Maternal Neonatal Nursing - Antepartum Period
A client is at risk for seizures due to pregnancy-induced hypertension. The healthcare provider orders 4 g magnesium sulfate in 250 ml D5W to be infused at 1 g/hour following a loading dose. What is the flow rate in milliliters per hour? Record your answer using a whole number.
63 To solve this, first set up a proportion and then solve for X:4 g/250 ml = 1 g/X4X = 250 mlX = 62.5 ml, which rounds to 63 ml/h.
The nurse is caring for a client who is 30 weeks pregnant and in preterm labor who has been prescribed a magnesium sulfate infusion. Which will the nurse include in the client's plan of care? Select all that apply. Assess deep tendon reflexes (DTRs) every 4 hours. Evaluate urinary output every 24 hours. Assess temperature frequently. Monitor respiratory rate hourly and as needed. Ensure that calcium gluconate is on hand.
Assess deep tendon reflexes (DTRs) every 4 hours. Monitor respiratory rate hourly and as needed. Ensure that calcium gluconate is on hand.
A client is admitted for an amniocentesis. Initial assessment findings include 16 weeks' gestation, vital signs within normal limits, hemoglobin 12.2 g/dL (122 g/L), hematocrit 35% (0.35), and type O-negative blood. Which action would the nurse complete first after amniocentesis has been completed? Administer a dose of Rohm(D) immune globulin intramuscularly. Teach the client about signs and symptoms of intra-amniotic infection. Assess fetal heart rate and compare to pre-procedure baseline. Change the procedure site dressing and assess for signs of infection.
Assess fetal heart rate and compare to pre-procedure baseline.
A woman with preeclampsia is receiving magnesium sulfate via infusion pump at 1 g/h. The nurse's assessment includes temperature 36.7°C; pulse 78; respirations 12/minute; blood pressure 128/82 mm Hg; urinary output 90 mL in last 4 hours via urinary catheter; patellar-tendon reflex absent; ankle clonus absent; fetal heart rate 120 beats/min; cervix 4 cm dilated, 80% effaced, station -1. Which is the most appropriate action for the nurse to take? Assess the urinary catheter for kinks in the drainage tubing and obtain a urine sample. Document findings and continue to monitor her progress in labor. Discontinue the magnesium sulfate infusion and notify the health care provider (HCP). Increase fluid intake intravenously and measure intake and output.
Discontinue the magnesium sulfate infusion and notify the health care provider (HCP).
A 40-year-old primigravid client with AB-positive blood visits the outpatient clinic for an amniocentesis at 16 weeks' gestation. The nurse determines that the most likely reason for the client's amniocentesis is to determine if the fetus has which problem? cri-du-chat syndrome ABO incompatibility erythroblastosis fetalis Down syndrome
Down Syndrome
The nurse is receiving shift report on four clients on an antenatal unit. The four clients are (1) a 35-week-gestation mother with severe pre-eclampsia started on a maintenance dose of magnesium sulfate 1 hour ago; (2) a 30-week-gestation patient with preterm labor on oral nifedipine and having no contractions in 6 hours; (3) a hyperemesis client with emesis four times in the past 12 hours; and (4) a 33-week-gestation client with placenta previa who began to feel pelvic pressure during change of shift report. In what order should the nurse see these clients? Assess the client with preterm labor for tolerance of nifedipine and the labor pattern. Evaluate the client with pre-eclampsia for maternal and fetal tolerance of magnesium sulfate and the labor pattern. Assess the hyperemesis client for nausea for further emesis, or dehydration. Evaluate the placenta previa client without an exam.
Evaluate the placenta previa client without an exam. Evaluate the client with pre-eclampsia for maternal and fetal tolerance of magnesium sulfate and the labor pattern. Assess the hyperemesis client for nausea for further emesis, or dehydration. Assess the client with preterm labor for tolerance of nifedipine and the labor pattern.
A client is told that she needs to have a nonstress test to determine fetal well-being. After 20 minutes of monitoring, the nurse reviews the strip and finds two 15-beat accelerations that lasted for 15 seconds. What should the nurse do next? Continue to monitor the baby for fetal distress. Notify the physician and transfer the mother to labor and delivery for imminent birth. Inform the physician and prepare for discharge; this client has a normal strip. Ask the mother to eat something and return for a repeat test; the results are inconclusive.
