Question 1

The nurse is planning an education session for pregnant adolescents. Which topics should the nurse include that incorporate the 2020 National Health Goals for pregnant women with special needs? (Select all that apply.)

Accepted Answer

The 2020 National Health Goals for pregnant women with special needs focus on teaching unintentional injury prevention, the dangers and complications of substance dependency, and both the psychological and physical concerns of teenage pregnancy. The nurse should include the topics that focus on alcohol, illicit drugs, and cigarette smoking. An adequate fluid intake is not a topic specific to a pregnant woman with special needs. The use of complementary therapy for delivery might not be appropriate for a pregnant adolescent because of cephalopelvic disproportion.

Question 2

A pregnant adolescent asks if the father of the baby can come into the room during the examination. Based on both the pregnant adolescent's and the father's needs, which is the best response for the nurse to make?

Accepted Answer

If the baby's father attends prenatal care, help him to feel welcome. Because he is not married, he does not have a legal right to participate in decisions concerning the pregnancy, abortion, or adoption, but he may not be devoid of feelings for the girl or the baby. If a complication occurs, he may feel genuine grief things are not going well.
Allowing him to offer support in the current pregnancy can help him learn more about himself as well as better define his role. In addition, be sure he receives compassionate education on preventing further pregnancies until he is more mature. The nurse does not need the parent's approval for the father of the baby to be present during the examination.

Question 3

The nurse is identifying nursing diagnoses appropriate for a pregnant patient who is substance dependent. Which diagnosis should the nurse identify as applicable to this patient's needs?

Accepted Answer

Illicit drugs can pass through the placenta and affect the developing fetus. The patient is also being harmed by the drugs. The most appropriate diagnosis for the patient would be risk for injury to self and fetus related to chronic substance dependency. Impaired home maintenance, risk for disruption of social interaction, and readiness for enhanced family coping would be appropriate for the pregnant patient who is physically or cognitively challenged.

Question 4

When planning care for a pregnant adolescent, what nursing action supports the developmental task of this age group?

Accepted Answer

Helping adolescents to make their own health care decisions at health care visits helps to foster a sense of independence. During a visit, the adolescent can weigh herself to feel independent. Insisting that no further sexual relations occur and delaying school do not foster a sense of independence. Permitting the pregnant adolescent to determine the total weight gain for the pregnancy would not be safe considering the patient is still developing physically.

Question 5

The nurse is reviewing nutritional needs with a pregnant adolescent. Which topic should the nurse include in the teaching plan for this patient?

Accepted Answer

Adolescents traditionally do not take medicine conscientiously, so they may need frequent reminders to take their vitamin or iron supplement. Stress these are intended to complement nutrition during pregnancy. For a reminder system, girls may need to post a medication reminder chart at home or in her school locker or set a reminder on her phone in order to increase adherence. Obtaining good pregnancy nutrition in restaurants, advantages of fresh foods, and learning to cook may or may not be appropriate to meet the nutritional needs of the pregnant adolescent.

Question 6

A pregnant adolescent is upset because she is not permitted to deliver the baby at an alternative birthing center. Why is the use of an alternative birthing center contraindicated for this patient?

Accepted Answer

Pregnant adolescents are prone to cephalopelvic disproportion because of the patient's incomplete pelvic growth. Using a birthing center could be dangerous for the patient and the fetus. The use of a birthing center is not contraindicated because the patient's parents disapprove of the center. There are no restrictions such as marital status or age on the use of a birthing center.

Question 7

A pregnant adolescent has many questions and concerns about the pregnancy and birthing process. What should the nurse recommend to this patient?

Accepted Answer

Peer companionship is a strong need for most adolescents. When girls become pregnant, because they are suddenly so different, they may find themselves cut off from fellow classmates. This is the prime opportunity to join a class of other adolescents in preparation for childbirth. The pregnant adolescent may or may not have a good relationship with her mother. The pregnant adolescent needs more than reading books about the pregnancy and childbirth. The health care provider may or may not be able to answer all of the pregnant adolescent's questions.

Question 8

An adolescent patient delivers an 8-lb baby after being in labor for 12 hours. During the postpartal period, which assessment is a priority for the nurse to complete?

Accepted Answer

Adolescents are more prone to postpartum hemorrhage than the average woman because if the patient's uterus is not yet fully developed, it becomes overdistended by pregnancy. An overdistended uterus will not contract as readily as a normally distended uterus in the postpartum period. This can lead to hemorrhage. Endometriosis, thrombophlebitis, and amniotic embolus are not expected postpartal complications for the adolescent patient.

