PassPoint: Antepartum Period ML8

During routine prenatal screening, a nurse tells a client that her blood sample will be used for alpha fetoprotein (AFP) testing. Which statement best describes what AFP testing indicates? A. "This test will screen for spina bifida, Down syndrome, or other genetic defects." B. "This screening indicates if your baby's lungs are mature." C. "This test will show if you have gestational diabetes." D. "To provide accurate results, this screening must be performed exactly at 25 weeks' gestation."

A AFP testing screens for spina bifida, Down syndrome, and other genetic defects. It must be performed at 16 to 18 weeks' gestation to provide accurate results. A 1-hour glucose tolerance test diagnoses gestational diabetes. Amniocentesis assesses the maturity of fetal lungs.

A new antenatal G6, T4, P0, A1, L4 client attends their first prenatal visit with their partner. The nurse is assessing this couple's psychological response to the pregnancy. Which finding requires the most immediate follow-up? A. The client's spouse is irritated that the client is not like they were before pregnancy. B. The couple is concerned with the financial changes this pregnancy causes. C. The client's spouse states that the pregnancy has changed the client's focus. D. The couple expresses ambivalence about the current pregnancy.

A Pregnancy creates changes in the parents. Being considerate, accepting changes, and being supportive of the current situation are considered acceptable responses by the client's spouse, rather than feeling irritation about these changes. Expressing concern over the financial changes of pregnancy and an expanded family is normal. The first trimester involves the client and family feeling ambivalent about pregnancy and moving toward acceptance of the changes associated with pregnancy. Maternal acceptance of the pregnancy and a subsequent change in the birth parent's focus are normal occurrences.

After the nurse reinforces the danger signs to report with a gravida 2 client at 32 weeks' gestation with an elevated blood pressure, which client statement(s) would demonstrate understanding of when to call the primary health care provider's (HCP's) office? Select all that apply. A. "if I see any bleeding, even if I have no pain" B. "if I feel dizzy when I get up quickly" C. "if the baby seems to be more active than usual" D. "if I have a pounding headache that will not go away" E. "if I notice the veins in my legs getting bigger" F. "if the leg cramps at night are waking me up"

A, C, D Vaginal bleeding with or without pain could signify placenta previa or abruptio placentae. A continuous or pounding headache could indicate an elevated blood pressure, and a change in the strength or frequency of fetal movements could indicate that the fetus is in distress. Orthostatic hypotension can occur during pregnancy and can be alleviated by rising slowly. Leg veins may increase in size as a result of additional pressure from the increasing uterine size; leg cramps may also occur and can commonly be decreased with calcium supplements.

The nurse is providing instruction to a woman who is 18 weeks pregnant. Which findings are expected at this time? Select all that apply. A. Fundal height of approximately 18 cm B. Insomnia C. Braxton-Hicks contractions D. Leg cramps E. Quickening

A,E Between 18 and 30 weeks' gestation, fundal height in centimeters is approximately the same as the number of weeks' gestation. In this case, the client is 18 weeks pregnant, so fundal height should measure approximately 18 cm. Quickening, which is typically described as light fluttering and is usually felt between 16 and 22 weeks' gestation, is caused by fetal movement. Insomnia, Braxton-Hicks contractions, and leg cramps are common during the third trimester.

A client, approximately 11 weeks pregnant, and their spouse are seen in the antepartal clinic. The client's spouse tells the nurse that they have also been experiencing nausea and vomiting and fatigue along with the client. The nurse interprets these findings as suggesting that the client's spouse is experiencing which complication? A. ptyalism B. mittelschmerz C. Couvade syndrome D. pica

C Couvade syndrome refers to the situation in which the expectant spouse or partner experiences some of the discomforts of pregnancy along with the pregnant client as a means of identifying with the pregnancy. Ptyalism is the term for excessive salivation. Mittelschmerz is the lower abdominal discomfort felt by some clients during ovulation. Pica refers to an oral craving for non-edible substances such as clay or starch that some pregnant clients experience.

During a routine prenatal visit, a pregnant client reports constipation, and the nurse teaches her how to relieve it. Which statement indicates the client's understanding of the nurse's instructions? A. "I'll take iron supplements regularly." B. "I'll decrease my intake of green, leafy vegetables." C. "I'll increase my intake of unrefined grains." D. "I'll limit fluid intake to four 8-oz (240 mL) glasses."

C To increase peristalsis and relieve constipation, the client should increase her intake of high-fiber foods (such as green, leafy vegetables; unrefined grains; and fruits) and fluids. The use of iron supplements can cause — rather than relieve — constipation.

A client who is 10 weeks pregnant develops spotting; however, the cervix remains closed. What should the nurse should suspect? A. missed abortion B. ectopic pregnancy C. threatened abortion D. inevitable abortion

C Spotting in the first trimester may indicate that the pregnancy is in jeopardy. Bed rest and avoidance of physical and emotional stress are recommended. Abortion is usually inevitable if the bleeding is accompanied by pain with dilation and effacement of the cervix. An inevitable abortion is associated with cervical dilation. An ectopic pregnancy is in the fallopian tubes, and a false positive pregnancy could reflect a missed abortion.

