woman exam 3

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

"I can understand your need to find an answer to what caused this. Let's talk about this further."

bacterial vaginosis

"stale fish" odor and thin, white homogeneous vaginal discharge

Breast self-examination is best performed a week after menses, when swelling has subsided. Breast self-examination is typically performed every month

. Both the breast area and the area between the breast and underarm, including the underarm itself, should be part of breast self-examination. The woman should use the pads of her three middle fingers for palpation.

Trichomoniasis, a protozoal infection, if present, causes petechial spots on the vaginal walls, cervical redness, and a profuse, whitish, bubbly discharge that has a foul smell

. It is important that trichomoniasis be treated in pregnancy as there is a link between these infections and preterm birth.

primary prevention Informing the client about factors in her lifestyle that might be modified to reduce her risk of developing POP would be an exmaple of primary prevention.

Actions that change overall background conditions to prevent some unwanted event or circumstance, such as injury, disease, or abuse.

A nurse is caring for a client at 38 weeks gestation who is diagnosed with chorioamnionitis. On which intervention should the nurse place priority?

Administer oxytocin. Chorioamnionitis is an indication for labor induction. The WBC, temperature, and amniotic fluid are not priority to assess because the nurse already knows the client has chorioamnionitis.

What questions would the nurse ask this client, considering her age and potential sensitivity to being labeled an "older" primipara?

Be non-judgmental in your history gathering and offer her pregnancy resources to read and explore.

infection of pregnant clients with parvovirus

Fetal nonimmune hydrops

trichomoniasis

Metronidazole

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

Pulmonary edema

The essential nursing action does not allow the client to push. The action is to have the client pant at the beginning of the contraction and then have the client blow through the peak of the contraction.

Pushing efforts before the cervix is fully dilated may result in cervical lacerations or cause edema of the cervix, slowing delivery of the fetus. No pushing should be accomplished at this time. It is difficult to divert energy but not push. Assuming a Fowler's position places weight on the perineum.

Zavanelli maneuver.

Pushing the fetal head back into the vagina is a

alleviate varicosities of the legs

Refrain from crossing legs when sitting for long periods.

Which assessment finding is most important as labor progresses?

The uterus relaxes completely between contractions.

caput succedaneum

diffuse edema of the fetal scalp that crosses the suture lines. reabsorbes within 1 to 3 days

transition phase progressing from 8 to 10 cm, with effacement from 80% to 100%.

lasting approximately 1 hour in the first birth and perhaps 15 to 30 minutes in successive birth contraction frequent (every 1 to 2 minutes), and they last longer (60 to 90 seconds). The average rate of fetal descent is 1 cm/hr in nulliparous women and 2 cm/hr in multiparous women.

fibrocystic breast

refrain from consuming salt in the diet

Intraductal papilloma

serosanguineous nipple discharge

fetal tachycardia

Maternal fever and prematurity

Fetal risks associated with a prolonged pregnancy include macrosomia, shoulder dystocia, brachial plexus injuries, low Apgar scores, postmaturity syndrome,

cephalopelvic disproportion, uteroplacental insufficiency, meconium aspiration, and intrauterine infection. Amniotic fluid volume begins to decline by 40 weeks of gestation, possibly leading to oligohydramnios.

Fibroadenomas are common, benign, solid breast tumors.

They can be stimulated by lactation. They usually feel round or oval, firm, rubbery and smooth, and are mobile and may be tender.

The nurse is caring for a client in the transition phase of the labor process. Which client statement requires nursing action?

When the client reports that her lips and fingers are tinging, the nurse is correct to understand that she is hyperventilating.

HELLP syndrome

A variant of gestational hypertension where hematologic conditions coexist with severe preeclampsia and hepatic dysfunction.

A client has been in labor for 10 hours and is 6 cm dilated. She has already expressed a desire to use nonpharmacologic pain management techniques. For the past hour, she has been lying in bed with her doula rubbing her back. Now, she has begun to moan loudly, grit her teeth, and bear down with each contraction. She rates her pain as 8 out of 10 with each contraction. What should the nurse do first?

Assess for labor progression.

When there is a contraction decrement, the contraction intensity is decreasing.

Blood flow improves to the fetus and the fetal heart rate should return to baseline. The fetus moves down the birth canal propelled by the intense contractions.

Prostaglandins influence labor in several ways, which include softening the cervix and stimulating the uterus to contract.

Braxton Hicks contractions occur more frequently and are more noticeable as pregnancy approaches term. These irregular, practice contractions usually decrease in intensity with walking and position changes.

About 80% of vaginal cancers are metastatic, primarily from the cervix and endometrium. These cancers invade the vagina directly.

Cancers from distant sites that metastasize to the vagina through the blood or lymphatic system are typically from the colon, kidneys, skin (melanoma), or breast.

