CHAPTER 12 PROMOTING FETAL AND MATERNAL HEALTH
HEALTH PROMOTION DURING PREGNANCY
SELF CARE NEEDS
A. Bathing
● At one time, tub baths were restricted during pregnancy because it
was feared that bath water would enter the vagina and cervix and
contaminate the uterine contents
● Women should not soak for long periods in extremely hot
water or hot tubs as heat exposure for a lengthy time
could lead to hyperthermia in the fetus
B. Breast Care
● A general rule is for a woman to wear a firm, supportive
bra with wide straps to spread breast weight across the
shoulders.
● Larger bra size to accommodate increasing breast size.
● 16th weeks: Colostrum secretion begins
C. Dental Care
● Gingival tissue tends to hypertrophy during pregnancy
● Encourage pregnant women to see their dentists regularly
for routine examination and cleaning
● because 9 months is a long time to be without preventive
dental care.
● A pregnant woman may want to consider delaying these until after
her baby is born. In the few instances when x-ray examinations are
necessary for dental health, they can be done safely as long as a
woman's abdomen is shielded with a lead apron.
● Action of bacteria on sugar -> lowers the pH of the
mouth -> creating an acid medium -> destruction of
the enamel of the teeth -> Tooth decay
● snack on nutritious foods, such as fresh fruits and
vegetables (e.g., apples and carrots),chocolate
D. Perineal Hygiene
● Douching is contraindicated during pregnancy.
● The force of the irrigating fluid could cause it to enter the
cervix and lead to infection.
● alters the pH of the vagina, leading to an increased risk of
bacterial growth.
E. Clothing
● Caution women to avoid tight-fitting items such as garters,
girdles with panty legs, and knee-high stockings during
pregnancy. These items impede lower-extremity
circulation.
● Suggest wearing shoes with a moderate to low heel to
minimize pelvic tilt and possible backache.
F. Sexual Activity
● Women with a history of spontaneous miscarriage
may be advised to avoid coitus during the time of the
pregnancy when a previous miscarriage occurred.
● Women whose membranes have ruptured or who have
vaginal spotting should be advised against coitus until
examined to prevent possible infection.
● Advise caution about male oral-female genital contact,
because accidental air embolism has been reported
from this act during pregnancy or following birth from air
entering open or fragile uterine arteries.
● Increase pelvic congestion: From additional uterine
blood supply: Increase clitoral sensation
● A side-by-side position or a woman in a superior position
may be more comfortable.
● Women may use female condoms throughout pregnancy.
G. Exercise
Extreme exercise: Low birth weight
Moderate exercise: Healthy
Advantages:
● - It can help prevent circulatory stasis in the lower
extremities.
● - It also can offer a general feeling of well-being.
● Note: Others may need to be cautioned to restrict
exercise or participation in contact sports.
Average well-nourished women: 3 times weekly, 30 minutes.
● - An exercise program should consist of 5 minutes of
warm-up exercises, an active "stimulus" phase of 20
minutes, and then 5 minutes of cool-down exercises.
During exercise a 23-year-old woman should have a pulse range of
● 137 - 167 (220 minus 23 times 70% and 85%, respectively)
During exercise a 35-year-old woman should have a pulse range of
● 129 -157 (220 minus 35 times 70% and 85%, respectively)
Long terms benefits of exercise program
• Lowering cholesterol level
• Reducing risk of osteoporosis
• Increasing energy level
• Maintaining a healthy body weight
• Decreasing risk of heart disease
• Increasing self-esteem and well-being
Walking
● is the best exercise during pregnancy, and women
jogging
● Late in pregnancy, can cause pelvic pain from relaxed
symphysis pubis movement
Swimming
● is a good activity for pregnant women is not
contraindicated as long as the membranes are intact
● It may help relieve backache during pregnancy
I. Sleep
● The optimal condition for body growth occurs when
growth hormone secretion is at its highest level—that is,
during sleep.
● overall increased metabolic demand of pregnancy -
reason for increased sleep
● Growth hormone is at highest level: Sleep
Difficulty falling asleep
1. Drinking a glass of warm milk
2. Relaxation exercises (lying quietly, systematically relaxing neck muscles,
shoulder muscles, arm muscles, and so on)
● Frequent waking this way leads to loss of rapid eye movement
(REM) sleep
Pyrosis (heartburn) or dyspnea (shortness of breath) also can cause her to
come awake, especially if she has been lying flat. In this instance, sleeping with
two pillows or on a couch with an armrest may be helpful.
Modified Sims position
● A good resting or sleeping position.
● This position puts the weight of the fetus on the bed, not
on the woman, and allows good circulation in lower
extremities.
J. Employment
● Changes in public assistance laws that encourage women to seek
employment have led to more women working during pregnancy
than ever before
● Family and Medical Leave Act
K. Travel
● Encourage women to wear seat belts during pregnancy. The bottom
strap should cross beneath the abdomen
Discomforts of Early Pregnancy:
The First Trimester
1. Breast Tenderness
● is often one of the first symptoms noticed in early
pregnancy
● It may be most noticeable on exposure to cold air.
● Patient Teaching: Encourage a woman to wear a bra with
a wide shoulder strap for support and to dress warmly to
avoid old drafts if cold increases symptoms.
2. Palmar Erythema
● Palmar pruritus occurs in early pregnancy and is
probably caused by increased estrogen levels.
● Constant redness or itching of the palms can make a
woman believe she has developed an allergy
● Patient Teaching: Explain that this type of itching in early
pregnancy is normal. As soon as a woman's body adjusts
to the increased level of estrogen, the erythema and
pruritus disappear
3. Constipation
● As peristalsis slows and the weight of a growing uterus
presses against the bowel, constipation can occur
● Weight of the growing fetus: Presses against bowel ->
slow peristalsis movement -> constipation
● Patient Teaching: Encourage her to evacuate her bowels
regularly. Increase the amount of fiber in her diet by
eating raw fruits, bran, and vegetables. To drink at least
eight 8-oz glasses of water daily.
● Women should not use mineral oil to relieve constipation
as it can absorb fat-soluble vitamins (A, D, K, and E
Caution: Enemas also should be avoided because their action might
initiate labor.
Extensive flatulence: Recommend avoiding gas forming foods, such
as cabbage or beans, to help control this problem.
4. Nausea, Vomiting, and Pyrosis
5. Fatigue
● Increase metabolic requirement: Fatigue
● can increase the amount of morning sickness a woman
experiences.
● A "feet-up" break during a workday helps prevent ankle
edema.
5. Muscle cramps
● Decrease serum calcium, Increase serum phosphorus
-> Muscle cramps
● Patient teaching: This problem is best relieved if a woman
lies on her back momentarily and extends her involved
leg while keeping her knee straight and dorsiflexing the
foot until the pain disappears
● Pregnant women also have a higher incidence of
“restless leg syndrome” (waking at night because of
spontaneous leg movement) than nonpregnant women
● Magnesium citrate or aluminum hydroxide gel (Amphojel)
● If a woman is experiencing frequent leg cramps, she may be
advised to take magnesium citrate or aluminum hydroxide gel
● Mirapex (pramipexole dihydrochloride) , a drug frequently
recommended for restless leg syndrome, should not be taken
during pregnancy.
6. Hypotension
● Supine hypotension is a symptom that occurs when a
woman lies on her back and the uterus presses on the
vena cava, impairing blood return to her heart.
● A woman experiences an irregular heart rate and a
feeling of apprehension.
● Patient teaching: Advise pregnant women to always rest
or sleep on their side, not their back. If they can only fall
asleep on their back, they should insert a small firm pillow
under their right hip to cause the weight of their uterus to
shift off their vena cava.
7. Varicosities
● development of tortuous leg veins, are common in
pregnancy because the weight of the distended uterus
puts pressure on the veins returning blood from the lower
extremities
Common in pregnancy:
Varicosities: Distended uterus -> Applies pressure -> Large vein
that carries blood back to the heart from your feet and legs.
● This causes pooling of blood and distention of the
vessels. The veins become engorged, inflamed, and
painful.
Risk Factors:
1. Family history of varicose veins.
2. Large fetus
3. Multiple pregnancy
Patient Teaching:
1. On the back with the legs raised against the wall (a small firm
pillow under their right
2. Caution women not to sit with their legs crossed or their knees bent
and to avoid constrictive knee-high hose or garters.
Some women, especially those who developed varicosities
during a previous pregnancy, may need elastic support stock
ings such as
● T.E.D Stockings - for relief of varicosities in a second pregnancy.
● Because it stimulates venous return
Vitamin C may be helpful in reducing the size of varicosities because
it is necessary for the formation of blood vessel collagen and
endothelium
–
8. Hemorrhoids
● (varicosities of the rectal veins) occur commonly in
pregnancy because of pressure on these veins from the
bulk of the growing uterus.
Patient Teaching:
1. Excellent way: Knee-chest position - for 10 to 15 minutes (To reduce
pressure on the rectal veins)
2. Daily bowel evacuation (To relieve constipation)

