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Exam 1 (Chapters 3, 8, 9, 11, 12, 13, 15, 16)

Terms in this set (581)

A

(Nutrient needs for energy—protein, calcium, iodine, zinc, B vitamins, and vitamin C—remain higher during lactation than during pregnancy. The need for iron is not higher during lactation than during pregnancy. A lactating woman does not have a greater requirement for vitamin A than a nonpregnant woman. Folic acid requirements are the highest during the first trimester of pregnancy.)

Which nutrient's recommended dietary allowance (RDA) is higher during lactation than during pregnancy?

A. Energy (kcal)
B. Iron
C. Vitamin A
D. Folic acid

C

(A pregnant woman's diet is consistent with that followed by a strict vegetarian (vegan). Vegans consume only plant products. Because vitamin B12 is found in foods of animal origin, this diet is deficient in vitamin B12. Depending on the woman's food choices, a pregnant woman's diet may be adequate in calcium. Protein needs can be sufficiently met by a vegetarian diet. The nurse should be more concerned with the woman's intake of vitamin B12 attributable to her dietary restrictions. Folic acid needs can be met by enriched bread products.)

A pregnant woman's diet consists almost entirely of whole grain breads and cereals, fruits, and vegetables. Which dietary requirement is the nurse most concerned about?

A. Calcium
B. Protein
C. Vitamin B12
D. Folic acid

B

(Lactose intolerance, which is an inability to digest milk sugar because of a lack of the enzyme lactose in the small intestine, is a problem that interferes with milk consumption. Milk consumption may cause abdominal cramping, bloating, and diarrhea in such people, although many lactose-intolerant individuals can tolerate small amounts of milk without symptoms. A woman with lactose intolerance is more likely to experience bloating and cramping, not heartburn. A client who breaks out in hives after consuming milk is more likely to have a milk allergy and should be advised to simply brush her teeth after consuming dairy products.)

Which statement made by a lactating woman leads the nurse to believe that the client might have lactose intolerance?

A. "I always have heartburn after I drink milk."
B. "If I drink more than a cup of milk, I usually have abdominal cramps and bloating."
C. "Drinking milk usually makes me break out in hives."
D. "Sometimes I notice that I have bad breath after I drink a cup of milk."

D

(Sardines are rich in calcium. Fresh apricots, canned clams, and spaghetti with meat sauce are not high in calcium.)

A client states that she does not drink milk. Which foods should the nurse encourage this woman to consume in greater amounts to increase her calcium intake?

A. Fresh apricots
B. Canned clams
C. Spaghetti with meat sauce
D. Canned sardines

C

(This woman has a normal BMI and should gain 11.5 to 16 kg during her pregnancy. A weight gain of 20 kg (44 lb) is unhealthy for most women; a weight gain of 16 kg (35 lb) is at the high end of the range of weight this woman should gain in her pregnancy; and a weight gain of 10 kg (22 lb) is appropriate for an obese woman. This woman has a normal BMI, which indicates that her weight is average.)

A 27-year-old pregnant woman had a preconceptual body mass index (BMI) of 19. What is this client's total recommended weight gain during pregnancy?

A. 20 kg (44 lb)
B. 16 kg (35 lb)
C. 12.5 kg (27.5 lb)
D. 10 kg (22 lb)

D

(A healthy diet before conception is the best way to ensure that adequate nutrients are available for the developing fetus. A woman's folate or folic acid intake is of particular concern in the periconception period. Neural tube defects are more common in infants of women with a poor folic acid intake. Depending on the type of contraception that she has been using, discontinuing all contraception at this time may not be appropriate. Advising this client to lose weight now so that she can gain more during pregnancy is also not appropriate advice. Depending on the type of medications the woman is taking, continuing to take them regularly may not be appropriate.)

A woman has come to the clinic for preconception counseling because she wants to start trying to get pregnant. Which guidance should she expect to receive?

A. "Discontinue all contraception now."
B. "Lose weight so that you can gain more during pregnancy."
C. "You may take any medications you have been regularly taking."
D. "Make sure you include adequate folic acid in your diet."

B

(Iron supplements taken at bedtime may reduce GI upset and should be taken at bedtime if abdominal discomfort occurs when iron supplements are taken between meals. Iron supplements are best absorbed if they are taken when the stomach is empty. Bran, tea, coffee, milk, and eggs may reduce absorption.)

To prevent gastrointestinal (GI) upset, when should a pregnant client be instructed to take the recommended iron supplements?

A. On a full stomach
B. At bedtime
C. After eating a meal
D. With milk

A

(Protein is the nutritional element basic to growth. An adequate protein intake is essential to meeting the increasing demands of pregnancy. These demands arise from the rapid growth of the fetus; the enlargement of the uterus, mammary glands, and placenta; the increase in the maternal blood volume; and the formation of the amniotic fluid. Iron intake prevents anemia. Calcium intake is needed for fetal bone and tooth development. Glycemic control is needed in those with diabetes; protein is one nutritional factor to consider for glycemic control but not the primary role of protein intake.)

After the nurse completes nutritional counseling for a pregnant woman, she asks the client to repeat the instructions to assess the client's understanding. Which statement indicates that the client understands the role of protein in her pregnancy?

A. "Protein will help my baby grow."
B. "Eating protein will prevent me from becoming anemic."
C. "Eating protein will make my baby have strong teeth after he is born."
D. "Eating protein will prevent me from being diabetic."

C

(Adolescents tend to have lower BMIs. In addition, the fetus and the still-growing mother appear to compete for nutrients. These factors, along with inadequate weight gain, lend themselves to a higher incidence of low-birth-weight babies. Obesity is associated with a higher-than-normal BMI. Unless the teenager has type 1 diabetes, an adolescent with a low BMI is less likely to develop gestational diabetes. High-birth-weight or large-for-gestational age (LGA) babies are most often associated with gestational diabetes.)

Pregnant adolescents are at greater risk for decreased BMI and "fad" dieting with which condition?

A. Obesity
B. Gestational diabetes
C. Low-birth-weight babies
D. High-birth-weight babies

B

(Nutritional status draws so much attention not only for its effect on a healthy pregnancy and birth but also because significant changes are within relatively easy reach. Pregnancy is a time when many women are motivated to learn about adequate nutrition and make changes to their diet that will benefit their baby. Pregnancy is not the time to begin a weight loss diet. Clients and their caregivers should still be concerned with appropriate weight gain.)

Maternal nutritional status is an especially significant factor of the many that influence the outcome of pregnancy. Why is this the case?

A. Maternal nutritional status is extremely difficult to adjust because of an individual's ingrained eating habits.
B. Adequate nutrition is an important preventive measure for a variety of problems.
C. Women love obsessing about their weight and diets.
D. A woman's preconception weight becomes irrelevant.

C

(IUGR is associated with women with inadequate weight gain. The primary factor in making a weight gain recommendation is the appropriateness of the prepregnancy weight for the woman's height. Obese women are twice as likely as women of normal weight to give birth to a child with major congenital defects. Overeating is only one of several likely causes.)

With regard to weight gain during pregnancy, the nurse should be aware of which important information?

A. In pregnancy, the woman's height is not a factor in determining her target weight.
B. Obese women may have their health concerns, but their risk of giving birth to a child with major congenital defects is the same as with women of normal weight.
C. Women with inadequate weight gain have an increased risk of delivering a preterm infant with intrauterine growth restriction (IUGR).
D. Greater than expected weight gain during pregnancy is almost always attributable to old-fashioned overeating.

A

(Six to eight glasses is still the standard for fluids; however, they should be the right fluids. All beverages containing caffeine, including tea, cocoa, and some soft drinks, should be avoided or should be consumed only in limited amounts. Artificial sweeteners, including aspartame, have no ill effects on the normal mother or fetus. However, mothers with phenylketonuria (PKU) should avoid aspartame. Although no evidence indicates that prenatal fluoride consumption reduces childhood tooth decay, fluoride still helps the mother.)

