OB Test 3 Review Questions

A patient is at risk for abruptio placentae. The patient asks what chance her baby has of survival. A correct response by the nurse is that perinatal mortality with abruption is: a. 5 percent. b. 25 percent. c. 10 percent. d. 20 percent.

25 percent. Rationale: Perinatal mortality with abruption placentae is 25 percent.

The nurse is providing prenatal care to a client pregnant with twins. How much weight should the nurse counsel this client to gain? a. 25-30 pounds. b. 15-20 pounds. c. 30-35 pounds. d. 35-45 pounds.

35-45 pounds. Rationale: A weight gain of 35-45 pounds, with a 15-20-pound weight gain by 20 weeks, has been recommended for women with multiple-gestation pregnancy.

The nurse is working with a pregnant adolescent. The client is experiencing morning sickness, and has not been able to eat regular meals. What would be the priority nursing diagnosis? a. Self-esteem Disturbance. b. Ineffective Individual Coping. c. Altered Nutrition: Less Than Body Requirements. d. Alteration in Comfort.

Altered Nutrition: Less Than Body Requirements. Rationale: Altered Nutrition: Less Than Body Requirements is the correct priority nursing diagnosis for a client who is unable to eat. Alteration in Comfort, Self-esteem Disturbance, and Ineffective Individual Coping might be correct secondary nursing diagnoses if more data are gathered to support them.

On examination at 16 weeks' gestation, the physician identifies a shorter-than-average cervix. This patient might be a candidate for: a. Fern test. b. Cerclage. c. Fetal fibronectin. d. Betamethasone.

Cerclage. Rationale: A shorter-than-average cervix can result in early dilatation and preterm delivery. Adding a cerclage will strengthen the cervix and allow a longer gestation.

A postpartum client who admits to heavy alcohol use asks the nurse about breastfeeding her baby. The nurse correctly teaches this client that excessive alcohol consumption while breastfeeding can: a. Cause mental retardation in the newborn. b. Decrease the maternal milk letdown reflex. c. Increase the maternal letdown reflex. d. Cause seizure disorders in the newborn.

Decrease the maternal milk letdown reflex. Rationale: Excessive alcohol consumption while breastfeeding can decrease, not increase, the maternal milk ejection reflex. Fetuses exposed to heroin in utero can experience seizure disorders as newborns. Mental abnormalities in the newborn can result from alcohol exposure in utero, not through consumption of breast milk.

A nurse is teaching psychosocial development to a group of adolescents. The nurse expects teens in which stage of adolescence to be most able to recognize STDs and pregnancy as risks of unprotected sex? a. Late adolescence. b. Preadolescence. c. Middle adolescence. d. Early adolescence.

Late adolescence. Rationale: In late adolescence (ages 18-19 years), teens are more at ease with their individuality and decision-making ability. They can think abstractly and anticipate consequences. Late adolescents are capable of formal operational thought. They learn to solve problems, to conceptualize, and to make decisions. These abilities help them see themselves as having control, which leads to the ability to understand and accept the consequences of their behavior.

A nurse in the birthing unit is caring for a client following an amniotomy. What is an appropriate nursing intervention? a. Replace expelled amniotic fluid every 1-2 hours. b. Encourage ambulation every 1-2 hours. c. Assess cervical dilation every 2 hours. d. Monitor temperature every 2 hours.

Monitor temperature every 2 hours. Rationale: Due to an increased risk of infection, the nurse should monitor temperature every 2 hours following an amniotomy. Vaginal exams are kept to a minimum to decrease the chance of infection. Bed rest is maintained unless the presenting part is engaged. Replacing expelled amniotic fluid every 1-2 hours is unnecessary, as amniotic fluid is constantly produced.

A client arrives in the labor room and says she started contracting 1 hour ago when her water broke. A vaginal exam reveals the patient to be complete and +2 station. She delivers 15 minutes later. The nurse understands that this type of labor is classified as: a. Precipitous labor. b. Rapid second stage. c. Dysfunctional birth. d. Imminent birth.

Precipitous labor. Rationale: Precipitous labor lasts less than 3 hours.

A client who has admitted to heavy alcohol use throughout her pregnancy just delivered a 6-pound baby. Which signs and symptoms in the mother should the nurse anticipate in the 12-48-hour postpartum period? Select all that apply. a. Neonatal abstinence syndrome. b. Fetal alcohol syndrome. c. Seizures. d, Delirium tremens.

Seizures. Delirium tremens. Rationale: As a result of alcohol dependence, the woman might have withdrawal seizures as early as 12-48 hours after she stops drinking. Delirium tremens could occur in the postpartum period, and the newborn might suffer a withdrawal syndrome. Neonatal abstinence and fetal alcohol syndrome are not maternal symptoms.

A client is admitted to the labor area with a pregnancy at 42 weeks' gestation. The nurse knows that this client is especially at risk for: (select all that apply) a. Neonatal respiratory depression. b. Uteroplacental insufficiency. c. Meconium stained amniotic fluid. d. Breech presentation.

Uteroplacental insufficiency. Rationale: Late decelerations are caused by decreased oxygen saturation as a result of a problem with the uteroplacental unit. Fetal head compression manifests in early decelerations. Fetal cardiac abnormalities are not associated with late decelerations and cord compression typically manifests in variable decelerations.

A client with Type I diabetes is admitted to the labor and birthing unit. What nursing actions should take priority in the intrapartal management of the patient with diabetes? Select all that apply. a. Hourly monitoring of coagulation studies. b. Hourly monitoring of blood sugar level. c. Maintaining two patent IV lines. d. Maintaining seizure precautions.

Maintaining two patent IV lines. Hourly monitoring of blood sugar level. Rationale: Frequently, maternal insulin requirements decrease dramatically during labor. Consequently, maternal glucose levels are measured hourly to determine insulin need. Often two IV lines are used, one with a 5% dextrose solution and one with a saline solution. The saline solution is then available for piggybacking insulin, or if a bolus is needed. Seizure precautions and coagulation are not priorities in diabetes.

A prenatal client asks the nurse, "How much weight should I gain, and when?" What is the best response by the nurse regarding the pattern of weight gain? a. "Gain 5 pounds in the first trimester, 10 pounds in the second trimester, and 15 pounds in the third trimester." b. "Gain 2-4 pounds in the first trimester and half a pound per week in the last two trimesters." c. "Gain 3.5-5 pounds in the first trimester and 1 pound per week in the last two trimesters." d. "Gain 10 pounds in the first trimester, 10 pounds in the second trimester, and 10 pounds in the third trimester."