3. Resting in a modified Sims' position daily
4. Woman who already has hemorrhoids: Stool softener
docusate sodium (Colace)
5. Applying witch hazel or cold compresses to external hemorrhoids can help
relieve pain.
9. Heart Palpitations
Normal: Due to circulatory adjustments necessary to accommodate
her increased blood supply during pregnancy.
10. Frequent Urination
● Pressure of the uterus -> Anterior Bladder
● It lasts for three months
1. Early pregnancy: the uterus presses against the bladder, causing
frequent urination.
2. Middle pregnancy: urinary frequency is relieved:
When the uterus rises above the bladder.
3. Late pregnancy: the uterus is again pressing on the
bladder, leading to the recurrence of urinary frequency:
As the fetal head presses against the bladder
Patient Teaching:
1. Ask her about any burning or pain on urination or whether she has noticed any
blood in her urine, signs of urinary tract infection.
2. Women should not restrict their fluid intake to try to diminish frequency of
urination, as fluids are necessary to allow their blood volume to double.
3. Suggesting that a woman reduce the amount of caffeine she is drinking may
be helpful.
4. A woman needs to understand that voiding more frequently is a normal
phenomenon.
Lightening
● The settling of the fetal head into the inlet of the pelvis at
pregnancy's end
Kegel Exercise
● are exercises designed to strengthen the pubococcygeal
muscles. Each is a separate exercise and should be done
about three times a day.
● helps strengthen urinary control, directly strengthens
perineal muscles for birth, and decreases the possibility of
stress incontinence.
1. Squeeze the muscles surrounding the vagina as if stopping the flow of urine.
Hold for 3 seconds. Relax. Repeat this sequence 10 times.
2. Contract and relax the muscles surrounding the vagina as rapidly as possible
10 to 25 times.
11. Abdominal Discomfort
● When a woman stands up quickly, she may experience a
pulling, sometimes sharp and frightening, pain in the right or left lower
abdomen from tension on a round ligament.
● Patient Teaching: She can prevent this from happening by
always rising slowly from a lying to a sitting, or from a
sitting to a standing position.
12. Leukorrhea
● Whitish, viscous vaginal discharge: high estrogen levels
and the increased blood supply to the vaginal epithelium
and cervix in pregnancy.
● A woman with vulvar pruritus needs evaluation because
this strongly indicates infection
Patient Teaching:
1. Daily bath or shower to wash away accumulated secretions and prevent vulvar
excoriation usually controls this problem.
2. Wearing cotton underpants and sleeping at night without underwear can be
helpful to reduce moisture and possible vulvar excoriation.
Note: Some women may need to wear a perineal
pad to control the discharge.
3. Caution women not to use tampons because this could lead to stasis of
secretions and subsequent infection.
Vulvar and Vaginal Infection
1. Avoiding tight underpants and pantyhose may help prevent vulvar and vaginal
infections, particularly yeast infections.
Discomforts of Middle to Late Pregnancy
At about the 20th to 24th weeks, the midpoint of pregnancy, a woman is usually
ready for further health teaching that relates to the new developments that will
occur in the latter half of pregnancy.
1. Backache
● As pregnancy advances: Lumbar Lordosis develops:
postural changes necessary to maintain balance lead to
backache.
Patient Teaching:
1. Wearing shoes with low to moderate heels reduces the amount of spinal
curvature necessary to maintain an upright posture.
2. Encouraging a woman to walk with her pelvis tilted forward (putting pelvic
support under the weight of the fetus)
Medication:
1. Acetaminophen (Tylenol) is considered to be safe and effective
for relieving this type of pain during pregnancy.
Pelvic Rocking or Tilting
● helps to prevent and relieve backache.
2. Headache
● Many women experience headaches during pregnancy,
apparently from their expanding blood volume, which puts
pressure on cerebral arteries.
● Expanding blood volume -> Pressure on the cerebral
arteries -> Headache
1. Resting with cold towels on their forehead and taking usual adult doses of
acetaminophen usually furnishes adequate relief.
3. Dyspnea
● As the expanding uterus places pressure on the
diaphragm, lung compression and shortness of breath
result
● Expanding uterus -> Pressure on the diaphragm ->
Lung compression -> Shortness of breath
Patient Teaching:
1. Advise her to sleep with her head and chest elevated so the weight of the
uterus falls away from her diaphragm.
2. As pregnancy progresses, she may require two or more pillows to sleep at
night to avoid the problem.
4. Ankle Edema
● It is considered normal: As long as proteinuria and
hypertension are absent.
● Cause: Caused by general fluid retention and reduced
blood circulation in the lower extremities because of
uterine pressure.
Patient Teaching:
1. Left side-lying position: Increases the kidney's glomerular filtration rate and
also allows good venous return.
5. Braxton Hicks Contractions
● Beginning as early as the 8th to 12th week of
pregnancy, the uterus periodically contracts and then
