Chapter 5 & 6

Which woman should the nurse identify is at risk for developing a hypertensive disorder of pregnancy? a. Primigravida who is obese b. Multipara who is 31 years old c. Multipara who had more than six previous pregnancies d. Primigravida who took oral contraceptives within 3 months of conception

a. Primigravida who is obese

A pregnant patient with a history of rheumatic heart disease since childhood is concerned about the birth of her baby and asks what to expect. What should a nurse explain about the birth? Select all that apply. a. Labor may be induced b. Birth may be mid-forceps assisted c. Birth may be vacuum extraction assisted d. Regional anesthesia may be administered e. Inhalation anesthesia may be administered

a. Labor may be induced c. Birth may be vacuum extraction assisted d. Regional anesthesia may be administered

A nurse is caring for a patient who had a spontaneous abortion. For what complication should the nurse assess this patient? a. Hemorrhage b. Dehydration c. Hypertension d. Subinvolution

a. Hemorrhage

A nurse anticipates that newborns of mothers who have diabetes often have tremors, periods of apnea, cyanosis, and poor sucking ability. With what complication are these signs associated? a. Hypoglycemia b. Hypercalcemia c. Central nervous system edema d. Congenital depression of the islets of Langerhans

a. Hypoglycemia

During a routine visit to the prenatal clinic, a client listens to the fetal heartbeat for the first time. The client, commenting on how rapid it is, appears frightened and asks whether this is normal. How should the nurse respond? a. "The heart rate is usually rapid and is in the expected range." b. "The heart rate is usually rapid and twice the mother's pulse rate." c. "The heart rate is rapid, but I'd be more concerned if it were slow." d. "The heart rate is rapid, but it accommodates the fetus's nutritional needs."

a. "The heart rate is usually rapid and is in the expected range."

A 16-year-old adolescent visits the prenatal clinic because she has missed three menstrual periods. Before her physical examination she says, "I don't know what the problem is, but I can't be pregnant." What is the nurse's most therapeutic response? a. "Many young women are irregular at your age." b. "You probably are pregnant if you had intercourse." c. "Why did you decide to come to the prenatal clinic?" d. "Should I ask the health care provider to talk to you?"

c. "Why did you decide to come to the prenatal clinic?"

A patient tells a nurse in the prenatal clinic that she has vaginal straining but no pain. Her history reveals amenorrhea for the last 2 months and pregnancy confirmation after her spontaneous abortion. What type of abortion is suspected? a. Missed b. Inevitable c. Threatened d. Incomplete

c. Threatened

A patient admitted with preeclampsia is receiving magnesium sulfate. Which assessment indicates that a therapeutic level of the medication has been reached? a. Respiratory rate of 12 b. Increased fetal activity c. Decreased urine output d. Deep tendon reflexes of +2

d. Deep tendon reflexes of +2

A 42-year-old client has an amniocentesis during the 16th week of gestation because of concern about Down syndrome. What additional information about the fetus will examination of the amniotic fluid reveal at this time? a. Lung maturity b. Type 1 diabetes c. Cardiac anomaly d. Neural tube defect

d. Neural tube defect

A client at 9 weeks' gestation asks the nurse in the prenatal clinic if she can have her chorionic villi sampling (CVS) done at this visit. At what week gestation should the nurse respond is the best time for this test? a. 8 weeks and less than 10 weeks b. 10 weeks and less than 12 weeks c. 12 weeks and less than 14 weeks d. 14 weeks and less than 16 weeks

b. 10 weeks and less than 12 weeks

What does a nurse anticipate will be provided for a newborn of a mother with a history of long-standing diabetes? a. Fast-acting insulin b. Special high-risk care c. Routine newborn care d. Limited glucose intake

b. Special high-risk care

A patient arrives at the hospital at 38 weeks' gestation with profuse vaginal bleeding. She states that it occurred suddenly without any contractions. Which condition may the patient be experiencing that requires immediate notification of the health care provider? a. Placenta previa b. Placenta accreta c. Ruptured uterus d. Concealed abruptio

a. Placenta previa

A patient at 37 weeks' gestation is admitted to the birthing unit from the emergency department. She had arrived by ambulance after a motor vehicle accident. Her vital signs are BP: 90/60; P: 108; R: 24. She is reporting sharp abdominal pain. What is the priority nursing intervention at this time? a. Apply an electronic fetal monitor b. Prepare for a possible cesarean birth c. Draw blood for a type and crossmatch d. Assess the amount of vaginal bleeding