Inform the physician and prepare for discharge; this client has a normal strip.
The nurse is assessing a pregnant client using Leopold's maneuvers. Which of the following nursing actions are appropriate for this assessment? Select all that apply. Have the client refrain from voiding for 2 hours prior to the exam. Position the client on her side. Palpate the client's upper abdomen using both hands. Note the shape and consistency of the palpated part. Note the mobility of the palpated part.
Palpate the client's upper abdomen using both hands. Note the shape and consistency of the palpated part. Note the mobility of the palpated part.
A multigravid client who stands for long periods while working in a factory visits the prenatal clinic at 35 weeks' gestation, stating, "The varicose veins in my legs have really been bothering me lately." Which instruction would be most helpful? Perform slow contraction and relaxation of the feet and ankles twice daily. Take frequent rest periods with the legs elevated above the hips. Avoid support hose that reach above the leg varicosities. Take a leave of absence from work to avoid prolonged standing.
Take frequent rest periods with the legs elevated above the hips.
A primigravida at 8 weeks' gestation tells the nurse that she wants an amniocentesis because there is a history of hemophilia A in her family. The nurse informs the client that she will need to wait until she is at 15 weeks' gestation for the amniocentesis. Which is the most appropriate rationale for the nurse's statement regarding amniocentesis at 15 weeks' gestation? Fetal development needs to be complete before testing. The volume of amniotic fluid needed for testing will be available by 15 weeks. Cells indicating hemophilia A are not produced until 15 weeks' gestation. Performing an amniocentesis prior to 15 weeks' gestation carries a greater infection rate.
The volume of amniotic fluid needed for testing will be available by 15 weeks.
A woman who has preeclampsia is receiving magnesium sulfate 20 grams per 500 mL of lactated Ringers via infusion pump. The prescribed rate of infusion is 2 grams/hour. How many mL/hour should the nurse set the infusion pump for? Record your answer using a whole number.
X = 500mL/20grams x 2grams/hour.X = 50 mL/hour.
The nurse is admitting a primigravid client at 37 weeks' gestation who has been diagnosed with preeclampsia to the labor and birth area. Which client care rooms is most appropriate for this client? a brightly lit private room at the end of the hall from the nurses' station a semiprivate room midway down the hall from the nurses' station a private room with many windows that is near the operating room a darkened private room as close to the nurses' station as possible
a darkened private room as close to the nurses' station as possible
A client at 36 weeks' gestation, begins to exhibit signs of labor after an eclamptic seizure. The nurse should assess the client for: abruptio placentae transverse lie placenta accreta uterine atony
abruptio placentae
Which condition poses the greatest risk to a 32-year-old client who is 15 weeks pregnant and has a history of hypertension? abruptio placentae preterm labor spontaneous abortion anemia
abruptio placentae
Which outcome would the nurse identify as the priority to achieve when developing the plan of care for a primigravid client at 38 weeks' gestation who is hospitalized with severe preeclampsia and receiving intravenous magnesium sulfate? decreased generalized edema within 8 hours decreased urinary output during the first 24 hours absence of any seizure activity during the first 48 hours sedation and decreased reflex excitability within 48 hours
absence of any seizure activity during the first 48 hours
A pregnant client at 26 weeks gestation walks a moderate distance to get to her prenatal class. When she gets to the class, she starts experiencing uterine cramping with no backache or bloody show. She is quite concerned about the cramping and asks the nurse what is happening. The most appropriate response from the nurse would be to tell the client the pains could be lightening and to count the movements over the next hour. advise the client to rest and drink fluids. advise her to see her physician immediately for preterm labor. explain to the client she may be miscarrying.
advise the client to rest and drink fluids.
