high risk antepartum
a nurse who is caring for a pregnant type 1 diabetic should carefully monitor the client for which of the following? select all that apply 1. urinary tract infection 2. multiple gestation 3. metabolic acidosis. 4. pathological hypotension 5. hypolipidemia
answer: 1,3. pregnant diabetic clients are at risk for urinary tract infections and acidosis. test taking tip: it is very important for the test taker to read each the responses carefully. if the test taker were to read the responses quickly, he or she might choose incorrect answers. for example, the test taker might pick pathological hypotension, assuming it says "hypertension". pregnant type 1 diabetics are at high risk for UTIs because their often excrete glucose in their urine. the glucose is an excellent medium for bacterial growth. they also should be assessed carefully for acidosis because an acidotic environment can be life threatening to a featus.
a biophysical profile (BPP) has been performed on a full-term client with severe preeclampsia. which of the following interpretations should the nurse make regarding the BPP results of 4? 1. fetal well being is compromised 2. clients blood pressure is returning to normal 3. client is at high risk for seizure 4. fetus's amniotic sac is about to rupture
answer: 1. a BPP of 4 indicated that fetal well being is compromised. test taking strategy: the BPP is performed when fetal well being is a concern. five assessments are performed via ultrasound: fetal breathing movements, gross body movements, fetal tone, fetal heart reactivity, and amniotic fluid volume. each assessment may receive a value of 0-2. a total score of 0-10 is possible. the lower the score, the more compromised is fetal health.
A pregnant diabetic has been diagnosed with hydramnios. Which of the following would explain this finding? 1. Excessive fetal urination. 2. Recurring hypoglycemic episodes. 3. Fetal sacral agenesis. 4. Placental vascular damage.
answer: 1. the hydramnios is likely a result of excessive fetal urination. test taking tips: fetuses of diabetic mothers often experience polyuria as a result of hyperglycemia. if the mother's diabetes is out of control, excess glucose diffuses across the placental membrane, resulting in the fetus becoming hyperglycemic. as a result, the fetus exhibits the classic sign of diabetes-- polyuria. if the mothers serum glucose levels are very high during the first trimester, it is likely that the fetus will develop structural congenital defects. sacral agenesis is one of the most severe of these defects.
a client, G2,P1001, telephones the gynecology office complaining of left-sided pain. which of the following questions by the triage nurse would help to determine whether one-sided pain is due to an ectopic pregnancy. 1. "when did you have your pregnancy test done?" 2. "when was the first day of your last menstrual period?" 3. "did you have any complications with your first pregnancy?" 4. "how old were you when you first got your period?"
answer: 2. the date of the last menstrual period helps assist the nurse in determining how many weeks pregnant the client is. test taking tips: the date of the last menstrual period is important for the nurse to know. ectopic pregnancies usually are diagnosed between 8-9 weeks gestation because of the gestational age, the conceptus is at a size that is too large for the fallopian tube to hold.
A patient, 32 weeks pregnant with severe headache, is admitted to the hospital with pre-eclampsia. In addition to obtaining baseline vital signs and placing the client on bedrest, the physician ordered the following four items. Which of the orders should the nurse preform first? 1. assess deep tendon reflexes 2. obtain complete blood count 3. assess baseline weight 4. obtain routine urinalysis
answer: 1. the nurse should check the clients patellar reflexes. the most common way to assess the deep tendon reflexes is to assess the patellar reflexes. test taking tip: preeclampsia is a very serious complication of pregnancy. the nurse must assess for changes in the blood count, for evidence of marked weight gain, and for changes in the urinalysis. by assessing for the patellar reflex first, however, the nurse can make a preliminary assessment of the severity of the preeclampsia. for example, if the reflexes are +2, the client would be much less likely to become eclamptic, that is, have a seizure, than a client who has +4 reflexes.
