antepartum nursing
b dizziness and lightheadedness are associated with orthostatic hypertension, which occurs when taking nifedipine.
a nurse is caring for a client who is receiving nifedipine for prevention of preterm labor. the nurse should monitor the client for which of the following manifestations? a) blood-tinged sputum b) dizziness c) pallor d) somnolence
a, b, d, e a urinary tract infection, multifetal pregnancy, diabetes mellitus, and uterine abnormalities are risk factors of preterm labor.
a nurse is caring for a client who reports manifestations of preterm labor. which of the following findings are risk factors of this condition? (select all that apply.) a) urinary tract infection b) multifetal pregnancy c) oligohydramnios d) diabetes mellitus e) uterine abnormalities
placental problems
-abruptio placentae (the premature separation of the placenta from the uterus) -placenta previa (the placenta abnormally implants in the lower segment of the uterus or over the cervical os instead of attaching to the fundus) -hydatidifrom mole/molar pregnancy (a group of rare tumors that form in the tissue that surrounds an egg after it is fertilized; this tissue is made of trophoblast cells, which connect the fertilized egg to the wall of the uterus and form part of the placenta; in GTD, a tumor forms instead of a healthy fetus) -abortion -incompetent cervix (premature dilation of the cervix or cervical insufficiency) -ectopic pregnancy (the abnormal implantation of a fertilized ovum outside of the uterine cavity usually in the fallopian tube, which can result in a tubal rupture causing a fatal hemorrhage)
complications during the prenatal period
-cardiac disease: congenital cardiac anomalies and valvular disorders (cardiac output and blood volume increase to meet the greater metabolic needs; heart rate increases during pregnancy) -hypertension in pregnancy (vasospasm, gestational hypertension, mild preeclampsia, severe preeclampsia, eclampsia, HELLP) -diabetes mellitus (pregestational, gestational) -hyperemesis gravidarum (excessive nausea and vomiting) -anemia -preterm labor (defined as uterine contractions and cervical changes that occur between 20 and 37 weeks of gestation) -premature rupture of membranes (spontaneous rupture of the amniotic membranes 1 hr or more prior to the onset of true labor) -preterm premature rupture of membranes (premature spontaneous rupture of membranes after 20 weeks of gestation and prior to 37 weeks of gestation)
methods of calculating delivery date
-nagele's rule: LMP-3 months+7 days -mcdonald's method: measure the uterine fundal height in centimeters from the symphysis pubis to the top of the uterine fundus between 18 and 32 weeks of gestation. estimate gestational age to be equal to that of the fundal height.
antepartum
-prenatal period=pregnancy- begins with conception and ends before birth
diagnostic tests
-prenatal routine lab tests (one-hour glucose tolerance, three-hour glucose tolerance, PAP, vaginal/cervical cultures, PPD, VDRL, HIV, infectious screening, MSAFP) -ultrasound -non-stress test (most widely used technique for antepartum evaluation of fetal well-being performed during the 3rd trimester) -contraction stress test (2 types- nipple-stimulated CST and oxytocin administration CST) -biophysical profile (uses a real time ultrasound to visualize physical and physiological characteristics of the fetus and observe for fetal biophysical response to stimuli; measures five variables with a score of 2 for each normal finding and a score of 0 for each abnormal finding) -amniocentesis (the aspiration of amniotic fluid for analysis) -percutaneous umbilical blood sampling (the most common method used for fetal blood sampling and transfusion) -chorionic villi sampling (assessment of a portion of the developing placenta) -maternal alphafetoprotein screening -quad marker screening
serum and urine pregnancy testing
-presence of human chorionic gonadotropin
signs of pregnancy
-presumptive -probable -positive
infections
-torch (toxoplasmosis, other, rubella, cytomegalovirus, herpes simplex) -group B streptococcus B-hemolytic
2 accurate use of naegele's rule requires that the woman have a regular 28-day menstrual cycle. subtract 3 months and add 7 days to the first day of the last menstrual period, october 19, 2020; subtract 3 months, july 19, 2020; add 7 days, july 26,2020; add 1 year, july 26, 2021.
a client arrives at the clinic for the first prenatal assessment. she tells the nurse that the first day of her last normal menstrual period was october 19, 2020. using naegele's rule, which date of expected delivery should the nurse document in the client's chart? 1) july 12, 2021 2) july 26, 2021 3) august 12, 2021 4) august 26, 2021
2 betamethasone, a glucocorticoid, is given to increase the production of surfactant to stimulate fetal lung maturation. it is administered to clients in preterm labor at 28 to 32 weeks of gestation if the labor can be inhibited for 48 hours. nalbuphine is an opioid analgesic. Rh immune globulin is given to Rh-negative clients to prevent sensitization. dinoprostone vaginal insert is a prostaglandin given to ripen and soften the cervix and to stimulate uterine contractions.
a client in preterm labor who is dilated to 4 cm has been started on magnesium sulfate and contractions have stopped. if the client's labor can be inhibited for the next 48 hours, the nurse anticipates a prescription for which medication? 1) nalbuphine 2) betamethasone 3) Rh immune globulin 4) dinoprostone vaginal insert
2 strict bed rest throughout the remainder of the pregnancy is not required for a threatened abortion. the client should watch for the evidence of the passage of tissue. the client is instructed to count the number of perineal pads used daily and to note the quantity and color of blood on the pad. the client is advised to curtail sexual activity until bleeding has ceased and for 2 weeks after the last evidence of bleeding or as recommended by the health care provider.
a client in the the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. a threatened abortion is suspected, and the nurse instructs the client regarding management of care. which statement made by the client indicates a need for further instruction? 1) "i will watch to see if i pass any tissue." 2) "i will maintain strict bed rest throughout the remainder of the pregnancy." 3) "i will count the number of perineal pads used on a daily basis and note the amount and color of blood on the pad." 4) "i will avoid sexual intercourse until the bleeding has stopped and for 2 weeks following the last episode of bleeding."
a nausea and vomiting during the first trimester might be relieved by eating crackers or plain toast prior to rising in the morning.
a client who is at 7 weeks of gestation is experiencing nausea and vomiting in the morning. which of the following information should the nurse include? a) eat crackers or plain toast before getting out of bed. b) awaken during the night to eat a snack. c) skip breakfast and eat lunch after nausea has subsided. d) eat a large evening meal.
b, c, e blunt abdominal trauma, cocaine use, and cigarette smoking are risk factors associated with abruptio placentae.
a nurse is providing care for a client who has a marginal abruptio placentae. which of the following findings are risk factors for developing this condition? (select all that apply.) a) fetal position b) blunt abdominal trauma c) cocaine use d) maternal age e) cigarette smoking
b feelings of ambivalence about pregnancy are normal during the first trimester.
a client who is at 8 weeks of gestation tells the nurse "i am not sure i am happy about being pregnant." which of the following responses should the nurse make? a) "i will inform the provider that you are having these feelings." b) "it is normal to have these feelings during the first few months of pregnancy." c) "you should be happy that you are going to bring a new life into the world." d) "i am going to make an appointment with the counselor for you to discuss these thoughts."
