Chapter 11 Nursing Care during pregnancy Test 1 Flashcards Preview

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Flashcards in Chapter 11 Nursing Care during pregnancy Test 1 Deck (48):
1

The nurse caring for the newly pregnant woman would advise her that ideally prenatal care should begin:
A. Before the first missed menstrual period
B. After the first missed menstrual period.
C. After the second missed menstrual period.
D. After the third missed menstrual period.

B. Prenatal care ideally should begin soon after the first missed menstrual period. Regular prenatal visits offer opportunities to ensure the health o the expectant mother and her infant.

2

A woman arrives at the clinic for a pregnancy test. The first day of her last menstrual period(LMP) was February 14, 2010. Her expected date of birth (EDB) would be:
A. September 17, 2010
B. November 7, 2010
C. November 21, 2010
D. December 17, 2010

C. Using Nägele’s rule, November 21, 2010, is the correct expected date of birth. The EDB is calculated by subtracting 3 months from the first day of the LMP and adding 7 days + 1 year to the day of the LMP. Therefore, with an LMP of February 14, 2010:
February 14, 2010 – 3 months = November 14, 2009 + 7 days = November 21, 2009 + 1 year = November 21, 2010

3

Prenatal testing for the human immunodeficiency virus (HIV) is recommended for:
a. All women, regardless of risk factors.
b. A woman who has had more than one sexual partner.
c. A woman who has had a sexually transmitted infection.
d. A woman who is monogamous with her partner.

A. Testing for the antibody to HIV is strongly recommended for all pregnant women. An HIV test is recommended for all women, regardless of risk factors. The incidence of perinatal transmission from an HIV-positive mother to her fetus ranges from 25% to 35%. Women who test positive for HIV can then be treated.

4

Which symptom is considered a first trimester warning sign and should be reported immediately by the pregnant woman to her health care provider?
A. nausea with occasional vomiting
B. fatigue
C. urinary frequency
D. vaginal bleeding

D. Signs and symptoms that must be reported include severe vomiting, fever and chills, burning on urination, diarrhea, abdominal cramping, and vaginal bleeding. These symptoms may be signs of potential complications of the pregnancy.

5

A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of exercise on the fetus. The nurse should inform her:
a. “You don’t need to modify your exercising any time during your pregnancy.”
b. “Stop exercising because it will harm the fetus.”
c. “You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month.”
d. “Jogging is too hard on your joints; switch to walking now.”

C. Typically running should be replaced with walking around the seventh month of pregnancy. The nurse should inform the woman that she may need to reduce her exercise level as the pregnancy progresses. Physical activity promotes a feeling of well being in pregnant women. It improves circulation, promotes relaxation and rest, and counteracts boredom.

6

Which blood pressure finding during the second trimester indicates a risk for pregnany induced hypertension?
a. Baseline BP 120/80, current BP 126/85
b. Baseline BP 100/70, current BP 130/85
c. Baseline BP 140/85, current BP 130/80
d. Baseline BP 110/60, current BP 110/60

B. An increase in the systolic BP of 30 mm Hg or more over the baseline pressure or an increase in the diastolic BP of 15 mm Hg or more over the baseline pressure is a significant finding, regardless of the absolute values. A current BP of 130/85 indicates that such increases have occurred in both the diastolic and systolic pressures.

7

The multiple marker test is used to assess the fetus for which condition?
A. Down syndrome
B. Diaphragmatic hernia
C. Congenital cardiac abnormality
D. Anencephaly

A. The maternal serum level of alpha-fetoprotein is used to screen for Down syndrome, neural tube defects, and other chromosome anomalies. The multiple marker test would not detect diaphragmatic hernia, congenital cardiac abnormality, or anecephaly. Additional testing such as ultrasonography and aminocentesis would be required to diagnose them.

8

A woman who is 32 week's pregnant is informed by the nurse that a danger sign of pregnancy could be:
A. constipation
B. alteration in the pattern of fetal movement
C. heart palpitations
D. edema in the ankles and feet at the end of the day

B. An alteration in the pattern or amount of fetal movement may indicate fetal jeopardy. Constipation, heart palpitations, and ankle and foot edema are normal discomforts of pregnancy that occur in the second and third trimesters.