an ultrasound has identified that a clients pregnancy is complicated by oligohydramnios. the nurse would expect that an ultrasound may show that the baby has which of the following structural defects? 1. dysplastic kidneys 2. coarctation of the aorta 3. hydrocephalus 4. hepatic cirrhosis
answer: 1. the nurse would expect that the baby has dysplastic kidneys. test taking tip: the majority of the amniotic fluid is produced by the fetal kidneys. when a pregnancy is complicated by the oligohydramnios, ultrasounds may be performed to check for defects in the fetal renal system.
a type 1 diabetic is being seen for preconception counseling. the nurse should emphasize that during the first trimester the woman may experience which of the following? 1. need for less insulin than she normally does 2. an increased risk for hyperglycemic episodes 3. signs and symptoms of hydramnios 4. a need to be hospitalized for fetal testing.
answer: 1. type 1 diabetes often need less insulin during the first trimester than they did preconception. test taking tip: nausea and vomiting are common complaints of gravid clients during the first trimester. as a result, women, including diabetic women, consume fewer calories than they did before becoming pregnant. their need for insulin drops commensurately. therefore, it is very important that the women monitor their blood glucose regularly upon awakening and throughout the day.
the nurse is evaluating the effectiveness of bedrest for a client with mild preeclampsia. which of the following signs/symptoms would the nurse determine is a positive finding? 1. weight loss 2. 2+ proteinuria 3. decrease in plasma protein 4. 3+ patellar reflexes
answer: 1. weight loss is a positive sign. since the client is losing protein, the nurse would evaluate a 0 trace amount of protein as a positive sign. a decrease in serum protein is a sign of pathology, an increase in serum protein would be a positive sign. 3+ reflexes are pathological, normal reflexes are 2+. test taking tip: the key to answering the question is the test takers ability to interpret the meaning of mild preeclampsia and to realize that this is an evaluation question. there are two levels of preeclampsia. mild preeclampsia is characterized by the following signs/symptoms: blood pressure 140/90, urine protein +2, patellar reflexes +3, and weight gain.
the nurse is caring for a 32-week G8P7007 with placenta previa. which of the following interventions would the nurse expect to inform? select all that apply. 1. daily contraction stress test. 2. blood type and cross match 3. bedrest with passive range of motion exercises 4. daily serum electrolyte assessment 5. weekly biophysical profiles
answer: 2,3,5. there should be blood available in the blood bank incase the woman begins to bleed, the nurse would expect to keep the woman on bedrest with bathroom privileges only. passive range of motion exercises will help to prevent atrophy of the woman's muscles. the nurse would expect that weekly biophysical profiles would be done to assess fetal well being. test taking tip: because clients with placenta previa are at high risk for bleeding from the placental site, it is essential that they be limited in their activity and have blood on hand in case of hemorrhage. in addition, their babies must be monitored carefully for signs of fetal well being. it would be inappropriate to stimulate contraction because dilation of the cervix would stimulate bleeding.
which of the following pregnant clients is most high risk for preterm premature rupture of membranes (PPROM)? select all that apply. 1. 31 weeks gestation with prolapsed mitral valve 2. 32 weeks gestation with urinary tract infection 3. 33 weeks gestation with twins post-in vitro fertilization 4. 34 weeks gestation with gestational diabetes 5. 35 weeks gestation with deep vein thrombosis
answer: 2,3. clients with UTIs and carrying twins are both risk factors for PPROM. test taking tip: although the exact mechanism is not well understood, clients who have UTIs are at high risk for PPROM. this is particularly important because pregnant clients often have UTI that present either with no symptoms at all or only with urinary frequency, a complaint of many pregnant clients.
a nurse is caring for four prenatal clients in the clinic. which of the clients is at high risk for placenta previa? select all that apply 1. jogger with low body mass index 2. primigravida who smokes 1 pack of cigarettes per day 3. infertility client who is carrying in-vitro triplets 4. registered professional nurse who works 12 hour shifts 5. police officer on foot patrol
answer: 2,3. smokers and a woman carrying triplets are both at risk for placenta previa. test taking tip: the placenta usually implants at a vascular site on the uterine wall. two of the woman are at high risk for placenta previa. there are three placentas nourishing fraternal triplets. because of the amount of space needed for the placentas, it is not unusual for one to implant near or over the cervical os. the uterine lining of woman who smoke is often not well perfused, sometimes resulting in the placenta implanting on or near the cervical os. women with vascular disease and grand multigravidas are also at high risk for placenta previa.