1 contraction stress test results may be interpreted as negative, positive, or equivocal. a negative test result indicates that no late decelerations occurred in the fetal heart rate, although the fetus was stressed by 3 contractions of at least 40 seconds' duration in a 10-minute period.
a nonstress test is performed on a client who is pregnant, and the results of the test indicate non-reactive findings. the primary health care provider prescribes a contraction stress test, and the results are documented as negative. how should the nurse document this finding? 1) a normal test result 2) an abnormal test result 3) a high risk for fetal demise 4) the need for a cesarean section
c a client who has a hydatidiform mole exhibits increased fundal height that is inconsistent with the week of gestation, and excessive nausea and vomiting due to elevated hCG levels. scant, dark discharge occurs in the second trimester.
a nurse at an antepartum clinic is caring for a client who is at 4 months of gestation. the client reports continued nausea; vomiting; and scant, prune-colored discharge. the client has experienced no weight loss and has a fundal height larger than expected. which of the following complications should the nurse suspect? a) hyperemesis gravidarum b) threatened abortion c) hydatidiform mole d) preterm labor
d neural tube defects are caused by folic acid deficiency. food sources of folic acid include fresh green leafy vegetables, liver, peanuts, cereals, and whole-grain breads.
a nurse in a clinic is teaching a client of childbearing age about recommended folic acid supplements. which of the following defects can occur in the fetus or neonate as a result of folic acid deficiency? a) iron deficiency anemia b) poor bone formation c) macrosomic fetus d) neural tube defects
d uterine pregnancy tests should be done on a first-voided morning specimen to provide the most accurate results.
a nurse in a clinic receives a phone call from a client who would like to be tested in the clinic to confirm a pregnancy. which of the following information should the nurse provide to the client? a) "you should wait until 4 weeks after conception to be tested." b) "you should be off any medications for 24 hours prior to the test." c) "you should be NPO for at least 8 hours prior to the test." d) "you should collect urine from the first morning void."
1 a support group can help the parents work through their pain by nonjudgmental sharing of feelings. the correct option identifies a statement that indicates positive, normal grieving.
a nurse in a maternity unit is providing emotional support to a client and her significant other who are preparing to be discharged from the hospital after the birth of a dead fetus. which statement made by the client indicates a component of the normal grieving process? 1) "we want to attend a support group." 2) "we never want to try to have a baby again." 3) "we are going to try to adopt a child immediately." 4) "we are okay, and we're going to try to have another baby immediately."
a, d, e T1 indicates the client has delivered one newborn at term, G3 indicates the client had two prior pregnancies and the client is currently pregnant, and L1 indicates the client has one living child.
a nurse in a prenatal clinic is caring for a client who is in the first trimester of pregnancy. the client's health record includes this data: G3 T1 P0 A1 L1. how should the nurse interpret this information? (select all that apply.) a) client has delivered one newborn at term. b) client has experience no preterm labor. c) client has been through active labor. d) client has had two prior pregnancies. e) client has one living child.
c maternal hypotension occurs when the client is lying in the supine position and the weight of the gravid uterus places pressure on the vena cava, decreasing venous blood flow to the heart.
a nurse in a prenatal clinic is caring for a client who is pregnant and experiencing episodes of maternal hypotension. the client asks the nurse what causes these episodes. which of the following responses should the nurse make? a) "this is due to an increase in blood volume." b) "this is due to pressure from the uterus on the diaphragm." c) "this is due to the weight of the uterus on the vena cava." d) "this is due to increased cardiac output."
b the nurse should be concerned about this client because they have exceeded the expected 3- to 4-lb weight gain of a client in the first trimester.
a nurse in a prenatal clinic is caring for four clients. which of the following clients' weight gain should the nurse report to the provider? a) 1.8 kg weight gain and is in the first trimester b) 3.6 kg weight gain and is in the first trimester c) 6.8 kg weight gain and is in the second trimester d) 11.3 kg weight gain and is in the third trimester
a good sources of calcium for bone and teeth formation include low-oxalate, dark green leafy vegetables.
a nurse in a prenatal clinic is providing education to a client who is at 8 weeks of gestation. the client states, "i don't like milk." which of the following foods should the nurse recommend as a good source of calcium? a) dark leafy vegetables b) deep red or orange vegetables c) white breads and rice d) meat, poultry, and fish
a, b, c, d, torch infections are flu-like in presentation, such as joint pain, malaise, and tender lymph nodes; they can include findings such as a rash.
a nurse in an antepartum clinic is assessing a client who has a TORCH infection. which of the following findings should the nurse expect? (select all that apply.) a) joint pain b) malaise c) rash d) urinary frequency e) tender lymph nodes
b manifestations of an ectopic pregnancy include unilateral lower quadrant pain with or without bleeding. use on an IUD is a risk factor associated with this condition.
a nurse in the emergency department is caring for a client who reports abrupt, sharp, right-sided lower quadrant abdominal pain and bright red vaginal bleeding. the client states, "i missed one menstrual cycle and cannot be pregnant because i have an intrauterine device." the nurse should suspect which of the following? a) missed abortion b) ectopic pregnancy c) severe preeclampsia d) hydatidiform mole
a, b, d a respiratory rate less than 12/min, urinary output less than 25 mL/hr, and decreased level of consciousness are manifestations of magnesium sulfate toxicity.
