Maternity Exam 6

1) A pregnant patient's healthcare provider is using the Hadlock method to determine gestational age and growth of the fetus. Which measurements will be used to make this fetal determination? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Femur length 2. Biparietal diameter 3. Head circumference 4. Abdominal circumference 5. Crown to rump measurement

Answer: 1, 2, 3, 4 Explanation: The Hadlock method uses an average of measures of the biparietal diameter, head circumference, abdominal circumference, and femur length to estimate gestational age. The crown to rump measurement is used to determine gestational age of an embryo between 6 and12 weeks.

1) A patient in the first trimester of pregnancy recently emigrated from a foreign country and is diagnosed with rubella. What can occur to the developing fetus because of this infection? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Congenital cataracts 2. Sensorineural deafness 3. Ophthalmia neonatorum 4. Congenital heart defects 5. Intrauterine growth restriction

Answer: 1, 2, 4 Explanation: The most common clinical signs of rubella syndrome are congenital cataracts, sensorineural deafness, and congenital heart defects. Ophthalmia neonatorum is associated with maternal gonorrhea at the time of birth. Intrauterine growth restriction is not associated with rubella.

1) The nurse is preparing teaching material for a patient with multiple sclerosis who is in the third trimester of pregnancy. What information should the nurse emphasize with this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Plan for frequent rest periods 2. Breastfeeding should be avoided 3. Plan to experience heightened pain during labor 4. Determine the need for childcare help after delivery 5. Relapses may increase during the first 3 months after delivery

Answer: 1, 4, 5 Explanation: For the pregnant patient with multiple sclerosis, the nurse should emphasize that the relapse rate is reduced during the second and third trimester but increased during the 3 months following birth. Exclusive breastfeeding for the first 2 months postpartum may be independently associated with decreased post-pregnancy relapse rate. Rest is important; help with childcare should be planned. Uterine contraction strength is not diminished, but because sensation is frequently lessened, labor may be almost painless.

1) A patient with gestational diabetes (G D M) is instructed to measure capillary blood glucose levels 4 times a day. If the patient eats meals at 8 a.m., 1 p.m., and 7 p.m., at which times should the nurse reinforce glucose testing to occur? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. 10 a.m. 2. 12 noon 3. 4 p.m. 4. 3 p.m. 5. 9 p.m.

Answer: 1, 4, 5 Explanation: Women with G D M typically measure their blood glucose four times a day - fasting and 1 to 2 hours after meals.

1) A pregnant patient weighing 165 lb is diagnosed with preeclampsia and is prescribed to ingest 1.5 g/kg/day of protein. How many grams of protein should the nurse instruct the patient to ingest?

Answer: 112.5 grams Explanation: First convert the patient's weight in lb to k g by dividing the weight by 2.2 or 165/2.2 = 75 k g. Next multiply the weight in k g by 1.5 grams of protein or 75 x 1.5 = 112.5 grams. The nurse should instruct the patient to ingest 112.5 grams of protein each day.

1) A patient in the 10th week of pregnancy is diagnosed with gestational diabetes. The dietician determines that the patient's daily caloric intake should be 2200 calories and instructs the patient to ingest 40% of calories from carbohydrates, 20% of calories from protein, and 40% of calories from fats. How many calories should the patient ingest of protein each day?

Answer: 440 calories Explanation: To determine the number of calories of protein that should be ingested each day the daily caloric total is multiplied by 20% or 2200 × 20% = 440 calories.

1) A pregnant patient is completing an ultrasound to grade the integrity of the placenta. Which diagram should the nurse provide to the patient if the findings are grade 0?

Answer: A Explanation: A) Choice 1 shows the ultrasonic appearance of a grade 0 placenta. Choice 2 shows the ultrasonic appearance of a grade I placenta. Choice 3 shows the ultrasonic appearance of a grade Ⅱ placenta. Choice 4 shows the ultrasonic appearance of a grade Ⅲ placenta.

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

Answer: D Explanation: A) Iron-rich foods and supplementation should be avoided. B) Because the client's iron levels are normal, increasing dietary iron will not affect the hemoglobin. C) Vitamin C increases iron absorption, but a client with thalassemia does not need additional iron. D) Folic acid supplements are indicated for women with thalassemia, but iron supplements are not.

1) A woman at 28 weeks' gestation is asked to keep a fetal activity record and to bring the results with her to her next clinic visit. One week later, she calls the clinic and anxiously tells the nurse that she has not felt the baby move for more than 30 minutes. Which of the following would be the nurse's most appropriate initial comment? A) "You need to come to the clinic right away for further evaluation." B) "Have you been smoking?" C) "When did you eat last?" D) "Your baby might be asleep."

Answer: D Explanation: A) The mother would need to come to the clinic only if there had been no fetal activity for several hours. B) Certain substances such as tobacco, drugs, alcohol, and caffeine have been shown to affect fetal movements and can increase fetal movement. C) After meals, an infant typically has increased movement. D) Lack of fetal activity for 30 minutes typically is insignificant. Movement varies considerably, but most women feel fetal movement at least 10 times in 3 hours.

1) The client at 24 weeks' gestation is experiencing painless vaginal bleeding after intercourse. The physician has ordered a transvaginal ultrasound examination. Which statements by the client indicate an understanding of why this exam has been requested? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) "This ultrasound will show the baby's gender." B) "This ultrasound might cause the miscarriage of my baby." C) "This ultrasound carries a risk of creating a uterine infection." D) "This ultrasound can determine the location of my placenta." E) "This ultrasound might detect whether the placenta is detaching prematurely."

Answer: D, E Explanation: A) Although gender can sometimes be detected with second-trimester ultrasound, that is never the primary reason for the procedure. B) Ultrasound is non-invasive, and does not increase the risk for either fetal loss or uterine infection. C) Ultrasound is non-invasive, and does not increase the risk for either fetal loss or uterine infection. D) Painless bleeding in the second and third trimesters can be a symptom of placenta previa. Transvaginal ultrasound will determine the placental location. Painless bleeding in the second and third trimesters can be a symptom of placenta previa. Transvaginal ultrasound will determine the placental location

1) A patient in the second trimester of pregnancy with gestational diabetes is counseled to ingest 35 calories/k g of ideal body weight. The patient's ideal weight is 154 l b s. How many calories should the patient ingest every day?

Answer: 2450 calories Explanation: First determine the patient's ideal body weight in k g by dividing 154 lbs. by 2.2 k g or 154/2.2 = 70 k g. Then multiply the weight in k g by the number of calories per k g to consume or 70 k g × 35 calories = 2450. The patient's daily caloric intake should be 2450 calories.

1) During a routine prenatal visit, the nurse suspects that the patient is experiencing undiagnosed depression. What findings did the nurse use to make this clinical determination? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Insomnia 2. Headaches 3. Fear of labor 4. Ritualistic behavior 5. Lack of interest in the pregnancy

Answer: 1, 2, 5 Explanation: Manifestations of depression in the pregnant patient include withdrawn behavior, physical fatigue due to insomnia, crying spells, sadness, hopelessness, feelings of guilt, lack of interest in the baby, thoughts of suicide, and headaches. Fear of labor is associated with a panic disorder. Ritualistic behavior is associated with obsessive-compulsive disorder (O C D).

1) The nurse is preparing to conduct a nonstress test with a pregnant patient. In which order should the nurse complete the steps of the procedure? 1. Obtain baseline measurement for 20 minutes 2. Place the patient in the semi-Fowler's position 3. Place the pressure transducer over the uterine fundus 4. Give the patient a handheld marker to indicate when fetal movement is felt 5. Place the ultrasound transducer from the external fetal monitor over the F H R

Answer: 2, 5, 3, 1, 4 Explanation: When conducting a nonstress test the nurse should first place the patient in the semi-Fowler's position. Then the ultrasound transducer form the external fetal monitor should be placed over the fetal heart rate. The pressure transducer is then placed over the uterine fundus. Baseline measurement should be obtained for 20 minutes. Finally, the nurse should provide the patient with a marker to indicate when fetal movement is felt.

1) The prenatal clinic nurse is explaining test results to a client who has had an assessment for fetal well-being. Which statement indicates that the client understands the test results? A) "The normal Doppler velocimetry wave result indicates my placenta is getting enough blood to the baby." B) "The reactive nonstress test means that my baby is not growing because of a lack of oxygen." C) "Because my contraction stress test was positive, we know that my baby will tolerate labor well." D) "My biophysical profile score of 6 points to everything being normal and healthy for my baby."

Answer: A Explanation: A) A decrease in fetal cardiac output or an increase in resistance of placental vessels will reduce umbilical artery blood flow. Doppler velocimetry is best used when intrauterine growth restriction is diagnosed; a normal result indicates that the baby is getting an adequate blood supply. B) The nonstress test involves using an external electronic fetal monitor to obtain a tracing of the fetal heart rate (F H R) and observation of acceleration of the F H R with fetal movement. C) A contraction stress test (C S T) provides a method for observing the response of the F H R to the stress of uterine contractions. The desired result is a negative test. D) A score of 6 is abnormal, and indicates that further assessment is needed.

1) A 27-year-old married woman is 16 weeks pregnant and has an abnormally low maternal serum alpha-fetoprotein test. Which statement indicates that the couple understands the implications of this test result? A) "We have decided to have an abortion if this baby has Down syndrome." B) "If we hadn't had this test, we wouldn't have to worry about this baby." C) "I'll eat plenty of dark green leafy vegetables until I have the ultrasound." D) "The ultrasound should be normal because I'm under the age of 35."

