Lina is an 18-year-old woman at 20 weeks' gestation. This is her ...

[darbym82]

Lina is an 18-year-old woman at 20 weeks' gestation. This is her first pregnancy. Lina is complaining of fatigue and listlessness.
 
  Her vital signs are within a normal range: BP = 118/60, pulse = 70, and respiratory rate 16 breaths per minute. Lina's fundal height is at the umbilicus, and she states that she is beginning to feel fetal movements. Her weight gain is 25 pounds over the prepregnant weight (110 lb), and her height is 5 feet 4 inches. The perinatal nurse's best approach to care at this visit is to:
  a. Ask Lina to keep a 3-day food diary to bring in to her next visit in 1 week.
  b. Explain to Lina that weight gain is not a concern in pregnancy, and she should not worry.
  c. Teach Lina about the expected normal weight gain during pregnancy (approximately 20 pounds by 20 weeks' gestation).
  d. Explain to Lina the possible concerns related to excessive weight gain in pregnancy, including the risk of gestational diabetes.

Question 2

The clinic nurse reviews the complete blood count results for a 30-year-old woman who is now 33 weeks' gestation. Tamara's hemoglobin value is 11.2 g/dL, and her hematocrit is 38. The clinic nurse interprets these findings as:
 
  a. Normal adult values
  b. Normal pregnancy values for the third trimester
  c. Increased adult values
  d. Increased values for 33 weeks' gestation

[xthemafja]

Answer to Question 1

ANS: a
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a. Nutrition and weight management play an essential role in the development of a healthy pregnancy. Not only does the patient need to have an understanding of the essential nutritional elements, she must also be able to assess and modify her diet for the developing fetus and her own nutritional maintenance. To facilitate this process, it is the nurse's responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices. To facilitate this process, it is the nurse's responsibility to gather more information on the woman's dietary practices through a food diary.
b. Nutrition and weight management play an essential role in the development of a healthy pregnancy. To facilitate this process, it is the nurse's responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices.
c. Nutrition and weight management play an essential role in the development of a healthy pregnancy. Not only does the patient need to have an understanding of the essential nutritional elements, she must also be able to assess and modify her diet for the developing fetus and her own nutritional maintenance. To facilitate this process, it is the nurse's responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices, not just inform the patient of expected normal weight gain.

d. Nutrition and weight management play an essential role in the development of a healthy pregnancy. Not only does the patient need to have an understanding of the essential nutritional elements, she must also be able to assess and modify her diet for the developing fetus and her own nutritional maintenance. To facilitate this process, it is the nurse's responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices.

Answer to Question 2

ANS: b
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a. The values are low normal for adults but represent normal findings for pregnant women.
b. During pregnancy the woman's hematocrit values may appear low due to the increase in total plasma volume (on average, 50). Because the plasma volume is greater than the increase in erythrocytes (30), the hematocrit decreases by about 7. This alteration is termed physiologic anemia of pregnancy, or pseudo-anemia. The hemodilution effect is most apparent at 32 to 34 weeks. The mean acceptable hemoglobin level in pregnancy is 11 to 12 g/dL of blood.
c. The values are not increased; they are low normal for adults but represent normal findings for pregnant women.
d. The values are not increased; they are low normal for adults but represent normal findings for pregnant women.