Which nutritional recommendation regarding fluids is accurate?

A. A woman's daily intake should be six to eight glasses of water, milk, and/or juice.
B. Coffee should be limited to no more than 2 cups, but tea and cocoa can be consumed without worry.
C. Of the artificial sweeteners, only aspartame has not been associated with any maternity health concerns.
D. Water with fluoride is especially encouraged because it reduces the child's risk of tooth decay.

C

(Iron should generally be supplemented, and folic acid supplements are often needed because folate is so important in pregnancy. Fat-soluble vitamins should be supplemented as a medical prescription, as vitamin D might be for lactose-intolerant women. Water-soluble vitamin C is sometimes naturally consumed in excess; vitamin B6 is prescribed only if the woman has a very poor diet; and zinc is sometimes supplemented. Most women get enough calcium.)

Which minerals and vitamins are usually recommended as a supplement in a pregnant client's diet?

A. Fat-soluble vitamins A and D
B. Water-soluble vitamins C and B6
C. Iron and folate
D. Calcium and zinc

D

(If taken in excess, vitamin A causes a number of problems. An analog of vitamin A appears in prescribed acne medications, which must not be taken during pregnancy. Zinc, vitamin D, and folic acid are all vital to good maternity and fetal health and are highly unlikely to be consumed in excess.)

Which vitamins or minerals may lead to congenital malformations of the fetus if taken in excess by the mother?

A. Zinc
B. Vitamin D
C. Folic acid
D. Vitamin A

C

(The consumption of foods low in nutritional value or of nonfood substances (e.g., dirt, laundry starch) is called pica. Preeclampsia is a vasospastic disease process encountered after 20 weeks of gestation. Characteristics of preeclampsia include increasing hypertension, proteinuria, and hemoconcentration. Pyrosis is a burning sensation in the epigastric region, otherwise known as heartburn. Purging refers to self-induced vomiting after consuming large quantities of food.)

While obtaining a diet history, the nurse might be told that the expectant mother has cravings for ice chips, cornstarch, and baking soda. Which nutritional problem does this behavior indicate?

A. Preeclampsia
B. Pyrosis
C. Pica
D. Purging

B

(A registered dietitian can help with therapeutic diets. Oral contraceptive use may interfere with the absorption of folic acid. Iron deficiency can appear if placement of an intrauterine device (IUD) results in blood loss. A woman's finances can affect her access to good nutrition; her education (or lack thereof) can influence the nurse's teaching decisions. The nutrition-related laboratory test that pregnant women usually need is a screen for anemia.)

Assessment of a woman's nutritional status includes a diet history, medication regimen, physical examination, and relevant laboratory tests. Which finding might require consultation to a higher level of care?

A. Oral contraceptive use may interfere with the absorption of iron.
B. Illnesses that have created nutritional deficits, such as PKU, may require nutritional care before conception.
C. The woman's socioeconomic status and educational level are not relevant to her examination; they are the province of the social worker.
D. Testing for diabetes is the only nutrition-related laboratory test most pregnant women need.

A

(Interestingly, some women can tolerate tart or salty foods when they are nauseated. Lemonade and potato chips are an ideal combination. The woman should avoid drinking too much when nausea is most likely, but she should increase her fluid levels later in the day when she feels better. The woman should avoid brushing her teeth immediately after eating. A small snack of cereal and milk or yogurt before bedtime may help the stomach in the morning.)

Which guidance might the nurse provide for a client with severe morning sickness?

A. Trying lemonade and potato chips
B. Drinking plenty of fluids early in the day
C. Immediately brushing her teeth after eating
D. Never snacking before bedtime

B

(As a precaution, the pregnant client should avoid eating shark, swordfish, and mackerel, as well as the less common tilefish. High levels of mercury can harm the developing nervous system of the fetus. Assisting the client in understanding the differences between numerous sources of mercury is essential for the nurse. A pregnant client may eat as much as 12 ounces a week of canned light tuna; however, canned white, albacore, or tuna steaks contain higher levels of mercury and should be limited to no more than 6 ounces per week. Pregnant women and mothers of young children should check with local advisories about the safety of fish caught by families and friends in nearby bodies of water. If no information is available, then these fish sources should be avoided, limited to less than 6 ounces per week, or the only fish consumed that week. Commercially caught fish that is low in mercury includes salmon, shrimp, pollock, or catfish. The pregnant client may eat up to 12 ounces of commercially caught fish per week. Additional information on levels of mercury in commercially caught fish is available at www.cfsan.fda.gov.)

Many clients are concerned about the increased levels of mercury in fish and may be reluctant to include this source of nutrients in their diet. What is the best advice for the nurse to provide?

A. Canned white tuna is a preferred choice.
B. Shark, swordfish, and mackerel should be avoided.
C. Fish caught in local waterways is the safest.
D. Salmon and shrimp contain high levels of mercury.

D

(The physiologic changes of pregnancy may complicate the interpretation of physical findings. Lower extremity edema often occurs when caloric and protein deficiencies are present; however, edema in the lower extremities may also be a common physical finding during the third trimester. Completing a thorough health history and physical assessment and requesting further laboratory testing, if indicated, are essential for the nurse. The malnourished pregnant client may display rapid heart rate, abnormal rhythm, enlarged heart, and elevated blood pressure. A client receiving adequate nutrition will have bright, shiny eyes with no sores and moist, pink membranes. Pale or red membranes, dryness, infection, dull appearance of the cornea, or blue sclerae are signs of poor nutrition. A client who is alert and responsive with good endurance is well nourished. A listless, cachectic, easily fatigued, and tired presentation would be an indication of a poor nutritional status.)

Nutrition is an alterable and important preventive measure for a variety of potential problems such as low birth weight and prematurity. While completing the physical assessment of the pregnant client, the nurse is able to evaluate the client's nutritional status by observing a number of physical signs. Which physical sign indicates to the nurse that the client has unmet nutritional needs?

A. Normal heart rate, rhythm, and blood pressure
B. Bright, clear, and shiny eyes
C. Alert and responsive with good endurance
D. Edema, tender calves, and tingling

A

(If no medical or obstetric problems contraindicate physical activity, then pregnant women should get 30 minutes of moderate physical exercise daily. Liberal amounts of fluid should be consumed before, during, and after exercise because dehydration can trigger premature labor. The woman's caloric intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise.)

A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. Which recommendation would the nurse make for this particular client after a tennis match?

A. Drink several glasses of fluid.
B. Eat extra protein sources such as peanut butter.
C. Enjoy salty foods to replace lost sodium.
D. Consume easily digested sources of carbohydrate.

D

(Eating small, frequent meals may help with heartburn, nausea, and vomiting. Substituting other calcium sources for milk, lying down after eating, and reducing fiber intake are inappropriate dietary suggestions for all pregnant women and do not alleviate heartburn.)

A woman in the 34th week of pregnancy reports that she is very uncomfortable because of heartburn. Which recommendation would be appropriate for this client?

A. Substitute other calcium sources for milk in her diet.
B. Lie down after each meal.
C. Reduce the amount of fiber she consumes.
D. Eat five small meals daily.

A

(Good sources for protein, such as meat, milk, eggs, and cheese, have a lot of calcium and iron. Most women already eat a high-protein diet and do not need to increase their intake. Protein is sufficiently important that specific servings of meat and dairy are recommended. High-protein supplements are not recommended because they have been associated with an increased incidence of preterm births.)

Which information regarding protein in the diet of a pregnant woman is most helpful to the client?