Answer: A Explanation: A) A low maternal serum alpha-fetoprotein test can indicate trisomy 18 or trisomy 21 (Down syndrome). Many couples abort a fetus that has a genetic abnormality that significantly affects quality of life or has multiple medical problems. Down syndrome is more likely to occur in the fetuses of women over the age of 35 at delivery, but is not limited to this age group. B) A low maternal serum alpha-fetoprotein test can indicate trisomy 18 or trisomy 21 (Down syndrome). C) The condition begins in very early fetal life. Dark green leafy vegetables contain folic acid. Low folic acid levels in the first trimester can lead to neural tube defects, which would cause a high maternal serum alpha-fetoprotein screen. D) Down syndrome is more likely to occur in women over the age of 35 at delivery, but is not limited to this age group.

1) A primary herpes simplex infection in the first trimester can increase the risk of which of the following? A) Spontaneous abortion B) Preterm labor C) Intrauterine growth restriction D) Neonatal infection

Answer: A Explanation: A) A primary herpes simplex infection can increase the risk of spontaneous abortion when infection occurs in the first trimester. B) Preterm labor (PTL) is a greater risk if the primary infection occurs late in the second trimester or early in the third trimester. C) Intrauterine growth restriction is a greater risk if the primary infection occurs late in the second trimester or early in the third trimester. Neonatal infection is a greater risk if the primary infection occurs late in the second trimester or early in the third trimester

1) The nurse is preparing a client for amniocentesis. Which statement would indicate that the client clearly understands the risks of amniocentesis? A) "I might go into labor early." B) "It could produce a congenital defect in my baby." C) "Actually, there are no real risks to this procedure." D) "The test could stunt my baby's growth."

Answer: A Explanation: A) Amniocentesis has the potential to cause spontaneous abortion. B) Congenital defects are the result of heredity or medications. C) Amniocentesis has potential complications such as infection, bleeding and spontaneous abortion. Growth retardation most commonly is associated with heredity or poor nutrition

1) The pregnant client and her partner are both 40 years old. The nurse is explaining the options of chorionic villus sampling (C V S) and amniocentesis for genetic testing. The nurse should correct the client if she makes which statement? A) "Amniocentesis results are available sooner than C V S results are." B) "C V S carries a higher risk of limb abnormalities." C) "Amniocentesis cannot detect a neural tube defect." D) "C V S is performed through my belly or my cervix."

Answer: A Explanation: A) Amniocentesis results take longer to process than do C V S results. B) Limb anomalies are associated with C V S, but not with amniocentesis. C) Neural tube defects are not genetic in nature; therefore, they are not detected by either amniocentesis or C V S. D) C V S can be performed through either a transabdominal or transvaginal approach.

1) A woman has a hydatidiform mole (molar pregnancy) evacuated, and is prepared for discharge. The nurse should make certain that the client understands that what is essential? A) That she not become pregnant until after the follow-up program is completed B) That she receive R h o G A M with her next pregnancy and birth C) That she has her blood pressure checked weekly for the next 30 days D) That she seek genetic counseling with her partner before the next pregnancy

Answer: A Explanation: A) Because of the risk of choriocarcinoma, the woman treated for hydatidiform mole should receive extensive follow-up therapy. Follow-up care includes a baseline chest X-ray to detect lung metastasis and a physical examination including a pelvic examination. The woman should avoid pregnancy during this time because the elevated h C G levels associated with pregnancy would cause confusion as to whether cancer had developed. B) There is no indication for the administration of R h o G A M. C) There is no indication of blood pressure problems or preeclampsia. D) This is not a genetic defect that genetic counseling could/would resolve.

1) During a prenatal exam, a client describes several psychosomatic symptoms and has several vague complaints. What could these behaviors indicate? A) Abuse B) Mental illness C) Depression D) Nothing, they are normal

Answer: A Explanation: A) Chronic psychosomatic symptoms and vague complaints can be indicators of abuse. B) Chronic psychosomatic symptoms and vague complaints are not indicators of mental illness. C) Chronic psychosomatic symptoms and vague complaints are not indicators of depression. D) Chronic psychosomatic symptoms and vague complaints should not be discounted as normal.

1) Which of the following symptoms, if progressive, are indicative of C H F, the heart's signal of its decreased ability to meet the demands of pregnancy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Palpitations B) Heart murmurs C) Dyspnea D) Frequent urination E) Rales

Answer: A, B, C, E Explanation: A) Palpitations are indicative of C H F. B) Heart murmurs are indicative of C H F. C) Dyspnea is indicative of C H F. D) Frequent urination is not indicative of C H F. Rales are indicative of CHF

1) The nurse is caring for a pregnant woman who admits to using cocaine and ecstasy on a regular basis. The client states, "Everybody knows that alcohol is bad during pregnancy, but what's the big deal about ecstasy?" What is the nurse's best response? A) "Ecstasy can cause a high fever in you and therefore cause the baby harm." B) "Ecstasy leads to deficiencies of thiamine and folic acid, which help the baby develop." C) "Ecstasy produces babies with small heads and short bodies with brain function alterations." D) "Ecstasy produces intrauterine growth restriction and meconium aspiration."

Answer: A Explanation: A) Hyperthermia (elevated temperature) is a side effect of M D M A (ecstasy). B) Alcohol, not ecstasy, causes deficiencies of thiamine and folic acid. Folic acid helps prevent neural tube defects. C) Cocaine, not ecstasy, causes these fetal effects (small heads and short bodies with brain function alterations). D) Heroin, not ecstasy, causes these fetal effects (intrauterine growth restriction and meconium aspiration).

1) A woman's history and appearance suggest drug abuse. What is the nurse's best approach? A) Ask the woman directly, "Do you use any street drugs?" B) Ask the woman whether she would like to talk to a counselor. C) Ask some questions about over-the-counter medications and avoid mention of illicit drugs. D) Explain how harmful drugs can be for her baby.

Answer: A Explanation: A) If drug abuse is suspected, the nurse should ask direct questions and be matter-of-fact and nonjudgmental to elicit honest responses. B) Advising the client to seek counseling would not occur until the nurse verifies that the woman uses street drugs. C) If abuse is suspected, the nurse should ask direct questions, beginning with less threatening questions about the use of tobacco, caffeine, and over-the-counter medications, but not avoid the mention of illicit drugs. D) When talking to clients in a therapeutic manner, it is important not to be threatening or judgmental; an example of judgmental behavior would be stating that the drugs will harm the baby.

1) A 28-year-old woman has been an insulin-dependent diabetic for 10 years. At 36 weeks' gestation, she has an amniocentesis. A lecithin/sphingomyelin (L/S) ratio test is performed on the sample of her amniotic fluid. Because she is a diabetic, what would an obtained 2:1 ratio indicate for the fetus? A) The fetus may or may not have immature lungs. B) The amniotic fluid is contaminated. C) The fetus has a neural tube defect. D) There is blood in the amniotic fluid.

Answer: A Explanation: A) Infants of diabetic mothers (I D Ms) have a high incidence of false-positive results (i.e., the L/S ratio is thought to indicate lung maturity, but after birth the baby develops R D S). B) Meconium contaminates the amniotic fluid and does not indicate fetal lung maturity. C) Neural tube defects are screened with the maternal serum alpha-fetoprotein test, and diagnosed with ultrasound. D) L B Cs testing, not a lecithin/sphingomyelin (L/S) ratio test, tests diabetic women and can be performed when there is blood in the amniotic fluid.

1) Infants of women with preeclampsia during pregnancy tend to be small for gestational age (SGA) because of which condition? A) Intrauterine growth restriction B) Oliguria C) Proteinuria D) Hypertension

Answer: A Explanation: A) Infants of women with preeclampsia during pregnancy tend to be small for gestational age (SGA) because of intrauterine growth restriction. The cause is related specifically to maternal vasospasm and hypovolemia, which result in fetal hypoxia and malnutrition. B) Oliguria is a sign of preeclampsia, but does not cause infants to be small for gestational age (SGA). C) Proteinuria is a sign of preeclampsia, but does not cause infants to be small for gestational age (SGA). D) Hypertension is a sign of preeclampsia, but does not cause infants to be small for gestational age (SGA).

1) The nurse is responding to phone calls. Whose call should the nurse return first? A) A client at 37 weeks' gestation reports no fetal movement for 24 hours. B) A client at 29 weeks' gestation reports increased fetal movement. C) A client at 32 weeks' gestation reports decreased fetal movement X 2 days. D) A client at 35 weeks' gestation reports decreased fetal movement X 4 hours.

Answer: A Explanation: A) Lack of fetal movement can be an indication of nonreassuring fetal status or even fetal death. This client is the highest priority. B) Increased fetal movement is not indicative of a problem. C) Although decreased fetal movement can indicate intrauterine growth restriction or fetal hypoxia, this client is not the highest priority. D) Although decreased fetal movement can indicate intrauterine growth restriction or fetal hypoxia, 4 hours is a very short period of time to assess decreased fetal movement.

1) The client with blood type A, R h-negative, delivered yesterday. Her infant is blood type AB, R h-positive. Which statement indicates that teaching has been effective? A) "I need to get R h o G A M so I don't have problems with my next pregnancy." B) "Because my baby is R h-positive, I don't need R h o G A M." C) "If my baby had the same blood type I do, it might cause complications." D) "Before my next pregnancy, I will need to have a R h o G A M shot."

Answer: A Explanation: A) Rh-negative mothers who give birth to R h-positive infants should receive R h immune globulin (R h o G A M) to prevent alloimmunization. B) If the baby is R h-negative, the mother does not need R h o G A M. C) It is specifically the R h factor that causes complications; ABO grouping does not cause alloimmunization. D) The injection must be given within 72 hours after delivery to prevent alloimmunization.

