ADVENTIST MEDICAL CENTER COLLEGE

BRGY. SAN MIGUEL, ILIGAN CITY

SCHOOL OF NURSING

CARE OF MOTHER, CHILD, AND ADOLSECENT – SECTION A

Related Learning Experience (Clinical: DR)
First Semester, AY 2021 – 2022

Name of Students: ______________________ Date: _______ Score: 40 pts

Case Scenario #5: Nursing Care to Promote Fetal and Maternal Health

A WOMAN WITH MIDPREGNANCY CONCERNS

Stephanie is a 26-year-old woman who comes to your prenatal clinic for care. This is her first pregnancy.
She is 28 weeks pregnant.

CHIEF CONCERN:
“I’m tired, and my back aches all the time.”

HISTORY OF CHIEF CONCERN:

A feeling of fatigue has been present from early pregnancy. Backache has been noticeable over the last
week. Pain is sharp and mostly on right side, noticed most at end of day.

FAMILY PROFILE:
The client works as an executive secretary for a major corporation in the inner city. She works 40 hours a
week; her job consists of sitting at desk for long stretches or else standing filing for long stretches. She had
fair degree of stress because she is secretary to two people who compete for her time. She does not smoke;
she has taken no alcohol since pregnancy began; she had no teratogenic exposure at work she is aware of.
Her husband, Jose, 30 years old, works as a carpenter. He is also not exposed to any teratogens of which she
is aware.
The client has been married for 4 years. She lives with her husband and two pedigreed dogs in a
high-rise condo in downtown city. She describes finances as “adequate although the mortgage is high.” She
has begun to prepare a section of the bedroom for the baby. She is unwilling to move because of the price of
a bigger condo and because present one is close to mother’s house. She plans to return to work following
birth; a sister will care for baby during the day.

HISTORY OF PAST ILLNESSES:

The client had mumps at age 8 years; she had rheumatic fever at age 12 years. She had no residual heart
disease; she had “some kind of measles” during college.

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HISTORY OF FAMILY ILLNESSES:
Her father died at age 43 years of arteriosclerotic heart disease; her paternal grandmother has type 2 diabetes
mellitus.

GYNECOLOGIC HISTORY:
Menarche was at age 11 years; cycle of 28 days with duration of flow 5 days, moderately heavy. She had
slight dysmenorrhea. She had no sexually transmitted infections. She was using a diaphragm and foam as
contraceptive measures before stopping to allow this pregnancy.

OBSTETRIC HISTORY:
She had no previous pregnancies. This pregnancy was intended.

DAY HISTORY:
Nutrition: 24-hour recall:
Breakfast: 1 cup coffee (decaffeinated) with cream; 2 slices toast; 1 glass orange juice; prenatal vitamin
Lunch: 1 cup fat-free yogurt; small green salad
Snack: 1 dish ice cream; 1 glass cola (caffeine free)
Dinner: 1 bowl onion soup; 1 serving rare roast beef; 1 serving green peas; 1 slice bread.
Snack: 1 piece apple pie; 1 glass skim milk
Sleep: Sleeps more than previously (6 hours per night), but backache has kept her awake the last two nights
Recreation: Participates on a synchronized swimming team at a local sports facility two times a week; walks
her dogs in a nearby deer refuge daily; exercise is minimal the rest of the week

REVIEW OF SYSTEMS:
Head: Occasional headache if she works too long at a computer
Eyes: No blurring of vision
GI: Has noticed “heartburn” off and on during pregnancy; some tendency toward constipation lately
GU: Slight discomfort on voiding for last 3 days; no vaginal discharge
Blood type: A positive; has never had a transfusion

PHYSICAL EXAMINATION:
Height: 5 ft 8 in.; weight: 110 lb before pregnancy (BMI: 16.7 or underweight), 15 lb gain in pregnancy;
blood pressure: 114/74 mmHg
General appearance: Well-dressed, alert, young adult woman

