Chapter 12- Maternity

A woman in the 34th week of pregnancy says to the nurse, "I still feel like having intercourse with my husband." The woman's pregnancy has been uneventful. The nurse responds based on the understanding that:

it is safe to have intercourse at this time.

On the first prenatal visit, examination of the woman's internal genitalia reveals a bluish coloration of the cervix and vaginal mucosa. The nurse documents this finding as:

Chadwick's sign.

A woman in the 34th week of pregnancy says to the nurse, "I still feel like having intercourse with my husband." The woman's pregnancy has been uneventful. The nurse responds based on the understanding that:

it is safe to have intercourse at this time.

On the first prenatal visit, examination of the woman's internal genitalia reveals a bluish coloration of the cervix and vaginal mucosa. The nurse documents this finding as:

Chadwick's sign.

A nurse is teaching a pregnant couple about childbirth education. The nurse determines that the teaching was successful when the couple makes which statement?

"We'll know what to do to actively take part in our child's birth."

When assessing a woman at follow-up prenatal visits, the nurse would anticipate which procedure to be performed?

fundal height measurement

When preparing a woman for an amniocentesis, the nurse would instruct her to perform which action?

Empty the bladder.

A client who is 4 months pregnant is at the prenatal clinic for her initial visit. Her history reveals she has 7-year-old twins who were born at 34 weeks gestation, a 2-year-old son 6. born at 39 weeks gestation, and a spontaneous abortion 1 year ago at 6 weeks gestation. Using the GTPAL method, the nurse would document her obstetric history as:

4 1 1 1 3.

A client's last menstrual period was April 11. Using Nagele's rule, her estimated date of birth (EDB) would be:

January 18.

During a nonstress test, when monitoring the fetal heart rate, the nurse notes that when the expectant mother reports fetal movement, the heart rate increases 15 beats or more above the baseline. The nurse interprets this as:

reactive pattern.

A client's maternal serum alpha-fetoprotein (MSAFP) level was unusually elevated at 17 weeks. The nurse suspects which condition?

open spinal defects

When the nurse is assessing a pregnant woman in her last trimester, which question would be most appropriate to use to gather information about weight gain and fluid retention?

"How swollen do your ankles appear before you go to bed?

A pregnant woman in the 36th week of gestation reports that her feet are quite swollen at the end of the day. After careful assessment, the nurse determines that this is an expected finding at this stage of pregnancy. Which intervention is appropriate for the nurse to suggest?

"Try elevating your legs when you sit."

A pregnant woman needs an update in her immunizations. Which vaccination would the nurse ensure that the woman receives?

hepatitis b

A pregnant woman is flying across the country to visit her family. After teaching the woman about traveling during pregnancy, which statement indicates that the teaching was successful?

"I'll get up and walk around the airplane about every 2 hours."

Which statement would the nurse include when teaching a pregnant woman about chorionic villi sampling?

"You'll have an ultrasound first and then the test."

A biophysical profile has been completed on a pregnant woman. The nurse interprets which score as normal?

9

A nurse is teaching a pregnant client in her first trimester about discomforts that she may experience. The nurse determines that the teaching was successful when the woman identifies which discomfort as common during the first trimester? Select all that apply.

urinary frequency

breast tenderness

cravings

A nurse is reviewing the medical record of a pregnant woman and notes that she is gravid II. The nurse interprets this to indicate the number of:

pregnancies.

A nurse measures a pregnant woman's fundal height and finds it to be 28 cm. The nurse interprets this to indicate that the client is at how many weeks' gestation?

28 weeks' gestation

A pregnant woman has a rubella titer drawn on her first prenatal visit. The nurse explains that this test measures:

immunity to German measles.

A nurse is working with a pregnancy woman to schedule follow-up visits for her pregnancy. Which statement by the woman indicates that she understands the scheduling?

"From now until I'm 28 weeks, I'll be coming once a month."

A nurse is describing the various birth methods to pregnant couples. Which information would the nurse include as part of the Lamaze method?

use of specific breathing and relaxation techniques

After teaching a group of prospective new parents about the different perinatal education methods, the nurse determines that the teaching was successful when the parents identify which method as the Bradley method?

partner-coached method

A pregnant woman in her second trimester tells the nurse, "I've been passing a lot of gas and feel bloated." Which suggestion would be helpful for the woman? Select all that apply.

