Exam 2 (9-13)

The woman's weight gain is appropriate for this stage of pregnancy. Although this is an accurate statement, it does not apply to this client. The desirable weight gain during pregnancy varies among women. The primary factor to consider in making a weight gain recommendation is the appropriateness of the prepregnancy weight for the woman s height. A commonly used method of evaluating the appropriateness of weight for height is body mass index (BMI). This woman has gained the appropriate amount of weight for her size at this point in her pregnancy.Weight gain should take place throughout the pregnancy. The optimal rate of weight gain depends on the stage of the pregnancy. This is an accurate statement. This woman's BMI is within the normal range. During the first trimester, the average total weight gain is only 1 to 2.5 kg.

A 22-year-old woman pregnant with a single fetus has a preconception body mass index (BMI) of 24. When she was seen in the clinic at 14 weeks of gestation, she had gained 1.8 kg (4 lbs) since conception. How would the nurse interpret this? 1 this weight gain indicates possible gestational hypertension 2 this weight gain indicates that the woman's infant is at risk for intrauterine growth restriction (IUGR) 3 this weight gain cannot be evaluated until the woman has been observed for several more weeks 4 the woman's weight gain is appropriate for this stage of pregnancy

Transvaginal ultrasound A biophysical profile is a method of biophysical assessment of fetal well-being in the third trimester. An amniocentesis is performed after the fourteenth week of pregnancy. A MSAFP test is performed from week 15 to week 22 of the gestation (weeks 16 to 18 are ideal). An ultrasound is the method of biophysical assessment of the infant that is performed at this gestational age. Transvaginal ultrasound is especially useful for obese women whose thick abdominal layers cannot be penetrated adequately with the abdominal approach.

A 40-year-old woman with a body mass index (BMI) indicating clinical obesity is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time to assess the status of the pregnancy? 1 Biophysical profile 2 Amniocentesis 3 Maternal serum alpha-fetoprotein (MSAFP) 4 Transvaginal ultrasound

2, 3, 5 A nonreactive test requires further evaluation. The testing period is often extended, usually for an additional 20 minutes, with the expectation that the fetal sleep state will change and the test will become reactive. During this time vibroacoustic stimulation (see later discussion) may be used to stimulate fetal activity. Vibroacoustic stimulation is often used to stimulate fetal activity if the initial NST result is nonreactive and thus hopefully shortens the time required to complete the test. Care providers sometimes suggest that the woman drink orange juice or be given glucose to increase her blood sugar level and thereby stimulate fetal movements. Although this practice is common, there is no evidence that it increases fetal activity. A needle biopsy is not part of a NST. Fetal heart rate(FHR) is recorded with a Doppler transducer, and a tocodynamometer is applied to detect uterine contractions or fetal movements. The tracing is observed for signs of fetal activity and a concurrent acceleration of FHR.

A nonstress test (NST) is ordered on a pregnant women at 37 weeks gestation. What are the most appropriate teaching points to include when explaining the procedure to the patient? (Select all that apply.) 1 After 20 minutes, a nonreactive reading indicates the test is complete. 2 Vibroacoustic stimulation may be used during the test. 3 Drinking orange juice before the test is appropriate. 4 A needle biopsy may be needed to stimulate contractions. 5 Two sensors are placed on the abdomen to measure contractions and fetal heart tones.

is considered negative if no late decelerations are observed with the contractions. Vibroacoustic stimulation is sometimes used with nonstress test (NST). Contraction stress test (CST) is invasive if stimulation is by IV oxytocin but not if by nipple stimulation. No late decelerations indicate a positive CST. CST is contraindicated if the membranes have ruptured.

A nurse providing care for the antepartum woman should understand that the contraction stress test (CST): 1 sometimes uses vibroacoustic stimulation. 2 is an invasive test; however, contractions are stimulated. 3 is considered negative if no late decelerations are observed with the contractions. 4 is more effective than nonstress test (NST) if the membranes have already been ruptured.

dietary management involves distributing nutrient requirements over three meals and two or three snacks. Oral hypoglycemic agents can be harmful to the fetus and less effective than insulin in achieving tight glucose control. In some women gestational diabetes can be controlled with dietary modifications alone. Blood, not urine, glucose levels are monitored several times a day. Urine is tested for ketone content; results should be negative. Small frequent meals over a 24-hour period help decrease the risk for hypoglycemia and ketoacidosis.