relaxes again.
● By middle or late pregnancy, the contractions become
stronger, and a woman who tenses at the sensation may
even experience some minimal pain, similar to a hard
menstrual cramp.
Preventing Fetal Exposure to Teratogens
Teratogen
● is any factor, chemical or physical, that adversely affects
the fertilized ovum, embryo, or fetus.
● At one time, it was assumed that a fetus in utero was
protected from chemical or physical injury by the
presence of the amniotic fluid and by the absence of any
direct placental exchange between mother and fetus
I. Effects of Teratogens on a Fetus
Teratogen: Before Implantation - either the zygote is destroyed or it appears
unaffected.
Teratogen: If the insult occurs when the main body systems are being formed (in
the second to eighth weeks of embryonic life) - a fetus is very vulnerable to injury.
Teratogen: During the last trimester, the potential for harm again decreases
because all the organs of a fetus are formed and are merely maturing.
Syphilis & Toxoplasmosis: These two infections can cause abnormalities in
organs that were originally formed normally.
Lead & Mercury: Attack and disable nervous tissue.
Thalidomide: A drug once used to relieve nausea in pregnancy, causes limb
defects.
Tetracycline: A common antibiotic, causes tooth enamel
deficiencies and, possibly, long-bone deformities.
Rubella Virus: The eyes, ears, heart, and brain are the four most commonly
attacked
II. Teratogenic Maternal Infection (TORCH)
1. Toxoplasmosis
● a protozoan infection, is spread most commonly through
contact with uncooked meat, although it may also be
contracted through handling cat stool in soil or cat litter.
Infection crosses the placenta:
Infant may be born with:
1. Central nervous system damage.
2. Hydrocephalus
3. Microcephaly
4. Intracerebral calcification
5. Retinal deformities
Patient Teaching:
Instruct pregnant women to avoid undercooked meat and also not to change a
cat litter box or work in soil in an area where cats may defecate to avoid
exposure to the disease.
2. Rubella
Fetal Damage:
● hearing impairment
● cognitive and motor challenges
● cataracts
● cardiac defects (most commonly patent ductus arteriosus
and pulmonary stenosis)
● intrauterine growth restriction (IUGR)
● thrombocytopenic purpura
● dental and facial clefts, such as cleft lip and palate.
●
First Prenatal Visit: Rubella titer
Result: >1:8 Immunity to rubella
Result: <1:8 Susceptible to viral infection
Caution: A woman who is not immunized before pregnancy cannot be immunized
during pregnancy because the vaccine uses a live virus that would have effects
similar to those occurring with a subclinical case of rubella.
Patient Teaching:
1. After a rubella immunization, a woman is advised not to become pregnant for 3
months, until the rubella virus is no longer active.
2. Immediately after a pregnancy, assess whether a woman with low rubella titers
would like to be immunized to provide protection against rubella in future
pregnancies
3. CONCERN: An increasing concern is women who demonstrate antibodies
against rubella yet still become reinfected during pregnancy.
3. Cytomegalovirus
● a member of the herpes virus family, is another teratogen
that can cause extensive damage to a fetus while causing
few symptoms in a woman.
● Droplet
● CMV infection crosses the placenta, the infant may be
born severely neurologically challenged
● The child's skin may be covered with large petechiae
("blueberry-muffifin" lesions).
4. Herpes Simplex Virus
● Genital herpes infection -> virus spreads into the
bloodstream (viremia) -> crosses the placenta to a fetus
posing substantial fetal risk.
1st Trimester: Severe congenital anomalies or spontaneous
miscarriage may occur.
2nd & 3rd Trimester: There is a high incidence of premature birth,
intrauterine growth restriction, and continuing infection of the newborn
at birth.
Patient Teaching:
1. For women with a history of genital herpes and existing genital lesions,
cesarean birth is often advised to reduce the risk of this route of infection.
Other Viral Diseases
1. Syphilis
● Early in pregnancy, when the cytotrophoblast layer of the
chorionic villi is still intact, the causative spirochete of
 syphilis, Treponema pallidum, cannot cross the placenta
and damage the fetus.
CAUTION: When this layer atrophies at about the 16th to 18th week of
pregnancy, however, the spirochete then can cross and cause extensive
damage.
If left untreated beyond the 18th week of gestation, hearing impairment, cognitive
challenge, osteochondritis, and fetal death are possible.
● First Prenatal visit: Serologic Screening
2. Lyme Disease
● After a tick bite, a typical skin rash, erythema chronicum
migrans (large, macular lesions with a clear center),
develops.
● Pain in large joints such as the knee may develop.
Infection in pregnancy can result in spontaneous
miscarriage or severe congenital anomalies.
Treatment:
1. The drugs used for nonpregnant adults, tetracycline and doxycycline,
cannot be used during pregnancy because they cause tooth discoloration and,
possibly, long-bone malformation in a fetus.
2. A course of penicillin will be prescribed to reduce symptoms in the pregnant