"Watch how much beans and onions you eat."

"Try exercising a little more."

"Some say that eating mints can help."

"Cut down on your intake of cheeses."

When describing perinatal education to a pregnant woman and her partner, the nurse emphasizes which goal as the primary one?

Provide knowledge and skills to actively participate in birth and parenting.

During a routine prenatal visit, a client, 36 weeks pregnant, states she has difficulty breathing and feels like her pulse rate is really fast. The nurse finds her pulse to be 100 beats per minute (increased from baseline readings of 70 to 74 beats per minute) and irregular, with bilateral crackles in the lower lung bases. The nurse would develop a plan of care identifying interventions to promote which area as the priority?

gas exchange

A pregnant woman is scheduled to undergo an amniocentesis. When explaining this test to the client, the nurse would also include information about which test being done at the same time?

ultrasound

A nurse is auscultating the chest of a client at 16 weeks' gestation. The nurse immediately notifies the health care provider about which finding?

heart rate 25 bpm above baseline

A nurse is reviewing the results of four clients who have undergone amniocentesis. Which client would the nurse recommend that the health care provider see first?

client at 38 weeks' gestation with fetal heart rate of 110 and green amniotic fluid sample

A pregnant woman is scheduled for chorionic villus sampling. The nurse is describing the procedure and the potential for complications. When providing care to the client after the testing, the nurse would be alert for which complication as the most common? Select all that apply.

vaginal bleeding

cramping

A 24-year-old client who is planning to become pregnant comes to the clinic for an evaluation. When assessing the client, which finding would alert the nurse to implement measures to reduce the client's risk for problems during pregnancy? Select all that apply.

drinks wine 3 to 4 times/week

uses ibuprofen daily

A client comes to the prenatal clinic for her first visit. When determining the client's estimated due date, the nurse understands what which method is the most accurate?

ultrasound

A woman arrives at the clinic seeking confirmation that she is pregnant. The following information is obtained: She is 24 years old with a body mass index (BMI) of 17.5. She admits to having used cocaine ―several times‖ during the past year and drinks alcohol occasionally. Her blood pressure (BP) is 108/70 mm Hg, her pulse rate is 72 beats/min, and her respiratory rate is 16 breaths/min. The family history is positive for diabetes mellitus and cancer. Her sister recently gave birth to an infant with a neural tube defect (NTD). Which characteristics place the woman in a high risk category?

Family history, BMI, and drug/alcohol abuse

A 39-year-old primigravida thinks that she is about 8 weeks pregnant, although she has had irregular menstrual periods all her life. She has a history of smoking approximately one pack of cigarettes a day, but she tells you that she is trying to cut down. Her laboratory data are within normal limits. What diagnostic technique could be used with this pregnant woman at this time?

Ultrasound examination

The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what other tool would be useful in confirming the diagnosis?

Doppler blood flow analysis

A 41-week pregnant multigravida presents in the labor and delivery unit after a nonstress test indicated that her fetus could be experiencing some difficulties in utero. Which diagnostic tool would yield more detailed information about the fetus?

Biophysical profile (BPP)

A 40-year-old woman is 10 weeks pregnant. Which diagnostic tool would be appropriate to suggest to her at this time?

Transvaginal ultrasound

A patient asks her nurse, ―My doctor told me that he is concerned with the grade of my placenta because I am overdue. What does that mean?‖ The best response by the nurse is

Your placenta changes as your pregnancy progresses, and it is given a score that indicates the amount of calcium deposits it has. The more calcium deposits, the higher the grade, or number, that is assigned to the placenta. It also means that less blood and oxygen can be delivered to your baby

A woman is undergoing a nipple-stimulated contraction stress test (CST). She is having contractions that occur every 3 minutes. The fetal heart rate (FHR) has a baseline of approximately 120 beats/min without any decelerations. The interpretation of this test is said to be

negative

When nurses help their expectant mothers assess the daily fetal movement counts, they should be aware that

the fetal alarm signal should go off when fetal movements stop entirely for 12 hours

In comparing the abdominal and transvaginal methods of ultrasound examination, nurses should explain to their patients that

the transvaginal examination allows pelvic anatomy to be evaluated in greater detail.

