Maternity 2B
.Which of the following, if noted in the maternal history, would the nurse identify as possibly contributing to the birth of an LGA newborn?
Diabetes
Which statement concerning the complication of maternal diabetes is the most accurate?
Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy.
The nurse has evaluated a client with preeclampsia by assessing DTRs. The result is a grade of 3+. Which DTR response most accurately describes this score?
More brisk than expected, slightly hyperactive
A 29-year-old client has gestational diabetes. The nurse is teaching her about managing her glucose levels. Which therapy would be most appropriate for this client?
diet
A pregnant client is diagnosed with syphilis. Which interviewing question would demonstrate respect for the client and therapeutic communication?
"I am sure it is frightening to you to be diagnosed with a disease that can affect your baby."
severe preeclampsia is indicated by
5 grams in a 24 hr specimen
A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. The client shows the nurse her readings for the past few days. Which reading signals the nurse that the client may require an adjustment of insulin or carbohydrates?
50 mg/dl just after waking up from a nap. This is too low; maybe eat a snack before going to sleep.
A client is 33 weeks pregnant and has had diabetes since age 21. When checking her fasting blood glucose level, which value would indicate the client's disease is controlled?
60 to 95 mg/dL.
A 29-year-old multigravida at 37 weeks' gestation is being treated for severe preeclampsia and has magnesium sulfate infusing at 3 g/h. To maintain safety for this client, the priority intervention is to:
Assess reflexes, clonus, visual disturbances, and headache.
A 32-year-old multigravida returns to the clinic for a routine prenatal visit at 36 weeks' gestation. The assessments during this visit include BP 140/90, P 80, and +2 edema of the ankles and feet. What further information should the nurse obtain to determine if this client is becoming preeclamptic?
Proteinuria.
The nurse is caring for a client with preeclampsia and understands the need to auscultate this client's lung sounds every 2 hours. Why would the nurse do this?
Pulmonary edema
A pregnant client with type I diabetes asks the nurse about how to best control her blood sugar while she is pregnant. The best reply would be for the woman to:
check her blood sugars frequently and adjust insulin accordingly.
The primary care provider prescribes 5% dextrose in Ringer's solution and magnesium sulfate intravenously for an adolescent client with preeclampsia. Before administering the magnesium sulfate, what is the most important assessment the nurse should make?
maternal respiratory rate
the development of preeclamptic S&S during the first half of pregnancy is often associated with
molar pregnancy multiple gestation preexisting hypertensive disease
Pregnant women are tested for gestational diabetes at?
24-28 weeks
A client with severe preeclampsia is receiving magnesium sulfate as part of the treatment plan. To ensure the client's safety, which compound would the nurse have readily available?
Calcium gluconate
A primigravid client at 37 weeks' gestation has been hospitalized for several days with severe preeclampsia. While caring for the client, the nurse observes that the client is beginning to have a seizure. Which action should the nurse do first?
Call for immediate assistance in the client's room.
When assessing a multiparous client following a vacuum-assisted birth, the nurse should be alert for what complication?
Cervical laceration.
A number of metabolic changes occur throughout pregnancy. Which physiologic adaptation of pregnancy will influence the nurse's plan of care?
During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus.
The nurse encourages a woman with gestational diabetes to maintain an active exercise period during pregnancy. Prior to this exercise period, the nurse would advise her to take which action?
Eat a sustaining-carbohydrate snack.
A G2P1 woman with type 1 diabetes is determined to be at 8 weeks' gestation by her health care provider. The nurse should point out which factor will help the client maintain glycemic control?
Exercise
A pregnant client has been diagnosed with gonorrhea. Which nursing interventions should be performed to prevent gonococcal ophthalmia neonatorum in the baby?
Instill a prophylactic agent in the eyes of the newborn.
A pregnant woman has been admitted to the hospital due to severe preeclampsia. Which measure will be important for the nurse to include in the care plan?
Institute and maintain seizure precautions.
Which neonatal complications are associated with hypertension in the mother?
Intrauterine growth restriction (IUGR) and prematurity
A pregnant woman in her 39th week of pregnancy presents to the clinic with a vaginal infection. She tests positive for chlamydia. What would this disease make her infant at risk for?
blindness
A young mother has tested positive for HIV. When discussing the situation with the client, the nurse should advise the mother that she should avoid which activity?
breastfeeding
A woman is 9 weeks gestation and admitted to the obstetrical unit for hyperemesis gravidarum. The highest priority intervention the nurse should anticipate is which of the following?
c) NPO for 24 hours
A client, 11 weeks pregnant, is admitted to the facility with hyperemesis gravidarum. She tells the nurse she has never known anyone who had such severe morning sickness. The nurse understands that hyperemesis gravidarum results from:
d) an unknown cause.
In caring for a pregnant client with hyperemesis gravidarum, which is the priority nursing intervention?
d) correction of fluid-electrolyte imbalance
A client is receiving I.V. magnesium sulfate for severe preeclampsia. The nurse should monitor for:
decreased urine output.
The nurse is discussing the insulin needs of a primaparous client with diabetes who has been using insulin for the past few years. The nurse informs the client that her insulin needs will increase during pregnancy based on the nurses understanding that the placenta produces:
hPL, which deceases the effectiveness of insulin
A woman who gave birth to a healthy baby 5 days ago is experiencing fatigue and weepiness, lasting for short periods each day. Which condition does the nurse believe is causing this experience?
postpartum baby blues
During a telephone follow-up conversation with a woman who is 4 days postpartum, the woman tells the nurse, "I don't know what's wrong. I love my son, but I feel so let down. I seem to cry for no reason!" Which condition might this new mother be experiencing?
Postpartum blues
The nurse is assessing a client who gave birth to a baby 1 week ago. She has been feeling sad, fatigued, and has been crying often. The client is most likely experiencing what?
