Antepartum Passpoint

Which outcome would the nurse identify as the priority to achieve when developing the plan of care for a primigravid client at 38 weeks' gestation who is hospitalized with severe preeclampsia and receiving intravenous magnesium sulfate?

absence of any seizure activity during the first 48 hours

In 6 months, a client is expecting a second child. During the psychosocial assessment, the client says to the nurse, "I've been through this before. Why are you asking me these questions?" What is the nurse's best response?

"Each pregnancy has a unique psychosocial meaning."

A nurse is using Doppler ultrasound to assess a pregnant client. When should the nurse expect to begin hearing fetal heart tones?

11 weeks' gestation

At 32 weeks' gestation, a client is admitted to the facility with a diagnosis of gestational hypertension. Based on this diagnosis, the nurse expects the assessment to reveal:

3+ edema in the lower extremities.

A nurse assesses a client for signs and symptoms of ectopic pregnancy. Which assessment finding should the nurse expect?

Abdominal pain

A 29-year-old multigravida at 37 weeks' gestation is being treated for severe preeclampsia and has magnesium sulfate infusing at 3 g/h. What is the priority intervention to maintain safety for this client?

Assess reflexes, clonus, visual disturbances, and headache.

A primigravid client with class II heart disease who is visiting the clinic at 8 weeks' gestation tells the nurse that she has been maintaining a low-sodium, 1,800-calorie diet. Which instruction should the nurse give the client?

Increase caloric intake to 2,200 calories daily to promote fetal growth.

A client is 8 weeks pregnant. Which teaching topic is most appropriate at this time?

common discomforts of pregnancy

The nurse is caring for a 38-year-old primigravida in the third trimester of pregnancy. The nurse plans to assess the client for manifestations of which complication?

preeclampsia

The primary health care provider prescribes intravenous magnesium sulfate for a primigravid client at 38 weeks' gestation diagnosed with severe preeclampsia. Which medication would be most important for the nurse to have readily available?

calcium gluconate

A client in her 34th week of pregnancy presents with sudden onset of bright red vaginal bleeding. Her uterus is soft, and she's experiencing no pain. Fetal heart rate is 120 beats/minute. Based on this history, what should the nurse suspect?

placenta previa

A primigravid client at 28 weeks' gestation tells the nurse that she and her husband wish to drive to visit relatives who live several hours away. Which of the following recommendations by the nurse would be best?

"Taking the trip is okay if you stop every 1 to 2 hours and walk."

A 22-year-old primigravida approaches the nurse during the prenatal clinic and states that her partner is saying hurtful comments about her weight gain. What is the most appropriate response from the nurse?

"Tell me how you are feeling about your partner's comments."

A client is admitted to the facility with a suspected ectopic pregnancy. When reviewing the client's health history for risk factors for this abnormal condition, the nurse expects to find:

a history of pelvic inflammatory disease.

A client has obtained levonorgestrel as emergency contraception. After unprotected intercourse, the client calls the clinic to ask questions about taking the contraceptives. The nurse realizes the client needs further explanation when she makes which statement?

"I can wait up to 4 days after intercourse to start taking these to prevent pregnancy."

After the nurse instructs a pregnant client about swimming and bathing during pregnancy, which client statement indicates the need for additional teaching?

"I can relax in a hot tub for about 20 minutes."

A primigravid client at 24 weeks' gestation has received permission from the primary care provider to make a 6-hour automobile trip to visit her parents. After the nurse teaches the client about precautions to take during the trip, which client statement indicates the need for further instruction?

"I'll sleep for 1 hour at the halfway point of the trip."

A pregnant client is experiencing a thin, odorless, vaginal discharge. What should the nurse instruct the client to do to prevent vaginal infections?

"Try wearing a panty liner and discarding it after every urination."