a nurse is administering magnesium sulfate IV for seizure prophylaxis to a client who has severe preeclampsia. which of the following indicates magnesium sulfate toxicity? (select all that apply.) a) respirations less than 12/min b) urinary output less than 25 mL/hr c) hyperreflexic deep-tendon reflexes d) decreased level of consciousness e) flushing and sweating
a, c, e the use of a vacuum extractor should be avoided for a client who is HIV positive due to risk of exposing the fetus to maternal blood; the use of forceps during delivery and internal fetal monitoring should be avoided due to the risk of fetal bleeding.
a nurse is admitting a client who is in labor and has HIV. which of the following interventions should the nurse identify as contraindicated for this client? (select all that apply.) a) vacuum extractor b) oxytocin infusion c) forceps d) internal fetal monitoring
a, c, d acute fetal distress, vaginal bleeding, and cervical dilation greater than 6 cm are complications that are contraindications for magnesium sulfate therapy.
a nurse is caring for a client who has a prescription for magnesium sulfate. the nurse should recognize that which of the following are contraindications for use of this medication? (select all that apply.) a) fetal distress b) preterm labor c) vaginal bleeding d) cervical dilation greater than 6 cm e) severe gestational hypertension
a ceftriaxone IM or doxycycline orally for 7 days is prescribed for the treatment of gonorrhea.
a nurse is caring for a client who has gonorrhea. which of the following medications should the nurse expect the provider will prescribe? a) ceftriaxone b) fluconazole c) metronidazole d) zidovudine
b the presence of ketones in the urine is associated with the breakdown of proteins and fats that occurs in a client who has hyperemesis gravidarum.
a nurse is caring for a client who has suspected hyperemesis gravidarum and is reviewing the client's laboratory reports. which of the following findings is a manifestation of this condition? a) Hgb 12.2 g/dL b) urine ketones present c) alanine aminotransferase 20 IU/L d) blood glucose 114 mg/dL
a, b, d diabetes, multifetal pregnancy, and gestational trophoblastic disease are risk factors for hyperemesis gravidarum.
a nurse is caring for a client who is at 14 weeks of gestation and had hyperemesis gravidarum. the nurse should identify that which of the following are risk factors for the client? (select all that apply.) a) diabetes b) multifetal pregnancy c) maternal age greater than 40 d) gestational trophoblastic disease e) oligohyramnios
a betamethasone is given to promote lung maturity if delivery is anticipated.
a nurse is caring for a client who is at 32 weeks of gestation and has a placenta previa. the nurse notes that the client is actively bleeding. which of the following medications should the nurse expect the provider will prescribe? a) betamethasone b) indomethacin c) nifedipine d) methylergonovine
d a client's report of severe shoulder pain is a finding associated with a ruptured ectopic pregnancy due to the presence of blood in the abdominal cavity, which irritates the diaphragm and phrenic nerve.
a nurse is caring for a client who is experiencing a ruptured ectopic pregnancy. which of the following findings is expected with this condition? a) no alteration in menses b) transvaginal ultrasound indicating a fetus in the uterus c) blood progesterone greater than the expected reference range d) report of severe shoulder pain
a, b, c, d erythromycin is administered to the infant immediately following delivery to prevent neisseria gonorrheae and chlamydia trachomatis; ritonavir is prescribed to a client in labor who is HIV-positive; penicillin G or ampicillin may be prescribed to treat positive GBS.
a nurse is caring for a client who is in labor. the nurse should identify that which of the following infections can be treated during labor or immediately following birth? (select all that apply.) a) gonorrhea b) chlamydia c) HIV d) group B streptococcus beta-hemolytic e) TORCH infection
b a test of the L/S ratio is done as a part of an amniocentesis to determine fetal lung maturity.
a nurse is caring for a client who is in preterm labor and is scheduled to undergo an amniocentesis. the nurse should evaluate which of the following tests to assess fetal lung maturity? a) alpha-fetoprotein b) lecithin/sphingomyelin ratio c) kleihauer-betke test d) indirect coombs' test
a, b, c decreased fetal movement, IUGR, and postmaturity are indications for a CST.
a nurse is caring for a client who is pregnant and is to undergo a contraction stress test. which of the following findings are indications for this procedure? (select all that apply.) a) decreased fetal movement b) intrauterine growth restriction c) postmaturity d) placenta previa e) amniotic fluid emboli
a vaginal bleeding indicates a potential complication of the placenta such as placenta previa. instruct the client to notify the provider immediately.
a nurse is caring for a client who is pregnant and reviewing manifestations of complications the client should promptly report to the provider. which of the following complications should the nurse include? a) vaginal bleeding b) swelling of the ankles c) heartburn after eating d) lightheadedness when lying on back
a april 1st minus 3 months plus 7 days and 1 year equals an estimated date of delivery of january 8.
a nurse is caring for a client who is pregnant and states that their last menstrual period was april 1st. which of the following is the client's estimated date of delivery? a) january 8 b) january 15 c) february 8 d) february 15
d the acoustic vibration device is activated for 3 seconds on the maternal abdomen over the fetal head to awaken a sleeping fetus.
a nurse is caring for a client who is pregnant and undergoing a nonstress test. the client asks why the nurse is using an acoustic vibration device. which of the following responses should the nurse make? a) "it is used to stimulate uterine contractions." b) "it will decrease the incidence of uterine contractions." c) "it lulls the fetus to sleep." d) "it awakens a sleeping fetus."
d calcium gluconate is the antidote for magnesium sulfate.
a nurse is caring for a client who is receiving IV magnesium sulfate. which of the following medications should the nurse anticipate administering if magnesium sulfate toxicity is suspected? a) nifedipine b) pyridoxine c) ferrous sulfate d) calcium gluconate
d betamethasone is a glucocorticoid given to clients in preterm labor to hasten surfactant production.
a nurse is providing care for a client who is in preterm labor at 32 weeks of gestation. which of the following medications should the nurse anticipate the provider will prescribe to hasten fetal lung maturity? a) calcium gluconate b) indomethacin c) nifedipine d) betamethasone
c a diet with increased vitamin C improves the absorption of ferrous sulfate.
a nurse is reviewing a new prescription for ferrous sulfate with a client who is at 12 weeks of gestation. which of the following statements by the client indicates understanding of the teaching? a) "i will take this pill with my breakfast." b) "i will take this medication with a glass of milk." c) "i plan to drink more orange juice while taking this pill." d) "i plan to add more calcium-rich foods to my diet while taking this medication."