Postpartum blues
After reviewing information about postpartum blues, a group of students demonstrate understanding when they state which of the following about this condition
Postpartum blues is a long-term emotional disturbance.
A 25-year-old pregnant client has just been diagnosed with hyperemesis gravidarum. Which instruction should the nurse prioritize during a teaching session?
Take your anti-nausea medicine around the clock.
Following an eclamptic seizure, the nurse should assess the client for which of the following?
Uterine contractions
A woman gave birth to a newborn via vaginal birth with the use of a vacuum extractor. The nurse would be alert for which possible effect in the newborn?
cephalhematoma
A pregnant woman with diabetes at 10 weeks' gestation has a glycosylated hemoglobin (HbA1c) level of 13%. At this time the nurse should be most concerned about which possible fetal outcome?
congenital anomalies
A client in her fifth month of pregnancy is having a routine clinic visit. The nurse should assess the client for which common second trimester condition?
physiological anemia
.A pregnant woman diagnosed with syphilis comes to the clinic for a visit. The nurse discusses the risk of transmitting the infection to her newborn, explaining that this infection is transmitted to the newborn through the:
placenta
The client requires vacuum extraction assistance. To provide easier access to the fetal head, the physician cuts a mediolateral episiotomy. After delivery, the client asks the nurse to describe the episiotomy. What does the nurse respond?
"The episiotomy is cut diagonally away from your vagina."
Which change best describes the insulin needs of a client with type 1 diabetes mellitus who has just delivered an infant vaginally without complications?
Decreased
When caring for the pregnant client with hyperemesis gravidarum, the nurse would further assess the client for which of the following?
Dehydration
A nurse suspects that a postpartum client is experiencing postpartum psychosis. Which of the following would most likely lead the nurse to suspect this condition?
Delirium Mania Bizarre behaviors Delirium Hallucinations Anger Thoughts of hurting both self and infant Severe - manifested from depression ii) Onset is within 3 weeks
A nurse is assessing a pregnant client with preeclampsia for suspected dependent edema. Which description of dependent edema is most accurate?
Dependent edema may be seen in the sacral area if the client is on bed rest.
Which adverse prenatal outcomes are associated with the HELLP syndrome? (Select all that apply.)
Placental abruption Renal failure Maternal and fetal death
Which assessment findings, experienced by the client at 36 weeks' gestation, would the nurse document as diagnostic signs of severe preeclampsia? Select all that apply.
Elevated liver enzymes +1 proteinuria BP of 164/110 Elevated serum creatinine
he nurse would be alert for possible placental abruption during labor when assessment reveals which of the following?
Gestational hypertension
What should be reported to the HCP in a pregnant woman with hyperemesis gravidarum?
Lack of urine output for 8 hours & Dark Urine
The nurse is reviewing the chart of a multigravid client at 39 weeks' gestation with suspected HELLP syndrome. The nurse should notify the health care provider about which of the following test results?
Lactate dehydrogenase (LDH) greater than 200 U/L (3.34 μkat/L).
A woman, 32 weeks' gestation, contracting every 3 min × 60 sec, is receiving magnesium sulfate. For which of the following maternal assessments is it critical for the nurse to monitor the client?
Low urinary output.
Because a pregnant clients diabetes has been poorly controlled throughout her pregnancy, the nurse would be alert for which of the following in the neonate at birth?
Macrosomia
A pregnant woman at 4 weeks' gestation who has preexisting diabetes mellitus visits her primary care provider for a check-up. Which fetal complications might occur because of this maternal condition? Select all that apply.
Macrosomia (oversized fetus) Respiratory disorder Congenital malformations
The nurse is preparing information for a client who has just been diagnosed with gestational diabetes. Which instruction should the nurse prioritize in this information?
Maintain a daily blood glucose log
Newborns receive an antibiotic in their eyes within the first hour after birth to prevent neonatorum ophthalmia. Which type of bacteria is most likely to cause this condition?
Neisseria gonorrhoeae
As a nurse begins the shift on the obstetrical unit, there are several new admissions. The client with which condition would be a candidate for induction?
Preeclampsia
According to research, which risk factor for PPD is likely to have the greatest effect on the client postpartum?
Prenatal depression
The client is being induced in response to worsening preeclampsia. She is also receiving magnesium sulfate. It appears that her labor has not become active, despite several hours of oxytocin administration. She asks the nurse, "Why is this taking so long?" What is the nurse's most appropriate response?
"The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor."
The nurse is grading a woman's reflexes. Which of the following grades would indicate reflexes that are slightly brisker than normal?
+3
After instructing a multigravid client diagnosed with mild preeclampsia how to keep a record of fetal movement patterns at home, the nurse determines that the teaching has been effective when the client says that she will count the number of times the baby moves during which of the following time spans?
1-hour period each day.
A group of students are reviewing information about sexually transmitted infections and their effect on pregnancy. The students demonstrate understanding of the information when they identify which infection as being responsible for ophthalmia neonatorum?
Gonorrhea
What laboratory marker is indicative of disseminated intravascular coagulation (DIC)?
Presence of fibrin split products
A woman is being closely monitored and treated for severe preeclampsia with magnesium sulfate. Which finding would alert the nurse to the development of magnesium toxicity in this client?
diminished reflexes
A nurse is caring for a pregnant client in her third trimester of pregnancy. The nurse educates the client to look for which danger sign of pregnancy needing immediate attention by the primary care provider?
dyspnea, abdominal pain indicates preterm labor, swelling of face and extremities, HUL
How is nausea and vomiting diagnosed if it persists past 20 weeks?
hyperemesis gravidarum
What is the most common medical complication of pregnancy?
hypertension
Which factor would contribute to a high-risk pregnancy?
type 1 diabetes
A woman with preterm labor is receiving magnesium sulfate. Which finding would require the nurse to intervene immediately?
