Choice A rationale

The nurse should include in the teaching that a client who is 23 weeks pregnant can receive an influenza vaccination during pregnancy. This is because the influenza vaccine is safe and recommended for pregnant women to protect both the mother and the baby from the flu.

Choice B rationale

The rubella vaccine is a live vaccine and is not recommended during pregnancy or while breastfeeding due to the potential risk to the baby. However, it can be given immediately after delivery if the woman is not immune.

Choice C rationale

The varicella vaccine is also a live vaccine and is not recommended during pregnancy. It should be given before pregnancy or immediately after delivery if the woman is not immune.

Choice D rationale

The Tdap (Tetanus, Diphtheria, Pertussis) vaccine is actually recommended during each pregnancy, regardless of the patient’s previous history of receiving the vaccine. The optimal timing for Tdap administration is between 27 and 36 weeks of gestation.

Choice A rationale

The statement “I will use only nonprescription medications while pregnant” indicates a need for further teaching. Not all nonprescription (over-the-counter) medications are safe to use during pregnancy. Some may have effects on the fetus and others may affect the course of the pregnancy.

Choice B rationale

It’s important for pregnant women to discuss any home remedies for nausea or other symptoms with their doctor, as some remedies may not be safe during pregnancy.

Choice C rationale

Monitoring weight gain during pregnancy is important as excessive or insufficient weight gain can lead to complications such as gestational diabetes, hypertension, or growth issues for the baby.

Choice D rationale

Reducing stress levels during pregnancy is beneficial for both the mother and the baby’s health. High levels of stress can lead to complications such as preterm labor and low birth weight.

Choice A rationale

While it’s important for the nurse to provide reassurance and support during the exam, this statement alone doesn’t address the client’s specific concerns or provide any useful information.

Choice B rationale

Telling the client to relax doesn’t address her concerns or provide any useful information. It’s normal to feel nervous before a pelvic exam, especially if it’s the first one.

Choice C rationale

Asking the client what part of the exam makes her most nervous allows the nurse to provide specific information and reassurance, which can help alleviate the client’s anxiety.

Choice D rationale

While a pelvic exam is often part of the process when starting oral contraceptives, it’s not always required. The need for a pelvic exam can depend on the client’s age, sexual history, and other factors.

Choice A rationale

The recommended time for rubella immunization for a woman who does not have immunity and is in the first trimester of pregnancy is shortly after giving birth. This is because the rubella vaccine is a live vaccine and is not recommended during pregnancy due to the potential risk to the fetus.

Choice B rationale

The rubella vaccine should not be given immediately during pregnancy due to the potential risk to the fetus.

Choice C rationale

While it’s ideal for a woman to be immune to rubella before she gets pregnant, if she finds out during pregnancy that she’s not immune, the vaccine should be given after delivery.

Choice D rationale

The rubella vaccine is not recommended during the third trimester of pregnancy due to the potential risk to the fetus.

Choice A rationale

A 38-year-old client who reports smoking one pack of cigarettes every day. Oral contraceptives are contraindicated in women who are over 35 years old and smoke. This is because the combination of oral contraceptives and smoking increases the risk of serious cardiovascular side effects, such as blood clots, stroke, or heart attack. These risks are even higher in women over 35 years old who smoke. Therefore, this client should not receive oral contraceptives due to the increased risk of these serious side effects.

Choice B rationale

A 28-year-old client who has a history of pelvic inflammatory disease. While pelvic inflammatory disease (PID) can lead to complications such as infertility and ectopic pregnancy, it is not a contraindication for the use of oral contraceptives. In fact, oral contraceptives can provide some protection against PID by causing changes in the cervix that make it more resistant to infection.

Choice C rationale

A 32-year-old client who has benign breast disease. Benign breast disease is not a contraindication for the use of oral contraceptives. While some studies have suggested a slightly increased risk of breast cancer in women who have used oral contraceptives, the risk appears to decrease over time once the contraceptives are stopped.

Choice D rationale

A 26-year-old client who has migraine headaches at the start of each menstrual cycle. While migraines can be a contraindication for the use of oral contraceptives, it generally applies to migraines with aura. Women who have migraines with aura have an increased risk of stroke when using oral contraceptives. However, for women who have migraines without aura, the benefits of using oral contraceptives usually outweigh the risks.

Choice A rationale

Moderate exercise improves circulation. This statement is accurate and should be included in the teaching. Regular moderate exercise during pregnancy can have many benefits, including improved circulation, which can help reduce swelling and varicose veins. It can also help manage weight gain, improve mood and energy levels, reduce pregnancy discomfort, prepare the body for labor, and boost stamina for labor and delivery.