A client at 24 weeks' gestation comes to the clinic for a prenatal check-up and reports that she has been "seeing double." The nurse checks the urine and determines that there is 3+ proteinuria. What does the nurse determine is the potential priority problem? A. placenta previa B. hyperemesis gravidarum C. preeclampsia D. gestational diabetes

C The visual disturbance and proteinuria suggest hypertension that has progressed to preeclampsia. The client with gestational diabetes would have elevated glucose levels. The client with hyperemesis gravidarum would present with intractable vomiting and signs of dehydration. Placenta previa is the covering of the cervical os with the placenta and would be demonstrated by painless vaginal bleeding.

The health care provider prescribes clomiphene citrate for a client who has been having difficulty getting pregnant. When teaching the client about this drug, the nurse should discuss discuss the increased chance of which condition? A. multiple gestation B. fibrocystic breast disease C. spontaneous abortion D. congenital anomalies

A Clomiphene citrate is a fertility drug that induces ovulation in clients desiring pregnancy. One of the drug's most common adverse effects is multiple gestation (twins or triplets). An increase in spontaneous abortions is not associated with clomiphene citrate. Evidence does not support an association between the use of clomiphene citrate and an increase in fibrocystic breast disease. An increase in congenital anomalies is not associated with clomiphene citrate.

A pregnant client is diagnosed with group B streptococcus chorioamnionitis. The nurse should expect to administer which medication to prevent fetal transmission? A. ceftriaxone I.M. to the neonate immediately after delivery B. methylprednisolone I.V. to the client C. penicillin G potassium I.V. to the client D. amoxicillin trihydrate P.O. to the client

C Administering penicillin G potassium I.V. before delivery will prevent fetal transmission of group B streptococcus infection. Amoxicillin P.O. isn't effective against chorioamnionitis caused by group B streptococcus. Treatment with penicillin G potassium should begin before delivery to prevent fetal transmission. Steroids, such as methylprednisolone, aren't bactericidal.

A pregnant client's last menstrual period began on October 12. Using Naegele's rule, the nurse calculates the estimated date of delivery (EDD) as: A. June 19. B. July 5. C. July 19. D. June 5.

C Using Naegele's rule, the nurse calculates the client's EDD by adding 7 days to the first day of the last menstrual period (12 + 7 = 19) and subtracting 3 months from the month of the last menstrual period (October - 3 months = July). This results in an EDD of July 19.

After determining that a pregnant client is Rh-negative, a physician orders an indirect Coombs' test. The purpose of performing this test with a pregnant client is to: A. determine the fetal blood Rh factor. B. detect maternal antibodies against fetal Rh-negative factor. C. determine the maternal blood Rh factor. D. detect maternal antibodies against fetal Rh-positive factor.

D The indirect Coombs' test measures the number of antibodies against fetal Rh-positive factor in maternal blood. The maternal blood Rh factor is determined before the indirect Coombs' test is done. No maternal antibodies against fetal Rh-negative factor exist.

A client at 37 weeks' gestation is scheduled for an ultrasound. What should the nurse instruct the client to do before the test? A. Take nothing by mouth after midnight before the test. B. Drink 1 to 2 L of fluid. C. Plan to remain in the clinic for 4 hours after the test. D. Eat a high-fiber meal after the test.

B The client should plan to drink 1 to 2 L of fluid before an ultrasound to ensure a full bladder, which provides better visualization of the fetus. The client does not need to be on nothing-by-mouth status before the test. The client does not need to remain in the clinic for 4 hours after the test. However, if the client were scheduled for a contraction stress test, they would be observed as an outpatient for 1 to 4 hours after the test to make certain that the contractions had stopped. The client does not need to eat a high-fiber meal after the test. A high-fiber meal typically is indicated after certain radiographic procedures, such as an upper gastrointestinal series.

A client at 38 weeks gestation with twins is placed on bed rest at home and has a home care nurse visit her on a regular basis. Which recommendation should the nurse suggest to her about her position in bed? A. The client should lie on her back as much as possible. B. The client can lie in whichever position is comfortable. C. The client should lie on her left side as much as possible. D. The client should lie on her right side as much as possible.

C Lying in the left lateral recumbent position decreases pressure on the vena cava, increasing venous return, circulatory volume, and placental and renal perfusion. Improved renal blood flow helps decrease angiotensin II levels, promotes diuresis, and lowers blood pressure. While the nurse does want to promote comfort, the client lying on her back may cause the uterus to put pressure on the vena cava, causing supine hypotensive syndrome. This pressure on the vena cava causes a decrease in blood flow and blood pressure. The left side-lying position is the most appropriate response.

A nurse is providing care for a pregnant client in her second trimester. Glucose tolerance test results show a blood glucose level of 160 mg/dl (8.8 mmol/L). The nurse should anticipate that the client will need to: A. learn about diet. B. take an oral antidiabetic drug. C. use insulin. D. monitor her urine for glucose.

