Maternity Prep-U Chapter 16 & 17

A pregnant client with a history of asthma since childhood presents for a prenatal visit. What statement by the client would the nurse prioritize?

"I sometimes get a bit wheezy."

Which medication would the nurse prepare to administer if prescribed as treatment for an unruptured ectopic pregnancy?

methotrexate

Which initial interview technique would be least effective in gathering information from a suspected abuse victim?

Ask the client to strip down and show you where she has been hurt.

A woman in her 20s has experienced a miscarriage at 10 weeks' gestation and asks the nurse at the hospital what went wrong. She is concerned that she did something that caused her to lose her baby. The nurse can reassure the woman by explaining that the most common cause of spontaneous miscarriage in the first trimester is related to which factor?

Chromosomal defects in the fetus

A 25-week-gestation client presents with a blood pressure of 152/99, pulse 78, no edema, and urine negative for protein. What would the nurse do next?

Notify the health care provider

A young mother gives birth to twin boys who shared the same placenta. What serious complication are they at risk for?

Twin-to-twin transfusion syndrome (TTTS)

Which compound would the nurse have readily available for a client who is receiving magnesium sulfate to treat severe preeclampsia?

calcium gluconate

The nurse is caring for a pregnant woman with diabetes mellitus. Which potential fetal complications should the nurse monitor the client for as she presents for her scheduled visits? Select all that apply.

congenital malformations macrosomia respiratory disorder

A nurse is taking a history of a client at 5 weeks' gestation in the prenatal clinic; however, the client is reporting dark brown vaginal discharge, nausea, and vomiting. Which diagnosis should the nurse suspect?

gestational trophoblastic disease

A pregnant client has been admitted with reports of brownish vaginal bleeding. On examination there is an elevated hCG level, absent fetal heart sounds, and a discrepancy between the uterine size and the gestational age. The nurse interprets these findings to suggest which condition?

gestational trophoblastic disease

A nurse is assisting a client in active labor whose diabetes has been poorly controlled. Which assessment of the neonate should be prioritize after its birth?

macrosomia

A client with hyperemesis gravidarum is admitted to the facility after being cared for at home without success. What would the nurse expect to include in the client's plan of care?

nothing by mouth

Which information on a client's health history would the nurse identify as contributing to the client's risk for an ectopic pregnancy?

recurrent pelvic infections

When assessing a pregnant woman with vaginal bleeding, the nurse would suspect a threatened abortion based on which finding?

slight vaginal bleeding

After teaching a woman who has had an evacuation for gestational trophoblastic disease (hydatidiform mole or molar pregnancy) about her condition, which statement indicates that the nurse's teaching was successful?

"I will be sure to avoid getting pregnant for at least 1 year."

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.

A woman with a history of asthma comes to the clinic for evaluation for pregnancy. The woman's pregnancy test is positive. When reviewing the woman's medication therapy regimen for asthma, which medication would the nurse identify as problematic for the woman now that she is pregnant?

oral prednison

A nurse is client teaching with a 30-year-old gravida 1 who has sickle cell anemia. Providing education on which topic is the highest nursing priority?

avoidance of infection

Upon entering the room of a client who has had a spontaneous abortion, the nurse observes the client crying. Which response by the nurse would be most appropriate?

"I'm sorry you lost your baby."

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

A 17-year-old G2 P0010 patient develops hypertension at 32 weeks and is required to limit her intake of sodium and increase her protein intake. The patient is out of work and does not attend school. Her time is spent primarily at the local shopping mall with friends. The best dietary suggestion that the home visiting nurse can make to this patient is:

Bring water and a lunch from home rather than eating at the food court

A patient is admitted with a diagnosis of ectopic pregnancy. For what should the nurse anticipate preparing the patient?

Immediate surgery

A 35-year-old client is seen for her 2-week postoperative appointment after a suction curettage was performed to evacuate a hydatidiform mole. The nurse explains that the human chorionic gonadotropin (hCG) levels will be reviewed every 2 weeks and teaches about the need for reliable contraception for the next 6 months to a year. The client states, "I'm 35 already. Why do I have to wait that long to get pregnant again?" What is the nurse's best response?

"A contraceptive is used so that a positive pregnancy test resulting from a new pregnancy will not be confused with the increased level of hCG that occurs with a developing malignancy."