"Gain 3.5-5 pounds in the first trimester and 1 pound per week in the last two trimesters." Rationale: 3.5-5 pounds in the first trimester and 1 pound per week in the last two trimesters is the normal pattern of weight gain.

A prenatal client tells the nurse about her craving for laundry starch. How should the nurse respond? a. "You have a condition called anorexia. This disorder will compromise fetal weight gain." b. "This craving is called pica. Try nonfat powdered milk to see if it satisfies your craving." c. "You have a condition called bulimia. You must stop the ingestion of laundry starch immediately." d. "Since you are a vegan, the ingestion of laundry starch is considered normal."

"This craving is called pica. Try nonfat powdered milk to see if it satisfies your craving." Rationale: The term for a craving for laundry starch or other not usually edible or nutritious items is 'pica.' Bulimia is an eating disorder characterized by bingeing and purging. Anorexia is an eating disorder characterized by extreme fear of weight gain.

A nurse is evaluating the background of four teenagers. Which statements by the teens should the nurse recognize as psychosocial factors contributing to the risk of pregnancy for these teens? Select all that apply. a. "I just want someone to love me." b. "I'd leave my boyfriend, but I'm afraid of what he might do." c. "I have a hard time feeling good about myself." d. "I want a prescription for oral contraceptives."

"I just want someone to love me." "I have a hard time feeling good about myself." "I'd leave my boyfriend, but I'm afraid of what he might do." Rationale: Family dysfunction and poor self-esteem are major risk factors for adolescent pregnancy. The adolescent girl might use pregnancy for various conscious or subconscious reasons: to punish her father and/or mother; to escape from an undesirable home situation; to gain attention; or to feel that she has someone to love and to love her. Teens that become pregnant compared to teens who have not been pregnant, have usually been physically, emotionally, or sexually abused. In fact, maltreatment of any kind is a high-risk contributor to early teen pregnancy. Contraceptive use is not a psychosocial risk. Answer 3 indicates low self-esteem. Answer 4 indicates a potentially coercive relationship, which could include maltreatment. Nursing Process:

A nurse is evaluating client teaching about nutrition. The nurse knows the teaching has been effective when the client states: a. "I should take my iron half an hour before breakfast." b. "I should take my iron right after a meal." c. "I should take my iron and vitamin whenever I remember them." d. "Iron is best absorbed when taken with milk."

"I should take my iron half an hour before breakfast." Rationale: Iron is best absorbed in an acid environment, and should be taken on an empty stomach. Calcium interferes with the absorption of iron.

A nurse is receiving shift reports on four clients in the birthing unit. For which client is the physician most likely to induce labor? a. A client at 41 weeks' gestation with an active vaginal herpes infection. b. A client at 40 weeks' gestation with pregnancy-induced hypertension. c. A client at 38 weeks' gestation with a prolapsed umbilical cord. d. A client at 39 weeks' gestation with a transverse fetal lie.

A client at 40 weeks' gestation with pregnancy-induced hypertension. Rationale: The client at 40 weeks' gestation with pregnancy-induced hypertension is the best candidate for an induction. A transverse fetal lie, an active vaginal herpes infection, and a prolapsed umbilical cord are all contraindications to an induction.

A nurse is admitting a laboring client with a breech presentation to the birthing unit. Where is the most appropriate place for the nurse to auscultate for fetal heart tones? a. Below the umbilicus. b. Lower right maternal quadrant. c. Above the umbilicus. d. Midline of the umbilicus.

Above the umbilicus. Rationale: Auscultate for fetal heart tones above the umbilicus for a breech presentation, below the umbilicus for a cephalic presentation.

A client at 30 weeks' gestation is admitted to the maternity unit with vaginal bleeding. What should be the nurse's initial nursing action? a. Count and weigh peripads. b. Start an intravenous infusion drip. c. Assess blood pressure and pulse. d. Observe for pallor, clammy skin, and perspiration.

Assess blood pressure and pulse. Rationale: The nurse's initial action for a client with vaginal bleeding at 30 weeks would be to assess blood pressure and pulse. Counting and weighing peripads; observing for pallor, clammy skin, and perspiration; and starting an intravenous infusion drip are all important actions for this client; they are just not the initial action.

The nurse is assessing a prenatal client diagnosed with possible placenta previa. What signs and symptoms should the nurse expect this client to demonstrate? a. Severe abdominal pain. b. Bright red vaginal bleeding. c. Absence of fetal heart sounds. d. Dark red vaginal bleeding.

Bright red vaginal bleeding. Rationale: Bright red vaginal bleeding is a sign that a prenatal client has possible placenta previa. Severe abdominal pain, possible absence of fetal heart sounds, and dark red vaginal bleeding are true of abruptio placentae.

A prenatal client with insulin-dependent diabetes asks the nurse about pregnancy-related complications from diabetes for her baby. The nurse responds that the baby is at risk for which of the following when the mother has insulin-dependent diabetes? Select all that apply. a. Congenital anomalies. b. Macrosomia. c. Respiratory distress syndrome. d. Hyperactivity.

Congenital anomalies. Macrosomia. Respiratory distress syndrome. Rationale: The infant of a diabetic mother is at risk for congenital anomalies, respiratory distress, and macrosomia. Hyperactivity is not a risk factor for a newborn whose mother has diabetes.

During a prenatal visit, a client states, "Sometimes my boyfriend hits me, but it is just when he is stressed at work. I know he loves the baby and me; it's just hard right now. He wouldn't really hurt me." The nurse's first priority is to: a. Notify the social worker immediately. b. Determine the client's immediate safety. c. Encourage the client to leave her partner as soon as possible for the sake of the baby. d. Give the client pamphlets with the contact information for local shelters.

Determine the client's immediate safety. Rationale: Answer (c) is correct; when working with clients who are victims of physical abuse, the priority is always to determine the client's immediate safety. Answer (a) is incorrect; notifying a social worker is an appropriate action but it is not the immediate priority. Answer (b) is incorrect; giving information to victims of abuse must be discreet; if the abuser feels the client may leave, the violence may escalate. Answer (d) is incorrect; there are numerous factors associated with deciding to leave an abusive relationship; it is seldom a rapid or easy process. The nurse's role is to support the client in developing the best safety plan.

The nurse is preparing a prenatal client for a transabdominal ultrasound. What nursing action should the nurse include in the preparations? Select all that apply. a. Advise the client to empty her bladder. b. Encourage the client to drink 1.5 quarts of fluid. c. Apply transmission gel over the client's abdomen. d. Place the client in a side lying position.