A. Many protein-rich foods are also good sources of calcium, iron, and B vitamins.
B. Many women need to increase their protein intake during pregnancy.
C. As with carbohydrates and fat, no specific recommendations exist for the amount of protein in the diet.
D. High-protein supplements can be used without risk by women on macrobiotic diets.

B

(A lactating woman needs to avoid consuming too much caffeine. Vitamin C, zinc, and protein levels need to be moderately higher during lactation than during pregnancy. The recommendations for iron and folic acid are lower during lactation. Lactating women should consume approximately 500 kcal more than their prepregnancy intake, at least 1800 kcal daily overall.)

A client states that she plans to breastfeed her newborn infant. What guidance would be useful for this new mother?

A. The mother's intake of vitamin C, zinc, and protein can now be lower than during pregnancy.
B. Caffeine consumed by the mother accumulates in the infant, who may be unusually active and wakeful.
C. Critical iron and folic acid levels must be maintained.
D. Lactating women can go back to their prepregnant caloric intake.

C

(Obstetricians today are seeing an increasing number of morbidly obese pregnant women weighing 400, 500, and 600 pounds. To manage their conditions and to meet their logistical needs, a new medical subspecialty,bariatric obstetrics, has arisen. Extra-wide blood pressure cuffs, scales that can accommodate up to 880 pounds, and extra-wide surgical tables designed to hold the weight of these women are used. Special techniques for ultrasound examination and longer surgical instruments for cesarean birth are also required. A temporal thermometer can be used for a pregnant client of any size.)

The labor and delivery nurse is preparing a client who is severely obese (bariatric) for an elective cesarean birth. Which piece of specialized equipment will not likely be needed when providing care for this pregnant woman?

A. Extra-long surgical instruments
B. Wide surgical table
C. Temporal thermometer
D. Increased diameter blood pressure cuff

D

(A weight gain of 5 to 9 kg will provide sufficient nutrients for the fetus. Overweight and obese women should be advised to lose weight before conception to achieve the best pregnancy outcomes. A higher weight gain in twin gestations may help prevent low birth weights. Adolescents need to gain weight toward the higher acceptable range, which provides for their own growth, as well as for fetal growth. In the past, women of short stature were advised to restrict their weight gain; however, evidence to support these guidelines has not been found.)

Which pregnant woman should strictly follow weight gain recommendations during pregnancy?

A. Pregnant with twins
B. In early adolescence
C. Shorter than 62 inches or 157 cm
D. Was 20 pounds overweight before pregnancy

D

(Complex carbohydrates supply the pregnant woman with vitamins, minerals, and fiber. The most common simple carbohydrate is table sugar, which is a source of energy but does not provide any nutrients. Fats provide 9 kcal in each gram, in contrast to carbohydrates and proteins, which provide only 4 kcal in each gram. Fiber is primarily supplied by complex carbohydrates.)

The major source of nutrients in the diet of a pregnant woman should be composed of what?

A. Simple sugars
B. Fats
C. Fiber
D. Complex carbohydrates

D

(Sources of folates include green leafy vegetables, whole grains, fruits, liver, dried peas, and beans. Chicken and cheese are excellent sources of protein but are poor sources for folates. Potatoes contain carbohydrates and vitamins and minerals but are poor sources for folates.)

A pregnant woman's diet may not meet her increased need for folates. Which food is a rich source of this nutrient?

A. Chicken
B. Cheese
C. Potatoes
D. Green leafy vegetables

C

(The recommended intake of protein for the pregnant woman is 70 g. Therefore, additional protein intakes of 5, 10, or 15 g would be inadequate to meet protein needs during pregnancy. A protein intake of 30 g is more than would be necessary and would add extra calories.)

If a client's normal prepregnancy diet contains 45 g of protein daily, how many more grams of protein should she consume per day during pregnancy?

A. 5
B. 10
C. 25
D. 30

D

(Understanding the client's food preferences and how she prepares food will assist the nurse in determining whether the client's culture is adversely affecting her nutritional intake. An evaluation of a client's weight gain during pregnancy should be included for all clients, not only for clients from different cultural backgrounds. The socioeconomic status of the client may alter the nutritional intake but not the cultural influence. Teaching the food groups to the client should come after assessing her food preferences.)

Which action is the first priority for the nurse who is assessing the influence of culture on a client's diet?

A. Evaluate the client's weight gain during pregnancy.
B. Assess the socioeconomic status of the client.
C. Discuss the four food groups with the client.
D. Identify the food preferences and methods of food preparation common to the client's culture.

A

(A weight gain of 30 pounds is one indication that the client has gained a sufficient amount for the nutritional needs of pregnancy. A daily supplement is not the best goal for this client and does not meet the basic need of proper nutrition during pregnancy. Decreasing snack foods may be needed and should be assessed; however, assessing weight gain is the best method of monitoring nutritional intake for this pregnant client. Although increasing the intake of complex carbohydrates is important for this client, monitoring the weight gain should be the end goal.)

The nurse has formulated a diagnosis of Imbalanced nutrition: Less than body requirements for the client. Which goal is most appropriate for this client to obtain?

A. Gain a total of 30 pounds.
B. Consistently take daily supplements.
C. Decrease her intake of snack foods.
D. Increase her intake of complex carbohydrates.

B

(Adolescents should gain in the upper range of the recommended weight gain. They also need to gain weight that would be expected for their own normal growth. Changes in the diet should be kept at a minimum. Snack foods can be included in moderation, and other foods can be added to make up for lost nutrients. Eliminating fast foods would make the adolescent appear different to her peers. The client should be taught to choose foods that add needed nutrients. Adolescents are willing to make changes; however, they still have the need to be similar to their peers.)

Which action is the highest priority for the nurse when educating a pregnant adolescent?

A. Emphasize the need to eliminate common teenage snack foods because they are high in fat and sodium.
B. Determine the weight gain needed to meet adolescent growth, and add 35 pounds.
C. Suggest that she not eat at fast-food restaurants to avoid foods of poor nutritional value.
D. Realize that most adolescents are unwilling to make dietary changes during pregnancy.

A, B, C, D

(The nurse should be especially aware that conditions such as diabetes can require in-depth dietary planning and evaluation. To prevent issues with hypoglycemia and hyperglycemia, as well as an increased risk for perinatal morbidity and mortality, the client with a preexisting or gestational illness would benefit from a referral to a dietitian. Consultation with a dietitian may ensure that cultural food beliefs are congruent with modern knowledge of fetal development and that adjustments can be made to ensure that all nutritional needs are met. The obese pregnant client may be under the misapprehension that, because of her excess weight, little or no weight gain is necessary. According to the Institute of Medicine, a client with a BMI in the obese range should gain at least 7 kg to ensure a healthy outcome. This client may require in-depth counseling on the optimal food choices. The vegetarian client needs to have her dietary intake carefully assessed to ensure that the optimal combination of amino acids and protein intake is achieved. Very strict vegetarians (vegans) who consume only plant products may also require vitamin B and mineral supplementation. A multifetal pregnancy can be managed by increasing the number of servings of complex carbohydrates and proteins.)

Most women with uncomplicated pregnancies can use the nurse as their primary source for nutritional information. However, the nurse or midwife may need to refer a client to a registered dietitian for in-depth nutritional counseling. Which conditions would require such a consultation? (Select all that apply.)