A The client will need to watch her overall diet intake to control her blood glucose level. The client's blood glucose level should be controlled initially by diet and exercise, rather than insulin. Oral antidiabetic drugs aren't used in pregnant clients. Urine glucose levels aren't an accurate indication of blood glucose levels.

A nurse is teaching a pregnant client how to distinguish false labor contractions from true labor contractions. Which statement by the client indicates an understanding of this concept? A. "False labor contractions become more intense during walking." B. "False labor contractions are regular." C. "False labor contractions start in the back and radiate to the abdomen." D. "False labor contractions are usually felt in the abdomen."

D False labor contractions are usually felt in the abdomen. In contrast, true labor contractions are regular, start in the back and radiate to the abdomen, and become more intense during walking.

A primigravid client in preparation for a parenting class asks how much blood is lost during an uncomplicated vaginal birth. What should the nurse tell the client? A. "The minimum blood loss considered within normal limits is 1000 mL." B. "The maximum blood loss considered within normal limits is 500 mL." C. "Blood loss during birth is rarely estimated unless there is a hemorrhage." D. "It would be very unusual if you lost more than 100 mL of blood during birth."

B In a normal birth and for the first 24 hours postpartum, a total blood loss not exceeding 500 mL is considered normal. Blood loss during birth is almost always estimated because it provides a valuable indicator for possible hemorrhage. A blood loss of 1000 mL is considered hemorrhage.

Which instruction should a nurse include in a home-safety teaching plan for a pregnant client? A. It's OK to clean your cat's litter box. B. Avoid having area rugs around your house. C. It's OK to wear high heels. D. Place a nonskid mat on the floor of the tub or shower.

D Using a mat for the floor of the shower or tub will prevent slipping. The client shouldn't clean the cat's litter box because doing so puts her at risk for toxoplasmosis. Wearing high heels may make the client lose balance and fall. The client doesn't need to completely avoid having area rugs around the house. Nonslip rugs can be used to prevent tripping or falling.

The nurse is admitting a client with a suspected diagnosis of abruptio placentae. Which assessment data would require the nurse to notify the healthcare provider immediately? Select all that apply. A. overt vaginal bleeding B. white creamy vaginal discharge C. decreased blood pressure D. a rigid abdomen E. increased heart rate F. gastrointestinal upset

A, C, D, E Abruptio placentae is the premature separation of a normally implanted placenta after the 20th week of gestation prior to birth. It is a medical emergency associated with potentially significant maternal blood loss. The onset is sudden. Bleeding can be concealed or visible, but visible blood is usually dark red. The abdomen is firm or rigid with the mother reporting constant pain, and the fetal heart rate is decreased. Vital signs can be within the normal range because a pregnant woman can lose up to 40% of her total blood volume without showing signs of shock, but it is important to assess for decreased blood pressure. When the blood pressure changes, the woman has lost a significant amount of blood. Tachycardia is a compensatory response to the blood loss. A creamy white vaginal discharge indicates a yeast infection. Symptoms of GI upset are not associated with an abruption.

A 34-year-old multiparous client at 16 weeks' gestation who received regular prenatal care for all of their previous pregnancies tells the nurse that they have already felt the baby move. How does the nurse interpret this finding? A. evidence that the client's estimated date of birth is probably off by a few weeks B. normal because multiparous clients can experience quickening between 14 and 20 weeks' gestation C. unusual because most multiparous clients do not experience quickening until 30 weeks' gestation D. the possibility that the client is carrying twins

B Although most multiparous women experience quickening at about 17½ weeks' gestation, some women may perceive it between 14 and 20 weeks' gestation because they have been pregnant before and know what to expect. Detecting movement early does not suggest a twin pregnancy. If the multiparous client does not experience quickening by 20 weeks' gestation, further investigation is warranted, because the fetus may have died, the client may have a hydatidiform mole, or the pregnancy dating is incorrect. There is no evidence that the client's expected date of birth is erroneous.

A nurse determines that a client is in false labor. After obtaining discharge orders, the nurse provides discharge teaching to the client. Which instruction is most appropriate at this time? A. "Drink coffee or tea to maintain hydration." B. "Apply cold compresses to relieve discomfort." C. "Return to the facility if fever occurs." D. "Maintain a supine position to promote rest."

C The nurse should instruct a client in false labor to return to the health care facility if she develops signs or symptoms of infection, such as a fever; if her membranes rupture; if vaginal bleeding occurs; or if her contractions become more intense. The nurse should suggest warm milk or herbal tea, which promote relaxation and rest, instead of coffee or caffeinated tea. Taking a warm tub bath or shower — not applying cold compresses — helps relieve discomfort. A semi-upright position with pillows placed under the client's knees promotes rest.

