Question 1

A new patient is being assessed by the perinatal nurse.For exercise,the woman practices yoga five times a week,walks her dog,and swims.What action should the nurse do first?

Accepted Answer

Women should adhere to some basic safety guidelines when formulating an exercise program.These guidelines include monitoring the breathing rate;ensuring that the ability to walk and talk comfortably is maintained during the physical activity;stopping the exercise when tired;avoiding exercises that can cause any degree of trauma to the abdomen or those that include rigorous bouncing,arching of the back,or bending beyond a 45-degree angle;and maintaining an adequate fluid intake.Because yoga involves different positions,the nurse should assess whether the patient engages in positions that involve arching the back.Swimming is good exercise and she should stop exercising if she gets fatigued,but asking about positions involves an immediate possible threat to the safety of the fetus.Extra water is needed no matter what type of exercise is being done.

Question 2

A 21-year-old pregnant woman smokes 8 to 10 cigarettes per day.The clinic nurse reviews the patient's diet with her and notes that she does not eat fruits or vegetables.Which action should the nurse recommend to this patient?

Accepted Answer

Food sources rich in vitamin C include produce such as red and green sweet peppers,oranges,kiwi fruit,grapefruit,strawberries,Brussels sprouts,cantaloupe,broccoli,sweet potatoes,tomato juice,cauliflower,pineapple,and kale.Most pregnant women are able to meet the recommended daily allowance (80 to 85 mg)by including at least one daily serving of citrus fruit or juice or vitamin C-rich food source,but women who smoke need more (NIH,2011).Although it is important for the woman to quit smoking,this alone will not help her meet her dietary need for Vitamin C.Because she does not eat the primary sources of this vitamin,an over-the-counter supplement would be her best option.

Question 3

A 24-year-old pregnant woman at 26 weeks' gestation is experiencing her third pregnancy.The patient's obstetric history includes one full-term birth and one preterm birth;both children are alive and well.Today,the patient arrives at the clinic with complaints of fatigue,insomnia,and continuous backache.She reports that she is a nurse on an oncology unit and is worried about continuing to work her 12-hour shifts.What advice by the nurse would be most appropriate?

Accepted Answer

Although many women do continue to work throughout their pregnancies,certain medical problems and pregnancy complications are a red flag for the woman to reduce her work hours.Examples of these conditions include back problems,preterm labor (both of which this woman has),diabetes,kidney disease,heart disease,hypertension,and a history of spontaneous abortion.Light duty may be an option in addition to decreasing the work hours.Taking more breaks might be advised as well,but with this woman's history and current health complaints she should consider decreasing her working hours.Other factors the nurse should discuss with the patient are the amount of heavy physical labor she does and her exposure to chemotherapeutic agents,both of which are possible environmental hazards to the pregnancy.

Question 4

The perinatal nurse recommends muscle-strengthening exercises to a woman who is pregnant for the first time.The woman states that she does not want to be "muscle-bound and masculine." What response by the nurse is best?

Accepted Answer

Muscle strengthening benefits the woman as she copes with the physical changes of pregnancy,which include weight gain and postural changes.Muscle-strengthening exercises also help to decrease the risk of ligament and joint injury.The other options do not explain this information,making it much less likely she will participate in these exercises.

Question 5

A woman in the perinatal clinic is upset that her impending childbirth will cause her to lose her job.What assessment question by the nurse would yield the most important information regarding this situation?

Accepted Answer

The Family Medical Leave Act of 1993 guarantees most women (and men)12 weeks of unpaid family leave following the birth or adoption of a child.The employee has the right to return to the job without loss of seniority,pay,or benefits.This act applies to federal,state,or local government organizations and any other organization that has 50 or more employees working within 75 miles of the workplace.The employee must have worked at this job at least 12 months or for at least 1,250 hours in the previous year to be eligible.By asking the woman where she works and how long she has been there,the nurse is assessing if the workplace must adhere to this act.Telling the woman she will probably want to quit her job is dismissive of her concerns.Making an appointment with human resources might be a good suggestion,but only after the nurse has assessed the patient's eligibility for the Family Medical Leave Act.Asking "why" questions is considered a communication barrier,as many people become defensive when questions are worded this way.

Question 6

The prenatal clinic nurse visits with a 32-year-old man.His partner is pregnant with her first child and is now at 12 weeks of gestation.The man states that he has been experiencing nausea and vomiting,fatigue,and weight gain.Which action by the nurse is most appropriate?

