Old's Maternal-Newborn Nursing and Women's Health, 11e (Davidson/London/Ladewig)

Chapter 12 Antepartum Nursing Assessment

1. While completing the medical and surgical history during the initial prenatal visit, the 16-year-old primigravida interrupts with "Why are you asking me all these questions? What difference does it make?" Which statement would best answer the client's questions?
2. "We ask these questions to detect anything that happened in your past that might affect the pregnancy."
3. "We ask these questions to see whether you can have prenatal visits less often than most clients do."
4. "We ask these questions to make sure that our paperwork and records are complete and up to date."
5. "We ask these questions to look for any health problems in the past that might affect your parenting."

Page Ref: 227—228

Cognitive Level: Applying

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

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | A A C N 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. | N L N 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: 1 Summarize the essential components of a prenatal history.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. A woman gave birth last week to a fetus at 18 weeks' gestation after her first pregnancy. She is in the clinic for follow-up, and notices that her chart states she has had one abortion. The client is upset over the use of this word. How can the nurse best explain this terminology to the client?
2. "Abortion is the obstetric term for all pregnancies that end before 20 weeks."
3. "Abortion is the word we use when someone has miscarried."
4. "Abortion is how we label babies born in the second trimester."
5. "Abortion is what we call all babies who are born dead."

Page Ref: 227

Cognitive Level: Understanding

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

Standards: Q S E N Competencies: Ⅰ. C. 1. Value seeing healthcare situations "through patients' eyes." | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Respect the patient's dignity, uniqueness, integrity, and self-determination and his or her own power and self-healing processes. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 2 Define common obstetric terminology found in the history of maternity patients.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. The clinic nurse is compiling data for a yearly report. Which client would be classified as a primigravida?
2. A client at 18 weeks' gestation who had a spontaneous loss at 12 weeks
3. A client at 13 weeks' gestation who had an ectopic pregnancy at 8 weeks
4. A client at 14 weeks' gestation who has a 3-year-old daughter at home
5. A client at 15 weeks' gestation who has never been pregnant before

Page Ref: 227

Cognitive Level: Remembering

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

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Define common obstetric terminology found in the history of maternity patients.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. The client has delivered her first child at 37 weeks. The nurse would describe this to the client as what type of delivery?
2. Preterm
3. Postterm
4. Early term
5. Near term

Page Ref: 227

Cognitive Level: Remembering

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

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 2 Define common obstetric terminology found in the history of maternity patients.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. The prenatal clinic nurse is designing a new prenatal intake information form for pregnant clients. Which question is best to include on this form?
2. Where was the father of the baby born?
3. Do genetic diseases run in the family of the baby's father?
4. What is the name of the baby's father?
5. Are you married to the father of the baby?

Page Ref: 228

Cognitive Level: Applying

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

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | A A C N 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. | N L N Competencies: Relationship-Centered Care: Appreciate the value of 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 Summarize the essential components of a prenatal history.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. A 25-year-old primigravida is at 20 weeks' gestation. The nurse takes her vital signs and notifies the healthcare provider immediately because of which finding?
2. Pulse 88/minute
3. Rhonchi in both bases
4. Temperature 37.4°C (99.3°F)
5. Blood pressure 122/78 m m H g

Page Ref: 235

Cognitive Level: Analyzing

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

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Safety and Quality: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Diagnosis.

Learning Outcome: 3 Predict the normal physiologic changes one would expect to find when performing a physical assessment on a pregnant woman.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. The clinic nurse is assisting with an initial prenatal assessment. The following findings are present: spider nevi on lower legs; dark pink, edematous nasal mucosa; mild enlargement of the thyroid gland; mottled skin and pallor on palms and nail beds; heart rate 88 with murmur present. What is the best action for the nurse to take based on these findings?
2. Document the findings on the prenatal chart.
3. Have the physician see the client today.
4. Instruct the client to avoid direct sunlight.
5. Analyze previous thyroid hormone lab results.

Page Ref: 234

Cognitive Level: Analyzing

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

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Safety and Quality: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Diagnosis.