The health care provider prescribes a maternal blood test for alpha-fetoprotein for a nulligravid client at 16 weeks' gestation. When developing the teaching plan, the nurse bases the explanations on the understanding that this test is used to detect which condition? A. Rh incompatibilities B. lecithin-sphingomyelin ratio C. inborn errors of metabolism D. neural tube defects

D A blood test for alpha-fetoprotein is recommended at 15 to 20 weeks' gestation to screen for certain chromosomal abnormalities and neural tube defects such as spina bifida. Chorionic villi sampling is used to detect chromosomal anomalies. Amniotic fluid amino acid determination is used to detect inborn errors of metabolism such as phenylketonuria. Amniocentesis is used to determine the lecithin-sphingomyelin ratio for fetal lung maturity, indicated by a ratio of 2:1, or chromosomal abnormalities. Rh incompatibilities are predicted with blood type testing measured with antigen tests.

A pregnant client is experiencing a thin, odorless, vaginal discharge. What should the nurse instruct the client to do to prevent vaginal infections? A. "Wash more thoroughly." B. "When you notice the discharge, take a bath and come into the office." C. "Don't worry, nothing will happen to you." D. "Try wearing a panty liner and discarding it after every urination."

D A thin, odorless vaginal discharge is typical during pregnancy. Keeping the area clean and dry by wearing panty liners will prevent infection. Taking a bath before an office visit to assess the discharge will wash away the bacteria needed for examination. Telling the client that she should not worry or that she is not keeping herself clean is not valid and does not offer reassurance.

A nurse is discussing preterm labor in a prenatal class. After class, a client asks the nurse to identify again the nursing strategies to prevent preterm labor. The client needs further instruction when they make which statement? A. "Cutting back on my smoking will not help my baby." B. "I need to stay hydrated all the time." C. "I should include frequent rest breaks if I travel." D. "Even dental infections can lead to preterm labor."

A Smoking is a major risk factor for preterm labor and decreased fetal weight. Clients struggling to quit should know decreasing cigarette use will help improve outcomes even if they cannot totally quit. Dehydration is a risk factor for preterm labor as is prolonged standing and remaining in one position. Infection anywhere in the body can lead to preterm labor through the inflammation pathway. While the client is taking trips, frequent emptying of the bladder prevents infection and ambulates the client.

Following an eclamptic seizure, the nurse should assess the client for which complication? A. polyuria B. facial flushing C. hypotension D. uterine contractions

D After an eclamptic seizure, the client commonly falls into a deep sleep or coma. The nurse must continually monitor the client for signs of impending labor because the client will not be able to verbalize that contractions are occurring. Oliguria is more common than polyuria after an eclamptic seizure. Facial flushing is not common unless it is caused by a reaction to a medication. Typically, the client remains hypertensive unless medications such as magnesium sulfate are administered.

The nurse is caring for a client who is 12 weeks' pregnant and speaks Spanish only. Which intervention(s) should the nurse include in the plan of care at the client's initial visit? Select all that apply. A. Discuss differences with the dominant culture. B. Provide brochures in the client's native language. C. Discuss contraception and options. D. Review nutritional preferences. E. Arrange for an interpreter for their appointments.

B, D, E Providing culturally sensitive care includes providing printed material in the client's native language. Discussing cultural differences is not a priority or important at the first visit. Clients need to have an interpreter for each prenatal visit to translate and interpret questions. Contraceptive options are not a priority for the first prenatal visit. Reviewing dietary intake and discussing nutrition are important components of early prenatal care.

The fetus of a multigravid client at 38 weeks' gestation is determined to be in a frank breech presentation. The nurse describes this presentation to the client as which fetal part coming in contact with the cervix? A. shoulder B. head C. buttocks D. both feet

C In a frank breech, the buttocks alone are at the cervix, while the knees are extended to rest on the chest. In a cephalic presentation, the head is the fetal body part first coming in contact with the cervix. Both feet at the cervix is termed double footling breech. In a shoulder presentation, one of the shoulders (actually the acromion process) presents to the cervix. Typically, the fetus is lying horizontally (transverse lie).

The nurse is caring for an expectant mother who asks how decisions are made if complications place both the mother and fetus at risk. What ethical principle will the nurse cite when responding to the client's question? A. nonmaleficence B. jurisprudence C, autonomy D. justice

C The principle of autonomy informs decisions when conflicts arise between maternal and fetal rights. The woman has the right to choose for herself what she believes to be in her best interest versus the well-being of the fetus. This is the concept of self-determination, of being in charge of one's person rather than another person determining what behavior or decision represents justice. Nonmaleficence refers to doing no harm. The client has the right to make choices that align with her belief system. Jurisprudence is the actual theory or study of law.

A client asks about complementary therapies for relief of discomfort related to pregnancy. Which comfort measure mentioned by the client indicates a need for further teaching? A. meditation B. music therapy C. herbal remedies D. acupuncture

C A pregnant woman should avoid all medication unless instructed by the physician. This includes herbal remedies, because their effects on the fetus have not been identified. Meditation, music therapy, and acupuncture have all proven to enhance relaxation without harm to the mother or baby.

An anxious young adult is brought to the interviewing room of a crisis shelter, sobbing and saying that they think they are pregnant but don't know what to do. Which nursing intervention is most appropriate at this time? A. Question the client about their feelings and possible parental reactions. B. Ask the client about the type of things that they had thought of doing. C. Recommend a pregnancy test after acknowledging the client's distress. D. Give the client some ideas about what to expect will happen next.

