Care of Mother, Child, Adolescent (Well Clients)

CHAPTER 11
Nursing Care Related to Assessment of a Pregnant Family

MASTERING THE INFORMATION

Activity A
1. A(n) gynecoid pelvis has a well-rounded inlet and a wide pubic arch.
2. In a(n) anthropoid pelvis, the transverse diameter is narrow and anteroposterior
diameter of the inlet is larger than normal.
3. A(n) platypelloid pelvis has an oval-shaped inlet and is smoothly curved.
4. In a(n) android pelvis, pubic arch forms an acute angle, narrowing lower
dimensions of the pelvis.

Activity B MATCHING
Match the terms in Column II with definition, example, or related statement from
Column I. Place the letter corresponding to the answer in the space provided.
Column I Column II
A 1. Atypical squamous cells (ASC) a. No precancerous or cancerous
cells are found.
B 2. High-grade squamous b. Some cells appear different than
intraepithelial lesion (HSIL) normal but cannot be classified as
precancerous.
C 3. Negative c. Moderate to severe
precancerous changes may have
been found in some cells.

Activity C
T 1. The cervical os is observed as round and small in a nulligravida client.

F 2. Petroleum lubricant should be used on the speculum when viewing the cervix.

F 3. When a client is infected with a Chlamydia infection, the vaginal mucosa appears
extremely inflamed with a greenish-yellow discharge.
 F 4. A platypelloid pelvis accommodates childbirth with fever difficulties than do the
other three types of pelvis.

T 5. The purpose of a prenatal visit is to establish a baseline of present health and

minimize the risk of possible complications.

APPLYING YOUR KNOWLEDGE

Activity D

Mrs. Goldstein is scheduled in the prenatal clinic for a pelvic examination. She will need
to be prepared for the examination of several internal and external reproductive organs.

1. What position should Mrs. Goldstein assume once she is on the examination table?

Allow Mrs. Goldstein the opportunity to talk with the person performing the examination
while sitting up, before being place in a lithotomy position.

2. Name the instruments that the nurse should have available for the examination.

Equipment required is a speculum (a metal or plastic instrument with movable flat

blades), a spatula for cervical scraping, a clean examining glove, lubricant, a glass slide
or liquid collection device for the Pap Smear, a culture tube, two or three sterile cotton-
tipped applicators or cytobrushes for obtaining cervical cultures, a good examining light,
and a stool at correct sitting height.

3. How might the examiner attempt to put Mrs. Goldstein at ease at ease before her
examination?

Allow Mrs. Goldstein the opportunity to talk with the person performing the examination
while sitting up as this can enhance her sense of self-esteem and control if she meets
her examiner first.

PRACTICING FOR NCLEX

Activity G

1. A pregnant client has delayed her first prenatal visit, coming to the clinic only after
she starts to experience edema of the feet and hands. The nurse takes a history and
performs a physical examination. The client's response to one of the nurse's questions
is, "This is my third pregnancy. I miscarried twice, the first time I was 8 weeks pregnant
and the last time I was 26 weeks." The nurse correctly records Mrs. Barton's pregnancy
status as:

a. gravida 2 P0

b. gravida 2 P1

c. gravida 3 P1

d. gravida 3 P0

2. During the examination of a pregnant client, while lying in the lithotomy position the
client complains of dizziness and nausea. What would be an appropriate nursing action
to relieve the client's discomfort?

a. Administering an antiemetic ordered by the physician

b. Offering small sips of ginger ale

c. Assisting the client to a side-lying position temporarily.

d. Discontinuing the examination

3. Diplopia was noted during the assessment of a pregnant client. How would you
describe this condition?

a. Elevated pigmentation of the skin

b. Double vision

c. Facial edema

d. Gingivitis

4. Which of the following injectable vaccines would be safe to administer to a pregnant

client?

a. Varicella

b. Measles

c. Mumps

d. Polio
5. A pregnant client is in her 33rd week of gestation. The nurse would assist the client in
scheduling her next appointment in

a. 1 month

b. 3 weeks

c. 2 weeks

d. 1 week

Activity H

1. You are teaching a pregnant woman about possible signs indicating complications
that need to be reported immediately. Which of the following would the nurse include in
the teaching?

a. Vaginal bleeding

b. Fever

c. Vomiting once a day

d. Abdominal pain

e. Stress incontinence

2. A woman comes to the clinic for a follow prenatal visit. She is 16 weeks pregnant.
Which of the following would be done?

a. Blood pressure measurement

b. Clean-catch urine specimen

c. Maternal serum level for alpha-fetoprotein

d. Glucose screening

e. Anti-Rh titer

3. Which of the following actions would be most helpful for improving prenatal care
services?
a. Ensuring privacy for all assessments being completed

b. Scheduling appointments within 24 hours of first calling the setting

c. Using waiting room time by providing education

d. Recording pregnancy information so the woman can read it

e. Encouraging women to participate in decision-making about care

 Care of Mother, Child, Adolescent (Well Clients)
CHAPTER 12
Nursing Care to Promote Fetal and Maternal Health

MASTERING THE INFORMATION

Activity A FILL IN THE BLANKS
Supply the missing term or the information requested.