Encourage the client to drink 1.5 quarts of fluid. Apply transmission gel over the client's abdomen. Rationale: After having the client void, assist her to a lithotomy position for a transabdominal ultrasound. Preparation for a transabdominal ultrasound includes encouraging the client to drink 1.5 quarts of fluid, maintaining a full bladder, and applying transmission gel over the client's abdomen.

A client is being maintained at home with a diagnosis of mild pre-eclampsia. Which of the following complaints require further evaluation? Select all that apply. a. Headache. b. Anxiety. c. Heartburn. d. Blurred vision.

Headache. Blurred vision. Rationale: Answers (c) and (d) are correct; headache and blurred vision are symptoms associated with worsening preeclampsia. Answer (a) is incorrect; heartburn is a familiar sensation and is less intense than the epigastric pain associated with severe preeclampsia. Answer (b) is incorrect; anxiety is a normal response to a complicated pregnancy.

A client is diagnosed during labor as persistent occiput posterior. Which intervention(s) might help? Select all that apply. a. Knee-chest position. b. Sims position. c. Pelvic rocking. d. Hands-and-knees (on all fours) position.

Knee-chest position, Hands-and-knees (on all fours) position, Pelvic rocking, Rationale: Knee-chest, hands-and-knees, and pelvic rocking all can assist in the fetus turning by changing position and allowing gravity to enhance the turning. Sims is used after the fetus turns

The physician orders an ultrasound for a prenatal client prior to an amniocentesis. The nurse explains to the client that the purpose of the ultrasound is to: a. Measure the fetus's biparietal diameter. b. Determine the gestational sac volume. c. Locate the placenta. d. Measure the fetus's crown-rump length.

Locate the placenta. Rationale: During an amniocentesis, the physician scans the uterus using ultrasound to identify the fetal and placental positions and to identify adequate pockets of amniotic fluid. Determination of the gestational sac volume, measuring the crown-rump length, and measuring the biparietal diameter are aspects of assessing fetal well-being (biophysical profile, or BPP), and might or might not be done prior to the amniocentesis, depending on gestational age.

The nurse is assessing a prenatal client at 30 weeks' gestation who was admitted to the hospital with complaints of severe nausea and vomiting, elevated alpha-fetoprotein, and a fundal height of 38 cm. What diagnosis should the nurse anticipate? a. Oligohydramnios. b. Multiple pregnancy. c. Abruptio placentae. d. Placenta previa.

Multiple pregnancy. Rationale: A prenatal client at 30 weeks' gestation with complaints of severe nausea and vomiting, elevated alpha-fetoprotein, and a fundal height of 38 is likely to have a multiple pregnancy. The alpha-fetoprotein level is usually elevated in twin or multiple-gestation pregnancies, and many women experience severe nausea and vomiting (due to elevated levels of the human chorionic gonadotropin [hCG] hormone). A client with abruptio placentae would complain of vaginal bleeding. A client with oligohydramnios is characterized by a decrease in amniotic fluid. A client with placenta previa would complain of painless vaginal bleeding.

The drug used in preterm labor that has few side effects and can be given orally or sublingually is: a. Betamethasone. b. Fetal fibronectin. c. Nifedipine. d. Magnesium sulfate.

Nifedipine. Rationale: Nifedipine is used orally or sublingually with preterm labor. Betamethasone is given during gestation to decrease the risk of neonatal respiratory distress. Fetal fibronectin is not a medication, but is a protein found in the amniotic fluid that when present is highly predictive of preterm delivery within 7-14 days. Magnesium sulfate is not given orally or sublingually.

The client asks for information about ectopic pregnancy. The nurse correctly responds by saying ectopic pregnancy is caused by: (Select all that apply.) a. Pelvic inflammatory disease (PID). b. Presence of an IUD. c. In utero exposure to diethylstilbestrol (DES). d. Endometriosis.

Pelvic inflammatory disease (PID). Endometriosis. Presence of an IUD. In utero exposure to diethylstilbestrol (DES). Rationale: Ectopic pregnancy can be caused by tubal damage from pelvic inflammatory disease (PID), previous tubal surgery, congenital anomalies of the tube, endometriosis, previous ectopic pregnancy, presence of an IUD, and in utero exposure to diethylstilbestrol (DES).

A prenatal client at 16 weeks' gestation presents to the clinic with unexplained bright red bleeding, cramping, and backache, which she has had for the past two days. A pelvic exam reveals a closed cervix. What type of abortion does this indicate? a. Threatened. b. Incomplete. c. Missed. d. Imminent.

Threatened. Rationale: A threatened abortion (miscarriage) has symptoms of vaginal bleeding and backache without cervical dilation. In an imminent abortion, the internal cervical os is dilated. Although the cervix is closed in a missed abortion, other symptoms would include a regression in breast changes and a brownish vaginal discharge. Diagnosis is made based on history, pelvic exam, and a negative pregnancy test. With an incomplete abortion, the embryo has passed out of the uterus, but the placenta remains, and the internal os is slightly dilated.

The nurse is caring for a client who is scheduled for an induction at 8 a.m. The physician has ordered misoprostol to be administered before the induction. In planning the client's care, the nurse should give the misoprostol no later than: a. 7 a.m. b. 4 a.m. c. 5 a.m. d. 6 a.m.

4 a.m. Rationale: Misoprostol can be administered every 3-6 hours until adequate cervical change occurs. The last dose of misoprostol needs to be administered at least 4 hours prior to the start of an induction.

The nurse is completing a history for a new client in the prenatal clinic. The client states that she had a ventricular septal defect successfully repaired with no further problems. The nurse anticipates what order for this client? a. Sodium restriction. b. Diuretics and strict bed rest. c. Antibiotic prophylaxis. d. Anticoagulant therapy.

Antibiotic prophylaxis. Rationale: Because of the risk of subacute bacterial endocarditis, even in cases where the heart defect was corrected surgically, antibiotic prophylaxis is often recommended at the time of birth. Treatment for peripartum cardiomyopathy (not cardiac defects) includes digoxin, diuretics, vasodilators as necessary, anticoagulants, sodium restriction, and strict bedrest.

A nurse is reviewing the charts of four clients in the birthing unit. Which client has an increased risk for an episiotomy? a. The client laboring in a supine position. b. The client with pregnancy-induced hypertension. c. The client with a fetus in an occiput-posterior position. d. The client with abruptio placentae.

The client with a fetus in the occiput-posterior position. Rationale: A client having a fetus in an occiput-posterior position would be at increased risk for having an episiotomy. A client with abruptio placentae is at increased risk for a cesarean birth. Pregnancy-induced hypertension is not a risk factor for having an episiotomy.

