Question 1

An expectant couple complains of dyspareunia.Which action by the nurse is best?

Accepted Answer

Dyspareunia is painful intercourse that may result from pelvic congestion and impaired circulation caused by the enlarging uterus during pregnancy.The nurse should reassure the couple that having sex during pregnancy is acceptable (unless there are medical reasons to contraindicate it)and suggest positions for sex that might be more comfortable for the woman.There is no reason to assess the woman's family history and genetic background.Simply explaining that dyspareunia is normal is dismissive of the couple's concern,although they should be reassured that this does sometimes happen and then they should be offered education on ways to alleviate it.

Question 2

A patient who has a previous diagnosis of round ligament pain is in the clinic for a follow-up visit.Which statement by the patient would indicate that teaching objectives for this problem have been met?

Accepted Answer

Round ligament pain is a common discomfort of pregnancy and the nurse can teach self-care measures such as supporting the uterus with a pillow when resting,warm baths,applying heat,and wearing a pregnancy girdle.Pregnant women should be taught to avoid all medications (both prescription and over the counter)without consulting with their health-care provider.Black,tarry stools are not related to round ligament pain.Black cohosh is a uterine stimulant and should be avoided during pregnancy.

Question 3

A woman in her third trimester is complaining of numbness and tingling in her fingers.Which action should the nurse take first?

Accepted Answer

Carpal tunnel syndrome is commonly seen in pregnancy and can be caused by either hyperventilation or from nerve compression of the median and ulnar nerves in the arm.If the woman is hyperventilating,the nurse can educate her about conscious control of breathing,which would provide relief quickly and easily.If hyperventilation does not seem to be the causative factor,the nurse can educate her about strategies for symptom control.These methods include maintaining good posture,elevating the hands on pillows when sleeping,wearing a wrist brace,and/or using a thermoskin carpal tunnel glove.Simply reassuring the woman that the condition is temporary does nothing to increase her comfort.A nerve conduction study is not needed at this time,but if the condition persists after childbirth,it could be an option.

Question 4

A nurse is describing various childbirth options to an expectant couple.The woman states "I want to do Lamaze because I hear you will have no pain with this method." Which response by the nurse is best?

Accepted Answer

Although Lamaze does teach that pain is a natural and normal part of childbirth,it also empowers the woman with strategies to cope with the pain in positive ways that facilitate the labor and birth process.It does not promise a pain-free childbirth and decisions about medications are left to the woman who has been educated about their effect on childbirth.Stating simply that pain is a normal part of childbirth without elaborating on how it is managed will not alleviate the patient's concern.

Question 5

A nurse is helping a pregnant woman prepare for a planned home birth.What action by the nurse takes priority?

Accepted Answer

Home births are an option for women who have low-risk pregnancies and no labor complications.However,according to a position statement by the American College of Obstetrics and Gynecology (ACOG),women who choose to deliver at home should be well- informed and should ensure access to rapid and timely transportation to the closest hospital in case of emergency (ACOG,2011).Obstetricians will not deliver babies at home.Although pain management may be an important consideration,this is not as important as ensuring the safety of both mother and baby.Trying to convince the woman to go against her beliefs is disrespectful.

Question 6

A pregnant woman has been brought to the emergency department by the rescue squad with symptoms of heat exhaustion after competing in an outdoor race on a hot day.Before discharge,the nurse teaches about appropriate exercise during pregnancy.The husband asks if the woman's having heat exhaustion will harm the baby.Which response by the nurse is most accurate?

Accepted Answer

The fetus is unable to reduce body temperature through perspiration or other means and instead must rely on the mother's body for temperature regulation.Possible complications of maternal hyperthermia include spontaneous abortion,preterm labor,and fetal distress.The nurse should educate the couple about exercise that won't increase the maternal temperature too much.Complications are possible,not definite;the baby being in a fluid environment does not regulate its temperature,and women who are pregnant can engage in aerobic activity following safety guidelines.

Question 7

A nurse is reviewing the care plan for a woman in the third trimester of her first pregnancy.Which action by the patient best indicates positive adaptation to the pregnancy and impending motherhood?

Accepted Answer

Attending prenatal classes,maintaining a healthy lifestyle,and having a prepared space for the baby are all tasks that indicate some degree of positive adaptation to a pregnancy.However,the best indicator of positive adaptation is when the woman can be described as well educated on pregnancy,growth and development of the fetus,and motherhood.This is much more inclusive than the other individual tasks.

Question 8

A woman who is 26 weeks pregnant has a blood pressure of 158/100 mm Hg.Which action by the nurse is most appropriate?

Accepted Answer

Preeclampsia is defined as a blood pressure greater than 140/90 mm Hg after 20 weeks' gestation accompanied by proteinuria.Other signs and symptoms include headache,visual changes,and edema.The nurse should suspect this condition and confirm it with a urine test for protein and by asking about the other symptoms.Assessing for other cardiovascular risk problems and teaching about anti-hypertensive medications are not warranted in this situation.

Question 9

A pregnant woman is complaining of urinary frequency and is worried about incontinence.Which teaching strategy should the nurse use when counseling this woman?

Accepted Answer

There are several physiological factors that cause urinary frequency and possible incontinence during pregnancy.Kegel exercises can improve both symptoms.The patient should remain well hydrated and void frequently.Sit-ups will not help with urinary frequency.

Question 10

A pregnant woman is being discharged from the hospital after an episode of preterm labor that has resolved.She asks the nurse if she can now return to her low-impact aerobics class.Which response by the nurse is best?

