Chapter 14 The Expectant Family: Needs and Care My Nursing Test Banks

Olds Maternal-Newborn Nursing and Womens Health, 10e (Davidson)

Chapter 14 The Expectant Family: Needs and Care

1) The nurse is presenting a class to women who are currently pregnant or are planning pregnancy in the near future. Which client statement indicates that additional teaching is required?

1. The older a woman is when she conceives, the safer the pregnancy is.

2. Pregnant teens can have additional nutritional needs.

3. A woman whose sisters all had hypertension will be watched carefully.

4. Pregnancy may be more difficult to achieve in my 40s.

Answer: 1

Explanation: 1. The health risks associated with pregnancy vary by age. The risk for maternal death is significantly higher for women over age 35 and even higher for women age 40 and older. The incidence of low-birth-weight infants, preterm births, miscarriage, stillbirth, and perinatal morbidity and mortality is higher among women age 35 or older.

Page Ref: 302

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 5 Explain the basic goals of childbirth education in providing care to expectant couples and their families.

MNL LO: 2.3.1 Determine factors to consider when providing are during the antepartum period.

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2) During home care of a low-risk pregnant client, the nurse provides care by assessing which of the following?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Urine

2. Weight

3. Diet

4. Pelvic measurements

5. Physical activity

Answer: 1, 2, 3, 5

Explanation: 1. Assessment of the clients urine can be done in the home setting.

2. Obtaining the clients weight can be done in the home setting.

3. Assessing the clients dietary intake can be done in the home setting.

5. The clients physical activity can be assessed in the home setting.

Page Ref: 272

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Relationship-Centered Care: Respect the patients dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing processes. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1 Describe the significance of using the nursing process to promote health in the woman and her family during pregnancy.

MNL LO: 2.3.1 Determine factors to consider when providing are during the antepartum period.

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3) A couple in their late 30s are pregnant for the first time. In evaluating the care delivered, the nurse assesses the mother for which of the following?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Makes appropriate healthcare choices

2. Receives effective healthcare through the pregnancy

3. Has a partner who is not interested in child care

4. Cannot cope with her life change

5. Wishes to have amniocentesis done

Answer: 1, 2

Explanation: 1. Expected outcomes of nursing care for a pregnant couple over 35 include that the client and her partner are knowledgeable about the pregnancy and make appropriate healthcare choices.

2. Expected outcomes of nursing care for a pregnant couple over 35 include the client and her partner receive effective health care throughout the pregnancy, birth, and postpartum period.

Page Ref: 303

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | AACN Essentials Competencies: IX. 13. Revise the plan of care based on an ongoing evaluation of patient outcomes. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 11 Compare similarities and differences in the needs of expectant women in various age groups.

MNL LO: 2.3.1 Determine factors to consider when providing are during the antepartum period.

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4) The nurse is caring for a pregnant client. The clients husband has come to the prenatal visit. Which question is the best for the nurse to use to assess the fathers adaptation to the pregnancy?

1. What kind of work do you do?

2. What furniture have you gotten for the baby?

3. How moody has your wife been lately?

4. How are you feeling about becoming a father?

Answer: 4

Explanation: 4. A husbands adaptation to pregnancy includes his feelings about impending fatherhood.

Page Ref: 273

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2 Describe actions the nurse can take to help maintain the well-being of the expectant father and siblings during a familys pregnancy.

MNL LO: 2.3.3 Implement client teaching that promotes health maintenance during pregnancy.

5) The nurse is preparing a class for expectant fathers. Which information should the nurse include?

1. Siblings adjust readily to the new baby.

2. Sexual activity is safe for normal pregnancy.

3. The expectant mother decides the feeding method.

4. Fathers are expected to be involved in labor and birth.

Answer: 2

Explanation: 2. In a healthy pregnancy, there is no medical reason to limit sexual activity.

Page Ref: 295

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2 Describe actions the nurse can take to help maintain the well-being of the expectant father and siblings during a familys pregnancy.

MNL LO: 2.3.3 Implement client teaching that promotes health maintenance during pregnancy.