A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes. The nurse caring for this client understands that: 1 oral hypoglycemic agents can be used if the woman is reluctant to give herself insulin. 2 dietary modifications and insulin are both required for adequate treatment. 3 glucose levels are monitored by testing urine 4 times a day and at bedtime. 4 dietary management involves distributing nutrient requirements over three meals and two or three snacks.

eat a high-protein snack before going to bed. Fluids should be taken between (not with) meals to provide for maximum nutrient uptake in the small intestine. A bedtime snack of slowly digested protein is especially important to prevent the occurrence of hypoglycemia during the night that would contribute to nausea. Dry carbohydrates such as plain toast or crackers are recommended before getting out of bed. Eating small, frequent meals (about 5 or 6 each day) with snacks helps to avoid a distended or empty stomach, both of which contribute to the development of nausea and vomiting.

A pregnant woman at 7 weeks of gestation complains to her nurse midwife about frequent episodes of nausea during the day with occasional vomiting. She asks what she can do to feel better. The nurse midwife could suggest that the woman: 1 drink warm fluids with each of her meals. 2 eat a high-protein snack before going to bed. 3 keep crackers and peanut butter at her bedside to eat in the morning before getting out of bed. 4 schedule three meals and one midafternoon snack a day.

eat small, frequent meals (every 2 to 3 hours). A pregnant woman experiencing nausea and vomiting should avoid consuming fluids early in the day or when nauseated. This is a correct suggestion for a woman experiencing nausea and vomiting. A pregnant woman experiencing nausea and vomiting should reduce her intake of fried foods and other fatty foods. A pregnant woman experiencing nausea and vomiting should avoid consuming fluids early in the morning or when nauseated but should compensate by drinking fluids at other times.

A pregnant woman experiencing nausea and vomiting should: 1 drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning. 2 eat small, frequent meals (every 2 to 3 hours). 3 increase her intake of high-fat foods to keep the stomach full and coated. 4 limit fluid intake throughout the day.

2, 3, 4 Carbamazepine (Tegretol) and valproate (Depakote) should be avoided if possible during pregnancy, especially during the first trimester, because their use is associated with NTDs in the fetus. Checking laboratory levels of medications, performing abdominal ultrasounds to assess fetal growth, and taking prenatal vitamins with vitamin D are all expected interventions for a pregnant woman diagnosed with epilepsy.

A pregnant woman in her first trimester with a history of epilepsy is transported to the hospital via ambulance after suffering a seizure in a restaurant. The nurse expects which health care provider orders to be included in the plan of care? (Select all that apply.) 1 Valporate (Depakote) 2 Serum lab levels of medication 3 Abdominal ultrasounds 4 Prenatal vitamins with vitamin D 5 Carbamazepine (Tegretol)

1, 3, 4, Fatigue, rather than hyperactivity is a common sign of systemic lupus erythematosus (SLE). Hypotension is not a characteristic sign of SLE. Common symptoms, including myalgias, fatigue, weight change, and fevers, occur in nearly all women with SLE at some time during the course of the disease. Although a diagnosis of SLE is suspected based on clinical signs and symptoms, it is confirmed by laboratory testing that demonstrates the presence of circulating autoantibodies. As is the case with other autoimmune diseases, SLE is characterized by a series of exacerbations (flares) and remissions (Chin and Branch, 2012).

A pregnant woman is being examined by the nurse in the outpatient obstetric clinic. The nurse suspects systemic lupus erythematosus (SLE) after revealing which symptoms? (Select all that apply.) 1 muscle aches 2 hyperactivity 3 weight changes 4 fever 5 hypotension

2, 3, 5, The diet for hyperemesis includes:Avoid an empty stomach. Eat frequently, at least every 2 to 3 hours. Separate liquids from solids and alternate every 2 to 3 hours.Eat a high-protein snack at bedtime.Eat dry, bland, low-fat, and high-protein foods. Cold foods may be better tolerated than those served at a warm temperature.In general, eat what sounds good to you rather than trying to balance your meals.Follow the salty and sweet approach; even so-called junk foods are okay.Eat protein after sweets.Dairy products may stay down more easily than other foods.If you vomit even when your stomach is empty, try sucking on a Popsicle.Try ginger tea. Peel and finely dice a knuckle-sized piece of ginger and place it in a mug of boiling water. Steep for 5 to 8 minutes and add brown sugar to taste.Try warm ginger ale (with sugar, not artificial sweetener) or water with a slice of lemon.Drink liquids from a cup with a lid.

A pregnant woman presents to the emergency department complaining of persistent nausea and vomiting. She is diagnosed with hyperemesis gravidarum. The nurse should include which information when teaching about diet for hyperemesis? (Select all that apply.) 1 Eat three larger meals a day. 2 Eat a high-protein snack at bedtime. 3 Ice cream may stay down better than other foods. 4 Avoid ginger tea or sweet drinks. 5 Eat what sounds good to you even if your meals are not well-balanced.

