Antepartum Period
A client is 33 weeks' pregnant and has had diabetes since age 21. When checking the fasting blood glucose level, which value would indicate the client's disease is controlled? -45 mg/dL (2.5 mmol/L) -85 mg/dL (4.7 mmol/L) -120 mg/dL (6.67 mmol/L) -136 mg/dL (7.56 mmol/L)
85 mg/dL (4.7 mmol/L) Explanation: The recommended fasting blood glucose level in the pregnant client with diabetes is 60 to 95 mg/dL (3.33 to 5.28 mmol/L). A fasting blood glucose level of 45 mg/dL (2.5 mmol/L) is low and may result in symptoms of hypoglycemia. A blood glucose level below 120 mg/dL (6.67 mmol/L) is recommended for 2-hour postprandial values. A blood glucose level above 136 mg/dL (7.56 mmol/L) in a pregnant client indicates hyperglycemia.
Which of the following would the nurse expect to find as presumptive signs of pregnancy? -Amenorrhea and quickening -Uterine enlargement and Chadwick's sign -A positive pregnancy test and a fetal outline -Braxton Hicks contractions and Hegar's sign
Amenorrhea and quickening Explanation: Presumptive signs, such as amenorrhea and quickening, are mostly subjective and may be indicative of other conditions or illnesses. Probable signs are objective but nonconclusive indicators — for example, Chadwick's sign, Hegar's sign, a positive pregnancy test, uterine enlargement, and Braxton Hicks contractions. Positive signs and objective indicators such as a fetal outline during an ultrasound confirm pregnancy.
A client who is 12 weeks pregnant attends a class on fetal development as part of a childbirth education program. The nurse provide which information that at 16 weeks' gestation the client's fetus will most likely present? -Be able to suck and swallow -Open the eyes -Have audible heart sounds -Have open nostrils
Have audible heart sounds Explanation: Fetal heart tones are usually audible with a fetoscope between 16 and 20 weeks' gestation. The fetus can suck and swallow at about 20 weeks' gestation. The eyes are open at approximately 28 weeks' gestation. The nostrils are open at about 21 to 28 weeks' gestation.
A client arrives at the clinic for a scheduled amniocentesis. Which question should the nurse ask? -"Have you had at least 1 L of water to drink?" -"Have you emptied your bladder?" -"Did you fast for the last 12 hours?" -"Do you have any problems lying on your left side?"
Have you emptied your bladder?" Explanation: Before amniocentesis, the client should void to empty the bladder, reducing the risk of bladder perforation. The client does not need to drink fluids before amniocentesis nor does she need to fast. The client should be placed in a supine position for the procedure.
A nurse is preparing a lecture for a prenatal class. Which hormone would the nurse include in the presentation as being responsible for maintaining pregnancy during the first 3 months? - Human chorionic gonadotropin (hCG) -Progesterone -Estrogen -Relaxin
Human chorionic gonadotropin (hCG) Explanation: The hormone hCG is responsible for maintaining pregnancy until the placenta is in place and functioning. Serial hCG levels are used to determine the status of the pregnancy in clients with complications. Progesterone and estrogen are important hormones responsible for many of the body's changes during pregnancy. Relaxin is an ovarian hormone that causes the mother to feel tired, thus promoting her to seek rest.
The nurse is caring for a client who is in the fourth stage of labor. How can the nurse assist with maintaining the primary focus of care at this time? -Prepare for impending delivery. -Monitor vital signs and client responses. -Make sure the uterus contracts firmly with placental separation. -Monitor station of the presenting part.
Monitor vital signs and client responses. Explanation: The focus of care in the fourth stage is to monitor vital signs and the client's response after delivery. The nurse monitors viral signs, fundus, and lochia every 15 minutes for the first hour and then follows agency protocol. The third stage of labor includes making sure the uterus contracts firmly with the delivery of the placenta. The second stage of labor prepares for impending delivery, and the first stage of labor is when the nurse monitors the station of the presenting part
A client in the first trimester of pregnancy joins a childbirth education class. During this trimester, the nurse is most likely to discuss which physiologic aspect of pregnancy? -Signs and symptoms of labor -Quickening and fetal movements -Warning signs of complications -False labor and true labor
Warning signs of complications Explanation: In early childbirth education classes, instruction on the physiologic aspects of pregnancy may include warning signs of complications, the anatomy and physiology of pregnancy, nutrition, and fetal development. Signs and symptoms of labor, quickening and fetal movements, and false and true labor are discussed in later classes.
