Chapter 11-Nursing Care of the Family During Pregnancy Flashcards
(44 cards)
- A nurse caring for a newly pregnant patient would advise them that ideally prenatal care should begin at what time?
a. Prenatal care should begin before the first missed menstrual period.
b. Prenatal care should begin after the first missed menstrual period.
c. Prenatal care should begin after the second missed menstrual period.
d. Prenatal care should begin after the third missed menstrual period.
ANS: B
Prenatal care ideally should begin soon after the first missed menstrual period. Regular prenatal visits offer opportunities to ensure the health of the expectant patient and their infant.
A patient arrives at the clinic for a pregnancy test. The first day of their last menstrual period (LMP) was February 14, 2021. What would be the baby’s expected date of birth (EDB)?
a. May 21, 2022
b. November 7, 2021
c. November 21, 2021
d. May 2, 2022
ANS: C
Using Nägele’s rule, November 21, 2021, is the correct EDB. 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, 2021: February 14, 2021 – 3 months = November 14, 2020 + 7 days = November 21, 2020 + 1 year = November 21, 2021.
For which pregnant patients would prenatal testing for the human immunodeficiency virus (HIV) be recommended?
a. All patients, regardless of risk factors
b. A patient who has had more than one sexual partner
c. A patient who has had a sexually transmitted infection
d. A patient who is monogamous with their partner
ANS: A
Testing for the antibody to HIV is strongly recommended for all pregnant patients, regardless of risk factors. With identification of HIV and prescribed antiretroviral medications, during pregnancy, the incidence of perinatal transmission from an HIV-positive mother to their fetus is less than 1%. Patients who test positive for HIV can then be treated.
A nurse would teach that which symptom is considered a first-trimester warning sign and should be reported immediately by the pregnant patient to their health care provider?
a. Nausea with occasional vomiting
b. Fatigue
c. Urinary frequency
d. Vaginal bleeding
ANS: 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. Nausea with occasional vomiting, fatigue, and urinary frequency are normal first-trimester concerns. Although they may be worrisome or annoying to the pregnant patient, they usually are not indications of pregnancy problems.
A pregnant patient at 10 weeks of gestation jogs three or four times per week. Which is true about exercise during pregnancy?
a. There is no need to modify exercise regimes at any time during pregnancy.
b. Exercising is contraindicated during the third trimester of pregnancy.
c. Exercise routines may need to be modified as pregnancy progresses.
d. Walking is recommended during pregnancy, not jogging.
ANS: C
Pregnant patients should be advised that they may have to modify their exercise later in pregnancy. The nurse should inform the patient that they may need to reduce their exercise level as the pregnancy progresses. Physical activity brings about a feeling of well-being in pregnant patients. It improves circulation, promotes relaxation and rest, and counteracts boredom. Simple measures should be initiated to prevent injuries, such as warm-up and stretching exercises to prepare the joints for more strenuous exercise.
A nurse would be most concerned about which blood pressure (BP) finding during the second trimester?
a. Baseline BP 120/80, current BP 126/85
b. Baseline BP 100/70, current BP 140/90
c. Baseline BP 140/85, current BP 130/80
d. Baseline BP 110/60, current BP 130/80
ANS: B
A systolic BP (SBP) of 140 mm Hg or more and a diastolic BP (DBP) of 90 mm Hg or more, based on the average of at least two measurements, suggest the presence of hypertension. A slight increase in BP of 126/85 does not meet the criteria for concern. Although the baseline BP is worrisome (an absolute systolic BP of 140 mm Hg or higher or a diastolic BP of 90 mm Hg or higher suggests hypertension), the subsequent pressures have decreased, not increased. The increase to 130/80 from 110/60 would not be the most concerning.
A nurse would teach a pregnant patient that which sign would be most concerning at 32 weeks of gestation?
a. Constipation
b. Alteration in the pattern of fetal movement
c. Heart palpitations
d. Edema in the ankles at the end of the day
ANS: B
An alteration in the pattern or amount of fetal movement may indicate fetal compromise. Constipation, heart palpitations, and foot edema are normal discomforts of pregnancy that occur in the second and third trimesters.