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HEENT: Normocephalic; red reflex; reads fine print without difficulty; hearing adequate for normal
conversation; nose: mucous membrane slightly swollen but not reddened; no palpable lymph nodes
present
Chest: Areolae of breasts enlarged and prominent; colostrum present on nipples; numerous veins
distinguishable on breasts; lungs sounds clear to auscultation; respiratory rate: 22 breaths/min;
occasional systolic heart murmur present; heart rate: 78 beats/min
Abdomen: Linea nigra and numerous striae present; fundal height: 22 cm; fetal movements palpated; FHR =
160 beats/min
Back: Area tender over right kidney; no tenderness at spinal column
Extremities: Slight varicosity formation on posterior surface of right leg; occasional spider angiomas
Rectum: Slight internal hemorrhoids present

LABORATORY REPORTS:
Hemoglobin: 10.5 g/dl
Hematocrit: 36%
Urinalysis by reagent strip: pH: 9; protein: trace; glucose: trace; ketones: negative; blood: +2; a clean catch
urine was obtained for culture

Stephanie was diagnosed as having a possible pyelonephritis based on the urinary discomfort, blood in
urine, right-sided back pain, and elevated temperature. She was instructed to increase her fluid intake to 2
quarts daily and placed on an oral antibiotic. She is to telephone if symptoms worsen; return to the clinic in
3 days for a repeat urine culture.

STUDY QUESTIONS:
1. Suppose Stephanie says she’s worried that her husband may not be monogamous and that she about
contacting a sexually transmitted infection during pregnancy. Contacting syphilis during pregnancy can
result in: (2 pts)
A. A green to brown maternal vaginal discharge.
B. Deformed and unusually sharp teeth in an infant.
C. Severe maternal abdominal gastrointestinal pain.
D. “Blueberry” or blue lesions on the mother’s skin.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

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2. Stephanie listed a number of varied concerns she has with pregnancy during her last visit. Based on these,
the best nursing diagnosis for her would be: (2 pts)
A. Constipation related to pressure of uterus on liver.
B. Risk for fluid volume deficit related to nausea.
C. Fatigue related to inability to sleep at night.
D. Altered sexual pattern related to pregnancy.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

3. Stephanie hates showers so takes a bath daily. She asks you if it’s safe to take tub baths during pregnancy.
Based on QSEN competencies to make care patient centered, your best answer would be: (2 pts)
A. “No. Warm water can lead to pelvic infections.”
B. “Yes, as long as her membranes are not ruptured.”
C. “Showering is more beneficial; she should change.”
D. “Cold showering helps prevent preterm labor.”
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

4. Stephanie states that her breasts feel tender at times. To wash them, you would recommend she:
A. Clean them with clear water. (2 pts)
B. Wash with alcohol compresses.
C. Scrub with cotton wool and soap.
D. Soak them daily in semi-warm milk.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

5. Stephanie has noticed itching of her palms since early in pregnancy. What is advice you should give her
regarding this? (2 pts)
A. This is likely a response to her elevated estrogen level.
B. She should change the type of hand cream she is using.
C. This could be a beginning sign of high blood pressure.
D. She should ask her supervisor for a new job assignment.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

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6. Stephanie wants to continue swimming. What guideline should Stephanie follow? (2 pts)
A. She should never swim in chlorine treated water.
B. She should use a breast but not a side stroke.
C. She should assess for ringing in her ears afterward.
D. She should not participate in high board diving.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

7. Stephanie is uncomfortable using a seatbelt when she drives. What is a general rule to advise pregnant
women regarding this? (2 pts)
A. Use one in the front seat but not in the back seat.
B. Never use a belt because they can cause uterine rupture.
C. She should continue to always use a full belt.
D. She should use the shoulder but not the lap belt.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

8. Although Stephanie is only 26 years old, she already has varicosities. What is the best way to reduce
these? (2 pts)
A. Discontinue all exercise during pregnancy, if possible.
B. Rest with her feet elevated in the morning and evening.
C. Assume a knee–chest position for 5 minutes every hour.
D. Wear knee-high stockings to increase pressure on leg veins.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
9. Stephanie reports she has bad back pain and is diagnosed as having a urinary tract infection (UTI). UTIs
are more apt to occur in pregnancy than usual for what reason? (2 pts)
A. The ureters are compressed by the uterus, leading to stasis of urine.
B. The urine has increased acidity because of the addition of fetal urine.
C. The kidneys are pushed entirely sideways so do not drain readily.
D. Follicle stimulating hormone causes ureter diameter to narrow.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