64 ounces of fluid If no medical or obstetric problems contraindicate physical activity, pregnant women should get 30 minutes of moderate physical exercise daily. Liberal amounts of fluid should be consumed before, during, and after exercise, because dehydration can trigger premature labor. Also the woman's calorie intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise. All pregnant women should consume the necessary amount of protein in their diet, regardless of level of activity. Many pregnant women of this gestation tend to retain fluid. This may contribute to hypertension and swelling. An adequate fluid intake prior to and after exercise should be sufficient. the woman's calorie and carbohydrate intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise.

A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse would be most concerned if this woman consumes which food during and after tennis matches? - 64 ounces of fluid - Extra protein sources, such as peanut butter - Salty foods to replace lost sodium - Easily digested sources of carbohydrate

2 to 5 lbs during the first trimester, then a pound each week until the end of pregnancy. A pound a week is not the correct guideline during pregnancy. A BMI of 22 represents a normal weight. Therefore, a total weight gain for pregnancy would be about 25 to 35 lbs or about 2 to 5 lbs in the first trimester and about 1 lb/week during the second and third trimesters. These are not accurate guidelines for weight gain during pregnancy. The total is correct, but the pattern needs to be explained.

A pregnant woman with a body mass index (BMI) of 22 asks the nurse how she should be gaining weight during pregnancy. The nurse's BEST response would be to tell the woman that her pattern of weight gain should be approximately: - a pound a week throughout pregnancy. - 2 to 5 lbs during the first trimester, then a pound each week until the end of pregnancy. - a pound a week during the first two trimesters, then 2 lbs per week during the third trimester. - a total of 25 to 35 lbs.

decreasing energy levels. Orthopnea is a finding that appears later when a failing heart reduces renal perfusion and fluid accumulates in the pulmonary interstitial space, leading to pulmonary edema. Decreasing energy level (fatigue) is an early finding of heart failure. Care must be taken to recognize it as a warning rather than a typical change of the third trimester. Cardiac decompensation is most likely to occur early in the third trimester, during childbirth, and during the first 48 hours following birth. A moist, frequent cough appears later when a failing heart reduces renal perfusion and fluid accumulates in the pulmonary interstitial space, leading to pulmonary edema. Crackles and rales appear later when a failing heart reduces renal perfusion and fluid accumulates in the pulmonary interstitial space, leading to pulmonary edema.

A pregnant woman with cardiac disease is informed about signs of cardiac decompensation. She should be told that the earliest sign of decompensation is most often: 1 orthopnea. 2 decreasing energy levels. 3 moist frequent cough and frothy sputum. 4 crackles (rales) at the bases of the lungs on auscultation.

placental abruption. Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture presents as hypotonic uterine activity, signs of hypovolemia, and in many cases the absence of pain. Placenta previa presents with bright red, painless vaginal bleeding. Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption). Women with hypertension are at increased risk for an abruption.

A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of: 1 eclamptic seizure. 2 rupture of the uterus. 3 placenta previa. 4 placental abruption.

hemorrhage. Hemorrhage is the most immediate risk because the lower uterine segment has limited ability to contract to reduce blood loss. Infection is a risk because of the location of the placental attachment site; however, it is not a priority concern at this time. Placenta previa poses no greater risk for urinary retention than with a normally implanted placenta. There is no greater risk for thrombophlebitis than with a normally implanted placenta.

A woman diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At the present time she is at the greatest risk for: 1 hemorrhage. 2 infection. 3 urinary retention. 4 thrombophlebitis.

"This test will observe for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby." An ultrasound is the test that requires a full bladder. An amniocentesis would be the test that a pregnant woman should be driven home afterward. A maternal alpha-fetoprotein test is used in conjunction with unconjugated estriol levels, and human chorionic gonadotropin helps to determine Down syndrome. The nonstress test is one of the most widely used techniques to determine fetal well-being and is accomplished by monitoring fetal heart rate in conjunction with fetal activity and movements.

A woman who is at 36 weeks of gestation is having a nonstress test. Which statement by the woman would indicate a correct understanding of the test? 1 "I will need to have a full bladder for the test to be done accurately." 2 "I should have my husband drive me home after the test because I may be nauseous." 3 "This test will help to determine if the baby has Down syndrome or a neural tube defect." 4 "This test will observe for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby."