C Before any interventions can occur, knowing whether the client is pregnant is crucial in formulating a plan of care. Asking the client about what things they had thought about doing, giving the client some ideas about what to expect next, and questioning the client about their feelings and possible parental reactions would be appropriate after it is determined that the client is pregnant.

A 36-year-old multigravid client is admitted to the hospital with a possible ruptured ectopic pregnancy. When the nurse is obtaining the client's history, which finding would be mostimportant to identify as a predisposing factor? A. urinary tract infection B. use of estrogen-progestin contraceptives C. episodes of pelvic inflammatory disease D. marijuana use during pregnancy

C Anything that causes a narrowing or constriction in the fallopian tubes so that a fertilized ovum cannot be properly transported to the uterus for implantation predisposes an ectopic pregnancy. Pelvic inflammatory disease is the most common cause of constricted or narrow tubes. Developmental defects are other possible causes. Ectopic pregnancy is not related to urinary tract infections. The use of marijuana during pregnancy is not associated with ectopic pregnancy, but its use can result in cognitive reduction if the client's use during pregnancy is extensive. Progestin-only contraceptives and intrauterine devices have been associated with ectopic pregnancy.

A client in her 34th week of pregnancy presents with sudden onset of bright red vaginal bleeding. Her uterus is soft, and she's experiencing no pain. Fetal heart rate is 120 beats/minute. Based on this history, what should the nurse suspect? A. preterm labor B. abruptio placentae C. threatened abortion D. placenta previa

D Placenta previa is associated with painless vaginal bleeding that occurs when the placenta or a portion of the placenta covers the cervical os. In abruptio placentae, the placenta tears away from the wall of the uterus before birth; the client usually has pain and a boardlike uterus. Preterm labor is associated with contractions and shouldn't involve bright red bleeding. By definition, threatened abortion occurs during the first 20 weeks' gestation.

A client is in the last trimester of pregnancy. The nurse should instruct the client to notify the primary health care provider immediately if she notices: A. increased vaginal mucus. B. dyspnea on exertion. C. hemorrhoids. D. blurred vision.

D Blurred vision or other visual disturbances, excessive weight gain, edema, and increased blood pressure may signal severe preeclampsia. This condition may lead to eclampsia, which has potentially serious consequences for the client and fetus. Although hemorrhoids may be a problem during pregnancy, they don't require immediate attention. Increased vaginal mucus and dyspnea on exertion are expected as pregnancy progresses.

A primigravid client visits the clinic for a routine examination at 35 weeks' gestation. The client's blood pressure is near the baseline of 120/74 mm Hg with no proteinuria or evidence of facial edema. The client asks the nurse, "What should I take if I get an occasional headache after looking at my computer at work all day?" Which over-the-counter medicine does the nurse consider to be safest for occasional use by a pregnant client with no known risks? A. naproxen B. ibuprofen C. aspirin D. acetaminophen

D The nurse should instruct the client that symptoms from an occasional headache due to eye strain or continuous work at a computer can be relieved by acetaminophen. Although this drug causes prostaglandin inhibition, this effect is rapidly reversed and cleared with no apparent harmful effects in pregnancy. If the headaches become more frequent or severe, the client should be instructed to contact the health care provider (HCP) immediately. Aspirin should be avoided during pregnancy because it inhibits prostaglandin synthesis. It also decreases uterine contractility and may delay the onset of labor or prolong pregnancy and labor. Aspirin decreases platelet aggregation, possibly increasing the risk for bleeding. Ibuprofen and naproxen can lead to premature closure of the fetal ductus arteriosus and decreased amniotic fluid with prolonged use. They may also prolong pregnancy or labor because of their antiprostaglandin effects.

When performing a vaginal examination on a pregnant client, the nurse determines the fetal head has reached the ischial spines. How would the nurse describe the station of the fetus at this time? A. -1 station B. +2 station C. 0 station D. +1 station

C The station is assessed in relation to the maternal ischial spines and the presenting fetal part. The spines are not sharp protrusions but rather blunted prominences at the mid-pelvis. The ischial spines serve as landmarks and have been designated 0 station. If the presenting part is palpated higher than the ischial spines, a negative number is assigned. If the presenting part is felt below the ischial spines, a positive number is assigned. Progressive fetal descent (-5 to +4) is the expected norm during labor.

The prenatal client wants to know why the nurse is asking about their use of herbal supplements. What is the nurse's best response? A. "You may need additional screening because herbal supplements often contain other ingredients that may affect your care." B. "Many herbal supplements change the way your body processes many medications and make them less ineffective." C. "Understanding the full picture of what herbal supplements you use to manage your health will help us better provide coordinated and safe care." D. "I need to assess your risk because most dietary supplements have not been tested in pregnant parents, nursing parents, or children."

C Clients often do not tell providers about the use of complementary and alternative approaches because they fear they will be judged. By approaching care as a partnership, the nurse sets the stage for open communication. All the other statements are true but begin the conversation in a way that suggests the client has done something wrong.

