Question 1

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)?

Accepted Answer

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.

Question 2

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?

Accepted Answer

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.

Question 3

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?

Accepted Answer

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.

Question 4

What is the primary role of the nonpregnant partner during pregnancy?

Accepted Answer

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.

Question 5

Which women should undergo prenatal testing for the human immunodeficiency virus (HIV)?

Accepted Answer

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.

Question 6

Which condition is likely to be identified by the quadruple marker screen?

Accepted Answer

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.

Question 7

A 3-year-old girl's mother is 6 months pregnant.What concern is this child most likely to verbalize?

Accepted Answer

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.

Question 8

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?

Accepted Answer

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.

Question 9

Ideally,when should prenatal care begin?

Accepted Answer

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.

Question 10

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?

Accepted Answer

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.

Question 11

During the physical examination of a client beginning prenatal care,which initial action is most important for the nurse to perform?

Accepted Answer

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.

Question 12

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?

Accepted Answer

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.

Question 13

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?

Accepted Answer

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.

Question 14

During the first trimester,which of the following changes regarding her sexual drive should a client be taught to expect?

Accepted Answer

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.

Question 15

Which client might be well advised to continue condom use during intercourse throughout her pregnancy?

Accepted Answer

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.

Question 16

During the initial visit with a client who is beginning prenatal care,which action should be the highest priority for the nurse?

Accepted Answer

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.

Question 17

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?

Accepted Answer

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.

Question 18

What represents a typical progression through the phases of a woman's establishing a relationship with the fetus?

Accepted Answer

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.

Question 19

What should the nurse be cognizant of concerning the client's reordering of personal relationships during pregnancy?

Accepted Answer

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.

Question 20

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?

Accepted Answer

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.

Quiz 14: Nursing Care of the Family During Pregnancy

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) ?