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NUR 300 WI Maternity & Women’s Health Care 12th Edition (2019/2020) - Chapter 14 – Central Michigan University | Nursing Care of the Family During Pregnancy

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NUR 300 WI Maternity & Women’s Health Care 12th Edition - Chapter 14 – Central Michigan University Chapter 14: Nursing Care of the Family During Pregnancy MULTIPLE CHOICE 1. Ideally, wh... en should prenatal care begin? a. Before the first missed menstrual period b. After the first missed menstrual period c. After the second missed menstrual period d. After the third missed menstrual period 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. DIF: Cognitive Level: Remember REF: IMS: 301 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 2. A woman arrives at the clinic for a pregnancy test. Her last menstrual period (LMP) was February 14, 2015. What is the clients expected date of birth (EDB)? a. September 17, 2015 b. November 7, 2015 c. November 21, 2015 d. December 17, 2015 Using the Ngeles 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 Ngeles rule, an EDB of November 7, 2015, is 2 weeks early. December 17, 2015, is almost a month past the correct EDB. DIF: Cognitive Level: Apply REF: IMS: 302 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 3. Which women should undergo prenatal testing for the human immunodeficiency virus (HIV)? a. All women, regardless of risk factors b. Women who have had more than one sexual partner c. Women who have had a sexually transmitted infection (STI) d. Woman who are monogamous with one partner 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. DIF: Cognitive Level: Understand REF: pp. 312, 313 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 4. 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? a. Nausea with occasional vomiting b. Fatigue c. Urinary frequency d. 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 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. DIF: Cognitive Level: Understand REF: IMS: 314 TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity 5. Which client might be well advised to continue condom use during intercourse throughout her pregnancy? a. Unmarried pregnant women b. Women at risk for acquiring or transmitting STIs c. All pregnant women d. Women at risk for candidiasis 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. DIF: Cognitive Level: Apply REF: IMS: 330 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 6. Which condition is likely to be identified by the quadruple marker screen? a. Down syndrome b. Diaphragmatic hernia c. Congenital cardiac abnormality d. Anencephaly 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. DIF: Cognitive Level: Knowledge REF: IMS: 316 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 7. 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? a. Kegel exercises b. Pelvic rock exercises c. Softer mattress d. Bed rest for 24 hours 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. DIF: Cognitive Level: Apply REF: IMS: 320 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 8. 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? a. Dont worry about it; youll feel better in a month or so. b. Have you talked to your husband about how you feel? c. Perhaps you really dont want to be pregnant. d. Hormone changes during pregnancy commonly result in mood swings. 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 womans responses are normal. She should be reassured about her feelings. DIF: Cognitive Level: Apply REF: IMS: 313 TOP: Nursing Process: Diagnosis MSC: Client Needs: Psychosocial Integrity 9. What is the primary role of the nonpregnant partner during pregnancy? a. To provide financial support b. To protect the pregnant woman from old wives tales c. To support and nurture the pregnant woman d. To make sure the pregnant woman keeps prenatal appointments The partners 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 partners primary role in pregnancy. Protecting the pregnant woman from old wives tales is not the partners role. The womans partner can encourage the client to keep all appointments; however, this is not the most important role during the pregnancy. DIF: Cognitive Level: Understand REF: IMS: 305 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity - - - - -- - - - - - - - - - - - - - - - - 25. Many pregnant women have questions regarding work and travel during pregnancy. Which education is a priority for the nurse to provide? a. Women should sit for as long as possible and cross their legs at the knees from time to time for exercise. b. Women should avoid seat belts and shoulder restraints in the car because they press on the fetus. c. Metal detectors at airport security checkpoints can harm the fetus if the woman passes through them a number of times. d. While working or traveling in a car or on an airplane, 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. Pregnant women must wear lap belts and shoulder restraints. The most common injury to the fetus comes from injury to the mother. Metal detectors at airport security checkpoints do not harm fetuses. DIF: Cognitive Level: Understand REF: IMS: 323 