A patient who is 14 weeks pregnant tells a nurse that they always had a glass of wine with dinner before they became pregnant. They have abstained during her first trimester and would like to know if it is safe to have a drink at dinner now. What is the basis for the nurse’s response?
a. It is alright to have one drink with dinner after the first trimester.
b. Weekly alcohol intake is not to exceed three drinks per week during any month of pregnancy.
c. Alcohol intake in pregnancy is to be limited to beer or wine.
d. It is best to abstain from any alcohol intake during pregnancy
ANS: D
Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout the pregnancy. A safe level of alcohol consumption during pregnancy has not yet been established. Although the consumption of occasional alcoholic beverages may not be harmful to the mother or her developing fetus, complete abstinence is strongly advised.
A pregnant patient at 18 weeks of gestation calls the clinic to report that they have been experiencing occasional backaches of mild-to-moderate intensity. What should a nurse recommend to the woman?
a. Do Kegel exercises.
b. Do pelvic rocking exercises.
c. Use a softer mattress.
d. Stay in bed for 24 hours.
ANS: B
Pelvic rocking exercises may help stretch and strengthen the abdominal and lower back muscles and relieve low back pain. Kegel exercises increase the tone of the pelvic area, not the back. A softer mattress may not provide the support needed to maintain proper alignment of the spine and may contribute to back pain. Stretching and other exercises to relieve back pain should be performed several times a day.
A nurse is aware that breastfeeding be contraindicated in which situation?
a. A pregnant patient has hepatitis B.
b. A pregnant patient has everted nipples.
c. A pregnant patient has a history of breast cancer 3 years ago.
d. A pregnant patient is human immunodeficiency virus (HIV) positive.
ANS: D
Patients who are HIV positive in developed countries are discouraged from breastfeeding because of the risk of HIV transmission. Although hepatitis B antigen has not been shown to be transmitted through breast milk, as an added precaution infants born to HBsAg-positive patients should receive the hepatitis B vaccine and immunoglobulin immediately after birth. Everted nipples are functional for breastfeeding. Newly diagnosed breast cancer would be a contraindication to breastfeeding.
What is the pregnant person’s partner’s main role in the pregnancy?
a. Provide financial support.
b. Protect the pregnant person from “old wives’ tales.”
c. Support and nurture the pregnant person.
d. Make sure the pregnant person keeps prenatal appointments.
ANS: C
The partner’s main role in pregnancy is to nurture the pregnant person and respond to their feelings of vulnerability. In older societies the man enacted the ritual couvade.
A nurse is aware that during the first trimester, a pregnant patient may expect which change in their sexual desire?
a. Their sexual desire is increased, related to enlarging breasts.
b. Their sexual desire is decreased, related to nausea and fatigue.
c. There is no change in sexual desire.
d. Their sexual desire is increased, related to increased levels of female hormones.
ANS: B
During the first trimester, the pregnant patient’s sexual desire may decrease, especially if they have breast tenderness, nausea, fatigue, or sleepiness. Libido may be depressed in the first trimester but often increases during the second trimester. During pregnancy the breasts may become enlarged and tender; this tends to interfere with coitus, thereby decreasing the desire to engage in sexual activity. Physiological changes such as breast enlargement, nausea, fatigue, abdominal changes, perineal enlargement, leukorrhea, pelvic vasocongestion, and orgasmic responses may affect sexuality and sexual expression
A nurse is aware that which behaviour indicates that a pregnant patient is “seeking safe passage” for themselves and their infant?
a. They keep all prenatal appointments.
b. They “eat for two.”
c. They drive their car slowly.
d. They wears only low-heeled shoes.
ANS: A
The goal of prenatal care is to foster a safe birth for the newborn and mother. Although eating properly, driving carefully, and using proper body mechanics are all healthy measures that a pregnant person can take, obtaining prenatal care is the optimal method for providing safety for both themselves and their baby.
A nurse is teaching a multiparous patient about a 3-year-old child’s probable response during the pregnancy?
a. How the baby will “get out”?
b. What the baby will eat?
c. Whether their mother will die?
d. What colour eyes the baby has?
ANS: 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 the 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 colour does not tend to be the focus of children’s questions about the impending birth of a sibling.