A client presents to the physician's office with complaints of right-sided abdominal pain, dizziness, and vaginal bleeding. A pelvic exam determines adnexal tenderness. What diagnosis should the nurse suspect? a. Cholelithiasis. b. Appendicitis. c. Threatened abortion. d. Ectopic pregnancy.

Ectopic pregnancy. Rationale: A client with an ectopic pregnancy would present to the physician's office with complaints of one-sided abdominal pain, dizziness, and vaginal bleeding, and would have adnexal tenderness on exam. Clients with a threatened abortion would have complaints of unexplained bleeding, cramping, or backache. A pelvic exam would reveal a closed cervix. Clients with appendicitis would have complaints of lower right-sided tenderness, low-grade fever, nausea, and often vomiting. Clients with cholelithiasis would have complaints of epigastric distress, such as fullness, distention, and vague pain in the right upper quadrant of the abdomen.

Nurses should evaluate family response to teen pregnancy. Which of the following psychosocial factors should be included in the nursing assessment of the family because of their potential influence on family response to teen pregnancy? Select all that apply. a. Birth setting. b. Cultural and religious beliefs. c. Nutritional status. d. Educational and career level.

Educational and career level. Cultural and religious beliefs. Rationale: In families that foster children's educational and career goals, adolescent pregnancy is often a shock. Cultural and religious beliefs can prevent some teens from seeking abortions. In populations in which adolescent pregnancy is more prevalent and more socially acceptable, family and friends might be more supportive of the adolescent parents. Nutritional status and birth setting are not psychosocial factors.

The client is experiencing late decelerations. The nurse understands that this is caused by: a. Fetal cardiac abnormality. b. Uteroplacental insufficiency. c. Umbilical cord compression. d. Fetal head compression.

Uteroplacental insufficiency. Rationale: Late decelerations are caused by decreased oxygen saturation as a result of a problem with the uteroplacental unit. Fetal head compression manifests in early decelerations. Fetal cardiac abnormalities are not associated with late decelerations and cord compression typically manifests in variable decelerations.

The nurse is writing a grant for an adolescent pregnancy prevention program. She needs to include factors that contribute to adolescent pregnancy. Select all that apply. a. Hispanic or African-American heritage. b. Poverty. c. Attending community college. d. Lack of adult supervision.

Poverty. Lack of adult supervision. Hispanic or African-American heritage. Rationale: Poverty, increased time spent without adult supervision, being African-American or Hispanic, low educational achievement, and a previous adolescent pregnancy are considered factors that contribute to adolescent pregnancy.

A gravida 2 para 1 prenatal client's ultrasound reveals twins. Her prepregnant weight is within normal limits. What is the pattern of weight gain that the nurse should recommend to the client during the second and third trimesters? a. 1 pound every other week. b. 1 pound per week. c. 1.5 pounds every other week. d. 1.5 pounds per week.

1.5 pounds per week. Rationale: For a normal-weight woman, the ideal pattern of weight gain during pregnancy is a gain of 3.5-5 pounds (1.6-2.3 kg) during the first trimester, followed by a gain of about 1 pound (0.5 kg) per week during the second and third trimesters. A normal-weight woman who is expecting twins should gain about 1.5 pounds per week during the second and third trimesters of her pregnancy. Nursing Process:

A prenatal client at 30 weeks' gestation is scheduled for a nonstress test (NST), and asks the nurse, "What is this test for?" The nurse correctly responds that the test is used to determine which of the following? Select all that apply. a. Accelerations of fetal heart rate. b. Fetal lung maturity. c. Adequate fetal oxygenation. d. Fetal well-being.

Adequate fetal oxygenation. Accelerations of fetal heart rate. Fetal well-being. Rationale: An NST documents fetal well-being by measuring fetal oxygenation and fetal heart rate accelerations, but not fetal lung maturity.

The nurse is caring for a prenatal client at 38 weeks' gestation whose ultrasound reveals approximately 3000 mL of amniotic fluid. She complains of shortness of breath, and has 2+ pitting edema in her lower extremities. The nurse anticipates preparation for: a. Intravenous antibiotics. b. Delivery by cesarean. c. Amniocentesis. d. Amnioinfusion.

Amniocentesis. Rationale: When the amount of amniotic fluid is 3000 mL or more, the woman experiences shortness of breath and edema in the lower extremities from compression of the vena cava. If the accumulation of amniotic fluid is severe enough to cause maternal dyspnea and pain, hospitalization and removal of the excessive fluid are required. A cesarean section delivery is contraindicated, because it could be dangerous to give anesthesia to a client with respiratory distress. Intravenous antibiotics would not be indicated, as it has not been established that the client has an infection. Amnioinfusion (instilling fluid into the uterus) is inappropriate for a client with excess amniotic fluid.

A nurse is caring for a client with an oxytocin infusion. What is the correct nursing action prior to increasing the oxytocin rate? a. Assess fetal heart rate. b. Assess cervical dilation. c. Assess maternal temperature. d. Evaluate the need for analgesia.

Assess fetal heart rate. Rationale: Assessing the fetal heart rate before increasing the oxytocin rate is crucial when caring for a client with an oxytocin infusion. Non-reassuring fetal status is a contraindication to oxytocin infusion. Assessing cervical dilatation is done after contractions have been established. When evaluating the need for analgesia, a vaginal exam should be performed to avoid giving the medication too early. Maternal blood pressure and pulse, not maternal temperature, should be measured to assess the effects of oxytocin.

A prenatal client at 22 weeks' gestation is scheduled for an amniocentesis. Which nursing actions would apply to any client undergoing this procedure? Select all that apply. a. Assess vital signs and fetal heart rate. b. Assess for bleeding. c. Administer Rh immune globulin to the client. d. Cleanse the skin with alcohol.

Assess for bleeding. Assess vital signs and fetal heart rate. Rationale: The skin is cleaned with a Betadine solution. The use of a local anesthesia at the needle insertion site is optional. A 22-gauge needle is then inserted into the uterine cavity, and amniotic fluid is withdrawn (Figure 21-20). After 15-20 mL of fluid has been removed, the needle is withdrawn and the site is assessed for streaming (movement of fluid), which is an indication of bleeding. The fetal heart rate and maternal vital signs are then assessed. Rh immune globulin is given only to all Rh-negative women.

A nurse is working with a pregnant teenager in the prenatal clinic. What would be the most important nursing action to help this teen meet the third-trimester developmental tasks of pregnancy? a. Assess the client for discomforts of pregnancy. b. Discuss continued education plans. c. Reassure the client that ambivalence is normal. d. Emphasize the need for good nutrition.