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

A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous (IV) infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature 37.1° C, pulse rate 96 beats/min, respiratory rate 24 breaths/min, blood pressure 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for: 1 hydralazine. 2 magnesium sulfate bolus. 3 diazepam. 4 calcium gluconate.

seizures do not occur. A temporary decrease in blood pressure can occur; however, this is not the purpose of administering this medication. Magnesium sulfate is a central nervous system (CNS) depressant given primarily to prevent seizures. Hypotonia is a sign of an excessive serum level of magnesium. It is critical that calcium gluconate be on hand to counteract the depressant effects of magnesium toxicity. Diuresis is not an expected outcome of magnesium sulfate administration.

A woman with severe preeclampsia is being treated with an intravenous (IV) infusion of magnesium sulfate. This treatment is considered successful if: 1 blood pressure is reduced to prepregnant baseline. 2 seizures do not occur. 3 deep tendon reflexes become hypotonic. 4 diuresis reduces fluid retention.

a respiratory rate of 10 breaths/min. Because magnesium sulfate is a central nervous system (CNS) depressant, the client will most likely become sedated when the infusion is initiated. A respiratory rate of 10 breaths/min indicates that the client is experiencing respiratory depression (bradypnea) from magnesium toxicity. Deep tendon reflexes of 2+ are a normal finding. Absent ankle clonus is a normal finding.

A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits: 1 a sleepy, sedated affect. 2 a respiratory rate of 10 breaths/min. 3 deep tendon reflexes of 2+. 4 absent ankle clonus.

the most important cause of perinatal loss in diabetic pregnancy is congenital malformations. Even with good control, sudden and unexplained stillbirth remains a major concern. Congenital malformations account for 30% to 50% of perinatal deaths. Infants of diabetic mothers are at increased risk for respiratory distress syndrome. The transition to extrauterine life often is marked by hypoglycemia and other metabolic abnormalities.

Diabetes in pregnancy puts the fetus at risk in several ways. Nurses should be aware that: 1 with good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern. 2 the most important cause of perinatal loss in diabetic pregnancy is congenital malformations. 3 infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring. 4 at birth, the neonate of a diabetic mother is no longer at any greater risk.

cardiac decompensation. Euglycemia is a condition of normal glucose levels. These symptoms indicate cardiac decompensation. Rheumatic fever can cause heart problems, but it does not present with these symptoms, which indicate cardiac decompensation. Pneumonia is an inflammation of the lungs and would not likely generate these symptoms, which indicate cardiac decompensation. Symptoms of cardiac decompensation may appear abruptly or gradually.

During a physical assessment of an at-risk client, the nurse notes generalized edema, crackles at the base of the lungs, and some pulse irregularity. These are most likely signs of: 1 euglycemia. 2 rheumatic fever. 3 pneumonia. 4 cardiac decompensation.

benzodiazepines. Disulfiram is contraindicated in pregnancy because it is teratogenic. Corticosteroids are not used to treat alcohol withdrawal. Symptoms that occur during alcohol withdrawal can be managed with short-acting barbiturates or benzodiazepines. Aminophylline is not used to treat alcohol withdrawal.

During pregnancy, alcohol withdrawal may be treated using: 1 disulfiram (Antabuse). 2 corticosteroids. 3 benzodiazepines. 4 aminophylline.

beginning at 32 weeks of gestation. Women often have few symptoms of asthma during the first trimester. The severity of symptoms peak starting at 32 weeks of gestation. Asthma appears to be associated with intrauterine growth restriction and preterm birth. During the last 4 weeks of pregnancy symptoms often subside. The period starting at 32 weeks of pregnancy is associated with the greatest severity of symptoms. Issues have often resolved by the time the woman delivers.

From 4% to 8% of pregnant women have asthma, making it one of the most common preexisting conditions of pregnancy. Severity of symptoms usually peaks: 1 in the first trimester. 2 beginning at 32 weeks of gestation. 3 during the last 4 weeks of pregnancy. 4 immediately after birth.

1, 3, 4, 5 Hypothyroidism is often associated with both infertility and an increased risk of miscarriage. Infants born to mothers with hypothyroidism are more likely to be of low birth weight or preterm. These outcomes can be improved with early diagnosis and treatment. Pregnant women with hypothyroidism are more likely to experience both preeclampsia and gestational hypertension. Placental abruption and stillbirth are risks associated with hypothyroidism. Placental abruption and stillbirth are risks associated with hypothyroidism.

