High Risk Mom-OB

The clinic nurse is teaching a pregnant client about her iron supplement. which information is included in the teaching? SATA 1. Iron does not affect the GI tract 2. A stool softener might be needed 3. Start a low dose, and increase it gradually 4. Expect the stool to be black and bloody 5. Iron absorption is poor if taken with meals

2, 3, 5 ( 2-iron can cause constipation, 3. To prevent anemia all women should start on 30 mg/day if anemia is diagnosed it is recommended to increase dose to 60-120 mg/day. 5. Iron absorption is reduced 40-50% if taken with meals)

The nurse has written the nursing dx injury, risk for d\a diabetic pregnant client. Interventions for this dx include which of the following? SATA 1. Assessment of fetal heart tones 2. Perform oxytocin challenge test, if ordered 3. Refer the client to a diabetes support group 4. Assist with the biophysical profiles assessment 5. Develop an appropriate teaching plan

1, 2, 4

During the history, the client admits to being HIV-positive and says she knows that she is about 116 weeks pregnant. Which statement made by the client indicates an understanding of the plan of care? 1. During labor and delivery, I can expect the zidovudine (ZDV) to be given in my IV 2. After delivery, the dose of zidovudine (ZDV) will be doubled to prevent further infection 3. My baby will be started on zidovudine fr six weeks following the birth 4.My baby's ZDV will be given in a cream form 5. May baby will not need ZDV if I take it during my pregnancy

1, 3 (ART therapy generally it includes oral Zidovudine ZDV during labor and until birth, and ZDV therapy for the infant for 6 weeks following birth)

A woman is to receive methotrexate IM for an ectopic pregnancy. The nurse should teach the woman about which of the following common side effects of the therapy? Select all that apply. 1. Nausea and vomiting. 2. Abdominal pain. 3. Fatigue. 4. Lightheadedness. 5. Breast tenderness.

1,2,3,4 (Because methotrexate is an antineoplastic agent, the nurse would expect to see the same types of complaints that he or she would see with a patient receiving chemotherapy for cancer. It is very important that the abdominal pain seen with the medication not be dismissed since the most common complaint of women with ectopic pregnancies is pain. The source of the pain, therefore, must be clearly identified. relatively long period of time. Their pulse rates, however, do rise. Nurses, therefore, must carefully attend to the pulse rate of pregnant women who have been injured or who are being ob- served for third-trimester bleeding. A drop in blood pressure is a very late and ominous sign.)

Which of the following symptoms, if progressive, are indicative of CHF, the heart signals of its decreased ability to meet the demands of pregnancy? 1. Palpitations 2. Heart Murmurs 3. Dyspnea 4. Frequent urination 5. Rales

1,2,3,5 (Rales is another name for crackles)

A 39-year-old, 16-week-gravid woman has had an amniocentesis. Before discharge, the nurse teaches the woman to call her doctor if she experiences any of the follow- ing side effects? Select all that apply. 1. Fever or chills. 2. Lack of fetal movement. 3. Abdominal pain. 4. Rash or pruritus. 5. Vaginal bleeding.

1,2,3,5 (The client should call her practitioner if she experiences fever or chills. 2. Because the fetus can be injured during an amniocentesis, the client should report either a decrease or an increase in fetal movement. 3. The client should report abdominal pain or cramping. An amniocentesis can precipitate preterm labor. 4. Neither rash nor pruritus is associated with amniocentesis. 5. The client should report any vaginal loss—blood or amniotic fluid. The placenta may become injured or the membranes may rupture during an amniocentesis.)

A type 1 diabetic client has developed polyhydramnios. The client should be taught to report which of the following? 1. Uterine contractions. 2. Reduced urinary output. 3. Marked fatigue. 4. Puerperal rash.

