Nokea
The pregnant client tells the nurse that she thinks she is carrying twins. In reviewing the client’s history and medical records, the nurse should determine that which factors are associated with a multiple gestation? Select all that apply.
- A. Elevated serum alpha-fetoprotein
- B. Use of reproductive technology
- C. Maternal age greater than 40
- D. History of twins in the family
- E. Elevated hemoglobin levels
Correct Answer: A,B,D
Rationale: An elevated serum alpha-fetoprotein level (an oncofetal protein normally produced by the fetal liver and yolk sac) is associated with a multiple gestation. The use of reproductive technology such as artificial insemination or fertility drugs is associated with a multiple gestation. History of twins in the family is associated with a multiple gestation. Maternal age greater than 40 is not associated with multiple gestation. An elevated Hgb is not associated with multiple gestation.
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Which resource should the nurse recommend for additional prenatal education?
- A. Reputable pregnancy websites
- B. Social media forums
- C. Unverified blogs
- D. Television advertisements
Correct Answer: A
Rationale: Reputable pregnancy websites provide evidence-based information, ensuring accurate and reliable prenatal education.
On the basis of this finding, the nurse can assume that the client is at least how many months' pregnant?
- A. 5 months
- B. 6 months
- C. 7 months
- D. 8 months
Correct Answer: A
Rationale: Ballottement, the rebound of the fetus when the cervix is tapped, is typically detectable around 4-5 months, indicating at least 5 months' gestation.
After delivering the full-term infant, the breastfeeding mother asks the nurse if there is any contraceptive method that she should avoid while she is breastfeeding. Which contraceptive should the nurse advise the client to avoid?
- A. A diaphragm
- B. An intrauterine device (IUD)
- C. The combined oral contraceptive (COC) pill
- D. The progesterone-only mini pill
Correct Answer: C
Rationale: Because a diaphragm must be fitted to the individual female cervix, the diaphragm must be rechecked for correct size after each childbirth; however, use of the diaphragm will not affect breast milk production. An IUD will not affect breast milk production unless the IUD is inserted within the first 48 hours postpartum; insertion should be delayed until 4 weeks postpartum. Birth control pills containing progesterone and estrogen (COC) can cause a decrease in milk volume and may affect the quality of the breast milk. The progesterone-only mini pill may be used by breastfeeding clients because it does not interfere with breast milk production. However, it is recommended that the mother wait 6 to 8 weeks before starting this method of contraception.
The 42-year-old client who had a partial hydatidiform molar pregnancy 3 months ago asks the nurse whether she and her husband can try conceiving again. Which response by the nurse is incorrect and warrants follow-up action by the observing nurse manager?
- A. “You will need serial levels of beta human chorionic gonadotropin (BHCG) drawn.”
- B. “You cannot conceive ever again because of your risk of choriocarcinoma.”
- C. “You should not become pregnant yet for 6 to 12 months.”
- D. “Your risk of another hydatidiform molar pregnancy is low.”
Correct Answer: B
Rationale: Women who have had a molar pregnancy can conceive again once their BHCG levels are normal and remain normal for a certain time period, usually 6 to 12 months. This response by the nurse is incorrect and should be followed up by the observing nurse manager. Because of the risk of choriocarcinoma, serial serum BHCG testing is completed after a hydatidiform molar pregnancy. Because the client will undergo serial serum BHCG testing after a hydatidiform molar pregnancy, she should not get pregnant for 6 to 12 months until testing is completed and it is confirmed that she does not have a malignancy. Couples with a past history of molar pregnancy have the same statistical chance of conceiving again and having a normal pregnancy as those without.
The Caucasian postpartum client asks the nurse if the stretch marks (striae gravidarum) on her abdomen will ever go away. Which response by the nurse is most accurate?
- A. “Your stretch marks should totally disappear over the next month.”
- B. “Your stretch marks will always appear raised and reddened.”
- C. “Your stretch marks will lighten in color with good skin hydration.”
- D. “Your stretch marks will fade to pale white over the next 3 to 6 months.”
Correct Answer: D
Rationale: Stretch marks will fade but will not totally disappear. Stretch marks will fade and will not always appear reddened. There is no evidence that keeping the skin hydrated will lighten the appearance of the stretch marks. In Caucasian women, stretch marks will fade to a pale white over 3 to 6 months.