Chapter 5&6 Review Maternal Health
An 18-year-old pregnant woman in her first trimester is admitted with an acute onset of right lower quadrant pain at the McBurney point. Appendicitis is suspected. For which clinical indicator should the nurse assess the patient to determine whether the pain is secondary to appendicitis?
Rebound tenderness
A teenager at 32 weeks gestation is hospitalized with preeclampsia. She is anorexic and appears depressed. Which comment indicates to the nurse that further exploration of the client's emotional status is indicated?
"I was really happy before I got pregnant."
A client visiting the prenatal clinic for the first time asks a nurse about the probability of having twins because her husband is one of a pair of fraternal twins. What is the appropriate response by the nurse?
"There is no greater probability of having twins than in the general population."
A 16-year-old adolescent visits the prenatal clinic because she has missed three menstrual periods. Before her physical examination she says, "I don't know what the problem is, but I can't be pregnant." What is the nurse's most therapeutic response?
"Why did you decide to come to the prenatal clinic?"
a client is scheduled for a non stress test in the 37th week of gestation a nurse explains the procedure which statement demonstrated that the client understand the teaching
"if the heart reacts well, my baby should do okay when I give birth"
after an incomplete abortion a patient tells a nurse that although her health care provider explained what an incomplete abortion was she did not understand what is the best response
"this is when the fetus is expelled but other parts of the pregnancy remain in the uterus"
A patient is discharged the same day after ambulatory surgery for a laparoscopic cholecystectomy. The nurse is providing discharge teaching about how many days the patient should wait to engage in certain activities. Place in order the activities from the first to the last in which the patient may engage.
1.getting out of bed in a chair, 2. performing light exercise, 3. showering, 4. driving a car, 5. lifting objects of more than 10 pounds
What should a nurse anticipate about the insulin requirements of a woman with diabetes on her first postpartum day?
A sharp and sudden decrease
A nurse notifies the health care provider that a patient has been admitted to the high-risk unit in her 36th week of gestation. She is bleeding, has severe abdominal pain and a rigid fundus, and is demonstrating signs of shock. For what intervention should the nurse prepare?
An immediate cesarean birth
A patient at 37 weeks gestation is admitted to the birthing unit from the emergency department. She had arrived by ambulance after a motor vehicle accident. Her vital signs are BP: 90/60; P: 108; R: 24. She is reporting sharp abdominal pain. What is the priority nursing intervention at this time?
Apply an electronic fetal monitor
What nursing intervention is specific for patients with cardiac problems who are in active labor?
Auscultating the lungs for crackles every 30 minutes
a patient is receiving magnesium sulfate therapy for severe preeclampsia what initial sign of toxicity should alert the nurse to intervene
hyperactive sensorium
A nurse is reviewing the obstetric history of a patient who had an abruptio placentae. What prenatal condition does the nurse expect the patient to have had?
Gestational Hypertension
A nurse is counseling a woman who was just diagnosed with a multiple gestation. Why does the nurse consider this pregnancy hgih risk?
Gestational anemia
A nurse in the prenatal clinic for a patient with heart disease who is in the second trimester. What hemodynamic of pregnancy may affect the patient at this time?
Heart rate acceleration in the last half of pregnancy
A patient who had a severe abruptio placentae asks the nurse why there was so much bleeding. What should the nurse consider is the cause of the heavy bleeding before responding in language the patient will understand?
Hypofibrinogenemia
A nurse anticipates that newborns of mothers who have diabetes often have tremors, periods of apnea, cyanosis, and poor sucking ability. With what complication are these signs associated?
Hypoglycemia
A patient with class I heart disease is admitted tot he birthing suite in active labor. In what position should the nurse place the patient?
Left lateral with head elevated
a 42-year old client has an amniocentesis during the 16th week of gestation because of concern about Down syndrome what additional information about the fetus will examination of the amniotic fluid reveal at this time
Neutral tube defect
a couple who recently emigrated from Israel tells a nurse in the prenatal clinic that they are concerned about a genetic disease that is prevalent among Jewish people which genetic test should the nurse recommend to determine the possibility of their children inheriting the disease
Tay-Sachs disease
A pregnant patient with a history of rheumatic heart disease since childhood is concerned about the birth of her baby and asks what to expect. What should a nurse explain about the birth? Select all that apply.
labor may be induced, birth may be vacuum extraction assisted, and regional anesthesia may be administered.