1. Uterine contractions. (Clients with hydramnios have excessive quantities of amniotic fluid in their uterine cavities. The excessive quantities likely result from in- creased fetal urine production resulting from the mother's having periods of hyperglycemia. When the uterus is overextended from the large quantities of fluid, these women are at high risk for preterm labor.-body is "tricked" into thinking she if father along"

A client, 32 weeks' gestation with placenta previa, is on total bed rest. The physician expects her to be hospitalized on bed rest until her cesarean section, which is scheduled for 38 weeks' gestation. To prevent complications while in the hospital, the nurse should do which of the following? Select all that apply. 1. Perform passive range of motion exercises. 2. Restrict the fluid intake of the client. 3. Decorate the room with pictures of family. 4. Encourage the client to eat a high-fiber diet. 5. Teach the client deep breathing exercises.

1,2,4,5 (1. Passive range of motion will help to decrease the potential for muscle atrophy. 2. Fluid restriction is inappropriate. To maintain healthy bowel and bladder function the client should drink large quantities of fluids. 3. This client is separated from family. The separation can lead to depression. Decorating the room and enabling family to visit freely is very important. 4. A high-fiber diet will help to maintain normal bowel function. 5. Deep breathing exercises are important in order to maintain the client's respiratory function.)

A woman, G1P0000, is 40 weeks' gestation. Her Bishop score is 4. Which of the following complementary therapies do midwives frequently recommend to clients in similar situations? Select all that apply. 1. Sexual intercourse. 2. Aromatherapy. 3. Breast stimulation. 4. Ingestion of castor oil. 5. Aerobic exercise.

1,3,4 (Castor oil stimulates the bowels. Prostaglandins, which ripen the cervix, are produced as a result of gastrointestinal stimulation. If there is any indication that the baby may be unable to withstand labor, however, these means should not be employed.)

A client who works as a waitress and is 35 weeks' gestation, telephones the labor suite after getting home from work and states, "I am feeling tightening in my groin about every 5 to 6 minutes." Which of the following comments by the nurse is appropriate at this time? 1. "Please lie down and drink about four full glasses of water or juice." 2. "You are having false labor pains so you need not worry about them." 3. "It is essential that you get to the hospital immediately." 4. "That is very normal for someone who is on her feet all day."

1. "Please lie down and drink about four full glasses of water or juice." (The first intervention for preterm labor is hydration. Clients who are de- hydrated are at high risk for preterm labor. After being hydrated it is possible that the client's cramping will stop. Preterm cramping should never be ignored. To assess whether or not a client is in true labor, clients are encouraged to improve their hydration. The client is encouraged to drink about 1 quart of fluid and to lie on her side. If the contractions do not stop, she should proceed to the hospital to have her cervix assessed. If the cervix be- gins to dilate or efface, a diagnosis of preterm labor would be made. If the contractions stop, clients are usually al- lowed to begin light exercise. But if the contractions restart, the woman should proceed to the hospital to be assessed.)

Because nausea and vomiting are such common complaints of pregnant women, the nurse provides anticipatory guidance to a 6-week gestation client by telling her to do which of the following? 1. Avoid eating greasy foods. 2. Drink orange juice before rising. 3. Drink 2 glasses of water with each meal. 4. Eat 3 large meals plus a bedtime snack.

1. Avoid eating greasy foods. ( Did you ever read anything about orange juice? NO! Don't add stuff the recommendation is crackers.

A hospitalized gravida's blood work is hematocrit 30% and hemoglobin 10 gm/dL. In light of the laboratory data, which of the following meal choices should the nurse recommend to this patient? 1. Chicken livers, sliced tomatoes, and dried apricots. 2. Cheese sandwich, tossed salad, and rice pudding. 3. Veggie burger, cucumber salad, and wedge of cantaloupe. 4. Bagel with cream cheese, pear, and hearts of lettuce.

1. Chicken livers, sliced tomatoes, and dried apricots. (Iron needs increase significantly during pregnancy to provide for fetal and maternal production of blood cells. Iron deficiency anemia can result from low iron stores and the high demand for iron during pregnancy. Lean meats; dark green, leafy vegetables; eggs; and whole-grain or enriched bread or cereals. as well as dried fruits, legumes, shellfish, and molasses are good sources of iron. Iron supplements are often prescribed, but the gastrointestinal (GI) distress from iron may make iron supplements difficult to maintain. The use of iron salt could provide the needed increase in iron while reducing sodium from regular salt use to season food. Milk and caffeine may interfere with iron absorption, so supplements should be taken with water.)