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6) The prenatal period should be used to expose the prospective parents to up-to-date, evidence-based information about which of the following topics?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Breastfeeding

2. Pain relief

3. Obstetric complications and procedures

4. Toddler care

5. Antepartum adjustment

Answer: 1, 2, 3

Explanation: 1. The prenatal period should expose prospective parents to up-to-date, evidence-based information about breastfeeding.

2. The prenatal period should expose prospective parents to up-to-date, evidence-based information about pain relief.

3. The prenatal period should expose prospective parents to up-to-date, evidence-based information about obstetric complications and procedures.

Page Ref: 280

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4 Identify information that expectant parents may need to assist them in making the best decisions possible about issues related to pregnancy, labor, and birth.

MNL LO: 2.3.3 Implement client teaching that promotes health maintenance during pregnancy.

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7) A Navajo client who is 36 weeks pregnant meets with a traditional healer as well as her physician. What does the nurse understand this to mean?

1. The client is seeking spiritual direction.

2. The client does not trust her physician.

3. The client will not adapt to mothering well.

4. The client is experiencing complications of pregnancy.

Answer: 1

Explanation: 1. Navajo clients are aware of the mind-soul connection, and might try to follow certain practices to have a healthy pregnancy and birth. Practices could include focus on peace and positive thoughts as well as certain types of prayers and ceremonies. A traditional healer may assist them.

Page Ref: 275

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. C. 1. Value seeing health care situations through patients eyes. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Relationship-Centered Care: Appreciate the patient as a whole person with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3 Discuss the significance of cultural considerations in managing nursing care during pregnancy.

MNL LO: 2.2.3 Recognize maternal cultural and spirituality factors that affect pregnancy.

8) A Chinese woman who is 12 weeks pregnant reports to the nurse that ginseng and bamboo leaves help reduce her anxiety. How should the nurse respond to this client?

1. Advise the client to give up the bamboo leaves but to continue taking ginseng.

2. Advise the client to give up all herbal remedies.

3. Tell the client that her remedies have no scientific foundation.

4. Assess where the client obtains her remedy, and investigate the source.

Answer: 2

Explanation: 2. In some cases, the nurse might want to suggest remedies that may be more effective than herbal remedies. However, if the home remedy is not harmful, there is no reason for the nurse to ask a client to discontinue this practice.

Page Ref: 275

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 17. Develop a beginning understanding of complementary and alternative modalities and their role in health care. | NLN Competencies: Relationship-Centered Care: Appreciate the patient as a whole person with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3 Discuss the significance of cultural considerations in managing nursing care during pregnancy.

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MNL LO: 2.2.3 Recognize maternal cultural and spirituality factors that affect pregnancy.

9) The OB-GYN nurse works in a clinic with a culturally diverse group of clients whose specific actions during pregnancy are often determined by cultural beliefs. The nurse recognizes that these beliefs about pregnancy and childbirth fall into which categories?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Prescriptive beliefs

2. Restrictive beliefs

3. Taboos

4. Cultural humility

5. Folk treatment beliefs

Answer: 1, 2, 3

Explanation: 1. Prescriptive beliefs or requirements describe expected behaviors.

2. Restrictive beliefs are stated negatively and limit behaviors.

3. Taboo beliefs refer to specific supernatural consequences.

Page Ref: 274

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. C. 5. Recognize personally held attitudes about working with patients from different ethnic, cultural, and social backgrounds. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Respect the patients dignity, uniqueness, integrity, and self-determination and his or her own power and self-healing processes. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3 Discuss the significance of cultural considerations in managing nursing care during pregnancy.

MNL LO: 2.2.3 Recognize maternal cultural and spirituality factors that affect pregnancy.

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10) Which of the following are specific culturally sensitive nursing considerations the nurse integrates into care of the pregnant client?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Counseling about home remedies

2. Discussing components of a balanced diet

3. Refusing to discuss birthing choices

4. Encouraging use of support systems

5. Instructing the client to use no home remedies

Answer: 1, 2, 4

Explanation: 1. The culturally sensitive nurse should find out what medications and home remedies the client is using, and counsel the client regarding overall effects.