d orange juice contains vitamin C, which aids in the absorption of iron.
a nurse is reviewing a new prescription for iron supplements with a client who is at 8 weeks of gestation and has iron deficiency anemia. which of the following beverages should the nurse instruct the client to take the iron supplements with? a) ice water b) low-fat or whole milk c) tea or coffee d) orange juice
d the client should record daily fetal kick counts.
a nurse is reviewing discharge teaching with a client who has premature rupture of membranes at 26 weeks of gestation. which of the following instructions should the nurse include in the teaching? a) use a condom with sexual intercourse. b) avoid bubble bath solution when taking a tub bath. c) wipe from the back to front when performing perineal hygiene. d) keep a daily record of fetal kick counts.
b, c, e fetal breathing movements, fetal tone, and amniotic fluid volume are included in the BPP.
a nurse is reviewing findings of a client's biophysical profile. the nurse should expect which of the following variables to be included in this test? (select all that apply.) a) fetal weight b) fetal breathing movement c) fetal tone d) fetal position e) amniotic fluid volume
d postpartum clients who are at risk for inadequate dietary calcium should continue taking calcium supplements during lactation.
a nurse is reviewing postpartum nutrition needs with a group of clients who have begun breastfeeding their newborns. which of the following statements by a member of the group indicates an understanding of the teaching? a) "i am glad i can have my morning coffee." b) "i should take folic acid to increase my milk supply." c) "i will continue adding 330 calories per day to my diet." d) "i will continue my calcium supplements because i don't like milk."
b, c, d goodell's sign, ballottement, and chadwick's sign are probable signs of pregnancy.
a nurse is reviewing the health record of a client who is pregnant. the provider indicated the client exhibits probable signs of pregnancy. which of the following findings should the nurse expect? (select all that apply.) a) montgomery's glands b) goodell's sign c) ballottement d) chadwick's sign e) quickening
a, b, c breast tenderness, urinary frequency, and epistaxis are common discomforts occurring during the first trimester of pregnancy.
a nurse is teaching a client who is at 6 weeks of gestation about common discomforts of pregnancy. which of the following findings should the nurse include? (select all that apply.) a) breast tenderness b) urinary frequency c) epistaxis d) dysuria e) epigastric pain
c the client's bladder should be empty to avoid an inadvertent puncture during the procedure.
a nurse is teaching a client who is pregnant about the amniocentesis procedure. which of the following statements should the nurse include in the teaching? a) "you will lay on your right side during the procedure." b) "you should not eat anything for 24 hours prior to the procedure." c) "you should empty your bladder prior to the procedure." d) "the test is done to determine gestational age."
c, d the pelvic rock or tilt exercise stretches the muscles of the lower back and helps relieve lower-back pain. the use of proper body mechanics prevents back injury due to the incorrect use of muscles when lifting.
a nurse is teaching a group of clients who are pregnant about measures to relieve backache during pregnancy. which of the following measures should the nurse include? (select all that apply.) a) avoid any lifting. b) perform kegel exercises twice a day. c) perform the pelvic rock exercise every day. d) use proper body mechanics. e) avoid constrictive clothing.
d toxoplasmosis, a TORCH infection, is contracted by consuming undercooked meat.
a nurse manager is reviewing ways to prevent a TORCH infection during pregnancy with a group of newly licensed nurses. which of the following statements by a nurse indicates understanding of the teaching? a) "obtain an immunization against rubella early in pregnancy." b) "seek prophylactic treatment if cytomegalovirus is detected during pregnancy." c) "a client should avoid crowded places during pregnancy." d) "a client should avoid consuming undercooked meat while pregnant."
2 leukorrhea begins during the first trimester. many clients notice a thin, colorless, or yellow vaginal discharge throughout pregnancy. some clients become distressed about this condition, but it does not require that the client report to the health clinic or emergency department immediately. if vaginal discharge is profuse, the client may use panty liners, but she should not wear tampons because of the risk of infection. if the client uses panty liners, she should change them frequently.
a pregnant client in the first trimester calls the nurse at a health care clinic and reports that she has noticed a thin, colorless vaginal drainage. the nurse should make which statement to the client? 1) "come to the clinic immediately." 2) "the vaginal discharge may be bothersome, but is a normal occurrence." 3) "report to the emergency department at the maternity center immediately." 4) "use tampons if the discharge is bothersome, but be sure to change the tampons every 2 hours."
4 severe preeclampsia can trigger disseminated intravascular coagulation because of the widespread damage to vascular integrity. bleeding is an early sign of DIC and should be reported to the primary health care provider if noted on assessment.
the nurse is performing an assessment on a pregnant client in the last trimester with a diagnosis of preeclampsia. the nurse reviews the assessment findings and determines that which finding is most commonly associated with a complication of this diagnosis? 1) enlargement of the breasts 2) complaints of feeling hot when the room is cool 3) periods of fetal movement followed by quiet periods 4) evidence of bleeding, such as in the gums, petechiae, and purpura
2, 4 magnesium toxicity can occur from magnesium sulfate therapy. signs of magnesium sulfate toxicity relate to the central nervous system depressant effect of the medication and include respiratory depression, loss of deep tendon reflexes, and a sudden decline in fetal heart rate and maternal heart rate and blood pressure. respiratory rate below 12 breaths per minute is a sign of toxicity. urine output should be at least 25 to 30 mL per hour. proteinuria of 3+ is an expected finding in a client with preeclampsia. presence of deep tendon reflexes is a normal and expected finding. therapeutic serum levels of magnesium are 4 to 7.5 mEq/L.
a pregnant client is receiving magnesium sulfate for the management of preeclampsia. the nurse determines that the client is experiencing toxicity from the medication if which findings are noted on assessment? select all that apply. 1) proteinuria of 3+ 2) respirations of 10 breaths per minute 3) presence of deep tendon reflexes 4) urine output of 20 mL in an hour 5) serum magnesium level of 4 mEq/L
3 braxton hicks contractions are irregular, painless contractions that may occur intermittently throughout pregnancy. because braxton hicks contractions may occur and are normal in some pregnant women during pregnancy, there is no reason to notify the primary health care provider. this client is not in preterm labor and, therefore, does not need to be placed on bed rest or be admitted to the hospital to be monitored.
a pregnant client is seen for a regular prenatal visit and tells the nurse that she is experiencing irregular contractions. the nurse determines that she is experiencing braxton hicks contractions. on the basis of this finding, which nursing actions is appropriate? 1) contact the primary health care provider. 2) instruct the client to maintain bed rest for the remainder of the pregnancy. 3) inform the client that these contractions are common and may occur throughout the pregnancy. 4) call the maternity unit and inform them that the client will be admitted in a preterm labor condition.
