NRSG 408 Test 3

Which postpartum infection is most often contracted by mothers who are breastfeeding? a. Endometritis b. Wound infections c. Mastitis d. Urinary tract infections (UTIs)

c. Mastitis

Which factors place a client at risk for postpartum infection? Select all that apply. a. Asthma b. Obesity c. Preeclampsia d. Hypothyroidism e. History of blood transfusion

b. Obesity c. Preeclampsia

The nurse knows that which factor(s) is associated with HELLP syndrome? a. It is a mild form of preeclampsia. b. It can be diagnosed by a nurse who is alert to its symptoms. c. It is characterized by hemolysis, elevated liver enzymes, and low platelet count. c. It is associated with preterm labor but not perinatal mortality.

c. It is characterized by hemolysis, elevated liver enzymes, and low platelet count.

A pregnant client at 14 weeks of gestation is admitted to the hospital with a diagnosis of hyperemesis gravidarum. Which is the primary goal of her treatment at this time? a. Rest the gastrointestinal tract by restricting all oral intake for 48 hours. b. Reduce emotional distress by encouraging the client to discuss her feelings. c. Reverse fluid, electrolyte, and acid-base imbalances. d. Restore the client's ability to take and retain oral fluid and foods.

c. Reverse fluid, electrolyte, and acid-base imbalances. Hyperemesis gravidarum: a severe type of nausea and vomiting during pregnancy; also, weight loss, feeling faint, and possibly dehydration.

Which complications are increased in pregnant clients with gonococcal infection? a. Condylomata lata b.. Tuboovarian abscess c. Chlamydial infection d. Amniotic infection syndrome

Amniotic infection syndrome Rationale: During pregnancy, sexually transmitted infections (STIs) may increase the risk of premature rupture of membranes. As a result, there may be placental, fetal, and umbilical cord inflammation, known as amniotic infection syndrome. Condylomata lata are wartlike infectious lesions on the vulva or the anus that are seen in clients with syphilis rather than gonorrhea. Tuboovarian abscess may be caused by pelvic inflammatory disease (PID) and is not directly associated with gonorrhea. Chlamydial infection is the most commonly reported STI; it is not a direct complication of gonococcal infection, though the two conditions are often comorbidities.

Which condition is associated with a high risk for disseminated intravascular coagulation (DIC)? a. Eclampsia b. Placenta previa c. Placental abruption d. Gestational hypertension

c. Placental abruption Placental abruption is the most common cause of severe consumptive coagulopathy in obstetrics.

Which nursing action would be included the initial treatment of a thyroid storm? Select all that apply. One, some, or all responses may be correct. a. Oxygen b. Intravenous fluids c. Administration of iodide d. Administration of dexamethasone e. High doses of propylthiouracil (PTU)

oxygen, IV fluids, high doses of propylthiouracil (PTU) (Iodide is administered after PTU.)

When assessing a postpartum client, the nurse finds that the client has excessive foul-smelling lochia. Which medication would be helpful in treating this condition? a. A broad-spectrum antibiotic b.. A diuretic to induce urination c. An intravenous oxytocin agent d. Intravenous fluids

a. A broad-spectrum antibiotic

Which medication would be indicated for a client with human papillomavirus (HPV) infection? a. Podofilox 0.5% solution b. Azithromycin 1 g orally c. Ceftriaxone 125 mg intramuscular d. Benzathine penicillin G 7.2 million units

a. Podofilox 0.5% solution Rationale: Podofilox 0.5% solution is a medication that would be used externally for the treatment of external genital warts caused by HPV. Azithromycin 1 g orally is prescribed for the treatment of Chlamydia infection. Ceftrioxazone is not used to treat external genital warts. Benzathine penicillin G is an antibiotic that is administered intravenously for the treatment of syphilis.

Which risk factors are associated with an increased risk for postpartum infection? Select all that apply. One, some, or all responses may be correct. a. Hematoma b. Prolonged labor c. Cesarean delivery d. Postpartum hemorrhage e. Prolonged rupture of membranes

All of the above

After massaging the boggy fundus of a client who delivered a large baby after a prolonged labor with a forceps-assisted birth, the nurse is unable to obtain a firm fundus. Which nursing action is indicated at this time? a. Increase the rate of the intravenous infusion. b. Massage the fundus while another nurse notifies the primary health care provider. c. Change the peripad, replacing it with a double pad. d. Administer a half-dose of a uterine-contracting medication.

b. Massage the fundus while another nurse notifies the primary health care provider.

A nurse is making rounds on a client who had a vaginal delivery, and suspects that the client is having excessive postpartum bleeding. Which would be the priority intervention at this time? a. Call the primary health care provider. b. Massage the uterine fundus. c. Increase the rate of intravenous fluids. d. Monitor pad count, and perform catheterization.

b. Massage the uterine fundus.

When assessing a pregnant client with heart disease, the nurse knows that which form of heart disease in women of childbearing years usually has a benign effect on pregnancy? a. Cardiomyopathy b. Mitral valve prolapse c. Rheumatic heart disease d. Congenital heart disease

b. Mitral valve prolapse Rationale: Mitral valve prolapse is a benign condition that is usually asymptomatic. Cardiomyopathy produces congestive heart failure during pregnancy. Rheumatic heart disease can lead to heart failure during pregnancy. Some congenital heart diseases will produce pulmonary hypertension or endocarditis during pregnancy.

Which statement by the client indicates a risk of genital tract infection? a. "I eat yogurt almost every day." b. "I use hosiery with a cotton crotch." c. "I take a bubble bath once a day." d. "I void before and after intercourse.

c. "I take a bubble bath once a day."

Which stressor can result in "empty nest syndrome"? a. Financial crisis caused by loss of job b. Loss of job caused by personal inefficiency c. Children leaving home to seek higher education d. Chronic illness, such as diabetes and hypertension

c. Children leaving home to seek higher education

Which medication is recommended treatment for the prevention of human immunodeficiency virus (HIV) transmission to the fetus during pregnancy? a. Acyclovir b. Ofloxacin c. Podophyllin d. Zidovudine

Zidovudine Rationale: Perinatal transmission of HIV has decreased significantly in the past decade as a result of prophylactic administration of the antiretroviral drug zidovudine to pregnant women in the prenatal and perinatal periods. Acyclovir is an antiviral treatment for herpes simplex virus (HSV). Ofloxacin is an antibacterial treatment for gonorrhea. Podophyllin is a solution used in the treatment of human papillomavirus.

The nurse is administering glucocorticoids to a pregnant client in preterm labor. When explaining the purpose of this medication to the client, which response by the nurse is accurate? a. To prevent fetal cerebral palsy b. To prevent early birth of the fetus c. To prevent gestational hypertension d. To prevent fetal respiratory distress syndrome

d. To prevent fetal respiratory distress syndrome Glucocorticosteroids: used for maturation of fetal lungs (ie. Dexamethasone (Decadron))

The nurse is teaching a client how to monitor blood glucose using a glucose meter. Arrange the steps of the procedure in the correct order for the client to perform. 1. Let blood be drawn into the test strip. 2. Gently squeeze the finger. 3. Select a site on the side of a finger. 4. Record the results displayed on the meter. 5. Wash hands with warm water. 6. Pierce the site with a lancet.