Hypothyroidism occurs in 2 to 3 pregnancies per 1000. Pregnant women with untreated hypothyroidism are at risk for: (Select all that apply.) 1 miscarriage 2 macrosomia 3 gestational hypertension 4 placental abruption 5 still birth

Administration of blood Primary medical management in all cases of disseminated intravascular coagulation (DIC) involves correction of the underlying cause, volume replacement, blood component therapy, optimization of oxygenation and perfusion status, and continued reassessment of laboratory parameters. Central monitoring would not be ordered initially in a woman with DIC because this can contribute to more areas of bleeding. Management of DIC includes volume replacement, not volume restriction. Steroids are not indicated for the management of DIC.

In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate? 1 Administration of blood 2 Preparation of the woman for invasive hemodynamic monitoring 3 Restriction of intravascular fluids 4 Administration of steroids

amount of insulin required prenatally. Although advanced maternal age may pose some health risks, for the woman with pregestational diabetes the most important factor remains the degree of glycemic control during pregnancy. The number of years since diagnosis is not as relevant to outcomes as the degree of glycemic control. The key to reducing risk in the pregestational diabetic woman is not the amount of insulin required but rather the level of glycemic control. Women with excellent glucose control and no blood vessel disease should have good pregnancy outcomes.

In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes that the most important factor affecting pregnancy outcome is the: 1 mother's age. 2 number of years since diabetes was diagnosed. 3 amount of insulin required prenatally. 4 degree of glycemic control during pregnancy.

maternal preeclampsia and fetal macrosomia. Premature rupture of membranes and neonatal sepsis are not risks associated with gestational diabetes. Hyperemesis is not seen with gestational diabetes, nor is there an association with low birth weight of the infant. Women with gestational diabetes have twice the risk of developing hypertensive disorders such as preeclampsia, and the baby usually has macrosomia. Placental previa and subsequent prematurity of the neonate are not risks associated with gestational diabetes.

Maternal and neonatal risks associated with gestational diabetes mellitus are: 1 maternal premature rupture of membranes and neonatal sepsis. 2 maternal hyperemesis and neonatal low birth weight. 3 maternal preeclampsia and fetal macrosomia. 4 maternal placenta previa and fetal prematurity.

MSAFP is a screening tool only; it identifies candidates for more definitive procedures. Chorionic villus sampling (CVS) does provide a rapid result, but it is declining in popularity because of advances in noninvasive screening techniques. Maternal serum alpha-fetoprotein (MSAFP) screening is recommended for all pregnant women. MSAFP, not percutaneous umbilical blood sampling (PUBS), is part of the quad-screen tests for Down syndrome. This is correct. MSAFP is a screening tool, not a diagnostic tool. Further diagnostic testing is indicated after an abnormal MSAFP.

Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including that: 1 chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis. 2 screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended only for women at risk for neural tube defects. 3 percutaneous umbilical blood sampling (PUBS) is one of the quad-screen tests for Down syndrome. 4 MSAFP is a screening tool only; it identifies candidates for more definitive procedures.

administer RhoD immunoglobulin. Because of the possibility of fetomaternal hemorrhage, administering RhoD immunoglobulin to the woman who is Rh negative is standard practice after an amniocentesis. Anticoagulants are not administered before amniocentesis as this would increase the risk of bleeding when the needle is inserted transabdominally. Computed tomography (CT) is not required before amniocentesis, because the procedure is ultrasound guided. The mother is not exposed to radiation during amniocentesis.

Prior to the patient undergoing amniocentesis, the most appropriate nursing intervention is to: 1 administer RhoD immunoglobulin. 2 administer anticoagulant. 3 send the patient for a computed tomography (CT) scan before the procedure. 4 assure the mother that short-term radiation exposure is not harmful to the fetus.

Prepare the woman for an ultrasound and blood work. Dilation and curretage (D&C) is not considered until signs of the progress to an inevitable abortion are noted or the contents are expelled and incomplete. Bed rest is recommended for 48 hours initially. Repetitive transvaginal ultrasounds and measurement of human chorionic gonadotropin (hCG) and progesterone levels may be performed to determine if the fetus is alive and within the uterus. If the pregnancy is lost, the woman should be guided through the grieving process. Telling the client that she can get pregnant again soon is not a therapeutic response because it discounts the importance of this pregnancy.

Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. What is an appropriate management approach for this type of abortion? 1 Prepare the woman for a dilation and curettage (D&C). 2 Place the woman on bed rest for at least 1 week and reevaluate. 3 Prepare the woman for an ultrasound and blood work. 4 Comfort the woman by telling her that if she loses this baby, she may attempt to get pregnant again in 1 month

an insufficient amount of hemoglobin is produced to fill the red blood cells (RBCs). Thalassemia is a hereditary disorder that involves the abnormal synthesis of the alpha or beta chains of hemoglobin. An insufficient amount of hemoglobin is produced to fill the RBCs. This is the underlying description for sickle cell anemia. Folate deficiency is the most common cause of megaloblastic anemias during pregnancy. B12 deficiency must also be considered if the pregnant woman presents with anemia.

Thalassemia is a relatively common anemia in which: 1 an insufficient amount of hemoglobin is produced to fill the red blood cells (RBCs). 2 RBCs have a normal life span but are sickled in shape. 3 folate deficiency occurs. 4 there are inadequate levels of vitamin B12.

2, 3, 4, Passive regurgitation may occur if patient is supine, leading to high risk for aspiration. Placental perfusion is decreased when the patient is in a supine position as well. The heart is displaced upward and to the left in pregnant patients. During pregnancy, there is dilation of the ureters and urethra, and the bladder is displaced forward placing the pregnant trauma patient at higher risk for urinary stasis, infection, and bladder trauma. The trauma patient can suffer blood loss and other complications, necessitating frequent monitoring of vital signs. While the pregnant patient is at risk for thrombus formation, the patient must be cleared by the health care provider before ambulating. The pregnant trauma patient is at higher risk for pelvic fracture, and therefore this condition must be ruled out first as well.

The emergency department nurse is assessing a pregnant trauma victim who just arrived at the hospital. What are the nurse's MOSTappropriate actions? (Select all that apply.) 1 Place the patient in a supine position. 2 Assess for point of maximal impulse at fourth intercostal space. 3 Collect urine for urinalysis and culture. 4 Frequent vital sign monitoring. 5 Assist with ambulation to decrease risk of thrombosis.

4, 5 Magnetic resonance imaging (MRI)is a noninvasive radiologic technique used for obstetric and gynecologic diagnosis. Similar to computed tomography (CT), MRI provides excellent pictures of soft tissue. Unlike CT, ionizing radiation is not used. Therefore, vascular structures within the body can be visualized and evaluated without injecting an iodinated contrast medium, thus eliminating any known biologic risk. Similar to sonography, MRI is noninvasive and can provide images in multiple planes, but no interference occurs from skeletal, fatty, or gas-filled structures, and imaging of deep pelvic structures does not require a full bladder. The woman is placed on a table in the supine position and moved into the bore of the main magnet, which is similar in appearance to a CT scanner. Depending on the reason for the study, the procedure may take from 20 to 60 minutes, during which time the woman must be perfectly still except for short respites.

The health care provider has ordered a magnetic resonance imaging (MRI) study to be done on a pregnant patient to evaluate fetal structure and growth. The nurse should include which instructions when preparing the patient for this test? (Select all that apply.) 1 A lead apron must be worn during the test. 2 A full bladder is required prior to the test. 3 An intravenous line must be inserted before the test. 4 Jewelry must be removed before the test. 5 Remain still throughout the test.

intense abdominal pain. Bleeding may be present in varying degrees for both placental conditions. Pain is absent with placenta previa and may be agonizing with abruptio placentae. Uterine activity may be present with both placental conditions. Cramping is a form of uterine activity that may be present in both placental conditions.

The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is: 1 bleeding. 2 intense abdominal pain. 3 uterine activity. 4 cramping.

1, 3, 4 Decreased urinary output and irritability are signs of severe eclampsia. Ankle clonus and epigastric pain are signs of severe eclampsia. Platelet count of less than 100,000/mm3 and visual problems are signs of severe preeclampsia. A transient headache and +1 proteinuria are signs of preeclampsia and should be monitored. Seizure activity and hyperreflexia are signs of severe eclampsia.

The nurse is caring for a woman who is at 24 weeks of gestation with suspected severe preeclampsia. Which signs and symptoms would the nurse expect to observe? (Select all that apply.) 1 Decreased urinary output and irritability 2 Transient headache and +1 proteinuria 3 Ankle clonus and epigastric pain 4 Platelet count of less than 100,000/mm3 and visual problems 5 Seizure activity and hypotension

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

The nurse is caring for a woman with mitral stenosis who is in the active stage. Which action should the nurse take to promote cardiac function? 1 Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics. 2 Prepare the woman for delivery by cesarean section since this is the recommended delivery method to sustain hemodynamics. 3 Encourage the woman to avoid the use of narcotics or epidural regional analgesia since this alters cardiac function. 4 Promote the use of the Valsalva maneuver during pushing in the second stage to improve diastolic ventricular filling.