a. Apply an electronic fetal monitor

The nurse is counseling a pregnant patient with type 1 diabetes about medication changes as the pregnancy progresses. Which medication will be needed in increased dosages during the second half of her pregnancy? a. Insulin b. Antihypertensives c. Pancreatic enzymes d. Estrogenic hormones

a. Insulin

A teenager at 32 weeks' gestation is hospitalized with preeclampsia. She is anorexic and appears depressed. Which comment indicates to the nurse that further exploration of the client's emotional status is indicated? a. "I'm tired of feeling so clumsy." b. "I'll be glad when I can sleep all night." c. "I dreamed my baby had only one arm." d. "I was really happy before I got pregnant."

d. "I was really happy before I got pregnant."

A client visiting the prenatal clinic for the first time asks a nurse about the probability of having twins because her husband is one of a pair of fraternal twins. What is the appropriate response by the nurse? a. "A sonogram will tell us if there's a twin pregnancy." b. "There's a 25 percent probability of you having twins." c. "The husband's history of being a twin increases the chance of having twins." d. "There's no greater probability of you having twins than in the general population."

d. "There's no greater probability of you having twins than in the general population."

After the incomplete abortion, a patient tells a nurse that although her health care provider explained what an incomplete abortion was, she did not understand. What is the nurse's best response? a. "I don't think you should focus on this anymore." b. "This is when the fetus dies but is retained in the uterus for at least 2 months." c. "I think it is best if you asked your health care provider for the answer to that question." d. "This is when the fetus is expelled but other parts of the pregnancy remain in the uterus."

d. "This is when the fetus is expelled but other parts of the pregnancy remain in the uterus."

A patient in the prenatal clinic is diagnosed with preeclampsia. What clinical findings support this diagnosis? a. Elevated blood pressure of 150/100 mm Hg b. Elevated blood pressure that is accompanied by a headache c. Blood pressure above the baseline while fluctuating at each reading d. Blood pressure more than 140 mm Hg systolic accompanied by proteinuria

d. Blood pressure more than 140 mm Hg systolic accompanied by proteinuria

Women who become pregnant for the first time at a later reproductive age (35 years of age or older) are at risk for what complications? Select all that apply. a. Preterm labor b. Multiple gestation c. Development of seizures d. Chromosomal anomalies e. Bleeding in the first trimester

a. Preterm labor b. Multiple gestation d. Chromosomal anomalies e. Bleeding in the first trimester

A nurse is monitoring a patient with severe preeclampsia who is receiving an infusion of magnesium sulfate. Assessment reveals a pulse rate of 55/minute, respirations of 12/minute, and a flushed face. What is the next nursing action? a. Continue the infusion and notify the health care provider. b. Stop the infusion and start an infusion of dextrose and water. c. Continue the infusion and document the findings on the clinical record. d. Decrease the rate of the infusion and obtain blood for a magnesium level.

b. Stop the infusion and start an infusion of dextrose and water.

When does a nurse caring for a patient with eclampsia determine that the risk for another seizure has subsided? a. After birth occurs b. After labor begins c. 48 hours postpartum d. 24 hours postpartum

c. 48 hours postpartum

What should a nurse anticipate about the insulin requirements of a woman with diabetes on her first postpartum day? a. A rapid increase b. Will remain unchanged c. A sharp and sudden decrease d. Will decrease slowly and steadily

c. A sharp and sudden decrease

Which sign or symptom leads a nurse to suspect that a patient has a tubal pregnancy? a. A painful mass centered in the abdomen b. Lower abdominal cramping for 1 week c. A sharp lower right or left abdominal pain radiating to the shoulder d. Leukorrhea or dysuria a few days after the first missed menstrual period

c. A sharp lower right or left abdominal pain radiating to the shoulder

What nursing intervention is specific for patients with cardiac problems who are in active labor? a. Encouraging frequent voiding b. Monitoring the blood pressure hourly c. Auscultating the lungs for crackles every 30 minutes d. Helping to turn from side to side at 15-minute intervals

c. Auscultating the lungs for crackles every 30 minutes

A nurse in the prenatal clinic is caring for a patient with heart disease who is in the second trimester. What hemodynamic of pregnancy may affect the patient at this time? a. Decrease in the number of RBCs b. Gradually increasing size of the uterus c. Heart rate acceleration in the last half of pregnancy d. Increase in cardiac output during the third trimester