A gravid client, 27 weeks' gestation, has been diagnosed with gestational diabetes. Which of the following therapies will most likely be ordered for this client? 1. Oral hypoglycemic agents. 2. Diet control with exercise. 3. Regular insulin injections. 4. Inhaled insulin.
answer: 2. about 95% of gestational diabetic clients are managed with diet and exercise alone. test taking tip: gestational diabetic clients are first counseled regarding proper diet and exercise as well as blood glucose assessment. the vast majority of women are able to regulate their glucose levels with this intervention. if the glucose levels do not stabilize, the obstetrician will determine whether to order oral hypoglycemic or injectable insulin.
in analyzing the need for health teaching in a client, G5P4004 with gestational diabetes, the nurse should as which of the following questions? 1. "how old were you at your first pregnancy?" 2. "do you exercise regularly?" 3. "is your partner diabetic?" 4. "do you work outside of the home?"
answer: 2. the likelihood of developing either gestational or type 2 diabetes is reduced when clients exercise regularly. test taking tip: there are a number of issues that the nurse should discuss with a client who has been diagnosed with gestational diabetes. the need for exercise is one of those topics. other topics are diet, blood glucose testing, treatment for hypoglycemic episodes, and the like.
a gravid woman has just been admitted to the emergency department subsequent to a head-on automobile accident. her body appears to be uninjured. the nurse carefully monitors the woman for which of the following complications of pregnancy? Select all that apply 1. placenta previa 2. traverse fetal lie 3. placental abruption 4. severe preeclampsia 5. preterm labor
answer: 3 and 5. placental abruption and preterm labor may develop due to an automobile accident. test taking tip: the fetus is well protected within the uterine body. the musculature of the uterus and the amniotic fluid provide the baby with enough cushioning to withstand minor bumps and falls. a major automobile accident can cause anything from preterm premature rupture of the membranes (PPROM), to preterm labor, to ruptured uterus, to placental abruption. the nurse should especially monitor the fetal heartbeat for any variations.
a client, 37 weeks gestation, has been advised that she is positive for GBS. which of the following comments by the nurse is appropriate at this time? 1. "the doctor will prescribe intravenous antibiotics for you. a visiting nurse will administer them to you in your home." 2. "you are at very high risk for an intrauterine infection. it is important for you to check your temperature every day" 3. "the bacteria are living in your vagina. they will not hurt you but we will give you medicine in labor to protect your baby from getting sick" 4. "the bacteria cause scarlet fever. if you notice that your tongue becomes very red and that you feel feverish you should call the doctor immediately"
answer: 3. exposure to GBS is very dangerous to a neonate. test taking tip: GBS can cause serious neonatal disease. babies are at high risk for meningitis, sepsis, pneumonia, and even death. IV antibiotics are administered to the laboring mother every 4 hours to decrease the colonization in the mothers vagina and rectum. in addition, the antibiotics cross the placenta and act as a prophylaxis for the baby.
a nurse is counseling a preeclamptic client about her diet. which should the nurse encourage the woman to do. 1. restrict sodium intake 2. increase intake of fluids 3. eat a well-balanced diet 4. avoid simple sugars
answer: 3. it is important for the client to eat a well-balanced diet. sodium restrictions are not recommended, there is no need to increase fluid intake, and although not the most nutritious of foods, there is no need to increase intake of simple sugars. test taking tip: clients with preeclampsia are losing albumin through their urine. they should eat a well balanced diet with sufficient protein to replace the lost protein. even though preeclamptic clients are hypertensive, it is not recommended that they restrict salt because during pregnancy the kidney is salt sparing. when salt is restricted, the kidneys become stressed.
