Antepartum Nursing

After the nurse instructs a pregnant client about swimming and bathing during pregnancy, which client statement indicates the need for additional teaching? "I should avoid sitting in a sauna for prolonged periods." "I can take a bath daily but should be careful not to fall." "I can continue to swim as long as my membranes aren't ruptured." "I can relax in a hot tub for about 20 minutes."

Correct response: "I can relax in a hot tub for about 20 minutes." Explanation: Exposure to temperature extremes, such as from a hot tub, can cause damage to the fetus. Therefore, the client should avoid relaxing in a hot tub. The client's statement that relaxing in the hot tub would be OK indicates a need for further teaching.Swimming and tub bathing are allowed as long as the client's membranes have not ruptured. During the last trimester of pregnancy, the client's center of gravity has shifted. Therefore, the nurse should emphasize safety during tub bathing and swimming. Sitting in a sauna can cause damage to the fetus due to temperature extremes, so this activity should be avoided. The statements that swimming is not harmful, that bathing is not harmful, and that prolonged sauna use should be avoided are all correct and indicate that teaching of these concepts is not needed.

During a routine prenatal visit, a pregnant client reports constipation, and the nurse teaches her how to relieve it. Which statement indicates the client's understanding of the nurse's instructions? "I'll take iron supplements regularly." "I'll decrease my intake of green, leafy vegetables." "I'll limit fluid intake to four 8-oz (240 mL) glasses." "I'll increase my intake of unrefined grains."

Correct response: "I'll increase my intake of unrefined grains." Explanation: To increase peristalsis and relieve constipation, the client should increase her intake of high-fiber foods (such as green, leafy vegetables; unrefined grains; and fruits) and fluids. The use of iron supplements can cause — rather than relieve — constipation.

The public health nurse is teaching a prenatal class about tobacco smoke during pregnancy. Which comment made by one of the class members demonstrates that the teaching was effective? "My newborn is more at risk for heart problems if I smoke during pregnancy." "If I continue to smoke during pregnancy, my baby could be born small." "Smoking during pregnancy increases the risk of having a cesarean section." "My newborn will be more relaxed if I smoke during pregnancy."

Correct response: "If I continue to smoke during pregnancy, my baby could be born small." Explanation: Smoking exposure during pregnancy increases the risk of intrauterine growth restriction or a small baby. Smoking exposure during pregnancy also increases the risk of the newborn being more irritable but does not increase the risk for congenital heart problems or the risk of a cesarean section.

A client is a gravida 2 para 1 and is currently 12 weeks gestation. She states that she drank beer throughout her last pregnancy. The client asks the nurse if it is okay to have a few drinks during this current pregnancy. Which response by the nurse would be most appropriate? "It is not safe to consume alcohol in the second and third trimesters but the first is safe if consumed in moderation." "It is safer to consume wine than beer during pregnancy." "It is safe to consume 5 ounces or less of alcohol per week in the first trimester." "It is not safe to consume alcohol during pregnancy."

Correct response: "It is not safe to consume alcohol during pregnancy." Explanation: Complete abstinence from alcohol use during pregnancy is recommended. A safe level of alcohol consumption during pregnancy has not yet been established. Conclusive evidence surrounding the effects of either social or moderate drinking on the fetus, regardless of trimester or gestation, are not available. The best answer is to advise the pregnant women to abstain from all alcohol usage.

When the nurse instructs a pregnant client with a history of varicose veins about strategies to promote comfort, which client statement indicates that the teaching has been successful? "Support hose can be put on just before bedtime." "Wearing knee-high stockings is better than pantyhose." "Lying down with my feet elevated should help." "Restricting milk intake may provide some relief."

Correct response: "Lying down with my feet elevated should help." Explanation: The enlarging uterus exerts pressure on blood vessels carrying blood to and from the lower part of the body, especially the extremities, predisposing the client to varicosities. Prevention and management of varicosities includes lying down with feet elevated several times a day to promote venous return and avoiding anything that constricts the legs or thighs, such as round garters or knee-high hose.Supportive hose or elastic stockings may be helpful but should be applied as soon as the client awakens in the morning.Restriction of milk intake has no effect on varicosities.Knee-high stockings could cause constriction and should be avoided.

A mother approaches the nurse to discuss which childbirth education classes she should take. Which one of the following responses would be the most appropriate initial response from the nurse? "Is this your first pregnancy?" "What can you afford?" "What do you want to learn about?" "What classes are available at the center?"

Correct response: "What do you want to learn about?" Explanation: To be client centered, the nurse needs to determine what this mother's learning needs are. Other barriers that exist, such as finances and access to classes, should be part of the nurse's role to work with the parent to overcome as part of working to full scope of practice. This would not be the first question asked, however.

A student nurse asks the registered nurse about pulse and blood pressure changes during the prenatal period. Which of the following responses about changes in the cardiovascular system in the first and second trimester of pregnancy is appropriate? "Women will likely experience increases in both their pulse and blood pressure." "Women will likely experience no change in their pulse or blood pressure." "Women will likely experience a decrease in their pulse and an increase in their blood pressure." "Women will likely experience an increase in their pulse and a decrease in their blood pressure."

Correct response: "Women will likely experience an increase in their pulse and a decrease in their blood pressure." Explanation: The pulse rate frequently increases during pregnancy, although the amount varies from a small increase to 10 to 15 beats per minute. The blood pressure generally decreases slightly during pregnancy, reaching its lowest point during the second trimester.

When assessing a pregnant client with diabetes mellitus, the nurse stays alert for signs and symptoms of a vaginal or urinary tract infection (UTI). Which laboratory value makes this client more susceptible to such infections? +3 urine glucose blood glucose level of 60 mg/dL (3.3mmol/L) potassium level of 3.0 mEq/L (3.0 mmol/L) hemoglobin A1C of 6.8% \]]]]]]]]]]]]]]

Correct response: +3 urine glucose Explanation: Glycosuria, evidenced by a +3 urine glucose level, predisposes the pregnant diabetic client to vaginal infections (especially Candida vaginitis) and UTIs, because the hormonal changes of pregnancy affect vaginal pH and the bladder. Electrolyte imbalances, such as a potassium level of 3.0 mEq/L and hypoglycemia, evidenced by a blood glucose level of 60 mg/dl (3.3 mmol/L), aren't associated with vaginal infections or UTIs. Hemoglobin A1C of 6.8% is within normal range for a client with diabetes and doesn't increase the client's risk for infection.

A client diagnosed with gestational hypertension must have weekly blood pressure checks and urine testing at a clinic. She does not have transportation. How can the nurse help this client be compliant with her care? Set up cab service. Ask the clinic case manager to speak with the client. Do nothing. It's the client's responsibility to find a way to get to the clinic. Ask the client to find a friend to help her.

Correct response: Ask the clinic case manager to speak with the client. Explanation: The nurse should ask the case manager to speak with the client because the case manager is familiar with community resources that can assist with transportation. Resources and additional support will greatly increase the client's compliance. The nurse can't set up cab service if the client doesn't have the funds to pay for transportation. The client may be noncompliant if she has no assistance or if she has to rely on a friend to help.

A 29-year-old multigravida at 37 weeks' gestation is being treated for severe preeclampsia and has magnesium sulfate infusing at 3 g/h. What is the priority intervention to maintain safety for this client? Maintain continuous fetal monitoring. Encourage family members to remain at bedside. Assess reflexes, clonus, visual disturbances, and headache. Monitor maternal liver studies every 4 hours.

Correct response: Assess reflexes, clonus, visual disturbances, and headache. Explanation: The central nervous system (CNS) functioning and freedom from injury is a priority in maintaining well-being of the maternal-fetal unit. If the mother suffers CNS damage related to hypertension or stroke, oxygenation status is compromised, and the well-being of both mother and infant are at risk. Continuous fetal monitoring is an assessment strategy for the infant only and would be of secondary importance to maternal CNS assessment because maternal oxygenation will dictate fetal oxygenation and well-being. In preeclampsia, frequent assessment of maternal reflexes, clonus, visual disturbances, and headache give clear evidence of the condition of the maternal CNS system. Monitoring the liver studies does give an indication of the status of the maternal system, but the less invasive and highly correlated condition of the maternal CNS system in assessing reflexes, maternal headache, visual disturbances, and clonus is the highest priority. Psychosocial care is a priority and can be accomplished in ways other than having the family remain at the bedside.