2 more than one medication may be used to prevent the growth of resistant organisms in a pregnant client with tuberculosis. treatment must continue for a prolonged period. the preferred treatment for the pregnant client is isoniazid plus rifampin daily for 9 months. ethambutol is added initially if medication resistance is suspected. pyridoxine often is administered with isoniazid to prevent fetal neurotoxicity. the client does not need to stay at home during treatment, and therapeutic abortion is not required.
a pregnant client reports to a health care clinic, complaining of loss of appetite, weight loss, and fatigue. after assessment of the client, tuberculosis is suspected. a sputum culture is obtained and identifies mycobacterium tuberculosis. which instruction should the nurse include in the client's teaching plan? 1) therapeutic abortion is required. 2) isoniazid plus rifampin will be required for 9 months. 3) she will have to stay at home until treatment is completed. 4) medication will not be started until after delivery of the fetus.
2, 3, 4, 5 rubella vaccine is administered to women who have not had rubella or women who are not serologically immune. the vaccine may be administered in the immediate postpartum period to prevent the possibility of contracting rubella in future pregnancies. the live attenuated rubella virus is not communicable in breast milk; breast-feeding does not need to be stopped. the client is counseled not to become pregnant for 1 to 3 months after immunization or as specified by the obstetrician because of a possible risk to a fetus from the live virus vaccine; the client must be using effective birth control at the time of the immunization. the client should avoid contact with immunosuppressed individuals because of their low immunity toward live viruses and because the virus is shed in the urine and other body fluids. the vaccine is administered by the subcutaneous route. a hypersensitivity reaction can occur if the client has an allergy to eggs because the vaccine is made from duck eggs. there is no useful or necessary reason for covering the area of the injection with a sterile gauze.
a rubella titer result if a 1-day postpartum client is less than 1:8, and a rubella virus vaccine is prescribed to be administered before discharge. the nurse provides which information to the client about the vaccine? select all that apply. 1) breast-feeding needs to be stopped for 3 months. 2) pregnancy needs to be avoided for 1 to 3 months. 3) the vaccine is administered by the subcutaneous route. 4) exposure to immunosuppressed individuals needs to be avoided. 5) a hypersensitivity reaction can occur if the client has an allergy to eggs. 6) the are of the injection needs to be covered with a sterile gauze for 1 week.
1 when a loss or death occurs, the nurse should ensure that parents have been honestly told about the situation by their primary health care provider or others on the health care team. it is important for the nurse to be with the parents at this time and to use therapeutic communication techniques. the nurse must also consider cultural and religious/spiritual practices and beliefs. the correct option provides a supportive, giving, and caring response.
a stillborn baby was delivered in the birthing suite a few hours ago. after the delivery, the family remained together, holding and touching the baby. which statement by the nurse would assist the family in their period of grief? 1) "what can i do for you?" 2) "now you have an angel in heaven." 3) "don't worry, there is nothing you could have done to prevent this from happening." 4) "we will see to it that you have an early discharge so that you don't have to be reminded of this experience."
1 abruptio placentae is the premature separation of the placenta from the uterine wall after the 20th week of gestation and before the fetus is delivered. the goal of management in abruptio placentae is to control the hemorrhage and deliver the fetus as soon as possible. delivery is the treatment of choice if the fetus is at term gestation or if the bleeding is moderate to severe and the client or fetus is in jeapordy.
an ultrasound is performed on a client at term gestation who is experiencing moderate vaginal bleeding. the results of the ultrasound indicate that abruptio placentae is present. on the basis of these findings, the nurse should prepare the client for which anticipated prescription? 1) delivery of the fetus 2) strict monitoring of intake and output 3) complete bed rest for the remainder of the pregnancy 4) the need for weekly monitoring of coagulation studies until the time of delivery
1, 3, 5 in a pregnant client, DIC is a condition in which the clotting cascade is activated, resulting in the formation of clots in the microcirculation. predisposing conditions include abruptio placentae, amniotic fluid embolism, gestational hypertension, HELLP syndrome, intrauterine fetal death, liver disease, sepsis, severe postpartum hemorrhage, and blood loss. delivering a large newborn is not considered a risk factor for DIC. hemorrhage is a risk factor for DIC; however, a loss of 500 mL is not considered hemorrhage.
the client in a maternity unit is reviewing the clients' records. which clients should the nurse identify as being at the most risk for developing disseminated intravascular coagulation? select all that apply. 1) a primigravida with abruptio placentae 2) a primigravida who delivered a 10-lb infant 3 hours ago 3) a gravida 2 who has just been diagnosed with dead fetus syndrome 4) a gravida 4 who delivered 8 hours ago and has lost 500 mL of blood 5) a primigravida at 29 weeks of gestation who was recently diagnosed with gestational hypertension
1, 3 HIV is transmitted by intimate sexual contact and the exchange of body fluids, exposure to infected blood, and passage from an infected woman to her fetus. clients who fall into the high-risk category for HIV infection include individuals who have used intravenous drugs, individuals who experience persistent and recurrent sexually transmitted infections, and individuals who have a history of multiple sexual partners. gestational diabetes mellitus does not predispose the client to HIV. a client with a heterosexual partner, particularly a client who has had only one sexual partner in 10 years, does not have a high risk for contracting HIV.
the clinic nurse is performing a psychosocial assessment of a client who has been told that she is pregnant. which assessment findings indicate to the nurse that the client is at risk for contracting human immunodeficiency virus? select all that apply. 1) the client has a history of intravenous drug use. 2) the client has a significant other who is heterosexual. 3) the client has a history of sexually transmitted infections. 4) the client has had one sexual partner for the past 10 years. 5) the client has a previous history of gestational diabetes mellitus.