Question 9

A postpartum patient who is severely hearing impaired is silently holding the newborn. What should the nurse suggest the patient do when caring for the baby?

Accepted Answer

If the baby hears, urge the patient to talk to the infant as care is given so the baby is introduced to sounds and words. Some patients whose speech is severely affected by a hearing disorder are reluctant to speak to strangers. Assure the patient that the infant welcomes the sound of her voice and will quiet readily to the sound. Being spoken to and sung to during the first year is important for overall development. The patient should not avoid speaking to the newborn. The sound of the mother's voice is preferred over the sound of television or radio.

Question 10

The nurse is caring for a 41-year-old patient who is pregnant with her first child. What can the nurse suggest to reduce the development of varicosities from the pregnancy? (Select all that apply.)

Accepted Answer

Interventions to reduce the development of varicosities while pregnant include taking walk breaks, resting in the Sims position, and resting with the legs elevated on a foot stool. Jogging in place will not reduce the onset of varicosities and might harm the patient and fetus. The patient should increase the intake of vitamin C, and not vitamin D, because vitamin C strengthens vein walls.

Question 11

A pregnant patient with a thoracic-level spinal cord injury from a skiing accident is confined to a wheelchair for ambulation. What should the nurse encourage the patient to do during pregnancy?

Accepted Answer

Patients who use wheelchairs are taught to press the hands against the armrests and lift the buttocks up off the wheelchair seat for 5 seconds every hour to prevent the formation of pressure ulcers on the buttocks and posterior thighs. Encourage a pregnant woman to continue to perform this maneuver during pregnancy because the increased weight of a fetus increases the risk for pressure ulcer formation from additional compression. The nurse should not encourage the pregnant patient to hold the breath, tense abdominal muscles, or do pelvic rocking movements.

Question 12

A postpartum patient with a high spinal cord injury has an indwelling urinary catheter placed for a cesarean birth. The patient's face is red and is complaining of a headache. A current blood pressure measurement is 160/120 mmHg. What should the nurse do first?

Accepted Answer

In a patient with a high spinal cord injury, the nurse needs to observe for autonomic dysreflexia during pregnancy, labor, and the immediate postpartum period. This is an exaggerated autonomic response to stimuli. Any irritating condition, such as a distended bladder, may initiate the response. Symptoms include severe hypertension, throbbing headache, and flushing of the skin. Immediate action is needed and includes elevating the patient's head to reduce cerebral pressure and locate the irritating stimulus, which is usually a distended bladder. If bladder distention is the cause and a catheter is in place, check to see why it is not draining and then encourage it to drain by unkinking or flushing to allow urine to flow freely again. As soon as the source of irritation is removed, symptoms typically fade quickly. The indwelling catheter does not need to be removed. Massaging the lower back will not help the symptoms. Lowering the head of the bed could cause the patient to have worsening symptoms.

Question 13

The nurse instructs a pregnant patient on ways to reduce unintentional injuries while pregnant. Which patient statement indicates that teaching has been effective?

Accepted Answer

Pregnancy counseling should include education about ways to avoid unintentional injuries such as using automobile seat belts. Puncture wounds need to be evaluated for depth. The patient might need a tetanus injection after this type of injury. If someone punches or kicks the pregnant patient's abdomen, the patient needs to be evaluated for damage to the uterus, bladder, or placenta. If the pregnant patient receives an animal bite, it needs to be evaluated and determined if the animal was rabid. If so, the patient needs rabies inoculations, which are safe to administer during pregnancy.

Question 14

A pregnant patient slipped and fell on an icy sidewalk a few weeks ago. During labor, the patient is experiencing extreme pain at the region of the symphysis pubis. What should be done to help this patient?

Accepted Answer

The laxness of body cartilage may cause separation of the symphysis pubis if a pregnant patient falls with the legs outspread. A suture separation this way is very painful, especially on walking or turning. If separation of the symphysis pubis is still present at the time of birth, this can make labor very painful, especially during the pelvic division of labor as the fetus is pushed through the pelvic ring. The patient may need additional analgesia at this time. Elevating the legs, positioning on the side, or applying heat to the region will not help with the pain from the injury.

Question 15

The nurse is concerned that a pregnant patient is using cocaine. What should the nurse suggest to the health care provider to confirm this suspicion?

Accepted Answer

Cocaine use can be detected by urinalysis because the metabolites of cocaine can be detected in urine up to 1 week after use. Electrocardiogram, complete blood count, and stool test for occult blood will not confirm the use of cocaine in the pregnant patient.

Quiz 22: Nursing Care of a Pregnant Family With Special Needs