a woman has been diagnosed with a ruptured ectopic pregnancy. which of the following signs and symptoms is characteristic of this diagnosis? 1. dark brown rectal bleeding 2. severe nausea and vomiting 3. sharp unilateral pain 4. marked hyperthermia
answer: 3. sharp unilateral pain is a common symptom of a ruptured ectopic. test taking tip: the most common location for an ectopic pregnancy to implant is in the fallopian tube. because the tubes are nonelastic, when the pregnancies become too big, the tube ruptures. unilateral pain can develop because only one tube is being affected by the condition, but some women complain of generalized abdominal pain.
a gravid client, G6P5005, 24 weeks gestation, has been admitted to the hospital for placenta previa. which of the following is an appropriate long-term goal for this client? 1. the client will state an understanding of need to complete bedrest. 2. the client will have a reactive nonstress test on day 2 of hospitalization 3. the client will be symptom free until at least 37 weeks gestation 4. the client will have normal vital signs on admission.
answer: 3. the client will be symptom free for at least 37 weeks gestation is a long-term goal. test taking tips: each and every one of the goal sis appropriate for the client with placenta previa. only the statement that projects the clients response into the future is, however, a long-term goal.
the nurse is educating a client who has been diagnosed with gestational diabetes how to preform home blood glucose testing. which of the following information should be included in the teaching session? 1. when pricking the fingertip, always prick the center of the fingertip. 2. one-hour postprandial glucose values should be 146 mg/dL or lower. 3. blood glucose testing should be performed 2 times a day--before breakfast and before bedtime. 4. all blood glucose results should be kept in a log for evaluation by the nurse and primary healthcare provider.
answer: 4. all blood glucose results should be kept in a log for evaluation by the nurse and primary healthcare provider. if the results are above cut values, the primary healthcare provider may order dietary changes or the addition of hypoglycemic medications to the clients therapeutic regimen. test taking tip: the American Diabetic Association has developed recommended cut values for blood glucose levels for gestational diabetic clients. the values are: fasting--at or below 95 mg/dL, and two hour postprandial--120 mg/dL.
a 26-week gestation woman is diagnosed with severe HELLP syndrome. the nurse will assess for which of the following signs/symptoms? 1. low serum creatinine 2. high serum protein 3. bloody stool 4. epigastric pain
answer: 4. epigastric pain is associated with the liver involvement of HELLP syndrome. the nurse would expect to see high serum creatinine levels associated with severe preeclampsia, the nurse would expect to see low serum protein levels with severe preeclampsia, bloody stools are never associated with severe preeclampsia. test taking tip: the acronym, HELLP, stands for the following signs/symptoms: hemolysis, elevated liver enzymes, and low platelets. when the liver is deprived of sufficient blood supply, as can occur with severe preeclampsia, the organ becomes ischemic and liver enzymes become elevated. in addition, the client experiences pain at the site of the liver as a result of the hypoxia in the liver.
An insulin-dependent diabetic woman will require higher doses of insulin as which of the following pregnancy hormones increases in her body? 1. Estrogen. 2. Progesterone. 3. Human chorionic gonadotropin. 4. Human placental lactogen.
answer: 4. human placental lactogen is an insulin antagonist, so the client will require higher doses of insulin as the level of placental lactogen increases. test taking tip: during the first trimester, the insulin needs of a women with type 1 diabetes are usually low. once the diabetic client enters the second trimester, however, insulin demands increases. one of the most important reaons that insulin demands increase is the increasingly higher level sof human placental lactogen produced by the placenta that are found in the mothers bloodstream.
a client has just been diagnosed with gestational diabetes. she cries "Oh no! I will never be able to give myself shots!!" which of the following responses by the nurse is appropriate at this time. 1. "I am sure you can learn for your baby." 2. "I will work with you until you feel comfortable giving yourself insulin." 3. "we will be giving you pills for your diabetes" 4. "if you follow your diet and exercise you will probably need no insulin"
answer: 4. it is unlikely that this client will need any medication. if the client follows her diet and exercises regularly, she will probably control her diabetes. test taking tips: the client should be reminded that if she follows her diet and exercises regularly she will likely be able to manage her diabetes without medication. she should also be encouraged to continue the diet and exercise after delivery to prevent the development of type 2 diabetes later in life.