Learning Outcome: 3 Predict the normal physiologic changes one would expect to find when performing a physical assessment on a pregnant woman.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. The nurse begins a prenatal assessment on a 25-year-old primigravida at 20 weeks' gestation and immediately contacts the healthcare provider because of which finding?
2. Pulse 88/minute
3. Respirations 30/minute
4. Temperature 37.4°C (99.3°F)
5. Blood pressure 118/82 m m H g

Page Ref: 234

Cognitive Level: Analyzing

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

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 3 Predict the normal physiologic changes one would expect to find when performing a physical assessment on a pregnant woman.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. The nurse is seeing prenatal clients in the clinic. Which client is exhibiting expected findings?
2. 12 weeks' gestation, with fetal heart tones heard by Doppler fetoscope
3. 22 weeks' gestation, client reports no fetal movement felt yet
4. 16 weeks' gestation, fundus three finger-breadths above umbilicus
5. Marked edema

Page Ref: 237

Cognitive Level: Applying

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

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 3 Predict the normal physiologic changes one would expect to find when performing a physical assessment on a pregnant woman.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. What signs would indicate that a pregnant client's urinalysis culture was abnormal?

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

Select all that apply.

1. p H 4.6-8
2. Alkaline urine
3. Cloudy appearance
4. Negative for protein and red blood cells
5. Hemoglobinuria

Page Ref: 239

Cognitive Level: Understanding

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

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | A A C N 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. | N L N 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 Predict the normal physiologic changes one would expect to find when performing a physical assessment on a pregnant woman.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. The nurse receives a phone call from a client who claims she is pregnant. The client reports that she has regular menses that occur every 28 days and last 5 days. The first day of her last menses was April 10. What would the client's estimated date of delivery (E D D) be if she is pregnant?
2. Nov. 13
3. Jan. 17
4. Jan. 10
5. Dec. 3

Page Ref: 242

Cognitive Level: Remembering

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

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | A A C N 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. | N L N 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: 4 Calculate the estimated date of birth using the common methods.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. The primigravida at 22 weeks' gestation has a fundal height palpated slightly below the umbilicus. Which of the following statements would best describe to the client why she needs to be seen by a physician today?
2. "Your baby is growing too much and getting too big."
3. "Your uterus might have an abnormal shape."
4. "The position of your baby can't be felt."
5. "Your baby might not be growing enough."

Page Ref: 243

Cognitive Level: Applying

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

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 13. Revise the plan of care based on an ongoing evaluation of patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 3 Predict the normal physiologic changes one would expect to find when performing a physical assessment on a pregnant woman.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. The nurse is explaining to a new prenatal client that the certified nurse-midwife will perform clinical pelvimetry as a part of the pelvic exam. The nurse knows that teaching has been successful when the client makes which statement about the reason for the exam?
2. "It will help us know how big a baby I can deliver vaginally."
3. "Doing this exam is a part of prenatal care at this clinic."
4. "My sister had both of her babies by cesarean."
5. "I am pregnant with my first child."

Page Ref: 244

Cognitive Level: Understanding

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

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N 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. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 5 Describe the essential measurements that can be determined by clinical pelvimetry.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. The nurse is assessing a newly pregnant client. Which finding does the nurse note as a normal psychosocial adjustment in this client's first trimester?
2. An unlisted telephone number
3. Reluctance to tell the partner of the pregnancy
4. Parental disapproval of the woman's partner
5. Ambivalence about the pregnancy

Page Ref: 240

Cognitive Level: Applying

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

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | A A C N 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. | N L N 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 Summarize the essential components of a prenatal history.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. The nurse is assessing a primiparous client who indicates that her religion is Judaism. Why is this information pertinent for the nurse to assess?
2. Religious and cultural background can impact what a client eats during pregnancy.
3. It provides a baseline from which to ask questions about the client's religious and cultural background.
4. Knowing the client's beliefs and behaviors regarding pregnancy is not important.
5. Clients sometimes encounter problems in their pregnancies based on what religion they practice.

Page Ref: 240, 249

Cognitive Level: Understanding

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

Standards: Q S E N Competencies: Ⅰ. C. 2. Respect and encourage individual expression of patient values, preferences, and expressed needs. | A A C N 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. | N L N Competencies: Relationship-Centered Care: Respect the patient's dignity, uniqueness, integrity, and self-determination and his or her own power and self-healing processes. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 1 Summarize the essential components of a prenatal history.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. What would the nurse include as part of a routine physical assessment for a second-trimester primiparous patient whose prenatal care began in the first trimester and is ongoing?
2. Pap smear
3. Hepatitis B screening (H Bs A g)
4. Fundal height measurement
5. Complete blood count

Page Ref: 243

Cognitive Level: Understanding

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

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | A A C N 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. | N L N 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 Predict the normal physiologic changes one would expect to find when performing a physical assessment on a pregnant woman.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. If a woman has the pre-existing condition of diabetes, the nurse knows that she would be prone to what high-risk factor when pregnant?
2. Vasospasm
3. Postpartum hemorrhage
4. Episodes of hypoglycemia and hyperglycemia
5. Cerebrovascular accident (C V A)