1+ deep tendon reflexes
After instructing a multigravid client diagnosed with mild preeclampsia how to keep a record of fetal movement patterns at home, the nurse determines that the teaching has been effective when the client says that she will count the number of times the baby moves during which of the following time spans?
1-hour period each day. (kick counts)
Which of the following patients is at increased risk for the development of preeclampsia?
27 year old infertility patient with twins 15 year old primip 25 year old gravida 2/1 with type 1 diabetes
A woman is receiving magnesium sulfate as part of her treatment for severe preeclampsia. The nurse is monitoring the woman's serum magnesium levels. The nurse determines that the drug is at a therapeutic level based on which result?
6.1 (between 5-8)
Which intrapartal assessment should be avoided when caring for a client with HELLP syndrome?
Abdominal palpation
A client is on magnesium sulfate for severe pre-eclampsia. The nurse must notify the attending physician regarding which of the following findings?
Serum magnesium level of 9 g/dL.
A 38-year-old client at about 14 weeks' gestation is admitted to the hospital with a diagnosis of preeclampsia. Soon after admission, the nurse would assess the client for signs and symptoms of which signs and symptoms?
gestational diabetes
is a category A drug that can be safely administered during pregnancy
magnesium sulfate
At 38 weeks' gestation, a primigravid client with poorly controlled diabetes and severe preeclampsia is admitted for a cesarean birth. The nurse explains to the client that childbirth helps to prevent which complication?
stillbirth (death)
A client has been admitted to the hospital with a diagnosis of severe preeclampsia. Which nursing intervention is the priority?
Confine the client to bed rest in a darkened room.
The client being cared for has severe preeclampsia and is receiving a magnesium sulfate infusion. Which new finding would give the nurse cause for concern?
Respiratory rate of 10 breaths per minute
A high-risk pregnant client is determined to have gestational hypertension. The nurse suspects that the client has developed severe preeclampsia based on which finding?
blurred vision
The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the oxytocin (Pitocin) infusion, the nurse reviews the woman's latest laboratory test findings, which reveal a platelet count of 90,000 mm3, an elevated aspartate aminotransaminase (AST) level, and a falling hematocrit. The laboratory results are indicative of which condition?
c.Hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome
A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. The nurse determines that the medication is at a therapeutic level based on which finding?
deep tendons reflexes 2+
A 16-year-old unmarried primigravid client at 37 weeks' gestation with severe preeclampsia is in early active labor. The client's blood pressure is 164/110 mm Hg. Which finding would alert the nurse that the client may be about to experience a seizure?
epigastric pain
A pregnant woman with preeclampsia is to receive magnesium sulfate IV. Which assessment should the nurse prioritize before administering a new dose?
patellar reflexes
The nurse is administering intravenous magnesium sulfate as prescribed for a client at 34 weeks' gestation with severe preeclampsia. What are desired outcomes of this therapy? Select all that apply.
temperature, 98° F (36.7° C); pulse, 72 beats/min; respiratory rate, 14 breaths/min deep tendon reflexes 2+ magnesium level = 5.6 mg/dL (2.8 mmol/L)
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
Which statement best describes chronic hypertension?
Chronic hypertension can occur independently of or simultaneously with preeclampsia.
A woman pregnant with twins comes to the clinic for an evaluation. While assessing the client, the nurse would be especially alert for signs and symptoms for which potential problem?
Preeclampsia
A woman develops HELLP syndrome. During labor, which of the following orders would you question?
Prepare her for epidural anesthesia.
What makes the diagnosis of gestational hypertension different from the diagnosis of preeclampsia?
Proteinuria
A woman with preeclampsia has a seizure. What is the nurse's highest priority during a seizure?
To stay with the client and call for help
The nurse is evaluating the effectiveness of bedrest for a client with mild pre-eclampsia. Which of the following signs/symptoms would the nurse determine is a positive finding?
Weight loss is a positive sign.
The nurse is describing pregnancy danger signs to a pregnant woman who is in her first trimester. Which danger sign might occur at this point in her pregnancy?
excessive vomiting, painful urination, severe/ persistent vomiting, and lower abdominal and shoulder pain
Women with mild gestational hypertension and mild preeclampsia can be safely managed at home with frequent maternal and fetal evaluation. Complete or partial bed rest is still frequently ordered by some providers. Which complication is rarely the result of prolonged bed rest?
fluid retention diuresis electrolyte imbalance weight loss
A 26 week gestation woman is diagnosed with severe preeclampsia with HELLP syndrome. The nurse will assess for which of the following signs/symptoms?
low serum creatinine
A nursing student working with a client in preterm labor correctly identifies which medication as being used to relax the smooth muscles of the uterus and for seizure prophylaxis and treatment in clients with preeclampsia?
magnesium sulfate
A primary care provider prescribes intravenous tocolytic therapy for a woman in preterm labor. Which agent would the nurse expect to administer?
magnesium sulfate
A 16-year-old primigravida at 35 weeks' gestation in active labor with severe preeclampsia is admitted to the hospital's labor unit. The nurse should notify the primary care provider immediately about which finding?
platelet count of 80,000/mcL (80 X 109/L) (indicated HELLP)
A 16-year-old primigravida at 35 weeks' gestation in active labor with severe preeclampsia is admitted to the hospital's labor unit. The nurse should notify the primary care provider immediately about which finding?
platelet count of 80,000/mcL (80 X 109/L) (less than 100,000)
A nurse administers magnesium sulfate via infusion pump to an eclamptic woman in labor. Which of the following outcomes indicates that the medication is effective?
Client has no grand mal seizures.