A. Preexisting or gestational illness such as diabetes
B. Ethnic or cultural food patterns
C. Obesity
D. Vegetarian diets
E. Multifetal pregnancy

B, C, D, E

(According to the U.S. Food and Drug Administration (2013), the "four simple steps" are:
• Clean: Frequently cleanse hands, food preparation surfaces, and utensils.
• Separate: Avoid contact among raw meat, fish, or poultry and other foods that will not be cooked before consumption
• Cook: Cook foods to the proper temperature.
• Chill: Properly store foods, and promptly refrigerate.
DIF: Cognitive Level: Apply REF: p. 361
TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance)

Foodborne illnesses can cause adverse effects for both mother and fetus. The nurse is in an ideal position to evaluate the client's knowledge regarding steps to prevent a foodborne illness. The nurse asks the client to "teach back" the fours simple steps of food preparation. What are they? (Select all that apply.)

A. Purchase
B. Clean
C. Separate
D. Cook
E. Chill

C

(Some patients decrease their food intake during pregnancy for fear of weight gain. This may affect fetal development. Therefore the nurse should teach the patient to maintain adequate nutrition. When the patient delivers the baby and begins to breastfeed, this will aid postpartum weight loss. However, most of the weight is lost after the child's birth due to reduction of fat. There is no evidence that reduced consumption of carbohydrates may cause fetal obesity. Fetal obesity can happen as a result of maternal obesity. Lack of proper nutrition causes ketonuria, which may lead to preterm delivery, not a delay in the delivery. Ketonuria happens because the body breaks down fats for energy because of the lack of carbohydrates. Carbohydrates and proteins are essential for fetal development. Therefore the nurse should suggest the patient eat a balanced diet, rather than increasing the intake of protein.)

The nurse notices that a pregnant patient is worried about gaining weight and has stayed away from eating foods high in carbohydrates. What should the nurse do to ensure adequate nutrition?

A. Inform the patient that lack of proper nutrition may delay the newborn's delivery date.
B. Suggest the patient increase her protein intake to compensate for the carbohydrate levels.
C. Inform the patient that breastfeeding aids in losing the weight gained during pregnancy.
D. Inform the patient that a decreased intake of carbohydrates during pregnancy causes fetal obesity.

A, C

(Grapes and apricots are some of the fruits that are common in the diets followed in the Middle East. Therefore the nurse should teach the patient to include grapes and apricots in the diet to improve the nutritional status. Peaches, star fruit, and pomegranates are not popular fruits in Middle East. Peaches are the most common fruits for Native American groups. Star fruit is a fruit commonly eaten by people in Chinese communities. Pomegranates are popular in Italian communities.)

The nurse instructs a Middle Eastern patient who is pregnant regarding the importance of including a good amount of fruits in the diet to improve folate levels in the body. Which fruits should the nurse recommend to the patient? Select all that apply.

A. Grapes
B. Peaches
C. Apricots
D. Star fruit
E. Pomegranates

B, C

(Consumption of alcohol by a lactating mother would affect the health of the infant. Maternal alcohol consumption causes delayed psychomotor development in the infant. Alcohol also inhibits the milk ejection reflex, so the infant may not be able to suck milk. The inability to produce milk is a side effect of smoking. Caffeine intake can lead to a reduced iron concentration in milk and causes the development of anemia in the infant. Caffeine does affect the activity levels of the mother but does not cause insomnia in the infant.)

A patient tells the nurse, "I abstained from alcohol throughout my pregnancy, but now that I have delivered my baby, I want to be able to drink alcohol." What should the nurse inform the patient? Select all that apply.

A. "You would not be able to produce sufficient milk for the baby."
B. "Your child may develop psychomotor retardation if you drink."
C. "Your child would not be able to suck milk if you have alcohol."
D. "Your child may become anemic if you drink any form of alcohol."
E. "Your child would not be able sleep properly if you have alcohol."

B

(Vitamin D plays a key role in the absorption and metabolism of calcium. A severe deficiency of vitamin D leads to tetany, neonatal hypocalcemia, and hypoplasia of tooth enamel. Thus the patient is most likely to have the risk for tetany. Goiter, ketonuria, and macrosomia are not related to vitamin D deficiency. Goiters occur because of an iodine deficiency. Ketonuria is the presence of ketones in urine and happens in patients with diabetes mellitus. Macrosomia is a risk that can happen with obese women during pregnancy.)

The nurse observes that a patient has a decreased vitamin D level during a prenatal visit. Which associated risk should the nurse suspect to observe in the patient?

A. Goiter
B. Tetany
C. Ketonuria
D. Macrosomia

C

(When the nurse is assessing a patient's socioeconomic status, the nurse should determine whether the patient has health insurance. Lack of health insurance may mean the patient does not have a job to pay for insurance or the income to pay for it privately. This may affect the patient's prenatal care if she cannot afford services. When the nurse asks about the family's medical history, this falls under the patient's personal history. The nurse asks about the community in which the patient lives when assessing the patient's environment. Medications can affect the fetus in a pregnant patient. Therefore the nurse should ask about the medications taken by the patient when assessing the patient's health status.)

What question does the nurse ask while assessing the socioeconomic status of a pregnant patient?

A. "What prescription medications do you take?"
B. "Do you have any factories around your house?"
C. "Do you have any medical or dental insurance?"
D. "Are there any diseases that run in your family?"

C

(Anemia is caused by decreased hemoglobin levels in the blood, which, in turn, is caused by decreased iron intake. Iron supplements are usually given to treat iron deficiency anemia. Tea, coffee, and milk decrease iron absorption, which reduces the efficiency of iron supplements. Therefore the nurse teaches the anemic patient to stop drinking tea, coffee, and milk with the iron supplement. Tea, coffee, and milk do not affect the plasma levels of caffeine, the hematopoiesis process, or cause RBC destruction.)

The nurse is teaching a patient with anemia when and how to take the prescribed iron supplements. The nurse provides a list of beverages for the patient to stay away from while taking the iron supplement. What is the rationale for this?

A. They can affect the process of hematopoiesis.
B. They increase red blood cell (RBC) destruction.
C. They can decrease iron supplement absorption.
D. They can increase the plasma levels of caffeine.

D

(A diet rich in vitamin B12 and folic acid is essential for proper neural development of the fetus during pregnancy. Asparagus, fortified cereals, and green leafy vegetables are rich sources of folic acid, and eggs are rich in vitamin B12. Therefore a diet containing these foods is most advisable for the patient to ensure proper neural development of the fetus. Nuts, beans and legumes, cocoa, meats, and whole grains are rich sources of magnesium. Iodized salt, milk and milk products, yeast breads, and rolls contain iodine. Citrus fruits, broccoli, melons, strawberries, and tomatoes are rich sources of vitamin C. Magnesium, iodine, and vitamin C do not affect the neural development of the fetus.)

The nurse is providing dietary education to a patient who is 4 months pregnant. Which diet should the nurse suggest to the patient for proper neural development of the fetus?

A. Nuts, beans and legumes, cocoa, meats, and whole grains
B. Iodized salt, milk and milk products, yeast breads, and rolls
C. Citrus fruits, broccoli, melons, strawberries, and tomatoes
D. Asparagus, eggs, fortified cereals, and green leafy vegetables

B

(Caffeine intake leads to reduced absorption of iron into the milk. In turn this reduces the concentration of iron in the milk, which may cause anemia in the newborn. Iron supplements are usually prescribed to prevent anemia in the mother. Iron does not cause anemia in the newborn. Folate supplements help prevent spina bifida (SB) in the newborn. Folate does not cause anemia in the newborn. Excess fluids help maintain the blood volume in the mother and enhance the formation of milk. Excess fluids do not cause anemia in the newborn.)

The nurse notices that the hemoglobin levels of an infant who is breastfed have reduced drastically since birth. What is the probable reason for the infant to have anemia?

A. The infant's mother is still taking folic acid and B vitamins.
B. The infant's mother is consuming large amounts of caffeine.
C. The infant's mother continues to take oral iron supplements.
D. The infant's mother drinks large amounts of water and juices.