2. The culturally sensitive nurse will discuss the importance of a well-balanced diet during pregnancy with consideration of the clients cultural beliefs and practices.

4. Encouraging the use of support systems and spiritual aids that provide comfort for the mother is important in culturally sensitive care.

Page Ref: 275

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Relationship-Centered Care: Appreciate the patient as a whole person with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3 Discuss the significance of cultural considerations in managing nursing care during pregnancy.

MNL LO: 2.2.3 Recognize maternal cultural and spirituality factors that affect pregnancy.

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11) The primiparous client has told the nurse that she is afraid she will develop hemorrhoids during pregnancy because her mother did. Which statement would be best for the nurse to make?

1. It is not unusual for women to develop hemorrhoids during pregnancy.

2. Most women dont have any problem until after theyve delivered.

3. If your mother had hemorrhoids, you will get them, too.

4. If you get hemorrhoids, you probably will need surgery to get rid of them.

Answer: 1

Explanation: 1. Many pregnant women will develop hemorrhoids. Hemorrhoids are varicosities of the veins in the lower end of the rectum and anus. During pregnancy, the gravid uterus presses on the veins and interferes with venous circulation. As the pregnancy progresses, the straining that accompanies constipation can contribute to the development of hemorrhoids.

Page Ref: 286

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage the patient or designated surrogates in active partnership that promotes health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6 Identify the common discomforts of pregnancy and their causes.

MNL LO: 2.3.2 Recognize common discomforts of pregnancy and measures that can provide relief.

12) Which statement, if made by a pregnant client, would indicate that she understands health promotion during pregnancy?

1. I lie down after eating to relieve heartburn.

2. I try to limit my fluid intake to 3 or 4 glasses each day.

3. I elevate my legs while sitting at my desk.

4. I am avoiding exercise to stay well rested.

Answer: 3

Explanation: 3. Elevating the legs can help decrease lower leg edema.

Page Ref: 285, 289

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 7 Summarize appropriate measures to alleviate the common discomforts of pregnancy.

MNL LO: 2.3.2 Recognize common discomforts of pregnancy and measures that can provide relief.

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13) The nurse is teaching an early pregnancy class for clients in the first trimester of pregnancy. Which statement by a client requires immediate intervention by the nurse?

1. When my nausea is bad, I will drink some ginger tea.

2. The fatigue I am experiencing will improve in the second trimester.

3. It is normal for my vaginal discharge to be green.

4. I will urinate less often during the middle of my pregnancy.

Answer: 3

Explanation: 3. Increased whitish vaginal discharge, called leukorrhea, is common in pregnancy. Green discharge is not a normal finding, and indicates a vaginal infection.

Page Ref: 283

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1 Describe the significance of using the nursing process to promote health in the woman and her family during pregnancy.

MNL LO: 2.3.3 Implement client teaching that promotes health maintenance during pregnancy.

14) A client at 36 weeks gestation is complaining of dyspnea when lying flat. What is the clinical reason for this complaint?

1. Maternal hypertension

2. Fundal height

3. Hydramnios

4. Congestive heart failure

Answer: 2

Explanation: 2. The dyspnea is resulting from the pressure of the enlarging uterus on the diaphragm.

Page Ref: 290

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 6 Identify the common discomforts of pregnancy and their causes.

MNL LO: 2.3.2 Recognize common discomforts of pregnancy and measures that can provide relief.

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15) The nurse assessing a pregnant African American woman in the first trimester understands that a cultural practice is which of the following?

1. Use of herbs like dandelion during pregnancy to increase lactation

2. Drinking ginseng tea for faintness

3. Eating clay to supply dietary minerals

4. Consulting a spiritual advisor to ensure a healthy pregnancy and birth

Answer: 3

Explanation: 3. African American pregnant women may be guided by their extended family into common practices such as geophagia, the ingestion of dirt or clay, which is believed to alleviate mineral deficiencies.

