Anepartum

Which meal should the nurse recommend for a pregnant client at 13 weeks gestation? 1. Baked chicken, turnip greens, peanut butter cookie, and grape juice 2. Baked swordfish, fries, baked apples, and fat-free milk 3. Chilled ham and cheese sandwich, broccoli, orange slices, and water(18%) 4. Fried liver and onions, pasteurized cheese squares, fresh fruit cup, and water(14%)

1. Baked chicken, turnip greens, peanut butter cookie, and grape juice During pregnancy, it is important for the client to consume a balanced diet with appropriate nutrients, vitamins, and minerals. Foods containing folic acid, protein, whole grains, iron, and omega-3 fatty acids are especially important. Due to the risk for bacterial contamination (eg, Listeria, toxoplasmosis), pregnant clients should avoid consuming unpasteurized milk products, unwashed fruits and vegetables, deli meat and hot dogs (unless heated until steaming hot), and raw fish/meat. They should also avoid intake of fish high in mercury (eg, shark, swordfish, king mackerel, tilefish). Educational objective:An appropriate diet is essential to meet the needs of the pregnant client and growing fetus. Pregnant clients should avoid deli meats and hot dogs (unless steaming hot), liver, unpasteurized milk products, unwashed fruits and vegetables, raw fish, and fish high in mercury.

The nurse is caring for a client at 21 weeks gestation with reports of occasional, bothersome heartburn (pyrosis). Which of the following lifestyle changes should the nurse recommend? Select all that apply. 1. Avoid intake of dairy products 2. Drink large amounts of fluid with meals 3. Eat several small meals each day 4. Eliminate fried, fatty foods 5. Lie down on the left side after meals

3. Eat several small meals each day 4. Eliminate fried, fatty foods Pyrosis, or heartburn, is common during pregnancy due to an increase of the progesterone hormone and uterine enlargement that displaces the stomach. Progesterone relaxes smooth muscles, resulting in esophageal sphincter relaxation. Gastric contents are then regurgitated, usually causing a burning sensation behind the sternum. The nurse should educate the client about lifestyle changes for reducing heartburn, such as: Keep the head of the bed elevated using pillows Sit upright after meals Eat small, frequent meals (Option 3) Avoid tight-fitting clothing Eliminate common dietary triggers (eg, fried/fatty foods, caffeine, citrus, chocolate, spicy foods, tomatoes, carbonated drinks, peppermint) (Option 4) Educational objective:Pyrosis is common during pregnancy due to an increase of the progesterone hormone, which causes the esophageal sphincter to relax. Lifestyle changes to reduce symptoms include eating smaller meals, avoiding trigger foods (eg, fried/fatty food), maintaining an upright position after meals, and drinking fluids mostly between meals.

The nurse is planning education for clients in group prenatal care who are entering the second trimester of pregnancy. Which of the following are appropriate for the nurse to include in second-trimester teaching? Select all that apply. 1. Anticipate light fetal movements around 16-20 weeks gestation 2. Expect to have an abdominal ultrasound for fetal anatomy evaluation 3. Gain about 1 lb (0.5 kg) per week if pre-pregnancy BMI was normal 4. Increase consumption of iron-rich foods like meat and dried fruit 5. Plan for gestational diabetes screening near the end of the second trimester

1. Anticipate light fetal movements around 16-20 weeks gestation 2. Expect to have an abdominal ultrasound for fetal anatomy evaluation 3. Gain about 1 lb (0.5 kg) per week if pre-pregnancy BMI was normal 4. Increase consumption of iron-rich foods like meat and dried fruit 5. Plan for gestational diabetes screening near the end of the second trimester NCLEX® CHANGE AS OF 2017 - Please note that select-all-that-apply (SATA) questions on NCLEX can now include any number of correct responses. Only ONE option or up to ALL options may be correct. UWorld questions now reflect this change. Visit NCSBN® NCLEX FAQs for more information. The second trimester (14 wk 0 d to 27 wk 6 d) is a time of positive changes for many pregnant clients (eg, improved nausea) and when physical evidence of the pregnancy is noted (eg, increased fundal height). The nurse should prepare clients for expected physical changes and discuss prevention of potential complications. Quickening, or a client's first perception of light fetal movement, is expected around 16-20 weeks gestation, depending on parity (Option 1). Weight gain increases by approximately 1 lb (0.5 kg) per week if pre-pregnancy BMI has been normal (Option 3). Increasing intake of iron-rich foods (eg, meat, dried fruit) and continuing prenatal vitamins both help to prevent anemia caused by increased fetal iron requirements after 20 weeks gestation (Option 4). Preterm labor warnings and signs of preeclampsia should be reviewed beginning at 20 weeks gestation. The nurse should also discuss routine screening/diagnostic tests performed during the second trimester. An ultrasound is performed around 18-20 weeks gestation to evaluate fetal anatomy and the placenta (Option 2). Screening for gestational diabetes mellitus (GDM) occurs between 24-28 weeks gestation (ie, 1-hour glucose challenge test) (Option 5). GDM is a complication of pregnancy caused by hormonally related maternal insulin resistance. Educational objective:During the second trimester, the nurse should provide guidance regarding fetal movements, weight gain, screening/diagnostic tests (eg, fetal anatomy ultrasound, 1-hour glucose challenge test), and increased requirements for iron to maintain maternal and fetal health.

A client at 20 weeks gestation reports "running to the bathroom all the time," pain with urination, and foul-smelling urine. Which question is most important for the nurse to ask when assessing the client? 1. "Are you having any pain in your lower back or flank area?" 2. "Do you wipe from front to back after urinating?" 3. "Have you found that you urinate more frequently since becoming pregnant?" 4. "Have you had a urinary tract infection in the past?"

1. "Are you having any pain in your lower back or flank area?" Urinary tract infections (UTIs) are common during pregnancy due to physiologic renal system changes (eg, ureter dilation, urine stasis). Most UTIs are confined to the lower urinary tract (ie, cystitis, or bladder infection). Symptoms include urinary frequency, dysuria, urgency, foul-smelling urine, and a sensation of bladder fullness. Diagnostic testing includes urinalysis and urine culture. Oral antibiotics are required to appropriately treat cystitis. If cystitis goes unreported or untreated, the infection may ascend to the kidneys and cause pyelonephritis. During pregnancy, pyelonephritis requires IV antibiotics and hospitalization because of the increased risk of preterm labor. Therefore, priority assessment is to rule out indicators of pyelonephritis (eg, flank pain, fever) in clients who report UTI symptoms to ensure appropriate diagnosis and treatment (Option 1). Educational objective: Urinary tract infections are common during pregnancy. If the client reports signs and symptoms of cystitis, the nurse's priority is to rule out ascending infection (ie, pyelonephritis), which would require hospitalization and IV antibiotics.

The nurse is reinforcing education to a group of clients that are pregnant or planning pregnancy. Which of the following client statements about alcohol use in pregnancy should concern the nurse? Select all that apply. 1. "As long as I don't binge drink, an occasional glass of wine is fine." 2. "I drank alcohol heavily before realizing I was pregnant, so there is no benefit to quitting now." 3. "If I drink alcohol, my baby may have withdrawal after birth but no permanent damage." 4. "It is important to stop drinking while I am trying to conceive." 5. "Third-trimester alcohol use is less harmful because the baby is fully developed."

1. "As long as I don't binge drink, an occasional glass of wine is fine." 2. "I drank alcohol heavily before realizing I was pregnant, so there is no benefit to quitting now." 3. "If I drink alcohol, my baby may have withdrawal after birth but no permanent damage." 5. "Third-trimester alcohol use is less harmful because the baby is fully developed." Alcohol consumption during pregnancy is concerning and is reported by 1 in 9 women according to research surveys. Nurses play a significant role in educating clients about the teratogenic risks of alcohol consumption, which include miscarriage, preterm birth, low birth weight, and fetal alcohol spectrum disorders (eg, fetal alcohol syndrome). Fetal alcohol spectrum disorders may not be diagnosed immediately, but a range of permanent neurodevelopmental abnormalities or dysmorphic facial features may occur (Option 3). During pregnancy, the nurse should screen for substance abuse to identify clients who consume alcohol. The nurse should educate clients that alcohol freely crosses the placenta into the fetal bloodstream, affecting the growth and development of the fetus at any gestational age. Therefore, no amount of alcohol intake during pregnancy is safe (Options 1 and 5). The nurse should also inform clients that discontinuing alcohol intake at any time during pregnancy can improve future outcomes for the child (Option 2). Educational objective:Alcohol consumption is concerning in pregnant clients. The nurse should inform clients that no amount of alcohol is safe during pregnancy and that consumption may lead to miscarriage, low birth weight, or fetal alcohol spectrum disorders. Pregnant clients or those planning pregnancy should abstain from alcohol to protect offspring from permanent abnormalities (eg, neurodevelopmental, facial).

The nurse is preparing to discharge a client following a first trimester miscarriage. Which of the following statements should the nurse include in discharge teaching for the client and partner? Select all that apply. 1. "Attending a support group with other people who had a pregnancy loss can be helpful." 2. "Genetic counseling is recommended for couples after their first miscarriage." 3. "One of the most important things you can do right now is communicate with your partner." 4. "The grieving period only lasts about 6 months following a miscarriage." 5. "Trying to conceive again can help you cope by giving you something to look forward to."

1. "Attending a support group with other people who had a pregnancy loss can be helpful." 3. "One of the most important things you can do right now is communicate with your partner." A spontaneous abortion (ie, miscarriage) is an unintentional pregnancy loss before 20 weeks gestation, most commonly occurring during the first trimester. Although miscarriage is common, its cause often remains unknown, sometimes leaving clients with no explanation. Clients may experience a profound sense of loss and a range of emotions including relief, uncertainty regarding future pregnancies, guilt, depression, and isolation. The nurse assists the client to grieve and cope with the psychosocial aspects of miscarriage by offering unbiased support and facilitating open communication. A pregnancy loss support group can assist the client with emotional healing and decrease feelings of isolation (Option 1). Encouraging the client and partner to communicate feelings and needs with one another can decrease relational conflict and stress (Option 3). Educational objective:Clients who have a spontaneous abortion (ie, miscarriage) may experience a profound sense of loss and a range of emotions. The nurse assists the client to cope with the psychosocial aspects of miscarriage by recommending support groups and encouraging communication between the client and partner.