(5) wash hands (3) select finger (6) pierce with lancet (2) squeeze finger (1) let blood be drawn on test strip (4) Record

Which vaccinations reduce the risk for contracting sexually transmitted infections (STIs)? Select all that apply. a. Hepatitis B b. Pneumococcal conjugate c. Meningococcal conjugate d. Human papillomavirus (HPV) e. Pneumococcal polysaccharide

(a) Hep B and (d) HPV

Which are the manifestations of HELLP syndrome? Select all that apply. a. Hemolysis b. Tachycardia c. Hyperventilation d. Low platelet count e. Elevated liver enzymes

Hemolysis, elevated liver enzymes, low platelet count

An 8-month-pregnant client presents with preeclampsia. Which clinical findings in the client indicate that the disease has progressed to HELLP syndrome? Select all that apply. a. Hepatic dysfunction b. Elevated liver enzymes c. Vaginal bleeding d. Low platelet count e. Chronic hypertension

Hepatic dysfunction, elevated liver enzymes, and low platelet count

The nurse is caring for a postpartum client with preeclampsia. Which statement would the nurse include in discharge teaching? a. "Return to the hospital if you have epigastric pain." b. "Take an analgesic if you have epigastric pain." c. "If you get a headache, relax. It will subside in a while." d. "Get an eye examination done if you have blurred vision."

a. "Return to the hospital if you have epigastric pain." S/sx: headache, visual disturbances, and epigastric pain

Which sexually transmitted infections are caused by bacteria? Select all that apply. a. Chlamydia b. Gonorrhea c. Trichomoniasis d. Hepatitis A and B e. Lymphogranuloma venereum

a. Chlamydia b. Gonorrhea e. Lymphogranuloma venereum Rationale: Chlamydia, gonorrhea, and lymphogranuloma venereum are sexually transmitted infections caused by bacteria. Chlamydia is caused by Chlamydia trachomatis. Gonorrhea is caused by Neisseria gonorrhoeae. Chlamydia trachomatis also causes lymphogranuloma. A protozoan parasite, Trichomonas vaginalis, causes trichomoniasis. Hepatitis A and B are viral infections caused by hepatitis A or B viruses.

Which is the role of a registered nurse in women's health promotion and illness prevention? Select all that apply. a. Integrating various modalities of care b. Providing comprehensive primary care c. Coordinating care in communities d. Working to influence health policy e. Collaborating with other health care practitioners

a. Integrating various modalities of care d. Working to influence health policy e. Collaborating with other health care practitioners

Which postpartum conditions are considered medical emergencies that require immediate treatment? a. Inversion of the uterus and hypovolemic shock b. Hypotonic uterus and coagulopathies c. Subinvolution of the uterus and idiopathic thrombocytopenic purpura (ITP) d. Disseminated intravascular coagulation (DIC) and uterine atony

a. Inversion of the uterus and hypovolemic shock Rationale: Inversion of the uterus and hypovolemic shock are considered medical emergencies. A hypotonic uterus can be managed with massage and oxytocin. Coagulopathies would be identified before delivery and treated accordingly. Although subinvolution of the uterus and ITP are serious conditions, they do not always require immediate treatment. ITP can be safely managed with corticosteroids or intravenous immunoglobulin. DIC and uterine atony are very serious obstetric complications; however, uterine inversion is a medical emergency requiring immediate intervention.

Which dietary recommendations are appropriate to discuss with a pregnant client with acute viral hepatitis? Select all that apply. One, some, or all responses may be correct. a. Low fat b. Low sodium c. High protein d. Low cholesterol e. High carbohydrate

a. Low fat c. High protein

Which initial treatment would the nurse anticipate when teaching an obstetric client who is newly diagnosed with idiopathic thrombocytopenic purpura (ITP)? a. Prednisone b. Splenectomy c. Platelet transfusion d. Coagulation studies

a. Prednisone Rationale: Medical management of the client with ITP is based on controlling platelet stability. A corticosteroid, such as prednisone, is used to manage ITP diagnosed during pregnancy. A splenectomy is only needed if there is no response to medical management. Platelet transfusions are administered when there is significant bleeding. Monitoring the platelet count is necessary throughout treatment.

Which are bacterial sexually transmitted infections (STIs)? Select all that apply. a. Syphilis b. Gonorrhea c. Chlamydia trachomatis d. Vulvovaginal candidiasis e. Pelvic inflammatory disease (PID)

a. Syphilis b. Gonorrhea c. Chlamydia trachomatis e. Pelvic inflammatory disease (PID) All except Vulvovaginal candidiasis. Rationale: Syphilis is caused by Treponema pallidum, which enters the subcutaneous tissue through microscopic abrasions that can occur during sexual intercourse. Gonorrhea is caused by the aerobic, gram-negative diplococcus Neisseria gonorrhoeae and is transmitted by sexual contact. C. trachomatis is the most commonly reported STI seen in sexually active women 15 to 24 years of age. PID is caused by N. gonorrhoeae, C. trachomatis, and a wide variety of anaerobic and aerobic bacteria. Women who have multiple sex partners and a history of STIs are at risk for PID. Vulvovaginal candidiasis is a yeast infection caused by Candida albicans and is not sexually transmitted or bacterial.

During a prenatal visit, the nurse finds that the client has decreased mobility and symptoms of preterm labor. Which intervention would the nurse follow to prevent thrombophlebitis? a. Teach gentle lower extremity exercises to the client. b. Suggest that the client lie in the supine position in bed. c. Provide a calm and soothing atmosphere for the client. d. Give tocolytic medications as per the primary health care provider's prescription.

a. Teach gentle lower extremity exercises to the client. Rationale: The primary health care provider may recommend reduced activity for the client experiencing preterm labor, depending on the severity of the symptoms. As a result, the client may be at risk for thrombophlebitis because of limited activity. The nurse would teach the client how to perform gentle exercises of the lower extremities. Suggesting that the client lie in the supine position may cause supine hypotension; instead, the nurse would suggest that the client lie in the side-lying position to help enhance placental perfusion. The nurse would provide a calm and soothing atmosphere to facilitate coping so as to reduce the client's anxiety, but this intervention would not prevent thrombophlebitis. Tocolytic medications are given to the client to inhibit uterine contractions, but they do not prevent thrombophlebitis.

Which nursing explanation is appropriate to include when preparing a client for a nonstress test? a. "I will be using stimulation to wake up the baby." b. "You can recline a bit with a slight tilt to the side." c. "Push this button when you feel the baby move." d. "You can lie on your back and get comfortable."

b. "You can recline a bit with a slight tilt to the side." Rationale: The client would be positioned in the semi-Fowler position with a slight lateral tilt to improve uterine perfusion and prevent supine hypotension. It is not necessary to use vibroacoustic stimulation to wake up the baby unless the fetal heart rate pattern is nonreactive. The client would be instructed to push a button if evidence of fetal movement is not on the tracing. The client would not be placed in the supine position as it can impede uterine perfusion and result in supine hypotension.

Which viral sexually transmitted infection (STI) is the most prevalent in the United States? a. Herpes simplex virus type 2 (HSV-2) b. Human papillomavirus (HPV) c. Human immunodeficiency virus (HIV) d. Cytomegalovirus (CMV)

b. HPV

Which nursing explanation is appropriate for a client who asks about decreasing the risk for transmission of human immunodeficiency virus (HIV) to her baby during birth? a. It is recommended that the baby be delivered by cesarean section. b. If the viral load is decreased and you are treated in the intrapartum period, the risk of transmission is reduced. d. If your viral load is low and you receive zidovudine during labor, there is minimal risk of your baby contracting HIV. d. To decrease the risk of transmitting HIV to the baby, it is essential that you receive adequate treatment during labor.

b. If the viral load is decreased and you are treated in the intrapartum period, the risk of transmission is reduced. Rationale: If the client's viral load is decreased and they are treated during the intrapartum period, the risk of transmission of HIV is reduced. Cesarean delivery is recommended for a client at 38 weeks of gestation with a viral load greater than 1000 copies per milliliter. Zidovudine is not administered to a client with a low viral load during the intrapartum period. Treatment is more effective in reducing transmission if it is provided throughout the pregnancy, not just in the intrapartum period.