Assessment of a client in active labor reveals the following: moderate discomfort; cervix dilated 3 cm, 0 station and completely effaced; and fetal heart rate of 136 bpm. Which should the nurse plan to do next? Assist the client with comfort measures and breathing techniques. Turn the client from the left side-lying position to the right side-lying position. Prepare the client for epidural anesthesia to relieve pain. Instruct the client that internal fetal monitoring is necessary.

Correct response: Assist the client with comfort measures and breathing techniques. Explanation: The client's assessment findings indicate that the client is in the latent phase of the first stage of labor. Therefore, the nurse should plan to assist the client with comfort measures and breathing techniques to relieve discomfort. The client can move around, walk, or ambulate at this phase of labor. If the client chooses to remain in bed, a left side-lying position provides the greatest perfusion. It is too early for the client to have an epidural anesthetic. Epidural anesthesia is usually administered when the cervix is dilated 4 to 5 cm. The fetal heart rate is normal, so internal fetal monitoring is not warranted at this time.

A client who is pregnant with her second child comes to the clinic complaining of a pulling and tightening sensation over her pubic bone every 15 minutes. She reports no vaginal fluid leakage. Because she has just entered her 36th week of pregnancy, she is apprehensive about her symptoms. Vaginal examination discloses a closed, thick, posterior cervix. These findings suggest that the client is experiencing: fetal distress. true labor contractions. Braxton Hicks contractions. back labor.

Correct response: Braxton Hicks contractions. Explanation: Braxton Hicks contractions cause pulling or tightening sensations, primarily over the pubic bone. Although these contractions may occur throughout pregnancy, they're most noticeable during the last 6 weeks of gestation in primigravid clients and the last 3 to 4 months in multiparous clients. Back labor refers to labor pain that typically starts in the back. Fetal distress doesn't cause contractions, although it may cause sharp abdominal pain. Decreased or absent fetal movements, green-tinged or yellowish green-tinged fluid, or port-wine-colored fluid may also indicate fetal distress. Pain from true labor contractions typically starts in the back and moves to the front of the fundus as a band of pressure that peaks and subsides in a regular pattern.

As the nurse enters the room of a newly admitted primigravid client diagnosed with severe preeclampsia, the client begins to experience a seizure. Which action should the nurse take first? Note the time when the seizure begins and ends. Call for immediate assistance. Turn the client to her left side. Insert an airway to improve oxygenation.

Correct response: Call for immediate assistance. Explanation: Principles of emergency management begin with calling for assistance. If a client begins to have a seizure, the first action by the nurse is to remain with the client and call for immediate assistance. The nurse needs to have some assistance in managing this client. After the seizure, the client needs intensive monitoring. An airway can be inserted, if appropriate, after the seizure ends. Noting the time the seizure begins and ends and turning the client to her left side should be done after assistance is obtained.

While assessing a multigravid client at 10 weeks' gestation, the nurse notes a purplish color to the vagina and cervix. The nurse documents this as what finding? Goodell's sign Chadwick's sign melasma Hegar's sign

Correct response: Chadwick's sign Explanation: A purplish blue discoloration of the vagina and cervix is termed Chadwick's sign; it is caused by increased vascularity of the vagina during pregnancy and is considered a probable sign of pregnancy. Goodell's sign, also considered a probable sign of pregnancy, refers to a softening of the cervix during pregnancy. Hegar's sign, also a probable sign of pregnancy, refers to a softening of the lower uterine segment. Melasma, the mask of pregnancy, refers to the pigmentation of the skin on the face during pregnancy. Melasma is considered a presumptive sign of pregnancy.

A 34-year-old multigravida at 36 weeks' gestation is diagnosed with preterm labor. The client has experienced one infant death due to preterm birth at 28 weeks' gestation. On admission to the antenatal unit, the nurse determines that the fetal heart rate is 140 bpm. What should the nurse do next? Administer oxygen by mask at 8 L/minute. Continue monitoring the client and fetus. Recheck the fetal heart rate again in 5 minutes. Notify the client's primary care provider immediately.

Correct response: Continue monitoring the client and fetus. Explanation: Fetal heart rate is normally between 110 and 160 bpm. The finding of a fetal heart rate at 140 bpm is within this normal range. Therefore, the nurse should continue to monitor the client and fetus.A fetal heart rate of 140 bpm is within the normal range of 110 to 160 bpm. Neither the fetus nor the mother is in any distress. Therefore, oxygen is not necessary.Because the fetal heart rate is not an abnormal reading, there is no need to notify the primary care provider, and the fetal heart rate does not need to be checked again in 5 minutes. However, continued monitoring based on agency policy is warranted.

A primigravid client at 16 weeks' gestation visits the clinic for a routine examination. The client tells the nurse that she knows someone whose baby was born with congenital toxoplasmosis. What should the nurse instruct the client to do to prevent transmission of the toxoplasmosis protozoan? Plan to be vaccinated for this condition at the next visit. Avoid contact with anyone diagnosed with this disease. Cook all meats, such as beef and pork, thoroughly. Consider a course of prophylactic penicillin as prevention.

Correct response: Cook all meats, such as beef and pork, thoroughly. Explanation: Toxoplasmosis is a protozoal infection caused by Toxoplasma gondii, which is transmitted through ingestion of raw or undercooked meat, through contact with infected cat feces, or across the placental barrier from the mother to the fetus. The mother should be instructed to cook all meats thoroughly, avoid touching the mucous membranes when handling raw meat, thoroughly clean all kitchen surfaces that have come in contact with raw meat, avoid uncooked eggs, and avoid contact with cat litter boxes and cat feces. The disease is not spread by contact with an infected person. Although prophylactic penicillin may be used for pregnant clients who test positive for group B streptococcus, penicillin is not used to treat toxoplasmosis. Toxoplasmosis may be treated with a combination of pyrimethamine and sulfadiazine, accompanied by folic acid to reduce the toxicity of the other two drugs. However, controversy exists about whether to treat the mother. There is no vaccine for toxoplasmosis. Although a vaccine exists for rubella, this is given within 72 hours postpartum if the client is not immune.

The nurse is caring for a client in the first trimester of pregnancy with a threatened miscarriage. The client is ordered to bed rest with bathroom privileges. The client is experiencing muscle cramps and pain in her legs while on bed rest. What is an appropriate recommendation from the nurse? Select all that apply. Frequently walking around the room. Roll side to side in bed a few times an hour. Do mild stretching exercises. Have support persons do passive ROM exercises. Do gentle exercises of the legs.

Correct response: Do gentle exercises of the legs. Roll side to side in bed a few times an hour. Do mild stretching exercises. Explanation: Some activity is recommended and can be done a few times per hour to improve muscle tone, circulation, and sense of well-being. These can include gentle exercises such as circling of the feet, rolling side to side, stretching, or gently tensing and relaxing leg muscles. Passive ROM exercises are not as effective as doing active gentle exercises. Walking around the room increases the risk of pregnancy loss with a threatened abortion.

A nurse is caring for a client who is 32 weeks gestation and being monitored in the antepartum unit for pre-eclampsia. The client suddenly reports continuous abdominal pain and vaginal bleeding. Which nursing interventions are priorities? Select all that apply. Monitor the amount of vaginal bleeding. Reassure the client that she will be able to continue the pregnancy. Auscultate fetal heart tones. Prepare for vaginal birth. Evaluate maternal vital signs. Monitor intake and output.

Correct response: Evaluate maternal vital signs. Auscultate fetal heart tones. Monitor the amount of vaginal bleeding. Monitor intake and output. Explanation: The client's symptoms indicate that regular assessment is needed. The nurse must immediately evaluate the mother's well-being by evaluating vital signs; evaluate the well-being of the fetus by auscultating fetal heart tones; monitor the amount of blood loss; and evaluate volume status by monitoring intake and output. At this point, there is no indication of an imminent vaginal birth. It is important to offer comforting words to the client but not offer false reassurance.

A client, now 37 weeks pregnant, calls the clinic because she is concerned about being short of breath and is unable to sleep unless she places three pillows under her head. After listening to the client's concerns, the nurse should take which action? Arrange for the client to be admitted to the birth center and prepare for birth. Make an appointment because the client needs to be evaluated. Explain that these are expected problems for the latter stages of pregnancy. Tell the client to go to the hospital; she may be experiencing signs of heart failure.