The nurse is providing teaching to a prenatal client about the 1-hour glucose challenge test that will be performed at the next visit. Which client statement indicates a need for further teaching? 1. "Fasting is required before the 1-hour glucose challenge test." 2. "One blood sample is obtained at the end of the test." 3. "The test includes drinking a 50-g glucose solution." 4. "The test's purpose is to screen for gestational diabetes, not diagnose it."

1. "Fasting is required before the 1-hour glucose challenge test." Gestational diabetes mellitus (GDM) is diagnosed in clients who have impaired blood glucose (BG) regulation due to physiologic pregnancy changes (eg, rising BG levels, insulin resistance). GDM screening occurs at 24-28 weeks gestation. If GDM is diagnosed, management includes nutritional counseling and, if needed, pharmacologic therapy. Two-step GDM testing begins with a screening test: the 1-hour glucose challenge test (GCT). The 1-hour GCT can be performed any time of day and does not require fasting (Option 1). If the client's serum BG is <140 mg/dL (7.8 mmol/L), GDM is unlikely, and the client requires no further testing. If serum BG is ≥140 mg/dL (7.8 mmol/L), the client requires a 2- or 3-hour glucose tolerance test (GTT) to diagnose GDM. Educational objective:The 1-hour glucose challenge test (GCT) screens pregnant clients for gestational diabetes mellitus. Screening occurs at 24-28 weeks gestation. The client ingests a 50-g glucose solution, and the nurse draws one blood sample an hour later. The 1-hour GCT can be performed any time of day and does not require fasting.

The nurse assesses a client at term gestation who reports having contractions for the last 2 hours. The client states, "I'm not sure, but I think my water broke." The nurse performs a nitrazine pH test, which turns blue. When documenting the results of the test, which client statement is most concerning to the nurse? 1. "I did have sexual intercourse with my partner 1 hour before coming in today." 2. "I have noticed constant wetness in my panties since I thought my water broke." 3. "It is difficult for me to tell if my water broke or if I just peed on myself a little bit." 4. "With my last three pregnancies, my water never broke on its own."

1. "I did have sexual intercourse with my partner 1 hour before coming in today." Testing vaginal secretions with a nitrazine pH test strip can help differentiate between amniotic fluid, which is alkaline, and normal vaginal fluids or urine, which are acidic. A yellow, olive, or green color suggests that amniotic membranes are intact. A bluish color suggests probable rupture of membranes (ROM). However, the presence of blood or semenmay result in a false positive, as serum and prostatic fluid are alkaline. A client history of recent sexual intercourse should alert the nurse to notify the health care provider that nitrazine results may be falsely positive due to the presence of semen in the vagina (Option 1). Educational objective:A nitrazine pH test strip can differentiate between alkaline amniotic fluid and vaginal secretions or urine, which are acidic. Recent sexual intercourse should alert the nurse to notify the health care provider that nitrazine results may be falsely positive due to the presence of semen (ie, an alkaline fluid) in the vagina. Additional Information Health Promotion and Maintenance NCSBN Client Need

A client at 35 weeks gestation is admitted to the labor and delivery unit for severe pre-eclampsia. She is started on IV magnesium sulfate for seizure prophylaxis. Which of the following signs indicate that the client has developed magnesium sulfate toxicity? Select all that apply. 1. 0/4 patellar reflex 2. Blood pressure of 156/84 mm Hg 3. Client voiding 600 mL in 8 hours 4. Respirations of 10/min 5. Serum magnesium level of 8.0 mEq/L (4 mmol/L)

1. 0/4 patellar reflex 4. Respirations of 10/min 5. Serum magnesium level of 8.0 mEq/L (4 mmol/L) IV magnesium sulfate is administered for seizure (eclampsia) prophylaxis in pregnant clients with pre-eclampsia. A loading dose of 4-6 g of magnesium sulfate, followed by a maintenance dose of 1-2 g/hr, helps achieve therapeuticmagnesium levels of 4-7 mEq/L (2.0-3.5 mmol/L). Magnesium toxicity may occur when magnesium levels are >7 mEq/L (3.5 mmol/L), which causes central nervous system depression and blocks neuromuscular transmission (Option 5). Absent or decreased deep tendon reflexes (DTRs) are the earliest sign of magnesium toxicity. DTRs, scored on a scale of 0 to 4+, should be frequently assessed during magnesium sulfate infusion; normal findings are 2+ (Option 1). If toxicity is not recognized early (eg, decreasing DTRs), clients can progress to respiratory depression (<12 breaths/min), followed by cardiac arrest (Option 4). Administration of calcium gluconate (antidote) is recommended in the event of cardiorespiratory compromise. Educational objective:The therapeutic level of magnesium for pre-eclampsia/eclampsia treatment is 4-7 mEq/L (2.0-3.5 mmol/L). Signs of magnesium toxicity may be noted with serum levels >7 mEq/L (3.5 mmol/L) and include absent or decreased deep tendon reflexes, respiratory depression, and cardiac arrest. Calcium gluconate (antidote) should be readily available in the event of cardiorespiratory compromise.

A client comes to the clinic indicating that a home pregnancy test was positive. The client's last menstrual period was September 7. Today is December 7. Which are true statements for this client? Select all that apply. 1. According to Naegele's rule, the expected date of delivery is June 14 2. Detection of the fetal heart rate via Doppler is possible 3. Fundal height should be 24 cm above the symphysis pubis 4. The client should be feeling fetal movement 5. Urinary frequency is a common symptom

1. According to Naegele's rule, the expected date of delivery is June 14 2. Detection of the fetal heart rate via Doppler is possible 5. Urinary frequency is a common symptom Naegele's rule, which is the last menstrual period minus 3 months plus 7 days, can be used to calculate a client's expected date of delivery. The accuracy of this method may be influenced by the regularity and length of the client's menstrual cycle. September 7 minus 3 months is June 7, plus 7 days is June 14 (Option 1). Detection of a fetal heart rate is possible using a Doppler by 10-12 weeks gestation (Option 2). Urinary frequency, a presumptive sign of pregnancy common in the first trimester, occurs primarily due to hormonal changes and anatomical changes in the renal system (Option 5). However, clients also reporting dysuria, fever/chills, or back pain should be evaluated for a urinary tract infection. Educational objective:Naegele's rule for estimating date of delivery is the last menstrual period minus 3 months plus 7 days. Fetal heart rate is detectable by Doppler at 10-12 weeks gestation. Urinary frequency is a presumptive sign of pregnancy in the first trimester.

The nurse is admitting a client at 41 weeks gestation for induction of labor due to oligohydramnios. Considering the client's indication for induction, what should the nurse anticipate? 1. Additional neonatal personnel present for birth 2. Intermittent fetal monitoring during labor 3. Need for forceps-assisted vaginal birth 4. Need for uterotonic drugs for postpartum hemorrhage

1. Additional neonatal personnel present for birth Amniotic fluid is produced by the fetal kidney and serves 2 major purposes - to prevent cord compression and promote lung development. Oligohydramnios is a condition characterized by low amniotic fluid volume. This can occur due to fetal kidney anomalies (eg, renal agenesis or urine flow obstruction) or fluid leaking through the vagina (eg, undiagnosed ruptured membranes). Fluid volume also declines gradually after 41 weeks. Small uterine size for gestational age or a fetal outline that is easily palpated through the maternal abdomen should raise suspicion for oligohydramnios. Ultrasound confirms the diagnosis. Major complications of oligohydramnios are: Pulmonary hypoplasia - due to the lack of normal alveolar distension by aspirated amniotic fluid. Therefore, additional neonatal personnel should attend the birth in anticipation of possible resuscitation Educational objective: Oligohydramnios increases the risk for umbilical cord compression and pulmonary hypoplasia. Additional neonatal personnel should be present for possible resuscitation and/or evaluation of the newborn. The nurse should anticipate continuous fetal monitoring during labor to monitor for signs of cord compression.

A nurse on the antepartum unit is caring for a pregnant client at 30 weeks gestation who was admitted with reports of vaginal bleeding. A diagnosis of placenta previa was confirmed by ultrasound. What should the nurse tell the client to anticipate? Select all that apply. 1. Additional ultrasound around 36 weeks gestation 2. Clearance for sexual activity if bleeding stops 3. Discharge home if bleeding stops and fetal status is reassuring 4. Scheduled cesarean birth before onset of labor 5. Weekly vaginal examinations to assess for cervical change

1. Additional ultrasound around 36 weeks gestation 3. Discharge home if bleeding stops and fetal status is reassuring 4. Scheduled cesarean birth before onset of labor In placenta previa, the placenta is implanted over or very near the cervix. This causes placental blood vessels to be disrupted during cervical dilation and effacement, which may result in massive blood loss and maternal/fetal compromise. Because of the increased risk of hemorrhage if contractions result in cervical change, a cesarean birth is planned for after 36 weeks gestation and prior to the onset of labor (Option 4). A stable client with no active bleeding and reassuring fetal status may be discharged home and managed in an outpatient setting (Option 3). However, the client must be closely monitored and instructed to return to the hospital immediately if bleeding recurs. As pregnancy progresses, the placenta grows in size and can potentially migrate away from the cervical opening, resulting in complete resolution of the previa. Therefore, an additional ultrasound is usually performed around 36 weeks gestation to assess placental location (Option 1). Educational objective:Clients with placenta previa are at risk for hemorrhage. Vaginal examinations are contraindicated, and pelvic rest is recommended to prevent disruption of placental vessels. A cesarean birth is planned prior to onset of labor.

