The nurse caring for a newly pregnant woman would advise her that ideally prenatal care should begin:
After the first missed menstrual period
Prenatal care ideally should begin soon after the first missed menstrual period. Regular prenatal visits offer opportunities to ensure the health of the expectant mother and her infant.
Prenatal testing for human immunodeficiency virus (HIV) is recommended for:
All women, regardless of risk factors.
Testing for the antibody to HIV is strongly recommended for all pregnant women. A HIV test is recommended for all women, regardless of risk factors. Women who test positive for HIV can be treated, reducing the risk of transmission to the fetus.
Which symptom is considered a first-trimester warning sign and should be reported immediately by the pregnant woman to her health care provider?
Vaginal bleeding
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.
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:
"You may find that you need to modify your exercise to walking later in your pregnancy"
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.
The multiple marker test is used to assess the fetus for which condition?
Down Syndrome
The maternal serum level of alpha-fetoprotein is used to screen for Down syndrome, neural tube defects, and other chromosome anomalies.
A woman who is 32 weeks' pregnant is informed by the nurse that a danger sign of pregnancy could be:
Alteration in the pattern of fetal movement
An alteration in the pattern or amount of fetal movement may indicate fetal jeopardy.
A woman who is 14 weeks pregnant tells the nurse that she always 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:
"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"
A safe level of alcohol consumption during pregnancy has not yet been established.
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 would recommend that she:
Do pelvic rock exercises.
Pelvic rock exercises may help stretch and strengthen the abdominal and lower back muscles and relieve low back pain
For what reason would breastfeeding be contraindicated?
Human immunodeficiency virus (HIV) positive
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.
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?
"Hormonal changes during pregnancy commonly result in mood swings."
The statement "Hormonal changes during pregnancy commonly result in mood swings" is accurate and the most appropriate response by the nurse
The nurse should be aware that the partner's main role in pregnancy is to:
Support and nurture the pregnant woman.
The partner's main role in pregnancy is to nurture the pregnant woman and respond to her feelings of vulnerability
During the first trimester, a woman can expect which of the following changes in her sexual desire?
A decrease, because of nausea and fatigue
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.
Which behavior indicates that a woman is "seeking safe passage" for herself and her infant?
She keeps all prenatal appointments.
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 all are healthy measures that a mother can take, obtaining prenatal care is the optimal method for providing safety for both herself and her baby.
A 3-year-old girl's mother is 6 months pregnant. What concern is this child likely to verbalize?
What the baby will eat
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.
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?
To protect the mother and fetus during pregnancy
The purpose of all cultural practices is to protect the mother and fetus during pregnancy. Although many cultures consider pregnancy normal, certain practices are expected of women of all cultures to ensure a good outcome.
What type of cultural concern is the most likely deterrent to many women seeking prenatal care?
Modesty
A concern for modesty is a deterrent to many women seeking prenatal care. For some women, exposing body parts, especially to a man, is considered a major violation of their modesty.
Which statement about pregnancy is accurate?
A normal pregnancy lasts about 10 lunar months.
A lunar month lasts 28 days, or 4 weeks. Pregnancy spans 9 calendar months but 10 lunar months.
In understanding and guiding a woman through her acceptance of pregnancy, a maternity nurse should be aware that:
Mood swings most likely are the result of worries about finances and a changed lifestyle as well as profound hormonal changes.
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.
With regard to a woman's reordering of personal relationships during pregnancy, the maternity nurse should understand that:
Women usually express two major relationship needs during pregnancy: feeling loved and valued and having the child accepted by the father.
Love and support help a woman feel better about her pregnancy. The most important person to the pregnant woman 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.
What represents a typical progression through the phases of a woman's establishing a relationship with the fetus?
"I am pregnant."—"I am going to have a baby."—"I am going to be a mother."
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.
As relates to the father's acceptance of the pregnancy and preparation for childbirth, the maternity nurse should know that:
The father goes through three phases of acceptance of his own.
A father typically goes through three phases of development to reach acceptance of fatherhood: the announcement phase, the moratorium phase, and the focusing phase. The father-child attachment can be as strong as the mother-child relationship and can also begin during pregnancy.
With regard to the initial visit with a client who is beginning prenatal care, nurses should be aware that:
Nurses should be alert to the appearance of potential parenting problems, such as depression or lack of family support.
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.
With regard to the initial physical examination of a woman beginning prenatal care, maternity nurses should be cognizant of:
The woman should empty her bladder before the pelvic examination is performed.
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.
With regard to follow-up visits for women receiving prenatal care, nurses should be aware that:
During the abdominal examination, the nurse should be alert for supine hypotension.
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.
While teaching the expectant mother about personal hygiene during pregnancy, maternity nurses should be aware that:
Tub bathing is permitted even in late pregnancy unless membranes have ruptured.
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.
The nurse should have knowledge of the purpose of the pinch test. It is used to:
Determine whether the nipple is everted or inverted.
The pinch test is used to determine whether the nipple is everted or inverted. Nipples must be everted to allow breastfeeding.
