Maternity Exam 2: CH 11, 12, 17-20

A patient with pregnancy-induced hypertension is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs are an indication of:

Worsening disease and impending convulsion

The nurse providing care for a woman with gestational diabetes understands that a laboratory test for glycosylated hemoglobin A1c:

Would be considered evidence of good diabetes control with a result of 5% to 6%

Complications and risks associated with cesarean births include (Select all that apply):

Wound dehiscence Hemorrhage Urinary tract infections Fetal injuries

Which description of postpartum restoration or healing times is accurate?

Vaginal rugae reappear by 3 weeks postpartum

The exact cause of preterm labor is unknown and believed to be multifactorial. Infection is thought to be a major factor in many preterm labors. Select the type of infection that has not been linked to preterm births.

Viral

When working with parents who have some form of sensory impairment, nurses should understand that ________ is an inaccurate statement.

Visually impaired mothers cannot overcome the infant's need for eye-to-eye contact

In the United States the en face position is preferred immediately after birth. Nurses can facilitate this process by all of these actions except

Washing both the infant's face and the mother's face

The priority nursing intervention after an amniotomy should be to:

Assess the fetal heart rate

A client is to have an amniotomy to induce labor. The nurse recognizes that the priority intervention after the amniotomy is to:

Assess the fetal heart rate (FHR)

The best way for the nurse to promote and support the maternal-infant bonding process is to:

Assist the family with rooming in

Which nursing action is most appropriate to correct a boggy uterus that is displaced above and to the right of the umbilicus?

Assist the patient in emptying her bladder

Discharge instruction, or teaching the woman what she needs to know to care for herself and her newborn, officially begins:

At the time of admission to the nurse's unit

Diabetes refers to a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin action, insulin secretion, or both. Over time, diabetes causes significant changes in the microvascular and macrovascular circulations. These complications include:

Atherosclerosis Retinopathy Nephropathy Neuropathy

After they are born, a crying infant may be soothed by being held in a position in which the newborn can hear the mother's heartbeat. This phenomenon is known as:

Biorhythmicity

During a physical assessment of an at-risk client, the nurse notes generalized edema, crackles at the base of the lungs, and some pulse irregularity. These are most likely signs of:

Cardiac decompensation

Concerning the use and abuse of legal drugs or substances, nurses should be aware that:

Caucasian women are more likely to experience alcohol-related problems

Congenital anomalies can occur with the use of antiepileptic drugs (AEDs), including (select all that apply)

Cleft lip. Congenital heart disease. Neural tube defects

Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with:

Congenital anomalies in the fetus

The nurse caring for the postpartum woman understands that breast engorgement is caused by:

Congestion of veins and lymphatics

With regard to the association of maternal diabetes and other risk situations affecting mother and fetus, nurses should be aware that:

Diabetic Ketoacidosis (DKA) can leat to fetal death at any time during pregnancy

Physiologic anemia often occurs during pregnancy as a result of:

Dilution of hemoglobin concentration

Nurses should know some basic definitions concerning preterm birth, preterm labor, and low birth weight. For instance:

Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks

The nurse caring for the pregnant client must understand that the hormone essential for maintaining pregnancy is:

Progesterone

In planning for home care of a woman with preterm labor, which concern must the nurse address?

Prolonged bed rest may cause negative physiologic effects

A 30-year-old multiparous woman has a boy who is 2½ years old and now an infant girl. She tells the nurse, "I don't know how I'll ever manage both children when I get home." Which suggestion would best help this woman alleviate sibling rivalry?

Realize that the regression in habits and behaviors in the older child is a typical reaction and that he needs extra love and attention at this time.

A man calls the nurse's station and states that his wife, who delivered 2 days ago, is happy one minute and crying the next. The man says, "She was never like this before the baby was born." The nurse's initial response could be to:

Reassure him that this behavior is normal

In follow-up appointments or visits with parents and their new baby, it may be useful if the nurse can identify parental behaviors that can either facilitate or inhibit attachment. What is a facilitating behavior?