Correct response: Explain that these are expected problems for the latter stages of pregnancy. Explanation: The nurse must distinguish between normal physiologic complaints of the latter stages of pregnancy and those that need referral to the health care provider. In this case, the client indicates normal physiologic changes caused by the growing uterus and pressure on the diaphragm. These signs don't indicate heart failure. The client doesn't need to be seen or admitted to the birth center.

A client who's 2 months pregnant complains of urinary frequency and says she gets up several times at night to go to the bathroom. She denies other urinary symptoms. How should the nurse intervene? Explain that urinary frequency isn't a sign of urinary tract infection (UTI). Explain that urinary frequency is expected during the first trimester. Advise the client to decrease her daily fluid intake. Refer the client to a urologist for further investigation.

Correct response: Explain that urinary frequency is expected during the first trimester. Explanation: Urinary frequency is expected during the first trimester as the growing uterus exerts pressure on the client's bladder. Although the client should increase fluid intake during pregnancy, she should avoid drinking fluids after 6 p.m. to reduce the need to get up at night. Because urinary frequency is a normal discomfort of pregnancy and the client has no other signs or symptoms of UTI, referral to a urologist is unnecessary. Urinary frequency, dysuria, and voiding of small amounts of urine indicate UTI.

A multipara at 16 weeks' gestation is diagnosed as having a fetus with probable anencephaly. The client is from a conservative faith and has decided to continue the pregnancy and donate the neonatal organs after the death of the neonate. What should the nurse do? Contact the client's minister to discuss the client's options related to the pregnancy. Explore his or her own feelings about the issues of anencephaly and organ donation. Advise the client that the prolonged neonatal death will be very painful for her. Ask the client if her family agrees with her decision.

Correct response: Explore his or her own feelings about the issues of anencephaly and organ donation. Explanation: Anencephaly is a neural tube defect that is not compatible with life, although some of these infants live for several days before death occurs. When the client has decided to continue the pregnancy and donate the neonatal organs after the death of the neonate, the nurse should remain nonjudgmental. The nurse should explore his or her feelings about the issue of anencephaly and organ donation. The nurse should not make judgments about the client's position, nor should the nurse try to persuade the client to terminate the pregnancy. Contacting the client's minister to explore the client's options is not appropriate. As the client is from a conservative faith, she probably has already discussed the matter with her minister. Telling the client that the neonatal death will be prolonged and painful to her is not helpful. Death may occur very soon after birth. Asking the client about her family's opinion does not help the support the client's decision.

A primigravid client with class II heart disease who is visiting the clinic at 8 weeks' gestation tells the nurse that she has been maintaining a low-sodium, 1,800-calorie diet. Which instruction should the nurse give the client? Increase caloric intake to 2,200 calories daily to promote fetal growth. Take iron supplements with milk to enhance absorption. Avoid folic acid supplements to prevent megaloblastic anemia. Severely restrict sodium intake throughout the pregnancy.

Correct response: Increase caloric intake to 2,200 calories daily to promote fetal growth. Explanation: The client can continue a low-sodium diet but should increase the caloric intake to 2,200 calories daily to provide adequate nutrients to support fetal growth and development. Folic acid supplements, a standard component of care, are used to prevent folic acid deficiency, which is associated with megaloblastic anemia during pregnancy. Severe restriction of sodium intake is not recommended because sodium is necessary to maintain fluid volume. Iron supplements should be taken with acidic foods and fluids (e.g., citrus juices) for maximum absorption. Milk decreases the absorption of iron.

A multigravid client at 34 weeks' gestation who is leaking amniotic fluid has just been hospitalized with a diagnosis of preterm premature rupture of membranes and preterm labor. The client's contractions are 20 minutes apart, lasting 20 to 30 seconds. Her cervix is dilated to 2 cm. The nurse reviews prescriptions (see chart). Which prescription should the nurse initiate first? Administer betamethasone. Initiate fetal and contraction monitoring. Obtain the urine specimen. Start the intravenous infusion.

Correct response: Initiate fetal and contraction monitoring. Explanation: The nurse should initiate fetal and contraction monitoring for this client upon arrival to the unit. This gives the nurse data regarding changes in fetal and maternal contraction status before completing the other prescriptions. Next, the betamethasone would be given to begin the maturation process for the fetal lungs. The nurse should then start an intravenous infusion to provide a line for immediate intravenous access, if needed, and provide hydration for the client. The nurse should obtain the urine specimen prior to administering any antibiotic therapy, if prescribed.

A client has meconium-stained amniotic fluid. Fetal scalp sampling indicates a blood pH of 7.12; fetal bradycardia is present. Based on these findings, the nurse should take which action? Administer amnioinfusion. Prepare for cesarean birth. Reposition the client. Start I.V. oxytocin infusion as ordered.

Correct response: Prepare for cesarean birth. Explanation: Fetal blood pH of 7.19 or lower signals severe fetal acidosis; meconium-stained amniotic fluid and bradycardia are further signs of fetal distress that warrant cesarean birth. Amnioinfusion is indicated when the only abnormal fetal finding is meconium-stained amniotic fluid. Client repositioning may improve uteroplacental perfusion, but only serves as a temporary measure because the risk of fetal asphyxia is imminent. Oxytocin administration increases contractions, exacerbating fetal stress.

Which of the following actions would the nurse perform if the nurse suspects the complication of thrombophlebitis in the leg in a postpartum woman? Select all that apply. Prepare for administration of Tissue Plasminogen Activator (TPA). Administer estrogens for lactation suppression. Place client on bed rest. Prepare the client for venous Doppler ultrasound. Assess vital signs.

Correct response: Prepare the client for venous Doppler ultrasound. Assess vital signs. Place client on bed rest. Explanation: Tenderness, elevated temperature of limb, consistent pain, and edema are indicators of thrombophlebitis. Changes in limb color of either blueness or redness can also occur with thrombophlebitis. With symptoms of thrombophlebitis, the client should be placed on bed rest, and the nurse should assess vital signs frequently. The client will need a diagnostic ultrasound of the vein for confirmation. The client will require anticoagulation, not TPA therapy. TPA in a postpartum woman would cause uncontrollable hemorrhage. Although the nurse wants to prevent dehydration, suppression of lactation would not be indicated. Giving the estrogens needed to stop breast milk production would also further increase the client's risk of clotting.

The nurse cares for a client who is 12 weeks pregnant and speaks Spanish only. Which interventions should the nurse include in the plan of care at the client's initial visit? Select all that apply. Review dietary intake and discuss nutrition. Discuss contraception and options. Discuss cultural differences and emphasize the differences between cultures. Provide brochures in the client's native language. Arrange for an interpreter for her appointments. Refer the client to a high-risk clinic.

Correct response: Provide brochures in the client's native language. Arrange for an interpreter for her appointments. Review dietary intake and discuss nutrition. Explanation: Providing culturally sensitive care includes providing printed material in the client's native language. There is nothing to indicate that this client is a high-risk pregnancy. Discussing cultural differences is not a priority or important at the first visit. Clients need to have an interpreter for each prenatal visit to translate and interpret questions. Contraceptive options are not a priority for the first prenatal visit. Reviewing dietary intake and discussing nutrition are an important component of early prenatal care.

An anxious young adult is brought to the interviewing room of a crisis shelter, sobbing and saying that she thinks she is pregnant but does not know what to do. Which nursing intervention is most appropriate at this time? Give the client some ideas about what to expect to happen next. Ask the client about the type of things that she had thought of doing. Question the client about her feelings and possible parental reactions. Recommend a pregnancy test after acknowledging the client's distress.

Correct response: Recommend a pregnancy test after acknowledging the client's distress. Explanation: Before any interventions can occur, knowing whether the client is pregnant is crucial in formulating a plan of care. Asking the client about what things she had thought about doing, giving the client some ideas about what to expect next, and questioning the client about her feelings and possible parental reactions would be appropriate after it is determined that the client is pregnant.

A client treated with terbutaline for premature labor is ready for discharge. Which instruction should the nurse include in the discharge teaching plan? Increase activity daily if not fatigued. Report a heart rate greater than 120 beats/minute to the health care provider. Call the health care provider if the fetus moves 10 times in an hour. Take terbutaline every 4 hours, during waking hours only.

Correct response: Report a heart rate greater than 120 beats/minute to the health care provider. Explanation: Because terbutaline can cause tachycardia, the client should be taught to monitor her radial pulse and call the health care provider for a heart rate greater than 120 beats/minute. Terbutaline must be taken every 4 to 6 hours around-the-clock to maintain an effective serum level that will suppress labor. A fetus normally moves 10 to 12 times per hour. The client does not need to contact the health care provider if such movement occurs. The client experiencing premature labor must maintain bed rest at home.