A 36-year-old multigravid client is admitted to the hospital with possible ruptured ectopic pregnancy. When obtaining the client's history, which finding would be most important to identify as a predisposing factor?

episodes of pelvic inflammatory disease

A 36-year-old primigravid client at 22 weeks' gestation without any complications to date is being seen in the clinic for a routine visit. Why does the nurse need to assess the client's fundal height?

estimate the fetal growth

The nurse is assessing fetal presentation in a multiparous client. The figure here indicates which presentation?

footling breech

A client, age 39, attends a regular prenatal check-up. She's 32 weeks pregnant. When assessing the client, the nurse should stay especially alert for signs and symptoms of:

gestational hypertension.

A multigravid client thought to be at 14 weeks' gestation reports that she is experiencing such severe morning sickness that she "has not been able to keep anything down for a week." The nurse should assess for signs and symptoms of which condition?

hypokalemia

As the nurse enters the room of a newly admitted primigravid client diagnosed with severe preeclampsia, the client begins to experience a seizure. The nurse should do which in order of priority from first to last? All options must be used.

Call for immediate assistance. Turn the client to her side. Maintain airway. Assess for ruptured membranes.

The nurse is working in the labor and birth unit when a client with active herpes simplex virus-Type 2 (HSV-2) appears in active labor. Which adjustment in the plan of care is anticipated?

Prepare the client for a cesarean section.

A 27-year-old primigravid client with insulin-dependent diabetes at 34 weeks' gestation undergoes a nonstress test, the results of which are documented as reactive. What should the nurse tell the client that the test results indicate?

There is evidence of fetal well-being.

A client is at 24 weeks' gestation. The nurse is reviewing the report of laboratory tests. The nurse should report which of these results to the health care provider?

VDRL

A primigravid client visits the clinic for a routine examination at 35 weeks' gestation. The client's blood pressure is near the baseline of 120/74 mm Hg with no proteinuria or evidence of facial edema. The client asks the nurse, "What should I take if I get an occasional headache after looking at my computer at work all day?" Which over-the-counter medicine does the nurse consider to be safest for occasional use by a pregnant client with no known risks?

acetaminophen

A client is admitted with a suspected abruptio placentae. The nurse should assess the client for which signs and symptoms? Select all that apply.

bleeding that is concealed or apparent abdominal rigidity painful abdomen

A nurse is developing a teaching plan for a primigravid client who's 2 months pregnant. The nurse should tell the client that fetal movement can be felt beginning at which time?

between 18 and 20 weeks' gestation

At a preconception visit a 24-year-old client is found to have malformation of the uterus. The nurse uses the accompanying figure to explain which type of uterine malformation?

bicornate uterus

A client is in the eighth month of pregnancy. To enhance cardiac output and renal function, the nurse should advise the client to use which body position?

left lateral

During routine preconception counseling, a client asks how early a pregnancy can be diagnosed. What is the nurse's best response?

"8 days after conception."

A primigravid client at 38 weeks' gestation diagnosed with mild preeclampsia calls the clinic nurse to say she has had a continuous headache for the past 2 days accompanied by nausea. The client does not want to take aspirin. What should the nurse should tell the client?

"I think the health care provider should see you today. Can you come to the clinic this morning?"

A 15-year-old client who is 26 weeks pregnant has been admitted to the labor and delivery unit with reports of abdominal pain. Her parents want to speak with a nurse about her condition. How should the nurse respond

"I'll need a signed consent from your daughter to give you medical information."

After discussing preconception needs with a nulliparous client who eats a primarily Asian diet, which client statement indicates the need for further instruction?

"If I become pregnant, I can continue to eat sushi twice a week."

When the nurse instructs a pregnant client with a history of varicose veins about strategies to promote comfort, which client statement indicates that the teaching has been successful?

"Lying down with my feet elevated should help."

The nurse is caring for a primigravid client at about 9 weeks' gestation. After explaining self-care measures for common discomforts of pregnancy, the nurse determines that the client understands the instructions when she makes which statement?

"Nausea and vomiting can be decreased if I eat a few crackers before arising."

During routine prenatal screening, a nurse tells a client that her blood sample will be used for alpha fetoprotein (AFP) testing. Which statement best describes what AFP testing indicates?

"This test will screen for spina bifida, Down syndrome, or other genetic defects."

A client who's 4 months pregnant asks the nurse about quantity and types of exercise during pregnancy. How should the nurse counsel the client?