c. Heart rate acceleration in the last half of pregnancy

A patient is receiving magnesium sulfate therapy for severe preeclampsia. What initial sign of toxicity should alert the nurse to intervene? a. Hyperactive sensorium b. Increase in respiratory rate c. Lack of the knee-jerk reflex d. Development of a cardiac dysrhythmia

c. Lack of the knee-jerk reflex

A client is scheduled for a nonstress test in the 37th week of gestation. A nurse explains the procedure. Which statement demonstrates that the client understands the teaching? a. "An IV will be needed to inject the medication." b. "My baby may get very restless after the procedure." c. "I hope this test does not cause my labor to begin early." d. "If the heart reacts well, my baby should do okay when I give birth."

d. "If the heart reacts well, my baby should do okay when I give birth."

A nurse is reviewing the obstetric history of a patient who had an abruptio placentae. What prenatal condition does the nurse expect the patient to have had? a. Cardiac disease b. Hyperthyroidism c. Gestational hypertension d. Cephalopelvic disproportion

c. Gestational hypertension

A nurse is monitoring a patient with severe preeclampsia for the onset of eclampsia. What clinical finding indicates an impending seizure? a. Persistent headache with blurred vision b. Epigastric pain with nausea and vomiting c. Spots with flashes of light before the eyes d. Rolling of the eyes to one side with a fixed state

d. Rolling of the eyes to one side with a fixed state

A couple who recently emigrated from Israel tells a nurse in the prenatal clinic that they are concerned about a genetic disease that is prevalent among Jewish people. Which genetic test should the nurse recommend to determine the possibility of their child inheriting the disease? a. Cystic fibrosis b. Phenylketonuria c. Turner syndrome d. Tay-Sachs disease

d. Tay-Sachs disease

How should a nurse screen a newborn of a diabetic mother for hypoglycemia? a. Test for glucose tolerance b. Draw blood for a serum glucose level c. Arrange for a fasting blood glucose level d. Test heel blood with a glucose-oxidase strip

d. Test heel blood with a glucose-oxidase strip

When caring for a woman who had a positive contraction stress test (CST), what complication does the nurse suspect? a. Preeclampsia b. Placenta previa c. Imminent preterm birth d. Uteroplacental insufficiency

d. Uteroplacental insufficiency

A nurse is counseling a woman who was just diagnosed with a multiple gestation. Why does the nurse consider this pregnancy high risk? a. Postpartum hemorrhage is an expected complication b. Perinatal mortality is two to three times greater in multiple than in single births c. Maternal mortality is higher during the prenatal period with a multiple gestation d. Optimum adjustment after a multiple birth requires 6 months to 1 year

b. Perinatal mortality is two to three times greater in multiple than in single births

A patient is discharged the same day after ambulatory surgery for a laparoscopic cholecystectomy. The nurse is providing discharge teaching about how many days the patient should wait to engage in certain activities. Place in order the activities from the first to the last in which the patient may engage. 1. Showering 2. Driving a car 3. Performing light exercise 4. Getting out of bed in a chair 5. Lifting objects of more than 10 pounds

Order: 4. Getting out of bed in a chair 3. Performing light exercise 1. Showering 2. Driving a car 5. Lifting objects of more than 10 pounds

A nurse is caring for a woman with cholelithiasis and obstructive jaundice. When assessing this patient, the nurse should be alert for which common clinical indicators associated with these conditions? Select all that apply. a. Ecchymosis b. Yellow sclera c. Dark brown stool d. Straw-colored urine e. Pain in right upper quadrant

a. Ecchymosis b. Yellow sclera e. Pain in right upper quadrant

A patient is admitted to the birthing suite with a blood pressure of 150/90 mm Hg. 3+ proteinuria, and edema of the hands and face. A diagnosis of severe preeclampsia is made. What other clinical findings support this diagnosis? Select all that apply. a. Headache b. Constipation c. Abdominal pain d. Vaginal bleeding e. Visual disturbances

a. Headache c. Abdominal pain e. Visual disturbance

A patient with the diagnosis of severe preeclampsia is admitted to the hospital from the emergency department. What precaution should the nurse initiate? a. Pad the side rails on the bed b. Place the call button next to the patient c. Have oxygen with face mask available d. Assign a nursing assistant to stay with the patient

a. Pad the side rails on the bed

A nurse in the birthing unit is caring for several clients. Which factor should the nurse anticipate will increase the risk for hypotonic uterine dystocia? a. Twin gestation b. Gestational anemia c. Hypertonic contractions d. Gestational hypertension