A primigravid client at 35 weeks gestation is scheduled for a biophysical profile. After instructing the client about the test, which client statement indicates effective teaching about what the test measures? amniotic fluid volume placement of the placenta amniotic fluid color fetal gestational age
amniotic fluid volume
A 30-year-old multiparous client has been prescribed oral contraceptives as a method of birth control. The nurse instructs the client that decreased effectiveness may occur if the client is prescribed which drug? indomethacin amitriptyline ampicillin omeprazole
ampicillin
A client is Rh(D)-negative and D-negative and hasn't formed Rh antibodies. When should the client receive RHO(D) immune globulin (RhoGAM) to prevent isoimmunization? at about 28 weeks' gestation only within 72 hours after birth only at about 28 weeks' gestation and again within 72 hours after birth at about 32 weeks' gestation and again within 24 hours after birth
at about 28 weeks' gestation and again within 72 hours after birth
When measuring the fundal height of a primigravid client at 20 weeks' gestation, the nurse will locate the fundal height at which point? halfway between the client's symphysis pubis and umbilicus at about the level of the client's umbilicus between the client's umbilicus and xiphoid process near the client's xiphoid process and compressing the diaphragm
at about the level of the client's umbilicus
During a nonstress test (NST), the electronic tracing displays a relatively flat line for fetal movement, making it difficult to evaluate the fetal heart rate (FHR). To mark the strip, a nurse should instruct the client to push the control button at which time? at the beginning of each fetal movement at the beginning of each contraction after every three fetal movements at the end of fetal movement
at the beginning of each fetal movement
A nurse is developing a teaching plan for a primigravid client who's 2 months pregnant. The nurse should tell the client that fetal movement can be felt beginning at which time? between 10 and 12 weeks' gestation between 18 and 20 weeks' gestation between 21 and 23 weeks' gestation between 24 and 26 weeks' gestation
between 18 and 20 weeks' gestation
A client with gestational hypertension receives magnesium sulfate 50% 4 g in 250 mL D5W over 20 minutes. What priority assessment should the nurse perform when administering this drug? temperature fetal heart rate deep tendon reflexes intake and output
deep tendon reflexes
A client wants to avoid methods of birth control that contain estrogen. Which method would be the nurse recommend? combined hormonal oral contraceptive etonogestrel/ethinyl estradiol vaginal ring depot medroxyprogesterone acetate injection birth control patch
depot medroxyprogesterone acetate injection
When teaching an antepartum client about the passage of the fetus through the birth canal during labor, the nurse describes the cardinal mechanisms of labor. Using a teaching pelvis and fetus, the nurse demonstrates which sequence during birth? Place these events in the proper sequence. All options must be used. internal rotation descent flexion external rotation extension expulsion
descent flexion internal rotation extension external rotation expulsion
During each prenatal checkup, a nurse obtains a client's weight and blood pressure and measures fundal height. What is another essential part of each prenatal checkup? evaluating the client for edema measuring the client's hemoglobin (Hb) level obtaining pelvic measurements determining the client's Rh factor
evaluating the client for edema
A client makes a routine visit to the prenatal clinic. Although the client is 14 weeks pregnant, the size of her uterus approximates an 18- to 20-week pregnancy. The physician diagnoses gestational trophoblastic disease and orders ultrasonography. The nurse expects ultrasonography to reveal: an empty gestational sac. grapelike clusters. a severely malformed fetus. an extrauterine pregnancy.
grapelike clusters.
A 24-year-old client, G3, T1, P1, A1, L1 at 32 weeks' gestation, is admitted to the hospital because of vaginal bleeding. After reviewing the client's history, which factor might lead the nurse to suspect abruptio placentae? several hypotensive episodes previous low transverse cesarean delivery one induced abortion history of cocaine use
history of cocaine use
When teaching a group of pregnant adolescent clients about reproduction and conception, the nurse is correct when stating that fertilization occurs: in the uterus. when the ovum is released. near the fimbriated end. in the first third of the fallopian tube.
in the first third of the fallopian tube.