1) The prenatal clinic nurse has received four phone calls. Which client should the nurse call back first? A) Pregnant woman at 28 weeks with history of asthma who is reporting difficulty breathing and shortness of breath B) Pregnant woman at 6 weeks with a seizure disorder who is inquiring which foods are good folic acid sources for her C) Pregnant woman at 35 weeks with a positive H B s A G who is wondering what treatment her baby will receive after birth D) Pregnant woman at 11 weeks with untreated hyperthyroidism who is describing the onset of vaginal bleeding

Answer: A Explanation: A) The goal of therapy is to prevent maternal exacerbations, because even a mild exacerbation can cause severe hypoxia-related complications in the fetus. B) Women with seizure disorders should be started on folic acid supplements prior to pregnancy, and should continue throughout pregnancy. However, this client is not the highest priority. C) A client with a positive H B s A G is contagious for hepatitis B. Within 12 hours of birth, infants born to women with H B V infection should receive hepatitis B immune globulin and the first dose of the H B V vaccine series. However, this client is not the highest priority. D) Pregnant women with untreated hyperthyroidism have increased rates of abortion, intrauterine death, and stillbirth. Vaginal bleeding at 11 weeks could indicate that spontaneous abortion is taking place. However, this client is not the highest priority.

1) The nurse is providing care to a client in labor who admits to using heroin throughout the pregnancy. Which will the neonate be at risk for following birth? A) Seizure activity B) Congenital anomalies C) Large for gestational age D) Cardiac anomalies

Answer: A Explanation: A) The neonate who has been exposed to heroin in utero is at an increased risk for seizure activity following birth. B) The neonate who has been exposed to heroin in utero is not at an increased risk for congenital anomalies. This is expected if the neonate was exposed to lithium carbonate while in utero. C) The neonate who has been exposed to heroin in utero is not an increased risk for being large for gestational age. This is expected for the neonate who is born to a mother who is diagnosed with gestational diabetes mellitus. D) The neonate who has been exposed to heroin in utero is not at an increased risk for cardiac anomalies. This is expected for the neonate who is exposed to cocaine in utero.

1) A woman at 7 weeks' gestation is diagnosed with hyperemesis gravidarum. Which nursing diagnosis would receive priority? A) Fluid Volume: Deficient B) Cardiac Output, Decreased C) Injury, Risk for D) Nutrition, Imbalanced: Less than Body Requirements

Answer: A Explanation: A) The newly admitted client with hyperemesis gravidarum has been experiencing excessive vomiting, and is in a fluid volume-deficit state. B) Because no preexisting cardiac condition is present, the body has compensated for this fluid loss. C) The risk for injury is present due to the symptoms of fluid volume deficit; however, it is not the priority. D) The nutrition status of the client is compromised until the emesis and the fluid volume status are corrected. But it is not the first priority.

1) At 32 weeks' gestation, a woman is scheduled for a second nonstress test (following one she had at 28 weeks' gestation). Which statement by the client would indicate an adequate understanding of this procedure? A) "I can't get up and walk around during the test." B) "I'll have an I V started before the test." C) "I can still smoke before the test." D) "I need to have a full bladder for this test."

Answer: A Explanation: A) The purpose of the nonstress test is to determine the results of movement on fetal heart rate. The N S T is typically performed with the woman in the semi-Fowler's position with a small pillow or blanket under the right hip to displace the uterus to the left. B) No I V is needed to administer medications. C) Cigarette smoking can adversely affect the test results, so the woman should be counseled to avoid smoking prior to testing. D) Clients usually are asked to have their bladders full only for ultrasounds.

1) The client at 14 weeks' gestation has undergone a transvaginal ultrasound to assess cervical length. The ultrasound revealed cervical funneling. How should the nurse explain these findings to the client? A) "Your cervix has become cone-shaped and more open at the end near the baby." B) "Your cervix is lengthened, and you will deliver your baby prematurely." C) "Your cervix is short, and has become wider at the end that extends into the vagina." D) "Your cervix was beginning to open but now is starting to close up again."

Answer: A Explanation: A) Transvaginal ultrasound can most accurately identify shortened cervical length and cervical funneling, which is a cone-shaped indentation in the cervical os indicating cervical insufficiency or risk of preterm labor. B) Transvaginal ultrasound can most accurately identify shortened cervical length and cervical funneling, not lengthening of the cervix. C) Transvaginal ultrasound can most accurately identify shortened cervical length and cervical funneling, which is a cone-shaped indentation in the cervical os indicating cervical insufficiency or risk of preterm labor. D) Cervical change in pregnancy is progressive, and the cervix does not spontaneously constrict or close again until after delivery.

1) A client is concerned because she has been told that her blood type and her baby's are incompatible. What is the nurse's best response? A) "This is called ABO incompatibility. It is somewhat common but rarely causes significant hemolysis, a breakdown of red blood cells." B) "This is a serious condition, and additional blood studies are currently in process to determine whether you need a medication to prevent it from occurring with a future pregnancy." C) "This is a condition caused by a blood incompatibility between you and your husband, but does not affect the baby." D) "This type of condition is very common, and the baby can receive a medication to prevent jaundice from occurring."

Answer: A Explanation: A) When blood types, not R h, are incompatible, it is called ABO incompatibility. The incompatibility occurs as a result of the maternal antibodies present in her serum and interaction between the antigen sites on the fetal RBCs. B) Although this can be serious, additional blood studies are not typically done. There is no medication that can be given to the mother to prevent this from occurring. C) The incompatibility is not between the mother's and the father's blood, but between the mother's and the infant's blood. D) ABO incompatibility is common, but there is no medication to give the baby that will prevent jaundice.

1) The nurse is performing a preoperative assessment on a client who is in the second trimester of pregnancy. For which finding(s) should the nurse monitor? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Respiratory infection B) Fever C) Urinary tract infection D) Anemia E) ABO incompatibility

Answer: A, B, C, D Explanation: A) Assessing for respiratory infections is an important part of the preoperative assessment for the client who is pregnant. B) Assessing for fever is an important part of the preoperative assessment for the client who is pregnant. C) Assessing for urinary tract infection is an important part of the preoperative assessment for the client who is pregnant. D) Assessing for anemia is an important part of the preoperative assessment for the client who is pregnant. E) ABO incompatibility is not routinely assessed as part of the preoperative assessment for the client who is pregnant, as it rarely has serious life-threatening consequences and is almost exclusively seen after the birth of the newborn.

1) When blood pressure and other signs indicate that preeclampsia is worsening, hospitalization is necessary to monitor the woman's condition closely. At that time, which of the following should be assessed? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Fetal heart rate B) Blood pressure C) Temperature D) Urine color E) Pulse and respirations

Answer: A, B, C, E Explanation: A) Determine the fetal heart rate along with blood pressure, or monitor continuously with the electronic fetal monitor if the situation indicates. B) Determine blood pressure every 1 to 4 hours, or more frequently if indicated by medication or other changes in the woman's status. C) Determine temperature every 4 hours, or every 2 hours if elevated or if premature rupture of the membranes (PROM) has occurred. D) Urine color is not monitored. However, urine output, urine protein, and urine specific gravity are monitored. E) Determine pulse rate and respirations along with blood pressure.

1) The client and her partner are carriers of sickle cell disease. They are considering prenatal diagnosis with either amniocentesis or chorionic villus sampling (C V S). Which statements indicate that further teaching is needed on these two diagnostic procedures? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) "Chorionic villus sampling carries a lower risk of miscarriage." B) "Amniocentesis can be done earlier in my pregnancy than C V S." C) "Neither test will conclusively diagnose sickle cell disease in our baby." D) "The diagnosis comes sooner if we have C V S, not amniocentesis." E) "Amniocentesis is more accurate in diagnosis than the C V S."

Answer: A, B, E Explanation: A) C V S has a risk of spontaneous abortion of 0.3% in cases. This rate is higher than second trimester amniocentesis. B) C V S is performed in some medical centers for first trimester diagnosis after 9 completed weeks. Amniocentesis is performed between 15 and 20 weeks' gestation. C) This is a true statement. D) C V S is performed in some medical centers for first trimester diagnosis after 9 completed weeks. Amniocentesis is performed between 15 and 20 weeks' gestation. E) Much like amniocentesis, chorionic villus sampling (C V S) is a procedure that is used to detect genetic, metabolic, and D N A abnormalities. C V S permits earlier diagnosis than can be obtained by amniocentesis.

1) During the history, the client admits to being H I V-positive and says she knows that she is about 16 weeks pregnant. Which statements made by the client indicate an understanding of the plan of care both during the pregnancy and postpartally? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) "During labor and delivery, I can expect the zidovudine (Z D V) to be given in my Ⅳ." B) "After delivery, the dose of zidovudine (Z D V) will be doubled to prevent further infection." C) "My baby will be started on zidovudine (Z D V) for six weeks following the birth." D) "My baby's zidovudine (Z D V) will be given in a cream form." E) "My baby will not need zidovudine (Z D V) if I take it during my pregnancy."

Answer: A, C Explanation: A) A R T therapy generally includes oral Zidovudine (Z D V) daily, Ⅳ Z D V during labor and until birth, and Z D V therapy for the infant for 6 weeks following birth. B) The mother will continue with her oral dosage of zidovudine (Z D V) after delivery just as prior to delivery. C) A R T therapy generally includes oral Zidovudine (Z D V) daily, Ⅳ Z D V during labor and until birth, and Z D V therapy for the infant for 6 weeks following birth. D) The initial treatment is zidovudine (Z D V) orally every day. E) The infant will be started on oral zidovudine (Z D V) after birth for 6 weeks.