To provide the patient with accurate information about dental care during pregnancy, maternity nurses should be aware that:
If dental treatment is necessary, the woman will be most comfortable with it in the second trimester.
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.
When discussing work and travel during pregnancy with a pregnant patient, nurses should instruct them that:
While working or traveling in a car or on a plane, women should arrange to walk around at least every hour or so.
Periodic walking helps prevent thrombophlebitis. Pregnant women should avoid sitting or standing for long periods and crossing the legs at the knees.
With regard to medications, herbs, shots, and other substances normally encountered by pregnant women, the maternity nurse should be aware that:
Both prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus.
Both prescription and 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.
Which statement about multifetal pregnancy is inaccurate?
Twin pregnancies come to term with the same frequency as single pregnancies.
Twin pregnancies often end in prematurity. Serious efforts should be made to bring the pregnancy to term. A woman with a multifetal pregnancy often develops anemia, suffers more or worse backache, and needs to gain more weight.
The phenomenon of someone other than the mother-to-be experiencing pregnancy-like symptoms such as nausea and weight gain applies to the:
Expectant father.
An expectant father's experiencing pregnancy-like symptoms is called the couvade syndrome.
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?
Eight to 12 women are placed in gestational-age cohort groups.
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.
While you are assessing the vital signs of a pregnant woman in her third trimester, the patient complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate?
Have the patient turn to her left side and recheck her blood pressure in 5 minutes.
Blood pressure is affected by maternal position during pregnancy. The supine position may cause occlusion of the vena cava and descending aorta. Turning the pregnant woman to a lateral recumbent position alleviates pressure on the blood vessels and quickly corrects supine hypotension.
Signs and symptoms that a woman should report immediately to her health care provider include (Select all that apply):
Vaginal bleeding.
Rupture of membranes.
Heartburn accompanied by severe headache.
Vaginal bleeding, rupture of membranes, and severe headaches all are signs of potential complications in pregnancy. Clients should be advised to report these signs to the health care provider.
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 (Select all that apply)?
Tetanus
Diphtheria
Hepatitis B
ANS: A, B, E
Immunization with live or attenuated live viruses is contraindicated during pregnancy because of potential teratogenicity. Vaccines consisting of killed viruses may be used. Immunizations that may be administered during pregnancy include tetanus, diphtheria, recombinant hepatitis B, and rabies vaccines.
All pregnant women should be instructed to recognize and report potential complications for each trimester of pregnancy. Match the sign or symptom with a possible cause.
Decreased fetal movement = fetal jeopardy or intrauterine fetal death
Severe backache & flank pain = kidney infection or stones
Glycosuria = gestational diabetes
Severe vomiting in early pregnancy = hyperemesis gravidarum
Epigastric pain in late pregnancy = hypertension, preeclampsia
A woman arrives at the clinic for a pregnancy test. The first day of her last menstrual period (LMP) was September 10, 2013. Her expected date of birth (EDB) would be?
June 17, 2014
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.
A maternal serum alpha-fetoprotein (MSAFP) test is performed at 16 to 18 weeks of gestation. An elevated level has been associated with:
open neural tube defects such as spina bifida
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.
A pregnant woman demonstrates understanding of the nurse's instructions regarding relief of leg cramps if she:
Extends her leg and dorsiflexes her foot during the cramp
Extending the leg and dorsiflexing the foot is the appropriate relief for a leg cramp.
During the first trimester the pregnant woman would be most motivated to learn about:
measures to reduce nausea and fatigue so she can feel better
During the first trimester a woman is egocentric and concerned about how she feels. She is working on the task of accepting her pregnancy.
If exhibited by an expectant father, what would be a warning sign of ineffective adaptation to his partner's first pregnancy?
Consistently changes the subject when the topic of the fetus/newborn is raised
This is an expected view for an expectant father. Persistent refusal to talk about the fetus-newborn may be a sign of a problem and should be assessed further.
A woman who is 14 weeks pregnant tells the nurse that she always 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 tells her:
"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."
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:
turn the woman on her side.
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.
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:
"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."
Mood swings are a normal finding in the first trimester; the woman does not need counseling.
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?
Rubella titer 1:6
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.
A woman who is 32 weeks pregnant is informed by the nurse that a danger sign of pregnancy could be:
alteration in the pattern of fetal movement.
An alteration in the pattern or amount of fetal movement may indicate fetal jeopardy.
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__.
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.
With regard to medications, herbs, shots, and other substances normally encountered, the maternity nurse should be aware that:
prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus.
Which statements about multifetal pregnancy are most appropriate? (Select all that apply)
- The expectant mother often develops anemia because the fetuses have a greater demand for iron
- the mother should be counseled to increase her nutritional intake and gain more weight
- backache and varicose veins are often more pronounced
The nurse advises the woman who wants to have a nurse-midwife provide obstetric care that:
she must be having a low-risk pregnancy
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.
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:
intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present
Safer-sex practices are always recommended; rupture of the membranes may require abstaining from intercourse.