The nurse should assess a 26-year-old multigravida at 30 weeks' gestation with premature rupture of the membranes for which manifestation? A. foul-smelling amniotic fluid B. tetanic uterine contractions C. uterine prolapse D. small-for-gestational-age fetus

A Although the cause of premature rupture of the membranes is unknown, it has been associated with cervical insufficiency, infection, trauma, and multiple pregnancies. Therefore, assessing the client for symptoms of infection, such as foul-smelling amniotic fluid, would be important.Uterine prolapse is not associated with premature rupture of the membranes.Because the client is at 30 weeks' gestation, they should be assessed for a small-for-gestational-age fetus. However, a small-for-gestational-age fetus is not related to premature rupture of membranes.Tetanic uterine contractions are associated with oxytocin administration, not with premature rupture of membranes.

A client treated with terbutaline for premature labor is ready for discharge. Which instruction should the nurse include in the discharge teaching plan? A. Report a heart rate greater than 120 beats/minute to the health care provider. B. Increase activity daily if not fatigued. C. Call the health care provider if the fetus moves 10 times in an hour. D. Take terbutaline every 4 hours, during waking hours only.

A Because terbutaline can cause tachycardia, the client should be taught to monitor her radial pulse and call the health care provider for a heart rate greater than 120 beats/minute. Terbutaline must be taken every 4 to 6 hours around-the-clock to maintain an effective serum level that will suppress labor. A fetus normally moves 10 to 12 times per hour. The client does not need to contact the health care provider if such movement occurs. The client experiencing premature labor must maintain bed rest at home.

The nurse is providing prenatal education regarding microorganisms to be avoided during pregnancy. Which of the following statements during the counseling session would indicate to the nurse that the client understands the teaching? A. "Women should avoid unpasteurized milk and cheese and undercooked meat." B. "Women should receive prophylactic antibiotics to prevent infection during their first trimester." C. "Women can be protected from most perinatal infections with vaccinations." D. "Women should avoid contact with cats while they are pregnant."

A Listeria and toxoplasmosis in pregnancy is contracted from unpasteurized milk, cheese, raw meat and cat feces (not cats themselves). Manifestations in the newborn may be lethal. There are vaccinations against rubella but not against the many other microorganisms such as cytomegalovirus, group B strep, parvovirus, toxoplasmosis, and listeria. Women identified as group B strep carriers should receive prophylactic antibiotics but only if they are carriers.

A 20-year-old client visiting the clinic requests the use of oral contraceptives. When reviewing the client's history, which finding would alert the nurse to a possible contraindication to using these agents? A. thrombophlebitis B. ulcerative colitis C. menorrhagia D. urinary tract infections

A Oral contraceptives are contraindicated for clients with a history of thrombophlebitis because a serious side effect of oral contraceptives is thrombus formation. Other contraindications include stroke and liver disease. Oral contraceptives are used cautiously in clients with hypertension or diabetes. Close follow-up with these clients is essential.Urinary tract infections (UTIs) do not contraindicate the use of oral contraceptives. If the client has a UTI, the nurse can instruct them to increase their fluid intake and wipe from front to back after urinating or defecating.Ulcerative colitis does not contraindicate using oral contraceptives.Menorrhagia is typically reduced through the use of oral contraceptives.

The nurse and the health care provider are planning care for a multigravida hospitalized at 36 weeks' gestation with confirmed rupture of membranes (ROM) and no evidence of labor. What action should the nurse take first? A. Obtain a vaginal culture for Neisseria gonorrhoeae. B. Schedule a sonogram for amniotic fluid volume index. C. Perform frequent assessments for cervical dilation (dilatation). D. Determine meaningful diversional activities.

A The exact etiology of preterm premature rupture of membranes is unknown. Infection is considered an etiology and a problem associated with the ROM and can be life-threatening for both the birth parent and the fetus. Sources of infection that cause rupture of membranes are often vaginal infections or urinary tract infections, and this assessment should be initiated first. The sonogram will be helpful if there is a need to determine the amount of amniotic fluid present or the need to find a pocket of fluid to determine fetal lung maturity. Repeated cervical examinations set the client up for infection; one exam would be needed to determine current status, but repetition is not indicated unless there is a need.Diversional activities will be an intervention that will be very helpful after stabilization of the client and if birth is not indicated at this time.

Lower back pain is a common concern among pregnant clients. Which comfort measure should a nurse include in the teaching plan for a pregnant client? A. Use an ergonomically correct desk chair. B. Bend at the waist, not at the knees. C. Wear high-heeled shoes. D. Avoid tilting the pelvis forward.

A The nurse should instruct the client to use an ergonomically correct desk chair to help alleviate lower back pain. Wearing high heels promotes imbalance and falls. The nurse should not instruct the client to avoid tilting the pelvis forward, because standing with her neck and shoulders straight and pelvis tilted forward alleviates stress caused by excess uterine weight. Bending and lifting at the knees (not at the waist) alleviates strain on lower back muscles.

