Maternity- prenatal period and risk conditions

The nurse is doing a 48 hour postpartum check on a client with mild gestational hypertension. Which data indicate that the GH is a concern? 1. urinary output has increased 2. there is no evidence of proteinuria 3. the client complains of a headache and blurred vision 4. the blood pressure reading has returned to the prenatal baseline

3 Rationale: options 1, 2, and 4 are all signs that gestational hypertension is not present. option 3 is a symptom of the worsening of the gestational hypertension and is a concern that needs to be reported

The client is undergoing an amniocentesis at 16 weeks to detect the presence of biochemical or chromosomal abnormalities. Which instruction should the nurse reinforce to the client? 1. the bladder must be full during the exam 2. the bladder must be empty during the exam 3. she will be given Rhogam because she is RH positive 4. do not eat or drink anything 4 to 6 hours before the exam

1 Rationale: before 20 weeks gestation, the bladder must be kept full during amniocentesis to support the weight of the uterus. after 20 weeks, the bladder should be empty to minimize the chance of puncturing the placenta or fetus. Rhogam is administered to rh negative women because of the risk of contact with fetal blood during the exam. there are no fluid or food restrictions. monitoring the fetal heart tones and the vital signs throughout and after the exam is an important intervention

The client at 38 weeks gestation is admitted to the birthing center in early labor. The client is carrying twins, and one of the fetuses is in a breech presentation. The nurse assists with planning care for the client and identifies which as least likely necessary for the care of this client? 1. measuring the fundal height 2. attaching electronic fetal monitoring 3. preparing the client for a possible c section 4. gathering equipment for starting an IV line

1 Rationale: option 1 is a low priority because fundal height should be measured at each antepartal clinic visit; it is not a priority of care during the intrapartum period. option 2, 3, and 4 are all high priorities. the twins should be monitored by dual electronic fetal monitoring, and any signs of distress should be reported. many health care providers choose to perform a cesarean birth if either of the twins is breech. the mother should have an IV line in place in case fluid or blood replacement is required

The nurse is monitoring a pregnant client with gestational hypertension who is at risk for preeclampsia. The nurse should check the client for which signs of preeclampsia? SATA 1. proteinuria 2. hypertension 3. low grade fever 4. increased pulse rate 5. increased resp rate

1, 2 Rationale: signs of preeclampsia are hypertension and proteinuria. a low grade fever, increased pulse rate, and increased resp rate are not associated with preeclampsia

The nurse has a teaching session with a malnourished client regarding iron supplementation to prevent anemia during pregnancy. Which would indicate successful learning? 1. iron supplements will give me diarrhea 2. the iron is needed for the red blood cells 3. meat does not provide iron and should be avoided 4. my body has all the iron it needs, and i don't need to take supplements

2 Rationale: a nutritional supplement that is commonly needed during pregnancy for the red blood cells is iron. anemia in pregnancy is primarily caused by iron deficiency. iron supplements usually cause constipation. meats are an excellent source of iron. iron for the fetus comes from the maternal serum

The nurse is reinforcing instructions to a pregnant client regarding measures to prevent heartburn. The nurse should instruct the client to take which best measure? 1. eliminate between meal snacks 2. drink decaffeinated coffee and tea 3. lie down for 30 mins after eating 4. substitute salt in cooking for other spices

2 Rationale: caffeine, like spices, may cause heartburn and needs to be avoided. spices tend to trigger heartburn. eating smaller, more frequent portions is preferable to eating three large meals to control heartburn. lying down after meals is likely to lead to reflux of stomach contents and cause heartburn. salt leads to retention of fluid

The perinatal client is admitted to the obstetric unit during an exacerbation of a heart condition. When planning for the nutritional requirements of the client, the nurse should consult with the dietitian to ensure which dietary measure? 1. a low calorie diet to ensure the absence of weight gain 2. a diet that is high in fluids and fiber to decrease constipation 3. a diet that is low in fluids and fiber to decrease blood volume 4. unlimited sodium intake to increase the circulating blood volume

2 Rationale: constipation causes the client to use valsalva's maneuver. this causes blood to rush to the heart and overload the cardiac system. the absence of weight gain is not recommended during pregnancy. diets that are low in fluid and fiber cause a decrease in blood volume, which in turn deprives the fetus of nutrients. too much sodium could cause an overload to the circulating blood volume and contribute to the cardiac condition

The nurse is assigned to assist with caring for a client who is at risk for eclampsia. If the client progresses from preeclampsia to eclampsia, the nurse should take which first action? 1. administer oxygen by face mask 2. clear and maintain an open airway 3. check the blood pressure and the fetal heart tones 4. prepare for the administration of IV magnesium sulfate

2 Rationale: the first actions are to maintain an open airway and to prevent injuries to the client. the client should be turned to the side and monitored for airway compromise