A nurse is caring for a client who is scheduled for amniocentesis. What will the nurse teach the client about this procedure? She may experience mild contractions after the procedure. She needs to empty her bladder prior to the procedure. Fetal monitoring will be done for 45 minutes prior to the procedure. An overnight stay in the hospital is needed.

Correct response: She needs to empty her bladder prior to the procedure. Explanation: While preparing a client for an amniocentesis, the woman should empty her bladder to avoid the risk of bladder puncture. The fetus will be monitored for 20 minutes prior to the procedure to evaluate fetal well-being and obtain a baseline to compare after the procedure. If the mother is Rh-negative, RhoGAM will be administered after the procedure to prevent potential sensitization to fetal blood. The fetal heart rate will be monitored continuously and the mother's vital signs every 15 minutes for an hour after the procedure. The nurse will assess the puncture site for bleeding. After recovery, the mother will go home to rest with instructions to report any bleeding or contractions. The mother should not have any contractions after the procedure.

After an amniotomy, which client goal should take the highest priority? The client will express increased knowledge about amniotomy. The client will report relief of pain. The client will display no signs of infection. The client will maintain adequate fetal tissue perfusion.

Correct response: The client will maintain adequate fetal tissue perfusion. Explanation: Amniotomy increases the risk of umbilical cord prolapse, which would impair the fetal blood supply and tissue perfusion. Because the fetus's life depends on the oxygen carried by that blood, maintaining fetal tissue perfusion takes priority over goals related to increased knowledge, infection prevention, and pain relief.

During a nonstress test (NST), a nurse notes three fetal heart rate (FHR) increases of 15 beats/minute, each lasting 15 seconds. These increases occur only with fetal movement. How should the nurse interpret this finding? The test is inconclusive and must be repeated. The fetus is nonreactive and hypoxic. The fetus is not in distress at this time. The client should undergo an oxytocin challenge test.

Correct response: The fetus is not in distress at this time. Explanation: The NST provides an indirect measurement of uteroplacental function. An electronic fetal monitoring device is used to measure fetal movement and increases in the fetal heart rate. The mother is given a button to push when she feels fetal movement so it can be recorded on the tracing. Prior to starting the testing, the nurse should obtain a baseline fetal monitor strip. Once testing starts, what is important is the acceleration of the fetal heart rate. A reactive NST includes at least two fetal heart rate accelerations from the baseline of at least 15 bpm for at least 15 seconds within a 20-minute testing time. If the test does not meet this criterion after 40 minutes, it is considered nonreactive.

A client, 30 weeks pregnant, is scheduled for a biophysical profile (BPP) to evaluate the health of the fetus. The client's BPP score is 8. What does this score indicate? The fetus isn't in distress at this time. The fetus should be delivered within 24 hours. The client should repeat the test in 24 hours. The client should repeat the test in 1 week.

Correct response: The fetus isn't in distress at this time. Explanation: The BPP evaluates fetal health by assessing five variables: fetal breathing movements, gross body movements, fetal tone, reactive fetal heart rate, and qualitative amniotic fluid volume. A normal response for each variable receives 2 points; an abnormal response receives 0 points. A score between 8 and 10 is considered normal, indicating that the fetus has a low risk of oxygen deprivation and isn't in distress. A fetus with a score of 6 or lower is at risk for asphyxia and premature birth; this score warrants detailed investigation. The BPP may be repeated if the score isn't within normal limits.

The community nurse works with the family to answer their questions on infant care. The nurse would like to maintain therapeutic boundaries within the therapeutic relationship. Which of the following is the best way to maintain boundaries? The nurse does not disclose her home address or accept the invitation to stay for lunch. The nurse communicates with the client via telephone. The nurse arrives on time and fulfills the client's needs. The nurse keeps the client's records secure when records are out of the office.

Correct response: The nurse does not disclose her home address or accept the invitation to stay for lunch. Explanation: The nurse demonstrates her professional boundaries by not disclosing personal identifiable information or accepting a meal. Keeping records secure maintains confidentiality. The nurse builds trust and rapport by coming on time and fulfilling needs. Communicating via telephone maintains professional communication.

A 27-year-old primigravid client with insulin-dependent diabetes at 34 weeks' gestation undergoes a nonstress test, the results of which are documented as reactive. What should the nurse tell the client that the test results indicate? A contraction stress test is necessary. There is evidence of fetal well-being. Chorionic villus sampling is necessary. The nonstress test should be repeated.

Correct response: There is evidence of fetal well-being. Explanation: The nonstress test is considered reactive when two or more fetal heart rate accelerations of at least 15 bpm occur (from a baseline fetal heart rate of 120 to 160 bpm), along with fetal movement, during a 10- to 20-minute period. A reactive nonstress test indicates fetal heart rate accelerations and well-being. There is no indication for further evaluation (such as a contraction stress test). However, contraction stress tests are commonly scheduled for pregnant clients with insulin-dependent diabetes in the latter part of pregnancy and are repeated periodically until birth. Chorionic villus sampling is usually performed early in the pregnancy to detect fetal abnormalities.

At an obstetrics and gynecology physician's office, a nurse and a nursing student discuss the prioritization of returning client phone messages. Which of the following clients would be a priority to call? Select all that apply. a client with spotting and cramping 1 day after a cerclage a client at 34 weeks reporting transient blurred vision and shoulder pain a client at 30 weeks reporting her morning sickness has suddenly returned a client at 32 weeks reporting a weight gain of 2 pounds (1 kg) over the last week a client at 36 weeks reporting feeling anxious and short of breath

Correct response: a client at 34 weeks reporting transient blurred vision and shoulder pain a client at 36 weeks reporting feeling anxious and short of breath a client at 30 weeks reporting her morning sickness has suddenly returned Explanation: Symptoms of preeclampsia include hypertension, proteinuria, edema, headache, abdominal pain/shoulder pain, lower back pain, sudden weight gain, and changes in vision. Clients could also report increased anxiety and sense of impending doom. These clients should come to the office and be assessed for preeclampsia. The client with the 2-pound (1 kg) weight gain over the last week would be an expected finding. Feeling cramping and spotting the day after a cerclage would also be an expected finding. "Morning sickness" should resolve after the first trimester, and a sudden return later in the pregnancy could be a symptom of preeclampsia.

Which outcome would the nurse identify as the priority to achieve when developing the plan of care for a primigravid client at 38 weeks' gestation who is hospitalized with severe preeclampsia and receiving intravenous magnesium sulfate? sedation and decreased reflex excitability within 48 hours absence of any seizure activity during the first 48 hours decreased generalized edema within 8 hours decreased urinary output during the first 24 hours

Correct response: absence of any seizure activity during the first 48 hours Explanation: The highest priority for a client with severe preeclampsia is to prevent seizures, thereby minimizing the possibility of adverse effects on the mother and fetus, and then to facilitate safe childbirth. Efforts to decrease edema, reduce blood pressure, increase urine output, limit kidney damage, and maintain sedation are desirable but are not as important as preventing seizures. It would take several days or weeks for the edema to be decreased. Sedation and decreased reflex excitability can occur with the administration of intravenous magnesium sulfate, which peaks in 30 minutes, much sooner than 48 hours.

A pregnant client is diagnosed with partial placenta previa. The nurse should prepare the client for which intervention? cesarean birth platelet infusion labor induction with oxytocin activity limited to bed rest

Correct response: activity limited to bed rest Explanation: Treatment of partial placenta previa includes bed rest, hydration, and careful monitoring of the client's bleeding.Placenta previa involves an abnormal implantation of the placenta. Platelets are not affected. Therefore, a platelet infusion is not necessary.Vaginal birth is the preferred method of birth. An immediate cesarean section is not warranted unless fetal distress occurs or the client begins to hemorrhage.Induction of labor should be initiated with caution and only if birth is indicated because of the risk for possible hemorrhage or fetal distress.

A charge nurse is completing client assignments for the nursing staff on the pediatric unit. Which client would the nurse refrain from assigning to a pregnant staff member? a 2-year-old with Kawasaki's disease an 8-year-old with Rubella a 3-month-old with Roseola a 6-year-old with ringworm

Correct response: an 8-year-old with Rubella Explanation: Rubella (German measles) has a teratogenic effect on the fetus. An infected child must be isolated from pregnant women. Ringworm is caused by a fungal infection on the skin. Standard hand hygiene is necessary. Kawasaki's disease is an autoimmune disease in which blood vessels become inflamed. Roseola is a virus transferred by oral secretions.