Which instruction would the nurse include when teaching a pregnant client with class II heart disease? a. Advise her to gain at least 30 pounds. b. Instruct her to avoid strenuous activity. c. Inform her of the need to limit fluid intake. d. Explain the importance of a diet high in calcium

b. Instruct her to avoid strenuous activity. Rationale: - Wt gain should be minimal - DON'T limit Fluid intake - Pt may be put on diuretic - Iron and folic acid intake is important to prevent anemia. A diet high in calcium would not be recommended.

When performing a health history with a pregnant client, the nurse knows that which hematologic disorder is transferred genetically from parents to offspring? a. Deep vein thrombosis b. von Willebrand disease c. Superficial vein thrombosis d. Idiopathic thrombocytopenia

b. von Willebrand disease Rationale: Von Willebrand disease is a hereditary disorder. It is a type of hemophilia caused by the deficiency of a blood clotting factor called von Willebrand factor. Deep vein thrombosis is not a hereditary disorder; it is caused by inflammation or partial obstruction of deep veins in the lower limb. Superficial vein thrombosis is not a hereditary disorder; it is caused by the inflammation or obstruction of superficial veins of the lower limb. Idiopathic thrombocytopenia is an autoimmune disorder; it is not transferred from parents to offspring.

On assessment of a pregnant client, the nurse concludes that the client is less likely to have a preterm delivery. Which client clinical finding led the nurse to conclude this? a. Previous cesarean delivery b. Preexisting diabetes mellitus c. Cervical length more than 30 mm d. Symptoms of chronic hypertension

c. Cervical length more than 30 mm Risk Factors for preterm birth: - previous c/s -

Which organism is the causative agent of ophthalmia neonatorum? a. Neisseria gonorrhea b. Human papillomavirus c. Chlamydia trachomatis d. Gardnerella and Mobiluncus

c. Chlamydia trachomatis

Which conditions describe the assessment findings for a client with secondary syphilis? Select all that apply. One, some, or all responses may be correct. a. Papules b. Chancre c. Lymphadenopathy d. Condylomata lata on the vulva, perineum, or anus e. Maculopapular rash on the hands and soles of the feet

c. Lymphadenopathy d. Condylomata lata on the vulva, perineum, or anus e. Maculopapular rash on the hands and soles of the feet Rationale: The assessment findings associated with secondary syphilis include lymphadenopathy, condylomata lata on the vulva, perineum, or anus, and a maculopapular rash on the hands and soles of the feet. Papules and chancre are clinical findings for a client with primary syphilis.

The nurse is monitoring a client's deep tendon reflexes (DTRs) while receiving magnesium sulfate therapy for treatment of preeclampsia. Which assessment finding would indicate a cause for concern? a. Bilateral DTRs noted at 2+ b. DTR response noted at 1+ since onset of therapy c. Positive clonus response elicited unilaterally d. Client reports no pain on examination of DTRs by nurse

c. Positive clonus response elicited unilaterally. Rationale: Mag is for seizure precautons.

Which infections are collectively known as TORCH infections? Select all that apply. a. Chlamydia b. Gonorrhea c. Toxoplasmosis d. German measles e. Cytomegalovirus f. Herpes genitalis

c. Toxoplasmosis d. German measles e. Cytomegalovirus f. Herpes genitalis Rationale: Toxoplasmosis, German measles, cytomegalovirus, and herpes genitalis are collectively known as TORCH infections. The causative agents of these infections cross the placenta and cause influenza-like symptoms in the mother and significant birth defects in the newborn. Chlamydia and gonorrhea do not cause significant birth defects and fetal death. Therefore, chlamydia and gonorrhea are not TORCH infections.

Which statement by the student nurse student regarding the management of reduced cervical competence (premature dilation of the cervix) indicates effective learning? a. "Progesterone supplementation is the only effective treatment." b. "An abdominal cerclage is performed in the first week of gestation." c. "Surgical treatment is ineffective in women with an extremely short cervix." d. "A prophylactic cerclage is used to constrict the internal os of the cervix."

d. "A prophylactic cerclage is used to constrict the internal os of the cervix." Rationale: The best treatment option for premature dilation of the cervix is to surgically place a prophylactic cerclage to constrict the internal os of the cervix. It is usually placed at 11 to 15 weeks of gestation.

Which is a possible reason for the absence of congenital anomaly in the offspring of a type 1 diabetic pregnant client? a. Vitamin supplements taken during pregnancy b. Calcium supplements taken during pregnancy c. Stable blood pressure maintained during pregnancy d. An euglycemic condition maintained during pregnancy

d. An euglycemic condition maintained during pregnancy Rationale: The rate of malformations is reduced if the client with insulin-dependent diabetes maintains euglycemia (normal blood sugar level) during pregnancy. The euglycemic condition should be maintained until the 56th day of pregnancy, because it is the period of organ development of the fetus. Vitamin supplements are given to pregnant clients to maintain a healthy, nutritional diet. Calcium supplements are prescribed to pregnant clients to prevent problems such as osteoporosis in the fetus. Maintaining a stable blood pressure will help prevent miscarriage during pregnancy.

Which is an early sign of hemorrhagic shock? a. Hypotension b. Altered mental status c. Cool, clammy, pale skin d. Capillary refill time of 4 seconds

d. Capillary refill time of 4 seconds

Which sign would the nurse observe in a client with hydatidiform mole? a. Clear vaginal discharge b. A small uterus c. Decreased fetal heart rate d. Dark brown vaginal discharge

d. Dark brown vaginal discharge

The nurse is assessing a pregnant client with preeclampsia on bed rest. Which region of the body would the nurse assess for edema in a client with preeclampsia? a. Foot region b. Ankle region c. Head region d. Sacral region

d. Sacral region Rationale: The nurse would check the sacral region for the presence of edema if the client is confined to the bed. If the pregnant client is ambulatory, then edema may first be evident in the feet and ankles.

Which fetal complication is increased by maternal cigarette smoking? a. Spina bifida b. Anencephaly c. Facial deformities d. Low birth weight

Low birth weight

A pregnant client reports abdominal pain in the right lower quadrant, along with nausea and vomiting. The urinalysis report shows an absence of urinary tract infection. A chest x-ray also rules out lower-lobe pneumonia. Which client condition would the nurse suspect? a. Appendicitis b. Cholelithiasis c. Placenta previa d. Uterine rupture

a. Appendicitis Note: - Cholelithiasis: RUQ pain - Placenta previa: when the placenta is implanted in the lower uterine segment covering the cervix, which causes bleeding when the cervix dilates. - Uterine rupture: a result of trauma, which may cause fetal death.

Which medication is contraindicated in a client who is on anticoagulant therapy? a. Aspirin b. Clindamycin c. Misoprostol d. Ergonovine

a. Aspirin Note: aspirin- NSAID, blood thinner clindamycin- abx misoprostol- anti-ulcer ergonovine- oxytocic

Which signs and symptoms would the nurse find in assessing the client with abruption placentae? Select all that apply. a. Hypoglycemia b. Abdominal pain c. Vaginal bleeding d. Delayed menses e. Uterine tenderness

Abdominal pain, vaginal bleeding, and uterine tenderness

-Drugs: Tocolytics: magnesium sulfate, terbutaline, nifedipine Glucocorticoid: dexamethasone Beta-Blocker: propranolol, labetalol hydrochloride Abx: metronidazole -Pitocin/Oxytocin -Calcium gluconate

TOCOLYTICS: cause relaxation of smooth muscles and are used to inhibit uterine contractions - Mag Sulfate: CNS depressant, smooth muscle relaxant; used to prevent or reduce the risk of cerebral palsy in the fetus if preterm birth appears inevitable; seizure prophylaxis; VS q15 minutes during loading dose of magnesium sulfate. - Terbutaline: beta adrenergic agonist relaxes uterus - Nifedipine: calcium channel blocker that is used in tocolytic therapy for preterm labor Glucocorticoid: used for fetal lung maturation - Dexamethasone (Decadron) Beta Blockers: - Propranolol: reverses intolerable cardiovascular effects of terbutaline. - Labetalol hydrochloride: used for sever HTN Dexamethasone is an antenatal glucocorticoid that is used to prevent the risk of respiratory distress syndrome in the fetus. Pitocin/Oxytocin: synthetic hormone used to induce labor and to control severe postpartum bleeding by making the uterus contract. Metronidazole: broad-spectrum antibiotic that is used to treat chorioamnionitis after cesarean delivery. Calcium gluconate: electrolyte replacement

When assessing a pregnant client with thalassemia, the nurse knows that which factor is related to this condition? a. An insufficient amount of hemoglobin is produced to fill the red blood cells (RBCs). b. The RBCs have a normal life span but are sickled in shape. 3 A folate deficiency occurs. 4 There are inadequate levels of vitamin B12.

a. An insufficient amount of hemoglobin is produced to fill the red blood cells (RBCs). Thalassemia: an inherited blood disorder involving the abnormal synthesis of the α or β chains of hemoglobin. You have less than normal amounts of an oxygen-carrying protein (hemoglobin) and fewer RBCs.