In anticipation of a complication that may develop in the second half of pregnancy, the nurse teaches an 18-week gravid client to call the office if she experiences which of the following? 1. Headache and decreased output. 2. Puffy feet. 3. Hemorrhoids and vaginal discharge. 4. Backache.

1. Headache and decreased output. (It is important for the test taker to realize that, although some symptoms like puffy feet may seem significant, they are normal in pregnancy, while other symptoms like headache, which in a nonpregnant woman would be considered benign, may be potentially very important in a pregnant woman.)

A gravid woman has sickle cell anemia. Which of the following situations could precipitate a vasoocclusive crisis in this woman? 1. Hypoxia. 2. Alkalosis. 3. Fluid overload. 4. Hyperglycemia.

1. Hypoxia. (Vasoocclusive crises are precipitated by hypoxia in pregnant as well as non-pregnant sickle cell clients.)

A type 1 diabetic is being seen for preconception counseling. The nurse should emphasize that during the first trimester the woman may experience which of the following? 1. Need for less insulin than she normally injects. 2. An increased risk for hyperglycemic episodes. 3. Signs and symptoms of hydramnios. 4. A need to be hospitalized for fetal testing.

1. Need for less insulin than she normally injects. (The client will be at high risk for hypo- glycemic episodes. Hydramnios does not develop until the 2nd or 3rd trimester.The client will likely be hospitalized during the 2nd and/or 3rd trimesters for fetal testing.-Nausea and vomiting are common complaints of gravid clients during the first trimester. As a result, women, including diabetic women, consume fewer calories than before becoming pregnant. Their need for insulin drops commensurately. Therefore, it is very important that the women monitor their blood glucose regularly upon awakening and throughout the day.)

A gravid woman, 36 weeks' gestation with type 1 diabetes, has just had a biophysical profile (BPP). Which of the following results should be reported to the obstetrician? 1. One fetal heart acceleration in 20 minutes. 2. Three episodes of fetal rhythmic breathing in 30 minutes. 3. Two episodes of fetal extension and flexion of 1 arm. 4. One amniotic fluid pocket measuring 3 cm.

1. One fetal heart acceleration in 20 minutes. (There should be a minimum of 2 fetal heart accelerations in 20 minutes (approximately 1 every 10 minutes).

A client is admitted to the birth setting in early labor. She is 3 cm dilated, -2 station, with intact membranes and FHR of 150bpm. Her membranes rupture spontaneously, and the FHR drops to 90 BMP with variable decelerations. What would the nurse's initial response be? 1. Perform a vaginal exam 2. Notify the physician 3. Place the client in left lateral position 4. Administer 02 at 2 L per nasal cannula

1. Perform a vaginal exam (Proplasepd umbilical cord can occur when the membranes rupture. The fetus is more likely to experience variable declarations because the amniotic fluid is insufficient to keep pressure off the umbilical cord. A vaginal exam is the best way to confirm.)

On ultrasound, it is noted that the pregnancy of a hospitalized woman who is carrying monochorionic twins is complicated by twin-to-twin transfusion. The nurse should carefully monitor this client for which of the following? 1. Rapid fundal growth. 2. Vaginal bleeding. 3. Projectile vomiting. 4. Congestive heart failure.

1. Rapid fundal growth. (the recipient twin—the twin receiving blood from the other twin—often produces large quantities of urine result- ing in polyhydramnios.)

A full-term newborn was just born. Which nursing intervention is important for the nurse to perform first? 1. Remove wet blankets 2. Assess Apgar score. 3. Insert eye prophylaxis. 4. Elicit the Moro reflex.

1. Remove wet blankets (When newborns are wet they can be- come hypothermic from heat loss resulting from evaporation. They may then develop cold stress syndrome. The first Apgar score is not done until 60 seconds after delivery. The wet blankets should have been removed from the baby well before that time.This is a prioritizing question. Every one of the actions will be performed after the birth of the baby. The nurse must know which action is performed first. Because hypothermia can compromise a neonate's transition to extrauterine life, it is essential to dry the baby immediately to minimize heat loss through evaporation. It is important for the test taker to review cold stress syndrome.)