1) The client at 34 weeks' gestation has been stabbed in the low abdomen by her boyfriend. She is brought to the emergency department for treatment. Which statements indicate that the client understands the treatment being administered? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) "The baby needs to be monitored to check the heart rate." B) "My bowel has probably been lacerated by the knife." C) "I might need an ultrasound to look at the baby." D) "The catheter in my bladder will prevent urinary complications." E) "The Ⅳ in my arm will replace the amniotic fluid if it is leaking."

Answer: A, C Explanation: A) Ongoing assessments of trauma include evaluation of uterine tone, contractions and tenderness, fundal height, fetal heart rate, intake and output and other indicators of shock, normal postoperative evaluation in those women requiring surgery, determination of neurologic status, and assessment of mental outlook and anxiety level. B) The pregnancy usually sustains the majority of the damage, sparing the bowel from injury. C) In cases of noncatastrophic trauma, where the mother's life is not directly threatened, fetal monitoring for 4 hours should be sufficient if there is no vaginal bleeding, uterine tenderness, contractions, or leaking amniotic fluid. D) The Foley catheter is placed to assess for hematuria. E) The Ⅳ will replace intravascular volume, not amniotic fluid.

1) The nurse is providing care to a laboring pregnant client who is diagnosed with sickle cell disease. What will the nurse prepare for upon delivery of the client's newborn, based on this diagnosis? A) Hemorrhage B) Intrauterine growth restriction C) Neonatal resuscitation D) Cesarean birth

Answer: B Explanation: A) A pregnant client diagnosed with sickle cell anemia is not at an increased risk for hemorrhage. B) When providing care for a pregnant client diagnosed with sickle cell anemia, the nurse will prepare for a neonate experiencing intrauterine growth restriction, as this is a known consequence during pregnancy. C) The newborn of a client diagnosed with sickle cell anemia is not at an increased risk for requiring neonatal resuscitation. D) A pregnant client diagnosed with sickle cell anemia is not at an increased for cesarean birth.

1) Which of the following tests provides information about the fetal number? A) Amniocentesis B) Standard second-trimester sonogram C) Beta h C G D) Maternal serum alpha-fetoprotein

Answer: B Explanation: A) Amniocentesis can make chromosomal and biochemical determinations and can validate abnormalities detected by ultrasound. B) A standard (comprehensive) second trimester sonogram provides information about the fetus, placenta, and uterine conditions, including fetal number. C) Serial quantitative beta h C G testing can be used to distinguish a normally developing fetus from an ectopic pregnancy. D) Maternal serum alpha-fetoprotein (M S A F P) is a component of the screening test, the "quadruple check" that utilizes the multiple markers, including A F P, h C G, diameric inhibin-A, and estriol, to screen pregnancies for N T D, trisomy 21 (Down syndrome), and trisomy 18.

1) The client at 9 weeks' gestation has been told that her H I V test was positive. The client is very upset, and tells the nurse, "I didn't know I had H I V! What will this do to my baby?" The nurse knows teaching has been effective when the client makes which statement? A) "I cannot take the medications that control H I V during my pregnancy, because they will harm the baby." B) "My baby can get H I V during the pregnancy and through my breast milk." C) "The pregnancy will increase the progression of my disease and will reduce my C D4 counts." D) "The H I V won't affect my baby, and I will have a low-risk pregnancy without additional testing."

Answer: B Explanation: A) Antiretroviral therapy is recommended to all infected pregnant women, regardless of whether or not they are symptomatic, to reduce the rate of perinatal transmission. B) H I V transmission can occur during pregnancy and through breast milk; however, it is believed that the majority of all infections occur during labor and birth. C) There is no evidence to indicate that pregnancy increases the progression of H I V/A I D S. D) A pregnancy complicated by H I V infection, even if asymptomatic, is considered high risk, and the fetus is monitored closely. Weekly non-stress testing (N S T) is begun at 32 weeks' gestation.

1) A newly diagnosed insulin-dependent type 1 diabetic with good blood sugar control is at 20 weeks' gestation. She asks the nurse how her diabetes will affect her baby. What would the best explanation include? A) "Your baby could be smaller than average at birth." B) "Your baby will probably be larger than average at birth." C) "As long as you control your blood sugar, your baby will not be affected at all." D) "Your baby might have high blood sugar for several days."

Answer: B Explanation: A) Characteristically, infants of mothers with diabetes are large for gestational age (L G A). B) Characteristically, infants of mothers with diabetes are large for gestational age (L G A), as a result of high levels of fetal insulin production stimulated by the high levels of glucose crossing the placenta from the mother. Sustained fetal hyperinsulinism and hyperglycemia ultimately lead to excessive growth, called macrosomia, and deposition of fat. C) The demands of pregnancy will make it difficult for the best of clients to control blood sugar on a regular basis. D) After birth, the umbilical cord is severed, and, thus, the generous maternal blood glucose supply is eliminated.

1) The nurse is assessing a client who has severe preeclampsia. What assessment finding should be reported to the physician? A) Excretion of less than 300 m g of protein in a 24-hour period B) Platelet count of less than 150,000/m m3 C) Urine output of 50 m L per hour D) 12 respirations

Answer: B Explanation: A) Excretion of more than 300 m g of protein in a 24-hour period is considered abnormal. B) HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) complicates 10% to 20% of severe preeclampsia cases and develops prior to 37 weeks' gestation 50% of the time. Vascular damage is associated with vasospasm, and platelets aggregate at sites of damage, resulting in low platelet count (less than 150,000/m m3). C) Urine output of a least 30m L/hour is considered normal. D) Respirations of 12 are normal.

1) The nurse anticipates that the physician will most likely order a cervicovaginal fetal fibronectin test for which client? A) The client at 34 weeks' gestation with gestational diabetes B) The client at 32 weeks' gestation with regular uterine contractions C) The client at 37 weeks' multi-fetal gestation D) The client at 20 weeks' gestation with ruptured amniotic membranes

Answer: B Explanation: A) Gestational diabetes does not predispose a client to preterm labor. B) The absence of cervicovaginal f F N between 20 and 34 weeks' gestation has been shown to be a strong predictor of a woman not experiencing preterm birth due to spontaneous preterm labor or premature rupture of membranes. Positive findings indicate a 99% probability of birth within the next 2 weeks. C) Multi-fetal pregnancies often experience preterm delivery, but the client at 37 weeks is at term. D) A pregnancy at 20 weeks has not reached the point of viability, and is treated as an impending spontaneous abortion, not preterm labor.

1) A client is at 12 weeks' gestation with her first baby. She has cardiac disease, class Ⅲ. She states that she had been taking sodium warfarin (Coumadin), but her physician changed her to heparin. She asks the nurse why this was done. What should the nurse's response be? A) "Heparin is used when coagulation problems are resolved." B) "Heparin is safer because it does not cross the placenta." C) "They are the same drug, but heparin is less expensive." D) "Coumadin interferes with iron absorption in the intestines."

Answer: B Explanation: A) Heparin is used when coagulation problems develop. B) Heparin is safest for the client to take because it does not cross the placental barrier. C) Heparin does not cost less than Coumadin. D) Coumadin does not interfere with iron absorption in the intestines.

1) A woman is 32 weeks pregnant. She is H I V-positive but asymptomatic. The nurse knows that what would be important in managing her pregnancy and delivery? A) An amniocentesis at 30 and 36 weeks B) Weekly non-stress testing beginning at 32 weeks' gestation C) Application of a fetal scalp electrode as soon as her membranes rupture in labor D) Administration of intravenous antibiotics during labor and delivery

Answer: B Explanation: A) Invasive procedures such as amniocentesis are avoided when possible to prevent the contamination of a noninfected infant. B) Weekly non-stress testing (N S T) is begun at 32 weeks' gestation and serial ultrasounds are done to detect I U G R. C) Invasive procedures are avoided when possible to prevent the contamination of a noninfected infant. D) Antibiotics would be ineffective for either the mother or the infant who was H I V-positive.

1) A 26-year-old client is 28 weeks pregnant. She has developed gestational diabetes. She is following a program of regular exercise, which includes walking, bicycling, and swimming. What instructions should be included in a teaching plan for this client? A) "Exercise either just before meals or wait until 2 hours after a meal." B) "Carry hard candy (or other simple sugar) when exercising." C) "If your blood sugar is 120 m g/d L, eat 20 g of carbohydrate." D) "If your blood sugar is more than 120 m g/d L, drink a glass of whole milk."

Answer: B Explanation: A) It is best to exercise just after the meal, in order to utilize the glucose. B) The nurse should advise her to carry a simple sugar such as hard candy, because of the possibility of exercise-induced hypoglycemia. C) A finger stick result of 120 m g/d L is considered to be normal. D) Such clients need no additional carbohydrate or protein intake.

1) The nurse is reviewing amniocentesis results. Which of the following would indicate that client care was appropriate? A) The client who is R h-positive received R h immune globulin after the amniocentesis. B) The client was monitored for 30 minutes after completion of the test. C) The client began vaginal spotting before leaving for home after the test. D) The client identified that she takes insulin before each meal and at bedtime.

Answer: B Explanation: A) Only R h-negative clients receive R h immune globulin after amniocentesis. The R h-positive client should not ever receive R h o G A M. B) 20 to 30 minutes of fetal monitoring is performed after the amniocentesis. C) Vaginal spotting after the amniocentesis is not an expected finding. Instruct the woman to report any changes or symptoms to her primary caregiver regarding vaginal discharge-either clear drainage or bleeding. D) Whether a client takes insulin has nothing to do with amniocentesis.

