Chapter 14 Flashcards
- Ideally, when should prenatal care 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
ANS: B
Prenatal care should begin soon after the first missed menstrual period. This offers the greatest opportunities to ensure the health of the expectant mother and her infant. Prenatal care before missing the first menstrual period is too early. It is unlikely the woman is even aware of the pregnancy. Ideally, prenatal visits should begin soon after the first period is missed. Beginning prenatal care after the third missed menstrual period is too late. The woman will have completed the first trimester by that time.
- A woman arrives at the clinic for a pregnancy test. Her last menstrual period (LMP) was February 14, 2015. What is the client’s expected date of birth (EDB)?
a. September 17, 2015
b. November 7, 2015
c. November 21, 2015
d. December 17, 2015
ANS: C
Using the Nägele’s rule, the EDB is calculated by subtracting 3 months from the month of the LMP and adding 7 days + 1 year to the day of the LMP. Therefore, with an LMP of February 14, 2015, her due date is November 21, 2015. September 17, 2015, is too short a period to complete a normal pregnancy. Using the Nägele’s rule, an EDB of November 7, 2015, is 2 weeks early. December 17, 2015, is almost a month past the correct EDB.
- Which women should undergo prenatal testing for the human immunodeficiency virus (HIV)?
a. All women, regardless of risk factors
b. Women who have had more than one sexual partner
c. Women who have had a sexually transmitted infection (STI)
d. Woman who are monogamous with one partner
ANS: A
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.
- Which sign or symptom is considered a first-trimester warning sign and should be immediately reported by the pregnant woman to her 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 complications of the pregnancy. Nausea with occasional vomiting is a normal first-trimester complaint. Although it may be worrisome or annoying to the mother, it is not usually an indication of a problem with the pregnancy. Fatigue is common during the first trimester. Because of physiologic changes that happen during pregnancy, clients should be taught that urinary frequency is normal.
- Which client might be well advised to continue condom use during intercourse throughout her pregnancy?
a. Unmarried pregnant women
b. Women at risk for acquiring or transmitting STIs
c. All pregnant women
d. Women at risk for candidiasis
ANS: B
The objective of safer sex is to provide prophylaxis against the acquisition and transmission of STIs. Because these diseases may be transmitted to the woman and then to her fetus, condom use is recommended throughout the pregnancy if the woman is at risk for acquiring an STI. Pregnant women are encouraged to practice safer sex behaviors. An unmarried pregnant woman may be in a monogamous relationship and not require the use of a condom. The client should be educated as to what may place both herself and her fetus at risk. Any pregnant woman can develop candidiasis, which is an infection not related to condom use.
- Which condition is likely to be identified by the quadruple marker screen?
a. Down syndrome
b. Diaphragmatic hernia
c. Congenital cardiac abnormality
d. Anencephaly
ANS: A
The maternal serum level marker of alpha-fetoprotein is used to screen for Down syndrome, trisomy 18, neural tube defects, and other chromosomal anomalies. The quadruple-marker screen will not detect diaphragmatic hernia. Additional testing, such as ultrasonography, is required to diagnose diaphragmatic hernia. Congenital cardiac abnormality will most likely be identified during an ultrasound examination. The quadruple-marker screen will not detect anencephaly.
- 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. Which intervention should the nurse recommend?
a. Kegel exercises
b. Pelvic rock exercises
c. Softer mattress
d. Bed rest for 24 hours
ANS: 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. 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.
- A woman is 3 months pregnant. At her prenatal visit she tells the nurse that she does not know what is happening; one minute she is 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. “Hormone changes during pregnancy commonly result in mood swings.”
ANS: D
Explaining that hormone changes can result in mood swings is an accurate statement and the most appropriate response by the nurse. Telling the woman not to worry dismisses her concerns and is not the most appropriate response. Although the woman should be encouraged to share her feelings, asking if she has spoken to her husband about them is not the most appropriate response and does not provide her with a rationale for the psychosocial dynamics of her pregnancy. Suggesting that the woman does not 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.