Page Ref: 246—247

Cognitive Level: Applying

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

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate effectively with different individuals (team members, other care providers, patients, families, etc.) so as to minimize risks associated with handoffs among providers and across transitions in care. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 7 Relate the danger signs of pregnancy to their possible causes.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. Which third-trimester client would the nurse suspect might be having difficulty with psychological adjustments to her pregnancy?
2. A woman who says, "Either a boy or a girl will be fine with me"
3. A woman who puts her feet up and listens to some music for 15 minutes when she is feeling too stressed
4. A woman who was a smoker but who has quit at least for the duration of her pregnancy
5. A woman who has not investigated the kind of clothing or feeding methods the baby will need

Page Ref: 253

Cognitive Level: Analyzing

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

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 8 Relate the components of the subsequent prenatal history and assessment to the progress of pregnancy and the nursing care of the prenatal patient.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. A nurse examining a prenatal client recognizes that a lag in progression of measurements of fundal height from week to week and month to month could signal what condition?
2. Twin pregnancy
3. Intrauterine growth restriction
4. Hydramnios
5. Breech position

Page Ref: 231

Cognitive Level: Applying

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

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | A A C N 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. | N L N Competencies: Relationship-Centered Care: Appreciate the patient as a whole person with his or her life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 3 Predict the normal physiologic changes one would expect to find when performing a physical assessment on a pregnant woman.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. The nurse at the prenatal clinic has four calls to return. Which call should the nurse return first?
2. Client at 32 weeks, reports headache and blurred vision.
3. Client at 18 weeks, reports no fetal movement in this pregnancy.
4. Client at 16 weeks, reports increased urinary frequency.
5. Client at 40 weeks, reports sudden gush of fluid and contractions.

Page Ref: 249

Cognitive Level: Analyzing

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

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 3 Predict the normal physiologic changes one would expect to find when performing a physical assessment on a pregnant woman.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. Screening for gestational diabetes mellitus (G D M) is typically completed between which of the following weeks of gestation?
2. 36 and 40 weeks
3. Before 20 weeks
4. 24 and 28 weeks
5. 30 and 34 weeks

Page Ref: 246

Cognitive Level: Remembering

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Summarize the results of the major screening tests used during the prenatal period in the assessment of the prenatal patient.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. A pregnant patient's first day of her last menstrual period was 6/14. What would be this patient's estimated date of birth?

Page Ref: 242

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N 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. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Assessment: Nursing Process.

Learning Outcome: 4 Calculate the estimated date of birth using the common methods.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. The nurse is measuring the fundal height of a patient who is at 28 weeks' gestation using the following method. What would be considered a normal finding?

1. 22 c m
2. 24 c m
3. 28 c m
4. 30 c m

Page Ref: 243

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N 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. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Evaluation: Nursing Process.

Learning Outcome: 3 Predict the normal physiologic changes one would expect to find when performing a physical assessment on a pregnant woman.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. The nurse is explaining pelvic measurements to a patient who is 20 weeks pregnant. On the diagram, which measurement should the nurse identify as being the smallest for the fetus to pass during delivery?

1. A
2. B
3. C
4. D

Page Ref: 244

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N 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. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 5 Describe the essential measurements that can be determined by clinical pelvimetry.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. A pregnant patient is having pelvic measurements made. Which approach should the examiner use to determine this patient's estimated length of the pubic ramus?

Page Ref: 247

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N 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. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Nursing Process.

Learning Outcome: 5 Describe the essential measurements that can be determined by clinical pelvimetry.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. During the examination of a patient who is pregnant 24 weeks, the healthcare provider performs the maneuver in the diagram below. What is being measured on this patient?

1. Subpubic angle
2. Transverse diameter
3. Anteroposterior sagittal diameter
4. Height and angle of the symphysis pubis

Page Ref: 246

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N 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. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Assessment: Nursing Process.

Learning Outcome: 5 Describe the essential measurements that can be determined by clinical pelvimetry.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. The nurse is collecting information during the health history assessment for the client profile during the initial prenatal visit. Which question is appropriate when assessing the current pregnancy?
2. "What was the date of your last menstrual period?"
3. "How many times have you been pregnant?"
4. "What were your children's birth weights?"
5. "How many living children do you have?"