9

A woman who is 14 weeks' pregnant tells the nurse that she alway had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know if it is safe for her to have a drink with dinner now. The nurse would tell her:
a. “Since you’re in your second trimester, there’s no problem with having one drink with dinner.”
b. “One drink every night is too much. One drink three times a week should be fine.”
c. “Since you’re in your second trimester, you can drink as much as you like.”
d. “Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy.”

D. "Because no one knows how much or how little alcohol it takes to cause fetal problems the best course is to abstain throughout your pregnancy" is an accurate statement. Complete abstinence is strongly advised.

10

A pregnant woman at 18 weeks of gestation calls the clinic to report that she has been experiencing occasional backaches of mild to moderate intensity. The nurse should recommend that she:
A. do Kegel exercises
B. do pelvic rock exercises
C. use a softer mattress
D. Stay in bed for 24 hours

B. Pelvic rock exercises may help stretch and strengthen the abdominal and lower back muscles and relieve low back pain. Stretching and other exercises to relieve back pain should be performed several times a day.

11

For what reason would breastfeeding be contraindicated?
A. Hepatitis B
B. everted nipples
C. history of breast cancer 3 years ago
D. HIV positive

D. Women who are HIV positive are discouraged from breastfeeding. Although hepatitis B antigen has not been shown to be transmitted through breast milk, as an added precaution infants born to HBsAg-positive women should receive the hepatitis B vaccine and immune globulin immediately after birth. Everted nipples are functional for breastfeeding. Newly diagnosed breast cancer would be a contraindication to breastfeeding.

12

A woman is 3 months pregnant. At her prenatal visit she tells the nurse that she doesn’t know what is happening; one minute she’s happy that she is pregnant, and the next minute she cries for no reason. Which response by the nurse is most appropriate?
a. “Don’t worry about it; you’ll feel better in a month or so.”
b. “Have you talked to your husband about how you feel?”
c. “Perhaps you really don’t want to be pregnant.”
d. “Hormonal changes during pregnancy commonly result in mood swings.”

D.“Hormonal changes during pregnancy commonly result in mood swings” is an accurate statement and the most appropriate response by the nurse. “Don’t worry about it; you’ll feel better in a month or so” dismisses the client’s concerns and is not the most appropriate response. Although women should be encouraged to share their feelings, “Have you talked to your husband about how you feel” is not the most appropriate response and does not provide the client with a rationale for the psychosocial dynamics of her pregnancy. “Perhaps you really don’t want to be pregnant” is completely inappropriate and deleterious to the psychologic well-being of the woman. Hormonal and metabolic adaptations often cause mood swings in pregnancy. The woman’s responses are normal. She should be reassured about her feelings.

13

The nurse should be aware that the partner's main role in pregnancy is to:
A. provide financial support
B. protect the pregnant woman from "old wives" tales
C. support and nurture the pregnant woman
D. make sure the pregnant woman keeps prenatal appointments

C. The partner’s main role in pregnancy is to nurture the pregnant woman and respond to her feelings of vulnerability. In older societies the man enacted the ritual couvade. Changing cultural and professional attitudes have encouraged fathers’ participation in the birth experience over the past 30 years.

14

During the first trimester a woman can expect which of the following changes in her sexual desire?
A. an increase, because of enlarging breasts
B. a decrease, because of nausea and fatigue
C. no change
D. an increase, because of increased levels of female hormones

B. Maternal physiologic changes such as breast enlargement, nausea, fatigue, abdominal changes, perineal enlargement, leukorrhea, pelvic vasocongestion, and orgasmic responses may affect sexuality and sexual expression. Libido may be depressed in the first trimester but often increases during the second and third trimesters. During pregnancy the breasts may become enlarged and tender; this tends to interfere with coitus, thereby decreasing the desire to engage in sexual activity. Libido may be depressed in the first trimester but often increases during the second and third trimesters. Maternal physiologic changes such as breast enlargement, nausea, fatigue, abdominal changes, perineal enlargement, leukorrhea, pelvic vasocongestion, and orgasmic responses may affect sexuality and sexual expression.