A 38-week gestation client, Bishop score 1, is advised by her nurse midwife to take evening primrose daily. The office nurse advises the client to report which of the following side effects that has been attributed to the oil? 1. Skin rash. 2. Pedal edema. 3. Blurred vision. 4. Tinnitus.

1. Skin rash

The nurse has taken a health history on four primigravid clients at their first prenatal visits. It is high priority that which of the clients receives nutrition counseling? 1. The woman diagnosed with phenylketonuria. 2. The woman who has Graves' disease. 3. The woman with Cushing's syndrome. 4. The woman diagnosed with myasthenia gravis.

1. The woman diagnosed with phenylketonuria (The client with phenylketonuria (PKU) must receive counseling from a registered dietitian. PKU is a genetic dis- ease that is characterized by the absence of the enzyme needed to metabolize phenylalanine, an essential amino acid. When patients with PKU consume phenylalanine, a metabolite that affects cognitive centers in the brain is created in the body. If a pregnant woman who has PKU were to eat foods high in phenylalanine, her baby would develop severe mental retardation in utero.

A 25-week-pregnant client, who had eaten a small breakfast, has been notified that her glucose challenge test results were 132 mg/dL 1 hour after ingesting the glu- cose. Which of the following is appropriate for the nurse to say at this time? 1. "Because you ate before the test, the results are invalid and will need to be repeated." 2. "Because your test results are higher than normal, you will have to have another more specific test." 3. "Because of the results you will have to have weekly glycohemoglobin testing done." 4. "Because your results are within normal limits you need not worry about gestational diabetes."

2. "Because your test results are higher than normal, you will have to have another more specific test." (The GCT is merely a screening test. The vast majority of women are sent for the test at about24 weeks' gestation when their human placental lactogen (a placental hormone that is an insulin antagonist) levels reach a specific point. If the GCT results are 130 mg/dL or higher, the client is re- ferred for a 3-hour glucose tolerance test.)

A client enters the prenatal clinic. She states that she missed her period yesterday and used a home pregnancy test this morning. She states that the results were negative, but "I still think I am pregnant." Which of the following statements would be appropriate for the nurse to make at this time? 1. "Your period is probably just irregular." 2. "We could do a blood test to check." 3. "Home pregnancy test results are very accurate." 4. "My recommendation would be to repeat the test in one week."

2. "We could do a blood test to check." (This response is correct. Serum pregnancy tests are more sensitive than urine tests are. The client could repeat the test, but since the more accurate serum test is available, it would be better for the nurse to recommend that action. At-home tests are reliable only if used correctly.)

Which of the following pregnant clients is most high risk for preterm premature rupture of the membranes (PPROM)? 1. 30-week gestation with prolapsed mitral valve (PMV). 2. 32-week gestation with urinary tract infection (UTI). 3. 34-week gestation with gestational diabetes (GDM). 4. 36-week gestation with deep vein thrombosis (DVT).

2. 32-week gestation with urinary tract infection (UTI). (Although the exact mechanism is not well understood, clients who have urinary tract infections are at high risk for PPROM. This is particularly important since pregnant clients often have urinary tract infections that present either with no symptoms at all or only with urinary frequency, a complaint of many pregnant clients.)

A gestational diabetic, who requires insulin therapy to control her blood glucose levels, telephones the triage nurse complaining of dizziness and headache. Which of the following actions should the nurse take at this time? 1. Have the client proceed to the office to see her physician. 2. Advise the client to drink a glass of milk and then call back. 3. Instruct the client to inject herself with regular insulin. 4. Tell the client immediately to telephone her medical doctor.

2. Advise the client to drink a glass of milk and then call back. (Because the signs and symptoms of hyperglycemia and hypoglycemia are very similar, it is important for the nurse to err on the side of caution. If the client should be hypo- glycemic, this is a medical emergency. Drinking a glass of milk will stabilize the glucose in the woman's body. If she is hyperglycemic, the milk may increase the glucose levels, but not significantly. A blood glucose assessment can be done and insulin can be administered, if needed, shortly after consuming the milk.)

