High risk antepartum

2

A 29 week gestation woman diagnosed with severe preeclampsia is noted to have BP of 170/112 4+ proteinuria, and a weight gain of 10 lbs. over the past 2 days. Which of the following S/s would the nurse also expect to see? 1. fundal height 32 cm 2. papilledema 3. patellar reflexes +2 4. nystagmus

2 (spina bifida is a neural tube defect possible lack of folic acid)

A 30 year old client G3 P1 who is planning to become pregnant again, states that her premature baby boy, born 8 years ago, died shortly after delivery from an infection secondary to spina bifida, Which of the following interventions is most important for this client? 1. grief counseling 2. nutrition counseling 3. infection control counseling 4. genestic counseling

1 (weight gain of 10 lbs in 4 weeks is worrisome. REcommended wt gain in 2nd and 3rd trimester is 1 pound per week....need to assess for reason)

A 32 week client was seen in the prenatal client at 28 weeks. Which of the following changes should the nurse highlight to the midwife? 1. wt change from 128 to 138 lbs 2. pulse rate change from 88 to 92 3. BP change from 120/80 to 118/78 4. RR change from 16 to 20

2 (Blood volume has doubled by the end of the 2nd trimester. If they bleed the BP maintains for a long time. Their pulse rate however does rise. A drop in BP is a late and ominous sign)

A gravid client is admitted and Dx with 3rd trimester bleeding. It is a priority for the nurse to assess for a change in which of the following VS? 1. Temp 2. Pulse 3. RR 4. BP

1

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

1 (acidosis not alkalosis proceeds a crisis.)

A gravid woman has sickle cell anemia. Which of the following situations could precipitate a vaso occlusive crisis in the woman? 1. hypoxia 2. alkalosis 3. fluid overload 4. hyperglycemia

4 (all are good, but fluids are priority)

A gravid woman with sickle cell anemia is admitted in vaso-occlusive crisis. Which of the following is the priority intervention that the nurse must perform? 1. admin narcotic analgesics 2. apply heat to swollen joints 3. place on strict bed rest 4. admin. IV solution

1,3,4 (swelling feet are normal in 3rd trimester.)

A nurse is completing a prenatal assessment on a woman who is 28 weeks. with gestational HTN. Which findings should be reported to the HCP? select all that apply 1. dull headache 2. edematous feet 3. blurred vision 4. 1+ urine 5. fundal height of 28 cm

1 (poor perfusion to kidneys, glomular filtration is altered. protein and albumin lost in urine. fluid 3rd spaces.)

A nurse remarks to a 38 week client, it looks like your hands and face are swollen. The client responds, yes you are right, why do you ask? The nurses response is based on the fact that the changes may be caused by which of the following? 1. altered glomerular filtration 2. cardiac failure 3. hepatic insufficiency 4. altered splenic circulation

b

A primigravida in preterm labor at 34 weeks gestation feels a sudden gush of water and tells the healthcare provider, "I think my water broke." What is the priority action by the healthcare provider? Choose 1 answer: A Prepare for imminent delivery B Assess the fetal heart rate C Assess the degree of cervical dilation D Take the woman's temperature

a

A primigravida who is at 38 weeks gestation calls the clinic stating she felt several contractions in her abdomen during the past hour. She reports that the contractions were irregular and they decreased after she took a walk around the block. Based on this information, what is the healthcare provider's best response? Choose 1 answer: A "Come to the hospital when your contractions are regular and about 5 minutes apart." B "You should wait 1 to 2 hours and then come to the hospital." C "Birth is imminent so you should come to the hospital immediately." D "Come to the hospital when your contractions are regular and about 1 minute apart."

a,c,e,f

A woman is admitted to the birthing center with a diagnosis of severe preeclampsia. Assessment findings include: blood pressure of 165/95 mmHg, 3+ proteinuria, and visual disturbances. Which of these additional assessment findings should the healthcare provider expect? Choose all answers that apply: A Edema of the hands and face B Fetal heart rate accelerations C Headache D Vaginal bleeding E Clonus F Right upper quadrant pain

a

A woman is admitted to the obstetric unit at 30 weeks gestation with a sudden onset of vaginal bleeding that is bright red in color. Her uterus is soft and her pain report is 0 on a 0 - 10 pain scale. The fetal heart rate is 140 beats/minute. The healthcare provider correctly identifies these assessment findings are related to which of the following problems? Choose 1 answer: A Placenta previa B Preterm labor C Abruptio placentae D Threatened abortion

3 (Rhogam is administered to all RH neg mothers. Fetal blood type is usually not known. Rhogam is not reconstituted. Rare cases the coombs test is positive, but the direct coombs test is usually negative)