The nurse is advising a pregnant client who has been prescribed lispro (Humalog). Which information would the nurse provide about the insulin? Select all that apply. a. It is rapid-acting insulin preferred for use during pregnancy. b. It is injected just before meals and causes less hyperglycemia. c. It has shorter duration of action as compared to regular insulin. d. It is released slowly in small amounts with no pronounced peak. e. Its action lasts for 12 hours maintaining optimal blood glucose levels.

a, b, c; rapid acting, admin before meals, short duration

Which nursing information is appropriate to discuss with a client who has received methotrexate therapy? Select all that apply. a. "Avoid vitamins and foods that contain folic acid." b. "Make sure to close the lid of the toilet and double-flush." c. "When you resume intercourse, you must use contraception for 3 months." d. "You will be scheduled for monthly measurements of β-hCG at 6 to 12 months." e. "You can resume intercourse when your β-hCG levels are normal for 3 consecutive weeks.

a. "Avoid vitamins and foods that contain folic acid." b. "Make sure to close the lid of the toilet and double-flush." c. "When you resume intercourse, you must use contraception for 3 months." Rationale: A client who has received methotrexate therapy would be instructed to avoid vitamins and foods that contain folic acid and to close the lid of the toilet and double-flush to prevent exposure to the drug. The nurse would further instruct the client to use contraception for 3 months after resuming intercourse. Monthly measurements of β-hCG at 6 to 12 months and the resumption of intercourse when β-hCG levels are normal for 3 consecutive weeks are instructions that apply for a client with a hydatidiform mole or molar pregnancy.

The nurse is caring for a pregnant client who is on antibiotic therapy to treat a urinary tract infection (UTI). Which dietary changes would the nurse suggest for this client? a. "Include yogurt, cheese, and milk in your diet." b. "Avoid folic acid supplements until the end of therapy." c. "Include vitamins C and E supplementation in your diet." d. "Reduce your dietary fat intake by 40 to 50 grams per day."

a. "Include yogurt, cheese, and milk in your diet."

A client with gestational hypertension is prescribed labetalol hydrochloride therapy, which is continued postpartum. Which instruction would the nurse provide the client about breastfeeding? a. "You may breastfeed the infant if you desire." b. "Breastfeeding may cause convulsions in the infant." c. "Breastfeed only once a day, and use infant formula." d. "There may be high levels of the drug in the breast milk."

a. "You may breastfeed the infant if you desire."

Which interventions would the nurse implement when providing care for a pregnant client with cystic fibrosis? Select all that apply. a. Assess the client's weight frequently. b. Assess for pulmonary infection. c. Assess for vitamin ADEK deficiency. d. Encourage exposure to sunlight. e. Monitor the fetal movements.

a. Assess the client's weight frequently. b. Assess for pulmonary infection. c. Assess for vitamin ADEK deficiency. d. Encourage exposure to sunlight. e. Monitor the fetal movements. All but exposure to sunlight. Rationale: The nurse would assess the client's weight frequently, because a weight gain of 11 to 12 kg is recommended during pregnancy. If the client does not gain an appropriate amount of weight, nasogastric tube feedings at night would be prescribed. The client is at an increased risk for pulmonary infection, so the nurse would be alert for infection so that prompt treatment can be initiated. Fat-soluble vitamins (ADEK) are not absorbed adequately in the client with cystic fibrosis; therefore, the nurse would monitor for deficiency so that prompt action can be taken. Fetal movement counts are recommended from 28 weeks of gestation to assess fetal well-being. Exposure to sunlight is recommended for clients with pruritus gravidarum (a skin disease) to decrease itching.

When is the appropriate time to place elastic compression stockings on the legs of a client who is being treated with intravenous (IV) heparin for deep venous thrombosis (DVT)? a. Before ambulating b. During treatment with IV heparin c. Throughout the client's time on bed rest d. While the client's leg is elevated

a. Before ambulating Rationale: The client would be taught how to put elastic compression stockings on the legs before ambulation. Compression stockings are not placed on the client's legs specifically during treatment with IV heparin, throughout the time on bed rest, or when the client's leg is elevated.

The nurse is teaching a pregnant client regarding the monitoring of daily fetal movement. Which finding should be reported to the primary health care provider? a. Fetal movement was not detected for 12 hours. b. An episode of limb straightening was observed. c. One episode of fetal breathing was seen in 30 minutes. d. An amniotic fluid index value of more than 5 cm.

a. Fetal movement was not detected for 12 hours

A client diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At the present time, the client is at the greatest risk for which complication? a. Hemorrhage b. Infection c. Urinary retention d. Thrombophlebitis

a. Hemorrhage

On reviewing the ultrasound report of a pregnant client, the nurse finds that the placenta is at a distance of 2.5 cm from the internal cervical os. Which complication is likely if the client has a vaginal delivery? a. Hemorrhage b. Hyperthyroidism c. Thrombocytopenia d. Hypofibrinogenemia

a. Hemorrhage Rationale: A placenta implanted in the lower uterine segment 2.5 cm from the internal cervical os indicates that the client has marginal placenta previa. In placenta previa, disruption of placental blood vessels occurs with stretching and thinning of the lower uterine segment, which results in bleeding. Therefore, the major maternal complication associated with placenta previa is hemorrhage.

A client 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 37.1° C, pulse rate 96 beats/min, respiratory rate 24 breaths/min, blood pressure 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the primary health care provider and anticipates a prescription for which medication? a. Hydralazine b. Magnesium sulfate bolus c. Diazepam d. Calcium gluconate

a. Hydralazine Rationale: Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. An additional bolus of magnesium sulfate may be prescribed for increasing signs of central nervous system irritability related to severe preeclampsia (e.g., clonus) or if eclampsia develops. Diazepam sometimes is used to stop or shorten eclamptic seizures. Calcium gluconate is used as the antidote for magnesium sulfate toxicity. The client is not currently displaying any signs or symptoms of magnesium toxicity.

The nurse caring for a pregnant client knows that which situation is the most common medical complication of pregnancy? a. Hypertension b. Hyperemesis gravidarum c. Hemorrhagic complications d. Infections

a. Hypertension

Which action would the nurse anticipate to be included in the plan of care based on evaluation of information in the electronic health record for a class C diabetic client presenting for a prenatal visit? a. Implementing fetal surveillance b. Increasing the dosage of insulin c. Decreasing the dosage of insulin d. Monitoring for diabetic ketoacidosis

a. Implementing fetal surveillance Rationale: The risk of intrauterine fetal death is increased during pregnancy; therefore fetal surveillance would be increased throughout the pregnancy.