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10. Which of the following in Stephanie’s history makes her most likely to contact toxoplasmosis during
pregnancy? (2 pts)
A. Her husband does not use a condom.
B. Her dietary history shows she eats Asian dishes containing raw meat.
C. She is reporting that she has constant back pain.
D. She owns two different types of pedigreed dogs.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
11. Stephanie is planning on traveling, and she will need some vaccines for travel safety. Which of the
following vaccines is contraindicated during pregnancy? (2 pts)
A. Tetanus toxoid.
B. There are no vaccines that are safe during pregnancy.
C. Rabies vaccine.
D. Rubella vaccine.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
12. The U.S. Food and Drug Administration (FDA) classifies drugs whether they’re safe or not for
pregnancy. The X classification means the drug: (2 pts)
A. Is untested for pregnancy.
B. Is marked as safe for pregnancy.
C. Is a known fetal teratogen.
D. Has no significant side effects.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
13. Another symptom of pregnancy Stephanie reports is frequency of urination. Once her UTI resolves and
she has no other urinary tract symptoms, you would provide what advice? (2 pts)
A. She should decrease her fluid intake to relieve this.
B. She may be developing gestational hypertension.
C. This will fade after 3 months and reappear after lightening.
D. Sleeping in a prone position usually helps make this seem less.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

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14. Which of the following activities that Stephanie participates in would cause you to worry she could be
exposed to a teratogen at work? (2 pts)
A. She cleans the top of her glass desk with formaldehyde.
B. She uses a lead pencil to fill in a great many forms.
C. She buys her lunch from a vending machine.
D. She cleans the coffee pot in the break room daily.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
15. You want to prepare Stephanie for beginning signs of labor. What would you teach her to expect? (2 pts)
A. First pains are usually sharp and centered in the abdomen.
B. Many women first experience labor as dull chest pain.
C. Low back pain is often the first sign of beginning labor.
D. Labor pains do not begin until after membranes rupture.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
16. Stephanie tells you she has had almost constant intense headaches since she started her new job. She
asks you if this sounds serious. You would tell her: (2 pts)
A. “No. Secretaries usually develop headaches from computer work.”
B. “Headache can be serious; she needs to call her primary health care provider.”
C. “It is serious only if she notices it at the end of the day.”
D. “Headache is a normal accompaniment to later pregnancy.”
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
17. Stephanie often soaks in a hot tub for half an hour after work. Advice you would give her regarding this
is: (2 pts)
A. Hyperthermia, possibly caused by hot tubs, can be teratogenic.
B. Soaking this way can help prevent backache during pregnancy.
C. She should drink fluid while in a hot tub to prevent dehydration.
D. She should turn the temperature down to below her own temperature.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
18. Stephanie asks you if it would be all right to visit the dentist during pregnancy. Your best answer would
be: (2 pts)
A “No. Teeth cleaning could release harmful bacteria into her bloodstream.”
B. “No. The vibration of the dental equipment could cause preterm labor.”
C. “Yes. But if this will include an X-ray, she should have lead apron protection.”
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D. “Yes, as long as she is more than 6 to 8 weeks away from her due date.”
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
19. You teach Stephanie about early signs of labor. How would you describe “lightening”? (2 pts)
A. A vaginal discharge of pale vaginal mucus
B. A feeling of cold across the abdomen
C. Settling of the fetal head into the pelvic inlet
D. A sharp hot pain that announces labor
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
20. Another sign of beginning labor you would want to teach Stephanie would be: (2 pts)
A. A feeling of acute hunger or craving for sweets.
B. Sudden discharge of colostrum from her breasts.
C. An area tender to touch around her umbilicus.
D. Mucus- and blood-streaked vaginal discharge.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

Assessed by:

_____________________
Name of Clinical Instructor