Assess the client for discomforts of pregnancy. Rationale: Assessing the client for discomforts of pregnancy is a third-trimester development task. Ambivalence about the pregnancy, the need for good nutrition, and discussing continued education plans are first-trimester developmental tasks.

A client at 28 weeks' gestation is admitted to the labor and birth unit. Which test would most likely be used to assess the client's comprehensive fetal status? a. Amniocentesis. b. Biophysical profile (BPP). c. Nonstress test (NST). d. Ultrasound for physical structure.

Biophysical profile (BPP). Rationale: Biophysical profile is a comprehensive test that would be used to assess the client's fetal status at 28 weeks' gestation. Ultrasound for physical structure is limited to identifying the growth and development of the fetus, and does not assess for other parameters of fetal well-being. Women with a high risk factor will probably begin having NSTs at 30-32 weeks' gestation and at frequent intervals for the remainder of the pregnancy. Amniocentesis late in pregnancy is used to test for lung maturity, not overall fetal status in labor, and when performed earlier it is used to test for specific disorders.

The nurse is caring for a laboring client with Type I diabetes. What are the signs and symptoms of hypoglycemia for which the nurse should assess? a. Frequent urination and headache. b. Headache and anorexia. c. Dry skin and blurred vision. d. Diaphoresis and disorientation.

Diaphoresis and disorientation. Rationale: Hypoglycemia manifests itself during labor in a Type I diabetic with diaphoresis and disorientation. There is usually hunger and decreased urination, with headache, clammy skin, and blurred vision.

A nurse working in the prenatal clinic is evaluating the nutritional status of four adolescents. Which adolescents have nutrition-related risk factors? Select all that apply. a. The adolescent who smokes. b. The adolescent who is 10 pounds underweight. c. The adolescent of normal height and weight. d. The adolescent who is diabetic.

The adolescent who smokes. The adolescent who is diabetic. The adolescent who is 10 pounds underweight. Rationale: Important nutrition-related factors to assess in pregnant adolescents include low prepregnant weight, low weight gain during pregnancy, young age at menarche, smoking, excessive prepregnant weight, anemia, unhealthy

If a client does not respond to standard home treatment for severe hyperemesis gravidarum, the nurse will anticipate adding which therapy on an outpatient basis? a. Low-fat soft diet. b. Complex carbohydrates with limited liquids. c. IV fluids. d. Total parenteral nutrition.

IV fluids. Rationale: If the woman does not respond to standard approaches to the control of nausea and vomiting in pregnancy, she might require intravenous (IV) fluids on an outpatient basis. Total parenteral nutrition would be started only if the client were unresponsive to IV hydration. Low-fat soft diet and complex carbohydrates with limited liquids are progressive diets after the client is stabilized for hyperemesis gravidarum.

A prenatal client's lab report reveals a low folic acid level. The nurse explains that a low folic acid level is associated with a higher incidence of: a. Respiratory problems. b. Spina bifida. c. Cardiac problems. d. Prematurity.

Spina bifida. Rationale: An inadequate intake of folic acid has been associated with neural tube defects (NTDs) (spina bifida, meningomyelocele) in the fetus or newborn. Prematurity and cardiac and respiratory problems are not affected by folic acid.

A client at 15 weeks' gestation presents to the prenatal clinic with "prune juice"-like vaginal bleeding. Other assessment data include a hematocrit of 10 and complaints of severe nausea and vomiting. What diagnosis should the nurse suspect? a. Prolapsed cord. b. Hydatidiform mole. c. Placenta previa. d. Abruptio placentae.

Hydatidiform mole. Rationale: In hydatidiform mole, vaginal bleeding occurs almost universally. It is often brownish due to liquefaction of the uterine clot. In addition, because serum hCG levels are higher with molar pregnancy than with normal pregnancy, the woman might experience hyperemesis gravidarum. Anemia occurs frequently due to blood loss and poor nutrition secondary to hyperemesis. Placenta previa symptoms include painless bright red vaginal bleeding, usually in the third trimester of pregnancy. Prolapsed cord symptoms include a trickle of bright red vaginal blood and possibly a visible cord at the vaginal opening. Abruptio placentae symptoms include vaginal bleeding (bright red or dark red), abdominal pain, and uterine tenderness.

Which of the following client statements indicate a need for additional education regarding avoidance of perinatal infection? Select all that apply. a. "If I have beta strep in labor, I will most likely need a C-section." b. "I need to buy a good pair of gloves for when I am working in the garden." c. "After receiving my rubella immunization, I will avoid getting pregnant for 1 month." d. "I will not let the cat sleep in our bed now that I am pregnant."

"If I have beta strep in labor, I will most likely need a C-section." "I will not let the cat sleep in our bed now that I am pregnant." Rationale: GBS requires antibiotic prophylaxis during labor, but a vaginal delivery is not contraindicated. Toxoplasmosis can be transferred in cat feces; clients should be instructed to avoid handling litter boxes. The client should avoid pregnancy for 1 month after receiving the rubella immunization and gardening gloves should be worn during pregnancy to avoid contact with soil organisms. These statements indicate client understanding.

A pregnant client asks why ultrasound is used so frequently during pregnancy. The nurse's response is based on her knowledge that the advantages of ultrasound include which of the following? Select all that apply. a. 'The ultrasound is the only test to determine gender." b. "It is noninvasive and painless." c. "It can be used to estimate gestational age." d. "Results are immediate."

"It is noninvasive and painless." "It can be used to estimate gestational age." "Results are immediate." Rationale: The ability to establish fetal age accurately by ultrasound is lost in the third trimester because fetal growth is not as uniform then as it is in the first two trimesters; however, ultrasound can be used to approximate gestational age within 1-3 weeks' accuracy during the third trimester. A comprehensive ultrasound is used to detect anatomical defects, not gestational age. Ultrasound is not used to determine gender.

Which of the following nursing statements made to a 17-year-old pregnant client at the initial prenatal visit would be most effective in developing a trusting nurse-client relationship? a. "Tell me what caused you to get pregnant while still in high school." b. "We don't have room in the exam room for your mother. I'm sure you'll do fine." c. "Since this is your first pelvic exam, I'd like to explain what will be happening." d. "We'll have to weigh you each time so we'll know if you've been eating correctly."

"Since this is your first pelvic exam, I'd like to explain what will be happening." Rationale: Explaining unfamiliar procedures to the adolescent client, who is likely to be anxious and fearful, will assist the nurse in developing a trusting relationship. Words should be weighed carefully, and should be nonjudgmental and sensitive to the client.