A nurse is planning care for an adolescent client who is 12 weeks' gestation. The nurse will monitor this client closely for the development of which complication during this stage of the pregnancy? postpartum depression gestational hypertension gestational diabetes iron-deficiency anemia
iron-deficiency anemia
When teaching a primigravid client with diabetes about common causes of hyperglycemia during pregnancy, the nurse would include which information? fetal macrosomia decreased fetal insulin maternal infection gestational hypertension
maternal infection
A nurse is caring for a client with hyperemesis gravidarum who will need close monitoring at home. When should the nurse begin discharge planning? on the day of discharge when the client expresses readiness to learn when the client's vomiting has stopped on admission to the facility
on admission to the facility
A 32-year-old female client visits the family planning clinic and requests an intrauterine device for contraception. When assessing the client, a history of which problem would be most important to determine? thrombophlebitis pelvic inflammatory disease previous liver disease coronary artery disease
pelvic inflammatory disease
During a childbirth preparation class, a primigravid client at 36 weeks' gestation tells the nurse, "My lower back has really been bothering me lately." Which exercise suggested would be most helpful? pelvic rocking deep breathing tailor sitting squatting
pelvic rocking
The nurse is caring for a 38-year-old primigravida in the third trimester of pregnancy. The nurse plans to assess the client for manifestations of which complication? pelvic inflammatory disease ruptured membranes cardiac overload preeclampsia
preeclampsia
A client who is 14 weeks' pregnant mentions that she has been having difficulty moving her bowels since she became pregnant. Which hormone is responsible for this common discomfort during pregnancy? progesterone estrogen testosterone human chorionic gonadotropin
progesterone
A client at 28 weeks' gestation is complaining of contractions. Following admission and hydration, the physician writes an order for the nurse to give 12 mg of betamethasone I.M. This medication is given to: slow contractions. enhance fetal growth. prevent infection. promote fetal lung maturity.
promote fetal lung maturity.
A nurse is developing a care plan for a client in her 34th week of gestation who's experiencing premature labor. What nonpharmacologic intervention should the plan include to halt premature labor? encouraging ambulation serving a nutritious diet promoting adequate hydration performing nipple stimulation
promoting adequate hydration
A 32-year-old multigravida returns to the clinic for a routine prenatal visit at 36 weeks' gestation. The assessments during this visit include: blood pressure 140/90 mm Hg; pulse 80 beats/min; respiratory rate 16 breaths/min. What further information should the nurse obtain to determine if this client is becoming preeclamptic? headaches blood glucose level proteinuria peripheral edema
proteinuria
A pregnant mother who has brought her toddler to the clinic for a check-up asks the nurse how she can keep her next baby from becoming obese. The mother plans to bottle-feed her next child. Which information should the nurse include in the teaching plan to help the mother avoid overnourishing her infant? recognizing clues indicating that a baby is full establishing a regular feeding schedule supplementing feedings with sterile water adding more water than directed when preparing formula
recognizing clues indicating that a baby is full
A client is diagnosed with oligohydramnios during a clinic visit. Before the client gives birth, the nurse should notify the nurses working in the nursery about the diagnosis so they are aware of which complication that's commonly associated with oligohydramnios? hypospadias talipes equinovarus Babinski's reflex renal malformations
renal malformations
When developing a teaching plan for a client who is 8 weeks pregnant, the nurse would suggest what foods to meet the client's need for increased folic acid? Select all that apply. spinach bananas seafood yogurt beans
spinach beans
A cerclage procedure is performed on a client at 20 weeks' gestation who is diagnosed with cervical incompetence. When preparing the discharge teaching plan, the nurse should expect to instruct the client to monitor herself for which problem? Braxton Hicks contractions nausea and vomiting symptoms of infection transient hypotension
symptoms of infection
A primigravid client at 26 weeks' gestation visits the clinic and tells the nurse that her lower back aches when she arrives home from work. The nurse should suggest that the client perform which exercise? tailor sitting leg lifting shoulder circling squatting
tailor sitting
A client who is 10 weeks pregnant develops spotting; however, the cervix remains closed. What should the nurse should suspect? threatened abortion inevitable abortion ectopic pregnancy missed abortion
threatened abortion
The nurse explains the complications of pregnancy that occur with diabetes to a primigravid client at 10 weeks' gestation who has a 5-year history of insulin-dependent diabetes. Which complication, if stated by the client, indicates the need for additional teaching? Candida albicans infection twin-to-twin transfer polyhydramnios preeclampsia
twin-to-twin transfer
A nurse is caring for a client after evacuation of a hydatidiform mole. The nurse should tell the client to: wait 1 month before trying to become pregnant again. make an appointment for follow-up human chorionic gonadotropin (hCG) level monitoring at the end of 1 year. discuss options for sterilization with the physician. use birth control for at least 1 year.
use birth control for at least 1 year.