1) If the woman is R h negative and not sensitized, she is given R h immune globulin to prevent what? A) The potential for hemorrhage B) Hyperhomocysteinemia C) Antibody formation D) Tubal pregnancy

Answer: C Explanation: A) If the woman is R h negative and not sensitized, she is not given R h immune globulin to prevent the potential for hemorrhage. B) Hyperhomocysteinemia (HHcy) is a risk factor for vascular disease. C) If the woman is R h negative and not sensitized, she is given R h immune globulin to prevent antibody formation. D) If the woman is R h negative and not sensitized, she is not given R h immune globulin to prevent a tubal pregnancy.

1) The nurse is doing preconception counseling with a 28-year-old woman with no prior pregnancies. Which statement made by the client indicates to the nurse that the client has understood the teaching? A) "I can continue to drink alcohol until I am diagnosed as pregnant." B) "I need to stop drinking alcohol completely when I start trying to get pregnant." C) "A beer once a week will not damage the fetus." D) "I can drink alcohol while breastfeeding because it doesn't pass into breast milk."

Answer: B Explanation: A) The expectant woman should avoid alcohol completely. B) Women should discontinue drinking alcohol when they start to attempt to become pregnant due to possible effects of alcohol on the fetus. C) The effects of alcohol on the fetus may include a group of signs referred to as fetal alcohol spectrum disorders (F A S D). D) Alcohol is excreted in breast milk; therefore, it should be avoided.

1) A client at 37 weeks' gestation has a mildly elevated blood pressure. Her antenatal testing demonstrates three contractions in 10 minutes, no decelerations, and accelerations four times in 1 hour. What would this test be considered? A) Positive nonstress test B) Negative contraction stress test C) Positive contraction stress test D) Negative nonstress test

Answer: B Explanation: A) The fact that contractions are present rules out the nonstress test. B) A negative C S T shows three contractions of good quality lasting 40 or more seconds in 10 minutes without evidence of late decelerations. This is the desired result. C) A positive C S T shows repetitive persistent late decelerations with more than 50% of the contractions. This is not a desired result. D) The fact that contractions are present rules out the nonstress test.

1) Of all the clients who have been scheduled to have a biophysical profile, the nurse should check with the physician to clarify the order for which client? A) A gravida with intrauterine growth restriction B) A gravida with mild hypotension of pregnancy C) A gravida who is postterm D) A gravida who complains of decreased fetal movement for 2 days

Answer: B Explanation: A) The infant who has intrauterine growth problems might be compromised due to placental insufficiency. B) The biophysical profile is used when there is a risk of placental and/or fetal compromise. The gravida with mild hypotension will need to be monitored more closely throughout the pregnancy, but is not a candidate at present for a biophysical profile. C) The infant who is postterm might be compromised due to placental insufficiency. D) The gravida who is experiencing decreased fetal movement for 2 days needs assessment of the placenta and the fetus.

1) Which of the following may be the main presenting symptom of iron deficiency anemia? A) Frequent urination B) Fatigue C) Nausea D) Headaches

Answer: B Explanation: A) The main presenting symptom of iron deficiency anemia would not be frequent urination. B) The main presenting symptom of iron deficiency anemia may be fatigue. C) The main presenting symptom of iron deficiency anemia would not be nausea. D) The main presenting symptom of iron deficiency anemia would not be headaches.

1) A client at 10 weeks' gestation has developed cholecystitis. If surgery is required, what is the safest time during pregnancy? A) Immediately, before the fetus gets any bigger B) Early in the second trimester C) As close to term as possible D) The risks are too high to do it anytime in pregnancy

Answer: B Explanation: A) The risk of miscarriage is greater in the first trimester. B) The early second trimester is the best time to operate because there is less risk of spontaneous abortion or early labor, and the uterus is not so large as to impinge on the abdominal field. C) A fetus close to term is so large that it might interfere with the abdominal field. D) There is always a risk, but it is greater in the first and third trimesters.

1) The nurse is caring for a client at 35 weeks' gestation who has been critically injured in a shooting. Which statement by the paramedics bringing the woman to the hospital would cause the greatest concern? A) "Blood pressure 110/68, pulse 90." B) "Entrance wound present below the umbilicus." C) "Client is positioned in a left lateral tilt." D) "Clear fluid is leaking from the vagina."

Answer: B Explanation: A) These are normal vital signs, indicating a hemodynamically stable client. B) Penetrating trauma includes gunshot wounds and stab wounds. The mother generally fares better than the fetus if the penetrating trauma involves the abdomen, as the enlarged uterus is likely to protect the mother's bowel from injury. C) Positioning the client in a lateral tilt position prevents vena cava syndrome. D) Clear fluid from the vagina could be amniotic fluid from spontaneous rupture of the membranes. Although this is not a normal finding at 35 weeks, this fetus is near term, and would likely survive birth at this time.

1) A woman is 16 weeks pregnant. She has had cramping, backache, and mild bleeding for the past 3 days. Her physician determines that her cervix is dilated to 2 centimeters, with 10% effacement, but membranes are still intact. She is crying, and says to the nurse, "Is my baby going to be okay?" In addition to acknowledging the client's fear, what should the nurse also say? A) "Your baby will be fine. We'll start IV, and get this stopped in no time at all." B) "Your cervix is beginning to dilate. That is a serious sign. We will continue to monitor you and the baby for now." C) "You are going to miscarry. But you should be relieved because most miscarriages are the result of abnormalities in the fetus." D) "I really can't say. However, when your physician comes, I'll ask her to talk to you about it."

Answer: B Explanation: A) This is a serious situation. The client should not be offered false hope of everything being fine. B) If bleeding persists and abortion is imminent or incomplete, the woman may be hospitalized, Ⅳ therapy or blood transfusions may be started to replace fluid, and dilation and curettage (D&C) or suction evacuation is performed to remove the remainder of the products of conception. C) The nurse should avoid giving a justification of the miscarriage. D) The nurse should not defer the conversation to someone else (e.g., the physician).

1) The prenatal clinic nurse is caring for a client with hyperemesis gravidarum at 14 weeks' gestation. The vital signs are: blood pressure 95/48, pulse 114, respirations 24. Which order should the nurse implement first? A) Weigh the client. B) Give 1 liter of lactated Ringer's solution Ⅳ. C) Administer 30 m L Maalox (magnesium hydroxide) orally. D) Encourage clear liquids orally.

Answer: B Explanation: A) Weighing the client provides information on weight gain or loss, but is not the top priority in a client with excessive vomiting during pregnancy. The vital signs indicate hypovolemia. B) The vital signs indicate hypovolemia from dehydration, which leads to hypotension and increased pulse rate. Giving this client a liter of lactated Ringer's solution intravenously will reestablish vascular volume and bring the blood pressure up, and the pulse and respiratory rate down. C) The vital signs indicate hypovolemia. There is no indication that the client has dyspepsia. D) Lack of tolerance of oral fluids through excessive vomiting is what has led to the hypovolemia.

1) Women with H I V should be evaluated and treated for other sexually transmitted infections and for what condition occurring more commonly in women with H I V? A) Syphilis B) Toxoplasmosis C) Gonorrhea D) Herpes

Answer: B Explanation: A) Women with H I V should be evaluated and treated for other sexually transmitted infections and for conditions occurring more commonly in women with H I V, such as tuberculosis, cytomegalovirus, toxoplasmosis, and cervical dysplasia. Syphilis occurs more often in men. B) Women with H I V should be evaluated and treated for other sexually transmitted infections and for conditions occurring more commonly in women with H I V, such as tuberculosis, cytomegalovirus, toxoplasmosis, and cervical dysplasia. C) Women with H I V should be evaluated and treated for other sexually transmitted infections and for conditions occurring more commonly in women with H I V, such as tuberculosis, cytomegalovirus, toxoplasmosis, and cervical dysplasia. Gonorrhea affects both men and women. Women with HIV should be evaluated and treated for other sexually transmitted infections and for conditions occurring more commonly in women with HIV, such as tuberculosis, cytomegalovirus, toxoplasmosis, and cervical dysplasia. Herpes affects both men and women

1) The nurse provides the following diagram to a patient who is 10 weeks pregnant and scheduled for a sonogram. Why is this test being used? A) Estimate fetal weight B) Determine gestational age C) Evaluate placenta integrity D) Calculate pelvis dimensions

Answer: B Explanation: B) An early transvaginal or abdominal sonogram is indicated when there is a need to establish an accurate gestational age. When dating a pregnancy using ultrasound the crown-rump length is considered most accurate for 6- to 12-week gestational periods (plus or minus 3 to 5 days). Dotted line shows the measurement from the top of the fetal crown (head) to the bottom of the rump (buttocks). This test is not used to estimate fetal weight, evaluate placental integrity, or calculate pelvis dimensions.

1) The nurse provides the following diagram to a patient in the 3rd trimester of pregnancy. For which diagnostic test is the nurse preparing this patient? A) Ultrasound B) Amniocentesis C) Biophysical profile D) Contraction stress test

Answer: B Explanation: B) For an amniocentesis the patient is usually scanned by ultrasound to determine the placental site and to locate a pocket of fluid. As the needle is inserted, three levels of resistance are felt when the needle penetrates the skin, fascia, and uterine wall. When the needle is placed within the amniotic cavity, amniotic fluid is withdrawn. A needle is not injected into the amniotic sac for an ultrasound, biophysical profile, or contraction stress test.

1) The nurse prepares teaching material for a patient who is experiencing a spontaneous abortion. Based upon the material selected, which type of abortion is the patient experiencing? A) Threatened B) Imminent C) Incomplete D) Complete

Answer: B Explanation: B) For an imminent abortion the placenta has separated from the uterine wall, the cervix has dilated, and the amount of bleeding has increased. For a threatened abortion the cervix is not dilated, and the placenta is still attached to the uterine wall, but some bleeding occurs. For an incomplete abortion the embryo/fetus has passed out of the uterus; however, the placenta remains. In a complete abortion all contents of the pregnancy have been expelled from the uterus.