An adolescent at 18 weeks' gestation complains to the nurse in the prenatal clinic about her 15-pound weight gain. What is the best response by the nurse? a. "You have not gained enough weight at this time in your pregnancy." b. "You should not gain any more weight until the third trimester." c. "You have gained an appropriate amount of weight." d. "You should continue to gain weight, but at a slower rate."

"You should continue to gain weight, but at a slower rate." Rationale: "You should continue to gain weight, but at a slower rate" is the best response to an adolescent who complains to the nurse about her 15-pound weight gain. Weight gain should be about 10 pounds by 18 weeks' gestation.

The nurse is giving discharge instructions to a postpartum client who is breastfeeding. The nurse should teach this client to consume ______ calories over the pregnancy requirements.

200 calories over the pregnancy requirements is the appropriate amount of calories for a total of 2,500-2,700 calories per day. A 500-kcal increase from her prepregnancy, not pregnancy, requirement is another way to indicate the recommended calories.

A prenatal client at 35 weeks' gestation is scheduled for an amniocentesis to determine fetal lung maturity. The nurse expects the lecithin/sphingomyelin (L/S) ratio to be: a. 1:1. b. 3:1. c. 2:1. d. 0.5:1.

2:1. Rationale: Early in pregnancy, the sphingomyelin concentration in amniotic fluid is greater than the concentration of lecithin, and so the L/S ratio is low. (Lecithin levels are low and sphingomyelin levels are high.) At about 32 weeks' gestation, sphingomyelin levels begin to fall and the amount of lecithin begins to increase. By 35 weeks' gestation, an L/S ratio of 2:1 (also reported as 2.0) is usually achieved in the normal fetus.

The nurse is reviewing four prenatal charts. Which client would be an appropriate candidate for a contraction stress test (CST)? a. A client with intrauterine growth retardation. b. A client with an incompetent cervix. c. A client with multiple gestation. d. A client with placenta previa.

A client with intrauterine growth retardation. Rationale: A contraction stress test (CST) is indicated for a client with intrauterine growth retardation (IUGR), because it will assess the respiratory function of the placenta, which can be adversely affected by the conditions causing IUGR. The CST is contraindicated in third-trimester bleeding from placenta previa or marginal abruptio placentae, previous cesarean with classical incision (vertical incision in the fundus of the uterus), premature rupture of the membranes, incompetent cervix, anomalies of the maternal reproductive organs, history of preterm labor (if being done prior to term), or multiple gestation.

A client of Chinese descent arrives in the labor unit. She indicates she was breech 2 weeks ago and used "moxa" to change her baby's position. An exam reveals a vertex presentation. The nurse understands that "moxa" is: (select all that apply) a. A traditional Chinese medicine. b. A complementary therapy c. An alternative therapy. d. A form of quackery.

A complementary therapy. A traditional Chinese medicine. Rationale: Moxa, a complementary therapy, is a traditional Chinese medicine in which an herb is rolled into cones and placed at specific points on the body. It is believed that this, in combination with acupuncture, can change the fetal position from breech to vertex.

A nurse is caring for a client during an amnioinfusion. Which fetal heart rate (FHR) pattern would be an expected outcome of a successful amnioinfusion? a. FHR pattern of 160-180 bpm. b. An increase in variable decelerations. c. A decrease in variable decelerations. d. FHR pattern of 100-110 bpm.

A decrease in variable decelerations. Rationale: Variable decelerations should decrease, not increase, following an amnioinfusion, because the fluid buffers the cord from being compressed. There should be no bradycardia or tachycardia.

The nurse is caring for a laboring client with a known history of cocaine abuse. What complication is most likely for this client? a. Abruptio placentae. b. Polyhydramnios. c. Placenta previa. d. Prolapsed cord.

Abruptio placentae. Rationale: Abruptio placentae is the most likely complication for a client with a known history of cocaine abuse. The incidence of abruptio placentae is approximately 1 in 100 births, and it occurs more frequently in pregnancies complicated by hypertension and cocaine abuse. Placenta previa can be a complication for women with multiple prior cesarean births. Prolapsed cord can be a complication with hydramnios, a small fetus, and a breech presentation. Polyhydramnios can be a complication of women with diabetes.

The nurse is planning a community program to decrease adolescent pregnancy. According to research, successful community teen pregnancy prevention programs use which approaches? a. Address societal issues of poverty and education. b. Programs are short-term due to limited teen attention span. c. Have a board of directors made up of community dignitaries. d. Focus on negative aspects of teen sexual behavior, pregnancy, and parenting.

Address societal issues of poverty and education. Rationale: Addressing societal issues of poverty and education is a successful approach to decrease adolescent pregnancy. Successful teenage pregnancy prevention programs are positive, include teens in the planning process, and begin before adolescence and continue throughout high school.

While the nurse is assisting the physician with a forceps-assisted birth, the fetal heart rate drops. The client's husband asks if there is concern for the fetus. To respond appropriately, which of the following must the nurse do? Select all that apply. a. Assess if the drop occurs during traction applied with the forceps. b. Assess for other indications of fetal distress. c. Assess the severity and duration of the heart rate drop. d. Reassure the client and her husband that this is normal.

Assess if the drop occurs during traction applied with the forceps. Assess the severity and duration of the heart rate drop. Assess for other indications of fetal distress. Rationale: Although it is not uncommon to observe mild fetal bradycardia as traction is being applied to the forceps, all factors must be assessed before reassuring the parents. Mild bradycardia during traction results from head compression, and is temporary.

The nurse is counseling a prenatal client regarding the need to take folic acid supplements during pregnancy. The nurse also encourages the client to eat foods high in folic acid, such as: a. Eggs and yogurt. b. Fresh green, leafy vegetables and legumes. c. Rice and pasta. d. Fruits and fruit juice.

Fresh green, leafy vegetables and legumes. Rationale: Fresh green, leafy vegetables and legumes are good sources of folic acid. Fruits and fruit juice, rice and pasta, eggs, and yogurt are not sources of folic acid.

Which client would most likely be induced with a prostaglandin agent? A woman with: (select all that apply) a. Gestational diabetes. b. Fetal distress. c. Severe pre-eclampsia. d. Postdate pregnancy.

Gestational diabetes. Postdate pregnancy. Rationale: Prostaglandin agents are typically used when labor induction is indicated but not urgent, such as with maternal gestational diabetes, postdates, or large-for-gestational-age fetuses who warrant birth occurring in the near future. For example, a woman who is over 41 weeks but has a very unfavorable cervix may be given prostaglandin gel to ripen her cervix before a Pitocin induction is scheduled. Fetal distress and severe pre-eclampsia warrant a more urgent response.