A client indicates the desire to become pregnant. Which of the following are important preconception education topics for the nurse to provide? Select all that apply. 1. Aim for BMI of 18.5-24.9 kg/m2 2. Avoid alcohol consumption and tobacco products 3. Ensure daily intake of 400 mcg of folic acid 4. Obtain testing for rubella immunity 5. Schedule dental wellness appointment

1. Aim for BMI of 18.5-24.9 kg/m2 2. Avoid alcohol consumption and tobacco products 3. Ensure daily intake of 400 mcg of folic acid 4. Obtain testing for rubella immunity 5. Schedule dental wellness appointment NCLEX® CHANGE AS OF 2017 - Please note that select-all-that-apply (SATA) questions on NCLEX can now include any number of correct responses. Only ONE option or up to ALL options may be correct. UWorld questions now reflect this change. Visit NCSBN® NCLEX FAQs for more information. Preconception counseling assesses for pregnancy risk factors and implements appropriate interventions to promote a healthy pregnancy. Some behaviors the client may begin independently include eating a nutritious diet; exercising; abstaining from alcohol, tobacco, and illicit drugs; and taking folic acid supplements. Obesity (BMI >30 kg/m2) during pregnancy is associated with an increased risk for fetal/maternal complications (eg, gestational diabetes, hypertension, cesarean birth). Achieving a normal BMI (18.5-24.9 kg/m2) is optimal (Option 1). No amount of alcohol is considered safe in pregnancy; complete abstinence from alcohol is recommended to avoid fetal alcohol syndrome. Smoking cessation is encouraged due to its association with fetal growth restriction; illicit drugs may also cause fetal harm (Option 2). Folic acid supplementation of at least 400 mcg per day for 3 months before pregnancy is recommended to reduce the incidence of neural tube defects (Option 3). Neural tube development begins around the third week following conception, before a woman may realize that she is pregnant. Finally, clients should visit their health care provider to discuss pregnancy's effect on certain health conditions (eg, asthma, diabetes) and check rubella immunity (Option 4). Rubella vaccination should be given if the client is nonimmune, and pregnancy should be avoided for at least 4 weeks after vaccination. Regular visits with a dentist can help prevent periodontal disease, which is associated with poor pregnancy outcomes (eg, preterm birth, low birth weight) (Option 5). Educational objective:Preconception care improves pregnancy outcomes and includes folic acid supplementation; regular dental care; updated vaccinations; avoidance of alcohol, smoking, and illicit drugs; and achieving a normal weight.

A client at 38 weeks gestation is brought to the emergency department after a motor vehicle crash. She reports severe, continuous abdominal pain. The nurse notes frequent uterine contractions and mild, dark vaginal bleeding. What actions should the nurse take? Select all that apply. 1. Anticipate emergent cesarean birth 2. Apply continuous external fetal monitoring 3. Assess routine vital signs every 4 hours 4. Draw blood for type and crossmatch 5. Initiate IV access with a 22-gauge catheter

1. Anticipate emergent cesarean birth 2. Apply continuous external fetal monitoring 4. Draw blood for type and crossmatch Placental abruption occurs when the placenta separates prematurely from the uterine wall, causing hemorrhage beneath the placenta. Abruptions are classified as partial, complete, or marginal and may be overt (visible vaginal bleeding) or concealed (bleeding behind placenta). Risk factors include abdominal trauma, hypertension, cocaine use, history of previous abruption, and preterm premature rupture of membranes. Symptoms and their severity depend on extent of abruption and include abdominal and/or back pain, uterine contractions, uterine rigidity, and dark red vaginal bleeding. Tachysystole (ie, excessive uterine contractions), with or without fetal distress, is often present, and continuous fetal monitoring is necessary (Option 2). A type and crossmatch should be drawn as treatment may include blood transfusion (Option 4). In severe cases, emergent cesarean birth is indicated (Option 1). Although blood loss is maternal, the loss of functional placental surface area can result in decreased placental perfusion, impaired fetal oxygenation, and fetal death. Educational objective:Placental abruption usually presents with abdominal pain and dark red vaginal bleeding. The main concerns are maternal blood loss resulting in hypotension and shock and fetal compromise. Maternal stabilization and expedited birth are indicated.

The nurse is providing nutrition counseling during a preconception visit to a client who does not eat green vegetables. In addition to a daily prenatal vitamin, which foods can the client add to the daily diet to decrease the risk of neural tube defects? Select all that apply. 1. Black beans and rice 2. Fortified breakfast cereal and milk 3. Medium baked sweet potato 4. Peanut butter on whole wheat toast 5. Raw carrots with cheese dip

1. Black beans and rice 2. Fortified breakfast cereal and milk 4. Peanut butter on whole wheat toast Folic acid, or folate, is a water-soluble, B-complex vitamin necessary for red blood cell production. Pregnant women and those attempting pregnancy need a minimum of 400 mcg of folic acid per day to decrease the chance of fetal neural tube defects (eg, spina bifida, anencephaly). Most prenatal vitamins contain 400-800 mcg of folic acid; additional folic acid can come from the diet. Leafy green vegetables are the best dietary sources of folic acid. However, other appropriate food choices include cooked beans, rice, fortified cereals, and peanut butter, which provide at least 40 mcg folic acid per serving (Options 1, 2, and 4). Educational objective:Folic acid is a B-complex vitamin that decreases the risk of fetal neural tube defects. Pregnant women require a minimum of 400 mcg of folic acid daily. Leafy green vegetables supply excellent dietary folic acid; alternate sources include beans, rice, peanut butter, and fortified cereals.

A pregnant client arrives in the labor and delivery unit with mild contractions and brisk, painless vaginal bleeding. The client received no prenatal care and reports being "about 7-8 months." Which actions should the nurse anticipate? Select all that apply. 1. Blood draw for type and screen 2. Electronic fetal monitoring 3. Initiation of 2 large-bore IV catheters 4. Pad counts to assess bleeding 5. Vaginal examination for cervical dilation

1. Blood draw for type and screen 2. Electronic fetal monitoring 3. Initiation of 2 large-bore IV catheters 4. Pad counts to assess bleeding Placenta previa is an abnormal implantation of the placenta resulting in partial or complete covering of the cervical os (opening). The condition is diagnosed by ultrasound. In clients reporting painless vaginal bleeding after 20 weeks gestation, placenta previa should be suspected. Placenta previa found early in pregnancy may resolve by the third trimester, but women with persistent placenta previa or hemorrhage require cesarean birth. A type and screen to determine blood type and Rh status is appropriate due to the potential for excessive blood loss and need for blood transfusion (Option 1). Fetal well-being is assessed via continuous electronic fetal monitoring to help determine appropriate timing for birth (Option 2). Large-bore IV access is established in anticipation of fluid resuscitation and administration of blood products (Option 3). The client should also be monitored frequently for any changes in bleeding via pad counts (Option 4). Educational objective:Placenta previa is suspected in clients reporting painless vaginal bleeding after 20 weeks gestation. Clients with placenta previa are at high risk for hemorrhage. The nurse should initiate electronic fetal monitoring and pad counts, draw a type and screen, and initiate large-bore IV access. Digital vaginal examinations are contraindicated.

A client who is being evaluated for suspected ectopic pregnancy reports sudden-onset, severe, right lower abdominal pain and dizziness. Which additional assessment findings will the nurse anticipate if the client is experiencing a ruptured ectopic pregnancy? Select all that apply. 1. Blood pressure 82/64 mm Hg 2. Crackles on auscultation 3. Distended jugular veins 4. Pulse 120/min 5. Shoulder pain

1. Blood pressure 82/64 mm Hg 4. Pulse 120/min 5. Shoulder pain Ectopic pregnancy occurs when a fertilized ovum implants outside the uterine cavity. The majority of ectopic pregnancies occur in the fallopian tubes. Risk factors include recurrent sexually transmitted infections, tubal damage or scarring, intrauterine devices, and previous tubal surgeries (eg, tubal ligation for sterilization). Clinical manifestations are lower-quadrant abdominal pain on one side, mild to moderate vaginal bleeding, and missed or delayed menses. Signs of subsequent hypovolemic (hemorrhagic) shock from ruptured ectopic pregnancy include dizziness, hypotension, and tachycardia. Free intraperitoneal blood pooling under the diaphragm can cause referred shoulder pain. Peritoneal signs (eg, tenderness, rigidity, low-grade fever) may develop subsequently. Educational objective:The fallopian tubes are the most common site for an ectopic pregnancy. As the ectopic pregnancy grows and expands, rupture may occur, resulting in active bleeding that progresses to life-threatening hypovolemic (hemorrhagic) shock. Signs of ruptured ectopic pregnancy may include severe abdominal pain, dizziness, and referred shoulder pain.

The nurse is reviewing laboratory results for several prenatal clients. Which finding is most important to report to the health care provider? 1. Client at 24 weeks gestation with hemoglobin of 9 g/dL (90 g/L) and hematocrit of 29% 2. Client at 26 weeks gestation whose 1-hour (50 g) oral glucose challenge test result is 120 mg/dL (6.7 mmol/L) 3. Client at 36 weeks gestation with blood pressure of 125/85 mm Hg and trace protein detected on urine dipstick 4. Client at 37 weeks gestation with a WBC count of 13,000/mm3 (13.0 x 109/L)

1. Client at 24 weeks gestation with hemoglobin of 9 g/dL (90 g/L) and hematocrit of 29% Anemia is a common complication of pregnancy, sometimes due to iron deficiency. During the second half of pregnancy, the fetus begins to store iron in preparation for extrauterine life and depletes maternal iron stores. Hemoglobin <11 g/dL (110 g/L) in the first or third trimester or <10.5 g/dL (105 g/L) in the second trimester is considered low. The nurse should evaluate a client with a hemoglobin of 9 g/dL (90 g/L) for symptoms of anemia (eg, fatigue, shortness of breath) and notify the health care provider because the client may require additional testing (eg, complete blood count, serum ferritin) and iron supplementation (Option 1). Educational objective:Anemia during pregnancy occurs when hemoglobin is <11 g/dL (110 g/L) in the first or third trimester or <10.5 g/dL (105 g/L) in the second trimester. The nurse should evaluate clients with low hemoglobin for symptoms of anemia and anticipate additional testing and/or iron supplementation.