Which finding should nurse expect when assessing a client with placenta previa? 1. severe occipital headache 2. history of thyroid cancer 3. pervious premature delivery 4. painless vaginal bleeding
answer: 4. painless vaginal bleeding is often the only symptom of placenta previa. the other options are not associated with placenta previa. test taking tip: there are three different forms of placenta previa: low lying placenta (one that lies adjected to, but not over, the internal cervical os), partial (one that partially covers the internal cervical os), and a complete (a placenta that completely covers the internal cervical os). there is no way to deliver a live baby vaginally when a client has a complete previa, although there are cases when live babies have been delivered when the clients had low-lying or partial previas.
a woman, 8 weeks pregnant, is admitted to the obstetric unit with a diagnosis of threatened abortion. which of the following tests would help to determine whether the woman is carrying a viable or nonviable pregnancy? 1. luteinizing hormone level 2. endometrial biopsy 3. hysterosalpingogram 4. serum progesterone level
answer: 4. serum progesterone will provide information on the viability of a pregnancy test taking tip: when a previously gravid client is seen by her healthcare practitioner with a compliant of vaginal bleeding, it is very important to determine the viability of the pregnancy as soon as possible. situational crises are often exacerbated when the clients face the unknown. one relatively easy way to determine the variability of the conceptus is by performing a serum progesterone test, high levels indicate a viable baby, whereas low levels indicate a pregnancy loss. ultrasonography to assess for a breathing heart and serum human chorionic gonadotropin levels may also be performed.
Nurses working in obstetric clinics know that, in general, teen pregnancies are high risk because of which of the following? 1. High probability of chromosomal anomalies. 2. High oral intake of manganese and zinc. 3. High numbers of postterm deliveries. 4. High number of late prenatal care registrants.
answer: 4. teens are less likely to delay entry into the healthcare system. test taking tip: late entry into prenatal care is particularly problematic for teen pregnancies. because organogenesis occurs during the first trimester, by the time many teens acknowledge that they are pregnant and seek care, they are already past this critical period. they are likely to have consumed damaging substances or at the very least, consumed inadequate quantities of essential nutrients such as folic acid.
which of the following nursing diagnoses would be most appropriate for a 15 year old woman who is in her first trimester of pregnancy? 1. sleep pattern disturbance related to discomforts of pregnancy. 2. knowledge deficit related to care of infants 3. anxiety related to fear of labor and delivery 4. ineffective individual coping related to developmental level.
answer: 4. the developmental tasks of adolescence are often in conflict with the tasks of pregnancy. this nursing diagnosis is the most appropriate. test taking tip: the major developmental tasks of adolescence--completing her education, developing abstract thinking, and developing skills that foster independence--can be in conflict with those of pregnancy. adolescents often test rules, use drugs, and drink alcohol, all of which are detrimental to the developing fetus. at the very least, teens socialize with friends, often eating at fast food restaurants where a well balanced high calcium high iron diet is hard to obtain.
A gravid client with 4+ proteinuria and 4+ reflexes is admitted to the hospital. The nurse must closely monitor the woman for which of the following? 1. Grand mal seizure. 2. High platelet count. 3. Explosive diarrhea. 4. Fractured pelvis.
answer: clients with severe preeclampsia are at high risk for seizure. clients with severe preeclampsia should be monitored for a drop in platelets, are not at risk for explosive diarrhea, and are not at risk for fractured pelvis. test taking tip: a client who is diagnosed with 4+ proteinuria and 4+ reflexes is severely preeclamptic and therefore at risk for becoming eclamptic. preeclamptic clients are diagnosed with eclampsia once they have had a seizure.