A nurse is collecting data on a client who believes she is pregnant. The nurse would suspect a hydatiform mole based on which finding? -rapid fetal heart tones -abnormally high hCG levels -slow uterine growth -lack of symptoms of pregnancy
abnormally high hCG levels Explanation: In a client with a hydatidiform mole, the trophoblast villi proliferate and then degenerate. Proliferating trophoblast cells produce abnormally high hCG levels. No fetal heart tones are heard because there is no viable fetus. The trophoblast cells rapidly proliferate, causing the uterus to grow fast and larger than expected for a given gestational date. The greatly elevated hCG levels cause a client with a hydatidiform mole to experience marked nausea and vomiting.
A client has gestational diabetes. When assisting with developing the plan of care for this client, which therapy would the nurse most likely identify as important for this client to manage glucose levels? -diet -long-acting insulin -oral hypoglycemic drugs -glucagon
diet Explanation: Clients with gestational diabetes are usually managed by diet alone to control their glucose intolerance. Long-acting insulin usually is not needed for blood glucose control in the client with gestational diabetes. Oral hypoglycemic drugs are contraindicated in pregnancy. Glucagon raises blood glucose and is used to treat hypoglycemic reactions.
A client makes a routine visit to the prenatal clinic. Although she believes that she is 14 weeks pregnant, the size of her uterus approximates that in an 18- to 20-week pregnancy. The health care provider diagnoses gestational trophoblastic disease and orders ultrasonography. The nurse expects ultrasonography to reveal: -an empty gestational sac. -grapelike clusters. -a severely malformed fetus. -an extrauterine pregnancy.
grapelike clusters. Explanation: In a client with gestational trophoblastic disease, an ultrasound performed after the third month shows grapelike clusters of transparent vesicles rather than a fetus. The vesicles contain a clear fluid and may involve all or part of the decidual lining of the uterus. Usually no embryo (and therefore no fetus) is present because it has been absorbed. Because there is no fetus, there can be no extrauterine pregnancy. An extrauterine pregnancy is seen with an ectopic pregnancy
The nurse is providing care to a pregnant client with preeclampsia. Magnesium sulfate has been ordered. The nurse understands that this drug is being given to prevent which condition? -hemorrhage -hypertension -hypomagnesemia -seizures
seizures Explanation: For clients with preeclampsia, magnesium sulfate is believed to depress seizure foci in the brain and peripheral neuromuscular blockade, thus preventing eclampsia. Magnesium does not help prevent hemorrhage in clients with preeclampsia. Antihypertensive drugs other than magnesium are preferred for sustained hypertension. Hypomagnesemia is not a complication of preeclampsia.
The nurse is providing care for a pregnant client with gestational diabetes. The client asks the nurse if her gestational diabetes will affect her delivery. The nurse should know that: -the delivery may need to be induced early. -the delivery must be by cesarean. -the mother will carry to term safely. -it's too early to tell.
the delivery may need to be induced early. Explanation: Early induction or early cesarean are possibilities if the mother has diabetes and euglycemia that hasn't been maintained during pregnancy. Cesarean delivery isn't always necessary.
A client is diagnosed with placenta previa at 28 weeks' gestation. Which procedure should the nurse prepare the client for? -stat culture and sensitivity -antenatal steroids after 34 weeks' gestation -ultrasound examination every 2 to 3 weeks -scheduled birth of the fetus before fetal maturity
ultrasound examination every 2 to 3 weeks Explanation: Fetal surveillance through ultrasound examination every 2 to 3 weeks is indicated to evaluate fetal growth, amniotic fluid, and placental location in clients with placenta previa being expectantly managed. A stat culture and sensitivity would be done for severe bleeding, or maternal or fetal distress, and is not part of expectant management. Antenatal steroids may be given to clients between 26 and 32 weeks' gestation to enhance fetal lung maturity. In a hemodynamically stable mother, birth of the fetus should be delayed until fetal lung maturity is attained.