The nurse is providing education to several first-trimester pregnant clients. Which client requires priority anticipatory teaching? 1. Client who gardens and eats homegrown vegetables 2. Client who has gained 4 lb (1.8 kg) from prepregnancy weight 3. Client who has noticed thin, milky white vaginal discharge 4. Client who practices yoga and swims in a pool 3 times a week

1. Client who gardens and eats homegrown vegetables Toxoplasmosis is a parasitic infection caused by Toxoplasma gondii, which may be acquired from exposure to infected cat feces or ingestion of undercooked meat or soil-contaminated fruits/vegetables. Pregnant clients who contract toxoplasmosis can transfer the infection to the fetus and potentially cause serious fetal harm (eg, stillbirth, malformations, blindness, mental disability). Pregnant clients should be advised to take precautions when gardening and thoroughly wash all produce to decrease exposure risk. Educational objective:Toxoplasmosis is a parasitic infection acquired by exposure to infected cat feces or ingestion of undercooked meat or soil-contaminated fruits/vegetables. Pregnant clients who contract toxoplasmosis may transfer the infection to the fetus and potentially cause serious fetal harm. Pregnant clients should take precautions when gardening and thoroughly wash all produce to decrease exposure risk.

The nurse reviews laboratory test results for a pregnant client at 32 weeks gestation. What is the nurse's best action based on these results? Click on the exhibit button for additional information. 1. Complete the client assessment and documentation 2. Draw another sample for repeat complete blood count 3. Prepare for transfusion of packed red blood cells 4. Request a prescription for iron supplementation

1. Complete the client assessment and documentation Pregnant women experience a 40%-45% increase in total blood volume during pregnancy to meet the increased oxygen demand and nutritional needs of the growing fetus and maternal tissues. Because the increase in plasma volume is greater than the increase in red blood cells, a hemodiluted state called physiologic anemia of pregnancy occurs, and is reflected in lower hemoglobin and hematocrit values. It is also normal for the white blood cell count to increase during pregnancy; counts can be as high as 15,000/mm3 (15.0 x 109/L). These laboratory results are within the normal ranges for a pregnant client in the third trimester, and no intervention is required (Options 1 and 2). Educational objective:Pregnant women experience an increase in total blood volume to meet the increased oxygen demand and nutritional needs of the growing fetus and maternal tissues. The increase in plasma volume is greater than the increase in red blood cells, creating a hemodiluted state termed physiologic anemia of pregnancy, which is reflected in decreased hemoglobin (>11.0 g/dL [>110 g/L]) and hematocrit (>33% [0.33]) values.

The nurse is caring for a client at 30 weeks gestation who is hospitalized for preeclampsia. After reviewing the client's chart and performing an initial assessment, the nurse notes several abnormal findings. Which finding should the nurse discuss with the health care provider immediately? 1. Dark red vaginal bleeding 2. Edema of the hands and face 3. Elevated liver enzyme 4. Urine output of 150 mL in 4 hours

1. Dark red vaginal bleeding Placental abruption is a potential complication of preeclampsia related to hypertension that can be life-threatening to the client or fetus. It causes premature detachment of the placenta from the uterine wall, resulting in bleeding from uterine blood vessels. Common manifestations include abdominal pain, dark red vaginal bleeding, a rigid uterus, abnormal fetal heart rate patterns, and uterine tachysystole. Once placental abruption occurs, fetal distress and maternal hypovolemia can develop quickly. Therefore, the nurse should report vaginal bleeding to the health care provider (HCP) immediately because emergency cesarean birth is very common if the client's or fetus' condition deteriorates (Option 1). Educational objective:Placental abruption is a severe complication of preeclampsia that can be life-threatening and requires emergency action. Manifestations include dark red vaginal bleeding, abdominal pain, a rigid uterus, abnormal fetal heart rate patterns, and uterine tachysystole.

The nurse is obtaining a client's history during an initial prenatal visit. The client's last menstrual period was from March 1 to March 5. Unprotected intercourse occurred on March 15. Slight vaginal spotting was noted on March 23. The client's menstrual cycles are regular and 28 days long. Using the Nägele rule, what is the estimated date of birth? 1. December 8 2. December 12 3. December 22 4. December 30

1. December 8 Establishing an estimated date of birth (EDB) is important because many decisions and interventions during pregnancy are based on this information (eg, labor induction, diagnosing preterm labor). Methods to determine EDB include the Nägele rule, ultrasound, fundal height measurement, and fetal heart rate auscultation via handheld Doppler monitor (at ~10 weeks gestation). The Nägele rule uses a standard formula based on the last normal menstrual period (LMP) to determine EDB based on a 28-day menstrual cycle: EDB = (LMP − 3 months) + 7 days. First day of LMP: March 1 Subtract 3 months: December 1 Add 7 days: December 8 This client's EDB is December 8 (Option 1). Educational objective:The Nägele rule is a standard formula based on the last normal menstrual period (LMP) that determines the estimated date of birth (EDB) based on a 28-day menstrual cycle: EDB = (LMP − 3 months) + 7 days.

A 37-weeks-pregnant woman comes to the emergency department with a fractured ankle. Which assessment finding is most concerning and requires the nurse to follow up? 1. Fetal heart rate remains 206/min 2. Fetus kicked 4 times in the past hour 3. Mother reports feeling 2 contractions every hour 4. Mother's hemoglobin is 11 g/dL (110 g/L)

1. Fetal heart rate remains 206/min Fetal tachycardia is a baseline of >160 beats/min for >10 minutes. Tachycardia needs evaluation and continued surveillance. The most sensitive indicators of fetus health are fetal movement and fetal heart rate. Educational objective:Sustained fetal tachycardia (>160/min for >10 minutes) is a concerning finding that requires further follow-up.

A client at 20 weeks gestation states that she started consuming an increased amount of cornstarch about 3 weeks ago. Based on this assessment, the nurse should anticipate that the health care provider will order which laboratory test(s)? 1. Hemoglobin and hematocrit levels 2. Human chorionic gonadotropin level 3. Serum folate level 4. White blood cell count

1. Hemoglobin and hematocrit levels Pica is the abnormal, compulsive craving for and consumption of substances normally not considered nutritionally valuable or edible. Common substances include ice, cornstarch, chalk, clay, dirt, and paper. Although the condition is not exclusive to pregnancy, many women only have pica when they are pregnant. Pica is often accompanied by iron deficiency anemia due to insufficient nutritional intake or impaired iron absorption. However, the exact relationship between pica and anemia is not fully understood. The health care provider would likely order hemoglobin and hematocrit levels to screen for the presence of anemia. Educational objective:Pica is the constant craving for and consumption of nonfood and/or nonnutritive food substances that may occur in pregnancy. It may be accompanied by iron deficiency anemia. Hemoglobin and hematocrit levels are useful in these clients to screen for anemia.

A pregnant client at 30 weeks gestation comes to the prenatal clinic. Which vaccines may be administered safely at this prenatal visit? Select all that apply. 1. Influenza injection 2. Influenza nasal spray 3. Measles, mumps, and rubella 4. Tetanus, diphtheria, and pertussis 5. Varicella

1. Influenza injection 4. Tetanus, diphtheria, and pertussis Health promotion during pregnancy includes the administration or avoidance of certain vaccines to decrease risks to mother and fetus. Pregnant women have suppressed immune systems and are at increased risk for illness and subsequent complications. Some viruses (eg, rubella, varicella) can cause severe birth defects if contracted during pregnancy. Inactivated vaccines contain a "killed" version of the virus and pose no risk of causing illness from the vaccine. Some vaccines contain weakened (ie, attenuated) live virus and pose a slight theoretical risk of contracting the illness from the vaccine. For this reason, women should not receive live virus vaccines during pregnancy or become pregnant within 4 weeks of receiving such a vaccine. The tetanus, diphtheria, and pertussis (Tdap) vaccine is recommended for all pregnant women between the beginning of the 27th and the end of the 36th week of gestation as it provides the newborn with passive immunity against pertussis (whooping cough) (Option 4). During influenza season (October-March), it is safe and recommended for pregnant women to receive the injectable inactivated influenza vaccine regardless of trimester (Option 1). Educational objective:Inactivated vaccines (eg, inactivated influenza; tetanus, diphtheria, and pertussis) may be given during pregnancy to protect pregnant clients from illness and provide the fetus with passive immunity. Live virus vaccines are contraindicated in pregnancy.

The nurse is preparing to assess a client visiting the women's health clinic. The client's obstetric history is documented as G5T1P2A1L2. Which interpretation of this notation is correct? 1. The client had 1 birth at 37 wk 0 d gestation or beyond 2. The client had 3 births between 20 wk 0 d and 36 wk 6 d gestation 3. The client has 3 currently living children 4. The client is currently not pregnant

1. The client had 1 birth at 37 wk 0 d gestation or beyond The GTPAL system is a shorthand system of documenting a client's obstetric history. This client (G5T1P2A1L2) has been pregnant 5 times (G5); had 1 term birth (T1), 2 preterm births (P2), and 1 abortion (A1); and has 2 currently living children (L2). The client's term birth is indicated by the T1 portion of the GTPAL notation (Option 1). (Option 2) The client had 2 preterm births, indicated by the P2 portion of the GTPAL notation. Educational objective:The GTPAL system notational components are G - gravida (number of pregnancies, regardless of outcome and including current pregnancies), T - term (37 wk 0 d gestation and beyond), P - preterm (20 wk 0 d through 36 wk 6 d gestation), A - abortions (before 20 wk 0 d gestation; spontaneous or induced), and L - currently living children.

The nurse is assessing a client at 36 weeks gestation during a routine prenatal visit. Which statement by the client should the nurse investigate first? 1. "I am not sleeping as well due to cramps in my calves at night." 2. "I have noticed less kicking movements as the baby grows bigger." 3. "Over the last few weeks, I have not been able to wear any of my shoes." 4. "Sometimes I feel short of breath after walking up a flight of stairs."