15

Which behavior indicates that a woman is "seeking safe passage" for herself and her infant?
A. she keeps all prenatal appointments
B. she eats for two
C. she drives her car slowly
D. she wears only low heeled shoes.

A. The goal of prenatal care is to foster a safe birth for the infant and mother. Although eating properly, driving carefully, and using proper body mechanics are all healthy measures that a mother can take, obtaining prenatal care is the optimal method for providing safety for both herself and her baby.

16

A 3 year old girl's mother is 6 months pregnant. What concern is this child likely to verbalize?
A. How the baby will get out
B. what will the baby eat
C. whether her mother will die
D. what color eyes the baby has

B. By age 3 or 4, children like to be told the story of their own beginning and accept its comparison with the present pregnancy. They like to listen to the fetal heartbeat and feel the baby move. Sometimes they worry about how the baby is being fed and what it wears. School-age children take a more clinical interest in their mother’s pregnancy and may want to know, “How did the baby get in there?” and “How will it get out?” Whether her mother will die does not tend to be the focus of a child’s questions about the impending birth of a sibling. The baby’s eye color does not tend to be the focus of children’s questions about the impending birth of a sibling.

17

In her work with pregnant women of various cultures, a nurse practitioner has observed various practices that seemed strange or unusual. She has learned that cultural rituals and practices during pregnancy seem to have one purpose in common. Which statement best describes that purpose?
a. To promote family unity
b. To ward off the “evil eye”
c. To appease the gods of fertility
d. To protect the mother and fetus during pregnancy

D. The purpose of all cultural practices is to protect the mother and fetus during pregnancy. Although many consider pregnancy normal, certain practices are expected of women of all cultures to ensure a good outcome. Cultural prescriptions tell women what to do, and cultural proscriptions establish taboos. The purposes of these practices are to prevent maternal illness resulting from a pregnancy-induced imbalanced state and to protect the vulnerable fetus.

18

What type of cultural concern is the most likely deterrent to many women seeking prenatal care?
A. religion
B. modesty
C. ignorance
D. belief that physicians are evil

B. A concern for modesty is a deterrent to many women seekng prenatal care. For some women exposing body parts, especially to a man, is considered a major violation of their modesty. Many cultural variations are found in prenatal care. Even if the prenatal care described is familiar to a woman, some practices may conflict with the beliefs and practices of a subculture group to which she belongs.

19

Which statement about pregnancy is accurate?
a. A normal pregnancy lasts about 10 lunar months.
b. A trimester is one third of a year.
c. The prenatal period extends from fertilization to conception.
d. The estimated date of confinement (EDC) is how long the mother will have to be bedridden after birth.

A. A lunar month lasts 28 days, or 4 weeks. Pregnancy spans 9 calendar months but 10 lunar months. A trimester is one third of a normal pregnancy, or about 13 to 14 weeks. The prenatal period covers the full course of pregnancy (prenatal means before birth). The EDC is now called the EDB, or estimated date of birth. It has nothing to do with the duration of bed rest.

20

In understanding and guiding a woman through her acceptance of pregnancy, a maternity nurse should be aware that:
a. Nonacceptance of the pregnancy very often equates to rejection of the child.
b. Mood swings most likely are the result of worries about finances and a changed lifestyle, as well as profound hormonal changes.
c. Ambivalent feelings during pregnancy usually are seen only in emotionally immature or very young mothers.
d. Conflicts such as not wanting to be pregnant or childrearing and career-related decisions need not be addressed during pregnancy, because they will resolve themselves naturally after birth.

B. Mood swings are natural and are likely to affect every woman to some degree. A woman may dislike being pregnant, refuse to accept it, and still love and accept the child. Ambivalent feelings about pregnancy are normal for mature or immature women, young or older. Conflicts such as not wanting to be pregnant or childrearing and career-related decisions need to be resolved. The baby ends the pregnancy but not all the issues.