A client has been admitted to the hospital with a diagnosis of severe preeclampsia. Which nursing intervention is the priority?

Confine the client to bed rest in a darkened room.

chlamydia

Doxycycline

chlamydia

Dysfunctional uterine bleeding

When the fetus is being deprived of oxygen the fetus will demonstrate late decelerations on the fetal monitoring strip. This is an indication the mother is in need of further assessment.

Early decelerations are a normal finding. Variable decelerations usually coincide with cord compressio

risk of acquiring cervical cancer

Early onset of sexual activity, within the first year of menarche

The nurse is caring for a pregnant client who indicates that she is fond of meat, works with children, and has a pet cat. Which instructions should the nurse give this client to prevent toxoplasmosis? Select all that apply.

Eat meat cooked to 160° F (71° C). Avoid cleaning the cat's litter box. Avoid outdoor activities such as gardening.

risk factors for ectopic pregnancy.

Examples include salpingitis, infection of the fallopian tube, endometriosis, history of prior ectopic pregnancy, any type of tubal surgery, congenital malformation of the tube, and multiple elective abortions.

forceps-assisted birth,

Failure of the fetal presenting part to rotate fully, descend in the pelvis, abnormal fetal heart rate patterns or acute pulmonary edema, and compromised maternal pushing sensations from anesthesia

IUGR (intrauterine growth restriction)

Fetal weight below 10th percentile for gestational age

Fibroadenomas: Seen in young women around 20's

Firm, rubbery, mobile mass Increases size/tenderness with Inc Estrogen Diagnosis - US or FNA Treat - leave alone or electively remove

Nursing guidelines for teaching how to manage urinary incontinence include performing pelvic floor exercises, increasing fiber and fluid in the diet, and controlling blood glucose.

Following these guidelines will decrease constipation, strengthen pelvic floor muscles, and prevent polyuria.

Normal results for the two-hour postprandial test based on age are: For those who do not have diabetes: less than 140 mg/dL.

For those who have diabetes: less than 180 mg/dL.

preeclampsia

Generalized vasospasm

fasting blood sugar A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes.

If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes. Oral glucose tolerance test

Cervical Cerclage (Shirodkar's procedure)

Is the placement of a large diameter Dacrom or Mersilene taope around the cervix at the level of the internal OS to prevent spontaneous abortion. The procedure is usually performed in late second trimester or early third trimester of pregnancy to correct an incompetent cervix.

Dinoprostone is approved by the FDA as the only cervical ripening agent to be used; however, ACOF acknowledges the apparent safety and effectiveness of misoprostol for this purpose as well.

It is contraindicated in women with prior uterine scars. It is also known to cause hyperstimulation of the uterus, which can lead to other complications. Magnesium sulfate is used in hygroscopic dilators to assist in a mechanical method of cervical dilation.

During the third trimester, the woman often questions her ability to become a mother. Accepting the pregnancy but not the fetus as yet and identifying what must be given up to assume new role are characteristic of the first trimester.

Learning how to delay own desires and acknowledging the fetus as a separate entity are characteristic of the second trimester.

The lochia may persist for 6 weeks after delivery; however, it should change in color and amount. For 3 to 4 days, lochia rubra is present in small to moderate amounts, mostly blood and dark red in color.

Lochia serosa is present on days 4 to 10, decreasing to small amounts, brownish to pinkish in color. The lochia alba is present after 10 days and becomes white or pale yellow because the bleeding has stopped. This may continue until the end of the 6 weeks.

A sudden noise can trigger a seizure in a severely preeclamptic woman. Room placement, therefore, should not be near a high traffic area or noise, such as by a supply room, the staff elevator, or nurse's station.

Magnesium sulfate has properties that act as a smooth-muscle relaxant; therefore, the uterus may fail to adequately contract after administration. Initial assessment begins with the assessment of the fundus.

The nurse is preparing information for a client who has just been diagnosed with gestational diabetes. Which instruction should the nurse prioritize in this information?

Maintain a daily blood glucose log

Primary prevention examples

Maintaining a healthy lifestyle despite genetics

A nurse caring for a pregnant client suspected substance use during pregnancy. What is the priority nursing intervention for this client?

Obtain a urine specimen for a drug screening.

indications for administration of oxytocin.

Postterm status, dysfunctional labor pattern, and prolonged ruptured membranes

A 55-year-old client presents to the clinic with persistent vulvar pruritus, burning, and a lump. She states she has had the symptoms for 5 months and has been trying to treat them with over-the-counter creams. She has a history of multiple sexual partners and HPV and is a smoker. What should the nurse do next?

Prepare the client for a biopsy of the lesion.

The nurse performs a nonstress test (NST) on a client at 36 weeks' gestation. What criteria does the nurse look for on the tracing to determine that the NST is reactive?

