The Pregnant Client in Childbirth Preparation Classes

A new antenatal G 6, P 4, Ab 1 patient attends her first prenatal appointment with her husband. The nurse is assessing this couple’s psychological response to their pregnancy. Which of the following requires the most immediate follow-up?

A. The couple is concerned with the financial changes this pregnancy causes.
B. The couple expresses ambivalence about the current pregnancy.
C. The father of the baby states that the pregnancy has changed the mother’s focus.
D. The father of the baby is irritated that the mother is not like she was before pregnancy.

Rationale D. Pregnancy creates changes in the mother and father. Being considerate, accepting differences, and supporting the current situation are considered acceptable responses by the father, rather than feeling irritation about these changes. Expressing concern with the economic changes pregnancy and an expanded family include is normal. The first trimester includes the patient and family feeling ambivalent about pregnancy and moving toward acceptance of the changes associated with pregnancy. Maternal acceptance of the pregnancy and a subsequent shift in her focus are everyday occurrences.

CN: Health promotion and maintenance; CL: Analyze

When preparing a prenatal class about endocrine changes that generally occur during pregnancy, the nurse should include information about the following subjects?

A. Human placental lactogen maintains the corpus luteum.
B. Progesterone is responsible for hyperpigmentation and vascular skin changes.
C. Estrogen relaxes the smooth muscle in the respiratory tract.
D. The thyroid enlarges with an increase in basal metabolic rate.

Rationale D. Thyroid enlargement and increased basal body metabolism are typical occurrences during pregnancy. Human placental lactogen enhances milk production. Estrogen is responsible for hyperpigmentation and vascular skin changes. Progesterone relaxes the smooth muscle in the respiratory tract.

CN: Health promotion and maintenance; CL: Create

When developing a group of parent classes on fetal development, which of the following should the nurse include as being developed by the end of the third month (9 to 12 weeks)?

A. External genitalia.
B. Myelinization of nerves.
C. Brown fat stores.
D. Air ducts and alveoli.

Rationale A. Although sex is not easily observed at 9 to 12 weeks, external genitalia is generated at this period of fetal development. Myelinization of the nerves begins at about 20 weeks gestation. Brown fat stores develop at approximately 21 to 24 weeks. Air ducts and alveoli develop later in the gestational period, at approximately 25 to 28 weeks.

CN: Health promotion and maintenance; CL: Apply

A primigravid patient attending parenthood classes tells the nurse a history of twins in her family. What should the nurse say to the client?

A. Monozygotic twins result from fertilization of two ova by different sperm.
B. Monozygotic twins occur by chance regardless of race or heredity.
C. Dizygotic twins are usually of the same sex.
D. Dizygotic twins occur more often in primigravid than in multigravid clients.

Rationale B. Monozygotic twinning is self-sufficient of race, age, parity, or heredity. Monozygotic twins occur from the fertilization of one ovum by two different sperm. Dizygotic twinning occurs with the fertilization of more than one ovum during conception. Dizygotic twins may be of the same sex or different sexes. Dizygotic twinning is correlated with increased parity, becoming pregnant within one month after stopping oral contraception, and infertility treatments. A primigravid client is less likely to conceive dizygotic twins.

CN: Health promotion and maintenance; CL: Apply

A primigravid client in preparation for Parenting class asks how much blood is lost during an uncomplicated delivery. The nurse should tell the woman:

A. “The maximum blood loss considered within normal limits is 500 mL.”
B. “The minimum blood loss considered within normal limits is 1,000 mL.”
C. “Blood loss during a delivery is rarely estimated unless there is a hemorrhage.”
D. “It would be very unusual if you lost more than 100 mL of blood during the delivery.”

Rationale A. In a standard delivery and for the first 24 hours postpartum, a total blood loss not passing from 500 mL is considered normal. Blood loss during delivery is almost always estimated because it provides a valuable indicator for possible bleeding. A blood loss of 1,000 mL is considered hemorrhage.

CN: Health promotion and maintenance; CL: Apply

Which of the following statements by a primigravid client about the amniotic fluid and sac indicates the need for further teaching?

A.“The amniotic fluid helps to dilate the cervix once labor begins.”
B. The amniotic fluid provides fetal nutrients.”
C. “Amniotic fluid provides a cushion against the impact of the maternal abdomen.”
D. “The fetus is kept at a stable temperature by the amniotic fluid and sac.”

Rationale B. Although the amniotic fluid promotes normal prenatal development by allowing symmetric development, it does not provide the fetus with nutrients. Instead, nutrients are supplied by the placenta. The amniotic fluid does help dilate the cervix once labor begins by pressure and gravity forces. The amniotic helps protect the fetus from injury by cushioning against the impact of the maternal abdomen and allows room and buoyancy for fetal movement. The amniotic fluid and sac keep the fetus at a stable temperature by maintaining a neutral thermal environment.

CN: Health promotion and maintenance; CL: Evaluate

During a childbirth preparation class, a primigravid client at 36 weeks’ gestation tells the nurse, “My lower back has been bothering me lately.” Which of the following exercises suggested by the nurse would be most helpful?

A. Pelvic rocking.
B. Deep breathing.
C. Tailor sitting.
D. Squatting.

Rationale A. Pelvic rocking helps relieve backache during pregnancy and early labor by making the spine more flexible. Deep breathing exercises assist with relaxation and pain relief during labor. Tailor for sitting and squatting help stretch the perineal muscles in preparation for delivery.

CN: Health promotion and maintenance; CL: Analyze

Rationale | The pregnant client receiving prenatal care and the nursing process.

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