Page Ref: 274

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. C. 4. Seek learning opportunities with patients who represent all aspects of human diversity. | AACN Essentials Competencies: IX. 17. Develop a beginning understanding of complementary and alternative modalities and their role in health care. | NLN Competencies: Relationship-Centered Care: Appreciate the patient as a whole person with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3 Discuss the significance of cultural considerations in managing nursing care during pregnancy.

MNL LO: 2.2.3 Recognize maternal cultural and spirituality factors that affect pregnancy.

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16) Remedies for back pain in pregnancy that are supported by research evidence and may safely be taught to any pregnant woman by the nurse include which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Pelvic tilt

2. Water aerobics

3. Sit-ups

4. Proper body mechanics

5. Maintaining good posture

Answer: 1, 2, 4, 5

Explanation: 1. The pelvic tilt can help restore proper body alignment and relieve back pain.

2. Exercise is an effective treatment for lower back pain. Exercise in water seems to provide benefits while being physically comfortable for expectant mothers.

4. The use of proper posture and good body mechanics throughout pregnancy is important.

5. Good posture is important because it allows more room for the stomach to function.

Page Ref: 287, 292, 293

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7 Summarize appropriate measures to alleviate the common discomforts of pregnancy.

MNL LO: 2.3.2 Recognize common discomforts of pregnancy and measures that can provide relief.

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17) A client in her third trimester of pregnancy reports frequent leg cramps. What strategy would be most appropriate for the nurse to suggest?

1. Point the toes of the affected leg

2. Increase intake of protein-rich foods

3. Limit activity for several days

4. Flex the foot to stretch the calf

Answer: 4

Explanation: 4. The nurse should advise the client to practice dorsiflexion of feet to stretch affected muscle.

Page Ref: 290

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 7. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7 Summarize appropriate measures to alleviate the common discomforts of pregnancy.

MNL LO: 2.3.2 Recognize common discomforts of pregnancy and measures that can provide relief.

18) The nurse in a prenatal clinic finds that four clients have called with complaints related to their pregnancies. Which call should the nurse return first?

1. Pregnant woman at 7 weeks gestation reporting nasal stuffiness

2. Pregnant woman at 38 weeks gestation experiencing rectal itching and hemorrhoids

3. Pregnant woman at 15 weeks gestation with nausea and vomiting and a 15-pound weight loss

4. Pregnant woman at 32 weeks gestation treating constipation with prune juice

Answer: 3

Explanation: 3. The nurse should return this call first because this patient is the highest priority. A 15-pound weight loss is not an expected finding. Although some nausea is common, the woman who suffers from extreme nausea coupled with vomiting requires further assessment.

Page Ref: 282

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: V. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the health care team. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6 Identify the common discomforts of pregnancy and their causes.

MNL LO: 2.3.2 Recognize common discomforts of pregnancy and measures that can provide relief.

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19) A 38-year-old client in her second trimester states a desire to begin an exercise program to decrease her fatigue. What is the most appropriate nursing response?

1. Fatigue should resolve in the second trimester, but walking daily might help.

2. Avoid a strenuous exercise regimen at your age. Drink coffee to combat fatigue.

3. Avoid an exercise regimen due to your pregnancy. Try to nap daily.

4. Fatigue will increase as pregnancy progresses, but running daily might help.

Answer: 1

Explanation: 1. Even mild to moderate exercise is beneficial during pregnancy. Regular exerciseat least 30 minutes of moderate exercise daily or at least most days of the weekis preferred.

Page Ref: 292

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11 Compare similarities and differences in the needs of expectant women in various age groups.

MNL LO: 2.3.3 Implement client teaching that promotes health maintenance during pregnancy.

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20) A client at 34 weeks gestation complains about pyrosis. The nurse teaches the patient that approaches to relieve the pyrosis include which of the following?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Eat small, frequent meals

2. Use high-sodium antacids

3. Avoid fried, fatty foods

4. Take sodium bicarbonate after meals

5. Do not lie down after eating

Answer: 1, 3, 5

Explanation: 1. Pyrosis (heartburn) can be relieved by eating small, more frequent meals.

3. Avoiding fatty, fried foods can relieve pyrosis.

5. Sitting up after meals will help decrease the pyrosis.

Page Ref: 289

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan and in all healthcare settings. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7 Summarize appropriate measures to alleviate the common discomforts of pregnancy.