Which nursing instruction is appropriate when discussing self-care after a miscarriage? Select all that apply. a. Increase dietary intake of iron. b. Avoid tub baths for 2 weeks. c. Avoid intercourse for 4 weeks. d. Avoid trying to get pregnant until a menstrual cycle has passed. e. Notify the health care provider if vaginal discharge has a foul odor.

a. Increase dietary intake of iron. b. Avoid tub baths for 2 weeks. e. Notify the health care provider if vaginal discharge has a foul odor. Rationale: The nurse would instruct the client to increase dietary intake of iron to promote tissue repair and red blood cell replacement. The client would be further instructed to avoid tub baths for 2 weeks and notify the health care provider if vaginal discharge has a foul odor. The client would be instructed to avoid intercourse for 2 weeks. There is no necessary time frame for which the client would avoid conception; however, the client and partner must allow themselves time to grieve before conceiving again.

Which nursing actions are included in the primary survey for a client at 19 weeks of gestation who has experienced a stab wound to the upper right abdominal quadrant and is not breathing? Select all that apply. a. Initiating an intravenous line b. Administering oxygen c. Performing an ultrasound examination d. Evaluating the fetal heart rate e. Using a jaw thrust to establish an airway

a. Initiating an intravenous line b. Administering oxygen e. Using a jaw thrust to establish an airway Rationale: Included in the primary survey for an obstetric client who is not breathing is initiating an intravenous line, administering oxygen, and using a jaw thrust to establish an airway. Performing an ultrasound examination and evaluating the fetal heart rate are included in the secondary survey.

The blood glucose level of a pregnant client is 325 mg/dL. Which test would be performed on the client to assess the risk of maternal or intrauterine fetal death? a. Ketones in urine b. Glucose in urine c. Arterial blood gases d.Abdominal ultrasonography

a. Ketones in urine Rationale: Diabetic ketoacidosis is a potentially fatal complication of diabetes that can lead to fetal death. This complication may occur if the client's blood glucose levels rise above 200 mg/dL. Diabetic ketoacidosis can be confirmed by assessing the presence of ketones in the urine. The client's blood glucose level is 325 mg/dL, hence the client has poorly controlled diabetes.

Which abnormal findings would the nurse immediately report to the health care provider for a client at 37 weeks of gestation who has been in a motor vehicle accident and is being discharged? Select all that apply. a. Leaking fluid b. Abdominal pain c. Vaginal bleeding d. Irregular contractions e. Decreased fetal movement

a. Leaking fluid b. Abdominal pain c. Vaginal bleeding e. Decreased fetal movement everything except irregular contractions

A nurse is caring for a client with mitral stenosis who is in the active stage of labor. Which action would the nurse take to promote cardiac function? a. Maintain the client in a side-lying position with the head and shoulders elevated to facilitate hemodynamics. b. Prepare the client for cesarean delivery because this is the recommended method to sustain hemodynamics. c. Encourage the client to avoid the use of narcotics or epidural regional analgesia because this alters cardiac function. d. Promote the use of the Valsalva maneuver during pushing in the second stage to improve diastolic ventricular filling.

a. Maintain the client in a side-lying position with the head and shoulders elevated to facilitate hemodynamics. Rationale: The side-lying position with the head and shoulders elevated helps facilitate hemodynamics during labor. A vaginal delivery is the preferred method for a client with cardiac disease because it sustains hemodynamics better than a cesarean delivery. The use of supportive care, medication, and narcotics or epidural regional analgesia is not contraindicated in the client with heart disease. Using the Valsalva maneuver during pushing in the second stage would be avoided because it reduces diastolic ventricular filling and obstructs left ventricular outflow.

The nurse is caring for a pregnant client with type 2 diabetes. What would the nurse teach the client about glucose metabolism in the first trimester? a. Maternal glucose levels are affected by nausea and cravings. b. The client's insulin dose may need to be increased to prevent hyperglycemia. c. The fetus will produce insulin in the fifth week of gestation. d. The client's fasting blood glucose level will increase.

a. Maternal glucose levels are affected by nausea and cravings.

A pregnant client who is in preterm labor has been prescribed dexamethasone. The nurse knows the reason for administering this drug would be to facilitate which action? a. Maturation of fetal lungs b. Relaxation of smooth muscles c. Inhibition of uterine contractions d. Central nervous system (CNS) depression

a. Maturation of fetal lungs Dexamethasone is a glucocorticoid and is administered to clients in preterm labor because it promotes fetal lung maturation. The drug facilitates the release of enzymes that induce production or release of lung surfactant.

A client is undergoing percutaneous umbilical blood sampling (PUBS). What is the best intervention for the nurse to perform after conducting the test? a. Monitor the fetal heart rate (FHR). b. Give fluids to the client frequently. c. Elevate the client's bed to a 60-degree angle. d. Check the patient's blood glucose levels.

a. Monitor the fetal heart rate (FHR). Rationale: an invasive procedure in which the fetal umbilical vessel is punctured for blood transfusion or sample collection. After 1 to 2 hours of performing this procedure, the nurse should monitor the fetal heart rate (FHR) to ensure safety.

Which is the most commonly used antenatal testing for a client at 39 weeks gestation who requires fetal assessment for decreased fetal movement? a. Nonstress test b. Biophysical profile c. Contraction stress test d. Vibroacoustic stimulation

a. Nonstress test Rationale: A nonstress test is the most widely applied method of antepartum evaluation of the fetus. A biophysical profile is used in the late second trimester and third trimester as a predictor of fetal well-being but is not the most commonly used method of antenatal testing. A contraction stress test is more time-consuming, expensive, and can be invasive.

Which factor is appropriate to identify when providing client instructions about daily monitoring of fetal kick counts? a. Obesity b. Alcohol c. Smoking d. Antidepressants

a. Obesity Rationale: Obesity decreases the perception of fetal movements. Alcohol, smoking, and antidepressants reduce fetal activity, not the maternal perception of movement.

A client reports painless, bright red vaginal bleeding during the second trimester of pregnancy. On assessment, the nurse notes decreased urine output, increased fundal height, and a nontender uterus with normal tone. Which client condition would the nurse interpret from these findings? a. Placenta previa b. Ectopic pregnancy c. Hydatidiform mole d. Normal development

a. Placenta previa Rationale: Placenta previa is an obstetric complication in which the placenta is implanted partially or completely in the lower uterine segment (near to or covering the cervix). Painless, bright red vaginal bleeding takes place during the second trimester. Decreased urine output, greater-than-expected fundal height, and a nontender uterus with normal tone are signs of placenta previa

The nurse is caring for a pregnant client who is scheduled for surgery. Which nursing intervention would help provide sufficient fetal oxygenation during the surgery? a. Positioning the client with a lateral tilt b. Providing clear liquids c. Palpating uterine contractions manually d. Giving an antacid before administering anesthesia

a. Positioning the client with a lateral tilt Note: a lateral tilt helps to avoid compression of the maternal vena cava; this improves fetal oxygenation during the surgery

Which obstetric or medical complications would the nurse be alert for when providing care to a pregnant client with diabetes mellitus? Select all that apply. a. Preeclampsia b. Hypoglycemia c. Hydramnios d. Monilial vaginitis e. Brachial plexus palsy

a. Preeclampsia b. Hypoglycemia c. Hydramnios d. Monilial vaginitis

The nurse is caring for a client whose labor is being augmented with oxytocin. The nurse knows that oxytocin would be discontinued immediately if there is evidence of which condition? a. Uterine contractions occurring every 8 to 10 minutes b. A fetal heart rate (FHR) of 180 with absence of variability c. The client needing to void d. Rupture of the amniotic membranes

b. A fetal heart rate (FHR) of 180 with absence of variability

The nurse is assessing a pregnant client with multifetal gestation. On reviewing the medical history, the nurse finds that the client had a preterm delivery during the first pregnancy. Which intervention would the nurse perform to help prevent preterm delivery in this client? a. Suggest that the client avoid smoking. b. Suggest that the client increase physical activity to prevent risk. c. Administer progesterone suppositories to the client. d. Administer a 17-alpha hydroxy progesterone injection to the client.

a. Suggest that the client avoid smoking. Rationale: To prevent preterm labor, the nurse would suggest health-promotion activities to the client, such as avoiding smoking. This helps promote intrauterine growth and fetal development. The nurse would suggest that the client get proper rest and care at home. The nurse would not suggest that the client increase physical activity, which could worsen the condition. Progesterone supplements, such as progesterone (Prometrium) suppositories and 17-alpha hydroxy progesterone injections, are ineffective in preventing preterm birth in clients with multifetal gestation.