2. "I have noticed less kicking movements as the baby grows bigger." Fetal movement is a sign of fetal health and indicates an intact fetal central nervous system. Fetal movement may occur numerous times per hour during the last trimester of pregnancy, although the client may not perceive every movement. Multiple factors (eg, maternal substance abuse, medications, fasting, fetal sleep) can affect fetal movement. However, fetal movements should not decrease as the fetus increases in size. Decreased fetal movement is a potential warning sign of fetal compromise (ie, impaired oxygenation), which may precede fetal death (Option 2). The nurse prioritizes assessment of client reports of decreased fetal movement to evaluate fetal well-being (eg, nonstress test). Educational objective:Fetal movement is a sign of fetal health and represents an intact fetal central nervous system. The nurse should educate clients that fetal movements do not decrease in the late third trimester and prioritize assessment of clients reporting decreased fetal movement.

The nurse is teaching a client, gravida 1 para 0, at 8 weeks gestation about expected weight gain during pregnancy. The client's prepregnancy BMI is 21 kg/m2. Which statement by the client indicates an appropriate understanding about weight gain? 1. "I should gain 10-15 lb (4.5-6.8 kg) during the first trimester." 2. "I should gain a total of about 30 lb (13.6 kg) during my pregnancy." 3. "I should gain no more than 0.5 lb (0.2 kg) per week during the third trimester." 4. "If I gain <20 lb (9.1 kg) during pregnancy, it will be easier to lose weight postpartum."

2. "I should gain a total of about 30 lb (13.6 kg) during my pregnancy." Appropriate weight gain during pregnancy decreases risks to the client and fetus. Expected weight gain is determined by prepregnancy BMI. Underweight clients need to gain more weight (1 lb [0.5 kg] per week) during the second and third trimesters of pregnancy than obese clients (0.5 lb [0.2 kg] per week). However, weight gain in the first trimester should be 1.1-4.4 lb (0.5-2.0 kg), regardless of BMI. With a prepregnancy BMI of 21 kg/m2, this client has an appropriate weight and should gain 25-35 lb (11.3-15.9 kg)over the course of the pregnancy (Option 2). Educational objective:Appropriate weight gain during pregnancy decreases risks to the client and fetus. Weight gain in the first trimester should be 1.1-4.4 lb (0.5-2.0 kg), regardless of BMI. The optimal total weight gain during pregnancy is determined by the client's prepregnancy BMI.

The nurse provides discharge instructions to a client at 14 weeks gestation who has received a prophylactic cervical cerclage. Which client statement indicates an understanding of teaching? 1. "I need to be on bed rest for the duration of my pregnancy." 2. "I will notify my health care provider if I start having low back aches." 3. "Pelvic pressure is to be expected after cerclage placement." 4. "The cerclage will be removed once my baby is at 28 weeks."

2. "I will notify my health care provider if I start having low back aches." A cervical cerclage is placed to prevent preterm delivery, usually in clients with histories of second trimester loss or premature birth. A heavy suture is placed transvaginally or transabdominally to keep the internal cervical os closed. Placement occurs at 12-14 weeks gestation for clients with a history of cervical insufficiency (ie, painless, premature cervical dilation and miscarriage or preterm delivery) or up to 23 weeks gestation if signs of cervical insufficiency (eg, short cervix) are noted. Discharge instructions include activity restriction and recognition of signs of preterm labor (eg, low back aches, contractions, pelvic pressure) and rupture of membranes (Option 2). Educational objective:Following cerclage placement, discharge teaching includes recognizing and reporting signs of preterm labor (eg, low back aches, contractions, pelvic pressure) or rupture of membranes and understanding activity restrictions (eg, bed rest for a short time after

The graduate nurse (GN) and supervising nurse are preparing to follow-up with a client who had a spontaneous abortion at 6 weeks gestation at home. Which of the following statements by the GN are appropriate? Select all that apply. 1. "Although the client is Rh negative, it is unnecessary to administer Rh immune globulin due to the client's early gestational age." 2. "I will reinforce teaching with the client about abstaining from sexual intercourse for two weeks." 3. "The client should call the health care provider for foul-smelling vaginal discharge, heavy vaginal bleeding, or severe pain." 4. "The client should continue prenatal vitamins with iron and take ibuprofen as needed for pain." 5. "To maintain perineal hygiene, the client should soak nightly in a bathtub and use mild soap."

2. "I will reinforce teaching with the client about abstaining from sexual intercourse for two weeks." 3. "The client should call the health care provider for foul-smelling vaginal discharge, heavy vaginal bleeding, or severe pain." 4. "The client should continue prenatal vitamins with iron and take ibuprofen as needed for pain." Spontaneous abortion (ie, miscarriage) describes an unintentional pregnancy loss before 20 weeks gestation, but most miscarriages occur during the first trimester. Physical recovery after a miscarriage takes several weeks and involves a return of hormones to prepregnancy levels, healing of the reproductive tract (ie, endometrium), and replenishing of depleted iron stores. The nurse should provide the following instructions to promote optimal physical healing from a miscarriage: Avoid sexual intercourse and tampons as prescribed (eg, 2 weeks) to prevent bacteria from ascending the reproductive tract and causing infection (eg, endometritis) (Option 2) Report foul-smelling vaginal discharge, heavy vaginal bleeding, and severe pain, which are potential signs of infection or retained products of conception (eg, fetal tissue) to the health care provider immediately (Option 3) Educational objective:Following a spontaneous abortion (ie, miscarriage), the nurse should instruct the client to avoid sexual intercourse and tub baths for approximately two weeks to prevent infection; take prenatal vitamins with iron to prevent anemia; use ibuprofen to alleviate cramping; and report foul-smelling vaginal discharge, heavy vaginal bleeding, and severe pain.

The graduate nurse (GN) is caring for a client at 20 weeks gestation with secondary syphilis. The client reports an allergic reaction to penicillin as a child but does not know what kind of reaction occurred. When discussing the client's potential treatment plan with the precepting nurse, which statement by the GN indicates an appropriate understanding? 1. "Doxycycline is an acceptable alternative to penicillin for treatment of syphilis during pregnancy." 2. "The client will require penicillin desensitization to receive appropriate treatment." 3. "The newborn can be treated after birth if antepartum treatment is contraindicated." 4. "Treatment is only effective if provided during the primary stage of syphilis."

2. "The client will require penicillin desensitization to receive appropriate treatment." Syphilis is a sexually transmitted infection that crosses the placenta and may have teratogenic effects on fetal development. All pregnant clients are screened for syphilis at the initial prenatal visit, and high-risk clients are screened again during the third trimester and labor. Maternal manifestations of syphilis may vary depending on the time of diagnosis. The only adequate prenatal treatment is IM penicillin injection (ie, benzathine penicillin G). Expected outcomes include resolution of maternal infection and prevention or treatment of fetal infection. If a pregnant client has a penicillin allergy, the nurse should anticipate penicillin desensitization so that adequate treatment can be provided (Option 2). Educational objective:Syphilis is a sexually transmitted infection that crosses the placenta and may have teratogenic effects on fetal development. If a pregnant client has a penicillin allergy, penicillin desensitization is recommended to receive appropriate treatment (ie, IM benzathine penicillin G) and prevent or treat congenital syphilis.

The initial prenatal laboratory screening results of a client at 12 weeks gestation indicate a rubella titer status of nonimmune. What will the nurse anticipate as the plan of care for this client? 1. Administer measles-mumps-rubella (MMR) vaccine now 2. Administer MMR vaccine immediately postpartum 3. Administer MMR vaccine in the third trimester 4. An MMR vaccine is not indicated for this client

2. Administer MMR vaccine immediately postpartum Educational objective:The measles-mumps-rubella vaccine is a live attenuated vaccine and is contraindicated in pregnancy due to the risk of teratogenic effects to the fetus. Clients who are nonimmune to rubella should receive the vaccine in the postpartum period. Pregnancy should be avoided for at least 1-3 months after immunization.

The nurse is reinforcing instructions to a client at 34 weeks gestation who is preparing to travel by airplane. Which of the following instructions are appropriate? Select all that apply. 1. Avoid getting up during the flight unless you need the restroom 2. Carry a copy of your most up-to-date prenatal record 3. Increase fluid intake before and during the flight 4. Secure the lap belt below the abdomen and across your hips when seated 5. Wear compression hose and loose-fitting clothing

2. Carry a copy of your most up-to-date prenatal record 3. Increase fluid intake before and during the flight 4. Secure the lap belt below the abdomen and across your hips when seated 5. Wear compression hose and loose-fitting clothing Travel during pregnancy requires special modifications and precautions to ensure client safety and reduce the potential for injury and pregnancy complications. Clients should get their health care provider's approval prior to traveling long distances. Domestic air travel is usually allowed for healthy clients at <36 weeks gestation. When reinforcing education about travel safety, the nurse should instruct the client to: carry an updated copy of the prenatal record in case emergency medical care is necessary during travel (Option 2). increase fluid intake to prevent dehydration and reduce the risk of thrombus formation or preterm contractions (Option 3). secure the lap belt under the gravid abdomen and across the hips and, if available, place shoulder belts lateral to the uterus and between the breasts to prevent complications from abdominal trauma (eg, placental abruption) (Option 4). wear compression stockings and unrestrictive clothing to improve venous return and decrease the risk of thrombus formation (Option 5). avoid traveling to Zika- or malaria-prevalent areas and remote areas with poor medical care or lack of sanitation. Educational objective:When education about travel safety to pregnant clients is reinforced, recommendations should include carrying the prenatal record; increasing fluid intake; wearing compression stockings and loose clothing; avoiding long periods of sitting; and wearing the lap belt underneath the gravid abdomen and across the hips.

The clinic nurse is collecting data on a pregnant client in the first trimester. Which finding is most concerning and warrants priority intervention? 1. Client has not been taking prenatal vitamins 2. Client is taking lisinopril to control hypertension 3. Client reports a whitish vaginal discharge 4. Client reports mild cramping pain in the lower abdomen

2. Client is taking lisinopril to control hypertension Angiotensin-converting enzyme (ACE) inhibitors (eg, enalapril, lisinopril, ramipril) and angiotensin II receptor blockers (eg, losartan, valsartan, telmisartan) should be avoided in clients who are planning to become pregnant. These drugs are teratogenic, leading to fetal renal and cardiac abnormalities, and are contraindicated in all stages of pregnancy. Educational objective:Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are teratogenic and need to be discontinued when planning pregnancy.