MNL LO: 2.3.2 Recognize common discomforts of pregnancy and measures that can provide relief.

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21) The pregnant client in her second trimester states, I didnt know my breasts would become so large. How do I find a good bra? The best answer for the nurse to make would be which of the following?

1. Avoid cotton fabrics and get an underwire bra; they fit everyone best.

2. Just buy a bra one cup size bigger than usual, and it will fit.

3. Look for wide straps and cups big enough for all of your breast tissue.

4. There isnt much you can do for comfort. Try not wearing a bra at all.

Answer: 3

Explanation: 3. The nurse should instruct the client to get a bra that fits with straps that are wide and do not stretch and a cup that holds all breast tissue comfortably.

Page Ref: 290

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7 Summarize appropriate measures to alleviate the common discomforts of pregnancy.

MNL LO: 2.3.2 Recognize common discomforts of pregnancy and measures that can provide relief.

22) A pregnant client who swims 3-5 times per week asks the nurse whether she should stop this activity. What is the appropriate nursing response?

1. You should decrease the number of times you swim per week.

2. Continuing your exercise program would be beneficial.

3. You should discontinue your exercise program immediately.

4. You should consider a less strenuous type of exercise.

Answer: 2

Explanation: 2. Mild to moderate exercise is beneficial during pregnancy. Regular exerciseat least 30 minutes of moderate exercise daily or at least most days of the weekis preferred.

Page Ref: 292

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1 Describe the significance of using the nursing process to promote health in the woman and her family during pregnancy.

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MNL LO: 2.3.3 Implement client teaching that promotes health maintenance during pregnancy.

23) The nurse is presenting a class of important dos and donts during pregnancy, including travel considerations. What method of travel does the nurse recommend as most appropriate for a client in her 25th week of pregnancy?

1. Automobile

2. Airplane

3. Train

4. None; this client should not travel

Answer: 3

Explanation: 3. As pregnancy progresses, travel by train is generally recommended for long distances.

Page Ref: 291

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1 Describe the significance of using the nursing process to promote health in the woman and her family during pregnancy.

MNL LO: 2.3.3 Implement client teaching that promotes health maintenance during pregnancy.

24) After teaching a pregnant client about the effects of smoking on pregnancy, the nurse knows that the client needs further education when she makes which statement?

1. I am at increased risk for preeclampsia.

2. I am at increased risk for preterm birth.

3. I am at increased risk for placenta previa.

4. I am at increased risk for abruptio placentae.

Answer: 1

Explanation: 1. Smoking is not associated with increased risk for preeclampsia.

Page Ref: 299

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1 Describe the significance of using the nursing process to promote health in the woman and her family during pregnancy.

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MNL LO: 2.3.3 Implement client teaching that promotes health maintenance during pregnancy.

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25) Which of the following drugs and drug categories can cause multiple fetal central nervous system (CNS), facial, and cardiovascular anomalies?

1. Category C: Zidovudine

2. Category B: Penicillin

3. Category X: Isotretinoin

4. Category A: Vitamin C

Answer: 3

Explanation: 3. Isotretinoin (Accutane), the acne medication, can cause multiple central nervous system (CNS), facial, and cardiovascular anomalies.

Page Ref: 299

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: V. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the health care team. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Promote communication and open reporting as a priority in health care. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4 Identify information that expectant parents may need to assist them in making the best decisions possible about issues related to pregnancy, labor, and birth.

MNL LO: 2.3.3 Implement client teaching that promotes health maintenance during pregnancy.

26) The prenatal client in her third trimester tells the clinic nurse that she works 8 hours a day as a cashier and stands when at work. What response by the nurse is best?

1. No problem. Your baby will be fine.

2. Do you get regular breaks for eating?

3. Your risk of preterm labor is higher.

4. Standing might increase ankle swelling.

Answer: 3

Explanation: 3. Pregnant women who are employed in jobs that require prolonged standing (more than 3 hours) do have a higher incidence of preterm birth.