1) The maternity nurse is preparing material for a staff development seminar on ectopic pregnancy. When using the diagram below, which area should the nurse identify as being the most common location for the implantation of an ectopic pregnancy? 1. A Fimbrial 2. B Ampulla 3. C Intramural 4. D Ovary

Answer: B Explanation: B) The most common location for implantation of an ectopic pregnancy is the ampulla of the tube. Fimbrial, intramural, and ovarian are not the most common locations for the implantation of an ectopic pregnancy.

1) The client presents to the clinic for an initial prenatal examination. She asks the nurse whether there might be a problem for her baby because she has type B R h-positive blood and her husband has type O R h-negative blood, or because her sister's baby had ABO incompatibility. What is the nurse's best answer? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) "Your baby would be at risk for R h problems if your husband were R h-negative." B) "R h problems only occur when the mother is R h-negative and the father is not." C) "ABO incompatibility occurs only after the baby is born." D) "We don't know for sure, but we can test for ABO incompatibility." E) "Your husband's being type B puts you at risk for ABO incompatibility."

Answer: B, C Explanation: A) R h incompatibility is a possibility when the mother is R h-negative and the father is R h-positive. B) R h incompatibility is a possibility when the mother is R h-negative and the father is R h-positive. C) ABO incompatibility is limited to type O mothers with a type A or B fetus and occurs after the baby is born. D) ABO incompatibility is limited to type O mothers with a type A or B fetus and occurs after the baby is born. E) The husband's blood type is not an issue for ABO incompatibility.

1) A woman is hospitalized with severe preeclampsia. The nurse is meal-planning with the client and encourages a diet that is high in what? A) Sodium B) Carbohydrates C) Protein D) Fruits

Answer: C Explanation A) It is important that the client limit her intake of sodium. B) While it is important that the client have an adequate intake of carbohydrates, another food group is more important. C) The client who experiences preeclampsia is losing protein. D) It is important that the client have adequate intake of fruits, but another food group is more important.

1) The maternal health nurse is caring for a pregnant client with obsessive-compulsive disorder (O C D). Which action will the nurse take when teaching the client, based on the client's psychological disorder? A) Allow the client opportunity for repetitive rituals. B) Ask the client to follow along with written material. C) Repeat instructions as needed. D) Provide multiple handouts with various photographs

Answer: C Explanation: A) Although those with O C D may have repetitive rituals, this does not promote learning and is not the best action for the nurse. B) While written material may be helpful as a supplement to learning, it may be difficult for the client with O C D to follow along. C) The best action for the nurse is to repeat any instructions or teachings as needed. This allows the client more opportunity to learn. While multiple learning techniques and opportunities are helpful for most individuals, those with OCD have a difficult time following along with teaching material

1) Whether sensitization is the result of a blood transfusion or maternal-fetal hemorrhage for any reason, what test can be performed to determine the amount of R h(D) positive blood present in the maternal circulation, and to calculate the amount of R h immune globulin needed? A) Indirect Coombs' test B) Non-stress test C) Kleihauer-Betke or rosette test D) Direct Coombs' test

Answer: C Explanation: A) An indirect Coombs' test is done on the mother's blood to measure the number of R h-positive antibodies. B) A non-stress test is performed to assess the fetal heart rate in response to fetal movement. C) A Kleihauer-Betke or rosette test can be performed to determine the amount of R h(D) positive blood present in the maternal circulation and to calculate the amount of R h immune globulin needed. D) A direct Coombs' test is done on the infant's blood to detect antibody-coated R h-positive R B Cs.

1) The nurse is supervising care in the emergency department. Which situation most requires an intervention? A) Moderate vaginal bleeding at 36 weeks' gestation; client has an Ⅳ of lactated Ringer's solution running at 125 m L/hour B) Spotting of pinkish-brown discharge at 6 weeks' gestation and abdominal cramping; ultrasound scheduled in 1 hour C) Bright red bleeding with clots at 32 weeks' gestation; pulse = 110, blood pressure 90/50, respirations = 20 D) Dark red bleeding at 30 weeks' gestation with normal vital signs; client reports an absence of fetal movement

Answer: C Explanation: A) Bleeding in the third trimester is usually due to placenta previa or placental abruption. The primary intervention for placenta previa or placental abruption is intravenous (Ⅳ) therapy, which the patient already has in place. B) Bleeding in the first trimester can be indicative of spontaneous abortion beginning, or of an ectopic pregnancy. Transvaginal ultrasound is used for diagnosis. C) Bleeding in the third trimester is usually due to placenta previa or placental abruption. Observe the woman for indications of shock, such as pallor, clammy skin, perspiration, dyspnea, or restlessness. Monitor vital signs, particularly blood pressure and pulse, for evidence of developing shock. D) Bleeding in the third trimester can indicate placental abruption. Normal vital signs indicate a normal vascular volume. Decrease in fetal movement or cessation of movement may indicate fetal compromise. The fetus is at greatest risk in this situation; the mother is stable.

1) A client who is 11 weeks pregnant presents to the emergency department with complaints of dizziness, lower abdominal pain, and right shoulder pain. Laboratory tests reveal a beta-hCG at a lower-than-expected level for this gestational age. An adnexal mass is palpable. Ultrasound confirms no intrauterine gestation. The client is crying and asks what is happening. The nurse knows that the most likely diagnosis is an ectopic pregnancy. Which statement should the nurse include? A) "You're feeling dizzy because the pregnancy is compressing your vena cava." B) "The pain is due to the baby putting pressure on nerves internally." C) "The baby is in the fallopian tube; the tube has ruptured and is causing bleeding." D) "This is a minor problem. The doctor will be right back to explain it to you."

Answer: C Explanation: A) Dizziness from vena cava compression occurs in the third trimester when women are supine. B) The fetus is too small to be putting pressure on the nerves. C) The woman who experiences one-sided lower abdominal pain or diffused lower abdominal pain, vasomotor disturbances such as fainting or dizziness, and referred right shoulder pain from blood irritating the subdiaphragmatic phrenic nerve is experiencing an ectopic pregnancy. D) Therapeutic communication requires giving the client an answer rather than referring the client to someone else.

1) The nurse knows that a lecithin/sphingomyelin (L/S) ratio finding of 2:1 in amniotic fluid means which of the following? A) Fetal lungs are still immature. B) The fetus has a congenital anomaly. C) Fetal lungs are mature. D) The fetus is small for gestational age.

Answer: C Explanation: A) Early in pregnancy the lecithin concentration in amniotic fluid is less than that of sphingomyelin (0.5:1 at 20 weeks), resulting in a low lecithin/sphingomyelin (L/S) ratio, which is not the case in this instance. B) The L/S ratio isn't a measurement for congenital anomalies or size of the fetus. C) The concentration of lecithin begins to exceed that of sphingomyelin, and at 35 weeks the L/S ratio is 2:1. When at least two times as much lecithin as sphingomyelin is found in the amniotic fluid, R D S is very unlikely. D) The L/S ratio isn't a measurement for congenital anomalies or size of the fetus.

1) The nurse is providing care to a client who would like to become pregnant within the next year. The client has a history of folic acid deficiency anemia and asks, "What can I do to decrease the risk of neural tube defects?" Which response by the nurse is most appropriate? A) "You will need to have genetic testing done to identify your risk." B) "Do you have a family history of these disorders?" C) "Daily consumption of orange juice decreases your risk." D) "You will be prescribed an iron supplement, which decreases your risk."

Answer: C Explanation: A) Genetic testing does not identify the risk for neural tube defects. This response is not appropriate by the nurse. B) Asking the client if there is a family history of neural tube defects will not decrease the client's risk. This response is not appropriate by the nurse. C) Daily consumption of foods rich in folic acid, such as orange juice, provides the client with the necessary amount of folic acid to decrease the risk of neural tube defects. This response is appropriate by the nurse. D) Folic acid supplements, not iron supplements, are prescribed to decrease the risk for neural tube defects. This response is not appropriate by the nurse.

1) The community nurse is working with a client at 32 weeks' gestation who has been diagnosed with preeclampsia. Which statement by the client would indicate that additional information is needed? A) "I should call the doctor if I develop a headache or blurred vision." B) "Lying on my left side as much as possible is good for the baby." C) "My urine could become darker and smaller in amount each day." D) "Pain in the top of my abdomen is a sign my condition is worsening."

Answer: C Explanation: A) Headache and blurred vision or other visual disturbances are an indication of worsening preeclampsia and should be reported to the physician. B) The left lateral position maximizes uterine and renal blood flow, and therefore is the optimal position for a client with preeclampsia. C) Oliguria is a complication of preeclampsia. Specific gravity of urine readings over 1.040 correlate with oliguria and proteinuria and should be reported to the physician. D) Liver distention causes epigastric pain and may ultimately result in rupture. It is a symptom of worsening preeclampsia, and should be reported to the physician.

1) During a nonstress test, the nurse notes that the fetal heart rate decelerates about 15 beats during a period of fetal movement. The decelerations occur twice during the test, and last 20 seconds each. The nurse realizes these results will be interpreted as which of the following? A) A negative test B) A reactive test C) A nonreactive test D) An equivocal test

Answer: C Explanation: A) Nonstress tests are scored as either reactive or nonreactive. B) A reactive N S T has two or more fetal heart accelerations within a 20-minute period. C) The F H R acceleration must be at least 15 beats per minute above baseline for at least 15 seconds from baseline to baseline. A nonreactive N S T is one that lacks sufficient F H R accelerations over a 40-minute period. D) Nonstress tests are scored as either reactive or nonreactive.

