A woman is 3 months pregnant.

At her prenatal visit, she tells the nurse that she does not know what is happening; one minute she's happy that she is pregnant, and the next minute she cries for no reason.
Which response by the nurse is most appropriate?

"Perhaps you really don't want to be pregnant.”.

"Hormonal changes during pregnancy commonly result in mood swings.”.

"Have you talked to your husband about how you feel?"

"Don't worry about it; you'll feel better in a month or so.”.

Answer and Explanation

The Correct Answer is B

Choice A rationale

This response is non-therapeutic and judgmental, potentially causing the patient to feel guilt or shame. It fails to recognize the physiological basis of emotional lability during the first trimester. Questioning a woman's desire for the pregnancy based on normal hormonal fluctuations can damage the nurse-patient relationship and increase maternal anxiety. Nurses must validate the patient's experience as a standard part of the transition to motherhood rather than questioning their personal motivations or intentions.

Choice B rationale

During the first trimester, levels of estrogen and progesterone rise rapidly to support the pregnancy, which directly affects the neurotransmitters in the brain that regulate mood. These physiological shifts often lead to ambivalence and emotional sensitivity, which are considered normal psychological adaptations. Providing this information helps the woman understand that her feelings are expected and biological in nature. This validation reduces stress by normalizing the experience and providing a clear scientific explanation for the symptoms.

Choice C rationale

While social support is important, this question shifts the focus away from the woman's immediate emotional concerns and fails to address the underlying cause of her mood swings. It implies that her feelings are a social problem to be managed rather than a physiological event to be understood. The nurse should first provide education about the normalcy of the situation before inquiring about external support systems to ensure the patient feels heard and supported professionally.

Choice D rationale

Telling a patient not to worry is a dismissive technique that minimizes their lived experience and shuts down further communication. While it is true that many women feel more emotionally stable in the second trimester as hormone levels plateau, this response offers false reassurance and fails to explain the science behind the current symptoms. Effective nursing care involves addressing the patient's current distress with factual information rather than making vague promises about future emotional states.

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Correct Answer is C

Explanation

Choice A rationale

Many medications, including over-the-counter drugs and herbal supplements, can be teratogenic, especially during the first trimester when organogenesis occurs. Preconception counseling must include a thorough review of all medications to ensure they are safe for a potential pregnancy. Some drugs have long half-lives or can cause fetal harm even shortly after conception. Therefore, advising a woman to continue all regular medications without a professional medical review is unsafe and scientifically unsound.

Choice B rationale

While the woman wants to get pregnant in three months, she does not necessarily need to discontinue all contraception immediately unless she is comfortable conceiving sooner. Some methods, like the copper IUD, allow for an immediate return to fertility, while others might require a short adjustment period. The focus of counseling should be on the timing of cessation relative to her goal, rather than an absolute command to stop all forms of birth control three months early.

Choice C rationale

Folic acid is a critical B vitamin required for DNA synthesis and the closure of the neural tube, which occurs within the first 28 days of pregnancy. Since many women do not realize they are pregnant during this vital window, starting a supplement of 400 to 800 micrograms daily at least one month before conception is vital. This prevents neural tube defects like spina bifida and ensures adequate folate levels are present during early embryonic development.

Choice D rationale

Intentional weight loss immediately before or during pregnancy should be approached with extreme caution and only under medical supervision. Restrictive dieting can lead to nutritional deficiencies in essential vitamins and minerals that are necessary for a healthy pregnancy. Instead of focusing on losing weight to gain more later, the emphasis should be on achieving a healthy body mass index and establishing balanced nutritional habits to support the metabolic demands of gestation.

A. While working or traveling in a car or on a plane, women should arrange to walk around at least every 2 hours or so. B. Women should avoid seat belts and shoulder restraints in the car because they press on the fetus. C. Metal detectors at airport security checkpoints can harm the fetus if the woman passes through them a number of times. D. Women should sit for as long as possible and cross their legs at the knees from time to time for exercise.

Correct Answer is A

Explanation

Choice A rationale

Pregnancy creates a hypercoagulable state due to increased coagulation factors and venous stasis from the enlarging uterus. Prolonged immobility during travel or work significantly raises the risk of deep vein thrombosis and pulmonary embolism. Walking every 2 hours promotes venous return by engaging the calf muscle pump, which helps prevent blood pooling in the lower extremities. This practice is essential for maintaining systemic circulation and ensuring optimal placental perfusion throughout the gestational period.

Choice B rationale

Safety restraints are mandatory for pregnant women to prevent maternal and fetal injury during motor vehicle accidents. The lap belt should be positioned low under the abdomen and across the bony pelvis, while the shoulder harness should be placed between the breasts. Research shows that maternal survival is the primary determinant of fetal survival in crashes. Avoiding seat belts increases the risk of ejection or blunt force trauma to the uterus during sudden deceleration.

Choice C rationale

Modern airport security metal detectors utilize low frequency electromagnetic fields to detect metallic objects. These devices do not use ionizing radiation, such as X-rays, which are known to be teratogenic in high doses. Extensive studies have confirmed that the non-ionizing energy emitted by metal detectors is safe for the developing fetus and does not cause chromosomal damage or developmental anomalies. Advanced imaging technology used at airports is also regulated to remain within safe limits.

Choice D rationale

Sitting for extended periods is contraindicated as it exacerbates venous congestion and increases the risk of edema and varicosities. Crossing the legs at the knees is particularly harmful because it further compresses the popliteal veins, obstructing blood flow and increasing the likelihood of thrombus formation. Pregnant women are encouraged to keep their legs uncrossed and to perform ankle pumps or frequent standing breaks to facilitate the movement of blood from the periphery back to the heart.

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A woman is 3 months pregnant. At her prenatal visit, she tells the nurse that she does not know what is happening; one minute she's happy that she is pregnant, and the next minute she cries for no reason. Which response by the nurse is most appropriate?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is A

Explanation

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A woman is 3 months pregnant.

At her prenatal visit, she tells the nurse that she does not know what is happening; one minute she's happy that she is pregnant, and the next minute she cries for no reason.
Which response by the nurse is most appropriate?