Which nursing interventions are appropriate for a client with a fluid imbalance resulting from postpartum hemorrhage? Select all that apply. a. Weighing peri pads b. Monitoring vital signs c. Assessing capillary refill d. Assessing arterial blood gas e. Providing oxygen supplementation

a. Weighing peri pads b. Monitoring vital signs

Which information would the nurse include when planning for an expected cesarean delivery for a client who has had a previous cesarean delivery and has a fetus in the transverse presentation? a. "Because this is a repeat procedure, you are at the lowest risk for complications." b. "Even though this is your second cesarean delivery, you may wish to review the preoperative and postoperative procedures." c. "Because this is your second cesarean delivery, you will recover faster." d. "You will not need preoperative teaching because this is your second cesarean delivery."

b. "Even though this is your second cesarean delivery, you may wish to review the preoperative and postoperative procedures."

A client who recently had a heart transplant with no evidence of rejection asks the nurse about the safety of conceiving a child. Which is the most accurate response by the nurse? a. "A heart transplant does not tolerate pregnancy." b. "You may conceive 1 year after the transplant." c. "The newborn may have congenital heart disease." d. "You may need to terminate pregnancy at any time."

b. "You may conceive 1 year after the transplant."

Which is the normal range of amniotic fluid index? a. 1 to 5 cm b. 10 to 25 cm c. 25 to 40 cm d. 40 to 65 cm

b. 10 to 25 cm Rationale: Amniotic fluid index is a biophysical profile that helps to estimate the amniotic fluid volume and fetal wellbeing. - NR: 10-25cm - Oligohydramnios: 1-5cm - Polyhydramnios: 25+ cm

A client with severe preeclampsia is receiving a magnesium sulfate infusion. Which assessment finding would be most concerning to the nurse? a. A sleepy, sedated affect b. A respiratory rate of 10 breaths/min c. Deep tendon reflexes of 2+ d. Absent ankle clonus

b. A respiratory rate of 10 breaths/min Rationale: A respiratory rate of 10 breaths/min indicates that the client is experiencing respiratory depression (bradypnea) from magnesium toxicity. Because magnesium sulfate is a central nervous system (CNS) depressant, the client will most likely become sedated when the infusion is initiated. Normal findings- DTRs 2+, absent ankle clonus

Which initial nursing action is appropriate when caring for a client who has had an eclamptic seizure? a. Start an IV b. Administer oxygen c. Monitor vital signs d. Insert an indwelling catheter

b. Administer oxygen Note: use a nonrebreather mask at 10 L/min

The nurse is caring for a diabetic client who is pregnant. Which education regarding self-care during illness would the nurse provide the client? Select all that apply. a. Avoid insulin if your appetite is less than normal. b. Drink as much fluid as possible. c. Obtain as much rest as possible. d. Check blood glucose levels at regular intervals. e. Seek emergency treatment if your glucose level exceeds 250 mg/dL.

b. Drink as much fluid as possible. c. Obtain as much rest as possible. d. Check blood glucose levels at regular intervals.

The nurse is caring for a client with rheumatic heart disease (RHD). Which medication would the primary health care provider prescribe to prevent pulmonary edema? a. Verapamil b. Furosemide c. Atenolol d. Warfarin

b. Furosemide Rationale: RHD causes pulmonary edema, atrial fibrillation, right-sided heart failure, infective endocarditis, pulmonary embolism, and massive hemoptysis. - Diuretics (ie. furosemide)→ used to prevent pulmonary edema. - Calcium channel blockers (ie. verapamil)→ used to prevent atrial fibrillation and control heart rate. - Beta blockers (ie. atenolol) are used to prevent tachycardia. - Anticoagulants (ie. Warfarin)→ used to prevent pulmonary embolism.

In assessing a postpartum client, the nurse is aware that which factor is the primary cause of thromboembolic disease? a. Viral infection b. Hypercoagulation c. Corticosteroid therapy d. Deficient clotting factors

b. Hypercoagulation

Which risk is a fetus subject to if chorionic villus sampling (CVS) is conducted in the 7th week of gestation? a. Reduced heart rate b. Limb reduction defects c. Decreased lung maturity d. Neural tube defect

b. Limb reduction defects Rationale: CVS can be performed in the first or second trimester, ideally between 10 and 13 weeks of gestation. Studies indicate that the fetus may be at increased risk for limb reduction defects when the test is performed before the ninth completed week of gestation.

The nurse is caring for a client with poorly controlled gestational diabetes. Which risks to the fetus would the nurse anticipate during the later pregnancy stages and birthing process? Select all that apply. a. Ketoacidosis b. Macrosomia c. Shoulder dystocia d. Facial nerve injury e. Hyperglycemia

b. Macrosomia c. Shoulder dystocia d. Facial nerve injury Note: Macrosomia: a birth weight of more than 4000 g (causes disproportionate increase in shoulder, trunk, and chest size, leading to the risk of shoulder dystocia Ketoacidosis: a result of uncontrolled glycemia

The nurse is reviewing the amniocentesis reports of a client at 20 weeks gestation and notes the presence of high alpha-fetoprotein (AFP) levels. Which should the nurse infer from this information related to the clinical condition of the fetus? a. Cardiac disorder b. Neurologic disorder c. Circulatory disorder d. Pulmonary disorder

b. Neurologic disorder Rationale: High AFP levels after 15 weeks of gestation indicate an open neural tube or other disorders relating to the central nervous system.

Which drug is used for treating a client with severe postpartum bleeding? a. Nifedipine b. Oxytocin c. Propranolol d. Metronidazole

b. Oxytocin - Oxytocin: synthetic hormone used to induce labor and to control severe postpartum bleeding by making the uterus contract. - Nifedipine: calcium channel blocker used in tocolytic therapy for preterm labor. - Propranolol: reverses intolerable cardiovascular effects of terbutaline. - Metronidazole: broad-spectrum antibiotic that is used to treat chorioamnionitis after cesarean delivery.

While assisting the primary health care provider performing an amniotomy, the nurse observes part of the umbilical cord protruding from the client's vagina. The nurse immediately positions the client in the Trendelenburg position and inserts a finger into the client's vagina. Which additional care intervention would the client need to prevent complications? a. Perform large-bore catheter suction. b. Prepare for an emergency cesarean delivery. c. Administer calcium gluconate intravenously. d. Administer terbutaline subcutaneously.

b. Prepare for an emergency cesarean delivery.

The nurse administers magnesium sulfate to stop labor in a pregnant client. Which symptoms would the nurse monitor to ensure the client's safety? a. Swollen legs b. Respiratory rate c. Eating patterns d. Maternal chills

b. Respiratory rate

A pregnant client is on tocolytic therapy with magnesium sulfate. Under which client circumstance would the nurse suggest discontinuing the therapy? a. Blood pressure is 120/80 mm Hg. b. Respiratory rate is 10 breaths/min. c. Urine output is 40 mL/hour. d. Serum magnesium level is 5 mEq/L.

b. Respiratory rate is 10 breaths/min.