Page Ref: 291

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Appreciate the patient as a whole person with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1 Describe the significance of using the nursing process to promote health in the woman and her family during pregnancy.

MNL LO: 2.3.3 Implement client teaching that promotes health maintenance during pregnancy.

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27) The pregnant client has asked the nurse what kinds of medications cause birth defects. Which statement would best answer this question?

1. Birth defects are very rare. Dont worry; your doctor will watch for problems.

2. To be safe, dont take any medication without talking to your doctor.

3. Too much vitamin C is one of the most common issues.

4. Almost all medications will cause birth defects in the first trimester.

Answer: 2

Explanation: 2. The nurse should remind the client of the need to check with her caregiver about medications. If a woman has taken a drug in category D or X, she should be informed of the risks associated with that drug and of her alternatives.

Page Ref: 299

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: V. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the health care team. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1 Describe the significance of using the nursing process to promote health in the woman and her family during pregnancy.

MNL LO: 2.3.3 Implement client teaching that promotes health maintenance during pregnancy.

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28) A pregnant client complains to the clinic nurse that her varicose veins are causing more discomfort than before. Which recommendations does the nurse make to the client?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Increase the time she stands.

2. Walk on a daily basis.

3. Not cross her legs at the knees.

4. Wear support hose.

5. Hyperextend her knee with her feet up.

Answer: 2, 3, 4

Explanation: 2. Regular exercise, such as swimming, cycling, or walking, promotes venous return, which helps prevent varicosities.

3. The client should avoid crossing her legs at the knees because of the pressure it puts on her veins.

4. Supportive hose or elastic stockings may be extremely helpful.

Page Ref: 285

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7 Summarize appropriate measures to alleviate the common discomforts of pregnancy.

MNL LO: 2.3.2 Recognize common discomforts of pregnancy and measures that can provide relief.

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29) Absolute contraindications to exercise while pregnant include which of the following?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Abruptio placentae

2. Placenta previa after 26 weeks gestation

3. Preeclampsia-eclampsia

4. Cervical insufficiency (cerclage)

5. Intrauterine growth restriction (IUGR)

Answer: 2, 3, 4

Explanation: 2. Placenta previa after 26 weeks gestation is an absolute contraindication to exercise.

3. Preeclampsia-eclampsia is an absolute contraindication to exercise.

4. Cervical insufficiency (cerclage) is an absolute contraindication to exercise.

Page Ref: 292

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: V. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the health care team. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4 Identify information that expectant parents may need to assist them in making the best decisions possible about issues related to pregnancy, labor, and birth.

MNL LO: 2.3.3 Implement client teaching that promotes health maintenance during pregnancy.

30) Intercourse is contraindicated if the pregnancy is vulnerable because of which diagnosis?

1. Gestational diabetes

2. Cervical insufficiency (cerclage)

3. Abruptio placentae

4. Placenta previa

Answer: 4

Explanation: 4. Intercourse is contraindicated if the pregnancy is vulnerable because of the diagnosis of threatened spontaneous abortion, placenta previa, or the risk of preterm labor.

Page Ref: 295

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: V. B. 4. Communicate observations or concerns related to hazards and errors to patients. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9 Identify some of the concerns that an expectant couple may have about sexual activity.

MNL LO: 2.3.3 Implement client teaching that promotes health maintenance during pregnancy.

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31) The nurse is discussing sexual intimacy with a pregnant couple. What should be included in the teaching plan?

1. Intercourse should stop by the beginning of the third trimester.

2. Breast fondling should be discouraged due to the potential for preterm labor.

3. The couple might need to experiment with different positions.

4. Use vaginal lubricant sparingly.

Answer: 3

Explanation: 3. As the uterus enlarges, the couple will have to experiment with different positions.

Page Ref: 295, 296

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9 Identify some of the concerns that an expectant couple may have about sexual activity.

MNL LO: 2.3.3 Implement client teaching that promotes health maintenance during pregnancy.

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32) The nurse is preparing a brochure for couples considering pregnancy after the age of 35. Which statements should be included?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. There is a decreased risk of Down syndrome.