1. Assessment of the pregnant woman concentrates on screening for the presence of

teratogens in the pregnant woman's environment and any abnormalities that might be
occurring with the pregnancy.

2. Breast tenderness is a common discomfort during the first trimester.

3. Hemorrhoids are varicosities of the rectal veins.

Activity B MATCHING
Match the terms in Column II with definition, example, or related statement from
Column I. Place the letter corresponding to the answer in the space provided.
Column I Column II
i 1. Braxton Hicks contractions a. Whitish, viscous vaginal discharge
f 2. Cytomegalovirus b. A possible result of expanding blood
volume that puts pressure on cerebral
arteries.
g 3. Fetal alcohol syndrome c. Any factor, chemical or physical, that
adversely affects the fertilized ovum, the
embryo, or the fetus.
a 4. Leukorrhea d. A protozoan infection spread through
contact with cat stool.
h 5. Palmar erythema e. Laterally lying with the abdomen on the
bed and the top leg forward. This position
puts the weight of the fetus on the bed,
not on the woman, and allows good
circulation in lower extremities.
b 6. Headache f. A member of the herpes family that can
cause extensive fetal damage.
J 7. Pelvic radiation g. Infant who is small for gestational age,
 with mental retardation and characteristic
craniofacial deformity.
e 8. Modified Sim's position h. Symptom occurring in early pregnancy,
probably caused by increased estrogen
levels
c 9. Teratogen i. Uterine cramps that may begin at the
8th to 12th week of pregnancy.
d 10. Toxoplasmosis j. Necessary avoidance by all women of
childbearing age except during the first 10
days of menstrual cycle.

Activity C SHORT ANSWER

Supply the missing term or the information requested.
1. What major intervention is associated with health promotion during pregnancy?

Education

2. For each of the following activities, discuss one concept that should be discussed
with the pregnant woman: bathing, breast care, perineal hygiene, dressing, sexual
activity, exercise, sleep, and travel.

Bathing- tubs are permitted unless membranes are ruptured cervical dilation is present,
or balance is disturbed.

Breast care- firm bra with wide straps, wash colostrum away with clean water, use pads
inside bra to keep nipples dry and change pads frequently.

Perineal hygiene- douching is contraindicated; wipe from front to back.

Dressing- common sense and comfort, moderate to low-heeled shoes, avoid restrictive
clothing, including garters, tight girdles, and knee-high stocking.

Sexual activity- permitted as tolerated, except when membranes have ruptured or

vaginal spotting is noted; if history of spontaneous abortion, refrain from sex until after
the time of prior abortion; use of condom with nonmonogamous partners, use caution
with oral-genital contact.

Exercise- individualized moderate activity, walking encouraged, jogging, or body contact

sports may be contraindicated.
Sleep- increased amounts encouraged, relaxation exercise, afternoon naps in late
pregnancy.

Travel- no restrictions in early pregnancy, late in pregnancy arrange for emergency care
in case of early labor; frequent stretching on long trips.

3. Describe five categories of potentially teratogenic drugs.

Category A- controlled studies in women fail to show risk to the fetus and the possibility
of fetal harm appears unlikely.

Category B- animal reproduction studies have not shown a fetal risk or adverse effect;
risk have not been confined in controlled studies in women.

Category C- either studies in animals have revealed adverse effect on the fetus and
there are no controlled studies in women or studies in women and animals are not
available.

Category D- there is confirmation of human fetal risk, but the benefits from use in
pregnant women may be acceptable despite the risk.

Category X- animal and human studies have shown fetal abnormalities. The drug is
contraindicated in women who are or may be pregnant.

4. Discuss two instructions the nurse should provide to a pregnant woman who will be
working related to all jobs, jobs requiring standing or walking.

Plan rest periods during your break periods rather than running errands, etc.; Try to use
at least part of your lunch hour to rest. Lie on your left side in a break room if possible. If
this is not possible, then rest sitting with your legs elevated.

5. Discuss how maternal stress may have a teratogenic effect.

Prolonged anxiety produces physiological changes leading to vasoconstriction,

including constriction of the uterine vessels that could interfere with blood and nutrient
supply to the fetus.