The nursery nurse is careful to wear gloves when admitting neonates into the nursery. Which of the following is the scientific rationale for this action? 1. Meconium is filled with enteric bacteria. 2. Amniotic fluid may contain harmful viruses. 3. The high alkalinity of fetal urine is caustic to the skin. 4. The baby is high risk for infection and must be protected.

2. Amniotic fluid may contain harmful viruses. (Amniotic fluid is a reservoir for viral diseases like HIV and hepatitis B. If the woman is infected with those viruses, the amniotic fluid will be infectious. Meconium is a sterile stool. Plus the new- born will not produce gastrointestinal bacteria until a few days after delivery. Although babies are at high risk for in- fection, there is no need for nurses to wear gloves routinely when caring for the babies. Immediately after delivery the nurse is protecting himself or herself from the baby, not the other way around.)

A woman, 6 weeks pregnant, is having a vaginal examination. Which of the follow- ing would the practitioner expect to find? 1. Thin cervical muscle. 2. An enlarged ovary. 3. Thick cervical mucus. 4. Pale pink vaginal wall.

2. An enlarged ovary (The cervix is long and thick in order to retain the pregnancy in the uterine cavity. The cervical mucus is thin and the vaginal wall is bluish in color as a result of elevated estrogen levels. The ovary is enlarged because the corpus luteum is still functioning.)

The nurse is assessing the Laboratory report of a 40 week gestation client. Which of the following values would the nurse expect to find elevated above Prepregancy levels? 1. Glucose. 2. Fibrinogen. 3. Hematocrit. 4. Bilirubin.

2. Fibrinogen (Fibrinogen levels will be elevated slightly in a 40-week pregnant woman because coagulation factors like fibrinogen increase to help prevent excessive blood loss during delivery. Hematocrit levels are usually slightly lower. Bilirubin levels should be within normal limits. During the latter part of the third trimester, coagulation factors increase in preparation for delivery. It is the body's means of protecting itself against a large loss of blood at delivery.)

A 29-week-gestation woman diagnosed with severe preeclampsia is noted to have blood pressure of 170/112, 4 proteinuria, and a weight gain of 10 pounds over the last 2 days. Which of the following signs/symptoms would the nurse also expect to see? 1. Fundal height of 32 cm. 2. Papilledema 3. Patellar reflexes of +2. 4. Nystagmus.

2. Papilledema (Intracranial pressure (ICP) is present in a client with severe preeclampsia because she is third spacing large quantities of fluid. As a result of the ICP, the optic disk swells, and papilledema is seen when the disk is viewed through an ophthalmoscope.)

A gravid client is admitted with a diagnosis of third-trimester bleeding. The nurse must carefully monitor for a change in which of the following vital signs? 1. Temperature. 2. Pulse. 3. Respirations. 4. Blood pressure.

2. Pulse (change in BP-is a late sign in the third trimester) (By the end of the second trimester, pregnant women have almost doubled their blood volume. Because of this, if they bleed, they are able to maintain their blood pressures for a relatively long period of time. Their pulse rates, however, do rise. Nurses, therefore, must carefully attend to the pulse rate of pregnant women who have been injured or who are being observed for third-trimester bleeding. A drop in blood pressure is a very late and ominous sign.)

A Client was admitted to the labor area at 5cm with ruptured membranes about 14 hours ago. what assessment data would be most beneficial for the nurse to collect? 1. Blood Pressure 2. Temperature 3.Pulse 4. Respiratory Rate

2. Temperature (Rupture of membranes places the mother at a risk for infection. Temperature is the primary and often first indication of a problem. -Thinks Mrs. Jaeger and sepsis)

A pregnant woman, 24 weeks' gestation, who has been diagnosed with gallstones is scheduled for surgery. In order to provide high-quality care, what should the nurse be aware of? 1. That preterm delivery of the baby must precede the cholescystectomy surgery. 2. That decreased gastric motility of pregnancy increases her risk of postoperative vomiting. 3. That physiological anemia of pregnancy increases her risk of perioperative hemorrhage. 4. That antiembolic stockings are contraindicated for the pregnant woman after surgery.