The nurse is caring for a client with severe preeclampsia who is on an intravenous infusion of magnesium sulfate. Which assessment parameter indicates that the treatment is a success? a. Edema is reduced b. Seizures do not occur c. Blood pressure is reduced d. Respiratory rate is reduced

b. Seizures do not occur

On reviewing the medical history of a pregnant client, the nurse finds that the client is taking carbamazepine. What consequence of the drug on the fetus should the nurse be aware of? a. Pyelectasis b. Spina bifida c. Omphalocele d. Lupus erythematosus

b. Spina bifida Rationale: Carbamazepine is a teratogenic drug that may cause neural tube defects.

A client with severe gestational hypertension is prescribed hydralazine. Which is the priority nursing intervention in this case? a. Assess for visual disturbances. b. Assess airway, breathing, and pulse. c. Assess blood pressure frequently. d. Prepare the client for nonstress testing.

c. Assess blood pressure frequently. Rationale: Hydralazine is an antihypertensive medication. The nurse would assess the client's blood pressure frequently because a precipitous drop can lead to shock and placental abruption.

Which testing would be available for a client at 11 weeks of gestation who requests a fetal genetic assessment? a. Ultrasonography b. Amniocentesis c. Chorionic villus sampling d. Percutaneous umbilical blood sampling (PUBS)

c. Chorionic villus sampling Rationale: - CVS: b/w 10 and 13 wks - Amniocentesis- after 14 wks - PUBS- after 18 wks b/c of the fragility of the cord vessels.

A client reports mild vaginal bleeding, pain, and cramping in her lower abdomen at 6 weeks of gestation. On performing a pelvic examination, the nurse finds that the client's cervical os is closed. What is the priority nursing intervention in this case? a. Administer intravenous fluids to the client. b. Administer carboprost tromethamine to the client. c. Determine the client's human chorionic gonadotropin and progesterone levels. d. Prompt termination of pregnancy in the client by the dilation and curettage method.

c. Determine the client's human chorionic gonadotropin and progesterone levels.

Which condition is characterized by implantation of fertilized ovum outside the uterine cavity? a. Placenta previa b. Molar pregnancy c. Ectopic pregnancy d. Cervical insufficiency

c. Ectopic pregnancy Placenta previa: when the placenta is implanted in the lower uterine segment. Molar pregnancy: a benign proliferative growth of the placental trophoblast. In this condition, the chorionic villi develop into cystic and avascular transparent vesicles that hang in a grapelike cluster. Cervical insufficiency: the passive and painless dilation of the cervix. It may lead to recurrent preterm

A cesarean delivery is planned for a diabetic client with fetal macrosomia. Which nursing intervention is appropriate when preparing the client for surgery? a. Instruct the client to avoid insulin the night before the surgery. b. Administer a full dose of insulin on the morning of the surgery. c. Ensure that the client has nothing by mouth on the morning of the surgery. d. Infuse intravenous 5% dextrose if the client's glucose level is below 100 mg/dL.

c. Ensure that the client has nothing by mouth on the morning of the surgery. Rationale: The client must take a full dose of insulin at bedtime the night before the surgery. The client is fasting; therefore insulin is not administered on the morning of the surgery. The client is given intravenous 5% dextrose if her glucose levels fall below 70 mg/dL during active labor.

The nurse is caring for a pregnant client who is scheduled for cordocentesis. Which could be a complication of the test? a. Destruction of red blood cells b. Fetal hyperbilirubinemia c. Fetomaternal hemorrhage d. Deformity of extremities

c. Fetomaternal hemorrhage Rationale: Cordocentesis is an invasive procedure also known as percutaneous umbilical blood sampling (PUBS). n this procedure, the fetal umbilical vessel is punctured. Therefore, there is a direct risk of fetomaternal hemorrhage.

A nurse providing care to a client in labor would be aware of which fact about cesarean delivery? a. It is declining in frequency in the United States. b. It is more likely to be done for the poor in public hospitals who do not get the nurse counseling that wealthier clients do. c. It is performed primarily for the health of the mother and fetus. d. It can be either elected or refused by clients as their absolute legal right.

c. It is performed primarily for the health of the mother and fetus.

The nurse is caring for a diabetic client who is breastfeeding her infant. Within which time frame after childbirth would the client's insulin requirements return to prepregnancy levels? a. Immediately after childbirth b. Seven to 10 days after childbirth c. On completion of weaning d. During the lactation period

c. On completion of weaning Rationale: The breastfeeding mother's insulin requirements return to prepregnancy levels after the infant has been completely weaned. At birth, there is a sudden drop in the levels of insulinase after expulsion of the placenta, but they do not return to prepregnancy levels. When the mother is not breastfeeding, the insulin carbohydrate balance returns in 7 to 10 days. Maternal glucose is used up during lactation; therefore the breastfeeding mother's insulin requirement remains low.

The nurse is preparing to administer intravenous magnesium sulfate to a client with preeclampsia. Meanwhile, the student nurse positions the client in the supine position, monitors the fetal heart rate (FHR), checks for baseline variability, and monitors for the absence of late decelerations. Which action by the student nurse indicates the need for further teaching? a. Checking for baseline variability b. Monitoring of the fetal heart rate (FHR) c. Placing the client in a supine position d. Monitoring for the absence of late decelerations

c. Placing the client in a supine position. Rationale: While caring for a pregnant client with preeclampsia and ineffective tissue perfusion, the nurse would place the client on her side, not in the supine position. This is done to maximize uteroplacental blood flow and ensure efficient uteroplacental oxygenation. This intervention also helps decrease the client's blood pressure, promote diuresis, and prevents supine hypotension. The student nurse would check for baseline variability, monitor the FHR, and check for the absence of late decelerations. These interventions promote the safety of the fetus.

The nurse caring for a 37-week-gestation client with gestational hypertension determines that the client has very elevated blood pressure. Which is the best intervention to prevent complications in the client? a. Instruct the client to stay in bed. b. Provide the client with a nutritious dietary plan. c. Prepare the client for induction of labor. d. Instruct the client to come next week.

c. Prepare the client for induction of labor. Rationale: A gestational age of 37 weeks in a client with gestational hypertension and dangerously high blood pressure indicates that labor should be induced as soon as possible. After 37 weeks of gestation, there may be detrimental effects of gestational hypertension on the fetus. Bed rest may not help relieve high blood pressure and therefore is not beneficial to the fetus. Nutritious food is essential for the client throughout pregnancy irrespective of the fetus' gestational age. Instructing the client to come next week may worsen the condition and may be fatal to the fetus.

Which clinical significance does a maternal blood Coombs test with a titer of 1:8 and increasing indicate? a. Fetal lung maturity b. Significant Rh compatibility c. Significant Rh incompatibility d. Fetus with trisomy 13, 18, or 21

c. Significant Rh incompatibility An increase indicates significant Rh incompatibility.

The nurse working in an obstetric clinic is taking health histories and knows that which client is at the highest risk of developing hydatidiform mole? a. A client with hypothyroidism b. A client with diabetes mellitus c. A client with systemic lupus erythematosus d. A client with prior molar pregnancy

d. A client with prior molar pregnancy Rationale: Hydatidiform mole is a benign proliferative growth of the placental trophoblast. A client with prior molar pregnancy is at a higher risk of developing hydatidiform mole. The presence of growing tissue in a molar pregnancy increases the risk of hydatidiform mole.

Which nursing information is recognized as part of the protocol of a perimortem cesarean delivery? a. The goal is to deliver the neonate in less than 5 minutes. b. Maternal resuscitation ceases after delivery of the neonate. c. The neonate must be delivered after 5 minutes of maternal resuscitation. d. After 4 minutes of maternal pulselessness, the neonate must be delivered.

d. After 4 minutes of maternal pulselessness, the neonate must be delivered. Rationale: After 4 minutes of maternal pulselessness, the neonate must be delivered to increase the chance of a favorable fetal outcome. The neonate would not be delivered in less than 5 minutes unless maternal pulselessness is present. Maternal resuscitation does not necessarily cease after delivery of the neonate. Emptying the uterine contents may improve the outcome of maternal resuscitation. The neonate would not need to be delivered after 5 minutes of maternal resuscitation if there is a maternal pulse.

