OB PREP U Chapter20/21

After teaching a woman who has had an evacuation for gestational trophoblastic disease (hydatidiform mole or molar pregnancy) about her condition, which statement indicates that the nurse's teaching was successful? "I won't use my birth control pills for at least a year or two." "My blood pressure will continue to be increased for about 6 more months." "My intake of iron will have to be closely monitored for 6 months." "I will be sure to avoid getting pregnant for at least 1 year."

"I will be sure to avoid getting pregnant for at least 1 year."

The nurse is caring for a pregnant woman determined to be at high risk for gestational diabetes. The nurse prepares to rescreen this client at which time frame? 24 to 28 weeks 20 to 24 weeks 28 to 32 weeks 16 to 20 weeks

24 to 28 weeks

A pregnant woman with type 2 diabetes is scheduled for a laboratory test of glycosylated hemoglobin (HbA1C). What does the nurse tell the client is a normal level for this test? 6% 14% 8% 12%

6%

A woman is receiving magnesium sulfate as part of her treatment for severe preeclampsia. The nurse is monitoring the woman's serum magnesium levels. The nurse determines that the drug is at a therapeutic level based on which result? 10.8 mEq/L 8.4 mEq/L 3.3 mEq/L 6.1 mEq/L

6.1 mEq/L

A nurse in the maternity triage unit is caring for a client with a suspected ectopic pregnancy. Which nursing intervention should the nurse perform first? Assess the client's vital signs. Obtain a surgical consent from the client. Administer oxygen to the client. Provide emotional support to the client and significant other.

Assess the client's vital signs.

A patient in her third trimester comes in for a routine prenatal visit. The nurse places her in a comfortable position and attaches the tocodynamometer and ultrasound monitor to the patient's abdomen. What is the purpose of this test? Assesses fetal position Assesses readiness for dilation Assesses readiness for delivery Assesses fetal well-being

Assesses fetal well-being

A woman in her 20s has experienced a spontaneous abortion (miscarriage) at 10 weeks' gestation and asks the nurse at the hospital what went wrong. She is concerned that she did something that caused her to lose her baby. The nurse can reassure the woman by explaining that the most common cause of miscarriage in the first trimester is related to which factor? Advanced maternal age Exposure to chemicals or radiation Faulty implantation Chromosomal defects in the fetus

Chromosomal defects in the fetus

A 28-year-old client with a history of endometriosis presents to the emergency department with severe abdominal pain and nausea and vomiting. The client also reports her periods are irregular with the last one being 2 months ago. The nurse prepares to assess for which possible cause for this client's complaints? Ectopic pregnancy Placenta previa Molar pregnancy Healthy pregnancy

Ectopic pregnancy

The nurse is orientating in the Labor and Delivery unit and asks her preceptor how to differentiate a client with preeclampsia from one with eclampsia. Which symptoms would the preceptor describe to the new nurse as indicative of severe preeclampsia? Select all that apply. Hyperactive deep tendon reflexes Nondependent edema Seizure Glycosuria Blood pressure above 160/110 mm Hg

Hyperactive deep tendon reflexes Nondependent edema Blood pressure above 160/110 mm Hg

A client at 11 weeks' gestation experiences pregnancy loss. The client asks the nurse if the bleeding and cramping that occurred during the miscarriage were caused by working long hours in a stressful environment. What is the most appropriate response from the nurse?

I can understand the need you want to know how this happened. We can discuss this further.

A patient is admitted with a diagnosis of ectopic pregnancy. For what should the nurse anticipate preparing the patient? Internal uterine monitoring Immediate surgery Bed rest for the next 4 weeks Intravenous administration of a tocolytic

Immediate surgery

A 25-year-old client at 22 weeks' gestation is noted to have proteinuria and dependent edema on her routine prenatal visit. Which additional assessment should the nurse prioritize and alert the RN or health care provider? Initial BP 110/60 mm Hg; current BP 112/86 mm Hg Initial BP 120/80mm Hg; current BP 130/88 mm Hg Initial BP 100/70 mm Hg; current BP 140/90 mm Hg Initial BP 140/85 mm Hg; current BP 130/80 mm Hg

Initial BP 100/70 mm Hg; current BP 140/90 mm Hg

A pregnant woman has been admitted to the hospital due to preeclampsia with severe features. Which measure will be important for the nurse to include in the care plan? Institute NPO status. Plan for immediate induction of labor. Institute and maintain seizure precautions. Admit the client to the middle of ICU where she can be constantly monitored.

Institute and maintain seizure precautions.