The nurse is obtaining a prenatal history from a client who's 8 weeks pregnant. To help determine whether the client is at risk for a TORCH infection, the nurse should ask: -"Have you ever had osteomyelitis?" -"Do you have any cats at home?" -"Do you have any birds at home?" -"Have you recently had a rubeola vaccination?"
"Do you have any cats at home?" Explanation: TORCH refers to Toxoplasmosis, Other Rubella virus, Cytomegalovirus, and Herpes simplex virus, agents that may infect the fetus or neonate, causing numerous ill effects. Toxoplasmosis is transmitted to humans through contact with the feces of infected cats (which may occur when emptying a litter box), through ingesting raw meat, or through contact with raw meat followed by improper hand washing. Osteomyelitis, a serious bone infection; histoplasmosis, which can be transmitted by birds; and rubeola aren't TORCH infections.
A client is expecting her second child in 6 months. During the psychosocial assessment, she says, "I've been through this before. Why are you asking me these questions?" What is an appropriate response by the nurse? -"Each pregnancy has a unique psychosocial meaning." -"The facility requires these answers of all pregnant clients." - "A second pregnancy may require more psychosocial adjustment." -"A client can develop couvade with any pregnancy."
"Each pregnancy has a unique psychosocial meaning." Explanation: With each pregnancy, a woman explores a new aspect of the mother role and must reformulate her self-image as a pregnant woman and a mother. The other options don't address the client's feelings. No evidence suggests that a second pregnancy requires more adjustment. Couvade symptoms occur in the father, not the mother.
A client has just expelled a hydatidiform mole. She's visibly upset over the loss and wants to know when she can try to become pregnant again. Which of the following would be the nurse's best response? -"I can see you're upset. Why don't we discuss this at a later time when you're feeling better." -"I can see that you're upset; however, you must wait at least 1 year before becoming pregnant again." -"Let me check with your health care provider and get you something that will help you relax." -"Pregnancy should be avoided until all of your tests are normal."
"I can see that you're upset; however, you must wait at least 1 year before becoming pregnant again." Explanation: Clients who develop a hydatidiform mole must be instructed to wait at least 1 year before attempting another pregnancy, despite testing that shows they have returned to normal. A hydatidiform mole is a precursor to cancer, so the client must be monitored carefully for 12 months by an experienced health care provider. Discussing this situation at a later time and checking with the health care provider to give the client something to relax ignore the client's immediate concerns. Telling her to wait until all tests are normal is vague and provides the client with little information.
During an initial prenatal visit, a client reports increased clear, watery vaginal drainage. When responding to the client about this report, which statement would be most appropriate? -"This is normal during pregnancy. Just be sure to wash daily with soap and water." -"You might have an infection. The drainage will have to be cultured." -"It's typical, but you need to douche daily to help keep the area clean." -"This is highly unusual. You must be seen by a health care provider immediately."
"This is normal during pregnancy. Just be sure to wash daily with soap and water." Explanation: Increased vaginal drainage that is clear and watery is normal during pregnancy. However, changes in vaginal pH place the client at increased risk for yeast infection. The nurse should continue to gather additional data from the client about the nature of the drainage. The client needs additional information about proper perineum care. Douching should be avoided during pregnancy.
The nurse is caring for a client suspected of having a hydatidiform mole. Which signs and symptoms would confirm this diagnosis? -heavy, bright-red bleeding every 21 days -fetal cardiac motion after 6 weeks' gestation -benign tumors found in the smooth muscle of the uterus -"snowstorm" pattern on ultrasound with no fetus or gestational sac
"snowstorm" pattern on ultrasound with no fetus or gestational sac Explanation: Ultrasound is the technique of choice in diagnosing a hydatidiform mole. The chorionic villi of a molar pregnancy resemble a "snowstorm" pattern on ultrasound. Bleeding with a hydatidiform mole is usually dark brown and may occur erratically for weeks or months. There is no cardiac activity because there is no fetus. Benign tumors found in the smooth muscle of the uterus are leiomyomas or fibroids.