A postpartum client who had a cesarean delivery reports fever, loss of appetite, pelvic pain, and foul-smelling lochia. On assessment, the nurse finds that the client has an increased pulse rate and uterine tenderness. Laboratory reports indicate significant leukocytosis. Which clinical condition would the nurse suspect based on these findings? a. Cystocele b. Rectocele c. Hematoma d. Endometritis

d. Endometritis Endometritis: a common postpartum infection that usually begins as a localized infection at the placental site and spreads to the entire endometrium. S/sx: fever, loss of appetite, pelvic pain, foul-smelling lochia, increased pulse rate, and uterine tenderness. Note: cystocele: protrusion of the bladder downward into the vagina. rectocele: herniation of the anterior rectal wall through the relaxed or ruptured vaginal fascia and rectovaginal septum.

Which tool is the most sensitive assessment for the diagnosis of placental abruption after abdominal trauma? a. Ultrasonography b. Kleihauer-Betke assay c. Abdominal palpation d. External fetal monitoring

d. External fetal monitoring Rationale: External monitoring b/c any changes in circulation and oxygenation are reflected in the FHR. Note: Kleihauer-Betke assay: used to identify fetomaternal hemorrhage, but doesn't detect placental abruption.

The nurse is caring for a client with gestational diabetes. Which education would the nurse provide the client regarding the use of insulin? a. Store unused vials of insulin in the freezer. b. Shake the prepared syringes well before use. c. Administer long-acting insulin before meals. d. Inject insulin in the abdomen.

d. Inject insulin in the abdomen. Sites for injection: - abdomen (*best absorbed here) - upper outer arm - thighs - butt

Which drug prevents the risk of cerebral palsy in the fetus? a. Nifedipine b. Propranolol c. Dexamethasone d. Magnesium sulfate

d. Magnesium sulfate

The ultrasound report of a 12-week-pregnant client shows a snowstorm pattern. On further examination, the nurse finds elevated human chorionic gonadotropin (hCG) levels and dark brown vaginal discharge. Which complication would the nurse expect in the client? a. Hemorrhage b. Hypertension c. Hyperglycemia d. Molar pregnancy

d. Molar pregnancy Rationale: Snowstorm pattern on ultrasonography, elevated hCG, and dark brown vaginal discharge indicate that the client has a hydatidiform mole. The risk of hemorrhage is predominant in the client with placenta previa.

A client who is pregnant already has type 2 diabetes and a hemoglobin A1c of 7. Which client condition would the nurse use to categorize this client as a diabetic? a. Gestational diabetes b. Insulin-dependent diabetes complicated by pregnancy c. Pregestational diabetes mellitus d. Non-insulin-dependent diabetes with complications

d. Non-insulin-dependent diabetes with complications Rationale: Pregestational diabetes mellitus is a term used to describe type 1 or type 2 diabetic clients in whom the diabetes existed before pregnancy. NR: HgA1c = 4-5.6% HgA1c = 5.7 - 6.4% (higher chance of getting DM) HgA1c of diabetic = 6.5% or more

For a client at 42 weeks of gestation, which finding requires more assessment by the nurse? a. Fetal heart rate of 120 beats/min b. Cervix dilated 2 cm and 50% effaced c. Score of 8 on the biophysical profile d. One fetal movement noted in 1 hour of assessment by the mother

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

A pregnant client after 20 weeks of gestation reports painless bright red vaginal bleeding. On assessment, the nurse finds that the client's vital signs are normal. Which condition would the nurse suspect in the client? a. Eclampsia b. Preeclampsia c. Pyelonephritis d. Placenta previa

d. Placenta previa Placenta previa: painless bright red vaginal bleeding during the second or third trimester of pregnancy. The client's vital signs may be normal even after blood loss, because a pregnant client can lose up to 40% of blood volume without any signs of shock. Eclampsia: the onset of seizure activity in a client with preeclampsia. Preeclampsia: hypertension and proteinuria after 20 weeks of gestation. Pyelonephritis: an infection caused by E. coli (UTI) and is identified by fever, shaking, chills, and aching in the lumbar area of the back.

A client 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 client condition would the nurse suspect? a. Eclamptic seizure b. Uterine rupture c. Placenta previa d. Placental abruption

d. Placental abruption Rationale: Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placental abruption.

The nurse is caring for a pregnant client diagnosed with mitral valve stenosis. Which position would the nurse suggest to the client to ensure a safe labor? a. Supine b. Standing c. Lithotomy d. Side-lying

d. Side-lying Rationale: Mitral valve stenosis occurs for various reasons, such as a stiffening of the valve leaflets resulting from rheumatic heart disease. During labor, it is very important to have adequate pain control to prevent tachycardia in these clients. A side-lying position is desired to prevent tachycardia. A supine position would not provide comfort; rather, it may cause supine hypotension. A standing position is not preferred in clients with mitral valve stenosis. The lithotomic position may increase the risk of pulmonary edema in clients with mitral valve stenosis.

The nurse is caring for a pregnant client at 19 weeks of gestation. On reviewing the ultrasound reports, the nurse notes that the fetus has a ventricular septal defect (VSD). The nurse knows which type of ultrasound helps detect VSD? a. Limited examination b. Non-medical examination c. Standard or basic examination d. Specialized or targeted examination

d. Specialized or targeted examination Rationale: Specialized or targeted examinations are performed if a client is suspected to be carrying an anatomically or physiologically abnormal fetus. A VSD is an anatomic defect in the ventricular septum, the wall dividing the left and right ventricles of the heart. Therefore, a specialized or targeted ultrasound examination of the heart is performed to detect a VSD

Which assessment finding would the nurse recognize as an indicator for early screening for gestational diabetes mellitus (GDM)? a. The client is 24 years of age. b. The client's body mass index (BMI) is 22. c. The client does not have diabetes. d. The client had a previous stillbirth.

d. The client had a previous stillbirth. Note: - Screening takes place b/w 24 and 28wks. - You will be screened earlier if you've had a previous stillbirth or birth of a malformed or macrosomic infant - Risk factors: maternal age older than 25 year, obese BMI - If the client does not have diabetes before gestation, the client need not be screened early for GDM.

The nurse is monitoring a pregnant client after amniotomy. Which observation would indicate a likelihood of umbilical cord compression? a. The fetal heart rate (FHR) confirms tachycardia. b. The client's vaginal drainage has a foul smell. c. The client has frequent maternal chills. d. The fetal heart rate (FHR) has variable decelerations.

d. The fetal heart rate (FHR) has variable decelerations. Rationale: Amniotomy is performed in a pregnant client to rupture the membranes artificially. After the procedure, the nurse would closely monitor the FHR. Reduced FHR and variable decelerations in FHR indicate that the umbilical cord is compressed. The nurse would immediately inform the primary health care provider of the client's condition. Tachycardia or increased FHR are common manifestations observed after amniotomy. Tachycardia would not require immediate clinical action. Maternal chills and foul-smelling vaginal discharge after amniotomy indicate infection of the ruptured membranes; however, this would not be a reason to expect umbilical cord compression.

During a prenatal check-up a client who is 7 months pregnant reports that she is able to feel about two kicks in an hour. The nurse refers the client for an ultrasound, and which is the primary reason for this referral? a. To check for fetal anomalies b. To check gestational age c. To check fetal position d. To check for fetal well-being

d. To check for fetal well-being NR: 30 kicks/hr in 3rd trimester

A 40-year-old woman with a body mass index over 30 is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time? a. Biophysical profile b. Amniocentesis c. Maternal serum alpha-fetoprotein (MSAFP) d. Transvaginal ultrasound

d. Transvaginal ultrasound Rationale: This ultrasound if useful for obese women whose thick abdominal layers cannot be penetrated adequately with the abdominal approach