21

With regard to a woman’s reordering of personal relationships during pregnancy, the maternity nurse should be aware that:
a. Because of the special motherhood bond, a woman’s relationship with her mother is even more important than with the father of the child.
b. Nurses need not get involved in any sexual issues the couple has during pregnancy, particularly if they have trouble communicating them to each other.
c. Women usually express two major relationship needs during pregnancy: feeling loved and valued and having the child accepted by the father.
d. The woman’s sexual desire is likely to be highest in the first trimester because of the excitement and because intercourse is physically easier.

C. Love and support help a woman feel better about her pregnancy. The most important person to the pregnant womain is usually the father. Nurses can facilitate communication between partners about sexual matters if, as is common, they are nervous about expressing their worries and feelings. The second trimester is the time when a woman’s sense of well-being, along with certain physical changes, increases her desire for sex. Desire is down in the first and third trimesters.

22

What represents a typical progression through the phases of a woman’s establishing a relationship with the fetus?
a. Accepts the fetus as distinct from herself—accepts the biologic fact of pregnancy—has a feeling of caring and responsibility
b. Fantasizes about the child’s gender and personality—views the child as part of herself—becomes introspective
c. Views the child as part of herself—has feelings of well-being—accepts the biologic fact of pregnancy
d. “I am pregnant.”— “I am going to have a baby.”—“I am going to be a mother.”

D. The woman first centers on herself as pregnant, then on the baby as an entity separate from herself, and then on her responsibilities as a mother. The expressions, “I am pregnant,” “I am going to have a baby,” and “I am going to be a mother” sum up the progression through the three phases.

23

With regard to the father’s acceptance of the pregnancy and preparation for childbirth, the maternity nurse should know that:
a. The father goes through three phases of acceptance of his own.
b. The father’s attachment to the fetus cannot be as strong as that of the mother because it does not start until after birth.
c. In the last 2 months of pregnancy, most expectant fathers suddenly get very protective of their established lifestyle and resist making changes to the home.
d. Typically men remain ambivalent about fatherhood right up to the birth of their child.

A. A father typically goes through three phases of acceptance: accepting the biologic fact, adjusting to the reality, and focusing on his role. The father-child attachment can be as strong as the mother-child relationship and can also begin during pregnancy. In the last 2 months of pregnancy many expectant fathers work hard to improve the environment of the home for the child. Typically the expectant father’s ambivalence ends by the first trimester, and he progresses to adjusting to the reality of the situation and then to focusing on his role.

24

With regard to the initial visit with a client who is beginning prenatal care, nurses should be aware that:
a. The first interview is a relaxed, get-acquainted affair in which nurses gather some general impressions.
b. If nurses observe handicapping conditions, they should be sensitive and not inquire about them because the client will do that in her own time.
c. Nurses should be alert to the appearance of potential parenting problems such as depression or lack of family support.
d. Because of legal complications, nurses should not ask about illegal drug use; that is left to physicians.

C. Besides these potential problems, nurses need to be alert to the woman's attitude toward health care. The initial interview needs to be planned, purposeful, and focused on specific content. A lot of ground must be covered. Nurses must be sensitive to special problems, but they do need to inquire because discovering individual needs is important. People with chronic or handicapping conditions forget to mention them because they have adapted to them. Getting information on drug use is important and can be done confidentially. Actual testing for drug use requires the client’s consent.

25

With regard to the initial physical examination of a woman beginning prenatal care, maternity nurses should be aware that:
a. Only women who show physical signs or meet the sociologic profile should be assessed for physical abuse.
b. The woman should empty her bladder before the pelvic examination is performed.
c. The distribution, amount, and quality of body hair are of no particular importance.
d. The size of the uterus is discounted in the initial examination because it is just going to get bigger soon.