A 14-year-old client confides to the school nurse that she is pregnant, likely in the second trimester, and has not had prenatal care. Which of the following topics should the nurse discuss with the client at this time? Select all that apply. 1. Desire for adoption planning services 2. Emotional response to the pregnancy 3. Family/social support systems 4. Nutritional habits and substance abuse 5. Plan for finishing high school

2. Emotional response to the pregnancy 3. Family/social support systems 4. Nutritional habits and substance abuse Pregnant adolescent clients are a unique population because of their increased risk for complications during pregnancy (eg, low birth weight, preterm birth, preeclampsia) and developmental needs. During an initial encounter with a pregnant adolescent, the nurse should discuss the client's emotional response to the pregnancy to build rapport and provide psychosocial support (Option 2). Discussing the client's level of family/social support or fear of social discrimination is appropriate because these factors may prevent the client from obtaining prenatal care (Option 3). Pregnant adolescents are vulnerable to poverty, dangerous living conditions, exposure to teratogens (eg, tobacco, alcohol, illicit drugs), poor nutritional status, and physical or sexual abuse, which can cause adverse fetal/maternal outcomes. Therefore, discussing these topics openly as soon as possible is appropriate to prevent harm (Option 4). Educational objective:Pregnant adolescent clients are at an increased risk for complications during pregnancy. Factors such as emotional response to the pregnancy, family/social support, nutritional status, and substance abuse impact the pregnancy and should be discussed during an initial encounter to establish rapport and prevent harm.

A client suspects she is pregnant and comes for prenatal evaluation. Which assessment findings indicate definitive evidence (positive signs) of pregnancy? Select all that apply. 1. Cervical softening on examination 2. Fetal heart tones detected by Doppler device 3. Positive serum human chorionic gonadotropin test 4. Report of fetal movement felt by client 5. Visualization of fetus by ultrasound

2. Fetal heart tones detected by Doppler device 3. Positive serum human chorionic gonadotropin test 5. Visualization of fetus by ultrasound Positive (diagnostic) signs of pregnancy represent conclusive evidence of pregnancy and cannot be attributed to any other etiology. These signs include a discernible fetal heartbeat heard by Doppler device, ultrasound visualization of the fetus, and fetal movement palpated or observed by the health care provider (HCP) (Options 2 and 5). Presumptive (subjective) signs of pregnancy are self-reported by the client (eg, breast tenderness, nausea, amenorrhea). These signs may be related to other medical conditions and therefore cannot be considered diagnostic of pregnancy. Probable (objective) signs of pregnancy are observed by the HCP during assessment and examination (eg, cervical changes, positive pregnancy test). Combined with subjective signs, objective signs may be more indicative of pregnancy but may still have alternate causes. Educational objective:Positive signs of pregnancy represent conclusive evidence of pregnancy. These signs include ultrasound visualization of the fetus, a distinguishable fetal heartbeat heard by Doppler device, and fetal movement palpated or observed by the health care provider.

The nurse is preparing a nutritional teaching plan for a client planning to become pregnant. Which foods would bestprevent neural tube defects? 1. Calcium-rich snacks 2. Fortified cereals 3. Organ meats 4. Wild salmon

2. Fortified cereals Explanation Women who are planning on becoming pregnant should consume 400-800 mcg of folic acid daily. Food options that are rich in folic acid include fortified grain products (eg, cereals, bread, pasta) and green, leafy vegetables (Option 2). Inadequate maternal intake of folic acid during the critical first 8 weeks after conception (often before a woman knows she is pregnant) increases the risk of fetal neural tube defects (NTDs), which inhibit proper development of the brain and spinal cord. Common NTDs are spina bifida and anencephaly (lack of cerebral hemispheres and overlying skull). Educational objective:Women who are planning to become pregnant should consume 400-800 mcg of folic acid daily to prevent neural tube defects (eg, spina bifida, anencephaly). Food options that are rich in folic acid include fortified grain products (eg, cereals, bread, pasta) and green, leafy vegetables.

A client at 34 weeks gestation reports constipation. The client has been taking 325 mg ferrous sulfate tid for anemia since the last appointment 4 weeks ago. Which recommendations should the nurse make for this client? Select all that apply. 1. Decreased daily dairy intake 2. Increased fruit and vegetable intake 3. Moderate-intensity regular exercise 4. One laxative twice daily for a week 5. Two cups of hot coffee each morning

2. Increased fruit and vegetable intake 3. Moderate-intensity regular exercise Constipation is a common discomfort of pregnancy and is due to an increase in the hormone progesterone, which causes decreased gastric motility. Ferrous sulfate (iron) supplementation may also cause constipation. Interventions to prevent or treat constipation include: High-fiber diet: High amounts of fruits, vegetables, breakfast cereals, whole-grain bread, prunes High fluid intake: 10-12 cups of fluid daily Regular exercise: Moderate-intensity exercise (eg, walking, swimming, aerobics) Bulk-forming fiber supplements: Psyllium, methylcellulose, wheat dextrin Educational objective:Constipation in pregnancy may be caused by increased progesterone levels and iron supplementation. It is best treated with 10-12 cups of fluid daily, a high-fiber diet/supplementation, and regular exercise. Clients should not take laxatives without first discussing this with the health care provider.

A nurse is caring for a pregnant client at 27 weeks gestation after a motor vehicle collision with side airbag deployment. The client's blood type is O negative. Which laboratory test should the nurse anticipate? 1. Group B streptococcal culture 2. Indirect Coombs test 3. Rubella immunity titer 4. Serum alpha-fetoprotein

2. Indirect Coombs test During pregnancy, the mother and fetus have separate blood supply mechanisms. However, disruption of this separation can occur at delivery or when trauma results in fetomaternal hemorrhage (eg, placental abruption after a motor vehicle collision). If an Rh-negative mother (eg, O negative blood type) is exposed to Rh-positive fetal blood (if the father is Rh positive), the pregnant client develops antibodies to the Rh antigen (ie, Rh sensitization), placing the current fetus and all future pregnancies at risk for serious complications (eg, hemolytic anemia). An indirect Coombs test is performed to screen for Rh sensitization any time hemorrhage secondary to placental abruption is suspected (eg, maternal trauma) (Option 2). Rh immune globulin (eg, RhoGAM) is administered to all Rh-negative pregnant clients at 28 weeks gestation and within 72 hours postpartum, as well as after any maternal trauma, to prevent the development of permanent Rh antibodies. RhoGAM is not effective once sensitization has occurred. Educational objective:Indirect Coombs testing screens for Rh sensitization in Rh-negative mothers. If the test results are positive, the fetus and subsequent pregnancies are at risk for serious complications. Rh immune globulin (eg, RhoGAM) is given at 28 weeks gestation and within 72 hours postpartum as well as any time there is maternal trauma.

The nurse is caring for a client in the first trimester during an initial prenatal clinic visit. Based on the information provided by the client, which factor places the client at an increased risk for preterm labor? 1. Age 25 2. Periodontal disease 3. Vegetarian diet 4. White ethnicity

2. Periodontal disease Preterm birth is defined as birth before 37 weeks and 0 days gestation. Infection (eg, periodontal disease, urinary tract infection) is strongly associated with preterm labor, particularly when untreated (Option 2). Infection causes release of inflammatory mediators such as prostaglandins, which are uterotonic (ie, promote contractions) and contribute to cervical softening. Some risk factors for preterm birth may be modifiable with lifestyle changes and early treatment. Risk factors should be addressed at the initial and each subsequent prenatal visit to allow for early identification and management. Some risk factors for preterm birth include: History of spontaneous preterm birth in a previous pregnancy (single largest independent risk factor) Previous cervical surgery, such as a cone biopsy (weakens cervical support) Tobacco and/or illicit drug use Educational objective:Infection (eg, periodontal disease, urinary tract infection) places pregnant clients at increased risk for preterm labor and birth. Other risk factors include history of preterm birth, previous cervical surgery, tobacco/illicit drug use, and maternal age <17 or >35.

A client at 39 weeks gestation with preeclampsia has a blood pressure of 170/100 mm Hg, 2+ proteinuria, and moderate peripheral edema. Immediately after hospital admission, she develops seizures and uterine contractions. Magnesium sulfate is prescribed. Which finding indicates that the drug has achieved the desired therapeutic effect? 1. Blood pressure <130/80 mm Hg 2. Seizure activity stops 3. Urine has 1+ protein 4. Uterine contractions stop

2. Seizure activity stops Preeclampsia is a systemic disease characterized by hypertension and proteinuria after the 20th gestational week with unknown etiology. Eclampsia is the onset of convulsions or seizures that cannot be attributed to other causes in a woman with preeclampsia. Delivery is the only cure for preeclampsia-eclampsia syndrome. Magnesium sulfate is a central nervous system depressant used to prevent/control seizure activity in preeclampsia/eclampsia clients. During administration, the nurse should assess vital signs, intake and output, and monitor for signs of magnesium toxicity (eg, decreased deep-tendon reflexes, respiratory depression, decreased urine output). A therapeutic magnesium level of 4-7 mEq/L (2.0-3.5 mmol/L) is necessary to prevent seizures in a preeclamptic client. Educational objective:Magnesium sulfate is prescribed for clients with preeclampsia to prevent seizure activity. A therapeutic magnesium level of 4-7 mEq/L (2.0-3.5 mmol/L) is necessary to prevent seizures in a preeclamptic client.

The graduate nurse (GN) is assisting the nurse preceptor to provide education to a client diagnosed with a molar pregnancy. Which statement by the GN requires the precepting nurse to intervene? 1. "A uterine evacuation procedure is the typical treatment for removing the abnormal tissue." 2. "We can provide you with resources for coping with perinatal loss if needed." 3. "You may start trying to conceive again as soon as you and your partner feel ready." 4. "You will need Rh immune globulin following a molar pregnancy because you have a Rh-negative blood type."