2. Preexisting medical conditions can complicate pregnancy.

3. Preterm births are more common.

4. Amniocentesis can be performed to detect genetic anomalies.

5. The increased fertility of women over age 35 makes conception easier.

Answer: 2, 3, 4

Explanation: 2. Preexisting medical conditions, such as hypertension or diabetes, probably play a more significant role than age in maternal well-being and the outcome of pregnancy.

3. The incidence of low-birth-weight infants, preterm births, miscarriage, stillbirth, and perinatal morbidity and mortality is higher among women age 35 or older.

4. Amniocentesis is offered to all women over age 35 to permit the early detection of several chromosomal abnormalities, including Down syndrome; noninvasive analysis of fetal nucleic acid is now commonly recommended to women of advanced maternal age.

Page Ref: 302

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, cultural, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 11 Compare similarities and differences in the needs of expectant women in various age groups.

MNL LO: 2.3.3 Implement client teaching that promotes health maintenance during pregnancy.

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33) The nurse is presenting a prenatal class to a group of women pregnant for the first time who are all over 35 years of age. The nurse knows that the advantage of waiting until later to start a family is which of the following?

1. That the woman will have an easier labor and delivery.

2. That the baby will be at less of a risk for congenital anomalies.

3. That the woman is more likely to be financially secure.

4. That the woman will be more fertile than a younger woman would.

Answer: 3

Explanation: 3. This delay in starting a family allows women to pursue advanced educational degrees and prepare financially for the impact children will have on their lives.

Page Ref: 301

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11 Compare similarities and differences in the needs of expectant women in various age groups.

MNL LO: 2.3.3 Implement client teaching that promotes health maintenance during pregnancy.

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34) The nurse working with mothers over 35 having their first baby knows there are some disadvantages. For what disadvantage would the nurse carefully assess in each client?

1. What kind of insurance the client has for maternity care

2. Whether the client is married

3. Whether the client will continue working after the baby arrives

4. Whether the client has any chronic disease that will have to be addressed

Answer: 4

Explanation: 4. It is important for the nurse to question and assess for any chronic illnesses. The risk of pregnancy complications is higher in women over age 35 who have a chronic condition such as hypertension or diabetes, or who are in poor general health.

Page Ref: 302

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 11 Compare similarities and differences in the needs of expectant women in various age groups.

MNL LO: 2.3.3 Implement client teaching that promotes health maintenance during pregnancy.

35) A 43-year-old client has just had a positive pregnancy test. She cries, and states, I just dont know what Ill do. I cant be pregnant. Which nursing diagnosis would be the most appropriate?

1. Decisional Conflict related to unexpected pregnancy

2. Knowledge, Deficient related to advanced maternal age

3. Depression related to unexpected pregnancy

4. Health Maintenance, Ineffective related to advanced maternal age

Answer: 1

Explanation: 1. Decisional Conflict related to unexpected pregnancy is the most appropriate nursing diagnosis.

Page Ref: 303

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 14. Participate in building consensus or resolving conflict in the context of patient care. | AACN Essentials Competencies: IX. 21. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 11 Compare similarities and differences in the needs of expectant women in various age groups.

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36) What self-care measures would a nurse recommend for a client in her first trimester to reduce the discomfort of nausea and vomiting?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Avoid odors or causative factors.

2. Have small but frequent meals.

3. Drink carbonated beverages.

4. Drink milk before arising in the morning.

5. Eat highly seasoned food.

Answer: 1, 2, 3

Explanation: 1. The nurse would recommend for a client in her first trimester to avoid odors and caustic factors to reduce the discomfort of nausea and vomiting.

2. The nurse would recommend for a client in her first trimester to have small but frequent meals to reduce the discomfort of nausea and vomiting.

3. The nurse would recommend for a client in her first trimester to drink carbonated beverages to reduce the discomfort of nausea and vomiting.

Page Ref: 289

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 8 Delineate self-care actions a pregnant woman and her family can take to maintain and promote well-being during each trimester of pregnancy.

MNL LO: 2.3.3 Implement client teaching that promotes health maintenance during pregnancy.

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