"Walk briskly for 10 to 15 minutes daily, and gradually increase this time."

A 20-year-old married client with a positive pregnancy test states, "Is it really true? I can not believe I am going to have a baby!" Which response by the nurse would be most appropriate at this time?

"Yes it is true. How does that make you feel?"

A client in the first trimester of pregnancy comes to the facility for a routine prenatal visit. The client reports mixed feelings about readiness to have a baby, even though this was a planned pregnancy. Which response should the nurse offer?

"You're feeling ambivalent, which is normal during the first trimester."

The nurse performs a routine prenatal assessment on a client at 35 weeks' gestation and finds vital signs: blood pressure 138/88 mm Hg, pulse 82/min, respirations 18/min, temperature 99.1° F (37.3° C). Which statement is most appropriate for the nurse to make at this time?

"Your blood pressure is slightly high. I will check it again before you leave."

A 34-year-old multigravida at 36 weeks' gestation is diagnosed with preterm labor. The client has experienced one infant death due to preterm birth at 28 weeks' gestation. On admission to the antenatal unit, the nurse determines that the fetal heart rate is 140 bpm. What should the nurse do next?

Continue monitoring the client and fetus.

A nurse is caring for a client at 30 weeks' gestation who has tested positive for the human immunodeficiency virus (HIV). What should the nurse tell the client when the client says that she wants to breast-feed her neonate?

Discourage breast-feeding because HIV can be transmitted through breast milk.

While assisting the physician with an amniocentesis on a multigravid client at 38 weeks' gestation, the nurse observes that the fluid is very cloudy and thick. The nurse interprets this finding as indicating which of the following?

Intrauterine infection.

A nurse is caring for a client who is scheduled for amniocentesis. What information about the procedure should be included in the health teaching for informed consent?

Name of procedure, how it's performed, description of alternate methods available, potential risk to mother and fetus, risks associated if the procedure isn't performed

A woman at 22 weeks' gestation has right upper quadrant pain radiating to her back. She rates the pain as 9 on a scale of 1 to 10 and says that it has occurred 2 times in the last week for about 4 hours at a time. She does not associate the pain with food. Which nursing measure is the highest priority for this client?

Refer the client to her health care provider for evaluation and treatment of the pain.

At an obstetrics and gynecology physician's office, a nurse and a nursing student discuss the prioritization of returning client phone messages. Which of the following clients would be a priority to call? Select all that apply.

a client at 34 weeks reporting transient blurred vision and shoulder pain a client at 36 weeks reporting feeling anxious and short of breath a client at 30 weeks reporting her morning sickness has suddenly returned

The health care provider prescribes clomiphene citrate for a woman who has been having difficulty getting pregnant. When teaching the client about this drug, the nurse should discuss what potential adverse effects?

chance of multiple gestation.

For the client who is receiving intravenous magnesium sulfate for severe preeclampsia, which assessment findings would alert the nurse to suspect hypermagnesemia?

decreased deep tendon reflexes

A client wants to avoid methods of birth control that contain estrogen. Which method would be the nurse recommend?

depot medroxyprogesterone acetate injection

Following a positive pregnancy test, a client begins discussing the changes that will occur in the next several months with the nurse. The nurse should include which information about a change the client can anticipate in the first trimester?

experiencing ambivalence about pregnancy

When evaluating a pregnant client's fundal height, the nurse should measure in which way?

from the symphysis pubis notch to the highest level of the fundus

A pregnant client comes to the facility for the first prenatal visit. After obtaining a health history and performing a physical examination, the nurse reviews the client's laboratory test results. Which findings suggest iron deficiency anemia?

hemoglobin 9 g/dL (90 g/L); hematocrit 30%

A client asks about complementary therapies for relief of discomfort related to pregnancy. Which comfort measure mentioned by the client indicates a need for further teaching?

herbal remedies

A 25-year-old client tells the nurse that she would like to become pregnant, but she has been diagnosed with blocked fallopian tubes due to pelvic inflammatory disease. When helping the client explore infertility treatment options, what is most appropriate for this client?