The parents hover around the infant, directing attention to and pointing at the infant

A pregnant woman is being discharged from the hospital after placement of cerclage because of a history of recurrent pregnancy loss secondary to an incompetent cervix. Discharge teaching should emphasize that:

The presence of any uterine cramping or low backache may indicate preterm labor and should be reported.

A woman gave birth vaginally to a 9-pound, 12-ounce girl yesterday. Her primary health care provider has written orders for perineal ice packs, use of a sitz bath tid, and a stool softener. What information is most closely correlated with these orders?

The woman has an episiotomy

A primiparous woman is to be discharged from the hospital tomorrow with her infant girl. Which behavior indicates a need for further intervention by the nurse before the woman can be discharged?

The woman leaves the infant on her bed while she takes a shower

To reassure and educate pregnant clients about changes in the uterus, nurses should be aware that:

The woman's increased urinary frequency in the first trimester is the result of exaggerated uterine antireflexion caused by softening

Which maternal condition always necessitates delivery by cesarean section?

Total placenta previa

In terms of the incidence and classification of diabetes, maternity nurses should know that:

Type 2 diabetes often goes under diagnosed

In terms of the incidence and classification of diabetes, maternity nurses should know that:

Type 2 diabetes often goes undiagnosed.

A parent who has a hearing impairment is presented with a number of challenges in parenting. Which nursing approaches are appropriate for working with hearing-impaired new parents (Select all that apply)?

Use devices that transform sound into light. Ascertain whether the patient can read lips before teaching. Written messages aid in communication.

A 25-year-old gravida 2, para 2-0-0-2 gave birth 4 hours ago to a 9-pound, 7-ounce boy after augmentation of labor with Pitocin. She puts on her call light and asks for her nurse right away, stating, "I'm bleeding a lot." The most likely cause of postpartum hemorrhage in this woman is:

Uterine atony

Autoimmune disorders often occur during pregnancy because a large percentage of women with an autoimmune disorder are of childbearing age. Identify all disorders that fall into the category of collagen vascular disease.

systemic lupus erythematosus Antiphospholipid syndrome Rheumatoid arthritis Myasthenia gravis

With regard to the care management of preterm labor, nurses should be aware that

the diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change.

Prophylaxis of subacute bacterial endocarditis is given before and after birth when a pregnant woman has:

valvular disease

During a prenatal visit, the nurse is explaining dietary management to a woman with pregestational diabetes. The nurse evaluates that teaching has been effective when the woman states:

"Diet and insulin needs change during pregnancy."

Childbirth may result in injuries to the vagina and uterus. Pelvic floor exercises also known as Kegel exercises will help to strengthen the perineal muscles and encourage healing. The nurse knows that the client understands the correct process for completing these conditioning exercises when she reports:

"I pretend that I am trying to stop the flow of urine midstream."

In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the client states:

"I will need to increase my insulin dosage during the first 3 months of pregnancy."

Which statement by a newly delivered woman indicates that she knows what to expect about her menstrual activity after childbirth?

"My First menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles."

Your patient is being induced because of her 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 it taking so long?" The most appropriate response by the nurse would be:

"The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor."

The perinatal nurse is giving discharge instructions to a woman after suction curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. The best response from the nurse would be:

"The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, it would make the diagnosis of this cancer more difficult." .

Because pregnant women may need surgery during pregnancy, nurses should be aware that:

The diagnosis of appendicitis may be difficult because the normal signs and symptoms mimic normal pregnancy changes in pregnancy.

Achieving and maintaining euglycemia comprise the primary goals of medical therapy for the pregnant woman with diabetes. These goals are achieved through a combination of diet, insulin, exercise, and blood glucose monitoring. The target blood glucose levels 1 hour after a meal should be: _________________

130-140

A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. GTPAL system?

3-1-0-1-0

Changes in blood volume after childbirth depend on several factors such as blood loss during childbirth and the amount of extravascular water (physiologic edema) mobilized and excreted. A postpartum nurse anticipates blood loss of (Select all that apply):

300mL to 500mL 500mL to 1000mL

The priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy is to:

Assess fetal heart rate (FHR) and maternal vital signs

A woman's obstetric history indicates that she is pregnant for the fourth time and all of her children from previous pregnancies are living. One was born at 39 weeks of gestation, twins were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system?