A woman is recieving Rhogam at 28 weeks gestation. Which of the following actions must the nurse perform before giving this injection? 1. validate the baby is RH negative 2. Assess that the direct Coombs test is positive 3. Verify the identity of the woman 4. Reconstitute the globulin with sterile water

a

A woman presents to the clinic because she missed her last menstrual period and thinks she may be pregnant. She reports fatigue, breast tenderness, urinary frequency, and nausea and vomiting in the morning. The healthcare provider will interpret these findings as which of the following changes of pregnancy? Choose 1 answer: A Presumptive B Possible C Probable D Positive

c

The healthcare provider is assessing a pregnant woman during her first prenatal visit. The patient reports she has a 5-year-old at home who was delivered at 39 weeks gestation. Her last pregnancy ended at 12 weeks gestation due to a spontaneous abortion. She delivered a set of twins at 22 weeks gestation. The twins died within 12 hours of birth. How will the healthcare provider document this patient's obstetrical history using the GTPAL system? Choose 1 answer: A G4 T1 P1 A1 L1 B G5 T2 P1 A0 L3 C G4 T1 P2 A1 L1 D G3 T2 P2 A0 L2

a,b,c,f

The healthcare provider is caring for a woman whose labor is being augmented with an IV oxytocin (Pitocin) infusion. For which of the following adverse effects of this medication will the nurse monitor? Choose all answers that apply: A Uterine rupture B Fetal hypoxia C Water intoxication D Hypotension E Hypoglycemia F Uterine tetany

a,c,d,f

The healthcare provider is reviewing the laboratory results of a woman in her second trimester of pregnancy. Which of the following are expected results for this patient? Choose all answers that apply: A Increased white blood cell count B Increased red blood cell count C Decreased hematocrit D Decreased hemoglobin E Decreased mean corpuscular hemoglobin F Increased fibrinogen

d

The healthcare provider is reviewing the results of a non-stress test (NST). In a 20 minute period, the test shows 2 fetal heart rate (FHR) accelerations above baseline that last 15 seconds. The FHR is 120 beats/minute, and the variability is average. How will the healthcare provider interpret this NST? Choose 1 answer: A Nonreactive B Positive C Negative D Reactive

1,5,6 (want VS wnl. ther. Mg level is 5-8 with therapy)

The nurse is administering Mg. Sulfate IV as prescribed for a client at 34 weeks with severe preeclampsia. What are the desired outcomes of this therapy? Select all that apply 1. temp 98, HR 72, RR 14 2. urinary output less than 30 mL/hr 3. FHR with late decelerations 4. BP of less that 140/90 5. DTR 2+ 6. Mg level 5.6

3,4,5,6

The nurse is developing a teaching plan for a client entering the 3rd trimester of preg. The nurse should include which information in the plan. Select all that apply 1. differentiating the fetus from self 2. ambivalence concerning preg. 3. experimenting with mothering roles 4. realignment of roles and tasks 5. trying various caregiver roles 6. concern about labor and birth

4 (estrogen is responsible for hyperpigmentation and vascular skin changes. Progesterone relaxes smooth muscle.)

When preparing a prenatal class about endocrine changes that normally occur during pregnancy, the nurse should include information about which subject? 1. HPL maintains the corpus luteum 2. Progesterone is responsible for hyperpigmentation and vascular skin changes 3. Estrogen relaxes smooth muscle in the respiratory tract 4. The thyroid enlarges with an increase in basal metabolic rate

3 (bedrest ,especially side lying helps improve perfusion to the placenta)

a client with mild preeclampsia who has been advised to be on bedrest at home asks why doing so is necessary. Which of the following is the best response for the nurse to give the client? 1. Bedrest will help you conserve energy for labor 2. bedrest will help to relieve Nausea and anorexia 3. reclining will increase the amount of O2 your baby gets 4. The position change will prevent the placenta from separating

1 (rubella is a teratogenic disease)

A child has been diagnosed with Rubella. What must the pediatric nurse teach the parents to do? 1. notify any exposed pregnant women 2. give oral penicillin ever 6 hrs for 10 full days 3. observe the child for signs of resp distress 4. admin diphenhydramine ever 4 hr as needed

2,3,4

A client at 28 weeks presents to the ER with a splitting headache. What actions are indicated by the nurse at this time? Select all that apply 1. reassure the client headaches are normal part of preg. 2. assess the client for vision changes or epigastric pain. 3. obtain a non stress test 4. assess the clients reflexes and presence of clonus 5. determine if the client has a documented ultrasound for this preg.

1 (weight loss is a positive sign. )

A nurse is evaluating the effectiveness of bedrest for a client with mild preeclampsia. Which of the following s/s would the nurse determine is a positive finding? 1. weight loss 2. DTR 2+ 3. Decrease in plasma protein 4. 3+ patellar reflexes

2 (cat= risk toxoplasmosis)

A nurse is interviewing a prenatal client. Which of the following factors in the clients history should the nurse highlight for the HCP> 1. That she is 18 years old 2. That she owns a cat and dog 3. That she eats PB daily 4. That she works as a surgeon

4 (perfusion to placenta drops with preeclampsia. Htn impairs blood flow. poor fetal nutrition results.)