An adolescent primigravid client at 26 weeks' gestation has gained 25 lb (11.34 kg) since becoming pregnant. Which of the following is the recommended amount of weight gain during the third trimester? A. 1 lb (0.45 kg) per week. B. 2 lb (0.91 kg) per week. C. 7 lb (3.18 kg) per month. D. 5 to 6 lb (2.27 to 2.72 kg) for the trimester.

A The pattern of weight gain is commonly more important than the amount. Clients should be advised to gain a total of 25 to 35 lb (11.34 to 15.88 kg) if they are of average weight when becoming pregnant. The recommended pattern is 1 lb (0.45 kg) per month in the first trimester, then 1 lb (0.45 kg) per week in the second and third trimesters. A sudden increase in weight gain is associated with pregnancy-induced hypertension, whereas a sudden weight loss may indicate an illness.

The nurse is caring for a 38-year-old primigravida in the third trimester of pregnancy. The nurse plans to assess the client for manifestations of which complication? A. preeclampsia B. ruptured membranes C. cardiac overload D. pelvic inflammatory disease

A There is a strong association between advanced maternal age and preeclampsia as well as chronic hypertension. The incidence of preeclampsia is greatest among primigravidas.Preeclampsia is much more common than pelvic inflammatory disease. The client in the third trimester rarely exhibits symptoms of pelvic inflammatory disease.Although the older client is at risk for preterm labor and birth, this client does not present any symptoms of preterm labor, such as ruptured membranes.Cardiac overload may occur in clients who have been diagnosed with cardiac disease. Cardiac adjustment in healthy women occurs during pregnancy, labor, and birth.

A client at 22 weeks' gestation has right upper quadrant pain radiating to their back. The client rates the pain as 9 on a scale of 0 to 10 and says that it has occurred two times in the last week for about 4 hours at a time. The client does not associate the pain with food. Which nursing measure is the highest priority for this client? A. Discuss nutritional strategies to decrease the possibility of heartburn. B. Refer the client to their health care provider for evaluation and treatment of the pain. C. Support the client's use of acetaminophen to relieve pain. D. Educate the client concerning changes occurring in the gallbladder as a result of pregnancy.

B The nurse seeing this client should refer the client to an HCP for further evaluation of the pain. This referral would allow a more definitive diagnosis and medical interventions that may include surgery. A referral would occur because of the client's high pain rating as well as the other symptoms, which suggest gallbladder disease. During pregnancy, the gallbladder is under the influence of progesterone, which is a smooth-muscle relaxant. Because bile does not move through the system as quickly during pregnancy, bile stasis and gallstone formation can occur. Although education should be a continuous strategy, with pain at this level, a brief explanation is most appropriate. Major emphasis should be placed on determining the cause and treating the pain. It is not appropriate for the nurse to diagnose pain at this level as heartburn. Discussing nutritional strategies to prevent heartburn is appropriate during pregnancy, but not in this situation. Acetaminophen is an acceptable medication to take during pregnancy, but it should not be used on a regular basis as it can mask other problems.

A client at 15 weeks' gestation presents to the obstetrical triage unit with dark brown vaginal bleeding and continuous nausea and vomiting. The client's blood pressure is 142/98 mm Hg and the fundal height is 19 cm. Which prescription is most important for the nurse to request from the primary health care provider? A. nothing-by-mouth (NPO) status for 24 hours B. a stat ultrasound C. a transfer to the antenatal unit D. intravenous magnesium sulfate

B The nurse should prepare the client for an ultrasound to determine the cause of the symptoms. Elevated blood pressure at this point in the pregnancy could indicate chronic hypertension as well as hydatidiform mole. The fundal height of 19 cm is higher than is typically found at 15 weeks' gestation and is indicative of a molar pregnancy (hydatidiform mole). The dark brown vaginal bleeding in isolation could indicate an abortion, but when placed in context with the other symptoms, it is likely related to a hydatidiform mole. The continuous nausea and vomiting are abnormal at this point in the pregnancy and can be a result of the high levels of progesterone from a molar pregnancy. There is no fetus involved; the blood pressure elevation and the continuous nausea and vomiting will resolve with evacuation of the mole, negating the need for magnesium sulfate therapy and placing the client on NPO status. Transferring the client to the antenatal unit is premature before a diagnosis has been made.

A multigravid client diagnosed with a probable ruptured ectopic pregnancy is scheduled for emergency surgery. In addition to monitoring the client's blood pressure before surgery, which factor is most important for the nurse to assess? A. uterine cramping B. hemoglobin and hematocrit C. pulse rate D. abdominal distention

C Fallopian tube rupture is an emergency situation because of extensive bleeding into the peritoneal cavity. Shock soon develops if precautionary measures are not taken. The nurse readying a client for surgery should be especially careful to monitor blood pressure and pulse rate for signs of impending shock. The nurse should be prepared to administer fluids, blood, or plasma expanders as necessary through an intravenous line that should already be in place. Because the fertilized ovum has implanted outside the uterus, uterine cramping is unlikely. However, abdominal tenderness or knifelike pain may occur. Abdominal fullness may be present, but abdominal distention is rare unless peritonitis has developed. Although the hemoglobin and hematocrit values may be checked routinely before surgery, the laboratory results may not truly reflect the presence or degree of acute hemorrhage.