APPLYING YOUR KNOWLEDGE

Activity D CASE STUDY

Ginene Varez, 31 years of age, visits your clinic for her first prenatal checkup. She is in her first
trimester of pregnancy. She complains of skipping heartbeats, headache, and nausea, and
states she is worried that the “tension” of her job as an accountant in a perfume factory will have
a negative effect on her baby. Her blood pressure and pulse are in the normal range.

1. What would you explain to Ginene about common physical change of pregnancy that has
likely resulted in both the headache and heart palpitations?

Many women experience headache during pregnancy, apparently from their expanding blood
volume, which puts pressure on cerebral arteries.

2. What measures would you suggest to help Ginene reduce anxiety from her job?

She should take a leave so that she can rest well and continue working if she finally gave birth
and a have a totally resting.

PRACTICING FOR NCLEX

Activity G MULTIPLE-CHOICE QUESTIONS

Circle the letter that corresponds to the best answer for each question.

1. Bobbi has been experiencing severe constipation during her eighth month of
pregnancy. An appropriate goal or outcome for Bobby would be to

a. become accustomed to the constipation and accept it as unavoidable.

b. consumes a diet containing high fiber, fruit, and extra amounts of fluid.

c. have a bowel movement every other day to avoid daily straining activities.

d. refrain from taking her iron supplement since it probably caused the problem.

2. When planning a teaching strategy for a pregnant woman, the nurse should do which
of the following?

a. Give information about how the woman can manage the specific problems she
identifies as relevant in her life.

b. Omit information related to minor pains of pregnancy to prevent the woman from
developing hypochondria.

c. Provide information to the woman in a group session with other pregnant women so
she can have someone to discuss it with.
d. During the first prenatal visit, teach a woman all the measures necessary for health
promotion throughout the pregnancy.

3. Bonnie, 6 months pregnant, is commuting 2 to 3 hours by car to school for a 6-week

session. You should discuss which of the following with Bonnie about travel?

a. Dangers related to wearing lap seatbelts during the early months of pregnancy.

b. Strategies to relieve stiffness and muscle aches and improving circulation during the
drive.

c. The importance of taking motion sickness medications to lessen the nausea from
driving.

d. The need to call her doctor and drive home immediately if she experiences premature
labor or any danger signs of pregnancy.

4. Sheila, 7 months pregnant, reports feeling her heart skipping a beat sometimes. You
recognize these as heart palpitations and identifies which of the following as an
appropriate outcome?

a. Demonstrate moving slowly from one position to another

b. Lying supine when sleeping to keep pressure on her vena cava

c. Planning a diet menu that includes high vitamin C content

d. Verbalizing intent to limit fluids to lower her heart’s workload

5. Dee is in her second month of pregnancy and complains of abdominal pain. Which
action would be most appropriate?

a. Encourage Dee to put strong direct pressure on her fundus and hold it for 15 minutes
whenever she feels this pain.

b. Inform Dee that abdominal pain is expected at this stage of her pregnancy and she
should learn to adjust to it.

c. Inquire about the specific nature and location of the pain Dee reported, since it could
indicate a complication.

6. Which of the following would you expect to assess less commonly in early
pregnancy?
a. Braxton Hicks contractions

b. Frequency of urination

c. Ankle edema

d. Varicosities

7. Tina is a heavy smoker (two packs per day) and is pregnant. Which of the following
measures undertaken by Tina would indicate that a teaching plan for her had been most
effective?

a. She limited her cigarette smoking to one pack per day during her last month of
pregnancy.

b. She decreased her smoking by two cigarettes per day until she had stopped
completely.

c. She stated she will smoke only filtered cigarettes while she is pregnant

d. she voiced understanding that she will use nicotine gum and stop smoking
immediately

Activity H

1. Which of the following are common discomforts experienced during the first trimester
of pregnancy?

a. Hemorrhoids

b. Breast tenderness

c. Diarrhea

d. Menstrual “spotting”

e. Frequent urination

2. Which of the following would be viewed as signs of beginning labor?

a. Depression

b. Rupture of membrane

c. Contractions
d. Slight elevation in temperature

e. Lightening

3. A nurse would assess a pregnant woman for maternal infections that may cause fetal
harm including which of the following?

a. Rubella

b. toxoplasmosis

c. Cytomegalovirus

d. Herpes simplex

e. Strep throat

f. Rhinovirus
 Care of Mother, Child, Adolescent (Well Clients)
CHAPTER 13
The Nursing Role in Promoting Nutritional Health During Pregnancy
MASTERING THE INFORMATION
Activity A
1. A weight gain of 11.2 to 15.9 kg is currently recommended as an average weight gain
in pregnancy.

2. Pregnant women who are vegetarians may lack vitamin D, vitamin B12, and calcium
in their diet.

3. Underweight women may need to increase their caloric intake by 500 to 1000
calories above the calories ordinarily specified during pregnancy.