B

(Edema usually refers to the abnormal accumulation of fluid in the interstitium. In the past it was believed to be caused by an excess of sodium. However, a moderate amount of edema is considered normal. This happens because of higher estrogen levels. Vitamin B deficiency causes neural tube defects. Taking in too many calories does not cause edema; it causes weight gain. Glucose is the basic source for energy, deficiency of which causes hypoglycemia and reduces stamina. However, it does not cause edema.)

When assessing a pregnant woman in the second trimester, the nurse finds the patient to be healthy, but the patient reports mild edema. What should the nurse infer from this finding?

A. The patient has a vitamin B deficiency.
B. This is a normal finding; it results from estrogen.
C. The patient is consuming too many calories.
D. The nurse should check the blood glucose

A, B, E

(Morning sickness is seen in most women during the first trimester. Hot foods have strong odors, which may stimulate the chemoreceptor trigger zone and cause nausea. Therefore the nurse should advise the patient to ingest the food when it is not too hot. The patient is usually taught to have smaller, more frequent meals every 2 to 3 hours because it prevents stomach distention. Starch reduces the concentration of gastric acid, which aids in preventing nausea. Therefore the nurse should teach the patient to incorporate foods that contain higher quantities of starch. Usually patients are instructed to include higher amounts of fluids during pregnancy to prevent dehydration caused by nausea. Fried foods and foods rich in fats tend to produce more acids that can aggravate nausea and contribute to reflux.)

What measures should the nurse instruct a pregnant patient to take to relieve the symptoms of morning sickness during the first trimester? Select all that apply.

A. Consume food when it is not hot.
B. Eat food in smaller portions.
C. Include smaller amounts of fluids.
D. Include foods that are high in fats.
E. Include food high in starch content.

B

(A BMI of 22 represents a normal weight. Therefore, a total weight gain for pregnancy is about 25 to 35 lbs or about 2 to 5 lbs in the first trimester and about 1 lb per week during the second and third trimesters. One pound per week is not the correct guideline during pregnancy. One pound per week during the first two trimesters and two pounds per week thereafter is not the correct guideline for weight gain during pregnancy. A total weight gain of 25 to 35 pounds is correct, but the pattern needs to be explained to the woman.)

A pregnant woman with a body mass index (BMI) of 22 asks the nurse how she should be gaining weight during pregnancy. The nurse's best response is to tell the woman that her pattern of weight gain should be approximately:

A. A pound a week throughout pregnancy.
B. 2 to 5 lbs during the first trimester, then a pound each week until the end of pregnancy.
C. A pound a week during the first two trimesters, then 2 lbs per week during the third trimester.
D. A total of 25 to 35 lbs

C

(A diet containing nuts, legumes, cocoa, and whole grains is suggested for a pregnant patient to improve the levels of magnesium. Magnesium is essential for energy metabolism, tissue growth, and muscle action. Thus the most appropriate reason for adding these in the diet is to eliminate the risk for magnesium deficiency. Nuts, legumes, cocoa, and whole grains are not rich sources of zinc, vitamin A, or vitamin D. Food sources high in zinc are liver, shellfish, meat, whole grains, and milk. Food sources containing vitamin A are dark green leafy vegetables, liver, fruits, fortified margarine, and butter. Foods rich in vitamin D are fortified milk, cereals, oily fish, butter, and liver.)

The nurse instructs the patient to eat nuts, legumes, cocoa, and whole grains during the second trimester of pregnancy. What is the rationale for this instruction? The patient has:

A. A diet that is low in zinc.
B. A low intake of vitamin A.
C. A low intake of magnesium.
D. Decreased vitamin D intake.

B

(A bedtime snack of slowly digested protein is especially important to prevent the occurrence of hypoglycemia during the night that can contribute to nausea. Fluids should be taken between (not with) meals to provide for maximum nutrient uptake in the small intestine. Dry carbohydrates such as plain toast or crackers are recommended before getting out of bed. Eating small, frequent meals (about five or six each day) with snacks helps to avoid a distended or empty stomach, both of which contribute to the development of nausea and vomiting.)

A pregnant woman at 7 weeks of gestation complains to her nurse-midwife about frequent episodes of nausea during the day with occasional vomiting. She asks what she can do to feel better. The nurse-midwife should suggest that the woman:

A. Drink warm fluids with each of her meals.
B. Eat a high-protein snack before going to bed.
C. Keep crackers and peanut butter at her bedside to eat in the morning before getting out of bed.
D. Schedule three meals and one midafternoon snack a day.

A

(Diverticulosis is a condition in which the patient develops muscular outpouchings in the colon. Intake of fibrous food reduces the risk for diverticulosis in a pregnant patient. Therefore the nurse should recommend that the patient incorporate the diet containing whole grains, bran, vegetables, and fruits. The intake of citrus fruits and dark green leafy vegetables is recommended for vitamin C deficiency. Shellfish, liver, meats, whole grains, and milk are recommended foods for a zinc deficiency. A diet containing iodized salt, seafood, milk products, and rolls is rich in iodine.)

A patient who is 6 months pregnant is diagnosed with diverticulosis. Which diet should the nurse recommend to the patient?

A. Whole grains, bran, vegetables, and fruits
B. Citrus fruits and dark green leafy vegetables
C. Shellfish, liver, meats, whole grains, and milk
D. Iodized salt, seafood, milk products, and rolls

A

(Brie, Camembert, and the soft Mexican cheeses are made with unpasteurized milk. Listeriosis is a disease caused by the infection of the bacteria Listeria, which is present in unpasteurized milk. This disease increases the risk for miscarriage, premature birth, and stillbirth in pregnant patients. Thus the nurse instructs the patient to stay away from those products that cause listeriosis. Brie, Camembert, and the soft Mexican cheeses are not associated with physiologic anemia, diverticulosis, and PKU. Pregnant patients with physiologic anemia are instructed to eat iron-rich foods. Pregnant patients are advised to eat fiber-rich food to prevent diverticulosis flare-ups. Pregnant patients with PKU should not use the artificial sweetener aspartame.)

The nurse instructs a pregnant patient to stay away from Brie, Camembert, and the soft Mexican cheeses. What would be the possible clinical reason for giving such advice to the patient?

A. Possibility of listeriosis developing
B. Physiologic anemia
C. Sigmoid diverticulosis
D. Phenylketonuria (PKU)

A, B, C, E

(Dried beans, seeds, peanut butter, and eggs provide protein. A bagel is an example of a whole grain food, not protein.)

The nurse is developing a dietary teaching plan for a patient on a vegetarian diet. The nurse should provide the patient with which examples of protein-containing foods? Select all that apply.

A. Dried beans
B. Seeds
C. Peanut butter
D. Bagel
E. Eggs

A, E

(Canned sardines and refried beans are rich sources of calcium. Therefore a diet containing these foods should be suggested for patients who do not drink milk. Avocado, cooked pasta, and bread have poor calcium content. These foods are rich sources of folic acid and are suggested to pregnant patients to increase folate levels.)

A pregnant patient does not drink milk because of lactose intolerance. Which foods should the nurse instruct the patient to incorporate in her diet to prevent calcium deficiency? Select all that apply.

A. Sardines
B. Avocadoes
C. Cooked pasta
D. Wheat bread
E. Refried beans

B

(The nurse suggests the patient prevent conception because the patient was using isotretinoin (Accutane) for the treatment of acne. It is because isotretinoin (Accutane) is teratogenic and associated with fetal malformations. Sucralose (Splenda), saccharin (Sweet'N Low), and aspartame (NutraSweet) are artificial sweeteners, which have no profound effect on pregnancy. However, aspartame (NutraSweet) contains phenylalanine, which is to be avoided in pregnant patients with phenylketonuria (PKU).)