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 26. Which statement accurately describes the centering model of care? a. Group sessions begin with the first prenatal visit. b. Blood pressure (BP), weight, and urine dipsticks are obtained by the nurse at each visit. c. Approximately 8 to 12 women are placed in each gestational-age cohort group. d. Outcomes are similar to traditional prenatal care. Gestational-age cohorts comprise the groups, with approximately 8 to 12 women in each group. The groups remain 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. Before the group sessions, the client has an individual assessment, physical examination, and history. At the beginning of each group meeting, clients measure their own BP, weight, and urine dips and enter these findings in their record. Fetal heart rate assessment and fundal height are obtained by the nurse. Results evaluating this approach have been very promising. In a recent study of adolescent clients, the number of LBW infants decreased and breastfeeding rates increased. DIF: Cognitive Level: Apply REF: IMS: 309 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 27. A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of the exercise on the fetus. Which guidance should the nurse provide? a. You dont need to modify your exercising any time during your pregnancy. b. Stop exercising because it will harm the fetus. c. You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month. d. Jogging is too hard on your joints; switch to walking now. 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. Physical activity promotes a feeling of well-being in pregnant women. It improves circulation, promotes relaxation and rest, and counteracts boredom. Simple measures should be initiated to prevent injuries, such as warm-up and stretching exercises to prepare the joints for more strenuous exercise. DIF: Cognitive Level: Apply REF: IMS: 319 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 28. Which sign of a potential complication is the most important for the nurse to share with the client? a. Constipation b. Alteration in the pattern of fetal movement c. Heart palpitations d. Edema in the ankles and feet at the end of the day An alteration in the pattern or amount of fetal movement may indicate fetal jeopardy. Constipation, heart palpitations, and ankle and foot edema are normal discomforts of pregnancy that occur in the second and third trimesters. DIF: Cognitive Level: Apply REF: pp. 327, 329 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 29. 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. Which guidance should the nurse provide? a. Since youre in your second trimester, theres no problem with having one drink with dinner. b. One drink every night is too much. One drink three times a week should be fine. c. Since youre in your second trimester, you can drink as much as you like. d. 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. The statement 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 is accurate. A safe level of alcohol consumption during pregnancy has not yet been established. Although the consumption of occasional alcoholic beverages may not be harmful to the mother or her developing fetus, complete abstinence is strongly advised. DIF: Cognitive Level: Apply REF: IMS: 326 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 30. Which behavior indicates that a woman is seeking safe passage for herself and her infant? a. She keeps all prenatal appointments. b. She eats for two. c. She slowly drives her car. d. She wears only low-heeled shoes. The goal of prenatal care is to foster a safe birth for the infant and mother. Although properly eating, carefully driving, 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. DIF: Cognitive Level: Understand REF: IMS: 308 TOP: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance 31. What type of cultural concern is the most likely deterrent to many women seeking prenatal care? a. Religion b. Modesty c. Ignorance d. Belief that physicians are evil 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. Many cultural variations are found in prenatal care. Even if the prenatal care described is familiar to a woman, some practices may conflict with the beliefs and practices of a subculture group to which she belongs. DIF: Cognitive Level: Apply REF: IMS: 331 TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity 32. The nurse working with pregnant clients must seek to gain understanding of the process whereby women accept their pregnancy. Which statement regarding this process is most accurate? a. Nonacceptance of the pregnancy very often equates to a rejection of the child. b. Mood swings are most likely the result of worries about finances and a changed lifestyle, as well as profound hormonal changes. c. Ambivalent feelings during pregnancy are usually only expressed in emotionally immature or very young mothers. d. Conflicts such as not wanting to be pregnant or childrearing and career-related decisions need not be addressed during pregnancy because they will naturally resolve themselves after birth. 