2. That decreased gastric motility of pregnancy increases her risk of postoperative vomiting. (This response is correct. Progesterone slows gastric motility, increasing the client's potential for postoperative vomiting and for postoperative gas pains.)

The nurse is caring for a client who was just admitted to the hospital to rule out an ectopic pregnancy. Which of the following orders is the most important for the nurse to perform? 1. Assess the client's temperature. 2. Document the time of the client's last meal. 3. Obtain urine for urinalysis and culture. 4. Report complaints of dizziness or weakness.

4. Report complaints of dizziness or weakness (It could be ruptured, she could be bleeding internally/hemorrhaging/go into shock, circulation is the priority here).

When is hemodilution at its highest point in pregnancy?

28-32 weeks

A diabetic pt goes into labor at 36 wks. Provided that tests for fetal lung maturity are successful, the nurse will anticipate which of the following interventions? 1. Administration of tocolytic therapy 2. beta-sympathomimetic administration 3. Allowance of labor to progress 4. Hourly blood glucose monitoring 5. C-section birth is indicated if evidence of reassuring fetal status exists

3,4 (there will be no attempt to stop the labor, as this can compromise the mother and fetus. 4 to reduce incidence of congenital anomalies and other problems in the newborn the woman should be euglycemic (normal blood sugar) throughout pregnancy & labor)

A 20-year-old client states that the at-home pregnancy test that she took this morn- ing was positive. Which of the following comments by the nurse is appropriate at this time? 1. "Congratulations, you and your family must be so happy." 2. "Have you told the baby's father yet?" 3. "How do you feel about the results?" 4. "Please tell me when your last menstrual period was."

3. "How do you feel about the results?" (It is important for the nurse to ask the young woman how she feels about being pregnant. She may decide not to continue with the pregnancy. This information is important, but it is not the best statement to make initially.Some pregnant women are happy about their pregnancy, some are sad, and still others are frightened.At the initial interview, it is essential that the nurse not assume that the woman will respond in any particular way. The nurse must ask open-ended questions in order to elicit the woman's feelings about the pregnancy)

A client with mild preeclampsia, who has been advised to be on bed rest at home, asks why it is necessary. Which of the following is the best response for the nurse to give the client? 1. "Bed rest will help you to conserve energy for your labor." 2. "Bed rest will help to relieve your nausea and anorexia." 3. "Reclining will increase the amount of oxygen that your baby gets." 4. "The position change will prevent the placenta from separating."

3. "Reclining will increase the amount of oxygen that your baby gets." (Bed rest, especially side-lying, helps to improve perfusion to the placenta. This question requires the nurse to have a clear understanding of the pathology of preeclampsia. Only with an understanding of the underlying disease, can the test taker be able to remember the rationale for many aspects of client care. The vital organs of preeclamptic clients are being poorly perfused as a result of abnormally high blood pressure. When a woman lies on her side, blood return to the heart is improved and the cardiac output is also improved. With improved cardiac output, perfusion to the placenta and other organs is improved.)

When counseling a preeclamptic client about her diet, what should the nurse encourage the woman to do? 1. Restrict sodium intake. 2. Increase intake of fluids. 3. Eat a well-balanced diet 4. Avoid simple sugars

3. Eat a well-balanced diet (Clients with preeclampsia are losing albumin through their urine. They should eat a well-balanced diet with sufficient protein to replace the lost protein. Even though preeclamptic clients are hypertensive, it is not recommended that they restrict salt—they should have a normal salt intake— because during pregnancy the kidney is salt sparing. When salt is restricted, the kidneys become stressed.)

A gravid woman, who is 42 weeks' gestation, has just had a 20-minute nonstress test (NST). Which of the following results would the nurse interpret as a reactive test? 1. Moderate fetal heart baseline variability. 2. Maternal heart rate accelerations to 140 bpm lasting at least 20 seconds. 3. Two fetal heart accelerations of 15 bpm lasting at least 15 seconds. 4. Absence of maternal premature ventricular contractions.