What nursing diagnosis is the most appropriate for a woman experiencing severe preeclampsia?
Risk for injury to mother and fetus, related to central nervous system (CNS) irritability
The nurse is appraising the medical record of a pregnant client who is resting in a darkened room and receiving betamethasone and magnesium sulfate. The nurse recognizes the client is being treated for which condition?
Severe preeclampsia
The client has been on magnesium sulfate for 20 hours for the treatment of preeclampsia. She just delivered a viable infant girl 30 minutes ago. What uterine findings does the nurse expect to observe or assess in this client?
Boggy uterus with heavy lochia flow (magnesium softens smooth mucles)
A primigravida is being monitored at the prenatal clinic for preeclampsia. Which finding is of greatest concern to the nurse?
Dipstick value of 3+ for protein in her urine 140/90 or higher 2 kg in one week
A patient is admitted to labor and delivery for management of severe preeclampsia. An IV infusion of magnesium sulfate is started. What is the primary goal for magnesium sulfate therapy?
Prevent maternal seizures
A: temperature, 98° F (36.7° C); pulse, 72 beats/min; respiratory rate, 14 breaths/minE: deep tendon reflexes 2+F: magnesium level = 5.6 mg/dL (2.8 mmol/L)
Reducing visual and auditory stimulation
The following hourly assessments are obtained by the nurse on a client with preeclampsia receiving magnesium sulfate: 97.3oF (36.2oC), HR 88, RR 1, BP 148/110 mm Hg. What other priority physical assessments by the nurse should be implemented to assess for potential toxicity?
Reflexes
A primary care provider prescribes oral tocolytic therapy for a woman with preterm labor. The nurse explains to the client about the drugs that may be used. The nurse determines that the client needs additional teaching when she states which drug might be used?
magnesium sulfate (not oral)
During a routine prenatal visit, a client is found to have proteinuria and a blood pressure rise to 140/90 mm Hg. The nurse recognizes that the client has which condition?
mild preeclampsia severe is 160/110 (6 hours apart on bedrest)
A 39-year-old multigravid client who is visiting the clinic at 14 weeks' gestation tells the nurse that she has had severe nausea and vomiting since becoming pregnant. The client's fundal measurement is 20 cm. The nurse should assess the client for signs and symptoms of which problem?
molar pregnancy
When teaching a multigravid client diagnosed with mild preeclampsia about nutritional needs, which type of diet should the nurse discuss?
regular diet
After instructing a multigravid client at 10 weeks' gestation diagnosed with chronic hypertension about the need for frequent prenatal visits, the nurse determines that the instructions have been successful when the client makes which statement?
"I need close monitoring because I may have a small-for-gestational-age infant."
The nurse provides teaching for a pregnant mom with hyperemesis gravidarum, and decides she needs further teaching when she says what?
"I will eat 3 good meals a day"
The nurse is teaching a client who is diagnosed with preeclampsia how to monitor her condition. The nurse determines the client needs more instruction after making which statement?
"If I have changes in my vision, I will lie down and rest."
The nurse is teaching a client with gestational diabetes about complications that can occur either following birth or at delivery for her baby. Which statement by the mother indicates that further teaching is needed by the nurse?
"If my blood sugars are elevated, my baby's lungs will mature faster, which is good."
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 health care provider concerning fetal movement?
"If the fetus moves more often than 3 times an hour."
A primigravid client with severe preeclampsia exhibits hyperactive, very brisk patellar reflexes with two beats of ankle clonus present. The nurse documents the patellar reflexes as which of the following?
4+
You are the home health nurse making an initial call on a new mother who delivered her third baby five days ago. The woman says to you "I just feel so down this time. Not at all like when I had my other babies. And this one just doesn't sleep. I feel so inadequate." What is the best response to this new mother?
"It sounds like you have the 'baby blues.' They are common after having a baby when you are not getting enough sleep, are busy with your other children, and are still a bit uncomfortable from the delivery. They will most likely go away in a day or two."
A client with mild pre-eclampsia 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?
"Reclining will increase the amount of oxygen that your baby gets."
A woman with worsening preeclampsia is admitted to the hospital's labor and birth unit. The physician explains the plan of care for severe preeclampsia, including the induction of labor, to the woman and her husband. Which statement by the husband leads the nurse to believe that the couple needs further information?
"Since we will be here for a while, I will call my mother so she can bring the two boys—2 years and 4 years of age—to visit their mother." (Quiet environment needed)
A woman's baby is HIV positive at birth. She asks the nurse if this means the baby will develop AIDS. Which statement would be the nurse's best answer?
"The antibodies may be those transferred across the placenta; the baby may not develop AIDS."
A nurse is assessing a postpartum client who is at home. Which statement by the client would lead the nurse to suspect that the client may be developing postpartum depression?
I'm feeling so guilty and worthless lately.
The American College of Obstetricians and Gynecologists (ACOG) has developed a comprehensive list of risk factors associated with the development of preeclampsia. Which client exhibits the greatest number of these risk factors?
19-year-old African American who is pregnant with twins
What is the role of the nurse during the preconception counseling of a pregnant client with chronic hypertension?
stressing the positive benefits of a healthy lifestyle
A client is 33 weeks pregnant and has had diabetes since age 21. When checking her fasting blood glucose level, which value would indicate the client's disease is controlled?
85 mg/dl (60-95 mg/dl)
A pregnant woman with gestational diabetes comes to the clinic for a fasting blood glucose level. When reviewing the results, the nurse determines that which result indicates good glucose control?
90 mg/dL
The laboring client participated in childbirth preparation classes that strongly discouraged the use of medications and intervention during labor. The client has been pushing for two hours, and is exhausted. The physician requests that a vacuum extractor be used to facilitate the birth. The client first states that she wants the birth to be normal, then allows the vacuum extraction. Following this, what should the nurse assess the client for after the birth?