3. "You may start trying to conceive again as soon as you and your partner feel ready." A molar pregnancy, or hydatidiform mole, is a type of gestational trophoblastic disease that results from abnormal fertilization. It causes rapidly growing trophoblastic tissue that is initially benign but may lead to gestational trophoblastic neoplasia (GTN) (eg, invasive mole, choriocarcinoma). If trophoblastic tissue continues to grow or metastasize after evacuation of a molar pregnancy, levels of human chorionic gonadotropin (hCG), a hormone that is also used to diagnose pregnancy, will continue to increase. Therefore, the nurse should emphasize the importance of avoiding pregnancy during follow-up care to allow health care providers to monitor for rising hCG levels, which may indicate malignant GTN (Option 3). Weekly monitoring of hCG levels is required at first, followed by continued monitoring for 6-12 months postpartum. Educational objective:Following a molar pregnancy, the nurse should instruct the client to avoid pregnancy during follow-up care while health care providers are monitoring human chorionic gonadotropin levels to ensure that gestational trophoblastic neoplasia (eg, choriocarcinoma) does not develop.

client with diabetes visits the clinic reporting breast tenderness, vaginal discharge, and urinary frequency. Which action is most important for the nurse to perform? 1. Ask if the client performs breast self-exams 2. Ask the client about characteristics of vaginal discharge 3. Assess the date of the client's last menstrual period 4. Review the client's home blood sugar logs

3. Assess the date of the client's last menstrual period Subjective (presumptive) signs of pregnancy are self-reported by a client. This client's symptoms could originate from pathologic causes (eg, urinary tract infection [UTI], sexually transmitted infection), but collectively these symptoms may be indicative of early pregnancy. Any client with possible signs/symptoms of early pregnancy should be asked about menstrual history (Option 3). Educational objective:Subjective (self-reported) signs of pregnancy may include leukorrhea, breast tenderness, and urinary frequency. Any client with possible signs/symptoms of early pregnancy should be asked about menstrual history.

Which client in a prenatal clinic should the nurse assess first? 1. Client at 11 weeks gestation with backache and pelvic pressure 2. Client at 16 weeks gestation with earache and sinus congestion 3. Client at 27 weeks gestation with headache and facial edema 4. Client at 37 weeks gestation with white vaginal discharge and urinary frequency

3. Client at 27 weeks gestation with headache and facial edema Gestational hypertension is new-onset high blood pressure (≥140/90 mm Hg) that occurs after 20 weeks gestation without proteinuria. The development of proteinuria with hypertension indicates preeclampsia, which may manifest with symptoms such as headache, visual disturbances, and facial swelling. This client is exhibiting symptoms of preeclampsia and should be assessed first (Option 3). Complications of preeclampsia may include thrombocytopenia, liver dysfunction, and renal insufficiency. Clients with preeclampsia must be monitored closely for sudden worsening, which can lead to serious complications, including eclampsia and/or HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets). Educational objective:The nurse should assess the client with symptoms of potentially serious complications first before assessing the remaining clients. Signs of hypertensive disorders during pregnancy may include headache and facial edema.

The nurse is performing assessments of several clients during routine prenatal visits. Which client should the nurse discuss with the health care provider first? 1. Client at 30 weeks gestation with darkened patches of skin on the face 2. Client at 32 weeks gestation with painless, flesh-colored bumps on the perianal area 3. Client at 34 weeks gestation with intense itching on the hands and feet that worsens at night but no rash 4. Client at 38 weeks gestation with stretch marks on the abdomen that have become reddened and pruritic

3. Client at 34 weeks gestation with intense itching on the hands and feet that worsens at night but no rash Intrahepatic cholestasis of pregnancy is a liver disorder exclusive to pregnancy that manifests with intense, generalized itching but no rash. Itching often involves the hands and feet and worsens at night. This condition increasesthe risk of intrauterine fetal demise and requires priority assessment by the health care provider (Option 3). Educational objective:Intrahepatic cholestasis of pregnancy is a liver disorder exclusive to pregnancy that manifests with intense, generalized itching but no rash. The condition requires priority assessment and intervention (eg, bile acid testing, fetal surveillance, ursodeoxycholic acid) due to an increased risk of fetal demise.

The nurse is documenting assessments of pregnant clients in the antepartum unit. Which client's assessment findings are most important to report to the health care provider? 1. Client at 28 weeks gestation with an asymptomatic systolic murmur 2. Client at 34 weeks gestation with 1+ edema of bilateral lower extremities 3. Client at 35 weeks gestation with painful genital lesions 4. Client at 39 weeks gestation with brownish, mucoid vaginal discharge

3. Client at 35 weeks gestation with painful genital lesions Painful genital lesions can be indicative of an outbreak of genital herpes simplex virus (HSV) and are a priority assessment finding to report to the health care provider. Herpes in pregnant women can be transmitted to the infant in utero (congenital HSV), perinatally, or postnatally as a result of direct contact with virus particles shed from the infected vulva, vagina, cervix, or perineum. Neonatal HSV infection has serious morbidity (eg, permanent neurologic sequelae) and mortality. Immediate antiviral therapy (eg, acyclovir) should be initiated to treat the active infection. Vaginal birth is not recommended in the presence of active lesions; cesarean birth helps reduce the risk of transmission to the newborn (Option 3). Educational objective:Painful genital lesions during pregnancy are a priority assessment finding to report to the health care provider. Active herpes lesions that are present at the onset of labor indicate the need for cesarean birth.

The nurse receives report on 4 first-trimester pregnant clients. Which client should the nurse assess first? 1. Client with hydatidiform mole reporting dark brown vaginal discharge 2. Client with hyperemesis gravidarum reporting excessive vomiting and weight loss 3. Client with suspected ectopic pregnancy reporting abdominal and shoulder pain 4. Client with threatened miscarriage who says, "I am a Jehovah's Witness."

3. Client with suspected ectopic pregnancy reporting abdominal and shoulder pain An ectopic pregnancy occurs when a fertilized egg implants and begins to grow outside the uterine cavity, frequently in the fallopian tubes. Clients with ectopic pregnancies may report a positive pregnancy test, vaginal spotting/bleeding, and/or abdominal pain. If untreated, continued growth can lead to fallopian tube rupture, resulting in hemorrhage and hemodynamic compromise. Intra-abdominal bleeding can lead to referred shoulder pain, a classic sign of diaphragm irritation. Ruptured ectopic pregnancy requires emergency surgical intervention and hemodynamic support (eg, IV fluids, blood transfusion) (Option 3). Educational objective:Ectopic pregnancy occurs when a fertilized egg implants and begins to grow outside the uterus, often in the fallopian tubes. Rupture of an ectopic pregnancy results in hemorrhage and requires emergency surgery. Shoulder pain in a client with ectopic pregnancy indicates intra-abdominal bleeding from a rupture.

A pregnant client comes in for a routine first prenatal examination. According to the last menstrual period, the estimated gestational age is 12 weeks. Where would the nurse expect to palpate the uterine fundus in this client? 1. 12 cm above the umbilicus 2. At the level of the umbilicus 3. Halfway between the symphysis pubis and the umbilicus 4. Just above the symphysis pubis

3. Halfway between the symphysis pubis and the umbilicus The enlarging pregnant uterus should be just above the symphysis pubis at approximately 12 weeks gestation (Option 4). At 16 weeks gestation, the fundus is roughly halfway between the symphysis pubis and the umbilicus. It reaches the umbilicus at 20-22 weeks gestation and approaches the xiphoid process around 36 weeks gestation. At 38-40 weeks, the fetus engages into the maternal pelvis and the fundal height drops. After 20 weeks gestation, the fundal height, measured in centimeters from the symphysis pubis to the top of the fundus, correlates closely to the weeks of gestation. Educational objective:The fundus rises above the symphysis pubis at approximately 12 weeks gestation, reaches the umbilicus at 20-22 weeks gestation, and reaches the xyphoid process at 36 weeks gestation. After 20 weeks gestation, the fundal height in centimeters correlates closely to the weeks of gestation.

A client who is 8 weeks pregnant reports morning sickness. What is the most appropriate response by the nurse? 1. Advise the client to consume hot, versus cold, foods 2. Instruct the client to drink 2 glasses of water with each meal 3. Suggest the client consume high-protein snacks on awakening 4. Tell the client that morning sickness should pass in a few weeks

3. Suggest the client consume high-protein snacks on awakening Morning sickness, characterized by nausea with or without vomiting, is a common problem during the first trimester of pregnancy. Although it is referred to as "morning" sickness, it can happen anytime throughout the day. It is thought to be due to rising hormone levels (ie, estrogen, progesterone, human chorionic gonadotropin). Initial interventions, focusing on diet management and triggering avoidance, include: Eating several small meals during the day (ie, high in protein or carbohydrates and low in fat) Drinking fluids (preferably clear, cold, carbonated beverages) between, rather than with, meals Having a high-protein snack before bedtime and on awakening (Option 3) Educational objective:Morning sickness can usually be relieved through lifestyle and dietary changes, including eating small and frequent meals, drinking cold fluids between meals, having a high-protein snack before bedtime and on awakening, and consuming foods/drinks containing ginger and vitamin B6.

The nurse is counseling a pregnant client who is HIV positive. Which information is appropriate to discuss? 1. Infant should be exclusively breastfed for 6 months to receive maternal antibodies 2. Infant will not require treatment for HIV after birth 3. prescribed antiretroviral therapy should be continued during pregnancy 4. Tetanus-diphtheria-pertussis vaccine should be avoided until after birth

3. prescribed antiretroviral therapy should be continued during pregnancy Perinatal transmission of HIV infection can occur from mother to baby anytime during the antepartum, intrapartum, or postpartum periods. Maternal antiretroviral therapy (ART) during pregnancy is imperative for decreasing viral load (amount of virus detectable in maternal serum) and decreasing risk of transmission to the fetus. Educational objective:Transmission of HIV infection from mother to baby can occur during antepartum, intrapartum, or postpartum periods. Maternal antiretroviral therapy (ART) during pregnancy is imperative for decreasing the risk of perinatal transmission. Pregnant clients who are HIV positive should receive recommended inactivated vaccines. Newborns born to HIV-positive clients should not breastfeed and should receive 4-6 weeks of ART after birth.

