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Chapter 04 prenatal care and adaptations to pregnancy
Maternity/Peds (PRN06900)
McFatter Technical College
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Chapter 04: Prenatal Care and Adaptations to Pregnancy
MULTIPLE CHOICE
- A woman who is 7 weeks pregnant tells the nurse that this is not her first pregnancy. She has a 2-year-old son and had one previous spontaneous abortion. How would the nurse document the patients obstetric history using the TPALM system? a. Gravida 2, para 20120 b. Gravida 3, para 10011 c. Gravida 3, para 10110 d. Gravida 2, para 11110 ANS: C Refer to Box 4-1 in the textbook for the TPALM system of identifying gravida and para.
DIF: Cognitive Level: Application REF: Page 48, Box 4- OBJ: 1 TOP: Definition of Terms KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
- A woman calls her health care provider to schedule prenatal visits in an uncomplicated pregnancy. How frequently will the nurse assist the patient to schedule these appointments? a. Every 3 weeks until the 6th month, then every 2 weeks until delivery b. Every 4 weeks until the 7th month, after which appointments will become more frequent c. Monthly until the 8th month d. Every 2 to 3 weeks for the entire pregnancy ANS: B Monthly visits are scheduled up to 28 weeks, and then visits increase to every 2 to 3 weeks through 36 weeks. From 36 weeks until delivery, visits are weekly.
DIF: Cognitive Level: Application REF: Page 46 OBJ: 2 | 3 TOP: Prenatal Visits KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
- During the physical examination for the first prenatal visit, it is noted that Chadwicks sign is present. What is Chadwicks sign? a. Bluish or purplish discoloration of the vulva, vagina, and cervix b. Presence of early fetal movements c. Darkening of the areola and breast tenderness d. Palpation of the fetal outline ANS: A Chadwicks sign is the purplish or bluish discoloration of the cervix and vagina.
DIF: Cognitive Level: Knowledge REF: Page 49 OBJ: 7 TOP: Normal Physiological Changes in Pregnancy KEY: Nursing Process Step: Data Collection MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- After the examination is completed, the patient asks the nurse why Chadwicks sign occurs during pregnancy. What would the nurse explain as the cause of Chadwicks sign? a. Enlargement of the uterus b. Progesterone action on the breasts c. Increasing activity of the fetus d. Vascular congestion in the pelvic area ANS: D Chadwicks sign is caused by increased vascular congestion in the cervical and vaginal area.
DIF: Cognitive Level: Comprehension REF: Page 49 OBJ: 6 | 7 TOP: Normal Physiological Changes in Pregnancy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- The nurse has explained physiological changes that occur during pregnancy. Which statement indicates that the woman understands the information? a. Blood pressure goes up toward the end of pregnancy. b. My breathing will get deeper and a little faster. c. Ill notice a decreased pigmentation in my skin. d. There will be a curvature in the upper spine area. ANS: B The pregnant woman breathes more deeply, and her respiratory rate may increase slightly.
DIF: Cognitive Level: Comprehension REF: Page 52 OBJ: 7 | 13 TOP: Normal Physiological Changes in Pregnancy KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- A woman reports that her last normal menstrual period began on August 5, 2013. What is this womans expected delivery date using Ngeles rule? a. April 30, 2014 b. May 5, 2014 c. May 12, 2014 d. May 26, 2014 ANS: C To determine the expected date of delivery, count backward 3 months from the first day of the last menstrual
c. 25 to 35 pounds d. 28 to 40 pounds ANS: C The recommended weight gain for a woman of normal weight before pregnancy is 25 to 35 pounds.
DIF: Cognitive Level: Knowledge REF: Page 57 OBJ: 8 TOP: Nutrition in Pregnancy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- When the nurse tells a pregnant woman that she needs 1200 mg of calcium daily during pregnancy, the woman responds, I dont like milk. What dietary adjustments could the nurse recommend? a. Increase intake of organ meats. b. Eat more green leafy vegetables. c. Choose more fresh fruits, particularly citrus fruits. d. Include molasses and whole-grain breads in the diet. ANS: B For women who do not like milk, other sources of calcium include enriched cereals, legumes, nuts, dried fruits, green leafy vegetables, and canned salmon and sardines that contain bones.