In the first trimester, ultrasonography can be used to gain information on

location of gestational sacs

Nurses should be aware that the biophysical profile (BPP)

is an accurate indicator of impending fetal death.

Compared with contraction stress test (CST), nonstress test (NST) for antepartum fetal assessment

has no known contraindications.

The nurse providing care for the antepartum woman should understand that contraction stress test (CST)

is considered negative if no late decelerations are observed with the contractions

Risk factors tend to be interrelated and cumulative in their effect. While planning the care for a laboring patient with diabetes mellitus, the nurse is aware that she is at a greater risk for

polyhydramnios

A pregnant woman‘s biophysical profile score is 8. She asks the nurse to explain the results. The nurse‘s best response is

The test results are within normal limits

Which analysis of maternal serum may predict chromosomal abnormalities in the fetus?

Multiple-marker screening

While working with the pregnant woman in her first trimester, the nurse is aware that chorionic villus sampling (CVS) can be performed during pregnancy at

10 weeks.

Which nursing intervention is necessary before a second-trimester transabdominal ultrasound?

Instruct the woman not void until after the test.

The nurse recognizes that a nonstress test (NST) in which two or more fetal heart rate (FHR) accelerations of 15 beats/min or more occur with fetal movement in a 20-minute period is

reactive

Intrauterine growth restriction (IUGR) is associated with numerous pregnancy-related risk factors. (Select all that apply.)

Poor material weight gain

Chronic maternal infections

Gestational hypertension

Smoking

Transvaginal ultrasonography is often performed during the first trimester. While preparing your 6-week gestation patient for this procedure, she expresses concerns over the necessity for this test. The nurse should explain that this diagnostic test may be indicated for a number of situations. (Select all that apply.)

Establish gestational age

Obesity

Fetal abnormalities

Ectopic pregnancy

While completing the medical and surgical history during the initial prenatal visit, the 16-year-old primigravida interrupts with "Why are you asking me all these questions? What difference does it make?" Which statement would best answer the client's questions?

"We ask these questions to detect anything that happened in your past that might affect the pregnancy."

A woman gave birth last week to a fetus at 18 weeks' gestation after her first pregnancy. She is in the clinic for follow-up, and notices that her chart states she has had one abortion. The client is upset over the use of this word. How can the nurse best explain this terminology to the client?

"Abortion is the obstetric term for all pregnancies that end before 20 weeks."

The clinic nurse is compiling data for a yearly report. Which client would be classified as a primigravida?

A client at 15 weeks' gestation who has never been pregnant before

The client has delivered her first child at 37 weeks. The nurse would describe this to the client as what type of delivery?

Early term

The prenatal clinic nurse is designing a new prenatal intake information form for pregnant clients. Which question is best to include on this form?

Do genetic diseases run in the family of the baby's father?

A 25-year-old primigravida is at 20 weeks' gestation. The nurse takes her vital signs and notifies the healthcare provider immediately because of which finding?

Rhonchi in both bases

The clinic nurse is assisting with an initial prenatal assessment. The following findings are present: spider nevi on lower legs; dark pink, edematous nasal mucosa; mild enlargement of the thyroid gland; mottled skin and pallor on palms and nail beds; heart rate 88 with murmur present. What is the best action for the nurse to take based on these findings?

Have the physician see the client today.

The nurse begins a prenatal assessment on a 25-year-old primigravida at 20 weeks' gestation and immediately contacts the healthcare provider because of which finding?

Respirations 30/minute

The nurse is seeing prenatal clients in the clinic. Which client is exhibiting expected findings?

12 weeks' gestation, with fetal heart tones heard by Doppler fetoscope

What signs would indicate that a pregnant client's urinalysis culture was abnormal?