A contraction stress test is scheduled for the client. The woman asks the nurse about the test. Which response describes the most accurate description of the test? 1. uterine contractions are stimulated by Leopold's maneuvers 2. an internal fetal monitor is attached, and you will walk on a treadmill until contractions begin 3. the uterus is stimulated to contract by either small amounts of oxytocin (pitocin) or by nipple stimulation 4. small amounts of oxytocin (pitocin) are administered during internal fetal monitoring to stimulate uterine contactions

3 Rationale: a contraction stress test assesses placental oxygenation and function and determines the fetuses ability to tolerate labor, as well as its well being. the test is performed if the nonstress test result is abnormal. during the stress test, the fetus is exposed to the stressor of contractions to assess the adequacy of placental perfusion under stimulated labor conditions. an external fetal monitor is applied to the mother, and a 20 to 30 minute baseline strip is recorded. the uterus is stimulated to contract, either by the administration of a dilute dose of pitocin or by having the mother use nipple stimulation, until three palpable contractions with a duration of 40 seconds of more during a 10 min period have occured. frequent maternal blood pressure readings are performed, and the client is monitored closely while increasing doses of oxytocin are given. leopold's maneuvers are performed to located the position of the fetus

The pregnant woman complains of being awakened frequently by leg cramps. The nurse reinforces instructions to the clients partner and should tell the client to perform which measure? 1. dorsiflex the clients foot while flexing the knee 2. plantarflex the clients foot while flexing the knee 3. dorsiflex the clients foot while extending the knee 4. plantarflex the clients foot while extending the knee

3 Rationale: leg cramps often occur when the pregnant woman stretches her leg and plantarflexes her foot. dorsiflexion of the foot while extending the knee stetches the gastrocnemius muscle, prevents the muscle from contracting, and halts the cramping.

The nurse caring for a client with abruptio placentae is monitoring the client for signs of disseminated intravascular coagulopathy (DIC). The nurse would suspect DIC if which is observed? 1. rapid clotting times 2. pain and swelling of the calf of one leg 3. lab values that indicate increased platelets 4. petechiae, oozing from injection sites, and hematuria

4 Rationale: DIC is a state of diffuse clotting in which clotting factors are consumed, which leads to widespread bleeding. platelet counts are decreased, because they are consumed by the process. coagulation studies show no clot formation (clotting times are thus prolonged), and fibrin plugs may clog the microvasculature diffusely rather than in an isolated area

During a prenatal visit, the nurse is explaining dietary management to a client with DM. The nurse determines that the teaching has been effective when the client makes which statement? 1. i can eat more sweets now because i need more calories 2. i need more fat in my diet so that the baby can gain enough weight 3. i need to eat a high protein, low carb diet now to control my blood glucose 4. i need to increase the fiber in my diet to control my blood glucose and prevent constipation

4 Rationale: an increase in calories is needed during pregnancy but concentrated sugars should be avoided because they may cause hyperglycemia. per HCP recommendations, fat intake should be 20%-30% of the total calories. in addition, the client with diabetes needs about 50%to 60% of her caloric intake from carbs and about 12% to 20% from protein. high fiber foods will control blood glucose levels and prevent constipation

The client at 28 weeks gestation is rh negative and Coombs antibody negative. The nurse determines that the client understands what the nurse has taught her about Rh sensitization when the client makes which statement? 1. i know i can never have another child 2. i am glad i wont have to have these shots if i have another child 3. i will have to have an injection once a month until the baby is born 4. i will tell the nurse at the hospital that i had rhogam during pregnancy

4 Rationale: as described in the question, it is accepted practice to administer rhogam to an rh negative woman at 28 weeks, with a second injection within 72 hrs of delivery. this prevents sensitization, which could jeopardize a future pregnancy. for subsequent pregnancies or abortions, the injections must be repeated, because the immunity is passive.

While assisting with the measurement of fundal height, the client at 36 weeks gestation states that she is feeling lightheaded. On the basis of the nurses knowledge of pregnancy, the nurse determines that this is most likely a result of which? 1. a full bladder 2. emotional instability 3. insufficient iron intake 4. compression of the vena cava

4 Rationale: compression of the inferior vena cava and aorta by the uterus may cause supine hypotension syndrome during pregnancy. Having the woman turn onto her left side or elevating the right buttock during fundal height measurement will prevent or correct the problem described in the question

The client is in her second trimester of pregnancy. She complains of frequent low back pain and ankle edema at the end of the day. The nurse should recommend which measure to help relieve both discomforts? 1. lie on the left side with the feet dorsiflexed 2. soak the feet in hot water after performing 10 pelvic tilt exercises 3. lie on the right side with the feet elevated on a pillow and a heating pad on the back 4. lie on the floor with the legs elevated onto a couch or padded chair, with the hips and knees at a right angle

4 Rationale: the position described in option 4 produce the posture of the pelvic tilt while countering gravity as the force that leads to the edema of the lower extremities. although the other options may seem useful, options 2 and 3 identify heart, which should be prescribed by the HCP.