DIF: Cognitive Level: Application REF: Page 60 OBJ: 8 | 13 TOP: Nutrition for Pregnancy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk
- A pregnant woman is experiencing nausea in the early morning. What recommendations would the nurse offer to alleviate this symptom? a. Eat three well-balanced meals per day and limit snacks. b. Drink a full glass of fluid at the beginning of each meal. c. Have crackers handy at the bedside, and eat a few before getting out of bed. d. Eat a bland diet and avoid concentrated sweets. ANS: C The nurse can recommend eating dry toast or crackers before getting out of bed in the morning to alleviate nausea during pregnancy.
DIF: Cognitive Level: Application REF: Page 65, Table 4- OBJ: 10 TOP: Common Discomforts in Pregnancy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- The patient who is 28 weeks pregnant shows a 10-pound weight gain from 2 weeks ago. What is the nurses initial action?
a. Assess food intake. b. Weigh the patient again. c. Take the blood pressure. d. Notify the physician. ANS: C The marked weight gain may be an indication of gestational hypertension. The blood pressure should be assessed before notifying the physician.
DIF: Cognitive Level: Application REF: Page 53 OBJ: 4 TOP: Gestational Hypertension KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- The patient remarks that she has heard some foods will enhance brain development of the fetus. The nurse replies that foods high in docosahexaenoic acid (DHA) are thought to enhance brain development. What food can the nurse recommend? a. Fried fish b. Olive oil c. Red meat d. Leafy green vegetables ANS: C Foods rich in DHA are red meat, flounder, halibut, and soybean and canola oil. Frying fish negatively alters the DHA.
DIF: Cognitive Level: Application REF: Page 55 OBJ: 8 TOP: Nutrition in Pregnancy KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
- The nurse encourages adequate intake of folic acid for women of childbearing age before and during pregnancy. What is folic acid thought to decrease the incidence of in fetal development? a. Structural heart defects b. Craniofacial deformities c. Limb deformities d. Neural tube defects ANS: D Folic acid can reduce the incidence of neural tube defects such as spina bifida and anencephaly.
DIF: Cognitive Level: Knowledge REF: Page 45 | Page 61 OBJ: 8 TOP: Nutrition for Pregnancy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk
- A pregnant woman inquires about exercising during pregnancy. What information should the nurse include when planning to educate this woman? a. Exercise elevates the mothers temperature and improves fetal circulation. b. Exercise increases catecholamines, which can prevent preterm labor. c. A regular schedule of moderate exercise during pregnancy is beneficial. d. Pregnant women should limit water intake during exercise. ANS: C In general, moderate exercise several times a week, from the 8th week through delivery, is advised during pregnancy.
DIF: Cognitive Level: Comprehension REF: Page 62 OBJ: 9 | 13 TOP: Exercise During Pregnancy KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- An ultrasound confirms that a 16-year-old girl is pregnant. How does the need for prenatal care and counseling for adolescents different from other age populations? a. A pregnant adolescent is experiencing two major life transitions at the same time. b. Adolescents who get pregnant are more likely to have other chronic health problems. c. Adolescents are at greater risk for multifetal pregnancies. d. At this age, a pregnant adolescent will accept the nurses advice. ANS: A The pregnant adolescent must cope with two of lifes most stress-laden transitions simultaneously: adolescence and parenthood.
DIF: Cognitive Level: Comprehension REF: Page 69 OBJ: 12 TOP: Psychological Adaptations to Pregnancy KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- At what age is a woman who becomes pregnant for the first time described as an elderly primip? a. After 25 years old b. After 28 years old c. After 30 years old d. After 35 years old ANS: D A woman over the age of 35 who becomes pregnant for the first time is described as an elderly primip.
DIF: Cognitive Level: Knowledge REF: Page 69 OBJ: 12 TOP: Elderly Primip KEY: Nursing Process Step: N/A
MSC: NCLEX: Physiological Integrity: Physical Adaptation
- The nurse explains that the softening of the cervix and vagina is a probable sign of pregnancy. What is the appropriate term for this sign? a. Chadwicks b. Hegars c. McDonalds d. Goodells ANS: D Goodells sign is one of the probable signs of pregnancy and describes a softened cervix and vagina.