The nurse reviews the medical history of a patient and instructs the patient to prevent conception. Which finding led the nurse to make such a decision? The patient is using:

A. Sucralose (Splenda).
B. Isotretinoin (Accutane).
C. Saccharin (Sweet'N Low).
D. Aspartame (NutraSweet).

B

(Both normal-weight and underweight women with inadequate weight gain have an increased risk of giving birth to an infant with intrauterine growth restriction. Spina bifida is not associated with inadequate maternal weight gain. An adequate amount of folic acid has been shown to reduce the incidence of this condition. Diabetes mellitus is not related to inadequate weight gain. A gestational diabetic mother is more likely to give birth to a large-for-gestational age infant. Down syndrome is the result of a trisomy 21, not inadequate maternal weight gain.)

Women with an inadequate weight gain during pregnancy are at higher risk of giving birth to an infant with:

A. Spina bifida.
B. Intrauterine growth restriction.
C. Diabetes mellitus.
D. Down syndrome.

A, B, C, E

(Underweight women need to gain the most. Obese women need to gain weight during pregnancy to equal the weight of the products of conception. Adolescents are still growing; therefore, their bodies naturally compete for nutrients with the fetus. Women bearing twins need to gain more weight (usually 16 to 20 kg), but not necessarily twice as much. Normal weight women should gain 11.5 to 16 kg.)

Which suggestions should the nurse include when teaching about appropriate weight gain in pregnancy? Select all that apply.

A. Underweight women should gain 12.5 to 18 kg.
B. Overweight women should gain at least 7 to 11.5 kg.
C. Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale.
D. In twin gestations, the weight gain recommended for a single fetus pregnancy should simply be doubled.
E. Normal weight women should gain 11.5 to 16 kg.

B

(Leg cramps during pregnancy result from an imbalance in the calcium levels in the body. Thus the nurse would include a food rich in calcium in the diet. Because the patient is a vegetarian, this can be accomplished by incorporating turnip greens in the diet. Turnip greens are turnip leaves that are rich in calcium. Even though sardines have high calcium content, the patient is a vegetarian and this is considered a meat source. Milk is the richest source of calcium. Hispanic people do not consume milk directly but use it as an additive in coffee. Having too much coffee also affects the pregnant patient's health adversely, so it should not be included. Melon fruit is rich in vitamin A but is not a good source of calcium; therefore the nurse should not suggest it to increase calcium in the patient's diet.)

The nurse is preparing a diet chart for a Hispanic pregnant patient who is a vegetarian. The patient complains of leg cramps. What does the nurse ensure to include in the patient's diet?

A. Melon fruit
B. Turnip greens
C. Whole or 2% milk
D. Canned sardines

A

(Hypertension is caused by decreased levels of potassium and increased intake of sodium. To prevent the risk for hypertension, the nurse instructs the patient to consume 8 to 10 cups of vegetables and fruits, low fat meats, and dairy products. These foods are rich sources of potassium and also reduce the sodium content in the body. This helps prevent hypertension. Milk is a rich source of calcium and does not prevent hypercalcemia. These food choices do not enhance uric acid excretion and therefore do not prevent hypouricemia. Hypothyroidism is caused by the imbalance of thyroid hormones.)

During the assessment of a pregnant patient, the nurse instructs the patient to eat eight to ten servings of vegetables and fruits, three servings of milk products, and incorporate low-fat meats daily. What is the most probable reason for giving such instruction? To prevent:

A. Hypertension
B. Hypercalcemia
C. Hypouricemia
D. Hypothyroidism

A

(If no medical or obstetric problems contraindicate physical activity, pregnant women should get 30 minutes of moderate physical exercise daily. Liberal amounts of fluid should be consumed before, during, and after exercise, because dehydration can trigger premature labor. Also, the woman's calorie intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise. All pregnant women should consume the necessary amount of protein in their diet, regardless of level of activity. Many pregnant women of this gestation tend to retain fluid. This may contribute to hypertension and swelling. An adequate fluid intake prior to and after exercise should be sufficient. The woman's calorie and carbohydrate intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise.)

A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse should be most concerned regarding what this woman consumes during and after tennis matches. Which is the most important?

A. Several glasses of fluid
B. Extra protein sources, such as peanut butter
C. Salty foods to replace lost sodium
D. Easily digested sources of carbohydrate

A

(Pica refers to the practice of consuming nonfood substances, such as clay and dirt. Consumption of soil and pulverized pottery causes high levels of lead in the mother and the child because of lead contamination of the soil. Anemia is usually caused by a lack of red blood cells (RBCs). An anemic patient may possibly be at risk for pica and may develop cravings for metallic items but will not show excessive amounts of lead in the body. Malnutrition in the mother leads to several severe risks like premature labor, miscarriage, or lack of nutrition in the child. Preeclampsia is the condition for high blood pressure and excess of protein in the urine of a pregnant woman. Preeclampsia may be caused by an imbalanced diet, but it does not show unusually high levels of lead in the body.)

The nurse is assessing a patient who recently delivered a child. The laboratory reports of both the mother and the child show high amounts of lead in the blood. What clinical condition observed in the mother during pregnancy could be the reason for the abnormal levels of lead?

A. Pica
B. Anemia
C. Malnutrition
D. Preeclampsia

D

(A BMI of 34.2 kg/m2 indicates that the patient is obese. Obese patients are more likely to develop preeclampsia as compared with their counterparts who have normal weight. Hypervitaminosis, severe hypotension, and lower extremity edema are not associated with preeclampsia. Deficiency of vitamin B6 is associated with preeclampsia. Hypertension during pregnancy, which is also referred to as gestational hypertension, is associated with preeclampsia. Small amounts of lower-extremity edema are normal in pregnant patients.)

The nurse observes a patient had preeclampsia during the second trimester of her pregnancy. Which is the most likely reason for preeclampsia in this patient?

A. Hypervitaminosis
B. Severe hypotension
C. Lower extremity edema
D. Body mass index (BMI) of 34.2 kg/m2

B

(A pregnant woman experiencing nausea and vomiting should eat small, frequent meals. She should avoid consuming fluids early in the day or when nauseated. She should reduce her intake of fried foods and other fatty foods and should avoid consuming fluids early in the morning or when nauseated but should compensate by drinking fluids at other times.)

A pregnant woman experiencing nausea and vomiting should:

A. Drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning.
B. Eat small, frequent meals (every 2 to 3 hours).
C. Increase her intake of high-fat foods to keep the stomach full and coated.
D. Limit fluid intake throughout the day.

Intrapartum Period

begins with the onset of regular uterine contractions and lasts until the expulsion of the placenta. The process by which this normally occurs is called labor.