B. An empty bladder facilitates the examination; this is also an opportunity to get a urine sample easily for a number of tests. All women should be assessed for a history of physical abuse, particularly because the likelihood of abuse increases during pregnancy. Noting body hair is important because body hair reflects nutritional status, endocrine function, and hygiene. Particular attention is paid to the size of the uterus because it is an indication of the duration of gestation.

26

With regard to follow-up visits for women receiving prenatal care, nurses should be aware that:
a. The interview portions become more intensive as the visits become more frequent over the course of the pregnancy.
b. Monthly visits are scheduled for the first trimester, every 2 weeks for the second trimester, and weekly for the third trimester.
c. During the abdominal examination the nurse should be alert for supine hypotension.
d. For pregnant women a systolic blood pressure (BP) of 130 and a diastolic BP of 80 is sufficient to be considered hypertensive.

C. The woman lies on her back during the abdominal examination, possibly compressing the vena cava and aorta, which can cause a decrease in blood pressure and a feeling of faintness. The interview portion of follow-up examinations is less extensive than in the initial prenatal visits, during which so much new information must be gathered. Monthly visits are routinely scheduled for the first and second trimesters; visits increase to every 2 weeks at week 28 and to once a week at week 36. For pregnant women hypertension is defined as a systolic BP of 140 or higher and a diastolic BP of 90 or higher.

27

With regard to their role in the personal hygiene of the expectant mother, maternity nurses should be aware that:
a. Tub bathing is permitted even in late pregnancy unless membranes have ruptured.
b. The perineum should be wiped from back to front.
c. Bubble bath and bath oils are permissible because they add an extra soothing and cleansing action to the bath.
d. Expectant mothers should use specially treated soap to cleanse the nipples.

A. The main danger from taking baths is falling in the tub. The perineum should be wiped from front to back. Bubble baths and bath oils should be avoided because they may irritate the urethra. Soap, alcohol, ointments, and tinctures should not be used to cleanse the nipples because they remove protective oils. Warm water is sufficient.

28

The nurse should be aware that the pinch test is used to:
A. check the sensitivity of the nipples
B. determine whether the nipple is everted or inverted
C. calculate the adipose buildup in the abdomen
D. see whether the fetus has become inactive.

B. The pinch test is used to deterine whether the nipple is everted or inverted. Nipples must be everted to allow breastfeeding.

29

With regard to dental care during pregnancy, maternity nurses should be aware that:
a. Dental care can be dropped from the priority list because the woman has enough to worry about and is getting a lot of calcium anyway.
b. Dental surgery, in particular, is contraindicated because of the psychologic stress it engenders.
c. If dental treatment is necessary, the woman will be most comfortable with it in the second trimester.
d. Dental care interferes with the expectant mother’s need to practice conscious relaxation.

C. The second trimester is best for dental treatment because that is when the woman will be able to sit most comfortably in the dental chair. Dental care such as brushing with fluoride toothpaste is especially important during pregnancy because nausea during pregnancy may lead to poor oral hygiene. Emergency dental surgery is permissible, but the mother must clearly understand the risks and benefits. Conscious relaxation is useful, and it may even help the woman get through any dental appointments; it is not a reason to avoid them.

30

With regard to work and travel during pregnancy, nurses should be aware that:
a. Women should sit for as long as possible and cross their legs at the knees from time to time for exercise.
b. Women should avoid seat belts and shoulder restraints in the car, because they press on the fetus.
c. Metal detectors at airport security checkpoints can harm the fetus if the woman passes through them a number of times.
d. While working or traveling in a car or on a plane, women should arrange to walk around at least every hour or so.

D. Periodic walking helps prevent thrombophlebitis. Pregnant women should avoid sitting or standing for long periods and crossing the legs at the knees. Pregnant women must wear lap belts and shoulder restraints. The most common injury to the fetus comes from injury to the mother. Metal detectors at airport security checkpoints do not harm fetuses.