- What is the primary role of the nonpregnant partner during pregnancy?
a. To provide financial support
b. To protect the pregnant woman from “old wives’ tales”
c. To support and nurture the pregnant woman
d. To make sure the pregnant woman keeps prenatal appointments
ANS: C
The partner’s primary role in pregnancy is to nurture the pregnant woman and respond to her feelings of vulnerability. Although financial support is important, it is not the partner’s primary role in pregnancy. Protecting the pregnant woman from “old wives’ tales” is not the partner’s role. The woman’s partner can encourage the client to keep all appointments; however, this is not the most important role during the pregnancy.
- During the first trimester, which of the following changes regarding her sexual drive should a client be taught to expect?
a. Increased sexual drive, because of enlarging breasts
b. Decreased sexual drive, because of nausea and fatigue
c. No change in her sexual drive
d. Increased sexual drive, because of increased levels of female hormones
ANS: B
A pregnant woman usually experiences a decrease, not an increase, in libido during the first trimester. 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, which tends to interfere with coitus, thereby decreasing the desire to engage in sexual activity.
- A 3-year-old girl’s mother is 6 months pregnant. What concern is this child most likely to verbalize?
a. How the baby will get out?
b. How will the baby eat?
c. Will you die having the baby?
d. What color eyes will the baby have?
ANS: B
By age 3 or 4 years, children like to be told the story of their own beginning and accept it being compared 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 will wear. 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 child’s mother will die does not tend to be the focus of her 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.
- In her work with pregnant women of different cultures, a nurse practitioner has observed various practices that seemed unfamiliar. The nurse practitioner 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
ANS: D
Although many cultures 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. Promoting family unity is important, although not usually the premise for cultural rituals and practices. Warding off the “evil eye” may be specific to one particular culture; however, it is not the primary purpose of these practices. Appeasing the gods of fertility is not the impetus behind cultural rituals.
- A client has arrived for her first prenatal appointment. She asked the nurse to explain exactly how long the pregnancy will be. What is the nurse’s best response?
a. Normal pregnancy is 10 lunar months.
b. Pregnancy is made up of four trimesters.
c. Pregnancy is considered term at 36 weeks.
d. Estimated date of delivery (EDD) is 40 completed weeks.
ANS: A
Pregnancy spans 9 calendar months; but, health care providers prefer to use the lunar month of 28 days or 4 weeks. Pregnancy consists of three trimesters, each approximately 13 weeks long. A pregnancy is considered term at 37 completed weeks; however, EDD is based upon 40 weeks of gestation.
- What should the nurse be cognizant of concerning the client’s reordering of personal relationships during pregnancy?
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.
ANS: C
Love and support help a woman feel better about her pregnancy. The most important person to the pregnant woman is usually the father of the child. Nurses can facilitate communication between partners about sexual matters if, as is common, they are nervous about expressing their worries and feelings to one another. The second trimester is the time when a woman’s sense of well-being, along with certain physical changes, increases her desire for sex. Sexual desire is down in the first and third trimesters.
- 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 feelings 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 the pregnancy.
d. “I am pregnant”—“I am going to have a baby”—“I am going to be a mother.”
ANS: 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. In phase one, the woman views the child as part of herself and not as a separate being. This is only the first step of the progression through phases of attachment. Accepting the fetus as distinct from herself occurs during the second phase of emotional attachment. Fantasizing about the child’s sex and personality based on fetal activity occurs during the third phase of attachment.
- Who is most likely to experience the phenomenon of someone other than the mother-to-be having pregnancy-like symptoms such as nausea and weight gain?
a. Mother of the pregnant woman
b. Couple’s teenage daughter
c. Sister of the pregnant woman
d. Expectant father
ANS: D
An expectant father’s experiencing of his partner’s pregnancy-like symptoms is called the couvade syndrome. The mother of the pregnant woman is unlikely to experience this phenomenon. She may be excited about becoming a grandmother or see her daughter’s pregnancy as a reminder that she is getting old. A couple’s teenage daughter is usually preoccupied with her own sexual development and may have difficulty accepting the overwhelming evidence of her parents’ sexual activity. It is the father of the pregnant woman, not the sister, who experiences these symptoms.