Childbirth

is the period from the conclusion of the pregnancy to the start of the extrauterine life of the infant

Maternal Factors that cause onset of labor

Uterine muscles are stretched
increased pressure on the cervix
estrogen increases
Progesterone is withdrawn
Oxytocin stimulates myometrial contraction
Oxytocin levels surge from stretching of the cervix

Fetal factors that cause onset of labor

-As placenta ages it begins to deteriorate, triggering contractions
-Prostaglandin synthesis by the fetal membranes
-Fetal cortisol rises causing the uterus to contract

The 4 P's that affect labor

-Powers (the contractions)
-Passage (the pelvis and the birth canal)
-Passenger (the fetus)
-Psyche (the response of the woman)

Powers

refer to the involuntary uterine contractions of labor and the voluntary pushing or bearing down powers that combine to propel and deliver the fetus and placenta from the uterus

The uterine muscle is known as the

myometrium

The upper segment of the uterus composes

two thirds of the uterus and contracts to push the fetus down

The lower segment of the uterus composes

the lower third of the uterus and the cervix and is less active, allowing the cervix to become thinner and pulled upward

Each contraction has a ________ ________ that allows the woman and uterine muscles to pause for rest.

resting phase

With every contraction ______ mL of blood leaves the utero-placental unit and moves back into maternal circulation

500 mL

Frequency

time from beginning of one contraction to the beginning of another. recorded in minutes

Duration

time from the beginning of a contraction to the end of the same contraction. It is recorded in seconds

Intensity

strength of the contraction that can be palpated using the fingertips on the maternal abdomen

Mild Intensity

the uterine wall is easily indented during contractions

Moderate Intensity

the uterine wall is resistant to indentation during a contraction

Strong Intensity

the uterine wall cannot be indented during a contraction

The three phases on a contraction

-Increment Phase
-Acme phase
-Decrement phase

Increment phase of contraction

ascending or buildup of the contraction that begins in the fundus and spreads throughout the uterus

Acme phase of contraction

peak of intensity

Decrement phase

descending or relaxation of the uterine muscle

Dilation

is the enlargement or opening of the cervical os from 1cm to 10 cm

Effacement

is the shortening and thinning of the cervix

Effacement often ________ dilation in a first time pregnancy

precedes

Effacement and dilation progression occurs _________ in subsequent pregnancies

together

Ferguson reflex

activating when the presenting part stretches the pelvic floor muscles

Passage

includes the bony pelvis and the soft tissues of the cervix, pelvic floor, vagina, and introitus (external opening to the vagina)

Types of bony pelvis

-Gynecoid (most common and found in 50% of women)
-Android
-Anthropoid
-Platypeloid (least common type and found in about 3% of women)

The anatomical structure of the pelvis includes the

ileum, the ischium, pubis, sacrum, and coccyx

The bony pelvis is divided into the

False and true pelvis

False pelvis

which is the shallow upper section of the pelvis

True pelvis

which is the lower part of the pelvis and consists of 3 planes. The inlet, the midpelvis and the outlet

The actions of the hormones ________ and ________ during pregnancy soften cartilage and increase elasticity of the ligaments, thus allowing room for the fetal head.

estrogen and relaxin

Station refers to the

relationship of the ischial spines to the presenting part of the fetus and assists in assessing for fetal descent during labor.

Station 0 is the

narrowest diameter the fetus must pass through during a vaginal birth

Passenger

is the fetus

Molding is the

ability of the fetal head to change shape to accommodate/fit through the maternal pelvis

The biparietal diameter BPD

is the largest transverse measurement and an important indicator of head size

Fetal attitude or posture is the

relationship of fetal parts to one another

Fetal lie refers to the

long axis (spine) of the fetus in relationship to the long axis (spine) of the woman

The longitudinal lie

the long axis of the mother and fetus are parallel (most common)

The transverse lie

the long axis of the fetus is perpendicular to the long axis of the mother. A fetus cannot be delivered transvaginally in transverse lie

Fetal presentation is determined by the

part of pole of the fetus that first enters the pelvic inlet

Presenting part is the

specific fetal structure lying nearest to the cervix

Cephalic- Vertex presentation

the head is sharply flexed and the chin is touching the thorax

Cephalic- Frontum or brow presentation

partial extension of the neck with the brow as the presenting part.

Cephalic - Face presentation

the neck is sharply extended and the back of the head (occiput) is arching to the fetal back

Breech presentation

the presenting part is the buttock or feet

3 breech presentations

-Complete
-Frank
-Footling

Fetal position is the relation of the reference point to the

maternal pelvis

There are six positions for each presentation

-right anterior
-right transverse
-right posterior
-left anterior
-left transverse
-left posterior

The specific fetal structure for cephalic presentation is

the occiput

The specific fetal structure for breech presentation is

the sacrum

The specific fetal structure for shoulder presentation is

the acromion

The specific fetal structure for face presentation is

the mentum

Position is designated by an abbreviation of

three letters

First letter designates the

location of presenting part left L or right R of the woman's pelvis

Second letter designates the

specific fetal part that is presenting
O-occiput
S-sacrum
M-mentum
A-acromion for shoulder

Third letter designates the relationship of the

presenting fetal part to the woman's pelvis
A-anterior
P-posterior
T-transverse

Lightening

refers to the descent of the fetus into the true pelvis that occurs approximately 2 weeks before term in first time pregnancies.
Breathing feels easier but increased bladder pressure

Braxton-Hicks

irregular contractions that do not result in cervical change, false labor

Bloody Show

brownish or blood tinged cervical mucus discharge referred to as a bloody show

Spontaneous rupture of the membranes SROM

labor should ideally occur within 24 hours

Tests to assess status of membranes

Nitrazine paper
Ferning

Nitrazine paper

is placed in a visible pool of fluid around the cervix and turns blue when in contact with amniotic fluid

Ferning

a sterile speculum exam may be performed to confirm rupture of membranes

Assess the amniotic fluid for

color amount and odor

Normal amniotic fluid appears

clear or cloudy and odor is like ocean water

True labor contractions occur at regular intervals and increase in

frequency, duration and intensity
- false labor is irregular contractions with little or no cervical changes

the woman should go to the birthing center when

-membranes rupture
-experiencing intense pain
-increase of bloody show

SROM

Spontaneous rupture of membranes may occur before the onset of labor but typically occcurs during labor

Cardinal movements of labor

the positional changes that the fetus goes through to best navigate the birth process

Engagement

when the greatest diameter of the fetal head passes through the pelvic inlet; can occur late in pregnancy or early in labor

Descent

movement of the fetus through the birth canal during the first and second stage of labor

Flexion

chin of the fetus moves toward the fetal chest

Labor or parturition

process by which the fetus, placenta and membranes are expelled through the uterus

Labor and birth divided into _______

stages

Stage 1

onset of labor and ends with complete cervical dilation

Stage 2

complete dilation of cervix and ends with delivery of baby

Stage 3

begins after delivery of baby and ends with delivery of placenta

Stage 4

begins after delivery of the placenta and is completed 4 hours later. It is the immediate postpartum period

Stage 1 of labor divided into 3 phases

latent
active
transition

Latent phase is

the early and slower part of labor with an average length of 9 hours for primiparous and 5 for multiparous

Characteristics of latent phase

-woman talkative and able to relax with contractions
- many women choose to stay home
-cervical dilation from 0-3 cm with effacement from 0-40%
-contractions occur every 5-10 minutes lasting 30-45 seconds and mild intensity

Active phase of labor is

averages 3-6 hours in length shorter for multigravidas

Characteristics of active phase

-woman decreased energy and fatigued
-cervix dilates 1.2 cm/hr for primiparous women and 1.5 cm/hr for multiparous women
-cervical dilation progresses from 4-7 cm with effacement of 40-80%
-contractions every 2-5 minutes with a duration of 45-60 seconds

Transition phase is

most difficult but shortest of the first stage of labor

Characteristics of transition phase is

-woman easily discouraged, irritable, overwhelmed and panicky
- cervical dilation from 8-10 cm with complete 100% effacement
- contractions every. 1-2 minutes lasting 60-90 seconds and intense
-exhaustion
-increase bloody show
-nausea and vomiting
-backache
-trembling
-diaphoresis
-strong urge to bear down or push

second stage of labor characteristics

-cervical dilation is complete to 10
-lasts 50 minutes for primigravidas and 20 minutes for multigravidas
-contractions are intense every 2 minutes and lasting 60-90 seconds in duration

Third stage of labor characteristics

-separation and expulsion of membranes
--separation within minutes after birth
-expulsion approximately 20 minutes
-normal blood loss of 500 mL

Episiotomy is an

incision in the perineum to provide more space for the presenting part for delivery

Lacerations are

tears in the perineum that may occur at delivery

1st Degree Laceration

involves the perineal skin and vaginal mucus membrane

2nd Degree Laceration

involves the skin, mucus membranes and fascia of the perineal body

3rd Degree Laceration

involves skin, mucus membranes, and muscle of the perineal body and extends to the rectal sphincter

4th Degree Laceration

extends into the rectal mucosa and exposes the lumen of the rectum

Fourth Stage of Labor

within 4 hours after labor stabilizing mother
- caring for both mother and the newborn

Apgar testing done at _______ and ________ minutes

1 and 5

Apgar tests for

-Respiratory effort
-Heart rate
-Muscle tone
-Reflex activity
-Color

Gateway theory of pain

only a limited number of sensations can travel along the pathways so an alternate activity can replace the sensation and reduce the impulses getting to the brain

Effleurages done by

lightly stroking the abdomen in rhythm with breathing during contractions

Assessment of labor pain should include

-intensity
-location
-pattern
-degree of distress for the woman

Routinly what is given after birth of the newborn to the newborn?