A client has severe preeclampsia. The nurse would expect the HCP to order tests to assess the fetus for which of the following? 1. severe anemia 2. hypoprothrombinemia 3. craniosynostosis 4. intrauterine growth restriction

3 ( a single shot of penicillin administered to the mother will cure her and protect the baby)

A patient who is 24 weeks has been diagnosed with syphilis. She asks the nurse how the infection will affect the baby. The nurse response should be based on the following: 1. She is at high risk for premature rupture of the membranes 2. the baby will be born with congenital syphilis 3. Penicillin therapy will reduce the risk to the fetus 4. The fetus will likely be born with a cardiac defect

3 (hypermagnesemia /toxicity include loss of DTR, urinary output decreases, RR decreases. First action is to stop Mag!!.)

A woman with preeclampsia is receiving Mg. Sulfate via infusion pump at 1g/hr. The nurse assessment includes temp 99, pulse 78, RR 12, BP 128/82, urinary output 90 mL in last 4 hrs via Foley, DTR reflex absent, ankle clonus absent, FHR 120, cervix 4 cm dilated. 80% effaced. station -1. Which is the most appropriate action for the nurse to take? 1.. assess the Foley for kinks in drainage tubing and obtain urine sample 2. Document findings, and continue to monitor labor progress 3. D/C the Mg sulfate and notify the HCP 4. Increase the fluid intake IV, and measure input and output.

1 (hydralazine lowers BP by peripheral dilation.)

After admin hydralazine 5 mg IV as prescribed for a primigravid with severe preeclampsia at 39 weeks, the nurse should assess the client for; 1. tachycardia 2. bradypnea 3. polyuria 4. dysphagia

2,3,4

An obese gravid woman is being seen in the prenatal clinic. The nurse will monitor her carefully throughout her pregnancy because she is at high risk for which of the following complications? Select all that apply 1. placenta previa 2. gestational diabetes 3. DVT 4. Pre-eclampsia 5. Chromosomal defects

3

At 32 weeks gestation a 15 year old primigravid client who is 5'2 and has gained a total of 20 lbs with a 1 lb gain in the last two weeks. Urinalysis reveals a negative glucose and a trace of protein. The nurse should advise the client that which factor increases her risk for preeclampsia? 1. total wt gain 2. short stature 3. adolescent age group 4. trace proteinuria

3 (principle of emerg, mngmt begins with calling for assist. )

As the nurse enters the room of a newly admit. primigravid diagnosed with severe preeclampsia, the client begins to experience a seizure. Which action should the nurse take first? 1. insert an airway to improve O2 2. note the time seizure begins and ends 3. call for immed. assistance 4. turn the client to her left side

2

At 28 weeks the mother receives Rhogam. Which of the following would indicate the med is effective? 1. The babys RH status changes to Rh negative 2. The mother produces no Rh antibodies 3. The baby produces no Rh antibodies 4. The mothers Rh status changes to Rh positive

1

For a client who is receiving IV Mg sulfate for severe preeclampsia, which assessment finding would alert the nurse to suspect hypermagnesemia? 1. decreased DTR 2. cool skin temp 3. rapid HR 4. tingling in toes

2

Prenatal teaching for a pregnant woman should include instructions to do which of the following? 1. refrain from touching her pet bird 2. wear gloves when gardening 3. cook pork until medium well done 4. avoid sleeping with the dog

a

The healthcare provider is caring for a woman who is in active labor at 40 weeks gestation. Which of the following best describes the correct placement of the external tocotransducer to monitor uterine activity? Choose 1 answer: A Near the uterine fundus B Midline on the lower abdomen C Over the umbilicus D Just above the symphysis pubis

4

The nurse is instructing a preeclamptic client about monitoring the movements of her fetus to determine fetal well being. Which statement by the client indicates that she needs further instruction about when to call the HCP concerning fetal movement. 1. if the fetus is becoming less active than before 2. if it takes longer each day for the fetus to move 10 times 3. if the fetus stops moving for 12 hours 4. if the fetus moves more often than 3 times an hour

d

When evaluating the fetal heart rate (FHR) pattern for a woman in active labor, the healthcare provider notes periodic decelerations in the FHR with the following characteristics: Gradual decrease in FHR Onset just prior to the uterine contraction 120 beats/minute at the peak of the uterine contraction Waveform inversely mirrors uterine contraction What is the healthcare provider's priority action? Choose 1 answer: A Administer oxygen by nasal cannula B Assist the woman to lay on her left side C Assess the degree of cervical dilation D Document this as a normal finding