a. Twin gestation

A nurse suspects that there is cephalopelvic disproportion in a client who is having a difficult labor. For which test should the nurse prepare the client? a. Ultrasound b. Fetal scalp pH c. Amniocentesis d. Digital pelvimetry

a. Ultrasound

A client pregnant with twins is told by the health care provider that she is at risk for postpartum hemorrhage. Later, the client asks the nurse why she is at risk for hemorrhage. What should the nurse consider is the cause of the postpartum hemorrhage before responding in language the client will understand? a. Uterine atony b. Mediolateral episiotomy c. Lacerations of the cervix d. Retained placental fragments

a. Uterine atony

A nurse is obtaining the health history from a patient with a diagnosis of a ruptured tubal pregnancy. At what point in the pregnancy does the nurse expect the patient to state when the low abdominal pain and vaginal bleeding started? a. At the end of the first trimester b. About the sixth week of pregnancy c. Midway through the second trimester d. When the first menstrual period was missed

b. About the sixth week of pregnancy

A nurse notifies the health care provider that a patient has been admitted to the high-risk unit in her 36th week of gestation. She is bleeding, has severe abdominal pain and a rigid fundus, and is demonstrating signs of shock. For what intervention should the nurse prepare? a. A high-forceps birth b. An immediate cesarean birth c. The insertion of an internal fetal monitor d. The administration of an oxytocin infusion

b. An immediate cesarean birth

A nurse is preparing a teaching plan for a pregnant patient with a history of cholelithiasis. Which information about why the ingestion of fatty foods will cause discomfort should the nurse include in the teaching plan? a. Fatty foods are hard to digest b. Bile flow into the intestine is obstructed c. The liver is manufacturing inadequate bile d. There is inadequate closure of the ampulla of Vater

b. Bile flow into the intestine is obstructed

Which clinical indicator should the nurse identify before scheduling a patient for an indoscopic retrograde cholangiopancreatography (ERCP)? a. Urine output b. Bilirubin level c. Blood pressure d. Serum glucose

b. Bilirubin level

A patient at 37 weeks' gestation arrives at the emergency department stating that she has abdominal pain but no vaginal bleeding. The health care provider diagnosis abruptio placentae. The patient asks the nurse why it is so painful. What should the nurse consider is the initial cause of the abdominal pain before responding in language the patient will understand? a. Hemorrhagic shock b. Concealed hemorrhage c. Blood in the myometrium d. Disseminated intravascular coagulation

b. Concealed hemorrhage

Sonography of a primigravida who is at 15 weeks´ gestation reveals a twin pregnancy. The nurse reviews with the client the risks of a multiple pregnancy that were explained by the health care provider. Which condition does the client identify that indicates the need for further instruction about complications associated with a multiple gestation? a. Preterm birth b. Down syndrome c. Twin-to-twin transfusion d. Gestational hypertension

b. Down syndrome

What assessment finding of a pregnant patient should alert the nurse to notify the health care provider? a. Dependent edema at 38 weeks' gestation b. Fundal height at the umbilicus at 16 weeks' gestation c. Fetal heart rate of 150 beats/min at 24 weeks' gestation d. Maternal heart rate of 92 beats/min at 28 weeks' gestation

b. Fundal height at the umbilicus at 16 weeks' gestation

A client is preterm labor at 35 weeks' gestation asks the nurse, "What determines whether my baby's lungs will be okay?" The nurse explains that a test of the amniotic fluid obtained through an amniocentesis will reflect fetal lung maturity. Which test should the nurse include in the discussion? a. Amniotic fluid index (AFI) b. Phosphatidylglycerol (PG) test c. Alpha-fetoprotein levels (AFP) d. Lecithin-sphingomyelin (L/S) ratio

b. Phosphatidylglycerol (PG) test

A patient at 28 weeks' gestation has a sonogram. The results reveal a small-for-gestational-age (SGA) fetus and a low-lying placenta. For what complication should the nurse assess this patient during the last trimester of pregnancy? a. Preterm labor b. Placenta previa c. Premature separation of the placenta d. Premature rupture of the membranes

b. Placenta previa

A healthcare provider orders a contraction stress test (CST) for a client whose nonstress test (NST) was nonreactive. Which maternal complications should alert the nurse to question the order? Select all that apply. a. Hypertension b. Preterm labor c. Drug addiction d. Incompetent cervix e. Premature rupture of membranes

b. Preterm labor d. Incompetent cervix e. Premature rupture of membranes

A client in the 18th week of pregnancy is scheduled for ultrasonography. What instruction should the nurse give the client? a. "Don't eat for 4 hours after the test." b. "Give yourself an enema the night before." c. "Don't urinate for at least 3 hour before the test." d. "You will be monitored closely afterward for signs of labor."

c. "Don't urinate for at least 3 hour before the test."