woman.
Borrelia burgdorferi
● Lyme disease, a multisystem disease caused by the
spirochete
● is spread by the bite of a deer tick.
Potentially Teratogenic Vaccines
● are contraindicated during pregnancy because they may
transmit the viral infection to a fetus.
Live virus vaccines, such as
● measles,
● HPV,
● mumps
● , rubella,
● poliomyelitis (Sabin type),
Teratogenicity of Cigarette Smoking
● infertility
● Cigarette smoking by a pregnant woman has been shown
to cause fetal growth restriction.
● fetus greater risk for being stillborn and, after birth,
● Low birth weight in infants of smoking mothers results
from vasoconstriction of the uterine vessels, an effect of
nicotine. This limits the blood supply to a fetus.
Teratogenicity of Alcohol
● Fetal alcohol syndrome
● Condition associated with an infant born to a woman who
uses alcohol during pregnancy; infant typically is small for
gestational age, cognitively challenged
Environmental Teratogens
For example, washing children's hair with a shampoo such as lindane (Kwell) to
remove lice should be limited to two exposures because of potential toxicity
Metal and Chemical Hazards
● Pesticides and carbon monoxide such as from automobile
exhaust should be avoided
● Women may ingest lead by drinking water that travels through old
pipes that are leaching lead or by "sniffing" lead-based gasoline.
● Lead ingestion during pregnancy may lead to a newborn who is
cognitively or neurologically challenged
Radiation
● Rapidly growing cells are extremely vulnerable to
destruction
● Radiation produces a range of malformations depending
on the stage of development of the embryo or fetus and
the strength and length of exposure
● scheduled for pelvic x-ray examinations only in the first 10
days of a menstrual cycle
Hyperthermia and Hypothermia
● Hyperthermia to a fetus can be detrimental to growth because it
interferes with cell metabolism
● This can occur from the use of saunas, hot tubs, or tanning beds,
from a work environment next to a furnace, such as in welding or
steel making, or from a high maternal fever early in pregnancy (4-6
weeks).
● Women who use a hot tub at 40° C should not stay in it for longer
than about 10 minutes at one time.
Teratogenic Maternal Stress
● If a woman sees a mouse during pregnancy, her child will be born
with a furry or mole like birthmark.
● Eating strawberries causes strawberry birthmarks.
● Looking at a handicapped child while pregnant will cause a child in
utero to be handicapped the same way.
Preparation for Labor
1. Lightening
● Lightening is the settling of the fetal head into the inlet of
the true pelvis
● It occurs approximately 2 weeks before labor in
primiparas but at unpredictable times in multiparas.
● Her abdominal contour is definitely changed, and on standing she
may experience frequency of urination or sciatic pain (pain across a
buttock radiating down her leg) from the lowered fetal position.
2. Show
● Is the common term used to describe the release of the
cervical plug (operculum) that formed during pregnancy.
● Operculum (Cervical plug)- is a plug that fills and seals
the cervical canal during pregnancy.
● It consists of a mucous, often blood-streaked vaginal
discharge and indicates the beginning of cervical
dilatation.
3. Rupture of Membranes
● A sudden gush of clear fluid (amniotic fluid) from the
vagina indicates rupture of the membranes.
● A woman should telephone her primary care provider immediately
when this occurs as after rupture of the membranes, there is a
danger of cord prolapse and uterine infection.
4. Excess Energy
● Feeling extremely energetic is a sign of labor important
for women to recognize.
● It occurs as part of the body's physiological preparation
for labor.
5. Uterine Contraction
● For most women, labor begins with contractions. True
labor contractions usually start in the back and sweep
forward across the abdomen like the tightening of a band.
● Advise a woman to call her primary care provider when
contractions begin to alert health care personnel that she
is in labor
QUIZ
1. Which finding from a woman's initial prenatal assessment would be considered
a possible complication of pregnancy that requires reporting to a primary care
provider for management?
A) episodes of double vision
B) increased lumbar curvature
C) nasal congestion and swollen nasal membranes
D) palpitations when lying on her back
2. A client the nurse meets in a prenatal clinic states that she has a vaginal
discharge and asks about douching. Which rule is safe regarding douching
during pregnancy?
A) Only commercial solutions should be used.
B) Routine douching is not advised.
C) The solution used never should be acid.
D) A room-temperature solution should not be used.
3. When discussing rest and sleep with a pregnant woman, the nurse would
discuss which position to use for napping?
A) on her stomach with a pillow under her breasts
B) on her side with the weight of the uterus on the bed
C) on her back with a pillow under her knees and hips
D) on her back with a pillow under her head
4. A pregnant woman experiences frequent leg cramps. Which measure would