1) The nurse is preparing a client in her second trimester for a three-dimensional ultrasound examination. Which statement indicates that teaching has been effective? A) "If the ultrasound is normal, it means my baby has no abnormalities." B) "The nuchal translucency measurement will diagnose Down syndrome." C) "I might be able to see who the baby looks like with the ultrasound." D) "Measuring the length of my cervix will determine whether I will deliver early."

Answer: C Explanation: A) Not all fetal anomalies are detectable by ultrasound. B) Nuchal translucency measurements are for detection, not diagnosis, of trisomies 13, 18, and 21. C) Three-dimensional ultrasound uses algorithms to vary opacity, transparency, and depth to project an image. This allows curved structures such as the fetal face to be viewed. D) Transvaginal ultrasound can most accurately identify shortened cervical length indicating cervical insufficiency or risk of preterm labor. However, a cervix of normal length does not preclude preterm birth.

1) The client with an abnormal quadruple screen is scheduled for an ultrasound. Which statement indicates that the client understands the need for this additional antepartal fetal surveillance? A) "After the ultrasound, my partner and I will decide how to decorate the nursery." B) "During the ultrasound we will see which of us the baby looks like most." C) "The ultrasound will show whether there are abnormalities with the baby's spine." D) "The blood test wasn't run correctly, and now we need to have the sonogram."

Answer: C Explanation: A) Parents often try to identify the baby's sex and which parent the fetus resembles more during an ultrasound. B) Parents often try to identify the baby's sex and which parent the fetus resembles more during an ultrasound. C) Ultrasound is used to detect neural tube defects. An abnormal serum quadruple screen is not the result of a lab error, and can indicate either an open neural tube defect or trisomy 18 or 21. D) Ultrasound is used to detect neural tube defects.

1) The nurse is providing care to a pregnant client who is diagnosed with iron deficiency anemia. Which teaching statement from the nurse to the client is appropriate? A) "You will need to begin iron supplements at 30 m g/day." B) "You will need to increase your intake of bananas." C) "You will need to increase your intake of green leafy vegetables." D) "You will need to begin iron supplements at 150 m g/day."

Answer: C Explanation: A) Pregnant clients are prescribed 30 m g of iron daily to prevent anemia. Once anemia is diagnosed, the prescribed dosage is increased. This teaching statement is not appropriate. B) Pregnant clients diagnosed with anemia should increase their consumption of foods that are rich in iron. Bananas are not rich in iron. This teaching statement is not appropriate. C) Pregnant clients diagnosed with anemia should increase their consumption of foods that are rich in iron. Green, leafy vegetables are rich in iron. This teaching statement is appropriate. D) Pregnant clients diagnosed with iron deficiency anemia will require an increased dose of supplemental iron, typically 60 m g to 120 m g/day.

1) When assisting with a transabdominal ultrasound 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.

Answer: C Explanation: A) Preliminary blood work may be obtained, not urinary samples. B) The morning of the procedure, the woman is asked to drink fluids to fill her bladder because displacement of an anteverted uterus by a full bladder may aid in positioning the uterus for catheter insertion. C) Clients are placed in a supine position on the table. D) Dietary intake is not relevant to this procedure.

1) Which of the following tests has become a widely accepted method of evaluating fetal status? A) Contraction stress test (C S T) B) M S A F P test C) Nonstress test (N S T) D) Nuchal translucency test

Answer: C Explanation: A) The contraction stress test (C S T) is a means of evaluating the respiratory function (oxygen and carbon dioxide exchange) of the placenta. B) The maternal serum alpha-fetoprotein (M S A F P) test is a component of the screening test, the "quadruple check" that utilizes multiple markers to screen pregnancies for N T D, trisomy 21 (Down syndrome), and trisomy 18. C) The nonstress test (N S T) has become a widely accepted method of evaluating fetal status. This test involves using an external electronic fetal monitor to obtain a tracing of the fetal heart rate (F H R) and observation of acceleration of the F H R with fetal movement. The nuchal translucency test

1) The nurse is conducting an admission assessment for a pregnant client who is in labor. Which finding would cause the nurse to expect that the client has been abusing an illegal substance? A) The client is asking for an epidural and rates pain as an 8 on a 0 to 10 numeric scale. B) The client is diaphoretic during the transition stage of labor. C) The client has constricted pupils and inflamed nasal mucosa. D) The client has a history of precipitous labor.

Answer: C Explanation: A) The nurse would not suspect that this client has been abusing an illegal substance based on asking for an epidural and rating pain as an 8 on a 0 to 10 numeric scale. B) The nurse would not suspect that this client has been abusing an illegal substance based on experiencing diaphoresis during the transition stage of labor. This is an expected finding. C) A client who has constricted pupils and inflamed nasal mucosa would be suspected of abusing illegal substances. D) A client who has a history of precipitous labor would not cause the nurse to expect substance abuse.

1) The nurse is caring for a postpartum client who is experiencing a sickle cell crisis. Which is the priority assessment by the nurse? A) Blood pressure B) Lochia C) Temperature D) Fundal height

Answer: C Explanation: A) The postpartum client experiencing a sickle cell crisis is at risk for infection. While monitoring blood pressure is important, this is not the priority assessment. B) The postpartum client experiencing a sickle cell crisis is at risk for infection. While monitoring lochia is important, this is not the priority assessment. C) The postpartum client experiencing a sickle cell crisis is at risk for infection. The priority assessment for this client is to closely monitor temperature. D) The postpartum client experiencing a sickle cell crisis is at risk for infection. While monitoring fundal height is important, this is not the priority assessment.

1) Which maternal-child client should the nurse see first? A) Blood type O, R h-negative B) Indirect Coombs' test negative C) Direct Coombs' test positive D) Blood type B, R h-positive

Answer: C Explanation: A) This client is R h-negative, but there is no indication that the alloimmunization has occurred. B) If the mother's indirect Coombs' test is negative and the infant's direct Coombs' test is negative (confirming that sensitization has not occurred), the mother is given R h immune globulin within 72 hours of birth. C) A direct Coombs' test is done on the infant's blood to detect antibody-coated R h-positive RBCs. If the mother's indirect Coombs' test is positive and her R h-positive infant has a positive direct Coombs' test, R h immune globulin is not given; in this case, the infant is carefully monitored for hemolytic disease. D) This client's blood type creates no problems.

1) A woman is experiencing preterm labor. The client asks why she is on betamethasone. Which is the nurse's best response? A) "This medication will halt the labor process until the baby is more mature." B) "This medication will relax the smooth muscles in the infant's lungs so the baby can breathe." C) "This medication is effective in stimulating lung development in the preterm infant." D) "This medication is an antibiotic that will treat your urinary tract infection, which caused preterm labor."

Answer: C Explanation: A) This medication has no effect on the labor process or on the smooth muscles in the lungs. B) This medication has no effect on the labor process or on the smooth muscles in the lungs. C) Betamethasone or dexamethasone is often administered to the woman whose fetus has an immature lung profile to promote fetal lung maturation. D) This medication is not an antibiotic, and therefore will not help resolve a urinary tract infection.

1) A woman asks her nurse what she can do before she begins trying to get pregnant to help her baby, as she is prone to anemia. What would the nurse correctly advise her to do? A) Get pregnant, then start iron supplementation. B) Add more carbohydrates to her diet. C) Begin taking folic acid supplements daily. D) Have a hemoglobin baseline done now so her progress can be followed.

Answer: C Explanation: A) Waiting until one is pregnant to add iron or evaluate a diet is not being proactive. B) Adding carbohydrates to her diet will not help prevent anemia. C) The common anemias of pregnancy are due to insufficient hemoglobin production related to nutritional deficiency in either iron or folic acid during pregnancy. Folic acid deficiency during pregnancy is prevented by a daily supplement of 0.4 m g (400 micrograms) of folate. D) Having a hemoglobin baseline done will not help the patient prevent anemia in pregnancy.

1) A female patient seeks medical attention for vaginal discharge that at times is bright red but is mostly dark brown in color. When preparing materials to share with this patient, why should the nurse include this diagram? A) It shows the size of the uterus. B) It explains the location of the cervix. C) It portrays the vessels within the uterus. D) It demonstrates the location of the uterus.

Answer: C Explanation: C) A common sign of a hydatidiform mole is vaginal bleeding, often brownish (the characteristic "prune juice" appearance), but sometimes bright red. In this figure, some of the hydropic vessels are being passed. This occurrence is diagnostic for hydatidiform mole. This diagram is not being used because it shows the size of the uterus, the location of the cervix, or the location of the uterus.

1) A standard ultrasound examination is performed during the second or third trimester and includes an evaluation of which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Confirm fetal heart activity. B) Evaluate the cervix. C) Determine fetal presentation. D) Assess amniotic fluid volume. E) Determine fetal number.

Answer: C, D, E Explanation: A) A limited ultrasound may be used to address a specific question or determine specific information including confirming fetal heart activity. B) A limited ultrasound may be used to address a specific question or determine specific information including evaluating the cervix. C) A standard ultrasound examination is performed during the second or third trimester and includes an evaluation to determine fetal presentation. D) A standard ultrasound examination is performed during the second or third trimester and includes an evaluation of amniotic fluid volume. E) A standard ultrasound examination is performed during the second or third trimester and includes an evaluation of fetal number.