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. Ambivalent feelings about pregnancy are normal for the mature or immature woman and for the younger or older woman. Conflicts such as not wanting to be pregnant or childrearing and career-related decisions need to be resolved. The baby ends the pregnancy but not all the issues. DIF: Cognitive Level: Understand REF: IMS: 303 TOP: Nursing Process: Diagnosis MSC: Client Needs: Psychosocial Integrity 33. What is important for the nurse to recognize regarding the new father and his acceptance of the pregnancy and preparation for childbirth? a. The father goes through three phases of acceptance of his own. b. The fathers attachment to the fetus cannot be as strong as that of the mother because it does not start until after the birth. c. In the last 2 months of pregnancy, most expectant fathers suddenly get very protective of their established lifestyle and resist making changes to the home. d. Typically, men remain ambivalent about fatherhood right up to the birth of their child. 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. During the last 2 months of the pregnancy, many expectant fathers work hard to improve the environment of the home for the child. Typically, the expectant fathers ambivalence ends by the first trimester, and he progresses to adjusting to the reality of the situation and then to focusing on his role. DIF: Cognitive Level: Comprehend REF: IMS: 305 TOP: Nursing Process: Diagnosis MSC: Client Needs: Psychosocial Integrity 34. Which consideration is essential for the nurse to understand regarding follow-up prenatal care visits? a. The interview portions become more intensive as the visits become more frequent over the course of the pregnancy. b. Monthly visits are scheduled for the first trimester, every 2 weeks for the second trimester, and weekly for the third trimester. c. During the abdominal examination, the nurse should be alert for supine hypotension. d. For pregnant women, a systolic BP of 130 mm Hg and a diastolic BP of 80 mm Hg is sufficient to be considered hypertensive. The woman lies on her back during the abdominal examination, possibly compressing the vena cava and aorta, which can cause a decrease in BP and a feeling of faintness. The interview portion of the follow-up examinations is less extensive than in the initial prenatal visits, during which so much new information must be gathered. Monthly visits are routinely scheduled for the first and second trimesters; visits increase to every 2 weeks at week 28 and to once a week at week 36. For pregnant women, hypertension is defined as a systolic BP of 140 mm Hg or higher and a diastolic BP of 90 mm Hg or higher. DIF: Cognitive Level: Understand REF: IMS: 312 TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 35. With regard to medications, herbs, boosters, and other substances normally encountered by pregnant women, what is important for the nurse to be aware of? a. Both prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. b. The greatest danger of drug-caused developmental deficits in the fetus is observed in the final trimester. c. Killed-virus vaccines (e.g., tetanus) should not be administered during pregnancy, but live-virus vaccines (e.g., measles) are permissible. d. No convincing evidence exists that secondhand smoke is potentially dangerous to 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, during which a woman may not realize that she is pregnant. Live-virus vaccines should be part of postpartum care; killed-virus vaccines may be administered during pregnancy. Secondhand smoke is associated with fetal growth restriction and increases in infant mortality. DIF: Cognitive Level: Understand REF: IMS: 326 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 36. Which statement regarding multifetal pregnancy is incorrect? a. The expectant mother often develops anemia because the fetuses have a greater demand for iron. b. Twin pregnancies come to term with the same frequency as single pregnancies. c. The mother should be counseled to increase her nutritional intake and gain more weight. d. Backache and varicose veins often are more pronounced with a multifetal pregnancy. 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. Counseling is needed to help her adjust to these conditions. DIF: Cognitive Level: Understand REF: IMS: 335 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 37. While assessing the vital signs of a pregnant woman in her third trimester, the client complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate? a. Have the patient stand up, and then retake her BP. b. Have the patient sit down, and then hold her arm in a dependent position. c. Have the patient lie supine for 5 minutes, and then recheck her BP on both arms. d. Have the patient turn to her left side, and then recheck her BP in 5 minutes. BP 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. Pressures are significantly higher when the client is standing. This option causes an increase in systolic and diastolic pressures. The arm should be supported at the same level of the heart. The supine position may cause occlusion of the vena cava and descending aorta, creating hypotension. DIF: Cognitive Level: Apply REF: IMS: 312 TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity [Show More]

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