After receiving large doses of an ovulatory stimulant such as menotropins, a client comes in for her office visit. Assessment reveals the following: 6-lb (3-kg) weight gain, ascites, and pedal edema. Based on this assessment, what should the nurse do next? A. Place the woman on bed rest. B. Prepare the woman for hospitalization. C. Notify the healthcare provider. D. Prepare for a paracentesis.

C Ovarian hyperstimulation syndrome is caused by an excessive response to the medications used to produce eggs and make them grow. With the increased number of growing follicles, the estradiol levels are increased, leading to fluid leaks in the abdomen. There is increased vascular permeability that causes rapid accumulation of fluid in the peritoneal cavity, thorax, and pericardium. Some symptoms of the problem are an increased weight gain of 3 pounds or more over a 2-day period, shortness of breath, abdominal pain, dehydration, vomiting, and the production of blood clots. The healthcare provider should be notified as soon as possible. The woman may require hospitalization and a paracentesis. If the woman is not admitted to the hospital, the woman should be instructed to stop the medication, rest, and drink large amounts of electrolyte fluids.

A client who's 4 months pregnant asks the nurse about quantity and types of exercise during pregnancy. How should the nurse counsel the client? A. "Exercise to raise the heart rate above 140 beats/minute for 20 minutes daily." B. "Perform gentle back-lying exercises for 30 minutes daily." C. "Walk briskly for 10 to 15 minutes daily, and gradually increase this time." D. "Try high-intensity aerobics, but limit sessions to 15 minutes daily."

C Taking brisk walks is one of the easiest ways to exercise during pregnancy. The client should begin by walking slowly for 10 to 15 minutes per day and increase gradually to a comfortable speed and a duration of 30 to 45 minutes per day. The pregnant client should avoid high-intensity aerobics because these greatly increase oxygen consumption; pregnancy itself not only increases oxygen consumption but reduces oxygen reserve. Starting from the fourth month of pregnancy, the client should avoid back-lying exercises because in this position the enlarged uterus may reduce blood flow through the vena cava. The client should avoid exercises that raise the heart rate over 140 beats/minute because the cardiovascular system already is stressed by increased blood volume during pregnancy.

A client is admitted for an amniocentesis. Initial assessment findings include 16 weeks' gestation, vital signs within normal limits, hemoglobin 12.2 g/dL (122 g/L), hematocrit 35% (0.35), and type O-negative blood. Which action would the nurse complete first after amniocentesis has been completed? A. Teach the client about signs and symptoms of intra-amniotic infection. B. Change the procedure site dressing and assess for signs of infection. C. Administer a dose of Rohm(D) immune globulin intramuscularly. D. Assess fetal heart rate and compare to pre-procedure baseline.

D After an amniocentesis, the client is placed in a position of comfort and the fetal heart rate is monitored and compared to the baseline tracings obtained pre-procedure to determine any signs of fetal distress. This is the first priority once the procedure is complete. Other immediate actions include monitoring maternal vital signs, which are reassessed every 15 minutes for 1 hour. The puncture site is assessed for bleeding or drainage, and the uterus is assessed for any contractions but these will be done once the fetal monitoring is established. Note that signs of infection at the site would not be apparent immediately after the procedure. Rohm(D) immune globulin is administered after an amniocentesis if the client is Rh negative to prevent potential sensitization to fetal blood but this is not as urgent to complete as identification of fetal distress. The client is sent home and instructed to notify the healthcare provider of any contractions, vaginal bleeding, fever, or other signs of intra-amniotic infection (chorioamnionitis), or any changes in fetal activity (increased or decreased). This teaching can happen after all the other actions have been completed.

When teaching a multigravida client diagnosed with mild preeclampsia about nutritional needs, the nurse should discuss which type of diet? A. high-protein B. low carbohydrate C. restricted sodium D. typical pregnancy

D For clients with mild preeclampsia, a regular diet with ample protein and calories is recommended. If the client experiences constipation, they should increase the fiber in their diet, such as by eating raw fruits and vegetables, and increase their fluid intake. A high-residue diet is not a nutritional need in clients with preeclampsia. Sodium and fluid intake should not be restricted or increased. A high-protein diet is unnecessary.

A client is admitted to the facility with a suspected ectopic pregnancy. When reviewing the client's health history for risk factors for this abnormal condition, what would the nurse mostexpect to find? A. grand multiparity (five or more births) B. use of an intrauterine device for 1 year C. use of a hormonal contraceptive for 5 years D. a history of pelvic inflammatory disease

D Pelvic inflammatory disease with accompanying salpingitis is commonly implicated in cases of tubal obstruction, the primary cause of ectopic pregnancy. Ectopic pregnancy isn't associated with grand multiparity or hormonal contraceptive use. Ectopic pregnancy is associated with use of an intrauterine device for 2 years or more.