3. Two fetal heart accelerations of 15 bpm lasting at least 15 seconds.(This is the definition of a reactive nonstress test—there are two fetal heart accelerations of 15 bpm lasting 15 or more seconds during a 20-minute period.)

The nurses caring for a client who was just admitted to rule out an ectopic pregnancy. Which orders are the most important for the nurse to perform? 1. Assess the client's temperature 2. Document the time of the client's last meal 3. Obtain urine for urinalysis and culture 4. Report Complaints of dizziness or weakness 5. Have the lab draw blood for B-hCG levels every 48 hours

4. Report Complaints of dizziness or weakness 5. Have the lab draw blood for B-hCG levels every 48 hours (Reporting complaints of dizziness and weakness is important, as it can indicate hypovolemia from internal bleeding. Circulation is the priority! You don't want mom to go into shock!-the lab needs to draw blood to determine if it is an ectopic pregnancy.)

During a prenatal interview, a client tells the nurse, "My mother told me she had toxemia during her pregnancy and almost died!" Which of the following questions should the nurse ask in response to this statement? 1. "Does your mother have a cardiac condition?" 2. "Did your mother tell you what she was toxic from?" 3. "Does your mother have diabetes now?" 4. "Did your mother say whether she had a seizure or not?"

4. "Did your mother say whether she had a seizure or not?" (The hypertensive ill- nesses of pregnancy used to be called toxemia of pregnancy as well as pregnancy- induced hypertension (PIH). That term is still heard in the community because the mothers and grandmothers of clients were told that they had toxemia of pregnancy. Because daughters of clients who have had preeclampsia are high risk for hypertensive illness, it is important to find out whether or not the client's mother had developed eclampsia.)

Which of the following statements is appropriate for the nurse to say to a patient with a complete placenta previa? 1. "During the first phase of labor you will do slow chest breathing." 2. "You should ambulate in the halls at least two times each day." 3. "The doctor will deliver you once you reach 25 weeks' gestation." 4. "Please remember to tell me if you become constipated."

4. "Please remember to tell me if you become constipated." (Straining at stool can result in enough pressure to result in placental bleeding.Clients diagnosed with complete placenta previa are usually maintained on bed rest. Because one of the many complications of bed rest is constipation, these clients must be monitored carefully. Many physicians order Colace (docusate sodium), a stool softener, to prevent this complication.)

A 26-week-gestation woman is diagnosed with severe preeclampsia with HELLP syndrome. The nurse will assess for which of the following signs/symptoms? 1. Low serum creatinine. 2. High serum protein. 3. Bloody stools. 4. Epigastric pain.

4. Epigastric pain. (When the liver is de- prived of sufficient blood supply, as can occur with severe preeclampsia, the organ becomes ischemic. The client experiences pain at the site of the liver as a result of the hypoxia in the liver.)

A 12-week-gravid client presents in the emergency department with abdominal cramps and scant dark red bleeding. What should the nurse assess this client for? 1. Shortness of breath. 2. Enlarging abdominal girth. 3. Hyperreflexia and clonus. 4. Fetal heart dysrhythmias.

4. Fetal heart dysrhythmias. (This client is showing signs of spontaneous abortion. The nurse should check the fetal heart rate.)

An insulin-dependent diabetic woman will require higher doses of insulin as which of the following pregnancy hormones increases in her body? 1. Estrogen. 2. Progesterone. 3. Human chorionic gonadotropin. 4. Human placental lactogen

4. Human placental lactogen (Human placental lactogen is an insulin antagonist so the client will require higher doses of insulin as the level of placental lactogen increases.)