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
ANS: D
Educators must build on cultural practices that promote the protection of the mother and fetus during pregnancy. Although many consider pregnancy normal, certain practices are expected of pregnant patients of all cultures to ensure a good outcome. Cultural prescriptions tell pregnant people 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.
A nurse understands that 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
ANS: B
A concern for modesty is a deterrent to many patients seeking prenatal care. For some patients 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 patient, some practices may conflict with their cultural beliefs and practices.
A nurse teaches a patient which information about pregnancy?
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 is on bedrest.
ANS: 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 bedrest.
Which should a nurse know to aid in understanding and guiding a patient through their acceptance of pregnancy?
a. Nonacceptance of the pregnancy very often equates to rejection of the child.
b. Mood swings most likely are the result of a changed lifestyle as well as profound
hormonal changes.
c. Ambivalent feelings usually are seen only in emotionally immature or very young
mothers.
d. Conflicts such as not wanting to be pregnant or child-rearing and career-related
decisions will resolve themselves naturally after birth.
ANS: 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 child-rearing and career-related decisions need to be resolved. The baby ends the pregnancy but not all the issues.
What would a nurse teach a patient with regards to reordering of personal relationships during pregnancy?
a. Because of the special motherhood bond, a pregnant patient’s relationship with
their 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. Pregnant patients usually express two major relationship needs during pregnancy:
feeling loved and valued and having the child be accepted by the partner.
d. The pregnant patient’s sexual desire is likely to be highest in the first trimester
because of the excitement and because intercourse is physically easier.
ANS: C
Love and support help a patient feel better about their pregnancy. The most important person to the pregnant patient is usually the father or partner. 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 pregnant patient’s sense of well-being, along with certain physical changes, increases their desire for sex. Desire is down in the first trimester.
What represents a typical progression through the phases of a patient establishing a relationship with the fetus?
a. Accepts the fetus as distinct from themselves—accepts the biological 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
themselves—becomes introspective
c. Views the child as part of themselves—has feelings of well-being—accepts the
biological fact of pregnancy
d. Accepts they are pregnant—acknowledges that they are going to have a
baby—accepts they are going to be a mother
ANS: D
The patient first centres on themselves as pregnant, then on the baby as an entity separate from themself, and then on their 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.
What should a nurse know with regard to the father’s acceptance of the pregnancy and preparation for childbirth?
a. For most men, pregnancy is a time of fantasy and intense learning.
b. The father’s attachment to the fetus cannot be as strong as that of the mother.
c. During 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.
ANS: A
For most partners, pregnancy is a time of preparation for the parental role, fantasy, great pleasure, and intense learning. The father– child attachment can be as strong as the mother–child relationship and can also begin during pregnancy. In the last 2 monthsof 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 they progress to adjusting to the reality of the situation and then to focusing on their role.
What should a nurse be aware of for the initial visit with a patient who is beginning prenatal care?
a. Maintain a relaxed, get-acquainted affair to gather general impressions.
b. Avoid assessing any handicap conditions until the second prenatal visit.
c. Be alert to the appearance of potential parenting problems, such as depression or
lack of family support.
d. Refrain from asking about illegal drug use; that is left to physicians.
ANS: C
Besides these potential problems, nurses need to be alert to the patient’s attitude toward health care. The initial inte rview needs to be planned, purposeful, and focused on specific content. A lot of ground must be covered. While nurses must be sensitive to special problems, 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 patient’s consent.
What should a nurse be aware of with regard to the initial physical examination of a patient beginning prenatal care?
a. Only patients who show physical signs or meet the sociological profile should be
assessed for physical abuse.
b. The patient should empty their 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.
ANS: B
An empty bladder facilitates the examination; this is also an opportunity to get a urine sample easily for a number of tests. All pregnant patients 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.
Which should a nurse be aware of to care for patients receiving prenatal care?
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 patients a systolic blood pressure (BP) of 130 and a diastolic BP of
80 is sufficient to be considered hypertensive.
ANS: C
The pregnant patient lies on their 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 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 patients hypertension is defined as a systolic BP of 140 or higher and a diastolic BP of 90 or higher.