1 a sign of preeclampsia is persistent hypertension. a low-grade fever or increased pulse rate is not associated with preeclampsia. generalized edema may occur but is not a specific sign of preeclampsia because it can occur in many conditions.
the home care nurse is monitoring a pregnant client who is at risk for preeclampsia. at each home care visit, the nurse assesses the client for which sign of preeclampsia? 1) hypertension 2) low-grade fever 3) generalized edema 4) increased pulse rate
4 if the client complains of a headache and blurred vision, the PHCP should be notified because these are signs of worsening preeclampsia.
the home care nurse visits a pregnant client who has a diagnosis of preeclampsia. which assessment finding indicates worsening of the preeclampsia and the need to notify the primary health care provider? 1) urinary output has increased. 2) dependent edema has resolved. 3) blood pressure reading is at the prenatal baseline. 4) the client complains of a headache and blurred vision.
2 placenta previa is an improperly implanted placenta in the lower uterine segment near or over the internal cervical os. manual pelvic examinations are contraindicated when vaginal bleeding is apparent until a diagnosis is made and placenta previa is ruled out. digital examination of the cervix can lead to hemorrhage. a diagnosis of placenta previa is made by ultrasound. the hemoglobin and hematocrit levels are monitored, and external electronic fetal heart rate monitoring is initiated. electronic fetal monitoring is crucial in evaluating the status of the fetus, who is at risk for severe hypoxia.
the maternity nurse is preparing for the admission of a client in the third trimester of pregnancy who is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. the nurse reviews the primary health care provider's prescriptions and should question which prescription? 1) prepare the client for an ultrasound. 2) obtain equipment for a manual pelvic examination. 3) prepare to draw a hemoglobin and hematocrit blood sample. 4) obtain equipment for external electronic fetal heart rate monitoring.
4 hepatitis B virus is highly contagious and is transmitted by direct contact with blood and body fluids of infected persons. the rationale for identifying childbearing clients with this disease is to provide adequate protection of the fetus and the newborn, to minimize transmission to other individuals, and to reduce maternal complications. the correct option provides the best evaluation of maternal understanding of disease transmission.
the nurse evaluates the ability of a hepatitis B-positive mother to provide safe bottle-feeding to her newborn during postpartum hospitalization. which maternal action best exemplifies the mother's knowledge of potential disease transmission to the newborn? 1) the mother requests that the window be closed before feeding. 2) the mother holds the newborn properly during feeding and burping. 3) the mother tests the temperature of the formula before initiating feeding. 4) the mother washes and dries her hands before and after self-care of the perineum and asks for a pair of gloves before feeding.
3 exercise is safe for a client with gestational diabetes mellitus and is helpful in lowering the blood glucose level. dietary modifications are the mainstay of treatment, and the client is placed on a standard diabetic diet. many clients are taught to perform blood glucose monitoring. if the client is not performing the blood glucose monitoring at home, it is performed at the clinic or obstetrician's office. signs of infection need to be reported to the obstetrician.
the nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes mellitus. which statement made by the client indicates a need for further teaching? 1) "i should stay on the diabetic diet." 2) "i should perform glucose monitoring at home." 3) "i should avoid exercise because of the negative effects on insulin production." 4) "i should be aware of any infections and report signs of infection immediately to my obstetrician."
1, 2, 3, 4 the probable signs of pregnancy include uterine enlargement, hegar's sign, goodell's sign, chadwick's sign, ballottement, braxton hicks contractions, and a positive pregnancy test for the presence of human chorionic gonadotropin. positive signs of pregnancy include fetal heart rate detected by electronic device at 10 to 12 weeks and by nonelectronic device at 20 weeks of gestation, active fetal movements palpable by the examiner, and an outline of the fetus by radiography or ultrasonography.
the nurse is performing an assessment on a client who suspects that she is pregnant and is checking the client for probable signs of pregnancy. the nurse should assess for which probable signs of pregnancy? select all that apply. 1) ballottement 2) chadwick's sign 3) uterine enlargement 4) positive pregnancy test 5) fetal heart rate detected by a nonelectronic device 6) outline of fetus via radiography or ultrsonography
2 the client should sit or lie quietly on her side to perform kick counts. lying flat on the back is not necessary to perform this procedure, can cause discomfort, and presents a risk of vena cava syndrome. the client is instructed to place her hands on the largest part of the abdomen and concentrate on the fetal movements. the client records the number of movements felt during a specified time period. the client needs to notify the primary health care provider if she feels fewer than 10 kicks over two consecutive 2-hour intervals or as instructed by the PHCP.
the nurse in a health care clinic is instructing a pregnant client how to perform "kick counts." which statement by the client indicates a need for further instruction? 1) "i will record the number of movements or kicks." 2) "i need to lie flat on my back to perform the procedure." 3) "if i count fewer than 10 kicks in a 2-hour period, i should count the kicks again over the next 2 hours." 4) "i should place my hands on the largest part of my abdomen and concentrate on the fetal movements to count the kicks."
2 in placenta previa, the placenta is implanted in the lower uterine segment. the lower uterine segment does not contain the same intertwining musculature as the fundus of the uterus, and this site is more prone to bleeding.
the nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with placenta previa. the nurse reviews the plan of care and prepares to monitor the client for which risk associated with placenta previa? 1) infection 2) hemorrhage 3) chronic hypertension 4) disseminated intravascular coagulation
2 abruptio placentae is the premature separation of the placenta from the uterine wall after the twentieth week of gestation and before the fetus is delivered. in abruptio placentae, acute abdominal pain is present. uterine tenderness accompanies placental abruption, especially with a central abruption and trapped blood behind the placenta. the abdomen feels hard and board-like on palpation as the blood penetrates the myometrium and causes uterine irritability. a soft abdomen and painless, bright red vaginal bleeding in the second or third trimester of pregnancy are signs of placenta previa.
the nurse is assessing a pregnant client in the second trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. which assessment finding should the nurse expect to note if this condition is present? 1) soft abdomen 2) uterine tenderness 3) absence of abdominal pain 4) painless, bright red vaginal bleeding
1 insulin needs decrease in the first trimester of pregnancy because of increased insulin production by the pancreas and increased peripheral sensitivity to insulin.
the nurse is assessing a pregnant client with type 1 diabetes mellitus about her understanding regarding changing insulin needs during pregnancy. the nurse determines that further teaching is needed if the client makes which statement? 1) "i will need to increase my insulin dosage during the first 3 months of pregnancy." 2) "my insulin dose will likely need to be increased during the second and third trimesters." 3) "episodes of hypoglycemia are more likely to occur during the first 3 months of pregnancy." 4) "my insulin needs should return to prepregnant levels within 7 to 10 days after birth if i am bottle-feeding."