Choice B rationale

Refrain from exercises that include stretching. This statement is not accurate and should not be included in the teaching. Stretching exercises can be beneficial during pregnancy. They can help improve flexibility, reduce muscle tension, alleviate pregnancy discomfort, and prevent muscle imbalances. However, pregnant women should be careful not to stretch too far, as the hormones produced during pregnancy can make the ligaments more flexible and easier to stretch, increasing the risk of injuries.

Choice C rationale

It is recommended to rest for 30 minutes before each new exercise. This statement is not accurate and should not be included in the teaching. While it’s important for pregnant women to rest and avoid overexertion, there’s no specific recommendation to rest for 30 minutes before each new exercise. Instead, pregnant women should listen to their bodies and rest as needed.

Choice D rationale

It is recommended to increase your weight-bearing exercises. This statement is not accurate and should not be included in the teaching. While weight-bearing exercises can be beneficial, they should be done with caution during pregnancy. Pregnant women should avoid heavy weights and exercises that put pressure on the joints, increase the risk of injury, or cause discomfort. Instead, they should focus on exercises that strengthen the muscles and improve balance and flexibility.

Choice A rationale

Maintain the patient on bed rest. This is a common nursing intervention for a patient who is experiencing an inevitable abortion. Bed rest can help reduce the risk of further complications, such as heavy bleeding. It can also provide the patient with a chance to rest and recover physically and emotionally.

Choice B rationale

Offer the option to view products of conception. This intervention may not be appropriate for all patients. While some patients may find it helpful to view the products of conception, others may find it distressing. It’s important to discuss this option with the patient and respect her wishes.

Choice C rationale

Administer oxygen via a nasal cannula. This intervention may not be necessary for all patients experiencing an inevitable abortion. While oxygen therapy can be used to treat hypoxia in patients with heavy bleeding, it’s not typically required unless the patient shows signs of hypoxia.

Choice D rationale

Instruct the patient to increase potassium-rich foods in the diet. This intervention is not typically part of the care plan for a patient experiencing an inevitable abortion. While a balanced diet is important for overall health, there’s no specific need to increase potassium-rich foods in the diet in this situation.

Choice D rationale

Unilateral, cramp-like abdominal pain. This is a common symptom of an ectopic pregnancy. The pain usually starts on one side of the abdomen after the early stages of pregnancy and may be accompanied by spotting or vaginal bleeding.

Choice A rationale

Large amount of vaginal bleeding. While vaginal bleeding can occur in an ectopic pregnancy, it’s usually light to moderate, not large. Heavy vaginal bleeding is more commonly associated with miscarriage or other conditions.

Choice B rationale

Severe nausea and vomiting. While some women with an ectopic pregnancy may experience nausea and vomiting, these symptoms are common in early pregnancy and are not specific to ectopic pregnancy.

Choice C rationale

Uterine enlargement greater than expected for gestational age. This is not a typical symptom of an ectopic pregnancy. In fact, because the pregnancy is not in the uterus, the size of the uterus may be smaller than expected for the gestational age.

Choice A rationale

Chloasma. Also known as melasma or the “mask of pregnancy,” chloasma is a common skin change during pregnancy. It appears as dark, irregular patches on the face19.

Choice B rationale

Linea nigra. This is a dark line that runs from the belly button to the pubic hair. It is another common skin change during pregnancy19.

Choice C rationale

Eczema. While some women may experience a worsening of eczema symptoms during pregnancy, it’s not a skin change that’s specifically associated with pregnancy19.

Choice D rationale

Psoriasis. Like eczema, psoriasis is not a skin change that’s specifically associated with pregnancy. Some women may see their psoriasis improve during pregnancy, while others may see it get worse19.

Choice E rationale

Striae gravidarum. Also known as stretch marks, these are another common skin change during pregnancy. They appear as pink, red, or purple streaks on the skin19.

Choice A rationale

Abdominal pain during pregnancy can be a normal part of the process as the body changes to accommodate the growing baby. However, severe abdominal pain is not normal and could be a sign of a serious condition such as preterm labor or an ectopic pregnancy.

Choice B rationale

Ballottement refers to a medical sign used in the physical examination of a pregnant woman to detect pregnancy. It involves a quick upward pushing against the uterus and feeling for return impact from the fetus. However, it is not a symptom to report during pregnancy.

Choice C rationale

A sudden gush of fluid from the vagina can be a sign of rupture of membranes, which can lead to premature birth if it occurs before 37 weeks of gestation. This is a critical symptom to report as it may indicate that labor is imminent.

Choice D rationale

Vaginal bleeding can be a sign of several serious conditions in pregnancy such as placenta previa or placental abruption. However, light spotting is common in early pregnancy.

Choice E rationale

Quickening refers to the first movement of the fetus felt by the mother, usually between 18 and 25 weeks of gestation. It is not a symptom to report during pregnancy.