A multigravid client at 38 weeks' gestation is scheduled to undergo a contraction stress test. What should the nurse include in the explanation as the purpose of this test? determination of fetal response during movements determination of the fetal biophysical profile evaluation of fetal lung maturity assessment of fetal ability to tolerate labor

Correct response: assessment of fetal ability to tolerate labor Explanation: The purpose of a contraction stress test is to determine fetal response during labor. If late decelerations are noted with the contractions, the test is considered positive or abnormal. Fetal lung maturity is evaluated through amniocentesis to obtain the lecithin-sphingomyelin ratio. The nonstress test is part of the biophysical profile. Determining fetal response during movements is evaluated as part of the nonstress test.

During a nonstress test (NST), the electronic tracing displays a relatively flat line for fetal movement, making it difficult to evaluate the fetal heart rate (FHR). To mark the strip, a nurse should instruct the client to push the control button at which time? at the beginning of each contraction at the beginning of each fetal movement after every three fetal movements at the end of fetal movement

Correct response: at the beginning of each fetal movement Explanation: An NST assesses the FHR during fetal movement. In a healthy fetus, the FHR accelerates with each movement. By pushing the control button when a fetal movement starts, the client marks the strip to allow easy correlation of fetal movement with the FHR. The FHR is assessed during uterine contractions in the oxytocin contraction test, not the NST. Pushing the control button after every three fetal movements or at the end of fetal movement wouldn't allow accurate comparison of fetal movement and FHR changes.

A nurse is assisting in developing a teaching plan for a client who is about to enter the third trimester of pregnancy. The teaching plan should note that which symptom should be reported immediately? hemorrhoids dyspnea on exertion increased vaginal mucus blurred vision

Correct response: blurred vision Explanation: During pregnancy, blurred vision may be a danger sign of preeclampsia or eclampsia, complications that require immediate attention because they can cause severe maternal and fetal consequences. Although hemorrhoids may occur during pregnancy, they do not require immediate attention. Dyspnea on exertion and increased vaginal mucus are common discomforts caused by the physiologic changes of pregnancy.

A client is in the last trimester of pregnancy. The nurse should instruct the client to notify the primary health care provider immediately if she notices: blurred vision. hemorrhoids. dyspnea on exertion. increased vaginal mucus.

Correct response: blurred vision. Explanation: Blurred vision or other visual disturbances, excessive weight gain, edema, and increased blood pressure may signal severe preeclampsia. This condition may lead to eclampsia, which has potentially serious consequences for the client and fetus. Although hemorrhoids may be a problem during pregnancy, they don't require immediate attention. Increased vaginal mucus and dyspnea on exertion are expected as pregnancy progresses.

During her first prenatal visit, a client asks a nurse what physiological changes she can expect during pregnancy. The nurse begins the discussion with the presumptive changes of pregnancy. Put the following presumptive changes in ascending chronological order according to when they occur. All options must be used. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1quickening 2breast changes 3appearance of linea nigra, melasma, and striae gravidarum 4uterine enlargement in which the uterus can be palpated over the symphysis pubis 5frequent urination

Correct response: breast changes frequent urination uterine enlargement in which the uterus can be palpated over the symphysis pubis quickening appearance of linea nigra, melasma, and striae gravidarum Explanation: Presumptive changes are subjective and can be caused by other medical conditions. Breast changes occur approximately 2 weeks after implantation of the embryo; frequent urination, at 3 weeks; fatigue and uterine enlargement over the symphysis pubis, at 18 weeks; quickening, between 18 and 20 weeks; and the appearance of linea nigra, melasma, and striae gravidarum, at 24 weeks.

A nurse is caring for a client in the first 4 weeks of pregnancy. The nurse should expect to collect which assessment findings? uterine enlargement fetal heart tones presence of menses breast sensitivity

Correct response: breast sensitivity Explanation: Breast sensitivity is the only sign assessed within the first 4 weeks of pregnancy. Amenorrhea, not the presence of menses, is expected during this time. Uterine enlargement and fetal heart tones don't occur until after the first 4 weeks of pregnancy.

The health care provider prescribes clomiphene citrate for a woman who has been having difficulty getting pregnant. When teaching the client about this drug, the nurse should discuss what potential adverse effects? chance of multiple gestation. increase in spontaneous abortions increase in congenital anomalies increase in fibrocystic breast disease

Correct response: chance of multiple gestation. Explanation: Clomiphene citrate is a fertility drug that induces ovulation in women desiring pregnancy. One of the drug's most common adverse effects is multiple gestation (twins or triplets).An increase in spontaneous abortions is not associated with clomiphene citrate.Evidence does not support an association between the use of clomiphene citrate and an increase in fibrocystic breast disease.An increase in congenital anomalies is not associated with clomiphene citrate.

The health care provider prescribes clomiphene citrate for a woman who has been having difficulty getting pregnant. When teaching the client about this drug, the nurse should discuss what potential adverse effects? increase in fibrocystic breast disease increase in congenital anomalies chance of multiple gestation. increase in spontaneous abortions

Correct response: chance of multiple gestation. Explanation: Clomiphene citrate is a fertility drug that induces ovulation in women desiring pregnancy. One of the drug's most common adverse effects is multiple gestation (twins or triplets).An increase in spontaneous abortions is not associated with clomiphene citrate.Evidence does not support an association between the use of clomiphene citrate and an increase in fibrocystic breast disease.An increase in congenital anomalies is not associated with clomiphene citrate.

A 24-year-old client admitted to the hospital is suspected of having an ectopic pregnancy. On admission, which factor would be most important to assess? type of oral contraceptives date of last menstrual period use of a diaphragm sexual practices

Correct response: date of last menstrual period Explanation: Although it may be important to obtain information from a client with suspected ectopic pregnancy concerning when she last had intercourse, whether she is taking birth control pills, and whether she has been pregnant previously, it is most important to determine the date of her last menstrual period and if she has experienced amenorrhea. Such information helps establish an accurate diagnosis. Usually the client with an ectopic pregnancy suspects or knows that she is pregnant, having missed one or two menstrual periods. However, if the client's menstrual cycle is irregular, she may be unaware that she is pregnant.Obtaining information about sexual practices would be important for the sexual history and helping to identify the frequency of sexual intercourse and possibility of pregnancy. However, this information is only helpful after obtaining the date of the client's last menstrual period.Information about birth control methods, such as use of a diaphragm or type of oral contraceptive, is important once the date of the client's last menstrual period is determined.

A multigravid client diagnosed with chronic hypertension is now in preterm labor at 34 weeks' gestation. The health care provider (HCP) has prescribed magnesium sulfate at 3 g/h. Which assessment finding indicates that the intended therapeutic effect has occurred? decrease in fetal heart rate accelerations decrease in maternal blood pressure rate decrease in the frequency and number of contractions decrease in maternal respiratory rate

Correct response: decrease in the frequency and number of contractions Explanation: Magnesium sulfate may be used as an anticonvulsive or a tocolytic agent. The intended effect for this client is to decrease the number and frequency of contractions. Even though this client has chronic hypertension, the first goal is to prevent childbirth in a 34 weeks' gestation client. If the blood pressure moves into the therapeutic range, that is a benefit for the client but it is not the major goal. Magnesium sulfate may decrease the accelerations found in this fetus as it decreases the ability of the infant to respond, acting on the infant in the same way it does on the mother. Maternal respiratory rate may also decrease, and a lower respiratory rate to 12 respirations/minute indicates that this level of magnesium sulfate is becoming toxic to this client.

A client with gestational hypertension receives magnesium sulfate 50% 4 g in 250 mL D5W over 20 minutes. What priority assessment should the nurse perform when administering this drug? intake and output deep tendon reflexes temperature fetal heart rate

Correct response: deep tendon reflexes Explanation: Magnesium sulfate is given to prevent and control seizures in clients with gestational hypertension. It is administered by IV; 4 g of a 50% solution in 250 mL D5W can be given as a bolus before the dose is titrated for continuous infusion. Magnesium sulfate is a general inhibitor of neurotransmission. As such, the two largest complications are the loss of deep tendon reflexes and the suppression of breathing. These are the priority assessments. If deep tendon reflexes decrease or the respiratory rate is 12 breaths/min or less, the medication should be discontinued and calcium gluconate administered. Magnesium sulfate is excreted entirely through the kidneys so intake and output should be evaluated hourly. The mother becomes very hot and flushed. This is a normal response. The fetal heart rate should not decrease from the drug.