the nurse include in her teaching plan to provide her with relief?
A) elevating her leg on two pillows
B) bending her knee and dorsiflexing her foot
C) plantar flexing her foot and wiggling her toes
D) extending her knee and dorsiflexing her foot
5. A woman is concerned that orgasm will be harmful during pregnancy. Which
statement is factual?
A) Most women do not experience orgasm during pregnancy.
B) Orgasm during pregnancy is potentially harmful.
C) Some women experience orgasm intensely during pregnancy.
D) Venous congestion in the pelvis makes orgasm painful.
6. A pregnant woman works as a secretary at a large corporation. She states that
she wants to take a leave of absence from work for pregnancy but is afraid she
will lose seniority standing because of this. You would advise her that
A) medically, it is not wise for any woman to work past the seventh month of
pregnancy.
B) legally, her employer cannot penalize her this way.
C) ethically, she has no right to ask for special favors.
D) personally, she is selfish to think of herself ahead of the baby this way.
7. A woman in early pregnancy asks you why she has palmar erythema. Your
reply would be based on the principle that palmar erythema is most likely caused
by which of the following?
A) An increased estrogen level
B) An allergy to fetal protein
C) Reduced serum protein
D) Chorionic gonadotropin hormone secretion
8. At midpoint during pregnancy, you review beginning signs of labor with a
patient. One of the beginning signs of labor you would review is
A) a sudden gush of clear fluid from the vagina.
B) excessive fatigue and headache.
C) sharp, right-sided abdominal pain.
D) an increased pulse rate and upper abdominal pain.
9. A pregnant woman enjoys exercising at a local health spa once a week. Which
comment would lead the nurse to believe she needs additional health teaching?
A) "I limit exercising to low-impact aerobics."
B) "Nothing feels nicer than a hot sauna after exercise."
C) "I'm learning to play table tennis."
D) "The gym gets hot and stuffy by midmorning."
10. An adolescent who is pregnant asks the nurse which sport would be safe for
her to learn during pregnancy. Which activity would the nurse suggest as safe?
A) bicycling
B) jogging
C) skiing
D) swimming
11. What advice would you give to a woman who is 4 months pregnant and owns
a cat?
A) Give it away until after delivery.
B) Be careful that it doesn't scratch her.
C) Ask someone else to change the cat litter.
D) Refrain from cleaning the cat's dish.
12. A woman who is 4 months pregnant notices frequent heart palpitations and
leg cramps. She is anxious to learn how to alleviate these. Which nursing
diagnosis would best apply to her?
A) Impaired urinary elimination related to inability to excrete creatine from her
muscles
B) Risk for ineffective breathing pattern related to pressure of the growing uterus
C) Pain related to severe complications of pregnancy
D) Health-seeking behaviors related to ways to relieve discomforts of
pregnancy
13. A pregnant woman has developed varicosities. Which statement would
suggest she needs additional health teaching?
A) "I maintain a high fluid intake."
B) "I'll try not to stand for long periods."
C) "I dorsiflex my feet and ankles frequently."
D) "I wear knee-highs rather than pantyhose."
14. What advice should the nurse provide to a pregnant client who admits to
continuing to drink alcohol 1 to 2 times a week?
A) She should avoid alcohol in the first trimester.
B) Alcohol should not be consumed during pregnancy.
C) The effects of alcohol on the fetus are not fully understood.
D) She may have an occasional drink after the first trimester.
16. A pregnant patient is experiencing a vaginal discharge and wants to douche.
What should the nurse instruct the patient about this health practice?
A) Avoid routine douching.
B) Use an alkaline solution.
C) Use only a commercial solution.
D) Use a solution that has been chilled.
17. The nurse is emphasizing the importance of adequate rest and sleep with a
pregnant patient. Which position should the nurse suggest the patient use?
A) On the back with a pillow under the head
B) On the stomach with a pillow under her breasts
C) On the back with a pillow under the knees and hips
D) On the side with the weight of the uterus on the bed
Ans: D
19. A pregnant patient is concerned that orgasm will be harmful to the developing
fetus. What should the nurse include when responding to this patient's concern?
A) Orgasm during pregnancy is potentially harmful.
B) Venous congestion in the pelvis makes orgasm painful.
C) Most women do not experience orgasm during pregnancy.
D) Some women experience orgasm intensely during pregnancy.
20. A pregnant patient who works as a secretary at a large corporation wants to
take a leave of absence from work but is afraid of losing seniority. What should
the nurse advise the patient?
A) The patient should not ask for special favors.
B) The leave of absence should occur after the baby is born.
C) The employer cannot penalize the patient for being pregnant.
D) It is not wise for any woman to work past the seventh month of pregnancy. D) An occasional drink is permitted only after the first trimester.