The nurse is caring for a pregnant client with fallopian tube rupture. Which intervention is the priority for this client? Monitor the client's beta-hCG level. Monitor the fetal heart rate (FHR). Monitor the client's vital signs and bleeding. Monitor the mass with transvaginal ultrasound.

Monitor the client's vital signs and bleeding.

A nurse is providing care to a client who has been diagnosed with a common benign form of gestational trophoblastic disease. The nurse identifies this as: hydatidiform mole. ectopic pregnancy. hydramnios. placenta accrete.

hydatidiform mole.

Which recommendation would the nurse give to a pregnant client with a sexually transmitted infection who is at risk for transmitting the infection? Take tub baths regularly. Pat or blot the skin dry. Participate in early prenatal care. Have regular cancer screening examinations.

Participate in early prenatal care.

The nurse is caring for a client with preeclampsia and understands the need to auscultate this client's lung sounds every 2 hours. Why would the nurse do this? Pulmonary hypertension Pulmonary emboli Pulmonary atelectasis Pulmonary edema

Pulmonary edema

The nurse is caring for a client who has a multifetal pregnancy. What topic should the nurse prioritize during health education? Signs of preterm labor Parenting skills Risk for hypertension Risk for blood incompatibilities

Signs of preterm labor

A client with severe preeclampsia is receiving magnesium sulfate as part of the treatment plan. To ensure the client's safety, which compound would the nurse have readily available? potassium chloride ferrous sulfate calcium gluconate calcium carbonate

calcium gluconate

A pregnant woman with diabetes at 10 weeks' gestation has a glycosylated hemoglobin (HbA1c) level of 13%. At this time the nurse should be most concerned about which possible fetal outcome? congenital anomalies placenta previa placental abruption (abruptio placentae) incompetent cervix

congenital anomalies

A nurse is monitoring a client with PROM who is in labor and observes meconium in the amniotic fluid. What does the observation of meconium indicate? central nervous system (CNS) involvement fetal distress related to hypoxia infection cord compression

fetal distress related to hypoxia

A nurse is conducting a refresher program for a group of perinatal nurses. Part of the program involves a discussion of HELLP. The nurse determines that the group needs additional teaching when they identify which aspect as a part of HELLP? hemolysis elevated lipoproteins liver enzyme elevation low platelet count

elevated lipoproteins

A woman with gestational hypertension develops eclampsia and experiences a seizure. Which intervention would the nurse identify as the priority? control of hypertension birth of the fetus oxygenation fluid replacement

oxygenation

A prenatal client who is 6 weeks' gestation calls the clinic to report vaginal bleeding. For what concern will the nurse further assess the client? Braxton Hicks contractions nuchal cord spontaneous abortion (miscarriage) urinary tract infection

spontaneous abortion (miscarriage)

A pregnant woman has arrived to the office reporting vaginal bleeding. Which finding during the assessment would lead the nurse to suspect an inevitable abortion? closed cervical os strong abdominal cramping no passage of fetal tissue slight vaginal bleeding

strong abdominal cramping

A nurse is assessing the following antenatal clients. Which client is at highest risk for having a multiple gestation? the 27-year-old client who gave birth to twins two years ago the 41-year-old client who conceived by in vitro fertilization the 19-year-old client diagnosed with polycystic ovarian syndrome the 38-year-old client whose spouse is a triplet

the 41-year-old client who conceived by in vitro fertilization

A woman at 8 weeks' gestation is admitted for ectopic pregnancy. She is asking why this has occurred. The nurse knows that which factor is a known risk factor for ectopic pregnancy? multiple gestation pregnancy high number of pregnancies use of IUD for contraception use of oral contraceptives

use of IUD for contraception

A woman with hyperemesis gravidarum asks the nurse about suggestions to minimize nausea and vomiting. Which suggestion would be most appropriate for the nurse to make? "Drink fluids in between meals rather than with meals." "Try to eat three large meals a day with less snacking." "Lie down for about an hour after you eat." "Make sure that anything around your waist is quite snug."

"Drink fluids in between meals rather than with meals."