A woman of 16 weeks' gestation telephones the nurse because she has passed some "berry-like" blood clots and now has continued dark brown vaginal bleeding. Which action would the nurse instruct the woman to do?

"Come to the health facility with any vaginal material passed."

A pregnant patient is diagnosed with placenta previa. Which action should the nurse implement immediately for this patient?

Assess fetal heart sounds with an external monitor.

The maternal health nurse cares for a homeless pregnant woman who presented to the emergency room in precipitous labor. The woman has not had prenatal care. Upon delivery, her infant weighs 4.6 kg and notes the infant appears to be jittery. Which nursing action will the nurse perform first?

Check the infant's blood glucose level

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

A 44-year-old client has lost several pregnancies over the last 10 years. For the past 3 months, she has had fatigue, nausea, and vomiting. She visits the clinic and takes a pregnancy test; the results are positive. Physical examination confirms a uterus enlarged to 13 weeks' gestation; fetal heart tones are heard. Ultrasound reveals that the client is experiencing some bleeding. Considering the client's prenatal history and age, what does the nurse recognize as the greatest risk for the client at this time?

pregnancy loss

A patient with diabetes is in the first trimester of pregnancy and is currently having difficulty keeping blood glucose levels within normal limits. The patient explains that she has been "eating for two" so the baby is healthy. How should the nurse respond to the patient?

"Elevated blood glucose levels in the first trimester have been linked to congenital anomalies."

A client at 11 weeks' gestation experiences pregnancy loss. The client asks the nurse if the bleeding and cramping that occurred during the miscarriage were caused by working long hours in a stressful environment. What is the most appropriate response from the nurse?

"I can understand your need to find an answer to what caused this. Let's talk about this further."

A mother is talking to the nurse and is concerned about managing her asthma while she is pregnant. Which response to the nurse's teaching indicates that the woman needs further instruction?

"I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring."

After a regular prenatal visit, a pregnant client asks the nurse to describe the differences between abruptio placentae and placenta previa. Which statement should the nurse include in the teaching?

"Placenta previa causes painless, bright red bleeding during pregnancy due to an abnormally implanted placenta that is too close to or covers the cervix; abruptio placentae is associated with dark red painful bleeding caused by premature separation of the placenta from the wall of the uterus before the end of labor."

A client with a history of cervical insufficiency is seen for reports of pink-tinged discharge and pelvic pressure. The primary care provider decides to perform a cervical cerclage. The nurse teaches the client about the procedure. Which client response indicates that the teaching has been effective?

"Purse-string sutures are placed in the cervix to prevent it from dilating."

A client, experiencing a threatened abortion, is concerned about losing the pregnancy and asks what she can do to help save her baby. What is the most appropriate response from the nurse?

"Restrict your physical activity to moderate bedrest."

A pregnant woman with diabetes is having a glycosylated hemoglobin (HbA1C) level drawn. Which result would require the nurse to revise the client's plan of care?

8.5%

A 38-year-old woman comes into the obstetrician's office for prenatal care, stating that she is about 12 weeks pregnant with her first child. What questions would the nurse ask this client, considering her age and potential sensitivity to being labeled an "older" primipara?

Be non-judgmental in your history gathering and offer her pregnancy resources to read and explore.

A nurse is caring for a young woman who is in her 10th week of gestation. She comes into the clinic reporting vaginal bleeding. Which assessment finding best correlates with a diagnosis of hydatidiform mole?

Dark red, "clumpy" vaginal discharge

A 20-year-old pregnant client is positive for hemoglobin S. The nurse explains to the client that she will need perform which actions during her pregnancy? Select all that apply.

Drink lots of fluids. Avoid conditions of low oxygen tension, such as high altitudes.

The maternal health nurse is caring for a pregnant client with a history of epilepsy. The client's antiepileptic drug (AED) levels have been in the non-therapeutic range the last two times the labs were drawn. Which factor does the nurse associate with this finding?

Drug metabolism changes during pregnancy

The nursing instructor is preparing a presentation illustrating spontaneous abortion. The instructor should point out that approximately 25% of all pregnancies end in spontaneous abortion.

False

The nurse is caring for a client with an ectopic pregnancy. Which symptom is a sign that the tube has ruptured?

Hypovolemic shock

A patient recovering from an uneventful vaginal delivery is prescribed Rho(D) immune globulin (RhIG). What should the nurse explain to the patient regarding the purpose of this medication?