A sense of failure and loss
A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes, dark red vaginal bleeding, and a tense, painful abdomen. Which clinical change does the nurse anticipate?
Abruptio placentae
A client at 36 weeks' gestation begins to exhibit signs of labor after an eclamptic seizure. The nurse should assess the client for:
Abruptio placentae.
A pregnant client at 32 weeks' gestation is treated with magnesium sulfate for seizure management. The nurse assesses which of the following for evidence of magnesium toxicity?
Absence of knee jerk response
A pregnant client is admitted to a health care unit with disseminated intravascular coagulation (DIC). Which of the following orders is the nurse most likely to receive regarding the therapy for such a client?
Administer cryoprecipitate and platelets.
In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate?
Administration of blood
A nurse is assessing a client for possible risk factors for chlamydia and gonorrhea. Which of the following would the nurse identify?
Age under 25 years
A nurse is providing education to a woman at 28 weeks' gestation who has tested positive for gestational diabetes mellitus (GDM). What would be important for the nurse to include in the client teaching?
She is at increased risk for type 2 diabetes mellitus after her baby is born.
A client who is HIV-positive is in her second trimester and remains asymptomatic. She voices concern about her newborns risk for the infection. Which of the following statements by the nurse would be most appropriate?
Antiretroviral medications are available to help reduce the risk of transmission
A client at 28 weeks' gestation presents to the emergency department with a "splitting headache." What actions are indicated by the nurse at this time? Select all that apply.
Assess the client for vision changes or epigastric pain Obtain a nonstress test. Assess the client's reflexes and presence of clonus.
A G1 P1001 mother is just home after giving birth to her first child 5 days ago. Her birth was complicated by an emergency cesarean birth resulting from incomplete cervical dilation (dilatation) and hemorrhage. The nurse determines that the mother has not slept longer than 3 hours at one time. The appropriate nursing diagnosis for this client care issue is:
At risk for postpartum depression due to inadequate rest.
As part of an inservice program, a nurse is describing a transient, self-limiting mood disorder that affects mothers after childbirth. The nurse correctly identifies this as postpartum:
Blues
.The nurse is assessing the newborn of a mother who had gestational diabetes. Which of the following would the nurse expect to find? (Select all that apply.)
Buffalo hump Distended upper abdomen Excessive subcutaneous fat
A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the client and documents the following findings: temperature of 37.1° C, pulse rate of 96 beats per minute, respiratory rate of 24 breaths per minute, BP of 155/112 mm Hg, 3+ DTRs, and no ankle clonus. The nurse calls the provider with an update. The nurse should anticipate an order for which medication?
Hydralazine
As the nurse enters the room of a newly admitted primigravid client diagnosed with severe preeclampsia, the client begins to experience a seizure. Which action should the nurse take first?
Call for immediate assistance.
A woman gave birth to a newborn via vaginal delivery with the use of a vacuum extractor. The nurse would be alert for which of the following in the newborn?
Caput succedaneum
A primipara, postpartum one day from a vaginal delivery, received magnesium sulfate in labor for severe pre-eclampsia. Which of the following healthcare referrals should the nurse recommend be made for the patient? Referral to:
Cardiologist.
A woman with a positive history of genital herpes is in active labor. She has small pin-point vesicles in the perineum area. Her membranes are ruptured, she is dilated 5cm, effaced 70%. The nurse should anticipate what type of delivery?
Cesarean.
An 18-year-old pregnant client is hospitalized as she recovers from hyperemesis gravidarum. The client reveals she wanted to have an abortion but the cultural background forbids it. She is very unhappy about being pregnant and even expresses a wish for a miscarriage. Which action should the LPN prioritize?
Consult with the RN about offering the client a chance to speak with a psychiatrist.
In caring for an immediate postpartum client, you note petechiae and oozing from her IV site. You would monitor her closely for the clotting disorder:
Disseminated intravascular coagulation (DIC)
A client is admitted to the hospital with severe pre-eclampsia. The nurse is assessing for clonus. Which of the following actions should the nurse perform?
Dorsiflex the woman's foot.
A woman with hyperemesis gravidarum asks the nurse about suggestions to minimize nausea and vomiting. Which suggestion would be most appropriate for the nurse to make?
Drink fluids in between meals rather than with meals.
A woman with severe pre-eclampsia, 38 weeks' gestation, is being induced with IV oxytocin (Pitocin). Which of the following would warrant the nurse to stop the infusion?
Duration of contractions of 130 seconds.
For which of the following problems would the nurse be alert in a pregnant woman with gestational diabetes?
Hydramnios related to glucose/insulin imbalance
To manage her diabetes appropriately and to ensure a good fetal outcome, how would the pregnant woman with diabetes alter her diet?
Eat her meals and snacks on a fixed schedule.
A pregnant client with hyperemesis gravidarum needs advice on how to minimize nausea and vomiting. Which instruction should the nurse give this client?
Eat small, frequent meals throughout the day.
A 40-week-gestation client has an admitting platelet count of 90,000 cells/mm 3 and a hematocrit of 29%. Her laboratory values 1 week earlier were platelet count 200,000 cells/mm 3 and hematocrit 37%. Which additional abnormal laboratory value would the nurse expect to see?
Elevated alanine transaminase (ALT).
A client visits a health care facility with complaints of amenorrhea for 10 weeks, fatigue, and breast tenderness. Which of the following additional signs and symptoms suggest the presence of molar pregnancy?
Elevated hCG levels Hyperemesis gravidarum Absence of fetal heart sound
A client in her second trimester arrives at a health care facility for a follow-up visit. During the exam, the client reports constipation. Which instruction should the nurse offer to help alleviate constipation?