A pregnant patient with intermittent preterm contractions at 30 weeks has been on weekly home care assessments for 1 month without health care visits to the doctor or any activities outside the home. The nurse has established adequate fetal growth and is aware that contractions have been occurring roughly two times a day. The patient makes little effort to look at the nurse or discuss her plans for the upcoming delivery. The nurse makes which diagnosis of the current needs of this patient? Threatened preterm delivery related to contractions, as evidenced by reports by the patient of contractions before 38 weeks' gestation Inadequate dietary intake related to activity restriction At risk for depression because of extended activity restriction, as evidenced by affect At risk for venous thromboembolism because of restricted activity

At risk for depression because of extended activity restriction, as evidenced by affect

The following hourly assessments are obtained by the nurse on a client with preeclampsia receiving magnesium sulfate: 97.3oF (36.2oC), HR 88, RR 12 breaths/min, BP 148/110 mm Hg. What other priority physical assessments by the nurse should be implemented to assess for potential toxicity? Magnesium sulfate level Reflexes Oxygen saturation Lung sounds

Reflexes

A primigravida 21-year-old client at 24 weeks' gestation has a 2-year history of HIV. As the nurse explains the various options for delivery, which factor should the nurse point out will influence the decision for a vaginal birth? The mother's age Prophylactic ART to infant at birth Amniocentesis results at 34 weeks The viral load

The viral load

A client in her first trimester arrives at the emergency room with reports of severe cramping and vaginal spotting. On examination, the health care provider informs her that no fetal heart sounds are evident and orders a dilatation and curettage. The client looks frightened and confused and states that she does not believe in abortion. Which statement by the nurse is best? "The choice is up to you but the health care provider is recommending an abortion." "I know that it is sad but the pregnancy must be terminated to save your life." "Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications." "You have experienced an incomplete miscarriage and must have the placenta and any other tissues cleaned out."

"Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications."

The nurse is monitoring a pregnant patient who is receiving intravenous magnesium sulfate for eclampsia. During the last assessment, the nurse was unable to elicit a patellar reflex. What should the nurse do? Measure blood pressure. Increase the infusion rate. Stop the current infusion. Check fetal heart rate.

Stop the current infusion.

While assessing a pregnant woman, the nurse suspects that the client may be at risk for hydramnios. Which information would the nurse use to support this suspicion? Select all that apply. fundal height below that for expected gestational age reports of shortness of breath difficulty obtaining fetal heart rate identifiable fetal parts on abdominal palpation history of diabetes

history of diabetes reports of shortness of breath difficulty obtaining fetal heart rate

The nurse is caring for a pregnant client with severe preeclampsia. Which nursing intervention should a nurse perform to institute and maintain seizure precautions in this client? Keep head of bed slightly elevated. Provide a well-lit room. Keep the suction equipment readily available. Place the client in a supine position.

Keep the suction equipment readily available.

A pregnant woman has just found out that she is having twin girls. She asks the nurse the difference between fraternal and identical twins. The nurse explains that with one set of twins there is fertilization of two ova, and with the other set one fertilized ovum splits. What type of twins result from the split ovum? both types can result from the split ovum identical fraternal neither type results from a split ovum

identical

Upon entering the room of a client who has had a spontaneous abortion, the nurse observes the client crying. Which response by the nurse would be most appropriate? "A baby still wasn't formed in your uterus." "Why are you crying?" "Will a pill help your pain?" "I'm sorry you lost your baby."

"I'm sorry you lost your baby."

The nurse is teaching a client who is diagnosed with preeclampsia how to monitor her condition. The nurse determines the client needs more instruction after making which statement? "If I have a severe headache, I'll call the clinic." "I will weigh myself every morning after voiding before breakfast." "I will count my baby's movements after each meal." "If I have changes in my vision, I will lie down and rest."

"If I have changes in my vision, I will lie down and rest."

The health care provider prescribes PGE2 for a woman to help evacuate the uterus following a spontaneous abortion. Which action would be most important for the nurse to do? Administer intramuscularly into the deltoid area. Use clean technique to administer the drug. Keep the gel cool until ready to use. Maintain the client supine for 30 minutes after administration.

Maintain the client supine for 30 minutes after administration.

A 35-year-old client is seen for her 2-week postoperative appointment after a suction curettage was performed to evacuate a hydatidiform mole. The nurse explains that the human chorionic gonadotropin (hCG) levels will be reviewed every 2 weeks and teaches about the need for reliable contraception for the next 6 months to a year. The client states, "I'm 35 already. Why do I have to wait that long to get pregnant again?" What is the nurse's best response? "Since you are at the end of your reproductive years, it is suggested that you don't try to have any more pregnancies." "You may need chemotherapy, so we don't want to risk pregnancy." "A contraceptive is used so that a positive pregnancy test resulting from a new pregnancy will not be confused with the increased level of hCG that occurs with a developing malignancy." "After a curettage procedure, it is recommended that you give your body some time to build up its stores."

"A contraceptive is used so that a positive pregnancy test resulting from a new pregnancy will not be confused with the increased level of hCG that occurs with a developing malignancy."