The nurse assesses for complications of pregnancy in a 19-year-old client. Which of the following data might indicate a complication associated with adolescent pregnancy? a. Hypertension, proteinuria, edema. b. Large-for-gestational-age infant. c. Painless vaginal spotting. d. Bright red, painful vaginal bleeding.

Hypertension, proteinuria, edema. Rationale: Risks for pregnant adolescents include preterm births, low-birth-weight infants, cephalopelvic disproportion, iron-deficiency anemia, and pre-eclampsia. Placenta previa, pregnancy-induced diabetes, and abruptio placentae are not common complications of pregnant adolescents.

The nurse is reviewing the lab tests of four prenatal clients. Which lab finding would support the diagnosis of hyperemesis gravidarum? a. Hypercalcemia. b. Hypokalemia. c. Hyperkalemia. d. Hypocalcemia.

Hypokalemia. Rationale: In severe cases, hyperemesis causes dehydration, which leads to fluid-electrolyte imbalance. Severe potassium loss can disrupt cardiac functioning. Potassium loss (hypokalemia), not hyperkalemia, is characteristic of hyperemesis gravidarum. Neither hypercalcemia nor hypocalcemia (low calcium) is characteristic of hyperemesis gravidarum.

1. The nurse is caring for a client whose uterine contractions are irregular and of low amplitude, and the dilatation of the cervix is less than 1 cm per hour. The nurse recognizes this pattern as: a. Hypotonic labor. b. Tachysystole labor. c. Arrest of descent. d. Normal labor.

Hypotonic labor. Rationale: Hypotonic labor is characterized by fewer than 2-3 contractions in a 10-minute period. Dysfunctional contractions are typically irregular in strength, timing, or both. These irregular uterine contractions often arrest cervical dilatation. Arrest of descent refers to lack of change in fetal station. Hypertonic labor is ineffectual uterine contractions of poor quality in the latent phase with increasing resting tone. Normal labor is characterized by regular contractions of moderate amplitude with a regular pattern of cervical change.

The nurse is teaching a client with diabetes about insulin requirements during pregnancy. Which statement should the nurse include regarding insulin requirements? a. Insulin needs decrease late in the third trimester. b. Insulin needs decrease early in the third trimester. c. Insulin needs increase early in the first trimester. d. Insulin needs increase in the second trimester.

Insulin needs increase in the second trimester. Rationale: During the first trimester, the need for insulin frequently decreases. Insulin requirements begin to rise in the second trimester as glucose use and glucose storage by the woman and fetus increase. Insulin requirements can double or quadruple by the end of pregnancy as a result of placental maturation and hPL production.

The nurse is teaching a prenatal client about chorionic villus sampling (CVS). The nurse correctly teaches the client that risks related to CVS include which of the following? Select all that apply. a. Spontaneous abortion. b. Intrauterine infection. c. Rupture of membranes. d. Maternal hypertension.

Intrauterine infection. Rupture of membranes. Spontaneous abortion. Rationale: Risks of CVS include failure to obtain tissue, rupture of membranes, leakage of amniotic fluid, bleeding, intrauterine infection, maternal tissue contamination of the specimen, and Rh alloimmunization. CVS testing has a higher rate of spontaneous abortion than does amniocentesis. Other complications include fetal limb defects and abnormalities of the fetal face and jaw (March of Dimes, 2003).

The nurse is caring for a laboring client with sickle-cell anemia. Which therapy should the nurse anticipate the physician ordering? a. Diuretics. b. Magnesium sulfate. c. Oxygen. d. Bronchodilators.

Oxygen. Rationale: Oxygen supplementation is an anticipated therapy for patients with sickle-cell anemia, to reduce the risk of their red blood cells sickling in the presence of decreased oxygen. Diuretics, magnesium sulfate, and bronchodilators are not anticipated for patients with sickle-cell anemia.

While monitoring the patient on the central monitor, the nurse notes a sudden drop in fetal heart rate to less than 100 beats per minute, and the contraction pattern appears titanic. Her abdomen is very tender to touch, and there is no increase in vaginal bleeding. One hour ago, the patient was 6 cm dilated, 80% effaced, and 0 station. The nurse understands that these symptoms are indicative of: a. Placental abruption. b. Disseminated intravascular coagulation. c. Impending seizure. d. Placenta previa.

Placental abruption. Rationale: Placental abruption is indicated by severe pain; sudden onset; uterine tenderness; and hard, intense contractions.

The nurse knows that hypertonic labor contractions, if unresolved, can develop into: a. Prolonged latent phase. b. Precipitous delivery. b. Late decelerations. d. Persistent occiput posterior.

Prolonged latent phase. Rationale: Tachysystole labor patterns are ineffective in dilating the cervix, and without intervention will manifest into a prolonged latent phase.

The nurse's teaching plan for the prenatal client who is a vegan should pay particular attention to which of the following? Select all that apply. a. Need for nutritional supplements. b. Animal sources of complete protein. c. Suggestions for ensuring adequate caloric intake. d. Plant sources of complete protein.

Plant sources of complete protein. Suggestions for ensuring adequate caloric intake. Need for nutritional supplements. Rationale: Vegans are "pure" vegetarians who will not eat any food from animal sources. The expectant woman who is vegan must eat the proper combination of foods to obtain adequate nutrients. She will need to combine foods from different vegetable sources to get enough complete proteins. Obtaining sufficient calories to ensure adequate weight gain might be difficult, because vegan diets tend to be high in fiber, and therefore filling. Because the best sources of iron, zinc, and vitamin B12 are animal products, vegan diets also might be low in these minerals. If she uses no soy milk, she also needs daily supplements of 1,200 mg of calcium and 10 mg of vitamin D.

The nurse is reviewing the complications of breech presentation in preparation for a prepared childbirth class. Which of the fetal/neonatal risks associated with breech presentation should she include? Select all that apply. a. Birth trauma. b. Prolapsed cord. c. Gestational diabetes. d. Macrosomia.

Prolapsed cord. Birth trauma. Rationale: Risks associated with breech presentation include: • Higher perinatal morbidity and mortality rates; • Increased risk of prolapsed cord, especially in incomplete breeches (because space is available between the cervix and presenting part); • Increased risk of cervical cord injuries due to hyperextension of the fetal head during vaginal birth; and • Increased risk of birth trauma (especially of the head) during either vaginal or cesarean breech birth. Macrosomia is not related to breech presentation. Gestational diabetes is not a fetal/neonatal risk, and is not related to breech presentation.