DIF: Cognitive Level: Knowledge REF: Page 49 OBJ: 1 | 6 | 7 TOP: Goodells Sign KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physical Adaptation
- When obtaining a prenatal history on a pregnant patient the nurse notes a family history of sickle cell disease. Given this information, what lab test can the nurse anticipate the physician will order? a. Endovaginal ultrasound b. Pap test c. Complete blood count d. Hemoglobin electrophoresis ANS: D Hemoglobin electrophoresis identifies presence of sickle cell trait or disease (in women of African or Mediterranean descent). It is ordered in the first trimester, if indicated.
DIF: Cognitive Level: Comprehension REF: Page 46, Table 4- OBJ: 3 TOP: Prenatal laboratory tests KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prenatal Care
- A pregnant woman is attending her second postpartum visit. Prenatal lab work indicates she is not immune to the rubella virus. What is the most appropriate nursing intervention? a. Provide the rubella vaccine as ordered by the physician immediately. b. Inform the woman she should receive the vaccine in the hospital after delivery. c. Hold all immunizations until 1 month postpartum. d. Encourage the patient to decide whether or not to get the rubella vaccine prenatally. ANS: B The rubella vaccine is contraindicated during pregnancy. A woman should be instructed to avoid pregnancy for at least 1 month following rubella immunization. It is not necessary to hold all immunizations until 1 month
a. Waddling gait b. Joint instability c. Urinary frequency d. Back pain e. Aching in cervical spine ANS: A, B A waddling gait and joint instability are the only signs that relate to joint changes. The other discomforts are related to the enlarging uterus with its attendant weight.
DIF: Cognitive Level: Comprehension REF: Page 55 OBJ: 7 TOP: Joint Changes KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- The nurse assesses the progress from the announcement stage of fatherhood to the acceptance stage when the patient reports which actions by the father? (Select all that apply.) a. Goes fishing every afternoon b. Has revised his financial plan c. Spends leisure time with his friends d. Traded his sports car for a sedan e. Helped select a crib ANS: B, D, E Active planning for an infant is an indication of the acceptance stage. Concentration on a hobby and spending time away from home are indicators of nonacceptance.
DIF: Cognitive Level: Comprehension REF: Page 68-69 OBJ: 11 TOP: Stages of Fatherhood KEY: Nursing Process Step: Data Collection MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
- What nursing interventions are appropriate for the prenatal patient in terms of prenatal care? (Select all that apply.) a. Offer nutritional counseling. b. Reinforce responsibility of parenthood. c. Reduce risk factors. d. Improve health practices. e. Make financial arrangements for delivery. ANS: A, B, C, D Nutritional counseling, reinforcing and discussing the responsibility of parenthood, reducing risk factors for the pregnant woman and the fetus, and improving health practices are all goals of prenatal care.
DIF: Cognitive Level: Comprehension REF: Page 44-45 OBJ: 2 | 3 TOP: Goals of Prenatal Care KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
- The nurse recognizes which behavior characteristic(s) of women in their first trimester of pregnancy? (Select all that apply.) a. Showing off her sonogram photos b. Ambivalence about pregnancy c. Emotional and labile mood d. Focusing on her infant e. Fatigue ANS: A, B, C, E Showing off photos, feeling ambivalence about the pregnancy, fragile emotions, and fatigue and sleepiness are all characteristic of behaviors seen in the first trimester. Women are not focused on their infant; they are focused on themselves and the physical changes they are experiencing.
DIF: Cognitive Level: Comprehension REF: Page 67 OBJ: 11 TOP: Behaviors of First Trimester KEY: Nursing Process Step: Data Collection MSC: NCLEX: Physiological Integrity: Physiological Adaptation
COMPLETION
- The number of years between menarche and the date of conception is known as ___________________ age.
ANS: gynecological
Gynecological age is a term that refers to the number of years between the starting of the menses and the date of conception.
DIF: Cognitive Level: Comprehension REF: Page 61 OBJ: 1 TOP: Gynecological Age KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
- The nurse reminds the prenatal patient that she should add ________ kcal to her daily intake to nourish the fetus.
ANS: 300
The recommended dietary intake increase is 300 kcal a day.
DIF: Cognitive Level: Comprehension REF: Page 69 OBJ: 3 TOP: Impact on the Father KEY: Nursing Process Step: Data Collection MSC: NCLEX: Health Promotion and Maintenance: Developmental Stages and Transitions
Chapter 04 prenatal care and adaptations to pregnancy
Course: Maternity/Peds (PRN06900)
University: McFatter Technical College
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