4-1-2-0-4

A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. She shows the nurse her readings for the past few days. Which one should the nurse tell her indicates a need for adjustment (insulin or sugar)?

60mg/dL just after waking up from a nap. This is too low; maybe eat a snack before going to sleep.

Your patient has been receiving magnesium sulfate for 20 hours for treatment of preeclampsia. She just delivered a viable infant girl 30 minutes ago. What uterine findings would you expect to observe/assess in this client?

A boggy uterus with heavy lochia flow

A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse?

A dipstick value of 3+ for protein in her urine

Which woman is most likely to experience strong afterpains?

A woman who is gravida 4, pare 4-0-0-4

A woman gave birth 48 hours ago to a healthy infant girl. She has decided to bottle-feed. During your assessment you notice that both of her breasts are swollen, warm, and tender on palpation. The woman should be advised that this condition can best be treated by:

Applying ice to the breasts for comfort

A woman is having her first child. She has been in labor for 15 hours. Two hours ago her vaginal examination revealed the cervix to be dilated to 5 cm and 100% effaced, and the presenting part was at station 0. Five minutes ago her vaginal examination indicated that there had been no change. What abnormal labor pattern is associated with this description?

Arrest of active phase

Appendicitis may be difficult to diagnose in pregnancy because the appendix is:

Displaced upward and laterally, high and to the right

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)

When caring for a pregnant woman with cardiac problems, the nurse must be alert for signs and symptoms of cardiac decompensation, which include:

Dyspnea; crackles; and an irregular weak pulse

When the pregnant diabetic woman experiences hypoglycemia while hospitalized, the nurse should intervene by having the patient:

Eat six saltine crackers

What finding on a prenatal visit at 10 weeks could suggest a hydatidiform mole?

Fundal height measurement of 18cm

The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion, the nurse reviews the woman's latest laboratory test findings, which reveal a platelet count of 90,000, an elevated aspartate transaminase (AST) level, and a falling hematocrit. The nurse notifies the physician because the laboratory results are indicative of:

HELLP Syndrome

Which breastfeeding patient is most likely to have severe afterbirth pains and request a narcotic analgesic?

Gravida 5, para 5

Women with hyperemesis gravidarum:

Have vomiting severe and persistent enough to cause weight loss, dehydration, and electrolyte imbalance

With regard to parents' early and extended contact with their infant and the relationships built, nurses should be aware that:

Extended contact is especially important for adolescents and low-income women because they are at risk for parenting inadequacies

In caring for a pregnant woman with sickle cell anemia, the nurse is aware that signs and symptoms of sickle cell crisis include:

Fever and Pain

Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother?

Hypoglycemia

As related to the care of the patient with miscarriage, nurses should be aware that:

If it occurs before the twelfth week of pregnancy, it may manifest only as moderate discomfort and blood loss.

A hospital has a number of different perineal pads available for use. A nurse is observed soaking several of them and writing down what she sees. This activity indicates that the nurse is trying to:

Improve the accuracy of blood loss estimation, which usually is a subjective assessment.

Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester?

Increased Pulse rate

Two days ago a woman gave birth to a full-term infant. Last night she awakened several times to urinate and noted that her gown and bedding were wet from profuse diaphoresis. One mechanism for the diaphoresis and diuresis that this woman is experiencing during the early postpartum period is:

Loss of increased blood volume associated with pregnancy.

Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for

Macrosomia

What concerns about parenthood are often expressed by visually impaired mothers?

Infant safety Transportation Missing out visually Needing extra time for parenting activities to accommodate the visual limitations

Other early sensual contacts between infant and mother involve sound and smell. Nurses should be aware that, despite what folk wisdom may say:

Infants can learn to distinguish their mother's voice from others soon after birth

Nurses should be aware that HELLP syndrome

Is characterized by hemolysis, elevated liver enzymes, and low platelets

In many hospitals new mothers are routinely presented with gift bags containing samples of infant formula. This practice:

Is inconsistent with the Baby Friendly Hospital Initiative

As related to the care of the patient with anemia, the nurse should be aware that:

It is the most common medical disorder of pregnancy

To reassure and educate pregnant clients about changes in their breasts, nurses should be aware that:

Lactation is inhibited until the estrogen level declines after birth

A placenta previa in which the placental edge just reaches the internal os is more commonly known as:

Marginal

What form of heart disease in women of childbearing years usually has a benign effect on pregnancy?