31

With regard to medications, hebs, shots, and other substances normally encountered, the maternity nurse should be aware that:
a. Both prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus.
b. The greatest danger of drug-caused developmental deficits in the fetus is seen in the final trimester.
c. Killed-virus vaccines (e.g., tetanus) should not be given during pregnancy, but live-virus vaccines (e.g., measles) are permissible.
d. No convincing evidence exists that secondhand smoke is potentially dangerous to the fetus.

A. Both prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. This is especially true for new medications and combinations of drugs. The greatest danger of drug-caused developmental defects exists in the interval from fertilization through the first trimester, when a woman may not realize that she is pregnant. Live-virus vaccines should be part of postpartum care; killed-virus vaccines may be administered during pregnancy. Secondhand smoke is associated with fetal growth restriction and increases in infant mortality.

32

Which statement about multifetal pregnancy is NOT accurate?
a. The expectant mother often develops anemia because the fetuses have a greater demand for iron.
b. Twin pregnancies come to term with the same frequency as single pregnancies.
c. The mother should be counseled to increase her nutritional intake and gain more weight.
d. Backache and varicose veins often are more pronounced.

B. Twin pregnancies often end in prematurity. Serious efforts should be made to bring the pregnancy to term. A woman with a multifetal pregnancy often develop anemia, suffers more or worse backache, and needs to gain more weight. Counseling is needed to help her adjust to these conditions.

33

The phenomenon of someone other than the mother to be experiencing pregnancy like symptoms such as nausea and weight gain applies to the:
A. mother of the pregnant woman
B. couple's teenage daughter
C. sister of the pregnant woman
D. expectant father

D. An expectant father's experiencing of his partner's pregnancy-like symptoms is called the couvade syndrome.

34

In response to requests by the U.S. Public Health Service for new models of prenatal care, an innovative new approach to prenatal care known as centering pregnancy was developed. Which statement would accurately apply to the centering model of care?
a. Group sessions begin with the first prenatal visit.
b. At each visit blood pressure, weight, and urine dipsticks are obtained by the nurse.
c. Eight to 12 women are placed in gestational-age cohort groups.
d. Outcomes are similar to those of traditional prenatal care.

C. Gestational age cohorts comprise the groups, with approximately 8 to 12 women in each group. This group remains intact throughout the pregnancy. Individual follow-up visits are scheduled as needed. Group sessions begin at 12 to 16 weeks of gestation and end with an early postpartum visit. Before group sessions the client has an individual assessment, physical examination, and history. At the beginning of each group meeting, clients measure their own blood pressure, weight, and urine dips and enter these in their record. Fetal heart rate assessment and fundal height are obtained by the nurse. Results evaluating this approach have been very promising. In a recent study of adolescent clients, there was a decrease in low-birth-weight infants and an increase in breastfeeding rates.

35

Signs and symptoms that a woman should report immediately to her health care provider include (choose all that apply):
a. Vaginal bleeding.
b. Rupture of membranes.
c. Heartburn accompanied by severe headache.
d. Decreased libido.
e. Urinary frequency.

A, B, C
Vaginal bleeding, rupture of membranes, and severe headaches are all signs of potential complications in pregnancy. Clients should be advised to report these signs to their health care provider. Decreased libido and urinary frequency are common discomforts of pregnancy that do not require immediate health care interventions.

36

A woman has just moved to the United States from Mexico. She is 3 months pregnant and has arrived for her first prenatal visit. During her assessment interview, you discover that she has not had any immunizations. Which immunizations should she receive at this point in her pregnancy? Choose all that apply.
a. Tetanus
b. Diphtheria
c. Chickenpox
d. Rubella
e. Hepatitis B

A, B, E
Immunization with live or attenuated live viruses is contraindicated during pregnancy because of its potential teratogenicity. Vaccines consisting of killed viruses may be used. Those that may be administered during pregnancy include tetanus, diphtheria, recombinant hepatitis B, and rabies vaccines.
Live-virus vaccines include those for measles (rubeola and rubella), chickenpox, and mumps.

37

During the first trimester the pregnant woman would be most motivated to learn about:

A. fetal development.
B. impact of a new baby on family members.
C. measures to reduce nausea and fatigue so she can feel better.
D. location of childbirth preparation and breastfeeding classes.