During a routine visit to the prenatal clinic a client listens to the fetal heartbeat for the first time the client commenting on how rapid it is appears frightened and asks whether this is normal how should a the nurse respond
" The heart rate is usually rapid and is in the expected range'
a client in the 18th week of pregnancy is scheduled for ultrasonography what instruction should the nurse give the client
"Don't urinate for at least 3 hours before the test"
A nurse is preparing a teaching plan for a pregnant patient with a history of cholelithiasis. Which information about why the ingestion of fatty foods will cause discomfort should the nurse include in the teaching plan?
Bile flow into the intestine is obstructed
Which clinical indicator should the nurse identify before scheduling a patient for an endoscopic retrograde cholangiopancreatography (ERCP)?
Bilirubin level
What nursing intervention should be included when caring for a patient with placenta previa?
Documentation of the amount of bleeding
which sign or symptom leads a nurse to suspect that a patient has a tubal pregnancy
a sharp lower right or left abdominal pain radiating to the shoulder
a patient in the prenatal clinic is diagnosed with preeclampsia what clinical findings support this diagnosis
blood pressure more than 140 mm Hg systolic accompanied by proteinuria
a few hours after being admitted to the hospital with a diagnosis is inevitable abortion a patient at 16 weeks gestation begins to experience bearing down sensations and suddenly expels the products of conception in bed what should the nurse do first
check the patients fundus for firmness
Sonography of a primigravida who is at 15 weeks gestation reveals a twin pregnancy. The nurse reviews with the client the risks of a multiple pregnancy that were explained by the health care provider. Which condition does the client identify that indicates the need for further instruction about complications associated with a multiple gestation?
down syndrome
a healthcare provider orders a contraction stress test (CST) for a client whose non stress test (NST) was nonreactive which maternal complications should alert the nurse to question the order select all that apply
preterm labor, incompetent cervix, premature rupture of membrane
Women who become pregnant for the first time as a later reproductive age (35 years of age or older) are at risk for what complications? Select all that apply.
preterm labor, multiple gestation, chromosomal anomalies, and bleeding in the first trimester.
which woman should the nurse identify is at risk of developing a hypertensive disorder of pregnancy
primigavida who is obese
a nurse is monitoring a patient with severe preeclampsia for the onset of eclampsia what clinical finding indicates an impending seizure
rolling of the eyes to one side with a fixed stare
a client who is scheduled for an amniocentesis states, "Im glad this test will be able to tell whether my baby is well or not." how should the nurse respond
"this test is useful in detecting potential defects due to chromosomal errors"
A client at 9 weeks gestation asks the nurse in the prenatal clinic if she can have her chorionic villi sampling (CVS) done at this visit at what week gestation should the nurse respond is the best time for this test
10 weeks and less than 12 weeks
A patient at 37 weeks gestation arrives at the emergency department stating that she has abdominal pain but no vaginal bleeding. The healthcare provider diagnoses abruptio placentae. The patient asks the nurse why it is so painful. What should the nurse consider is the initial cause of the abdominal pain before responding in language the patient will understand?
Concealed hemorrhage
A patient is scheduled for a sonogram at 36 weeks gestation. Shortly before the test she tells teh nurse that she has severe abdominal pain. Assessment reveals heavy vaginal bleeding, a drop in blood pressure, and an increased pulse rate. What complication does the nurse suspect?
Complete abruptio placentae
a patient admitted with preeclampsia is receiving magnesium sulfate which assessment indicates that a therapeutic level of the medication has been reached
Deep tendon reflexes of +2
The nurse is counseling a pregnant patient with type 1 diabetes about medication changes as the pregnancy progresses. Which medication will be needed in increased dosages during the second half of her pregnancy>
Insulin
A patient at 28 weeks gestation has a sonogram. The results reveal a small-for-gestational-age (SGA) fetus and a low-lying placenta. For what complication should the nurse assess this patient during the last trimester of pregnancy?
