Prenatal And Antepartum Support
Help Questions
NCLEX-PN › Prenatal And Antepartum Support
A practical nurse (PN) is reinforcing teaching about nutrition to a client at 10 weeks gestation. Which statement by the client indicates an understanding of the teaching?
“I need to avoid all dairy products to prevent allergies in my baby.”
“I should eat for two now, so I’ll double my usual calorie intake.”
“I can stop taking my prenatal vitamins if I eat a balanced diet.”
“I need to increase my folic acid intake to prevent birth defects.”
Explanation
The correct statement indicates an understanding of the importance of folic acid in preventing neural tube defects in the developing fetus. Doubling caloric intake is a common misconception and can lead to excessive weight gain. Prenatal vitamins are necessary to supplement a balanced diet and ensure adequate micronutrient levels. Avoiding dairy is unnecessary unless the client has a lactose intolerance and could lead to inadequate calcium intake.
A client in the first trimester of pregnancy reports frequent nausea and vomiting. Which suggestion should the PN offer to help manage this discomfort?
“Lie down immediately after eating to promote digestion.”
“Drink a large glass of water with each meal.”
“Eat three large, high-fat meals per day.”
“Eat small, frequent meals and snacks throughout the day.”
Explanation
Eating small, frequent meals helps to keep the stomach from becoming too empty or too full, which can trigger nausea. Large, high-fat meals can worsen nausea and are hard to digest. Drinking large amounts of fluid with meals can increase stomach distention and nausea. Lying down after eating can worsen heartburn and does not aid in managing nausea.
The PN is collecting data from a client at 32 weeks gestation. Which client statement requires immediate notification of the registered nurse (RN)?
“I’ve noticed a blurry spot in my vision that won’t go away.”
“I’ve been feeling more Braxton Hicks contractions lately.”
“I have to urinate more frequently than I did last month.”
“My feet are more swollen at the end of the day.”
Explanation
Visual disturbances, such as blurred vision or seeing spots, can be a sign of preeclampsia, a serious hypertensive disorder of pregnancy that requires immediate evaluation by the RN and healthcare provider. Dependent edema (swollen feet), urinary frequency, and Braxton Hicks contractions are all common and expected findings in the third trimester.
The PN is preparing to measure the fundal height of a client at 28 weeks gestation. Which action should the PN take to ensure an accurate measurement?
Place the client in a left lateral recumbent position.
Ensure the client has had a full glass of water.
Measure from the xiphoid process to the top of the fundus.
Ask the client to empty her bladder before the measurement.
Explanation
A full bladder can displace the uterus upward and lead to an inaccurate fundal height measurement. Therefore, the client should be asked to void before the procedure. The client should be positioned supine with knees slightly flexed. The measurement is taken from the top of the symphysis pubis to the top of the uterine fundus.
The PN is reinforcing instructions about monitoring fetal movement to a client at 30 weeks gestation. Which statement by the client indicates that further teaching is needed?
“I should count the baby's movements at about the same time each day.”
“I should feel at least 10 movements in a 2-hour period.”
“If I notice a lot of movement, I should call the clinic immediately.”
“If the baby is less active, I can try drinking a cold, sugary drink.”
Explanation
Further teaching is needed because a significant decrease or absence of fetal movement is the primary concern that needs to be reported, not an increase. Active fetal movement is a sign of well-being. The other statements reflect a correct understanding of how to perform and interpret fetal kick counts.
A client in her first trimester tells the PN that she enjoys a glass of wine with dinner several times a week. What is the most appropriate response by the PN?
“You should switch to beer, as it has a lower alcohol content.”
“It's best to avoid all alcohol, as no amount is considered safe during pregnancy.”
“You can continue drinking wine until the third trimester.”
“One glass of wine is fine, but you should not drink any hard liquor.”
Explanation
Current medical guidelines state that no amount of alcohol is safe during pregnancy due to the risk of fetal alcohol spectrum disorders. The PN must reinforce this critical health information. Suggesting other forms of alcohol or setting arbitrary limits is incorrect and dangerous advice.
A pregnant client expresses anxiety about her ability to care for a newborn. Which action by the PN demonstrates therapeutic communication?
“Don't worry, it will all come naturally once the baby is born.”
“You should read some parenting books to feel more prepared.”
“Tell me more about what is making you feel anxious.”
“Many new mothers feel that way, but you'll be fine.”
Explanation
Using an open-ended statement like “Tell me more…” is a therapeutic technique that encourages the client to verbalize her feelings and concerns. The other options are non-therapeutic: offering false reassurance (A, D) or giving unsolicited advice (C), which can block communication and invalidate the client's feelings.
A client at 26 weeks gestation is scheduled for a 1-hour glucose tolerance test. The PN is reinforcing instructions for the test. Which instruction is correct?
“You should eat a high-carbohydrate meal right before the test.”
“You must fast for 12 hours before coming to the lab.”
“You will be asked to drink a sweet liquid, and your blood will be drawn one hour later.”
“This test requires three separate blood draws over a three-hour period.”
Explanation
This correctly describes the procedure for the 1-hour glucose challenge test, which is a screening for gestational diabetes. Fasting is not required for the 1-hour screening test. Eating a high-carb meal just before could skew the results. The 3-hour glucose tolerance test (a diagnostic test) requires fasting and multiple blood draws.
The PN is reinforcing teaching for a pregnant client who has been prescribed ferrous sulfate for anemia. Which statement indicates the client understands how to take this medication?
“I should take this medication on an empty stomach with orange juice.”
“I will take my iron pill with a glass of milk to prevent an upset stomach.”
“I can crush the pill and mix it in with my morning coffee.”
“My stools will probably be lighter in color while taking this pill.”
Explanation
Iron is best absorbed on an empty stomach, and absorption is enhanced by Vitamin C, which is found in orange juice. Milk and other dairy products contain calcium, which can inhibit iron absorption. Iron supplements typically cause stools to become dark green or black, not lighter. Coffee and tea can also decrease iron absorption.
The PN is collecting data on a client at 24 weeks gestation. The client reports that she has had a persistent, severe headache for the past two days. What is the PN's priority action?
Document the finding in the client's chart.
Report the finding to the registered nurse (RN) immediately.
Recommend the client take acetaminophen.
Advise the client to rest in a dark, quiet room.
Explanation
A persistent, severe headache is a potential sign of preeclampsia, which requires prompt assessment and intervention. The PN's priority is to recognize this danger sign and report it to the RN for further evaluation. Recommending medication or rest, or simply documenting, delays necessary assessment by the RN or provider.