C. Fetal development concerns are more apparent in the second trimester when the woman is feeling fetal movement. Impact of a new baby on the family would be appropriate topics for the second trimester when the fetus becomes “real” as its movements are felt and its heartbeat heard. During this trimester a woman works on the task of, “I am going to have a baby.” During the first trimester a woman is egocentric and concerned about how she feels. She is working on the task of accepting her pregnancy. Motivation to learn about childbirth techniques and breastfeeding is greatest for most women during the third trimester as the reality of impending birth and becoming a parent is accepted. A goal is to achieve a safe passage for herself and her baby.

38

An expectant father confides in the nurse that his pregnant wife, 10 weeks of gestation, is driving him crazy. “One minute she seems happy, and the next minute she is crying over nothing at all. Is there something wrong with her?” The nurse's BEST response would be:

A. “This is normal behavior and should begin to subside by the second trimester.”
B. “She may be having difficulty adjusting to pregnancy; I will refer her to a counselor that I know.”
C. “This is called emotional liability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant.”
D. “You seem impatient with her. Perhaps this is precipitating her behavior.”

C. This is the most appropriate response since it gives an explanation and a time frame for when the mood swings may stop. This statement is judgmental and not appropriate.

39

If exhibited by an expectant father, what would be a warning sign of ineffective adaptation to his partner's first pregnancy?

A. Views pregnancy with pride as a confirmation of his virility
B. Consistently changes the subject when the topic of the fetus/newborn is raised
C. Expresses concern that he might faint at the birth of his baby
D. Experiences nausea and fatigue, along with his partner, during the first trimester

B. Persistent refusal to talk about the fetus-newborn may be a sign of a problem and should be assessed further.

40

What laboratory results would be a cause for concern if exhibited by a woman at her first prenatal visit during the second month of her pregnancy?

A. Hematocrit 38%, hemoglobin 13 g/dL
B. White blood cell count 6000/mm3
C. Platelets 300,000/mm3
D. Rubella titer 1:6

D. A rubella titer of less than 1:10 indicates a lack of immunity to rubella, a viral infection that has the potential to cause teratogenic effects on fetal development. Arrangements should be made to administer the rubella vaccine after birth during the postpartum period since administration of rubella, a live vaccine, would be contraindicated during pregnancy. Women receiving the vaccine during the postpartum period should be cautioned to avoid pregnancy for 3 months.

41

A maternal serum alpha-fetoprotein (MSAFP) test is performed at 16 to 18 weeks of gestation. An elevated level has been associated with:

A. Down syndrome.
B. sickle cell anemia.
C. cardiac defects.
D. open neural tube defects such as spina bifida.

D. Low levels of MSAFP are associated with Down syndrome. Sickle cell anemia is not detected by the MSAFP. Cardiac defects would not be detected with the MSAFP. A triple marker test determines the levels of MSAFP along with serum levels of estriol and human chorionic gonadotropin; an elevated level is associated with open neural tube defects.

42

An expectant couple asks the nurse about intercourse during pregnancy and if it is safe for the baby. The nurse should tell the couple that:

A. intercourse should be avoided if any spotting from the vagina occurs afterward.
B. intercourse is safe until the third trimester.
C. safer-sex practices should be used once the membranes rupture.
D. intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present.


D. Some spotting can normally occur as a result of the increased fragility and vascularity of the cervix and vagina during pregnancy. Intercourse can continue as long as the pregnancy is progressing normally. Safer-sex practices are always recommended; rupture of the membranes may require abstaining from intercourse. Uterine contractions that accompany orgasm can stimulate labor and would be problematic if the woman were at risk for or had a history of preterm labor.

43

A pregnant woman at 32 weeks of gestation complains of feeling dizzy and light-headed while her fundal height is being measured. Her skin is pale and moist. The nurse’s initial response would be to:

A. assess the woman’s blood pressure and pulse.
B. have the woman breathe into a paper bag.
C. raise the woman’s legs.
D. turn the woman on her side.