Alkaline urine

Cloudy appearance

Hemoglobinuria

The nurse receives a phone call from a client who claims she is pregnant. The client reports that she has regular menses that occur every 28 days and last 5 days. The first day of her last menses was April 10. What would the client's estimated date of delivery (E D D) be if she is pregnant?

Jan. 17

The primigravida at 22 weeks' gestation has a fundal height palpated slightly below the umbilicus. Which of the following statements would best describe to the client why she needs to be seen by a physician today?

"Your baby might not be growing enough."

The nurse is explaining to a new prenatal client that the certified nurse-midwife will perform clinical pelvimetry as a part of the pelvic exam. The nurse knows that teaching has been successful when the client makes which statement about the reason for the exam?

"It will help us know how big a baby I can deliver vaginally."

The nurse is assessing a newly pregnant client. Which finding does the nurse note as a normal psychosocial adjustment in this client's first trimester?

Ambivalence about the pregnancy

The nurse is assessing a primiparous client who indicates that her religion is Judaism. Why is this information pertinent for the nurse to assess?

It provides a baseline from which to ask questions about the client's religious and cultural background

What would the nurse include as part of a routine physical assessment for a second- trimester primiparous patient whose prenatal care began in the first trimester and is ongoing?

Fundal height measurement

If a woman has the pre-existing condition of diabetes, the nurse knows that she would be prone to what high-risk factor when pregnant?

Cerebrovascular accident (C V A)

Which third-trimester client would the nurse suspect might be having difficulty with psychological adjustments to her pregnancy?

A woman who has not investigated the kind of clothing or feeding methods the baby will need

A nurse examining a prenatal client recognizes that a lag in progression of measurements of fundal height from week to week and month to month could signal what condition?

Intrauterine growth restriction

The nurse at the prenatal clinic has four calls to return. Which call should the nurse return first?

Client at 32 weeks, reports headache and blurred vision.

Screening for gestational diabetes mellitus (G D M) is typically completed between which of the following weeks of gestation?

24 and 28 weeks

A pregnant patient's first day of her last menstrual period was 6/14. What would be this patient's estimated date of birth?

3/21

The nurse is measuring the fundal height of a patient who is at 28 weeks' gestation using the following method. What would be considered a normal finding?

28 cm

The nurse is explaining pelvic measurements to a patient who is 20 weeks pregnant. On the diagram, which measurement should the nurse identify as being the smallest for the fetus to pass during delivery?

B

A pregnant patient is having pelvic measurements made. Which approach should the examiner use to determine this patient's estimated length of the pubic ramus?

During the examination of a patient who is pregnant 24 weeks, the healthcare provider performs the maneuver in the diagram below. What is being measured on this patient?

Transverse diameter

The nurse is collecting information during the health history assessment for the client profile during the initial prenatal visit. Which question is appropriate when assessing the current pregnancy?

"What was the date of your last menstrual period?"

The nurse is assessing an obese pregnant client during a routine prenatal visit. Which is the priority assessment for this client?

Blood pressure

The nurse is providing care to a pregnant client diagnosed with a urinary tract infection (U T I) during a routine prenatal visit. What will the nurse educate the client about based on this data?

Preterm labor

The nurse is preparing to assess the pregnant client's fundal height during a routine prenatal visit. Which nursing action is appropriate in this situation?

Asking the client to empty her bladder prior to the procedure

The nurse is explaining "quickening" to a client who is pregnant for the first time. Which client indicates the need for further education on this topic?

"It is an indication that I am experiencing preterm labor."

The nurse is teaching a pregnant client the clinical manifestations associated with preterm labor. Which client statement indicates the need for further education?

"Vomiting is a sign of preterm labor."

The nurse is conducting an initial prenatal assessment for a pregnant client. Which screenings should the nurse prepare the client for during this visit?

Complete blood count (C B C)

ABO and Rh typing

HIV screening

Urinalysis

Which serum markers are assessed when conducting a quadruple screen?

Alpha-fetoprotein (A F P)

Human chorionic gonadotropin (h C G)

Unconjugated estriol (U E)

Inhibin-A

The nurse is teaching the pregnant client about the symptoms of preeclampsia. Which clinical manifestations will the nurse include in the teaching session?

Dizziness

Blurred vision

Severe headache