21. A pregnant patient is concerned that she is allergic to something because her 31. A pregnant patient is planning travel to a foreign country as part of a work
hands have been red and itchy since becoming pregnant. What should the nurse assignment and needs immunizations. What should the nurse instruct the patient
explain as the cause of the patient's symptoms? about immunizations while pregnant?

A) Allergy to fetal protein A) Immunizations should be restricted to live viruses only.

B) Reduced serum protein B) There are no restrictions on immunizations while pregnant.
C) Increased estrogen level C) The only immunization that should be avoided is for the flu.
D) Chorionic gonadotropin hormone secretion D) Live virus immunizations are contraindicated while pregnant.

22. The nurse is reviewing the signs of labor with a patient entering the last
phase of the third trimester of pregnancy. What should the nurse include as an
indication that the labor is beginning?
A) Excessive fatigue and headache
B) Sharp, right-sided abdominal pain
C) Sudden gush of clear fluid from the vagina
D) An increased pulse rate and upper abdominal pain
32. A pregnant patient reports feeling pain similar to menstrual cramps. What
should the nurse explain about this patient's symptoms?
A) Exercise helps reduce the frequency of them.
B) If rhythmical, they could indicate preterm labor.
C) Lying down for a few hours will help them stop.
D) They are false labor and do not need to be reported.