3

When teaching a multigravid client diagnosed with MILD preeclampsia about nutritional needs, which type of diet should the nurse discuss? 1. high residue diet 2. low sodium diet 3. regular diet 4. high protein diet

1,2,3,5

A 39 year old 16 week gravid client has amniocentesis. Before discharge, the nurse teaches the woman to call her doctor if she experiences which of the following side effects? select all that apply. 1. fever or chills 2. lack of fetal movement 3, abdominal pain 4, rash or pruritus 5. vaginal bleeding

2

A 24 week primigravid client is being seen in the prenatal clinic. She states I have had a terrible headache for the past 2 days. Which of the following is the most appropriate action for the nurse to perform next? 1. inquire about allergies 2. take the BP 3. Assess fundal height 4. Ask about work stress

3 (predisposes to preterm labor)

A client 8 weeks pregnant has been diagnosed with bicornuate uterus. Which of the following signs should the nurse teach the client to carefully monitor for? 1. hyperthermia 2. palpitations 3. cramping 4. oliguria

3 (dorsiflex ,release, count pulsations)

A client is admitted to the hospital with severe preeclampsia. The nurse is assessing for clonus. Which of the following actions should the nurse perform? 1. strike the womans patellar tendon 2. palpate the womans ankle 3. dorsiflex the womans foot 4. position the womans feet flat on the floor

3

A client taking Zoloft for depression for 2 years is seen for a prenatal appt. She states " I just read that my baby is going to be really sick if I keep taking Zoloft. So I have stopped my med." The nurses response is based on which of the following information? 1. There is evidence that other antidepressant meds can cause birth defects. but SSRI's are safe to take during pregnancy 2. Although some evidence shows that SSRI's can cause birth defects, the defects are easily repaired following delivery 3. Although some evidence shows SSRI meds can cause birth defects, the health and well being of the mother may outweigh the potential injury to the baby 4. There is no evidence that SSRI meds are injurious prenatally, but the woman should be advised not to breast feed the infant while taking the med.

1 (attempt to lower BP by placing in lateral side lying position)

A client who is 34 weeks is admitted to the labor and birth unit with the Dx of preeclampsia. The clients VS are as follows; BP 149/92, HR 62, RR 18, Temp 98.4. What is the priority intervention? 1. Encourage client to lie in lateral position 2, Admin. antihypertensive agent 3. Notify the HCP of the clients BP 4. Check the cervix

1 (DTR's to check seizure risks! )

A patient 32 weeks pregnant with severe headache is admitted to the hospital with pre eclampsia. In addition to obtaining baseline VS and placing the client on bedrest, the Dr ordered the following four items. Which of the orders should the nurse perform first? 1. assess DTR's 2. obtain CBC 3. Assess baseline weight 4. Obtain routine urinalysis

4

A preg. Latina is being seen in the clinic with diarrhea, fever, stiff neck and headache. Upon inquiry the nurse learns that the woman drinks unpasteurized milk, and eats soft cheese daily. For which of the following bacterial infections should this woman be assessed? 1. staph aureus 2. strep albican 3. psuedomonas aeurginosa 4. listeria monocytogenes

2

A primigravid client attending parenthood classes tells the nurse there is a history of twins in her family. What should the nurse tell the client? 1. Monozygotic twins result from fertilization of one ovum 2. Monozygotic twins occur by chance regardless of race or heredity 3. Dizygotic twins are normally the same sex 4. Dizygotic twins occur more often in primigravid than in multigravid clients

4 (very brisk patellar!!)

A primigravid client with severe preeclampsia exhibits hyperactive very brisk patellar reflexes with two beats of ankle clonus present. How does the nurse document the patellar reflexes? 1. 1+ 2. 2+ 3. 3+ 4. 4+

a,b,c,e,f

A woman who has a diagnosis of preeclampsia is in active labor and is receiving an IV infusion of magnesium sulfate. When planning care for this woman, which of these are a priority for the healthcare provider to monitor? Choose all answers that apply: A Respiratory rate B Deep tendon reflexes C BUN and creatinine D Blood glucose levels E Urine intake and output F Blood pressure

b

A woman whose pregnancy has been confirmed asks the healthcare provider when her baby is due. The first day of her last menstrual period was March 20. Using Naegele's rule, the healthcare provider estimates the date of birth (EDB) to be which of the following? Choose 1 answer: Choose 1 answer: A February 13 B December 27 C January 17 D December 20

a

A woman with a history of pelvic inflammatory disease (PID) presents to the urgent care clinic with a report of dizziness, sharp abdominal pain, and scant dark red vaginal discharge. She has missed two menstrual periods and thinks she might be pregnant. A pregnancy test confirms her pregnancy. These assessment findings indicate the woman is experiencing which of the following problems? Choose 1 answer: A Ruptured ectopic pregnancy B Gestational trophoblastic disease C Placenta abruption D Placenta previa