Ensure adequate hydration and bulk in the diet.
A 16-year-old unmarried primigravid client at 37 weeks' gestation with severe preeclampsia is in early active labor. The client's blood pressure is 164/110 mm Hg. Which of the following would alert the nurse that the client may be about to experience a seizure?
Epigastric pain
A home health care nurse is visiting a pregnant client with preeclampsia who is being managed at home. The nurse is reviewing the situations for which the client should contact the nurse. The nurse determines that the client demonstrates understanding when identifying which situation(s) as needing to be reported? Select all that apply.
Excessive heartburn Dizziness Blurred vision
The nurse assessing a multigravida at 36 weeks' gestation plans to assess the client for symptoms of preeclampsia. The nurse determines the highest priority assessment would be of the client's:
Face
After instructing a primigravid client at 38 weeks' gestation about how preeclampsia can affect the client and the growing fetus, the nurse realizes that the client needs additional instruction when she says that preeclampsia can lead to which of the following?
Hydrocephalic infant.
0.A nurse is assessing a pregnant woman with gestational hypertension. Which of the following would lead the nurse to suspect that the client has developed severe preeclampsia?
Hyperreflexia
The nurse teaches a patient with hyperemesis gravidarum when to notify the provider, the nurse recognizes clarification is needed when the patient says she will notify the HCP for which sign?
Frequent Urination
An obese gravid woman is being seen in the prenatal clinic. The nurse will monitor this client carefully throughout her pregnancy because she is at high risk for which of the following complications of pregnancy? Select all that apply.
Gestational diabetes Deep vein thrombosis Pre-eclampsia.
Thrombocytopenia, increased LFTs, decreased Hct during pregnancy may indicate
HELLP syndrome
When a woman is diagnosed with postpartum depression (PPD) with psychotic features, what is the nurse's primary concern in planning the client's care?
Harming her infant
A pregnant client at 32 weeks' gestation has mild preeclampsia. She is discharged to home with instructions to remain on bed rest. She should also be instructed to call her physician if she experiences which symptoms? Select all that apply.
Headache Blurred vision Epigastric pain. Severe nausea and vomiting.
The nurse is educating a client with type 1 diabetes about the complications associated with diabetes and pregnancy. Which problems would the nurse include in her teaching? Select all that apply.
Increased risk of spontaneous abortion Polyhydramnios Hypertension
Which intervention is most important when planning care for a client with severe gestational hypertension?
Induction of labor is likely, as near term as possible.
Which of the following changes in B/P assessment findings during the second trimester indicate the highest risk for preeclampsia.
Initial BP 100/70, current BP 140/90. (dystolic change of 30 or more from preganancy)
The nurse who is caring for a woman hospitalized for hyperemesis gravidarum would expect the initial treatment to involve what?
Intravenous (IV) therapy to correct fluid and electrolyte imbalances
The nurse is caring for a pregnant client with severe preeclampsia. Which nursing intervention should a nurse perform to institute and maintain seizure precautions in this client?
Keep the suction equipment readily available.
A pregnant woman is being evaluated for HELLP. The nurse reviews the client's diagnostic test results. An elevation in which result would the nurse interpret as helping to confirm this diagnosis?
LDH Lactate dehydrogenase
What are the major goals of nursing care related to pregnancy-induced hypertension with preeclampsia?
Maintenance of uteroplacental perfusion; prevention of seizures; prevention of complications such as HELLP syndrome, DIC and abruption
A maternal indication for the use of vacuum extraction is:
Maternal exhaustion
During a routine prenatal check-up, the nurse interviews a pregnant client to identify possible risk factors for developing gestational diabetes. Which of the following would alert the nurse to an increased risk? Select all that apply.
Maternal obesity with body mass index more than 35 Previous birth of small for gestational age baby Client of African-American lineage
A woman develops gestational diabetes. Which of the following assessments should she make daily?
Measure serum for glucose level by a finger prick.
A postoperative cesarean client who was diagnosed with severe pre-eclampsia in labor and delivery is transferred to the postpartum unit. The nurse is reviewing the client's doctor's orders. Which of the following medications that were ordered by the doctor should the nurse question?
Methergine (methylergonovine).
A client has just given birth. During labor, the fetus was in a brow presentation, but after a prolonged labor, the fetus converted to occiput presentation, and was delivered vaginally with vacuum extractor assistance. The nurse should explain to the parents that:
Molding of the head will subside in a few days.
Assessment of a pregnant client reveals that she has tested positive for a sexually transmitted infection (STI). The nurse understands that the client's newborn is at risk for which of the following?
Neurologic damage
A client's vital signs and reflexes were normal throughout pregnancy, labor, and delivery. Four hours after delivery the client's vitals are 98.6°F, P 72, R 20, BP 150/100, and her reflexes are 4+. She has an intravenous infusion running with 20 units of Pitocin (oxytocin) added. Which of the following actions by the nurse is appropriate?
Notify the obstetrician of the findings.
A pregnant woman diagnosed with diabetes should be instructed to do which of the following?
Notify the physician if unable to eat because of nausea and vomiting.
A pregnant client with severe pre-eclampsia has developed the HELLP syndrome. In addition to the observations necessary for pre-eclampsia, what other nursing intervention is critical for this patient?
Observation for bleeding
A client is being admitted to the labor suite with a diagnosis of eclampsia. The fetal heart rate tracing shows moderate variability with early decelerations. Which of the following actions by the nurse is appropriate at this time?
Pad the side rails and head of the bed.
A 29-week-gestation woman diagnosed with severe pre-eclampsia is noted to have blood pressure of 170/112, 4+ proteinuria, and a weight gain of 10 pounds over the past 2 days. Which of the following signs/symptoms would the nurse also expect to see?
Papilledema.