Activity B
1. Complete protein

A food containing all eight essential amino acids.

2. Hyperplasia

An increase in the number of cells formed.

3. Incomplete protein

Food containing fewer than eight of the essential amino acids.

4. Lactase

The enzyme needed to break down milk sugar into glucose and galactose.

5. Linoleic acid

A fatty oil that cannot be manufactured in the body from other sources.

6. Obese

For a woman weighing over 200 pounds, having a body mass index over 30, or being
50% above ideal body weight.
7. Phenylketonuria

An inability to convert an essential amino acid into tyrosine.

8. Pica

An abnormal craving for nonfood substances.

9. Complementary proteins

Foods that when cooked together provide all eight amino acids.

10. Pyrosis

A burning sensation along the esophagus caused by a decrease in gastric motility.

Activity C
1. Discuss the relationship between maternal dietary intake and fetal growth and
development.

Inadequate maternal dietary intake could result in fetal deprivation with premature birth,
stillborn, small-for-gestational age newborn, functional immaturity, or birth anomalies.

2. What factors may cause a woman to have decreased nutritional stores during
pregnancy?

High parity, short intervals between pregnancy, or rigorous dieting for weight loss.

3. Discuss two types of food that should be avoided in pregnancy. Why should these
foods be avoided?

Food with caffeine should be avoided because caffeine stimulates the central nervous
system and is associated with low birth weight. Artificial sweeteners should be avoided
as much as possible, since safety is not completely established; saccharine is
eliminated slowly from the fetus; alcoholic beverages should not be ingested because of
their potentially teratogenic effects on the fetus.

4. Indicate the sources of the following substances and their significance for the
pregnant woman: protein, calcium, fat, folic acid, iodine, and iron.

Protein- Source: Meat, eggs, milk. Significance: Supplies needed B vitamins, B12, and
essential amino acids.
Calcium- Source: Milk, milk products. Significance: Necessary for fetal skeletal and
tooth formation.

Fat- Source: vegetable oils are preferred. Significance: supplies essential fatty acid
needed for new cell growth.

Folic acid- Source: fresh fruits and vegetables. Significance: necessary for red blood
cell formation.

Iodine- Source: iodized salt, seafood. Significance: essential for the formation of
thyroxine and proper thyroid gland function.

Iron- Source: organ meats, eggs, green leafy vegetables, whole grains, enriched
breads, dried fruit. Significance: needed to build hemoglobin and increased red cell
volume.

APPLYING YOUR KNOWLEDGE

Activity D

Ellen, age 16 years, is in her second trimester of pregnancy. She is at the clinic for her initial
prenatal visit.

1. What are the most important initial assessment you would make before discussing nutritional
needs with Ellen?

Determine whether a client is eating healthy food and evaluate any cultural, environmental, or
social lifestyles that could affect eating habits.

2. What nutritional intake behaviors do most adolescents exhibit that might make it difficult to
promote adequate nutrition for Ellen and her fetus?

Their eating habits and diet.

3. Compare the dietary instructions you might provide for a pregnant adolescent like Ellen with
those for a pregnant woman over age of 40 years.

PRACTICING FOR NCLEX

Activity G

1. Which of the following measures undertaken by a pregnant woman would indicate

that a teaching plan on nutrition during pregnancy had been effective?
c. States she understands that, although she is obese, she should not diet to lose
weight but should avoid eating empty calories.

2. Pam is a 23-year old single mother who has a 15-month-old and a 3-month-old who
was premature; she had a miscarriage before the birth of her 3-month-old. Her diet
history revealed that she likes to eat fish and chicken. Pam should be considered at
nutritional risk because of her

a. Prior pregnancies

3. A woman with phenylketonuria should do which of the following?

c. Return to a low-phenylalanine diet before becoming pregnant.

4. Which of the following would be an appropriate nursing intervention to help a woman

with nausea and vomiting maintain adequate nutritional intake?

b. Encourage her to eat meals before going to bed, when nausea is less severe.

Activity H

1. Which of the following foods would be most appropriate for the nurse to suggest a
pregnant client consume if that client is experiencing low hemoglobin levels?

a. Eggs

d. green leafy vegetable

e. organ meats

2. Bonnie, 3 months pregnant, has reported for her first prenatal visit. You should
instruct her to do which of the following?

a. Eat foods rich in protein, iron, and other nutrients to provide an additional 300
calories each day

d. Eat small and frequent meals to increase absorption and decrease nausea

3. A pregnant woman is experiencing pyrosis. Which of the following instructions would

be most helpful?

a. Eating small more frequent meals rather than larger ones

b. sleeping on her left side with two pillows

c. waiting at least 2 hours after eating before attempting to lie down.