Placenta previa
A 38-year-old client attends the prenatal clinic for the first time a nurse explains that several tests will be performed one of which is the serum alpha-fetoprotein test the client asks what the test will reveal what should the nurse include in the reply
Open neutral tube defects
a client is preterm labor at 35 weeks gestation asks the nurse, " what determines whether my baby's lungs will be okay?" the nurse explains that a test of the amniotic fluid obtained through an amniocentesis will reflect fetal lung maturity which test should the nurse include in the discussion
Phosphatidylglycerol (PG) test
A patient arrives at the hospital at 38 weeks gestation with profuse vaginal bleeding. She states that it occurred suddenly without any contractions. Which condition may the patient be experiencing that requires immediate notification of the health care provider?
Placenta Previa
How should a nurse screen a newborn of a diabetic mother for hypoglycemia?
Test heel blood with a glucose-oxidase strip
a nurse suspects that there is cephalopelvic dis proportion in a client who is having a difficult labor for which test should the nurse prepare the client
Ultrasound
when caring for a woman who had a positive contraction stress test (CST) what complication does the nurse suspect
Uteroplacental insufficiency
a nurse is obtaining the health history from a patient with a diagnosis of a ruptured tubal pregnancy at what point in the pregnancy does the nurse expect the patient to state when the low abdominal pain and vaginal bleeding started
about the sixth week of pregnancy
A nursre is caring for a woman with cholelithiasis and obstructive jaundice. When assessing this patient, the nurse should be alert for which the common clinical indicators associated with these conditions? select all that apply.
ecchymosis, yellow sclera, and pain in right upper quadrant
a nurse is caring for a patient who had a spontaneous abortion the patient asks why spontaneous abortion occur the nurse responds that they are most commonly caused by what
embryonic defects
What is the initial responsibility of a nurse when teaching the pregnant adolescent?
encouraging her to continue regularly scheduled prenatal care
A pregnant patient with class II heart disease is concerned that her pregnancy will be an added burden on her already compromised heart. A nurse explains that during pregnancy the cardiac system is most compromised during the what?
first 2 days after birth
what assessment finding of a pregnant patient should alert the nurse to notify the health care provider
fundal height at the umbilicus at 16 weeks gestation
a patient is admitted to the birthing suite with a blood pressure of 150/90 mm Hg 3+ proteinuria and edema of the hands and face a diagnosis of severe preeclampsia is made what other clinical findings support this diagnosis select all that apply
headache, abdominal pain, visual disturbances
a nurse is caring for a patient who had a spontaneous abortion for what complication should the nurse assess this patient
hemorrhage
when does a nurse caring for a patient with eclampsia determine that the risk for another seizure has subsided
48 hours of postpartum
a patient with the diagnosis of severe preeclampsia is admitted to the hospital from the emergency department what precaution should the nurse initiate
pad the side rails on the bed
What does a nurse anticipate will be provided for a newborn of a mother with a history of long-standing diabetes?
special high-risk care
a nurse is monitoring a patient with severe preeclampsia who is receiving an infusion of magnesium sulfate assessment reveals a pulse rate of 55/minute respirations of 12/minute and a flushed face what is the nest nursing action
stop the infusion and start an infusion of dextrose and water
a patient tells a nurse in the prenatal clinic that she has vaginal staining but no pain her history reveals amenorrhea for the last 2 months and pregnancy confirmation after her first missed she is admitted to the high risk unit because she may be having a spontaneous abortion what type of abortion is suspected
threatened
A nurse in the birthing unit is caring for several clients. Which factor should the nurse anticipate will increase the risk for hypnotic uterine dystocia?
twin gestation
a nurse is assessing a patient with a tentative diagnosis of hydration mole which clinical finding should the nurse anticipate
unusual uterine enlargement
A client pregnant with twins is told by the health care provider that she is at risk for postpartum hemorrhage. What should the nurse consider is the cause of the postpartum hemorrhage before responding in language teh client will understand?
uterine atony