Dried beans, seeds, peanut butter, eggs All of the foods listed expect a bagel provide protein. A bagel is an example of a whole grain food, not protein.

The nurse is developing a dietary teaching plan for a patient on a vegetarian diet. The nurse should provide the patient with which examples of protein containing foods? (Select all that apply.) 1 dried beans 2 seeds 3 peanut butter 4 bagel 5 eggs

"I should eat foods that are high in iron and protein to help my body heal." After a miscarriage a woman may experience mood swings and depression from the reduction of hormones and the grieving process. Sexual intercourse should be avoided for 2 weeks or until the bleeding has stopped and should avoid pregnancy for 2 months. A woman who has experienced a miscarriage should be advised to eat foods that are high in iron and protein to help replenish her body after the loss. The woman should not experience bright red, heavy, profuse bleeding; this should be reported to the health care provider.

The nurse is preparing to discharge a 30-year-old woman who has experienced a miscarriage at 10 weeks of gestation. Which statement by the woman would indicate a correct understanding of the discharge instructions? 1 "I will not experience mood swings since I was only at 10 weeks of gestation." 2 "I will avoid sexual intercourse for 6 weeks and pregnancy for 6 months." 3 "I should eat foods that are high in iron and protein to help my body heal." 4 "I should expect the bleeding to be heavy and bright red for at least 1 week."

Indirect Coombs' test The indirect Coombs' test is a screening tool for Rh incompatibility. If the maternal titer for Rh antibodies is greater than 1:8, amniocentesis for determination of bilirubin in amniotic fluid is indicated to establish the severity of fetal hemolytic anemia. Hemoglobin reveals the oxygen carrying capacity of the blood. Human chorionic gonadotropin (hCG) is the hormone of pregnancy. Maternal serum alpha-fetoprotein (MSAFP) levels are used as a screening tool for neural tube defects (NTDs) in pregnancy

The nurse is reviewing laboratory values to determine Rh incompatibility between mother and fetus. The nurse should assess which specific lab result? 1 Indirect Coombs' test 2 Hemoglobin level 3 hCG (human chorionic gonadotrophin) level 4 Maternal serum alpha-fetoprotein (MSAFP)

constipation is common with iron supplements. These beverages inhibit iron absorption when consumed at the same time as iron. Vitamin C promotes iron absorption. Children who ingest iron can get very sick and even die. Constipation can be a problem.

When counseling a client about getting enough iron in her diet, the maternity nurse should tell her that: 1 milk, coffee, and tea aid iron absorption if consumed at the same time as iron. 2 iron absorption is inhibited by a diet rich in vitamin C. 3 iron supplements are permissible for children in small doses. 4 constipation is common with iron supplements.

Doppler blood flow analysis Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and the placenta. It is a helpful tool in the management of high risk pregnancies because of intrauterine growth restriction (IUGR), diabetes mellitus, multiple fetuses, or preterm labor. Because of the potential risk of inducing labor and causing fetal distress, a contraction stress test (CST) is not performed on a woman whose fetus is preterm. Indications for an amniocentesis include diagnosis of genetic disorders or congenital anomalies, assessment of pulmonary maturity, and the diagnosis of fetal hemolytic disease, not IUGR. Fetal kick count monitoring is performed to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation. Although this may be a useful tool at some point later in this woman's pregnancy, it is not used to diagnose IUGR.

The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what would be another tool useful in confirming the diagnosis? 1 Doppler blood flow analysis 2 Contraction stress test (CST) 3 Amniocentesis 4 Daily fetal movement counts

Maternal diabetes mellitus and postmaturity Decreased fetal movement is an indicator for performing a contraction stress test; the size (small for gestational age) is not an indicator. Maternal diabetes mellitus and postmaturity are two indications for performing a contraction stress test. Although adolescent pregnancy and poor prenatal care are risk factors of poor fetal outcomes, they are not indicators for performing a contraction stress test. Intrauterine growth restriction is an indicator; but history of a previous stillbirth, not preterm labor, is the other indicator.

What is an indicator for performing a contraction stress test? 1 Increased fetal movement and small for gestational age 2 Maternal diabetes mellitus and postmaturity 3 Adolescent pregnancy and poor prenatal care 4 History of preterm labor and intrauterine growth restriction

review the woman's current dietary intake. Reviewing the women's dietary intake as the first step will help to establish if she has a balanced diet or if changes in the diet are required. These are correct actions on the part of the nurse, but the first action should be to assess the patient's current dietary pattern and practices since instruction should be geared to what she already knows and does.