1) A clinic nurse is planning when to administer R h immune globulin (R h o G A M) to an R h-negative pregnant client. When should the first dose of R h o G A M be administered? A) After the birth of the infant B) 1 month postpartum C) During labor D) At 28 weeks' gestation

Answer: D Explanation: A) After birth would be too late for the first dose of R h o G A M if transplacental hemorrhage, which is possible during pregnancy, has occurred. B) One month postpartum would be too late for the first dose of R h o G A M if transplacental hemorrhage, which is possible during pregnancy, has occurred. C) During labor would be too late for the first dose of R h o G A M if transplacental hemorrhage, which is possible during pregnancy, has occurred. D) When the woman is R h negative and not sensitized and the father is R h positive or unknown, R h immune globulin is given prophylactically at 28 weeks' gestation.

1) A 26-year-old client is 26 weeks pregnant. Her previous births include two large-for-gestational-age babies and one unexplained stillbirth. Which tests would the nurse anticipate as being most definitive in diagnosing gestational diabetes? A) A 50g, 1-hour glucose screening test B) A single fasting glucose level C) A 100g, 1-hour glucose tolerance test D) A 100g, 3-hour glucose tolerance test

Answer: D Explanation: A) All women get the initial 50 g of glucose and a 1-hour screening. B) A single fasting glucose level is not an adequate indicator of the glucose level in relation to food. C) The 100g, 1-hour tolerance test is not an adequate indicator of the glucose level in relation to food. D) Gestational diabetes is diagnosed if two or more of the following values are met or exceeded after taking the 100 g, 3-hour O G T T: Fasting: 95 m g/d L; 1 hour: 180 m g/d L; 2 hours: 155 m g/d L; 3 hours: 140 m g/d L.

1) A 21-year-old woman 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? A) "I will be sure to take a rest period every afternoon." B) "I would like to take childbirth education classes in my last trimester." C) "I will have to cancel our trip to Disney World." D) "I am going to start my classes in water aerobics next week."

Answer: D Explanation: A) Because the heart disease is class Ⅲ, this client is encouraged to get adequate rest. B) Childbirth classes would be helpful for the client as long as she were careful not to overexert herself. C) Travel during the pregnancy would be based upon the tolerance of the client. However, a trip to Disney World would involve a large amount of activity, which would stress the pregnancy. D) With the slightest exertion, the client's heart rate will rise, and she will become symptomatic. Therefore, she should not establish a new exercise program.

1) A 20-year-old woman is at 28 weeks' gestation. Her prenatal history reveals past drug abuse, and urine screening indicates that she has recently used heroin. The nurse should recognize that the woman is at increased risk for which condition? A) Erythroblastosis fetalis B) Diabetes mellitus C) Abruptio placentae D) Pregnancy-induced hypertension

Answer: D Explanation: A) Erythroblastosis fetalis is secondary to physiological blood disorders such as R h incompatibility. B) Diabetes is an endocrine disorder that is unrelated to drug use and abuse. C) Abruptio placentae is seen more commonly with cocaine or crack use. D) Women who use heroin are at risk for poor nutrition, anemia, and pregnancy-induced hypertension (or preeclampsia-eclampsia).

1) The community health nurse is teaching a class about causes of traumatic injury leading to pregnancy complications. What statement should the nurse include in the teaching? A) "Although falls are an uncommon cause of trauma, it is important to know what to do in the case of these incidents." B) "In early pregnancy, the woman is at a greater risk for injury due to decreased balance and coordination." C) "The pregnant woman should be given the same care as any person suffering from trauma." D) "Violence, including domestic violence, is the most common cause of injury for pregnant women, after motor vehicle accidents."

Answer: D Explanation: A) Falls are a common cause of trauma in the client who is pregnant. B) Late pregnancy, not early pregnancy, causes a decrease in balance in the client who is pregnant. C) The physiologic changes that occur with pregnancy have clinical implications for victims of trauma; the client who is pregnant does not receive the same care. D) Violence, including domestic violence, is the next most common cause of injury for clients who are pregnant after motor vehicle accidents. This is the statement the nurse should include in the teaching.

1) The nurse is presenting a class to newly pregnant families. What form of trauma will the nurse describe as the leading cause of fetal and maternal death? A) Falls B) Domestic violence C) Gun accidents D) Motor vehicle accidents

Answer: D Explanation: A) Falls are not the leading cause of fetal and maternal death. B) Domestic violence is not the leading cause of fetal and maternal death. C) Gun accidents are not common in pregnancy. D) Trauma from motor vehicle accidents is the leading cause of fetal and maternal death.

1) A pregnant woman is married to an intravenous drug user. She had a negative H I V screening test just after missing her first menstrual period. What would indicate that the client needs to be retested for H I V? A) Hemoglobin of 11 g/d L and a rapid weight gain B) Elevated blood pressure and ankle edema C) Shortness of breath and frequent urination D) Persistent candidiasis

Answer: D Explanation: A) Hemoglobin of 11 g/d L and a rapid weight gain do not indicate a need to be retested for H I V. B) Elevated blood pressure and ankle edema do not indicate a need to be retested for H I V. C) Shortness of breath and frequent urination do not indicate a need to retest for H I V. D) Signs and symptoms of infections include fever, weight loss, fatigue, persistent candidiasis, diarrhea, cough, and skin lesions (Kaposi's sarcoma and hairy leukoplakia in the mouth).

1) A 21-year-old at 12 weeks' gestation with her first baby has known cardiac disease, class Ⅲ, as a result of childhood rheumatic fever. During a prenatal visit, the nurse reviews the signs of cardiac decompensation with her. The nurse will know that the client understands these signs and symptoms if she states that she would notify her doctor if she had which symptom? A) "A pulse rate increase of 10 beats per minute" B) "Breast tenderness" C) "Mild ankle edema" D) "A frequent cough"

Answer: D Explanation: A) In most pregnant clients, the heart rate will increase. B) Most pregnant clients will develop breast tenderness. C) The client with rheumatic heart disease who develops congestive heart failure would have severe ankle edema. D) The heart's signal of its decreased ability to meet the demands of pregnancy includes frequent cough (with or without hemoptysis).

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

Answer: D Explanation: A) Ketones are produced when fat is being utilized for glucose, and this is not a desirable response. B) Frequent urination is an indication of glucose above the renal threshold, and is not a good indicator of diabetic stability. C) Diabetes is a result of lack of insulin production. If the insulin is being produced, the body will utilize it. D) The client who understands the disease process is aware that if the body is not getting the glucose it needs, the message of hunger will be sent to the brain.

1) The client at 20 weeks' gestation has had an ultrasound that revealed a neural tube defect in her fetus. The client's hemoglobin level is 8.5. The nurse should include which statement when discussing these findings with the client? A) "Your low iron intake has caused anemia, which leads to the neural tube defect." B) "You should increase your vitamin C intake to improve your anemia." C) "You are too picky about food. Your poor diet caused your baby's defect." D) "You haven't had enough folic acid in your diet. You should take a supplement."

Answer: D Explanation: A) Low hemoglobin does not cause neural tube defects. B) Vitamin C will increase iron absorption, but this client is deficient in folic acid. C) Therapeutic communication requires that the nurse avoid making judgmental statements. D) An inadequate intake of folic acid has been associated with neural tube defects (N T Ds) (e.g., spina bifida, anencephaly, meningomyelocele) in the fetus or newborn.

1) The nurse is returning phone calls from clients. Which client does the nurse anticipate would not require a serum beta h C G? A) A client with a risk of ectopic pregnancy B) A client with spotting during pregnancy C) A client with previous pelvic inflammatory disease D) A client with a previous history of twins

Answer: D Explanation: A) Serial quantitative beta h C G testing can be used to distinguish a normally developing fetus from an ectopic pregnancy. B) Serologic evaluation in the first trimester is indicated for women with vaginal bleeding. C) Serial quantitative beta h C G testing can be used to distinguish a normally developing fetus from a risk of ectopic pregnancy (intrauterine device in place, previous pelvic inflammatory disease, or reversal of a tubal sterilization). D) A previous history of twins is not a risk factor for ectopic pregnancy. Beta h C G testing is not indicated for this client.

1) Each of the following pregnant women is scheduled for a 14-week antepartal visit. In planning care, the nurse would give priority teaching on amniotic fluid alpha-fetoprotein (A F P) screening to which client? A) 28-year-old with history of rheumatic heart disease B) 18-year-old with exposure to H I V C) 20-year-old with a history of preterm labor D) 35-year-old with a child with spina bifida

Answer: D Explanation: A) The client with rheumatic heart disease would need to be monitored for pregnancy-related physiological stress. B) The client with H I V exposure needs H I V testing and protection education. C) The client with a history of preterm labor needs education on prevention and on signs and symptoms of preterm labor. D) Alpha-fetoprotein (A F P) is a fetal protein that is excreted from the fetal yolk sac during the first 6 weeks of pregnancy. A F P levels can be high or low, with each having different implications for the fetus. If the fetus has a neural tube defect (N T D), the A F P levels will be elevated. N T Ds can range from anencephaly to spina bifida. With a past history of a child with spina bifida, this client would be strongly encouraged to have the A F P screening.

1) The nurse is working in an outpatient clinic. Which client's indications most warrant fetal monitoring in the third trimester? A) Gravida 4, para 3, 39 weeks, with a history of one spontaneous abortion at 8 weeks B) Gravida 1, para 0, 40 weeks, with a history of endometriosis and a prior appendectomy C) Gravida 3, para 2, with a history of gestational diabetes controlled by diet D) Gravida 2, para 1, 36 weeks, with a history of preterm labor or cervical insufficiency

Answer: D Explanation: A) The client with the spontaneous abortion would have needed to be monitored in the first trimester. B) The client with endometriosis and appendectomy would have been a concern with conception. C) The client with a history of gestational diabetes controlled by diet would need maternal monitoring and fetal monitoring if she developed gestational diabetes again. D) The client with a history of preterm labor or cervical insufficiency needs close monitoring for preterm labor onset.