23. A pregnant patient enjoys exercising at a local health spa once a week.
Which patient comment indicates to the nurse that additional health teaching is
needed?
A) "I'm learning to play table tennis."
B) "I limit exercising to low-impact aerobics."
C) "The gym gets hot and stuffy by midmorning."
D) "Nothing feels nicer than a hot tub soak after exercise."
24. An adolescent asks which sport would be safe for her to learn during
pregnancy. Which activity should the nurse suggest to the patient?
A) Skiing
B) Jogging
C) Bicycling
D) Swimming
25. What advice should the nurse provide to a patient who is 4 months pregnant
and owns a cat?
A) Give it away until after delivery.
B) Refrain from cleaning the cat's dish.
C) Be careful that it doesn't scratch the skin.
D) Ask someone else to change the cat litter.
33. A pregnant patient has a history of genital herpes lesions and has
experienced outbreaks periodically throughout the pregnancy. What should the
nurse instruct the patient regarding this virus if lesions are present at the time of
delivery?
A) A cesarean section will be advised at the time of birth.
B) There are no precautions needed at the time of birth.
C) The patient will need medication immediately after birth.
D) The baby will be given a vaccination against the virus at birth.
34. Which statement would indicate a pregnant nurse needs additional health
teaching about avoiding teratogens during pregnancy while at work?
A) "I care for about five clients a day."
B) "Latex gloves irritate my hands, so I don't use them."
C) "I never accompany clients to the X-ray department."
D) "I find giving emotional support taxing."
=====================
The client is being seen at 24 weeks' gestation at the prenatal clinic. At her last
routine visit, the fundus was located at the umbilicus. Today, the fundus is
measured and found to be 23 cm. How should the nurse interpret this finding?
● Fundus is at the appropriate level.