2 pregnancy outcomes can be described with the acronym GTPAL. G is gravidity, the number of pregnancies; T is term births, the number born at term; P is preterm births, the number born before 37 weeks of gestation; A is abortions or miscarriages, the number of abortions or miscarriages; and L is the number of current living children. a woman who is pregnant with twins and has a child has a gravida of 2. because the child was delivered at 38 weeks, the number of term births is 1, and the number of preterm births is 0. the number of abortions is 0, and the number of living children is 1.
the nurse is collecting data during an admission assessment of a client who is pregnant with twins. the client has a healthy 5-year-old child who was delivered at 38 weeks and tells the nurse that she does not have a history of any type of abortion or fetal demise. using GTPAL, what should the nurse document in the client's chart? 1) G=3, T=2, P=0, A=0, L=1 2) G=2, T=1, P=0, A=0, L=1 3) G=1, T=1, P=1, A=0, L=1 4) G=2, T=0, P=0, A=0, L=1
1, 4, 5 magnesium sulfate is a central nervous system depressant and relaxes smooth muscle, including the uterus. it is used to halt preterm labor contractions and is used for preeclampsia clients to prevent seizures. adverse effects include flushing, depressed respirations, depressed deep tendon reflexes, hypotension, extreme muscle weakness, decreased urine output, pulmonary edema, and elevated serum magnesium levels.
the nurse is monitoring a client in preterm labor who is receiving intravenous magnesium sulfate. the nurse should monitor for which adverse effects of this medication? select all that apply. 1) flushing 2) hypertension 3) increased urine output 4) depressed respirations 5) extreme muscle weakness 6) hyperactive deep tendon reflexes
3 during the second and third trimesters, fundal height in centimeters approximately equals the fetus's age in weeks +/- 2 cm. therefore, if the client is at 28 weeks' gestation, a fundal height of 30 cm would indicate that the client is measuring normal for gestational age. at 16 weeks, the fundus can be located halfway between the symphysis pubis and the umbilicus. at 36 weeks, the fundus is at the xiphoid process.
the nurse is performing an assessment of a pregnant client who is at 28 weeks of gestation. the nurse measures the fundal height in centimeters and notes that the fundal height is 30 cm. how should the nurse interpret this finding? 1) the client is measuring large for gestational age. 2) the client is measuring small for gestational age. 3) the client is measuring normal for gestational age. 4) more evidence is needed to determine size for gestational age.
4, 5, 6 placenta previa is an improperly implanted placenta in the lower uterine segment near or over the internal cervical os. painless, bright red vaginal bleeding in the second or third trimester of pregnancy is a sign of placenta previa. the client has a soft, relaxed, nontender uterus, and fundal height may be more than expected for gestational age. in abruptio placentae, severe abdominal pain is present. uterine tenderness accompanies placental abruption. in addition, in abruptio placentae, the abdomen feels hard and board-like on palpation, as the blood penetrates the myometrium and causes uterine irritability.
the nurse is performing an assessment on a client diagnosed with placenta previa. which assessment findings should the nurse expect to note? select all that apply. 1) uterine rigidity 2) uterine tenderness 3) severe abdominal pain 4) bright red vaginal bleeding 5) soft, relaxed, nontender uterus 6) fundal height may be greater than expected for gestational age
2, 3, 5 the obese pregnant client is at risk for complications such as venous thromboembolism and increased need for cesarean section. additionally, the obese client requires special considerations pertaining to nursing care. to prevent venous thromboembolism, particularly in the client who required cesarean section, frequent and early ambulation, prior to and after surgery, is recommended. routine administration of prophylactic pharmacological venous thromboembolism medications such as heparin is also commonly prescribed. an overbed lift may be needed to transfer a client from a bed to an operating table if cesarean section is necessary. increased monitoring and cleansing of a cesarean incision, if present, is necessary due to the increased abdominal fat. thromboembolism stockings or sequential compression devices will likely be prescribed because of the client's increased risk of blood clots.
the nurse is planning to admit a pregnant client who is obese. in planning care for this client, which potential client needs should the nurse anticipate? select all that apply. 1) bed rest as a necessary preventative measure may be prescribed. 2) administration of subcutaneous heparin postdelivery as prescribed. 3) an overbed lift may be necessary if the client requires a cesarean section. 4) less frequent cleansing of a cesarean incision, if present, may be prescribed. 5) thromboembolism stockings or sequential compression devices may be prescribed.
3 because amniocentesis is an invasive procedure, informed consent needs to be obtained before the procedure. after the procedure, the client is instructed to rest, but may resume light activity after the cramping subsides. the client is instructed to keep the puncture site clean and to report any complications, such as chills, fever, bleeding, leakage of fluid at the needle insertion site, decreased fetal movement, uterine contractions, or cramping. amniocentesis is an outpatient procedure and may be done in the obstetrician's office or in a special prenatal testing unit. hospitalization is not necessary after the procedure.
the nurse is providing instructions to a pregnant client who is scheduled for an amniocentesis. what instruction should the nurse provide? 1) strict bed rest is required after the procedure. 2) hospitalization is necessary for 24 hours after the procedure. 3) an informed consent needs to be signed before the procedure. 4) a fever is expected after the procedure because of the trauma to the abdomen.
4 constipation can cause the client to use the valsalva maneuver. the valsalva maneuver should be avoided in clients with cardiac disease because it can cause blood to rush to the heart and overload the cardiac system. constipation can be prevented by the addition of fluids and a high-fiber diet. a low-calorie diet is not recommended during pregnancy and could be harmful to the fetus. sodium should be restricted as prescribed by the primary health care provider, because excess sodium would cause an overload to the circulating blood volume and contribute to cardiac complications. diets low in fluid can cause a decrease in blood volume, which could deprive the fetus of nutrients.
the nurse is providing instructions to a pregnant client with a history of cardiac disease regarding appropriate dietary measures. which statement, if made by the client, indicates an understanding of the information provided by the nurse? 1) "i should increase my sodium intake during pregnancy." 2) "i should lower my blood volume by limiting my fluids." 3) "i should maintain a low-calorie diet to prevent any weight gain." 4) "i should drink adequate fluids and increase my intake of high-fiber foods."