in vitro fertilization

A pregnant client complains of nausea every morning and again before meals. As a result of the nausea, the clien has been unable to eat enough and has lost weight. Which nonpharmacologic intervention should the nurse recommend?

keeping crackers at the bedside to eat before getting out of bed

A nurse is caring for a client in the 13th week of pregnancy who develops hyperemesis gravidarum. The nurse is reviewing the client's laboratory report. Which finding indicates the need for intervention?

ketones in urine

A primigravida, currently about 8 weeks pregnant, and her husband ask when they should begin the preparation for childbirth classes that discuss maternal nutrition during pregnancy. Which time would be most appropriate for the nurse to suggest that they begin the classes?

now during the first trimester of pregnancy

A woman who's 10 weeks pregnant tells the nurse that she's worried about her fatigue and frequent urination. The nurse should:

recognize these as normal early pregnancy signs and symptoms.

A nurse is providing dietary teaching to a pregnant client. To help meet iron needs, the nurse should advise the client to eat:

spinach and beef.

After administering hydralazine 5 mg intravenously as prescribed for a primigravid client with severe preeclampsia at 39 weeks' gestation, the nurse should assess the client for which complication?

tachycardia.

After instructing a primigravid client about the functions of the placenta, the nurse determines that the client needs additional teaching when she says that which hormone is produced by the placenta?

testosterone

When the nurse is working in the mother-baby unit, which client would the nurse anticipate giving Rho(D) immune globulin (human) to?

the Rh-negative mother with an Rh-positive baby

A client and her partner, both 25 years old, are having trouble conceiving. Infertility in this couple is defined as:

the inability to conceive after 1 year of unprotected attempts.

A primigravid client at 32 weeks' gestation with ruptured membranes is prescribed to receive betamethasone 12 mg intramuscularly for two doses 24 hours apart. When teaching the client about the medication, what should the nurse include as the purpose of this drug?

to accelerate fetal lung maturity

A client asks, "Can my partner and I still engage in sexual intercourse while I'm pregnant?" What should the nurse tell the client?

"Although your sexual desire may change, intercourse is safe during an uncomplicated pregnancy."

A 36-year-old multipara client is 20 weeks gestation and comes to the prenatal clinic in distress. She has been experiencing edema of her lower extremities and headaches two to three times a week. She is worried about her pregnancy and her own health. What is an appropriate response from the nurse?

"I am glad you came in. We need to do more assessments."

A nurse is providing care for a pregnant 16-year-old. The client says that she is concerned she may gain too much weight and wants to start dieting. The nurse should respond by saying:

"Nutrition is important because depriving your baby of nutrients can cause developmental and growth problems."

The team on an antepartum unit consists of two registered nurses (RN), one licensed vocational nurse (LVN), and one nursing assistant. Which one of the following conditions would be appropriate to assign the LVN?

A client with gestational hypertension

A client treated with terbutaline for premature labor is ready for discharge. Which instruction should the nurse include in the discharge teaching plan?

Report a heart rate greater than 120 beats/minute to the health care provider.

A client with gestational hypertension receives magnesium sulfate, 4 g in 50% solution I.V. over 20 minutes. What is the purpose of administering magnesium sulfate to this client?

To prevent seizures

A 32-year-old female client visits the family planning clinic and requests an intrauterine device for contraception. When assessing the client, a history of which problem would be most important to determine?

pelvic inflammatory disease

Which intervention listed in the care plan for a client with an ectopic pregnancy requires revision?

providing for dietary needs and nursing in a dark quiet room

A new nurse is asked to start an I.V. on an antepartum client. The new nurse has performed the procedure only once and isn't familiar with the I.V. pumps used in this facility. The new nurse should:

review the unit's procedure manual.

A multigravid client visits the clinic because she suspects that she is pregnant but is unable to tell the nurse when her last menstrual period began. The client has a history of preterm birth. The nurse instructs the client that the gestational age of the fetus can be estimated by which procedure?

ultrasonography

During a visit to the prenatal clinic, a pregnant client at 32 weeks' gestation reports heartburn. The client needs further instruction when she says she must do what to manage her heartburn?

Consume liquids only between meals.