A client who is scheduled for an amniocentesis states, "I'm glad this test will be able to tell whether my baby is well or not." How should the nurse respond? a. "Research has shown that this is an excellent test." b. "A normal amniocentesis is a reliable indicator of a healthy baby." c. "This test is useful in detecting potential defects due to chromosomal errors." d. "An amniocentesis is a valuable tool for detecting congential defects in the developing fetus."

c. "This test is useful in detecting potential defects due to chromosomal errors."

What nursing intervention should be included when caring for a patient with placenta previa? a. Vital signs at least once per shift b. Tap water enema before the birth c. Documentation of the amount of bleeding d. Limited ambulation until the bleeding stops

c. Documentation of the amount of bleeding

A patient with class 1 heart disease is admitted to the birthing suite in active labor. In what position should the nurse place the patient? a. High fowler b. Semi fowler c. Left lateral with head elevated d. Right lateral with head elevated

c. Left lateral with head elevated

A 38-year-old client attends the prenatal clinic for the first time. A nurse explains that several tests will be performed, one of which is the serum alpha-fetoprotein test. The client asks what the test will reveal. What should the nurse include in the reply? a. Trisomy 21 b. Turner syndrome c. Open neural tube defects d. Chromosomal aberrations

c. Open neural tube defects

An 18-year-old pregnant woman in her first trimester is admitted with an acute onset of right lower quadrant pain at the McBurney point. Appendicitis is suspected. For which clinical indicator should the nurse assess the patient to determine whether the pain is secondary to appendicitis? a. Urinary retention b. Gastric hyperacidity c. Rebound tenderness d. Increased lower bowel motility

c. Rebound tenderness

A nurse is assessing a patient with a tentative diagnosis of hydatidiform mole. Which clinical finding should the nurse anticipate? a. Hypotension b. Decreased fetal heart rate c. Unusual uterine enlargement d. Painless, heavy vaginal bleeding

c. Unusual uterine enlargement

A few hours after being admitted to the hospital with a diagnosis of inevitable abortion, a patient at 16 weeks' gestation begins to experience bearing-down sensations and suddenly expels the products of conception in bed. What should the nurse do first? a. Notify the health care provider b. Administer the prescribed sedative c. Take the patient to the operating room d. Check the patient's fundus for firmness

d. Check the patient's fundus for firmness

A patient is scheduled for a sonogram at 36 weeks' gestation. Shortly before the test she tells the nurse that she has severe abdominal pain. Assessment reveals heavy vaginal bleeding, a drop in blood pressure, and an increased pulse rate. What complication does the nurse suspect? a. Hydatidiform mole b. Vena caval syndrome c. Marginal placenta previa d. Complete abruptio placentae

d. Complete abruptio placentae

A nurse is caring for a patient who had a spontaneous abortion. The patient asks why spontaneous abortions occur. The nurse responds that they are most commonly caused by what? a. Physical trauma b. Unresolved stress c. Congenital defects d. Embryonic defects

d. Embryonic defects

What is the initial responsibility of a nurse when teaching the pregnant adolescent? a. Instructing her about the care of an infant b. Informing her of the benefits of breastfeeding c. Advising her to watch for danger signs of preeclampsia d. Encouraging her to continue regularly scheduled prenatal care

d. Encouraging her to continue regularly scheduled prenatal care

A pregnant patient with class II heart disease is concerned that her pregnancy will be an added burden on her already compromised heart. A nurse explains that during pregnancy the cardiac system is most compromised during the what? a. First trimester b. Third trimester c. Transitional phase of labor d. First 2 days after the birth

d. First 2 days after the birth

A patient who had a severe abruptio placentae asks the nurse why there was so much bleeding. What should the nurse consider is the cause of the heavy bleeding before responding in language the patient will understand? a. Polycythemia b. Thrombocytopenia c. Hyperglobulinemia d. Hypofibrinogenemia

d. Hypofibrinogenemia