Mitral valve prolapse

For a woman at 42 weeks of gestation, which finding would require further assessment by the nurse?

One fetal movement noted in 1 hour of assessment by the mother

The early postpartum period is a time of emotional and physical vulnerability. Many mothers can easily become psychologically overwhelmed by the reality of their new parental responsibilities. Fatigue compounds these issues. Although the baby blues are a common occurrence in the postpartum period, about one-half million women in America experience a more severe syndrome known as postpartum depression (PPD). Which statement regarding PPD is essential for the nurse to be aware of when attempting to formulate a nursing diagnosis?

PPD can easily go undetected

With regard to the adaptation of other family members, mainly siblings and grandparents, to the newborn, nurses should be aware that:

Participation in preparation classes helps both siblings and grandparents.

The reported incidence of ectopic pregnancy in the United States has risen steadily over the past 2 decades. Causes include the increase in STDs accompanied by tubal infection and damage. The popularity of contraceptive devices such as the IUD has also increased the risk for ectopic pregnancy. The nurse who suspects that a patient has early signs of ectopic pregnancy should be observing her for symptoms such as (Select all that apply):

Pelvic pain Abdominal pain Vaginal spotting or light bleeding Missed period

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. The nurse suspects the onset of:

Placental abruption

Glucose metabolism is profoundly affected during pregnancy because:

Placental hormones are antagonistic to insulin, thus resulting in insulin resistance

Which assessment is least likely to be associated with a breech presentation?

Post-term gestation

During a phone 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!" The nurse recognizes that the woman is experiencing:

Postpartum (PP) blues

What laboratory marker is indicative of disseminated intravascular coagulation (DIC)?

Presence of fibrin split products

To provide optimum care for the postpartum woman, the nurse understands that the most common causes of subinvolution are:

Retained placental fragments and infection

The standard of care for obstetrics dictates that an internal version may be used to manipulate the:

Second twin from a transverse lie to a breech presentation during vaginal birth.

The nurse observes several interactions between a postpartum woman and her new son. What behavior, if exhibited by this woman, does the nurse identify as a possible maladaptive behavior regarding parent-infant attachment?

Seldom makes eye contact with her son

In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, what finding would alert the nurse to possible side effects?

Serum magnesium level of 10mg/dL

The musculoskeletal system adapts to the changes that occur during pregnancy. A woman can expect to experience what change?

She will have increased lordosis

The nurse observes that a 15-year-old new mother appears to ignore her newborn. A strategy that the nurse can use to facilitate mother-infant attachment in this mother is:

Show the mother how the infant initiates interaction and pays attention to her.

Maternal PKU is an important health concern during pregnancy because:

The fetus may develop neurologic problems.

Diabetes in pregnancy puts the fetus at risk in several ways. Nurses should be aware that:

The most important cause of perinatal loss in diabetic pregnancy is congenital malformations

Diabetes in pregnancy puts the fetus at risk in several ways. Nurses should be aware that:

The most important cause of perinatal loss in diabetic pregnancy is congenital malformations.

Which condition would not be classified as a bleeding disorder in late pregnancy?

Spontaneous abortion

A woman with preeclampsia has a seizure. The nurse's primary duty during the seizure is to:

Stay with the client and call for help

A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to:

Stimulate fetal surfactant production

________ use/abuse during pregnancy causes vasoconstriction and decreased placental perfusion, resulting in maternal and neonatal complications

Tabacco

A woman gave birth to a 7-pound, 6-ounce infant girl 1 hour ago. The birth was vaginal, and the estimated blood loss (EBL) was approximately 1500 mL. When assessing the woman's vital signs, the nurse would be concerned to see:

Temperature 37.9° C, heart rate 120, respirations 20, blood pressure (BP) 90/50.

As relates to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that:

its most important function is to afford the opportunity to administer antenatal glucocorticoids.