During a prenatal visit, a pregnant client with cardiac disease and slight functional limitations reports increased fatigue. To help combat this problem, the nurse should advise the client to: divide daily food intake into five or six meals. take a vitamin and mineral supplement. eat three well-balanced meals per day. exercise 1 hour before each meal.

Correct response: divide daily food intake into five or six meals. Explanation: To combat fatigue, the nurse should advise the client to divide her daily food intake into five or six meals eaten throughout the day to minimize the energy expenditure associated with consuming three larger meals. Exercising before meals would increase fatigue, interfering with the client's nutritional intake. Vitamin and mineral supplements are appropriate for anyone, not specifically pregnant clients, and have little effect on fatigue.

A nurse is completing a prenatal assessment on a woman who is 28 weeks pregnant with gestational hypertension. Which findings should be reported to the primary care provider? Select all that apply. 1+ urine protein blurred vision fundal height of 28 centimeters weight gain of 1 lb (500 g) per week dull headache

Correct response: dull headache blurred vision 1+ urine protein Explanation: The nurse must be alert for any signs and symptoms of superimposed preeclampsia in women with gestational hypertension. Dull headache, blurred vision, and protein in urine are all classic signs of preeclampsia in pregnancy and must be reported to the primary care provider immediately. Weight gain of 1 lb (500 grams) per week is an expected finding. Fundal height of 28 cm is an expected finding.

On arrival at the emergency department, a client tells the nurse that she suspects that she may be pregnant but has been having a small amount of bleeding and has severe pain in the lower abdomen. The client's blood pressure is 70/50 mm Hg, and her pulse rate is 120 bpm. The nurse notifies the primary health care provider (HCP) immediately because of the possibility of which complication? ectopic pregnancy. abruptio placentae. complete abortion. gestational trophoblastic disease.

Correct response: ectopic pregnancy. Explanation: The client's signs and symptoms indicate a probable ectopic pregnancy, which can be confirmed by ultrasound examination or by culdocentesis. The HCP is notified immediately because hypovolemic shock may develop without external bleeding. Once the fallopian tube ruptures, blood will enter the pelvic cavity, resulting in shock. Abruptio placentae would be manifested by a board-like uterus in the third trimester. Gestational trophoblastic disease would be suspected if the client exhibited no fetal heart rate and symptoms of pregnancy-induced hypertension before 20 weeks' gestation. A client with a complete abortion would exhibit a normal pulse and blood pressure with scant vaginal bleeding.

Following a positive pregnancy test, a client begins discussing the changes that will occur in the next several months with the nurse. The nurse should include which information about a change the client can anticipate in the first trimester? experiencing ambivalence about pregnancy differentiating the self from the fetus enjoying the role of nurturer preparing for the reality of parenthood

Correct response: experiencing ambivalence about pregnancy Explanation: Many women in their first trimester feel ambivalent about being pregnant because of the significant life changes that occur for most women who have a child. Ambivalence can be expressed as a list of positive and negative consequences of having a child, consideration of financial and social implications, and possible career changes. During the second trimester, the infant becomes a separate individual to the mother. The mother will begin to enjoy the role of nurturer postpartum. During the third trimester, the mother begins to prepare for parenthood and all of the tasks that parenthood includes.

Following a positive pregnancy test, a client begins discussing the changes that will occur in the next several months with the nurse. The nurse should include which information about a change the client can anticipate in the first trimester? experiencing ambivalence about pregnancy preparing for the reality of parenthood differentiating the self from the fetus enjoying the role of nurturer

Correct response: experiencing ambivalence about pregnancy Explanation: Many women in their first trimester feel ambivalent about being pregnant because of the significant life changes that occur for most women who have a child. Ambivalence can be expressed as a list of positive and negative consequences of having a child, consideration of financial and social implications, and possible career changes. During the second trimester, the infant becomes a separate individual to the mother. The mother will begin to enjoy the role of nurturer postpartum. During the third trimester, the mother begins to prepare for parenthood and all of the tasks that parenthood includes.

A client is having a level 2 ultrasound. A nurse knows that physicians order this procedure for diagnostic purposes when fetal development is in question. to provide images of the fetus for family and friends. to satisfy the client's curiosity. to assess the correct date of gestation.

Correct response: for diagnostic purposes when fetal development is in question. Explanation: Level 2 ultrasound is more sophisticated and can visualize fetal structures more clearly than a level 1 ultrasound. It's used for diagnostic purposes when fetal development is in question. Typically, level 1 ultrasound is used to assess gestational age. Diagnostic ultrasounds aren't ordered to satisfy the client's curiosity or to provide images of the fetus for family and friends.

A client is having a level 2 ultrasound. A nurse knows that physicians order this procedure to assess the correct date of gestation. for diagnostic purposes when fetal development is in question. to satisfy the client's curiosity. to provide images of the fetus for family and friends.

Correct response: for diagnostic purposes when fetal development is in question. Explanation: Level 2 ultrasound is more sophisticated and can visualize fetal structures more clearly than a level 1 ultrasound. It's used for diagnostic purposes when fetal development is in question. Typically, level 1 ultrasound is used to assess gestational age. Diagnostic ultrasounds aren't ordered to satisfy the client's curiosity or to provide images of the fetus for family and friends.

A client makes a routine visit to the prenatal clinic. Although the client is 14 weeks pregnant, the size of her uterus approximates an 18- to 20-week pregnancy. The physician diagnoses gestational trophoblastic disease and orders ultrasonography. The nurse expects ultrasonography to reveal: an extrauterine pregnancy. grapelike clusters. an empty gestational sac. a severely malformed fetus.

Correct response: grapelike clusters. Explanation: In a client with gestational trophoblastic disease, an ultrasound performed after the third month shows grapelike clusters of transparent vesicles rather than a fetus. The vesicles contain a clear fluid and may involve all or part of the decidual lining of the uterus. Usually no embryo (and therefore no fetus) is present because it has been absorbed. Because there is no fetus, there can be no extrauterine pregnancy. An extrauterine pregnancy occurs with an ectopic pregnancy.

An antenatal primigravid client has just been informed that she is carrying twins. The plan of care includes educating the client concerning factors that put her at risk for problems during the pregnancy. The nurse realizes the client needs further instruction when she indicates carrying twins puts her at risk for which complication? group B streptococcus twin-to-twin transfusion preterm labor anemia

Correct response: group B streptococcus Explanation: Group B Streptococcus is a risk factor for all pregnant women and is not limited to those carrying twins. The multiple gestation client is at risk for preterm labor because uterine distention, a major factor initiating preterm labor, is more likely with a twin gestation. The normal uterus is only able to distend to a certain point and when that point is reached, labor may be initiated. Twin-to-twin transfusion drains blood from one twin to the second and is a problem that may occur with multiple gestation. The donor twin may become growth restricted and can have oligohydramnios while the recipient twin may become polycythemic with polyhydramnios and develop heart failure. Anemia is a common problem with multiple gestation clients. The mother is commonly unable to consume enough protein, calcium, and iron to supply her needs and those of the fetuses. A maternal hemoglobin level below 11 mg/dL (110 g/L) is considered anemic.

Which finding provides the most evidence that a fetus might have a gastrointestinal tract anomaly? meconium in the amniotic fluid low implantation of the placenta increased amount of amniotic fluid preeclampsia in the last trimester

Correct response: increased amount of amniotic fluid Explanation: Maternal hydramnios occurs when the fetus has a congenital obstruction of the gastrointestinal tract, such as in the presence of a tracheoesophageal fistula. The fetus normally swallows amniotic fluid and absorbs the fluid from the gastrointestinal tract. Excretion then occurs through the kidneys and placenta. Most fluid absorption occurs in the colon. Absorption cannot occur when the fetus has a gastrointestinal obstruction. Meconium in the amniotic fluid, low implantation of the placenta, and preeclampsia could occur but are more specifically associated with fetal hypoxia.

A pregnant client with diabetes mellitus is at risk for having a large-for-gestational-age neonate because: excess sugar causes reduced placental functioning. the mother follows a high-calorie diet. excess insulin reduces placental functioning. insulin acts as a growth hormone on the fetus.