A 21 year old women is at 12 weeks gestation with her first baby. She has cardiac disease, class III, as a result of having had childhood rheumatic fever. Which planned activity would indicate to the nurse that the client needs further teaching? 1. I will be sure to take a rest period every afternoon 2. I would like. to take child birth education classes in my last trimester 3. I will have to cancel our trip to disney world 4. I am going to start my classes in water aerobics next week

4. I am going to start my classes in water aerobics next week (with the slightest exertion, the clients heart rate will rise and she will become symptomatic. Therefore she should not establish a new exercise program)

The client has just been diagnosed as diabetic. The nurse knows the teaching was effective when the client makes which statement? 1. Ketones on my urine mean that my body is using the glucose correctly 2. I should be urinating frequently and in large amounts to get rid of the extra sugar 3. My pancreas is making enough insulin, but my body isn't using it correctly 4. I might be hungry frequently because the sugar isn't getting into the tissue the way it should.

4. I might be hungry frequently because the sugar isn't getting into the tissue the way it should. (It never says what kind of diabetes the women has so 3 is incorrect. Because the body os not getting the glucose it needs hunger signals are sent to the brain)

A client has severe preeclampsia. The nurse would expect the primary health care practitioner to order tests to assess the fetus for which of the following? 1. Severe anemia. 2. Hypoprothrombinemia. 3. Craniosynostosis. 4. Intrauterine growth restriction.

4. Intrauterine growth restriction. (Perfusion to the placenta drops when clients are preeclamptic because the client's hypertension impairs adequate blood flow. When the placenta is poorly perfused, the baby is poorly nourished. Without the nourishment provided by the mother through the umbilical vein, the fetus' growth is affected.)

A gravid woman is carrying monochorionic twins. For which of the following com- plications should this pregnancy be monitored? 1. Oligohydramnios. 2. Placenta previa. 3. Cephalopelvic disproportion. 4. Twin-to-twin transfusion.

4. Twin-to-twin transfusion. (The key to answering this question is the fact that the twins originate from the same egg—that is, they are monozygotic twins. They share a placenta and a chorion. Because their blood supply is originating from the same source, the twins' circulations are connected. As a result, one twin may become the donor twin while the second twin may become the recipient. The donor grows poorly and develops severe anemia. The recipient becomes polycythemic and large.)

The client with thalassemia intermedia has a hgb level of 9.0. The nurse is preparing an education session for the client. Which statement should the nurse include? 1. You need to increase your intake of meat and other iron-rich foods 2. Your low hgb could put you into preterm labor 3. Increasing your vitamin C intake will help your hgb levels 4. You should not take iron supplements

4. You should not take iron supplements (thalassemia is sickle cell-they should not take iron supplements)

Chloasma

A "Presumptive Sign" of pregnancy of skin on the face (mask of pregnancy)

Women with HIV should be evaluated and treated for other sexually transmitted infections. What condition occurs more commonly in women with HIV? A. Syphilis B. Toxoplasmosis C. Gonorrhea D. Herpes

B. Toxoplasmosis (Immune-compromised persons such as patients who received transplants or those infected with HIV are more likely to have severe toxoplasmosis infection.)

When assisting with a transabdominal sampling, which of the following would the nurse do? A. Obtain preliminary Urinary samples B. Have the woman empty her bladder before the test begins C.Assist the woman into a supine position on the examining table D. Instruct the woman to eat a fat-free meal 2 hours before the scheduled test time

C.Assist the woman into a supine position on the examining table

Type of miscarriage where all the products of conception are expelled. The uterus is contracted and the cervical may be closed

Complete abortion

Type of miscarriage where parts of the products of conception are retained, most often the placenta.

Incomplete abortion

Type of abortion where the fetus dies in utero but is not expelled

Missed abortion

A client is admitted to the hospital with severe preeclampsia. The nurse is assessing for clonus. Which of the following actions should the nurse perform? 1. Strike the woman's patellar tendon. 2. Palpate the woman's ankle. 3. Dorsiflex the woman's foot. 4. Position the woman's feet flat on the floor.

When clients have severe preeclampsia, they are often hypereflexic and develop clonus. To assess for clonus, the nurse should dorsiflex the foot and then let the foot go. The nurse should observe for and count any pulsations of the foot. The number of pulsations is documented. The higher the number of pulsations, the more irritable the woman's central nervous system.