name and procedure is used in the operating room, inpatient, and in ambulatory settings regardless of the procedure. It is logical to place clients with obvious communicable diseases by themselves, but nausea and vomiting are a “normal” situation in early pregnancy and not contagious. CN: Risk reduction; CL: Evaluate