Correct response: insulin acts as a growth hormone on the fetus. Explanation: Insulin acts as a growth hormone on the fetus. Therefore, pregnant clients with diabetes must maintain good glucose control. Large babies are prone to complications and may have to be delivered by cesarean birth. Neither excess sugar nor excess insulin reduces placental functioning. A high-calorie diet helps control the mother's disease and doesn't contribute to neonatal size.

A nurse is planning care for an adolescent client who is 12 weeks' gestation. The nurse will monitor this client closely for the development of which complication during this stage of the pregnancy? postpartum depression gestational hypertension iron-deficiency anemia gestational diabetes

Correct response: iron-deficiency anemia Explanation: Adolescent pregnancies have a high risk for obstetric complications such as preterm labor and births, low birthweight infants, iron-deficiency anemia, sexually transmitted infections, poor maternal weight gain, preeclampsia, poor eating habits, nutrition, and postpartum depression. Menstrual losses often lead to iron-deficiency anemia in women during their reproductive years meaning anemia can be an existing issue at the time of conception. In the case of an adolescent client, the client is also still developing, which consumes additional iron stores compared to an adult client. The consumption of iron during pregnancy for fetal growth and an increased blood supply compounds the anemia even further. At 12 weeks' gestation, preeclampsia or gestational hypertension is unlikely as this develops usually after 20 weeks. The client could be at risk for depression but not postpartum depression while still in the antepartum stage. Younger clients are not at increased risk for gestational diabetes and this complication usually occurs after the 24th week of pregnancy which is why screening is done between 24 and 28 weeks.

A multigravid client is admitted to the hospital with a diagnosis of ectopic pregnancy. The nurse anticipates that, because the client's fallopian tube has not yet ruptured, which medication may be prescribed? medroxyprogesterone dyphylline methotrexate progestin contraceptives

Correct response: methotrexate Explanation: Because the fallopian tube has not yet ruptured, methotrexate may be given, followed by leucovorin. This chemotherapeutic agent attacks the fast-growing zygote and trophoblast cells. RU-486 is also effective. A hysterosalpingogram is usually performed after chemotherapy to determine whether the tube is still patent. Progestin-only contraceptives and medroxyprogesterone are ineffective in clearing the fallopian tube. Dyphylline is a bronchodilator and is not used.

While the nurse is caring for a 27-year-old primigravida at 20 weeks' gestation, the client asks if she should plan to attend childbirth preparation classes. What is an expected outcome of attending these classes? decreased length of labor increased support from the significant other greater control over birth plans need for less pain medication in labor

Correct response: need for less pain medication in labor Explanation: The single documented effect of childbirth preparation classes is the use of less pain medication in labor. Additionally, the belief is that childbirth education classes are critically important in empowering women with the knowledge of the choices that they may have to make during the birth experience, possibly enhancing their self-esteem and increasing satisfaction with the birth experience.No documented evidence suggests that childbirth preparation classes affect the length of labor, the mother's control over her birth plans, or the support provided by the significant other.

A primigravida, currently about 8 weeks pregnant, and her husband ask when they should begin the preparation for childbirth classes that discuss maternal nutrition during pregnancy. Which time would be most appropriate for the nurse to suggest that they begin the classes? as soon as the client experiences lightening now during the first trimester of pregnancy after scheduling a visit with the dietitian toward the end of the second trimester

Correct response: now during the first trimester of pregnancy Explanation: Early pregnancy classes, which typically focus on maternal nutrition, minor discomforts of pregnancy, and newborn nutrition, are appropriate for clients seeking early obstetric care. Typically, couples begin attending these classes during the first trimester. This allows the woman to incorporate proper nutritional guidelines into her diet. The couple then has ample time to decide the method of choice for feeding the newborn. Most clients make the decision to breastfeed or bottle-feed by the sixth month of pregnancy.Lightening occurs about 1 to 2 weeks before the beginning of labor. The couple should have attended childbirth classes before this time.Although clients often have a visit with a dietitian early in pregnancy, they need not wait for this to occur before participating in childbirth classes.Toward the end of the second trimester or the beginning of the third trimester, couples are usually psychologically ready for the pregnancy to end and are ready for classes dealing with labor and birth, newborn care, and postpartum care.

A client at 24 weeks' gestation comes to the clinic for a prenatal check-up and reports that she has been "seeing double." The nurse checks the urine and determines that there is 3+ proteinuria. What does the nurse determine is the potential priority problem? gestational diabetes preeclampsia hyperemesis gravidarum placenta previa

Correct response: preeclampsia Explanation: The visual disturbance and proteinuria suggest hypertension that has progressed to preeclampsia. The client with gestational diabetes would have elevated glucose levels. The client with hyperemesis gravidarum would present with intractable vomiting and signs of dehydration. Placenta previa is the covering of the cervical os with the placenta and would be demonstrated by painless vaginal bleeding.

A client at 24 weeks' gestation comes to the clinic for a prenatal check-up and reports that she has been "seeing double." The nurse checks the urine and determines that there is 3+ proteinuria. What does the nurse determine is the potential priority problem? hyperemesis gravidarum gestational diabetes preeclampsia placenta previa

Correct response: preeclampsia Explanation: The visual disturbance and proteinuria suggest hypertension that has progressed to preeclampsia. The client with gestational diabetes would have elevated glucose levels. The client with hyperemesis gravidarum would present with intractable vomiting and signs of dehydration. Placenta previa is the covering of the cervical os with the placenta and would be demonstrated by painless vaginal bleeding.

The nurse is caring for a 38-year-old primigravida in the third trimester of pregnancy. The nurse plans to assess the client for manifestations of which complication? cardiac overload ruptured membranes pelvic inflammatory disease preeclampsia

Correct response: preeclampsia Explanation: There is a strong association between advanced maternal age and preeclampsia as well as chronic hypertension. The incidence of preeclampsia is greatest among primigravidas.Preeclampsia is much more common than pelvic inflammatory disease. The client in the third trimester rarely exhibits symptoms of pelvic inflammatory disease.Although the older client is at risk for preterm labor and birth, this client does not present any symptoms of preterm labor, such as ruptured membranes.Cardiac overload may occur with clients who have been diagnosed with cardiac disease. Cardiac adjustment in healthy women occurs during pregnancy, labor, and birth.

Which intervention listed in the care plan for a client with an ectopic pregnancy requires revision? assessing vital signs and managing pain managing pain and providing emotional support providing for dietary needs and nursing in a dark quiet room providing emotional support and assessing per vaginal loss

Correct response: providing for dietary needs and nursing in a dark quiet room Explanation: Providing for the client's dietary needs is not appropriate because the client should not eat or drink anything pending surgery. Nursing the client in a dark quiet room is not appropriate for a client with ectopic pregnancy. Assessing vital signs for indicators of potential shock, managing pain, assessing per vaginal loss, and providing emotional support are essential nursing interventions in caring for a client with an ectopic pregnancy.

A 20-year-old client's pregnancy is confirmed at a clinic. She says her partner will be excited but she is concerned because she herself is not excited. She fears this feeling may mean she will be a bad mother. The nurse should respond by: recommending she talk her feelings over with her partner. exploring her feelings. referring her to counseling. reassuring her such feelings are normal in the beginning of pregnancy.

Correct response: reassuring her such feelings are normal in the beginning of pregnancy. Explanation: Misgivings and fears are common in the beginning of pregnancy. Such feelings don't necessarily mean that the client requires counseling at this time. Exploring the client's feelings may help her understand her concerns more deeply, but won't provide reassurance that her feelings are normal. The client may benefit by discussing her feelings with her partner, but the partner also needs to be reassured that these feelings are normal at this time.

A 15-year-old primigravid client at approximately 16 weeks' gestation tells the nurse that she has been experiencing an occasional sharp pain from the fundus to her pubic bone on the left side. The nurse determines that the client is most likely experiencing which complication? appendicitis fetal movement preterm labor round ligament pain

Correct response: round ligament pain Explanation: Based on the description, the client is most likely experiencing round ligament pain. The round ligaments, two fibrous muscular cords passing from the body of the uterus near the attachments of the fallopian tubes through the broad ligaments into the inguinal canal and inserting into the fascia of the vulva, act as stays to steady the uterus. If a pregnant woman moves quickly, she may pull one of these ligaments and feel a quick, sharp pain. Appendicitis usually causes pain on the right side of the lower abdomen. Typically the client would present with other signs and symptoms such as fever, nausea, and vomiting. Although preterm labor occurs before 38 weeks' gestation, preterm labor at 16 weeks is highly uncommon. Spontaneous abortions typically occur at 8 to 12 weeks' gestation. The second trimester is generally uneventful unless trauma occurs. Generally, fetal movement may be felt as a fluttering feeling beginning between 16 and 20 weeks' gestation. However, this feeling is usually not painful.