1 perinatal transmission of HIV can occur during the antepartum period, during labor and birth, or in the postpartum period if the mother is breast-feeding. clients who have HIV will most likely be advised not to breast-feed; however, PHCPs recommendations regarding breast-feeding are always followed. there is no physiological reason why the newborn needs to be fed by nasogastric tube.
the nurse is providing instructions to a pregnant client with human immunodeficiency virus infection regarding care to the newborn after delivery. the client asks the nurse about the feeding options that are available. which response should the nurse make to the client? 1) "you will need to bottle-feed your newborn." 2) "you will need to feed your newborn by nasogastric tube feeding." 3) "you will be able to breast-feed for 6 months and then will need to switch to bottle-feeding." 4) "you will be able to breast-feed for 9 months and then will need to switch to bottle-feeding."
terbutaline
therapeutic use -preterm labor inhibition adverse drug reactions -respiratory effects: pulmonary edema, dyspnea, cough, tachypnea -cardiac effects: tachycardia, myocardial ischemia, chest pain, palpitations, hypotension -hypokalemia -hyperglycemia -fetal effects: hypotension, tachycardia, hyperinsulinemia/hypoglycemia, hyperbilirubinemia, hypocalcemia interventions -monitor respiratory status, including oxygen saturation. -initiate fluid restrictions if indicated. -stop tocolytic therapy for indications of pulmonary edema. -obtain baseline vital signs and an ECG before tocolytic therapy. -monitor fetal and maternal heart rate and blood pressure. -monitor patterns and intensity of chest pain. -stop tocolytic therapy for indications of maternal tachycardia, dysrhythmias, chest pain, or blood pressure below set parameters -prepare to administer propranolol to counteract cardiac adverse effects. -monitor cardiovascular status for 12 hr after discontinuation for tocolytic therapy. -initiate fluid and electrolyte remediation or replacement. -monitor blood glucose levels, especially for clients who have diabetes mellitus. -adjust dosages of insulin/hypoglycemic drugs accordingly. -monitor fetal heart rate and rhythm and report signs of fetal distress. -stop the infusion for serious alterations in fetal heart rate or rhythm. administration -confirm preterm labor and gestation between 20 and 36 weeks. -usually administered subcutaneously every 20 min, up to 3 hr, no longer than 48 hr -less often administered by IV infusion -monitor fetal heart rate and rhythm, and report signs of maternal or fetal distress. -stop the infusion for serious alterations in fetal heart rate or rhythm. client instructions -report shortness of breath, difficulty breathing, or cough. -report palpitations or chest pain. -report weakness, nausea, palpitations, or paresthesia. -report polyphagia, polydipsia, and polyuria. contraindications -known sensitivity precautions -diabetes mellitus -cardiac disease, hypertension -hyperthyroidism -glaucoma interactions -hypoglycemic drugs require increased dosing due to hyperglycemic effects. -monoamine oxidase inhibitors and tricyclic antidepressants increase the risk of hypertension, tachycardia, and angina.
magnesium sulfate
therapeutic use -prevent and treat seizure activity in client with severe preeclampsia or eclampsia adverse drug reactions -flushing, diaphoresis -drowsiness, muscle weakness -maternal hypotension, bradycardia, bradypnea -depressed/absent deep tendon reflexes -altered level of consciousness -decreased urine output -magnesium toxicity -reduced variability of fetal heart rate interventions -monitor infusion site. -check client for adverse effects. -check client before and throughout therapy for headache, dizziness, blurred vision, and muscle weakness. -monitor blood pressure, pulse, and respiratory rate every 15 to 30 min. -report respiratory rate of 12/min or less. -monitor DTRs every 1 to 4 hr. -discontinue infusion and notify provider of diminished or absent reflex. -monitor level of consciousness before initiation of medication and throughout therapy. -monitor strict input and output, with urinary output hourly. -monitor serum magnesium levels. -ensure antidote for toxicity, calcium gluconate or calcium chloride, is readily available. -monitor breath sounds. -report presence of crackles. -discontinue infusion and notify provider of findings. -monitor fetal heart rate for decreased variability. administration -loading dose of 4 to 6 g intermittent IV bolus as a secondary infusion over 15 to 30 min. use a volumetric pump to ensure accuracy of dose. -administer maintenance dose by continuous infusion at 2 g/hr. -monitor blood levels to maintain therapeutic level at 4 to 7 mEq/L. client instructions -tell the client to report adverse effects. -provide comfort measures. -instruct the client to change positions slowly from supine to upright and to sit until dizziness resolves. -assist the client as needed to promote safety. -explain the purpose of strict measurement of oral intake and urinary output. -explain that it is used to prevent seizures. -explain to the client the importance of frequent monitoring and respiratory status. -explain to the client the importance of frequent monitoring of fetal heart rate. contraindications -anuria -hypermagnesemia -heart block -hypocalcemia precautions -kidney disease -cardiac disease interactions -decreased absorption of tetracyclines -Ca channel blockers- increases antihypertensive effects
betamethasone
therapeutic use -to increase the production of lung surfactant and to accelerate lung maturity in fetuses between 24 and 34 weeks' gestation -to reduce the risk of respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, and neonatal death adverse drug reactions -pulmonary edema -hyperglycemia -hypertension interventions -monitor lung sounds and other indications. -report crackles in the lungs, productive cough, dyspnea, cyanosis, and other clinical manifestations of pulmonary edema to the provider. -monitor and treat episodes of hyperglycemia. -monitor blood pressure. administration -12 mg IM for 2-3 doses 24 hr apart -give deep IM in ventral gluteal or vastus lateralis muscle client instructions -instruct client to report shortness of breath, cough, and increased production of sputum. -tell the client to report polyphagia, polydipsia, or polyuria. -instruct client to report headache and dizziness. contraindications -hypersensitivity to any component -systemic fungal infections precautions -avoid using higher-than-recommended doses. interactions -glucocorticoids can decrease antibody responses to vaccines and can increase the risk of infection from live vaccines. -immunizations should be avoided while glucocorticoids are in use.