Which of the following physical findings would lead the nurse to suspect that a client with severe pre-eclampsia has developed HELLP syndrome?
Petechiae Jaundice.
A woman with diabetes is considering becoming pregnant. She asks the nurse whether she will be able to take oral hypoglycemics when she is pregnant. The nurses response is based on the understanding that oral hypoglycemics:
Show promising results but more studies are needed to confirm their effectiveness
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.
Placental abruption Preterm labor
Which physiologic alteration of pregnancy most significantly affects glucose metabolism?
Placental hormones are antagonistic to insulin, thus resulting in insulin resistance.
The nurse is providing education to women who had diabetes prior to pregnancy. The nurse is discussing pregnancy-related complications from diabetes. Which of the following is a potential complication?
Polyhydramnios
A 27-year-old woman has a 4-month-old baby. For the past 3 months, the client has been experiencing intense sadness, anxiety, and hopelessness. After having thoughts of killing her baby, she decided to seek help. What is the likely the cause of this client's experience?
Postpartum depression
A 17-year-old primigravida with type 1 diabetes is at 37 weeks gestation comes to the clinic for an evaluation. The nurse notes her blood sugar has been poorly controlled and the health care provider is suspecting the fetus has macrosomia. The nurse predicts which step will be completed next?
Preparing for amniocentesis and fetal lung maturity assessment
Which preexisting factor is known to increase the risk of GDM?
Previous birth of large infant
A nurse is explaining to a group of nursing students that eclampsia or seizures in pregnant women are preceded by an acute increase in maternal blood pressure. Which of the following are features of an acute increase in blood pressure? Select all that apply.
Proteinuria Hypereflexia Blurring of vision
The maternal health nurse is caring for a group of high-risk pregnant clients. Which client condition will the nurse identify as being the highest risk for pregnancy?
Pulmonary hypertension
After teaching a group of students about the use of antiretroviral agents in pregnant women who are HIV- positive, the instructor determines that the teaching was successful when the group identifies which of the following as the underlying rationale?
Reduction in viral loads in the blood
A patient is placed on bedrest at home for mild pre-eclampsia at 38 weeks' gestation. Which of the following must the nurse teach the patient regarding her condition?
Report swollen hands and face.
The nursery nurse notes that one of the newborn infants has white patches on his tongue that look like milk curds. What action would be appropriate for the nurse to take?
Report the finding to the pediatrician.
The nurse notes the following vital signs of a postoperative cesarean client during the immediate postpartum period: 100.0°F, P 68, R 12, BP 130/80. Which of the following is a correct interpretation of the findings?
Respirations are too low, a sign of medication toxicity.
A client is on magnesium sulfate via IV pump for severe pre-eclampsia. Other than patellar reflex assessments, which of the following noninvasive assessments should the nurse perform to monitor the client for early signs of magnesium sulfate toxicity?
Serial grip strengths.
The nurse is caring for a client diagnosed with diabetes mellitus who is reporting burning pain of his feet. The nurse would interpret this as:
Somatic neuropathyf
The nurse is planning care for a client at risk for postpartum depression. Which statement regarding postpartum depression does the nurse need to be aware of when attempting to formulate a plan of care?
Symptoms of postpartum depression can easily go undetected.
The nurse is administering intravenous magnesium sulfate as prescribed for a client at 34 weeks' gestation with severe preeclampsia. Which of the following are desired outcomes of this therapy? Select all that apply.
T 98 (36.7), P 72, R 14. DTR 2+ Magnesium level = 5.6 mg/dL (2.8 mmol/L).
The nurse is caring for a woman at 32 weeks gestation with severe preeclampsia. Which assessment finding should the nurse prioritize after the administration of hydralazine to this client?
Tachycardia
The nurse is caring for a patient who desires to become pregnant within a few months. Which outcome regarding folic acid intake would be appropriate for this patient?
The client will begin taking 400 μg of folic acid every day.
A client is 3 days post-cesarean delivery for eclampsia. The client is receiving hydralazine (Apresoline) 10 mg 4 times a day by mouth. Which of the following findings would indicate that the medication is effective?
The client's blood pressure has dropped from 160/120 to 130/90.
Which of the following statements about the fetal effects of preeclampsia is true?
The fetus can be affected by preeclampsia before the mother shows any signs and symptoms
The client has been pushing for 2 hours and is exhausted. The physician is performing a vacuum extraction to assist the birth. Which finding is expected and normal?
The location of the vacuum is apparent on the fetal scalp after birth.
The obstetrician opts to use a vacuum extractor for a delivery. The nurse understands that:
There should be further fetal descent with the first two pulls.
The physicians/CNM opts to use a vacuum extractor for a delivery. What does the nurse understand?
There should be further fetal descent with the first two "pop-offs."
A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment, the nurse finds the following vital signs: temperature 37.3° C, pulse rate 88 beats per minute, respiratory rate 10 breaths per minute, BP 148/90 mm Hg, absent deep tendon reflexes (DTRs), and no ankle clonus. The client complains, "I'm so thirsty and warm." What is the nurse's immediate action?
To discontinue the magnesium sulfate infusion
What should you teach a pregnant mom with hyperemesis gravidarum about eating?
To eat small, frequent meals and avoid spicy foods
What is the primary purpose for magnesium sulfate administration for clients with preeclampsia and eclampsia?
To prevent convulsions
In terms of the incidence and classification of diabetes, which information should the nurse keep in mind when evaluating clients during their ongoing prenatal appointments?
Type 2 diabetes often goes undiagnosed.
A client has been receiving magnesium sulfate for severe pre-eclampsia for 12 hours. Her reflexes are 0 and her respiratory rate is 10. Which of the following situations could be a precipitating factor in these findings?
Urinary output 240 mL/12 hr.