When planning a diet with a pregnant woman, the nurse's FIRST action would be to: 1 review the woman's current dietary intake. 2 teach the woman about the food pyramid. 3 caution the woman to avoid large doses of vitamins, especially those that are fat-soluble. 4 instruct the woman to limit the intake of fatty foods.

Iron and folate Fat-soluble vitamins should be supplemented as a medical prescription, as vitamin D might be for lactose-intolerant women. Water-soluble vitamin C sometimes is consumed in excess naturally; vitamin B6 is prescribed only if the woman has a very poor diet. Iron generally should be supplemented, and folic acid supplements often are needed because folate is so important. Zinc sometimes is supplemented. Most women get enough calcium.

Which minerals and vitamins usually are recommended as a supplement a pregnant woman's diet? 1 Fat-soluble vitamins A and D 2 Water-soluble vitamins C and B6 3 Iron and folate 4 Calcium and zinc

Heroin The opiates include opium, heroin, meperidine, morphine, codeine, and methadone. The signs and symptoms of heroin use are euphoria, relaxation, relief from pain, detachment from reality, impaired judgment, drowsiness, constricted pupils, nausea, constipation, slurred speech, and respiratory depression. Possible effects on pregnancy include preeclampsia, intrauterine growth restriction, miscarriage, premature rupture of membranes, infections, breech presentation, and preterm labor. Alcohol is not an opiate. PCP is not an opiate. Cocaine is not an opiate.

Which opiate causes euphoria, relaxation, drowsiness, and detachment from reality and has possible effects on the pregnancy, including preeclampsia, intrauterine growth restriction, and premature rupture of membranes? 1 Heroin 2 Alcohol 3 Phencyclidine palmitate (PCP) 4 Cocaine

1, 2, 3, 5 Underweight women need to gain the most. Obese women need to gain weight during pregnancy to equal the weight of the products of conception. Adolescents are still growing; therefore, their bodies naturally compete for nutrients with the fetus. Women bearing twins need to gain more weight (usually 16 to 20 kg), but not necessarily twice as much. Normal weight women should gain 11.5 to 16 kg.

Which suggestions should the nurse include when teaching about appropriate weight gain in pregnancy? (Select all that apply.) 1 underweight women should gain 12.5 to 18 kg. 2 obese women should gain at least 7 to 11.5 kg. 3 adolescents are encouraged to strive for weight gains at the upper end of the recommended scale. 4 in twin gestations, the weight gain recommended for a single fetus pregnancy should simply be doubled. 5 normal weight women should gain 11.5 to 16 kg.

caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful. Vitamin C, zinc, and protein levels need to be moderately higher during lactation than during pregnancy. A lactating woman needs to avoid consuming too much caffeine. The recommendations for iron and folic acid are somewhat lower during lactation. Lactating women should consume about 500 kcal more than their prepregnancy intake, at least 1800 kcal daily overall.

With regard to nutritional needs during lactation, a maternity nurse should be aware that: 1 the mother's intake of vitamin C, zinc, and protein now can be lower than during pregnancy. 2 caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful. 3 critical iron and folic acid levels must be maintained. 4 lactating women can go back to their prepregnant calorie intake.

many protein-rich foods are also good sources of calcium, iron, and B vitamins. Good protein sources such as meat, milk, eggs, and cheese have a lot of calcium and iron. Most women already eat a high-protein diet and do not need to increase their intake. Protein is sufficiently important that specific servings of meat and dairy are recommended. High-protein supplements are not recommended because they have been associated with an increased incidence of preterm births.

With regard to protein in the diet of pregnant women, nurses should be aware that: 1 many protein-rich foods are also good sources of calcium, iron, and B vitamins. 2 many women need to increase their protein intake during pregnancy. 3 as with carbohydrates and fat, no specific recommendations exist for the amount of protein in the diet. 4 high-protein supplements can be used without risk by women on macrobiotic diets.

intrauterine growth restriction. Spina bifida is not associated with inadequate maternal weight gain. An adequate amount of folic acid has been shown to reduce the incidence of this condition. Both normal-weight and underweight women with inadequate weight gain have an increased risk of giving birth to an infant with intrauterine growth restriction. Diabetes mellitus is not related to inadequate weight gain. A gestational diabetic mother is more likely to give birth to a large-for-gestational age infant. Down syndrome is the result of a trisomy 21, not inadequate maternal weight gain.

Women with an inadequate weight gain during pregnancy are at higher risk of giving birth to an infant with: 1 spina bifida. 2 intrauterine growth restriction. 3 diabetes mellitus. 4 Down syndrome.