26. A woman who is 4 months pregnant asks what can be done to alleviate The nurse is performing a measurement of fundal height in a client whose
frequent heart palpitations and leg cramps. Which nursing diagnosis would be pregnancy has reached 36 weeks of gestation. During the measurement the
applicable to the patient at this time? client begins to feel lightheaded. On the basis of knowledge of the physiological
changes of pregnancy, the nurse understands that which is the cause of the
A) Pain related to severe complications of pregnancy lightheadedness?
B) Health-seeking behaviors related to ways to relieve discomforts of ● Compression of the vena cava
pregnancy
C) Risk for ineffective breathing pattern related to pressure of the growing uterus
D) Impaired urinary elimination related to inability to excrete creatine from the
muscles
Ans: B

27. During the previous prenatal visit, the nurse instructed a pregnant patient on
ways to reduce the impact of varicosities. Which patient statement indicates that
additional teaching is needed?

A) "I drink fluid throughout the day."

B) "I'll try not to stand for long periods."
C) "I point my toes up and down frequently."
D) "I wear knee-highs rather than pantyhose."

28. A nurse is 5 weeks pregnant and works on a care area where chemotherapy
is administered to patients. Which statement indicates that this nurse needs
additional health teaching about avoiding teratogens during pregnancy?

A) "I care for about five patients a day."

B) "I find giving emotional support taxing."
C) "Latex gloves irritate my hands, so I don't use them."
D) "I never accompany patients to the X-ray department."

29. What advice should the nurse provide to a pregnant patient who admits to
continuing to drink alcohol one to two times a week?

A) Avoid all alcohol while pregnant.

B) Avoid alcohol in the first trimester.
C) The effects of alcohol on the fetus are not fully understood.