Page Ref: 241

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅲ. B. 3. Base individualized care plan on client values, clinical expertise and evidence. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in clients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice: apply health promotion/disease prevention strategies; apply health policy. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 1 Summarize the essential components of a prenatal history.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. The nurse is assessing an obese pregnant client during a routine prenatal visit. Which is the priority assessment for this client?
2. Complete blood count (C B C)
3. Basic metabolic panel (B M P)
4. Blood pressure
5. Fetal heart rate

Page Ref: 251

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide client-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in clients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice: apply health promotion/disease prevention strategies; apply health policy. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 8 Relate the components of the subsequent prenatal history and assessment to the progress of pregnancy and the nursing care of the prenatal client.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. The nurse is providing care to a pregnant client diagnosed with a urinary tract infection (U T I) during a routine prenatal visit. What will the nurse educate the client about based on this data?
2. Gestational hypertension
3. Gestational diabetes mellitus
4. Preterm labor
5. Anemia

Page Ref: 233

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide client-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in clients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice: apply health promotion/disease prevention strategies; apply health policy. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 8 Relate the components of the subsequent prenatal history and assessment to the progress of pregnancy and the nursing care of the prenatal client.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. The nurse is preparing to assess the pregnant client's fundal height during a routine prenatal visit. Which nursing action is appropriate in this situation?
2. Telling the client not to eat or drink for one hour after the procedure
3. Asking the client to empty her bladder prior to the procedure
4. Obtaining informed consent for the procedure
5. Assessing blood pressure after the procedure

Page Ref: 243

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅲ. B. 3. Base individualized care plan on client values, clinical expertise and evidence. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in clients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; apply health promotion/disease prevention strategies; apply health policy. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 5 Describe the essential measurements that can be determined by clinical pelvimetry.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. The nurse is explaining "quickening" to a client who is pregnant for the first time. Which client indicates the need for further education on this topic?
2. "It will feel like butterflies in my stomach."
3. "It might feel like I have gas."
4. "It should occur during the second trimester of my pregnancy."
5. "It is an indication that I am experiencing preterm labor."

Page Ref: 243

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅲ. B. 3. Base individualized care plan on client values, clinical expertise and evidence. | A A C N Essentials Competencies: I X.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in clients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice: apply health promotion/disease prevention strategies; apply health policy. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 3 Predict the normal physiologic changes one would expect to find when performing a physical assessment on a pregnant woman.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. The nurse is teaching a pregnant client the clinical manifestations associated with preterm labor. Which client statement indicates the need for further education?
2. "Menstrual-like cramps are a sign of preterm labor."
3. "A dull low backache is a sign of preterm labor."
4. "Diarrhea is a sign of preterm labor."
5. "Vomiting is a sign of preterm labor."

Page Ref: 248

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅲ. B. 3. Base individualized care plan on client values, clinical expertise and evidence. | A A C N Essentials Competencies: I X.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in clients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; apply health promotion/disease prevention strategies; apply health policy. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 7 Relate the danger signs of pregnancy to their possible causes.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. The nurse is conducting an initial prenatal assessment for a pregnant client. Which screenings should the nurse prepare the client for during this visit?

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

Select all that apply.

1. Complete blood count (C B C)
2. Glucose tolerance test (G T T)
3. A B O and Rh typing
4. H I V screening
5. Urinalysis

Page Ref: 252

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅲ. B. 3. Base individualized care plan on client values, clinical expertise and evidence. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in clients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; apply health promotion/disease prevention strategies; apply health policy. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 6 Summarize the results of the major screening tests used during the prenatal period in the assessment of the prenatal patient.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. Which serum markers are assessed when conducting a quadruple screen?

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

Select all that apply.

1. Alpha-fetoprotein (A F P)
2. Human chorionic gonadotropin (h C G)
3. Unconjugated estriol (U E)
4. Inhibin-A
5. Glycated hemoglobin

Page Ref: 248

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅲ. B. 3. Base individualized care plan on client values, clinical expertise and evidence. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in clients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; apply health promotion/disease prevention strategies; apply health policy. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 6 Summarize the results of the major screening tests used during the prenatal period in the assessment of the prenatal patient.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.

1. The nurse is teaching the pregnant client about the symptoms of preeclampsia. Which clinical manifestations will the nurse include in the teaching session?

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

Select all that apply.

1. Dizziness
2. Blurred vision
3. Abdominal pain
4. Vaginal bleeding
5. Severe headache

Page Ref: 249

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅲ. B. 3. Base individualized care plan on client values, clinical expertise and evidence. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in clients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice: apply health promotion/disease prevention strategies; apply health policy. | Nursing/Integrated Concepts: Teaching and Learning.

Learning Outcome: 7 Relate the danger signs of pregnancy to their possible causes.

M N L L O: Demonstrate ability to perform assessment and interpret data for a patient during the antepartum period.