Accepted Answer

Couvade syndrome is when a male partner experiences the same maternal signs and symptoms as the woman.The nurse should reassure the man that this is an often-occurring finding.The nurse would not need to encourage the man to make an appointment with his health-care provider unless the symptoms became severe.The woman's primary health-care provider does not need to prescribe anti-emetics,nor does the nurse need to assess the man further for cancer risk factors.

Question 7

An 18-year-old woman at 18 weeks' gestation is being seen in the prenatal clinic.Her weight gain is 25 pounds over her prepregnant weight.Which is the perinatal nurse's best approach to care at this visit?

Accepted Answer

This woman has gained much more than the average weight gain in the first trimester (1-2.5 kg).Nutrition and weight management play an essential role in the development of a healthy pregnancy.Not only does the patient need to have an understanding of the essential nutritional elements,she must also be able to assess and modify her diet for the developing fetus and her own nutritional maintenance.To facilitate this process,it is the nurse's responsibility to provide education and counseling concerning dietary intake,weight management,and potentially harmful nutritional practices.The nurse should facilitate this process while the woman is at her appointment.After assessment and mutually planning nutritional goals,the nurse can educate the woman about the possible concerns related to excessive weight gain and teach about the normal trajectory of weight gain during pregnancy.This series of actions follows the nursing process best.

Question 8

A student nurse asks the faculty about the importance of preconception counseling.Which response by the faculty is best?

Accepted Answer

Preconception counseling is an ideal time to identify conditions (physical,psychosocial,environmental,or social)that could lead to a future negative pregnancy outcome.The patient can be educated about the risks and assist in developing a plan to mitigate or avoid them.Providing birth control options can be an important part of preconception care,but this answer is too limited to be the best choice.Stating that reproductive care is important is vague.A goal of Healthy People 2020 is to increase the number of women getting preconception and prenatal care.

Question 9

The clinic nurse is assessing a woman in her 30th week of pregnancy.Her fundal height is 23 centimeters.What other assessment finding would the nurse correlate with this condition?

Accepted Answer

True anemia,or iron-deficiency anemia,occurs when the hemoglobin level drops below 10 g/dL.The blood's decreased oxygen-carrying capacity causes a reduction in oxygen transport to the developing fetus.Decreased fetal oxygen transport has been associated with intrauterine growth restriction and preterm birth.The patient's lower-than-expected fundal height measurement could also be indicative of intrauterine growth restriction.The blood glucose,although slightly high,is not related,nor is leukorrhea (a common finding in pregnancy)or an elevated platelet count.

Question 10

After questioning a pregnant woman about her fluid intake,the nurse discovers that the patient is drinking four glasses of diet cola per day.Which response by the nurse is best?

Accepted Answer

The primary sources of caffeine for pregnant women are coffee,tea,and soda.Research shows that small amounts of caffeine (less than 2 cups a day)are probably safe;however,higher amounts cause central nervous system stimulation and can increase the chance of spontaneous abortions,stress the fetus's metabolic system,and decrease blood flow to the placenta.Women should be encouraged to restrict their intake of caffeinated beverages and taught that even decaffeinated beverages still contain some caffeine.

Question 11

The perinatal nurse would assess which newborn system as a priority after birth if a woman admitted to cocaine use during her pregnancy?

Accepted Answer

Although it is difficult to assess for complications from cocaine because of the likelihood of multi-drug abuse,common complications seen from its use include congenital abnormalities in the skull,brain,face,eyes,intestines,heart,limbs,genitals,and urinary tract.

Question 12

The prenatal nurse has reviewed a patient's 3-day diet recall and notes that the patient typically eats a deli meat sandwich or hot dog,chips,and an apple for lunch.Breakfast consists of cereal,milk,and juice;and dinner contains meat,a starch,vegetables,and a salad.What action by the nurse is most important? .

Accepted Answer

Pregnant women should be taught proper food handling to prevent foodborne illnesses.Deli meats,hot dogs,and luncheon meats should be stored at 40° or less,heated before eating,and consumed within 4 days.Tuna should be eaten in moderation and fish such as shark,swordfish,king mackerel,and tilefish should be avoided in pregnancy because of mercury poisoning.Promoting safety is a priority.The woman may or may not need more calories from protein.Obtaining the patient's weight and documentation are important prenatal activities,but are not the best answer because the nurse needs to assess the woman's knowledge and practice of safe food handling first.

Question 13

Which patient would the perinatal nurse assess as being most at risk for maternal attachment problems?

