NCLEX OB ANTEPARTUM
After instructing a multigravid client at 10 weeks gestation diagnosed with chronic hypertension about the need for frequent prenatal visits, the nurse determines that the instructions have been successful when the client makes which statement?
"I need close monitoring because I may have a small-for-gestational-age-infant"
An obese 36 year old multigravid client at 12 weeks gestation has a hx of chronic hypertension. The client was treated with methyldopa before becoming pregnant. When counseling the client about diet during pregnancy, the nurse realizes that the client needs additional instruction when they make which statement?
"I need to reduce my caloric intake to 1200 calories a day"
A primigravid client at 38 weeks gestation diagnosed with mild preeclampsia calls the clinic nurse to say they have had a continuous headache for the past two days accompanied by nausea. The client does not want to take aspirin. What should the nurse tell the client?
"I think the health care provider should see you today. Can you come to the clinic this morning?"
Which statement by the client indicates an understanding of the teaching regarding the corticosteroids during preterm labor?
"The corticosteroids may help my babies lungs mature"
The nurse instructs a preeclamptic client about monitoring the movements of their fetus to determine fetal well-being. Which statement by the client indicates that they need further instruction about when to call the health care provider (HCP) concerning fetal movement?
"if the fetus moves more often than three times an hour"
After the nurse reinforces the danger signs to report with a gravida 2 client at 32 weeks gestation with an elevated BP, which client statements would demonstrate understanding of when to call the primary health care provider's office? Select all that apply
-"If I see any bleeding, even if I have no pain" -" If I have a pounding headache that will not go away" -"If the baby seems to be more active than usual"
A client at 28 weeks gestation presents to the emergency department with a "splitting ......". What actions would be indicated by the nurse at this time?
-Assess client for vision changes or epigastric pain -Obtain NST -Assess client's reflexes and presence of clonus
The nurse is administering IV mag sulfate as prescribed for a client at 34 weeks gestation with severe preeclampsia. Which outcomes of this therapy would be desired? Select all that apply
-Temp: 98 Pulse: 72 Resp rate: 14 -Deep tendon reflexes +2 -Absence of seizures
The antenatal clinic nurse is educating the client with gestational diabetes soon after diagnosis. Evaluation for this client session will include which outcomes?
-The client states the need to maintain blood glucose levels between 70-110 -The client describes a planned walking program while pregnant -The client will strive to maintain a hemoglobin A1C of less than 6% -The client will continue taking prenatal vitamins, iron, and folic acid
A nurse is completing a prenatal assessment on a client who is 28 weeks pregnant with gestational hypertension. Which findings should be reported to the primary health care provider? Select all that apply
-dull headache -blurred vision -1+ urine protein
A primigravid client with severe preeclampsia exhibits hyperactive, very brisk patellar reflexes with two beats of ankle clonus present. How does the nurse document the patellar reflexes?
4+
A laboring client with preeclampsia is prescribed magnesium sulfate 2 g per hour IV piggyback. The pharmacy sends the IV to the unit labeled "magnesium sulfate 20 g/500 mL normal saline." To deliver the correct dose, the nurse should set the pump to deliver how many milliliters per hour?
50 mL
When developing a teaching plan for a primigravid client with insulin-dependent diabetes about monitoring blood glucose control and insulin dosages at home, the nurse would expect to include which desired target range for blood glucose levels?
70-100 before meals and bedtime snacks
Which outcome would the nurse identify as priority to achieve when developing the plan of care for a primigravid client at 38 weeks gestation who is hospitalized with severe preeclampsia receiving IV mag sulfate?
Absence of any seizure activity during first 48 hours
At 32 weeks gestation, a 15 year old primigravid client who is 5 feet, 2 inches has gained a total of 20 lbs, with a 1 lb gain in the last 2 weeks. Urinalysis reveals negative glucose and a trace of protein. The nurse should advise the client that which factor increases the risk for preeclampsia?
Adolescent age group
A client presents to the obstetric triage unit with no prenatal care and painless, bright red vaginal bleeding. Which interventions are most indicated?
Applying an external fetal monitor and completing a physical assessment
A 29-year-old multigravida at 37 weeks' gestation is being treated for severe preeclampsia and has magnesium sulfate infusing at 3 grams per hour. To maintain safety for this client, the priority intervention is to
Assess reflexes, clonus, visual disturbances, and headache
In which maternal locations would the nurse place the ultrasound transducer of the external FHR monitor if a fetus at 34 weeks gestation is in the left occiput anterior position?
Below the umbillicus on left side
A primigravid client at 34 weeks gestation is experiencing contractions every 3-4 minutes lasting for 35 seconds. The client's cervix is 2 cm dilated and 50% effaced. While the nurse is assessing the client's VS, the client says, "I think my bag of water just broke." Which intervention would the nurse do first?
Check status of FHR!!!
The nurse is planning care for a multigravid client hospitalized at 36 weeks gestation with rupture of membranes and no evidence of labs . What prescription would the nurse anticipate the HCP?
Cultures for chorioamnionitis
For the client who is receiving IV mag sulfate for severe preeclampsia, which assessment finding would alert the nurse to hypermagnesemia?
Decreased deep tendon reflexes
After teaching a primigravid client with diabetes about the symptoms of hyperglycemia and hypoglycemia, the nurse determines that the client understands the instruction when they say that hyperglycemia may be manifested by which symptom?
Dehydration
A client with preeclampsia is receiving mag sulfate via infusion pump at 1 g per hour. The nurse's assessment includes temperature 98.1, pulse 78 bpm, respirations 12 breaths/min, blood pressure 128/82, urinary output 90 mL in last four hours via urinary catheter; patellar-tendon reflex absent, aknle clonus absent, FHR 120 bpm, cervix 4cm dilated, 80% effaced, station-1. Which is the most appropriate action for the nurse to take?