The nurse is performing a pelvic exam on a laboring client, and discovers a loop of cord in the vagina. What is the priority nursing action? a. Place client in a side-lying position to increase perfusion. b. Call the physician or nurse-midwife for emergency delivery. c. Push the presenting part upward off the umbilical cord. d. Administer oxygen at 5 L per minute per face mask.

Push the presenting part upward off the umbilical cord. Rationale: If a loop of cord is discovered, the examiner must provide firm pressure on the fetal presenting (to relieve compression) until the fetus is delivered. Administering oxygen at 5 L per minute, calling the physician or nurse-midwife, and placing the client in a side-lying position are appropriate actions but not the priority nursing action.

A nurse is preparing a prenatal client with a breech presentation for an external cephalic version (ECV). What condition must be met prior to this procedure? a. Reactive non-stress test. b. Mild labor contractions. c. Fetal breech must be engaged in the pelvis. d. 34 weeks' gestational age.

Reactive non-stress test. Rationale: The fetus must be more than 36 weeks' gestation, with a reactive non-stress test, and not engaged in the pelvis.

A nurse is teaching a prenatal nutrition class. Which meal is highest in protein? a. Sausage, eggs with cheese, toast, and coffee. b. Peanut butter sandwich, pea soup, and lemonade. c. Fortified cereal, toast, and orange juice. d. Toasted cheese sandwich, tomato soup, and iced tea.

Sausage, eggs with cheese, toast, and coffee. Rationale: Animal products such as meat, fish, poultry, and eggs provide high-quality protein. Dairy products are also important protein sources. Various kinds of hard and soft cheeses and cottage cheese are excellent protein sources. The meal of sausage, eggs with cheese, toast, and coffee contains the highest amount of protein (at about 21 grams); this meal has three protein sources: meat, eggs, and cheese. The menu of toasted cheese sandwich, tomato soup, and iced tea contains about 12-13 grams of protein; the meal of peanut butter sandwich, pea soup, and lemonade contains about 15 grams of protein; and the menu of fortified cereal, toast, and orange juice contains about 12-13 grams of protein, but none of these is the highest.

A nurse is caring for a preoperative cesarean birth client. The surgery is scheduled, and is not an emergency. The patient has never been hospitalized, has never had surgery, and is very anxious. In planning care, which nursing action takes top priority? a. Notify the physician. b. Administer oral antacid. c. Sit and talk with the patient. d. Teach the client that she will need to cough and deep-breathe every shift postoperatively.

Sit and talk with the patient. Rationale: Preparing the woman and her family for birth involves more than the procedures of establishing an intravenous line, instilling a urinary indwelling catheter, performing an abdominal prep, or administering pre-op medications. If the cesarean birth is scheduled and not an emergency, the nurse has ample time for preoperative teaching and providing emotional support. The context in which this information is relayed should be birth-oriented rather than surgery-oriented. This provides an opportunity for the woman to express her concerns, ask questions, and develop a relationship with the nurse. Good communication skills are essential in preparing the woman and her support person. The use of therapeutic touch and direct eye contact (if culturally acceptable and possible) assist the woman in maintaining a sense of control, and can lessen anxiety. The client's anxiety is a priority, and if not addressed will interfere with her ability to retain information presented as part of preoperative teaching. It is within nursing scope of practice to intervene to decrease anxiety.

The nurse is providing prenatal care to an asymptomatic HIV-infected client. Which nursing interventions should take priority? Select all that apply. a. Taking the client's temperature. b. Performing a vision test. c. Performing a hearing test. d. Skin assessment.

Taking the client's temperature. Performing a vision test. Skin assessment. Rationale: In monitoring the asymptomatic pregnant woman who is HIV-positive, the nurse needs to be alert for nonspecific symptoms such as fever, weight loss, fatigue, persistent candidiasis, diarrhea, cough, skin lesions, and behavior changes. These can be signs of developing symptomatic HIV infection. At each prenatal visit, asymptomatic, HIV-infected women are monitored for early signs of complications, such as weight loss in the second or third trimesters, or fever. The clinician inspects the mouth for signs of infections such as thrush (candidiasis) or hairy leukoplakia; the lungs are auscultated for signs of pneumonia; and the lymph nodes, liver, and spleen are palpated for signs of enlargement. Each trimester the woman should have a visual examination and examination of the retina to detect such complications as toxoplasmosis. Performing a hearing test is not a priority intervention.

A prenatal client in her second trimester is admitted to the maternity unit with painless, bright red vaginal bleeding. What test might the physician order? a. Ultrasound. b. Alpha-fetoprotein (AFP). c. Contraction stress test (CST). d. Amniocentesis.

Ultrasound. Rationale: An ultrasound for placenta location to rule out placenta previa would be ordered for a client who presents with painless, bright red vaginal bleeding. The ability to see the lower portion of the uterus and cervix with ultrasound is particularly important when vaginal bleeding is noted and placenta previa is the suspected cause. Alpha-fetoprotein (AFP) is a test used to screen for neural tube defects. A contraction stress test is ordered in the third trimester to evaluate the respiratory function of the placenta. Amniocentesis is a procedure used for genetic diagnosis or, in later pregnancy, for lung maturity studies.

A nurse is planning a prenatal program for a group of adolescents. Which teaching techniques will be most appropriate for this age group? Select all that apply. a. Include infant growth and development content. b. Use a variety of teaching methods. c. Assign teaching content to the students. d. Hold separate academic classes for pregnant teens.

Use a variety of teaching methods. Include infant growth and development content. Rationale: The most effective method of prenatal education for teens appears to be mainstreaming the pregnant adolescent in academic classes with her peers and adding classes appropriate to her needs during pregnancy and postpartum. To keep the attention of the participants, it is important to use a variety of teaching strategies including audiovisual aids, demonstrations, and games. Classes about growth and development beginning with the newborn and early-infancy periods can help teenage parents develop realistic expectations of their infants, and can help decrease child abuse.

The nurse is caring for a third-trimester prenatal client admitted with bright red, painless vaginal bleeding. Which nursing intervention is not recommended? a. Vaginal exams. b. Bed rest with bathroom privileges. c. Application of an internal uterine pressure catheter. d. Intravenous fluids with lactated Ringer's.

Vaginal exams. Rationale: Vaginal exams are contraindicated on a client with placenta previa. This is due to the increased risk of perforating the placenta. Nursing management may include intravenous fluids with lactated Ringer's; bed rest with bathroom privileges; and monitoring vital signs, contractions, bleeding, and fetal heart rate.