A nurse is interviewing a pregnant woman who has come to the clinic for her first prenatal visit. During the interview, the client tells the nurse that she works in a day care center with 2- and 3-year olds. Based on the client's history, the nurse would be alert for the development of which condition?
cytomegalovirus
The nurse is caring for a client experiencing a prolonged second stage of labor. The nurse would place priority on preparing the client for which intervention?
a forceps and vacuum-assisted birth
A woman at 26 weeks' gestation is undergoing screening for diabetes with a 1-hour oral glucose challenge test. On the client's return visit, the nurse anticipates the need to schedule a 3-hour glucose challenge test based on which result of the previous test?
above 140
Disseminated intravascular coagulation is a life-threatening condition that the nurse recognizes can occur as a complication secondary to which primary conditions?
abruptio placenta severe preeclampsia septicemia • Placental abruption • Preeclampsia or eclampsia/HELLP syndrome • Amniotic fluid embolism • Postpartum hemorrhage • Sepsis • Acute fatty liver of pregnancy • Retained IUFD (delayed birth of a dead fetus)
At 32 weeks' gestation, a 15-year-old primigravid client who is 5 feet, 2 inches (157.5 cm) tall has gained a total of 20 lb (9.1 kg), with a 1-lb (0.45 kg) gain in the last 2 weeks. Urinalysis reveals negative glucose and a trace of protein. The nurse should advise the client that which factors increases her risk for preeclampsia?
adolescent age group
The clinic nurse teaches a pregestational type 1 diabetic client that constant insulin levels are very important during pregnancy. The nurse tells the client that the best way to maintain a constant insulin level is to use:
an insulin pump.
A nurse suspects that a client may be developing disseminated intravascular coagulation. The woman has a history of abruptio placenta during delivery. Which finding would help to support the nurse's suspicion?
appearance of petechiae • Signs of thrombosis (e.g., peripheral cyanosis, renal impairment, drowsiness, confusion, coma, cardiorespiratory failure) • Bleeding from at least 3 unrelated sites • Spontaneous epistaxis (nosebleed) • Oozing from venipuncture sites or other sites of trauma • Petechiae (e.g., on the arm where blood pressure cuff was placed) • Ecchymosis (bruising) • Large subcutaneous hematomas • Hypotension • Tachycardia
The nurse is teaching a pregnant woman with iron-deficiency anemia about her prescribed iron supplement. The nurse determines that the teaching was successful when the client states that she will take the supplement with:
citrus juice (orange)
A nurse is conducting a class for pregnant women with diabetes. Which factor would the nurse emphasize as being most important in helping to reduce the maternal/fetal/neonatal complications associated with pregnancy and diabetes?
degree of glycemic control achieved during the pregnancy
A pregnant client with diabetes in the hospital reports waking up with shakiness and diaphoresis. Which action should the nurse prioritize after discovering the client's fasting blood sugar is 60 mg/dL?
form of carbohydrate, such as crackers, and milk,
Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother?
hypoglycemia
The nurse is developing a plan of care for a client who is receiving aggressive drug therapy for treatment of HIV. The goal of this therapy is to:
improve survival rates.
A pregnant woman with diabetes is having her glycosylated hemoglobin level evaluated. The nurse determines that the woman's glucose is under control and continues the woman's plan of care based on which result?
less than 7
Over the past 20 weeks, the following blood pressure readings are documented for a pregnant client with chronic hypertension: week 16 - 124/86 mm Hg; week 20 - 138/90 mm Hg; week 24 - 140/92 mm Hg; and week 28 - 142/94 mm Hg. The nurse interprets these findings as indicating which classification of her blood pressure?
mild hypertensive
A client with hyperemesis gravidarum is admitted to the facility after being cared for at home without success. Which of the following would the nurse expect to include in the clients plan of care?
nothing by mouth
The nurse is preparing the plan of care for a woman hospitalized for hyperemesis gravidarum. Which interventions would the nurse most likely include? Select all that apply.
obtaining baseline blood electrolyte levels administering antiemetic agents maintaining NPO status for the first day or two monitoring intake and output
A woman with gestational hypertension experiences a seizure. Which of the following would be the priority?
oxygenation
The nurse is assessing a client at a postpartum visit and notes the client is emotionally sensitive, complains about being a failure, and appears extremely sad. The nurse concludes the client is presenting with which potential condition?
postpartum depression
At the 6-week visit following delivery of her infant, a postpartum client reports extreme fatigue, feelings of sadness and anxiety, and insomnia. Based on these assessment findings, the nurse documents that the client is exhibiting characteristics of:
postpartum depression.
A client is diagnosed with peripartum cardiomyopathy (PPCM). Which therapy would the nurse expect to administer to the client?
restricted sodium intake
A nurse is caring for a client who has had an intrauterine fetal death with prolonged retention of the fetus. For which signs and symptoms should the nurse watch to assess for an increased risk of disseminated intravascular coagulation? Select all that apply.
tachycardia bleeding gums acute renal failure
A client with hyperemesis gravidarum is on a clear liquid diet. The nurse should serve this client:
tea and gelatin dessert.
A nurse is caring for a pregnant client admitted with mild preeclampsia. Which assessment finding should the nurse prioritize?
urine output of less than 15 mL/hr
A nurse is caring for a pregnant client in her second trimester of pregnancy. The nurse educates the client to look for which danger sign of pregnancy needing immediate attention by the primary care provider?
vaginal bleeding, facial edema (gestational hypertension),
The client has been pushing for two hours, and is exhausted. The fetal head is visible between contractions. The physician informs the client that a vacuum extractor could be used to facilitate the delivery. Which statement indicates that the client needs additional information about vacuum extraction assistance?
"I can stop pushing and just rest if the vacuum extractor is used."