Discontinue the mag sulfate infusion, and notify the health care provider
A client who is 34 weeks pregnant is admitted to the labor and birth room with the diagnosis preeclampsia. Client's BP is 149/92, pulse of 62, respirations 18, temp of 98.4. What is the priority intervention?
Encourage the client to lie in a latent position
A 16 year old primigravid client at 37 weeks gestation with severe preeclampsia is in early active labor. The client's BP is 164/110 . Which finding would alert the nurse that the client may be about to experience a seizure?
Epigastric pain
When caring for a multigravid client admitted to the hospital with vaginal bleeding at 38 weeks gestation, the nurse would anticipate administering IV which therapeutic agent if the client develops disseminated intravascular coagulation(DIC)?
Fresh frozen platelets
A 24 year old client, G3, T1, P1, A1, L1 at 32 weeks gestation, is admitted to the hospital because of vaginal bleeding. After reviewing the client's hx, the nurse might suspect abruptio placentae based on which factor?
Hx of cocaine use
After instructing a primigravid client at 38 weeks gestation about how preeclampsia can affect the client and the growing fetus, the nurse realizes that the client needs additional instruction when they say that preeclampsia can lead to which problem?
Hydrocephalic infant
A multigravid client at 34 weeks gestation with premature rupture of membranes tests positive for group B streptococcus. The client is having contractions every 4-6 minutes. The client's VS are: BP 120/80, temp: 100, pulse 100 bmp, respirations 18. Which medication would the nurse expect the HCP to prescribe?
IV penicillin
A primigravid client with insulin dependent diabetes tells the nurse that the contraction stress test performed earlier in the day was suspicious. The nurse interprets this test result as showing which fetal heart rate pattern?
Inconsistent late decelerations
Which action should the nurse take first when admitting a multigravid client at 36 weeks gestation with a probable diagnosis of abruptio placentae?
Insert a large gauge IV catheter
Which statement about a fetal biophysical profile would be incorporated into the teaching plan for a primigravid client with insulin dependent diabetes?
It is noninvasive using real time ultrasound
When the nurse is preparing the room for admission of a multigravida client at 36 weeks gestation diagnosed with severe preeclampsia, which item is most important for the nurse to obtain?
Padding for the side rails
When the nurse is assessing a 34 year old multigravid client at 34 weeks gestation experiencing moderate vaginal bleeding, which symptom would most likely alert the nurse that placenta previa is present?
Painless vaginal bleeding
Soon after administration of a primigravid client at 38 weeks gestation with severe preeclampsia, the primary health care provider prescribes a continuous IV infusion of 5% dextrose in Ringer's lactate solution and 4 g of mag sulfate. While the medication is being administered, which assessment finding should the nurse report immediately?
Respiratory rate of 12 breaths/min
At 38 weeks gestation, a primigravid client with poorly controlled diabetes and severe preeclampsia is admitted for a cesarean birth. The nurse explains to the client that birth helps prevent which complication?
Stillbirth
After administering hydralazine 5 mg IV as prescribed for a primigravid client with severe preeclampsia at 39 weeks gestation, the nurse should assess the client for which complication?
Tachycardia
A primigravid client at 30 weeks gestation has been admitted to the hospital with premature rupture of the membranes without contractions. The client's cervix is 2 cm dilated and 50% effaced. Which factor is most important for the nurse to assess next?
Temperature
The health care provider has determined that a preterm labor client at 34 weeks gestation has no fetal fibronectin present. Based on the finding, the nurse would anticipate which client finding within the next week?
The client will not develop preterm labor
Following a cesarean birth for abruptio placentae, a multigravid client tells the nurse, "I feel like such a failure. None of my other childbirths were like this." The nurse's response to the client is based on the understanding of which of the following?
The client's feeling of grief is a normal reaction
A 27 year old primigravid client with insulin dependent diabetes at 34 weeks gestation undergoes a NST, the results of which are documented as reactive. What should the nurse tell the client that the test results indicate?
There is evidence of fetal well-being
With plans to breastfeed their neonate, a pregnant client with insulin dependent diabetes asks the nurse about insulin needs during the postpartum period. Which statement about postpartum insulin requirements for the breastfeeding parent should the nurse include in the explanation?
They fall significantly in the immediate postpartum period
A 30 year old multigravid client at 8 weeks gestation has a hx of insulin dependent diabetes since age 20. When explaining the importance of blood glucose control during pregnancy, the nurse should tell the client that what will occur regarding the client's insulin needs during the first trimester?
They may decrease
The nurse explains the possible complications of pregnancy to a primigravid client at 10 weeks gestation who has a 5 year hx of insulin dependent diabetes. Which complication, if stated by the client, indicates the need for additional teaching?
Twin-to-twin transfusion
When teaching a multigravida client diagnosed with mild preeclampsia about nutritional needs, the nurse should discuss which type of diet?
Typical pregnancy diet
The nurse is caring for a 22 year old gravida 2, para 2 client who has disseminated intravascular coagulation after the birth of a dead fetus. Which finding is the highest priority to report to the health care provider?
Urinary output of 25 mL in the past hour
As the nurse enters the room of a newly admitted primigravid client diagnosed with severe preeclampsia, the client begins to experience a seizure. Which action should the nurse take first?
call for immediate assistance
A 32-year-old multigravida returns to the clinic for a routine prenatal visit at 36 weeks' gestation. The assessments during this visit include: blood pressure 140/90 mm Hg; pulse 80 beats/min; respiratory rate 16 breaths/min. What further information should the nurse obtain to determine if this client is becoming preeclamptic?
proteinuria (protein in urine)
Following an eclamptic seizure, the nurse should assess the client for which complication?
uterine contractions