- During the initial visit with a client who is beginning prenatal care, which action should be the highest priority for the nurse?
a. The first interview is a relaxed, get-acquainted affair during which the nurse gathers some general impressions of his or her new client.
b. If the nurse observed handicapping conditions, he or she should be sensitive and not inquire about them because the client will do that in her own time.
c. The nurse should be alert to the appearance of potential parenting problems, such as depression or lack of family support.
d. Because of legal complications, the nurse should not ask about illegal drug use; that is left to the physician.
ANS: C
Besides these potential problems, the nurse needs to be alert to the woman’s attitude toward keeping regular health care appointments. If the client lacks insurance, then the nurse may be able to direct her to resources that provide assistance for pregnant women (i.e., Women, Infants, and Children [WIC]; Medicaid). The initial interview needs to be planned, purposeful, and focused on specific content. A lot of ground must be covered. The nurse must be sensitive to special problems; he or she should inquire because discovering individual needs is important. A client with a chronic or handicapping condition might forget to mention it because she has adapted to it. Obtaining information on drug use is important and can be confidentially done. Actual testing for drug use requires the client’s consent.
- A pregnant couple has formulated a birth plan and is reviewing it with the nurse at an expectant parent’s class. Which aspect of their birth plan should be considered potentially unrealistic and require further discussion with the nurse?
a. “My husband and I have agreed that my sister will be my coach because he becomes anxious with regard to medical procedures and blood. He will be nearby and check on me every so often to make sure everything is okay.”
b. “We plan to use the techniques taught in the Lamaze classes to reduce the pain experienced during labor.”
c. “We want the labor and birth to take place in a birthing room. My husband will come in the minute the baby is born.”
d. “Regardless of the circumstances, we do not want the fetal monitor used during labor because it will interfere with movement and doing effleurage.”
ANS: D
Because monitoring is essential to assess fetal well-being, fetal monitoring is not a factor that can be determined by the couple. The nurse should fully explain its importance. The option for intermittent electronic monitoring could be explored if this is a low-risk pregnancy and as long as labor is normally progressing. The birth plan is a tool with which parents can explore their childbirth options; however, the plan must be viewed as tentative. Having the woman’s sister as her coach with her husband nearby is an acceptable request for a laboring woman. Using breathing techniques to alleviate pain is a realistic part of a birth plan. Not all fathers are able to be present during the birth; however, this couple has made a realistic plan that works for their specific situation.
- During the physical examination of a client beginning prenatal care, which initial action is most important for the nurse to perform?
a. Only women who show physical signs or meet the sociologic profile should be assessed for physical abuse.
b. The client should empty her bladder before the pelvic examination.
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 will be increasing in size during the second trimester.
ANS: B
The nurse should instruct the client to empty her bladder. An empty bladder facilitates the examination and also provides an opportunity to obtain a urine sample 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.
- A woman who is 16 weeks pregnant has come in for a follow-up visit with her significant other. To reassure the client regarding fetal well-being, which is the highest priority action for the nurse to perform?
a. Assess the fetal heart tones with a Doppler stethoscope.
b. Measure the girth of the woman’s abdomen.
c. Complete an ultrasound examination (sonogram).
d. Offer the woman and her family the opportunity to listen to the fetal heart tones.
ANS: D
To provide the parents with the greatest sense of reassurance, the nurse should offer to have the client and her significant other the chance to listen to their baby’s heartbeat. A fetoscope can detect the fetal heart rate around 20 weeks of gestation. Doppler can detect the fetal heart rate between 10 and 12 weeks and should be performed as part of routine fetal assessment. Abdominal girth is not a valid measure for determining fetal well-being. Fundal height is an important measure that should be determined with precision, with the same technique and positioning of the client consistently used at every prenatal visit. Routine ultrasound examinations are recommended in early pregnancy; they date the pregnancy and provide useful information about the health of the fetus. However, they are not necessary at each prenatal visit.
- What is the primary role of the doula during labor?
a. Helps the woman perform Lamaze breathing techniques and to provide support to the woman and her partner
b. Checks the fetal monitor tracing for effects of the labor process on the fetal heart rate
c. Takes the place of the father as a coach and support provider
d. Administers pain medications as needed by the woman
ANS: A
A doula is professionally trained to provide labor support, including physical, emotional, and informational support, to both the woman and her partner during labor and the birth. The doula does not become involved with clinical tasks.