Accepted Answer

Maternal attachment to the fetus is an important area to assess and can be useful in identifying families at risk for maladaptive behaviors (Youngkin et al.,2012).The nurse should assess for indicators such as unintended pregnancy,intimate partner violence,difficulties in the partner relationship,sexually transmitted infections,limited financial resources,substance use,adolescence,poor social support systems,low educational level,and the presence of mental conditions that might interfere with the patient's ability to bond with and care for the infant.The divorced,unemployed woman experiencing an unexpected pregnancy has the most risk factors.

Question 14

The perinatal nurse notes that a patient has the diagnosis of ptyalism.What topic should the nurse include in the patient's teaching plan?

Accepted Answer

Ptyalism is an excessive production of saliva.Possible helpful strategies include sucking on hard candy,brushing the teeth often,drinking plenty of water in small sips,and consuming small frequent meals with fewer starchy foods.Acupuncture can help with nausea and vomiting,vulvar hygiene would be recommended for leukorrhea,and eating more red meat may help with dietary insufficiencies.

Question 15

A perinatal nurse is assessing a pregnant woman's medications and finds that one of them is categorized as Category D.What information should the nurse provide this patient?

Accepted Answer

There are five categories of drugs based on fetal risk: Category A: no associated fetal risk,safe to take during pregnancy;Category B: no associated fetal risk in animals,fetal risk in humans not identified;Category C: evidence of adverse effects in animal fetuses,fetal risk in humans not identified;Category D: evidence of adverse effects and fetal risk in humans,benefits and risks must be considered before prescribing;and Category X: evidence of fetal risk and congenital anomalies in humans,risks outweigh the benefits,should not be prescribed during pregnancy.

Question 16

The prenatal clinic nurse meets with a 30-year-old woman who is experiencing her first pregnancy.The patient's quadruple-marker screen result is positive at 17 weeks of gestation.Which action by the nurse is most important?

Accepted Answer

A positive quadruple-marker screen result indicates an increased risk for fetal chromosomal abnormalities or neural tube defects, and a referral to a genetics counselor is necessary for further assessment and counseling. Calling a social worker may be beneficial, but it is not the most important action in this situation. Documenting the findings in the chart is necessary but does not provide direct patient care. Preparing the woman for intrauterine death is not relevant in this case.

Question 17

A nurse is teaching a nonsmoking pregnant woman about the iron tablets she was just prescribed.What information is most important for the nurse to teach the patient?

Accepted Answer

Vitamin C enhances the absorption of iron,and a nonsmoking woman should be able to get sufficient iron from a glass of citrus juice daily.Iron tablets should be taken between meals,using a beverage other than tea,coffee,or milk.Dark,tarry stools are a known side effect of iron.Women on iron should also be on prenatal vitamins.

Question 18

A woman comes to the clinic for her 24-week prenatal visit.This is her second pregnancy.The patient does not wish to know her weight and when her clinic record is reviewed,her total weight gain for this pregnancy is 5 pounds.She is very concerned about her changing body shape.What disorder does the nurse suspect?

Accepted Answer

Anorexia nervosa is characterized by a distorted body image and an intense fear of becoming obese.Patients with anorexia nervosa lose weight either by excessive dieting or by purging themselves of calories they have ingested.Because this woman has gained very little weight and has concerns about her body shape,the nurse should suspect anorexia and assess the patient further.Anemia,gestational diabetes,and gestational hypertension do not manifest with these symptoms.

Question 19

The nurse explains to the prenatal class attendees that at full term about 10 to 11% of the maternal weight gain is attributed to which of the following?

Accepted Answer

During early pregnancy,maternal weight gain is related to an increased blood volume,which is necessary to supply the enlarging uterus and to support fetal growth and development.As the pregnancy progresses,enlargement of the placenta and fetal body add to the woman's increase in weight.By term,maternal extracellular fluid,blood,uterine tissue,and breast tissue comprise 35% of the gestational weight gain;the maternal reserves comprise 27%;fetal tissue comprises 27%;and placental fluid comprises 11% of the total maternal weight gain (Cunningham et al.,2010).

Question 20

The nurse in a family practice clinic is working with a woman of childbearing age who recently was married and has no plans to have children yet.Which action by the nurse is most important?

Accepted Answer

Because of the strong connection between folic acid deficiency and the subsequent development of neural tube defects,all women of childbearing age should take a folic acid supplement of at least 400 mcg/day (0.4 mg/day).Because the woman may not realize that she is pregnant early in her pregnancy when neural tube defects occur,prophylactic supplementation is recommended.The other options may be applicable too,but they are not as important as educating the woman about the importance of folic acid.

Quiz 10: Promoting a Healthy Pregnancy