Student Review Questions

Student Review Questions Chapter 12, Nursing Care During Pregnancy

1. A pregnant woman comes to the clinic for a visit. This is her third pregnancy. She had a miscarriage at 12 weeks and gave birth to a son, now 3 years old, at 32 weeks. Using the GTPAL system, the nurse would document this woman’s obstetric history as:

31021 *30111 21212 20111

The woman’s obstetric history would be documented as 30111: G (gravida) = 3 (current pregnancy), T (term pregnancies) = 0, P (number of preterm pregnancies) = 1, A (number of pregnancies ending before 20 weeks viability) = 1, and L (number of living children) = 1.

2. In a woman who is 20 weeks pregnant, the nurse would expect to palpate the fundus at which of the following locations?

Symphysis pubis Between the symphysis and umbilicus *At the umbilicus Just below the ensiform cartilage

At 20 weeks’ gestation, the fundus can be palpated at the umbilicus. The fundus at 12 weeks’ gestation is palpated at the symphysis pubis. At 16 weeks, the fundus is midway between the symphysis pubis and umbilicus. At 36 weeks, the fundus can be palpated just below the ensiform cartilage.

3. The diagonal conjugate of a pregnant woman’s pelvis is measured. Which measurement would suggest a potential problem?

*12.0 cm 12.5 cm 13.0 cm 13.5 cm

The diagonal conjugate, which usually measures 12.5 cm or greater, indicates the anteroposterior diameter of the pelvic inlet. The diagonal conjugate is the most useful measurement for estimating pelvic size because a misfit with the fetal head occurs if it is too small. 4. A woman is in her early second trimester of pregnancy. The nurse would instruct the woman to return for a follow-up visit every:

*4 weeks 3 weeks 2 weeks 1 week

The recommended follow-up schedule is every 4 weeks up to 28 weeks, every 2 weeks from 29 to 36 weeks, and then every week from 37 weeks to birth.

5. After teaching a pregnant woman about how to count fetal movements, the nurse determines that the teaching was successful when the client states which of the following?

“I’ll do the count once a week on a morning that I’m not rushed for work.” *“I’ll sit comfortably in a reclining chair or lie on my side when I do the counts.” “I won’t expect more than three movements to happen in an hour.” “I’ll do the counts while I’m sitting and watching my son’s basketball game.”

A relaxed environment and comfortable position, as well as consistency in performing the counts, are important so the woman can identify changes. The woman needs to monitor fetal movement counts consistently, at approximately the same time each day. She should report a count of less than three fetal movements within an hour. She should perform the counts in a relaxed environment and comfortable position, such as the semi- Fowler’s or side-lying position.

6. A pregnant woman at 26 weeks’ gestation arrives for a follow-up visit. Which of the following assessments, in addition to measuring fundal height and fetal heart rate, would the nurse expect to complete? Select all that apply.

*Blood pressure *Weight Edema *Urine testing *Blood glucose level

Up to 28 weeks’ gestation, follow-up visits involve assessing the client’s blood pressure and weight, doing urine testing for protein and glucose, and measuring fundal height and fetal heart rate. Between weeks 24 and 28, a blood glucose level is obtained. Assessment for edema is typically done between 29 and 36 weeks’ gestation. 7. The nurse is preparing a teaching plan for a pregnant woman about the signs and symptoms she should report immediately to her health care provider. Which of the following would the nurse include? Select all that apply.

*Headache with visual changes in the third trimester Urinary frequency in the third trimester *Sudden leakage of fluid during the second trimester Nausea with vomiting during the first trimester *Lower abdominal pain with shoulder pain in the first trimester Backache during the second trimester

Danger signs and symptoms that need to be reported immediately include headache with visual changes and sudden leakage of fluid in the third trimester, and lower abdominal pain accompanied by shoulder pain in the first trimester. Urinary frequency in the third trimester, nausea and vomiting during the first trimester, and backache during the second trimester are common discomforts of pregnancy.

8. When providing preconception care to a client, which medication would the nurse identify as being safe to continue during pregnancy?

Accutane Lithium Warfarin *Famotidine

Famotidine is a category B drug that is often used during pregnancy and does not appear to cause major birth defects or other fetal problems. Accutane and warfarin are category X drugs and should never be taken during pregnancy. Lithium is a category D drug with clear health risks for the fetus and should be avoided during pregnancy.

9. After teaching the pregnant woman about ways to minimize flatulence and bloating during pregnancy, which statement indicates the need for additional teaching?

“I’ll try to drink more fluids to help move things along.” *“I’ll switch to chewing gum instead of using mints.” “I’ll stay away from foods like cabbage and brussels sprouts.” “I’ll increase the time I spend walking each day.” Eating mints can help reduce flatulence; chewing gum increases the amount of air that is swallowed, increasing gas build-up. Increasing fluid intake helps to reduce flatus. Gas- forming foods such as beans, cabbage, and onions should be avoided. Increasing physical exercise, such as walking, helps reduce flatus. 10. When describing the role of a doula to a group of pregnant women, which of the following would the nurse include?

The doula is a professionally trained nurse hired to provide physical and emotional support. The doula can perform any necessary clinical procedures. *The doula primarily focuses on providing continuous labor support. The doula is capable of handling high-risk births and emergencies.

Doulas provide the woman with continuous support throughout labor. The doula is a laywoman trained to provide women and families with encouragement, emotional and physical support, and information through late pregnancy, labor, and birth. Doulas do not perform any clinical procedures and they are not trained to handle high-risk births and emergencies.