Accepted Answer

Premature labor,along with several other conditions,is an absolute contraindication to aerobic exercise during pregnancy.Although being able to talk while exercising is an important safety tip,this woman should not be engaging in any aerobics for the duration of this pregnancy.

Question 11

A woman in her second trimester wants to continue her weight-lifting and exercise plan.Which exercise would the nurse advise against participating in?

Accepted Answer

Lunges may injure connective tissue in the pelvic area and should be avoided.The other
exercises are acceptable,but the woman should be cautioned to use resistance bands instead of
free weights.

Question 12

A pregnant woman in her third trimester presents to the emergency department after fainting upon rising from a supine position.Which activity should the nurse perform first?

Accepted Answer

Supine hypotension is caused by the pressure of the enlarging uterus on the inferior vena cava while the woman is in a supine position.Vena caval compression impedes venous blood flow,reduces the amount of blood in the heart,and decreases cardiac output,causing dizziness and syncope.Pathological causes of supine hypotension include cardiac or respiratory disorders,anemia,hypoglycemia,dehydration,anxiety,and stress.Hypoglycemia can be treated rapidly if that is the cause.The other actions are appropriate as well,but the priority action would be to identify a condition that is readily treatable.

Question 13

A nurse is planning to teach a prenatal class on the Dick-Read method of childbirth.Which information should the nurse plan to include?

Accepted Answer

The founder of the Dick-Read method of childbirth was convinced that the pain associated with labor and birth was caused by tension and fear.These conditions stimulate the woman's sympathetic nervous system,decrease blood flow to the uterus,and lead to uterine hypoxia.Relaxation restores the blood flow.Placing the baby in a warm tub of water is a component of the LeBoyer method;consciously controlled breathing as the main coping strategy is part of the Lamaze method;and although Dick-Read did not advocate for the use of pain medication,he did approve it when the woman was unable to relax or was experiencing complications.

Question 14

A woman's birth plan specifies the Odent method of childbirth.Early in her admission,the woman asks about having an epidural for pain control.Which action by the nurse is best?

Accepted Answer

The Odent method involves the woman's giving birth in a warm water bath.Not every woman is a candidate for this method,including women who have rupture of the membranes or other complications that require continuous fetal monitoring.Epidural anesthesia requires continuous fetal monitoring,so if she chooses an epidural,she will not be able to use the Odent method.The nurse should advise her of this so that the woman is well informed before making a final decision.Asking why she wants pain control sounds judgmental.Breathing techniques are the primary method of coping with pain in the Lamaze method.If the woman decides to go ahead with the epidural,then by all means the nurse should facilitate its placement.

Question 15

A patient in the prenatal clinic had a negative rubella titer.Which action by the nurse is most appropriate?

Accepted Answer

Rubella (German measles)can cause fetal abnormalities if the pregnant woman contracts it during the first trimester,so all pregnant women are screened for immunity.A positive test means the woman is immune to the disease,whereas a negative test indicates susceptibility to it.The woman needs to avoid people who may be ill with rubella and be immunized after her delivery.There is no need for a double check of the results.

Question 16

A perinatal clinic nurse educated a pregnant woman about basic prenatal exercises.On a return visit,which statement by the patient indicates that teaching goals have been met?

Accepted Answer

Kegel exercises are among the basic prenatal exercises taught to all pregnant women.In order to do them correctly,the woman needs to learn to isolate the pubococcygeal (PC)muscle.Women can obtain benefits from exercising as little as 10 minutes a day;jumping rope should be avoided because it involves too much bouncing;and when the pregnant woman is fatigued,she should rest.

Question 17

A patient on the postpartum floor of the hospital has a body mass index (BMI)of 38 and just gave birth to a healthy baby girl by Cesarean section.Which action by the nurse takes highest priority?

Accepted Answer

All of these interventions are appropriate for this patient.However,patient safety is the priority.Women with Level 2 obesity (BMI 35-39.9)are at higher risk of wound infection and breakdown.The nurse should place a priority on hand hygiene and close monitoring of the incision.

Question 18

A woman admitted in labor asks if she can have a doula present with her.The nurse understands that a doula is which of the following?

Accepted Answer

A doula is a woman who is experienced in childbirth and who provides physical and emotional support to the mother during labor,birth,and the postpartum period.A doula is not a massage therapist,nor a trained labor coach,and a doula is not licensed to deliver babies.

Question 19

A pregnant woman lifts weights regularly with a partner.What modification to this activity should the nurse suggest?

Accepted Answer

Lifting from a supine position can cause vena cava syndrome and decreased placental perfusion,so the woman should be instructed to adjust the weight bench to a tilted position.Heavy weights can overload the loosened joints,so using lighter weights with more repetitions is recommended.Holding the breath can cause a Valsalva maneuver,which decreases placental perfusion.Resistance bands are preferred to reduce the likelihood of abdominal injury.

Question 20

A woman in her second trimester continues to smoke a pack of cigarettes a day despite stating that she understands why smoking is bad for her and for her fetus.Which action by the nurse is best?

Accepted Answer

Research shows that women who continue to smoke during pregnancy often report high levels of trauma and abuse and higher levels of PTSD symptoms.Women who smoke as a coping mechanism are even more likely to smoke during pregnancy (Lopez,Konrath,& Seng,2011).The nurse should assess for these factors.Documentation is important,but is not the best answer because the nurse does not do anything to assist the patient;documentation alone is the answer only when the data are normal.Reviewing prior teaching may be helpful,but if the nurse does not help the patient address the core issue of smoking,this review will be unhelpful and a waste of time.Showing babies born with abnormalities is demeaning and could be interpreted as threatening.

Quiz 10: Promoting a Healthy Pregnancy