It prevents maternal D antibody formation.

The nurse is caring for a pregnant client with pregestational diabetes. Which goal does the nurse identify as priority during the client's pregnancy?

Maintain glycemic control

The maternal health nurse is caring for a pregnant client with a history of asthma who requires maintenance medication for the management of the disease. Which action by the nurse best reinforces information provided to the client regarding maintenance of her health?

Observe the client taking her inhaler.

A woman is having her second baby. Her blood type is O- and the father's blood type is O+. Her first baby was also O+. Inadvertently, she did not receive RhoGam after her first delivery. How would the physician ascertain if this fetus is affected by an Rh incompatibility?

Perform a cordocentesis on the fetus.

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

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

A nurse is conducting a presentation for a group of pregnant women about conditions that can occur during pregnancy and that place the woman at high-risk. When discussing blood incompatibilities, which measure would the nurse explain as most effective in preventing isoimmunization during pregnancy?

Rho(D) immune globulin administration to Rh-negative women

The nurse is caring for a client who has a multifetal pregnancy. What topic should the nurse prioritize during health education?

Signs of preterm labor

The nurse is monitoring a pregnant patient who is receiving intravenous magnesium sulfate for eclampsia. During the last assessment, the nurse was unable to elicit a patellar reflex. What should the nurse do?

Stop the current infusion.

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.

A pregnant patient with a history of premature cervical dilatation undergoes cervical cerclage. Which outcome indicates that this procedure has been successful?

The client delivers a full-term fetus at 39 weeks' gestation.

A client who is 10 weeks' pregnant reports during a social assessment interview that she has two indoor cats, lives alone, fixes her own meals and enjoys gardening. What precautions would the nurse recommend the woman take to prevent the possibility of contracting toxoplasmosis? Select all that apply.

Use gloves when planting her vegetable garden. Make sure meats are cooked to 152ºF (66.7℃); do not eat raw or rare meats.

The obstetric nurse is caring for a pregnant client who has been diagnosed with hydatidiform mole. What assessment should the nurse prioritize?

Vaginal bleeding

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 pregnant woman is admitted to the hospital with a diagnosis of placenta previa. Which action would be the priority for this woman on admission?

assessing fetal heart tones by use of an external monitor

It is determined that a client's blood Rh is negative and her partner's is positive. To help prevent Rh isoimmunization, the nurse would expect to administer Rho(D) immune globulin at which time?

at 28 weeks' gestation and again within 72 hours after birth

A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. Which finding would the nurse interpret as indicating a therapeutic level of medication?

deep tendons reflexes 2+

The nurse is assessing a pregnant client with a known history of congestive heart failure who is in her third trimester. Which assessment findings should the nurse prioritize?

dyspnea, crackles, and irregular weak pulse

A nurse suspects that a client is developing HELLP syndrome. The nurse notifies the health care provider based on which finding?

elevated liver enzymes

A woman with an incomplete abortion is to receive misoprostol. The woman asks the nurse, "Why am I getting this drug?" The nurse responds to the client, integrating understanding that this drug achieves which effect?

ensures passage of all the products of conception

A client in her 20th week of gestation develops HELLP syndrome. What are features of HELLP syndrome? Select all that apply.

hemolysis elevated liver enzymes low platelet count

What would be the physiologic basis for a placenta previa?

low placental implantation

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

A pregnant woman with preeclampsia is to receive magnesium sulfate IV. Which assessment should the nurse prioritize before administering a new dose?

patellar reflex

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 client in her first trimester arrives at the emergency room with reports of severe cramping and vaginal spotting. On examination, the health care provider informs her that no fetal heart sounds are evident and orders a dilatation and curettage. The client looks frightened and confused and states that she does not believe in abortion. Which statement by the nurse is best?

"Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications."

A nurse in the maternity triage unit is caring for a client with a suspected ectopic pregnancy. Which nursing intervention should the nurse perform first?

Assess the client's vital signs.

A patient with asthma who is 32 weeks' pregnant is concerned that the health care provider has reduced the doses of asthma maintenance medications. How should the nurse respond to this patient's concern?

Asthma medication may reduce labor contractions and should be reduced.

A woman at 10 weeks gestation comes to the clinic for an evaluation. Which assessment finding should the nurse prioritize?

fundal height measurement of 18 cm

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