1. Erythromycin - prophylaxis to prevent chlamidia and infections
2. Vitamin K - IM to prevent hemorragic disease caused by vitamin K deficit
3. Hepatitis B vaccine

Use of medication in the relief of pain during labor falls into two major categories

Anesthesia
Analgesia

Basic principles when using analgesia include

-labor should be established
-medication should provide relief to the woman with minimal risk to the baby

Basic principles of anesthesia include

-local anesthesia is used at the time of delivery for episiotomy and repair
-regional anesthesia is used during labor and at delivery
-regional or general anesthesia is used for c-section deliveries

Epidural anesthesia involves the placement of a

very small catheter and injection of local anesthesia and or analgesia between the fourth and fifth vertebrae into the epidural space

Combined spinal epidural anesthesia CSE

involves the injection of local anesthetic and/or analgesic into the subarachnoid space. Some patients may be able to ambulate. referred to as walking epidural

Analgesics commonly used in labor

Meperidine - neonatal respiratory depression
Sublimaze
Butorphanol - NO respiratory depression SE

Epidural Block

can be used during the first stage or second stage of labor
- has the potential for 100% blackage of pain
- vaginal or c - section

Epidural analgesia is the

most common form of pain relief in the U.S.
- placement of a very small catheter and injection of local anesthesia between the 4th and 5th vertebrae into the epidural space
- IV bolus may be ordered to prevent incidence of hypotension

Spinal Block

second stage of labor or in use for a c - section
- rapid acting and can last up to 3 hours

General Anesthesia

mainly in an emergency c - section

Primary reason for administering Nubain to a woman in active labor is to

relieve pain

Labor pain in active labor is primarily caused by

uterine contractions

Passenger as one of the 4 P's refers to

fetus

Nurses manage the care of patients receiving regional anesthesia

false

Supportive activities in labor are

techniques used to help women in labor

An involuntary urge to push is most likely a sign of

-low fetal station
-imminent delivery

False labor is characterized by

irregular contractions with no cervical change

Women who have a support person with them in labor are more likely to

experience fewer labor complications

A sterile vaginal exam reveals that the woman is 5 cm / 80% effaced / 0 station. Based on this exam the woman is

in the active phase

A common side effect of epidural anesthesia in labor includes

maternal hypotension

When does the first trimester of pregnancy occur?

Week 1-13

What is amenorrhea and what hormone causes it?

Absence of menstrual cycle and caused by progesterone

What are common signs and symptoms of pregnancy?

N/V
Urinary frequency
Breast tenderness

What is a pregnancy test based on?

HCG levels

What is it called when fetal vital signs are all over the place? Is this good or bad?

High baseline variability, good

What is it called when fetal vital signs are constant or not changing? Is this good or bad?

Low baseline variability, bad

What are the three signs and pregnancy in their order?

Chadwicks- Bluish color of vaginal mucosa and cervix
Goodell's- Softening of cervix
Hegar's- Softening of the lower uterine segment

What is linea nigra?

Dark line down the middle of abdomen

What is abdominal striae?

Stretch marks

What is facial chloasma?

Mask of pregnancy

When can you hear a baby's HR with dopplers?

10-12 weeks

When can you hear a baby's HR with a fetoscope?

17-20 weeks

What is gravidity?

# of times you've been pregnant

What is parity?

# of times in which the fetus reaches 20 weeks

When is a baby considered viable?

24 weeks

What does TPAL stand for?

Term
Preterm
Abortion
Living

What is Naegele's rule for Due date?

First day of LMP
- add 7 days
- subtract 3 months
- add 1 year

Increase calories by ____ per day after the first trimester. Adolescent increase by ______

300
500

Expect to gain __ pounds in first trimester

What should women take prenatally and why?

Folic acid and vitamin C to avoid neuro tube defects- 400 mcg/day

If the maternal HR goes over _____ , CO and uterine perfusion will drop

140

Should women take any medications they want when pregnant?

NO! They should ask their doctor before taking anything

What can smoking during pregnancy cause?

Small for gestational age babies

What are the 5 things measured on a BPP test?

- Heart rate
- Movement
- Muscle tone
- Breathing
- Amniotic fluid

How often should a pregnant woman see a caregiver?

First 28 weeks-once a month
28-36 weeks-once every 2 weeks
36 weeks-every week

When does the second trimester of pregnancy occur?

14-26 weeks

Women should expect to gain _____ lbs per week

Quickening is also known as?

Fetal movement

What should the babies heart rate be in the second trimester?

120-160

Will the woman be experiencing n/v, breast tenderness, urinary frequency in the 2nd trimester?

no, yes, no

When does the third trimester of pregnancy occur?

27-40 weeks

Weight gain should be no more then ____ a week

1 lb

How is the fetal position determined?

Leopolds maneuver

Lightening is also known as?

The baby dropping, usually occurs 2 weeks before term

What is engagement?

When the presenting part (hopefully the head) is the pelvic inlet

What are fetal stations?

Measured in cm's, measures the relationship of the presenting part of the fetus and the ischia spines of the mother

When should the client go to the hospital?

When contractions are 5 minutes apart or membranes ruptured

What are we worried about when the membranes rupture?

Prolapse cord

When doing a non-stress test what do we want to see?

Two or more accelerations of 15 beats/minute with fetal movement

When is a BPP done?

Third trimester

What is the observation time of a BPP

30 minutes

What does a BPP measure?

HR
Muscle tone
Movement
Breathing
Amniotic fluid

What is a Contraction Stress Test and when is it done?

It is done when the NST is non reactive and it determines if fetal can handle the stress of uterine contractions

What are the 3 types of decelerations?

- early
- late
- variable

What are late decelerations? Is this good or bad?

When the heart rate slows down at the end of a contraction
Bad!!! Caused by uteroplacental insufficiency

How do you treat late decelerations? (LION)

Lye on left side
IV
Oxygen
Notify

What are early decelerations? Is this good or bad?

When the heart rate slows down at the beginning of a contraction
Good

Are variable decelerations good or bad and what are they caused by?

VERY BAD!!!! Caused by prolapsed cord

When is a epidural administered?

Stage 1 @ 3-4cm

What is a major complication of epidurals?

Hypotension
Give bolus 1000ml NS or RL to fight hypotension

What 3 complications do we need to monitor a patient who is on oxytocin for?

Hypertonic labor
Fetal distress
Uterine rupture

What is the difference between complete uterine rupture and incomplete?

Complete - through uterine wall into the peritoneal cavity
Incomplete - through uterine wall but stop in peritoneum

What are VBAC clients at high risk for?

Uterine rupture because of the scar

When should you d/c oxytocin?

Contractions too often
Contractions last too long
Fetal distress

What position should the women be in receiving oxytocin?

Any position except flat on back

TACHYCARDIA + POSTPARTUM ---->