A pregnant client in the first trimester tells the clinic nurse she will be traveling to an area with a known Zika virus outbreak and expresses concern regarding disease transmission. Which statement by the nurse is most appropriate? 1. "If you experience Zika symptoms, notify your health care provider." 2. "Take precautions against mosquito bites throughout the trip." 3. "You are not far enough along for the Zika virus to affect your baby." 4. "You should consider postponing your trip until after you have the baby."

4. "You should consider postponing your trip until after you have the baby." Zika virus is transmitted via mosquitoes, sexual contact, and infected bodily fluids. Zika causes viral symptoms (eg, low-grade fever, arthralgias) and has been shown to cause microcephaly, developmental dysfunction, and encephalitis in babies born to Zika-infected women. Women who are attempting to conceive and those who are pregnant are encouraged to avoid travel to areas affected by Zika until after birth (Option 4). For clients currently living in a Zika-affected area, proper mosquito precautions (eg, insect repellant containing DEET) and safe sex practices (eg, barrier methods) should be utilized, and routine Zika testing may be provided. Educational objective:Zika infection in a pregnant woman can cause birth defects and developmental dysfunction. Current guidelines recommend that pregnant women avoid travel to Zika-affected areas.

The nurse performs initial assessments of four clients in a prenatal clinic. Which client findings are abnormal and require further assessment? 1. Client at 9 weeks gestation with a normal BMI and a weight gain of 2 lb (1 kg) from pre-pregnancy weight 2. Client at 15 weeks gestation with headaches relieved by acetaminophen 3. Client at 19 weeks gestation with bleeding gums after brushing and flossing teeth 4. Client at 20 weeks gestation with an increase in diastolic blood pressure of 15 mm Hg since last visit

4. Client at 20 weeks gestation with an increase in diastolic blood pressure of 15 mm Hg since last visit Physiologic decreases in systemic vascular resistance during pregnancy cause a steady, slight decrease in blood pressure(BP) beginning in the first trimester and reaching the lowest point around 24-32 weeks gestation. In the third trimester, BP gradually returns to pre-pregnancy baseline. Monitoring BP during pregnancy assists in the detection of hypertensive disorders of pregnancy (chronic hypertension, gestational hypertension, preeclampsia, eclampsia). Some clients with only mildly elevated BP may develop eclampsia or HELLP syndrome (hemolysis, elevated liver enzymes, low platelets). An increase in BP of ≥30 mm Hg systolic or ≥15 mm Hg diastolic over pre/early-pregnancy measurements, even in the absence of hypertension (ie, ≥140/90 mm Hg), is a deviation from normal physiologic BP responses in pregnancy and requires further assessment for other signs/symptoms (eg, proteinuria, headache, right upper quadrant pain) (Option 4). Educational objective:Physiologic decreases in systemic vascular resistance cause a steady, slight decrease in blood pressure (BP) beginning in the first trimester and reaching its lowest point around 24-32 weeks gestation. An increase in BP of ≥30 mm Hg systolic or ≥15 mm Hg diastolic over pre/early-pregnancy measurements requires further assessment.

The obstetric nurse is reviewing phone messages. Which client should the nurse call first? 1. Client at 18 weeks gestation taking ceftriaxone and reporting mild diarrhea 2. Client at 22 weeks gestation with twins who is taking acetaminophen twice a day 3. Client at 28 weeks gestation taking metronidazole and reporting dark-colored urine 4. Client at 32 weeks gestation taking ibuprofen for moderate back pain

4. Client at 32 weeks gestation taking ibuprofen for moderate back pain Nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen, indomethacin, naproxen) inhibit prostaglandin synthesis and can be taken to decrease pain and inflammation or to reduce fever. NSAIDs are pregnancy category C in the first and second trimesters and pregnancy category D in the third trimester. NSAIDs must be avoided during the third trimester due to the risk of causing premature closure of the ductus arteriosus in the fetus (Option 4). During the first and second trimesters, NSAIDs should be taken only if benefits outweigh risks and under the supervision of a health care provider (HCP). Educational objective:Nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in the third trimester due to risk of premature closure of the fetal ductus arteriosus. NSAIDs should be taken only under the direction and supervision of a health care provider during the first and second trimesters.

A nurse is caring for a client at 12 weeks gestation who is admitted for hyperemesis gravidarum. Which clinical manifestation should the nurse expect? 1. Abdominal pain and low-grade fever 2. Blood pressure ≥140/90 mm Hg 3. High urine protein leve 4. Moderate to high urine ketones

4. Moderate to high urine ketones Hyperemesis gravidarum (HG) is characterized by severe, persistent nausea and vomiting during pregnancy that usually leads to considerable weight loss (ie, ≥5% of prepregnancy weight), fluid and electrolyte imbalances (eg, hypokalemia), and nutritional deficiencies. Clients with HG may require hospitalization for IV fluid replacement and antiemetic therapy. Routine laboratory assessment for HG includes urinalysis dipstick testing to monitor the client's health status. Expected findings include an elevated urine specific gravity and ketonuria (Option 4). Urine specific gravity increases when urine is concentrated due to dehydration, and ketones are a by-product of the fat breakdown that occurs in starvation states. Educational objective:Hyperemesis gravidarum (ie, excessive vomiting during pregnancy) leads to fluid and electrolyte imbalances (eg, hypokalemia, hypotension), weight loss of ≥5% of prepregnancy weight, nutritional deficiencies, and ketonuria. Urine ketones are expected because they are a by-product of fat breakdown, which occurs in starvation states.

The nurse is caring for a client who reports severe abdominal pain and vaginal spotting. The client had a positive urine pregnancy test at home, and her last menstrual period was 8 weeks ago. Which client report to the nurse is most concerning? 1. Abdominal pain rated as 8 out of 10 2. History of pelvic inflammatory disease 3. Intermittent nausea and vomiting for the past 7 days 4. Right shoulder pain and dizziness

4. Right shoulder pain and dizziness Symptoms of ectopic pregnancy may include lower abdominal and pelvic pain; amenorrhea, possibly followed by vaginal spotting or bleeding; and a palpable adnexal mass on pelvic examination. An ectopic pregnancy may implant in one of many locations outside the uterine cavity, including the fallopian tubes, ovaries, or abdominal cavity. As the ectopic pregnancy outgrows its environment, it may rupture, causing life-threatening maternal hemorrhage. Symptoms indicative of a ruptured ectopic pregnancy include hypotension, tachycardia, dizziness, and referred shoulder pain (Option 4). Shoulder pain results from irritation of the diaphragm by intraabdominal blood. A ruptured ectopic pregnancy is a surgical emergency and requires immediate intervention. Educational objective:An ectopic pregnancy may rupture prior to diagnosis, causing life-threatening maternal hemorrhage. Symptoms of a ruptured ectopic pregnancy include hypotension, tachycardia, dizziness, and referred shoulder pain. Ruptured ectopic pregnancy is a surgical emergency requiring immediate intervention.

When triaging 4 pregnant clients in the obstetric clinic, the nurse should alert the health care provider to see which client first? 1. First-trimester client reporting frequent nausea and vomiting 2. Second-trimester client with dysuria and urinary frequency 3. Second-trimester client with obesity reporting decrease in fetal movement 4. Third-trimester client with right upper quadrant pain and nausea

4. Third-trimester client with right upper quadrant pain and nausea Right upper quadrant (RUQ) or epigastric pain can be an indicator of HELLP syndrome, a severe form of preeclampsia. HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelet count) is often mistaken for viral gastroenteritis due to its variable and nonspecific presentation. Misdiagnosis may lead to severe complications (eg, placental abruption, liver failure, stroke) and/or maternal/fetal death. Clients may have RUQ pain, nausea, vomiting, and malaise. Headache, visual changes, proteinuria, and hypertension may or may not be present. (Option 1) Nausea and vomiting during the first trimester are normal, expected findings. Vomiting that continues past the first trimester or that is accompanied by fever, pain, or weight loss is considered abnormal and requires intervention. (Option 2) Although urinary frequency is common in pregnancy, dysuria could indicate a urinary tract infection. This client should be evaluated but does not take priority over a client with symptoms of HELLP. (Option 3) Maternal perception of fetal movement can be altered by obesity, maternal position, fetal sleep cycle, fetal position, anterior placenta, and amniotic fluid volume (increased or decreased). This client should be evaluated to determine the cause of decreased fetal movement; however, this is not the priority. Educational objective:HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelet count) is a severe form of preeclampsia. Its clinical presentation can be quite variable and may include nonspecific symptoms such as right upper quadrant/epigastric pain, nausea, vomiting, and malaise. Complications including placental abruption, stroke, and death may occur if HELLP syndrome is not treated immediately.

A pregnant client at 39 weeks gestation is brought to the emergency department in stable condition following a motor vehicle collision. The client, who is secured supine on a backboard, suddenly becomes pale with a blood pressure of 88/50 mm Hg. Which action should the nurse take first? 1. Administer normal saline fluid bolus 2. Ask about any prenatal complications 3. Initiate fetal heart rate monitoring 4. Tilt the backboard to one side

4. Tilt the backboard to one side During stabilization of a pregnant client after trauma (eg, motor vehicle collision, fall), uterine displacement is the first step to address supine hypotension (due to aortocaval compression and decreased venous return to the heart) and promote blood circulation to the fetus. The client should be tilted laterally while strapped on the backboard to promote venous return and protect the client from further potential spinal injury (Option 4). Manifestations of aortocaval compression (eg, hypotension, pallor, dizziness) may mimic those of other complications of trauma. It is therefore critical to reassess blood pressure after uterine displacement to identify persistent hypotension, which may indicate hemorrhage caused by trauma (eg, placental abruption). Educational objective:During stabilization of a pregnant client after trauma, uterine displacement is the first step to prevent/correct supine hypotension and promote blood circulation to the fetus. A lateral tilt of the backboard can correct aortocaval compression while protecting the client from further spinal injury.