A client in the first trimester of pregnancy joins a childbirth education class. During this trimester, the class is most likely to cover which physiologic aspect of pregnancy? signs and symptoms of labor quickening and fetal movements warning signs of complications false labor and true labor
warning signs of complications
The nurse is teaching a new prenatal client about her iron-deficiency anemia during pregnancy. Which statement indicates that the client needs further instruction about her anemia? "I will need to take iron supplements now." "I may have anemia because my family is of Asian descent." "I am considered anemic if my hemoglobin is below 11 g/dl (110 g/l)." "The anemia increases the workload on my heart."
"I may have anemia because my family is of Asian descent."
An obese 36-year-old multigravid client at 12 weeks' gestation has a history of chronic hypertension. She was treated with methyldopa before becoming pregnant. When counseling the client about diet during pregnancy, the nurse realizes that the client needs additional instruction when she makes which statement? "I need to reduce my caloric intake to 1,200 calories a day." "A regular diet is recommended during pregnancy." "I should eat more frequent meals if I get heartburn." "I need to consume more fluids and fiber each day."
"I need to reduce my caloric intake to 1,200 calories a day."
A client at 36 weeks' gestation tells the nurse, "I've been having a lot of backaches lately." After giving instructions about how to decrease the backaches, the nurse determines that the client needs further instruction when she makes which statement? "I should walk with my pelvis tilted backward." "I may need to put a board under my mattress." "I should squat and not bend to pick up objects." "I should wear flat or low-heeled shoes."
"I should walk with my pelvis tilted backward."
The nurse instructs a preeclamptic client about monitoring the movements of her fetus to determine fetal well-being. Which statement by the client indicates that she needs further instruction about when to call the health care provider (HCP) concerning fetal movement? "If the fetus is becoming less active than before." "If it takes longer each day for the fetus to move 10 times." "If the fetus stops moving for 12 hours." "If the fetus moves more often than 3 times an hour."
"If the fetus moves more often than 3 times an hour."
A client with type 1 diabetes has just learned she's pregnant. The nurse is teaching her about insulin requirements during pregnancy. Which guideline should the nurse provide? "Insulin requirements don't change during pregnancy. Continue your current regimen." "Insulin requirements usually decrease during the last two trimesters." "Insulin requirements usually decrease during the first trimester." "Insulin requirements increase greatly during labor."
"Insulin requirements usually decrease during the first trimester."
A client asks the nurse why vitamin C intake is so important during pregnancy. How should the nurse respond? "Vitamin C is required to promote blood clot and collagen formation." "Supplemental vitamin C in large doses can prevent neural tube defects." "Eating moderate amounts of foods high in vitamin C helps metabolize fats and carbohydrates." "Studies have shown that vitamin C helps the growth of fetal bones."
"Vitamin C is required to promote blood clot and collagen formation."
A client has just expelled a hydatidiform mole. She's visibly upset over the loss and wants to know when she can try to become pregnant again. How should the nurse respond? "Why don't we discuss this with you at a later time when you're feeling better." "You must wait at least 1 year before becoming pregnant again." "Let me check with your physician and get you something that will help you relax." "Pregnancy should be avoided until all of your testing is normal."
"You must wait at least 1 year before becoming pregnant again."
When assessing a pregnant client with diabetes mellitus, the nurse stays alert for signs and symptoms of a vaginal or urinary tract infection (UTI). Which laboratory value makes this client more susceptible to such infections? potassium level of 3.0 mEq/L (3.0 mmol/L) +3 urine glucose hemoglobin A1C of 6.8% blood glucose level of 60 mg/dL (3.3mmol/L)
+3 urine glucose
A nurse in a prenatal clinic is assessing a client who is 28 weeks' pregnant. Which findings lead the nurse to suspect that the client has mild preeclampsia? glycosuria and blood pressure of 150/92 mmHg reduced urine output, 1+ edema 1+ protein, blood pressure 142/92 mmHg blood pressure 138/78 mmHg, 1+ edema in feet
1+ protein, blood pressure 142/92 mmHg
The primary health care provider (HCP) orders 1,000 mL of Ringer's lactate intravenously over an 8-hour period for a 29-year-old primigravid client at 16 weeks' gestation with hyperemesis. The drip factor is 12 gtt/mL. The nurse should administer the IV infusion at how many drops per minute? Record your answer as a whole number.
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