D. Vital signs can be assessed next. Breathing into a paper bag is the solution for dizziness related to respiratory alkalosis associated with hyperventilation. Raising her legs will not solve the problem since pressure will still remain on the major abdominal blood vessels, thereby continuing to impede cardiac output. During a fundal height measurement the woman is placed in a supine position. This woman is experiencing supine hypotension as a result of uterine compression of the vena cava and abdominal aorta. Turning her on her side will remove the compression and restore cardiac output and blood pressure.

44

A pregnant woman demonstrates understanding of the nurse’s instructions regarding relief of leg cramps if she:

A. Wiggles and points her toes during the cramp.
B. Applies cold compresses to the affected leg.
C. Extends her leg and dorsiflexes her foot during the cramp.
D. Avoids weight bearing on the affected leg during the cramp.

C. Pointing toes can aggravate rather than relieve the cramp. Application of heat is recommended. Extending the leg and dorsiflexing the foot is the appropriate relief for a leg cramp. Bearing weight on the affected leg can help to relieve the leg cramp, so it should not be avoided.

45

With regard to medications, herbs, shots, and other substances normally encountered, the maternity nurse should be aware that:

A. prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus.
B. the greatest danger of drug-caused developmental deficits in the fetus is seen in the final trimester.
C. killed-virus vaccines (e.g., tetanus) should not be given during pregnancy, but live-virus vaccines (e.g., measles) are permissible.
D. no convincing evidence exists that secondhand smoke is potentially dangerous to the fetus.

A. This is especially true for new medications and combinations of drugs. The greatest danger of drug-caused developmental defects exists in the interval from fertilization through the first trimester, when a woman may not realize that she is pregnant. Live-virus vaccines should be part of postpartum care; killed-virus vaccines may be administered during pregnancy. Secondhand smoke is associated with fetal growth restriction and increases in infant mortality.

46

The nurse advises the woman who wants to have a nurse-midwife provide obstetric care that:

A. she will have to give birth at home.
B. she must see an obstetrician as well as the midwife during pregnancy.
C. she will not be able to have epidural analgesia for labor pain.
D. she must be having a low-risk pregnancy.


D. Most nurse-midwife births are managed in hospitals or birth centers; a few may be managed in the home. Nurse-midwives may practice with physicians or independently with an arrangement for physician backup. They must refer clients to physicians for complications. Care in a midwifery model is noninterventional, and the woman and family usually are encouraged to be active participants in the care. This does not imply that medications for pain control are prohibited. Midwives usually see low-risk obstetric clients. Care is often noninterventional with active involvement from the woman and her family. Nurse-midwives must refer clients to physicians for complications.

47

Which statements about multifetal pregnancy are most appropriate? (Select all that apply.)

A. The expectant mother often develops anemia because the fetuses have a greater demand for iron.
B. Twin pregnancies come to term with the same frequency as single pregnancies.
C. The mother should be counseled to increase her nutritional intake and gain more weight.
D. Backache and varicose veins are often more pronounced.
E. Spontaneous rupture of membranes before term is uncommon.

A C D
A woman with a multifetal pregnancy often develops anemia due to the increased demands of two fetuses. This should be monitored closely throughout her pregnancy. Twin pregnancies often end in prematurity. Serious efforts should be made to bring the pregnancy to term. The client may need nutrition counseling to ensure that she gains more weight than what is needed for a singleton birth. The considerable uterine distention is likely to cause backache and leg varicosities. Maternal support hose should be recommended. Spontaneous rupture of membranes before term is common.

48

A pregnant woman's last menstrual period began on April 8, 2009, and ended on April 13. Using Nägele's rule, her estimated date of birth would be________.

I

•January 15, 2010.


Nägele's rule requires subtracting 3 months and adding 7 days and 1 year if appropriate to the first day of a pregnant woman’s last menstrual period. When this rule is used with April 8, 2009, the estimated date of birth is January 15, 2010.