An 18-year-old pregnant client tells the nurse that she is concerned that she may not be able to take care of herself during her pregnancy. She states that she is not sure what prenatal care is available, or if she should access it. The nurse should recognize that the client: should be referred to community resources available for pregnant women. may not take care of herself. may not be fit to take care of a child. needs to find a second job.

Correct response: should be referred to community resources available for pregnant women. Explanation: The client needs to know that many freely available resources exist, and the nurse should help her to find such resources. It doesn't necessarily mean that the client has no interest in caring for herself or her child.

During prenatal screening of a client with diabetes, the nurse should keep in mind that the client is at increased risk for which complications? Select all that apply. spontaneous abortion Rh incompatibility stillbirth placenta previa pregnancy-induced hypertension

Correct response: stillbirth pregnancy-induced hypertension spontaneous abortion Explanation: Clients with diabetes are at increased risk for intrauterine fetal death after 36 weeks' gestation. Gestational diabetes is also associated with an increased risk of pregnancy-induced hypertension and spontaneous abortion. The risk of Rh incompatibility and placenta previa is not increased in the client with diabetes.

During prenatal screening of a client with diabetes, the nurse should keep in mind that the client is at increased risk for which complications? Select all that apply. stillbirth spontaneous abortion pregnancy-induced hypertension placenta previa Rh incompatibility

Correct response: stillbirth pregnancy-induced hypertension spontaneous abortion Explanation: Clients with diabetes are at increased risk for intrauterine fetal death after 36 weeks' gestation. Gestational diabetes is also associated with an increased risk of pregnancy-induced hypertension and spontaneous abortion. The risk of Rh incompatibility and placenta previa is not increased in the client with diabetes.

When developing the plan of care for a multigravid client with class III heart disease, the nurse should expect to assess the client frequently for which problem? tachycardia dehydration nausea and vomiting iron-deficiency anemia

Correct response: tachycardia Explanation: Assessing for signs and symptoms associated with cardiac decompensation is the priority. Class III heart disease during pregnancy has a 25% to 50% mortality. These clients are markedly compromised, with marked limitation of physical activity. They frequently experience fatigue, palpitations, dyspnea, or anginal pain. A pulse rate greater than 100 bpm or a respiratory rate greater than 25 breaths/min may indicate cardiac decompensation that could result in cardiac arrest. Additional symptoms include dyspnea, peripheral edema, orthopnea, tachypnea, rales, and hemoptysis.

The nurse is administering intravenous magnesium sulfate as prescribed for a client at 34 weeks' gestation with severe preeclampsia. What are desired outcomes of this therapy? Select all that apply. urinary output less than 30 mL/h temperature, 98° F (36.7° C); pulse, 72 beats/min; respiratory rate, 14 breaths/min deep tendon reflexes 2+ fetal heart rate with late decelerations blood pressure less than 140/90 mm Hg magnesium level = 5.6 mg/dL (2.8 mmol/L)

Correct response: temperature, 98° F (36.7° C); pulse, 72 beats/min; respiratory rate, 14 breaths/min deep tendon reflexes 2+ magnesium level = 5.6 mg/dL (2.8 mmol/L) Explanation: The use of magnesium sulfate as an anticonvulsant acts to depress the central nervous system by blocking peripheral neuromuscular transmissions and decreasing the amount of acetylcholine liberated. The primary goal of magnesium sulfate therapy is to prevent seizures. While being used, the temperature and pulse of the client should remain within normal limits. The respiratory rate needs to be greater than 12 respirations per minute (rpm). Rates at 12 rpm or lower are associated with respiratory depression and are seen with magnesium toxicity. Renal compromise is identified with a urinary output of less than 30 mL/hour. A fetal heart rate that is maintained within the 112 to 160 range is desired without later or variable decelerations. While extreme elevations of blood pressure must be treated, achieving a normal pressure carries the risk of decreasing perfusion to the fetus. Deep tendon reflexes should not be diminished or exaggerated. The therapeutic magnesium sulfate level of 5 to 8 mg/dL (2.5 to 4 mmol/L) is to be maintained.

A client and her partner, both 25 years old, are having trouble conceiving. Infertility in this couple is defined as: a low sperm count and decreased motility. the inability to conceive after 1 year of unprotected attempts. the inability to conceive after 6 months of unprotected attempts. the inability to sustain a pregnancy.

Correct response: the inability to conceive after 1 year of unprotected attempts. Explanation: The determination of infertility is based on age. In a couple younger than 30 years old, infertility is defined as failure to conceive after 1 year of unprotected intercourse. In a couple age 30 or older, the time period is reduced to 6 months of unprotected intercourse. The inability to sustain a pregnancy doesn't factor into the definition of infertility. A low sperm count and decreased motility may contribute to infertility, but they don't determine infertility.

A client is at 24 weeks' gestation. The nurse is reviewing the report of laboratory tests. The nurse should report which of these results to the health care provider? blood glucose blood type VDRL rubella titer

Correct response: VDRL Explanation: The nurse reports the results of the VDRL to the HCP. The pregnant client must be treated for syphilis to prevent perinatal transmission of the disease. The rubella titer and blood sugar values are within normal range. The blood type is not a significant factor in this situation.

A client who is 10 weeks pregnant develops spotting; however, the cervix remains closed. What should the nurse should suspect? threatened abortion ectopic pregnancy missed abortion inevitable abortion

Correct response: threatened abortion Explanation: Spotting in the first trimester may indicate that the pregnancy is in jeopardy. Bed rest and avoidance of physical and emotional stress are recommended. Abortion is usually inevitable if the bleeding is accompanied by pain with dilation and effacement of the cervix. An inevitable abortion is associated with cervical dilation. An ectopic pregnancy is in the fallopian tubes, and a false positive pregnancy could reflect a missed abortion.

A client at 28 weeks gestation is admitted to the maternity unit in preterm labor. The client asks the nurse if there is anything that can be done to stop the preterm labor. Which one of the following is the most appropriate response from the nurse? "Is there any family member that I can call for you?" "The obstetrician will have to evaluate the viability your fetus." "A cerclage may be performed depending on the competency of your cervix." "There is nothing that can stop the progression of the birth."

Correct response: "A cerclage may be performed depending on the competency of your cervix." Explanation: A cerclage is a surgical procedure where a stitch is placed by the physician in the cervix to prevent a spontaneous abortion or premature birth. The physician would have to determine the competency of the cervix, cervical dilation, and placement of the amniotic sac to determine whether the procedure is an option to stop progression of the birth. This is a potential option for the family. A 28-week fetus is considered viable and responding about confirming the viability of the fetus is not therapeutic at this time. Coordinating other family members to come into the hospital for support is an important response but not the first response from the nurse.

At what gestational age should a primigravida expect to start feeling quickening? 18 to 20 weeks 12 weeks 21 to 23 weeks 26 weeks

Correct response: 18 to 20 weeks Explanation: For the client who's pregnant for the first time, quickening occurs around 18 to 20 weeks. Women who have had children will feel quickening earlier, usually around week 16, because they recognize the sensations.

A 20-year-old client visiting the clinic requests the use of oral contraceptives. When reviewing the client's history, which finding would alert the nurse to a possible contraindication to using these agents? urinary tract infections menorrhagia ulcerative colitis thrombophlebitis

Correct response: thrombophlebitis Explanation: Oral contraceptives are contraindicated for clients with a history of thrombophlebitis because a serious side effect of oral contraceptives is thrombus formation. Other contraindications include stroke and liver disease. Oral contraceptives are used cautiously in clients with hypertension or diabetes. Close follow-up of these clients is essential.Urinary tract infections (UTIs) do not contraindicate the use of oral contraceptives. If the client is suffering from UTIs, the nurse can instruct her to increase her fluid intake and wipe from front to back after urinating or defecating.Ulcerative colitis does not contraindicate using oral contraceptives.Menorrhagia is typically reduced through the use of oral contraceptives.