Presence of 2 accelerations in 20 minutes

Fats are essential during pregnancy, and vegetable oils are a good source.Estrogen aids in developing the ductal system of the breasts in preparation for lactation during pregnancy. hPL prepares the mammary glands for lactation.

Progesterone supports the endometrium of the uterus to provide an environment conducive to fetal survival. Oxytocin is responsible for uterine contractions, both before and after birth. Oxytocin is also responsible for milk ejection during breastfeeding.

Retrogressive changes represent a return to prepregnancy conditions and include involution of the uterus, contraction of the cervix, decrease of pregnancy hormones, and return of the blood volume to prepregnancy level.

Progressive changes involve changes to new processes or roles, such as the formation of breast milk (lactation) and the beginning of a parental role.

Tamoxifen is referred to as a chemopreventive agent, not a chemotherapeutic agent. It does prevent osteoporosis, but this response does not address breast cancer prevention.

Raloxifene is another drug that shows promise as a chemopreventive agent. Tamoxifen reduces breast cancer incidence by 49%.

fallopian tube has ruptured

Referred pain to the shoulder area indicates bleeding into the abdomen caused by phrenic nerve irritation when a tubal pregnancy ruptures. Vaginal spotting, nausea, and breast tenderness are typical findings of early pregnancy and an unruptured ectopic pregnancy.

Secondary prevention examples

Screenings, redirectional therapies, medications

A client in latent labor for the past 12 hours is requesting medication to help her rest. The nurse predicts the health care provider will prescribe which medication?

Secobarbital

positive for cytomegalovirus

Signs that are likely to be present in the 10 percent of newborns who are symptomatic at birth include microcephaly, seizures, IUGR, hepatosplenomegaly, jaundice, and rash.

symptoms of inflammatory breast cancer.

Skin edema, redness, and warmth

When assessing a pregnant woman with vaginal bleeding, the nurse would suspect a threatened abortion based on which finding?

Slight vaginal bleeding early in pregnancy, no cervical dilation, and a closed cervical os

nevitable abortion

Strong abdominal cramping

A client at 37 weeks' gestation presents to the emergency department with a BP 150/108 mm Hg, 1+ pedal edema, 1+ proteinuria, and normal deep tendon reflexes. Which assessment should the nurse prioritize as the client is administered magnesium sulfate IV?

The level of magnesium in therapeutic range is 4 to 8 mg/dL. If magnesium toxicity occurs, one sign in the client will be a decrease in the respiratory rate and a potential respiratory arrest. Respiratory rate will be monitored when on this medication.

A nurse is caring for a pregnant adolescent client, who is in her first trimester, during a visit to the maternal child clinic. Which important area should the nurse address during assessment of the client?

The nurse should address the client's knowledge of child development during assessment of the pregnant adolescent client.

The nurse, along with the primary care provider, has to assess for fetal anomalies, which are usually associated with a shoulder presentation during a vaginal birth.

The other conditions include placenta previa and multiple gestations. Uterine abnormalities, congenital anomalies, and prematurity are conditions associated with a breech presentation of the fetus during a vaginal birth.

Multiple gestation involves two or more fetuses.

The perinatal complications associated with multiple pregnancy include preterm birth, maternal hypertension and congenital anomalies.

In a local health care facility, a newborn is admitted to the transition nursery for close observation following birth, and to provide attachment time with his parents since his mother is febrile and hypertensive. Assessments will be conducted for what period of time after admission to the nursery?

The stabilization and transition time for a newborn is 6 to 12 hours when the nurse will closely observe the newborn, monitoring its blood sugar, heart rate, respiratory status and temperature and complete a full physical exam.

A primigravida 21-year-old client at 24 weeks' gestation has a 2-year history of HIV. As the nurse explains the various options for delivery, which factor should the nurse point out will influence the decision for a vaginal birth?

The viral load

Tocolytic Tocolytics are medications used to suppress premature labor.

Tocolytic therapy is provided when delivery would result in premature birth, postponing delivery long enough for the administration of glucocorticoids, which accelerate fetal lung maturity but may take one to two days before its effects are seen

At what time is the laboring client encouraged to push?

When the cervix is fully dilated

A client has just had an epidural placed. Before the procedure, her vital signs were as follows: BP 120/70, P90 bmp, R18 per min, and O2 sat 98%. Now, 3 minutes after the procedure, the client says she feels lightheaded and nauseous. Her vital signs are BP 80/40, P100 bmp, R20 per min, and O2 sat 96%. Which interventions should the nurse perform?

You Selected: Assist the client to semi-Fowler's position, assess the fetal heart rate, start an IV bolus of 500 mL, and administer oxygen via face mask.

A gonorrhea infection presents with

a thick, greenish-yellow discharge and extreme inflammation.

A nurse is caring for a 30-year-old woman who was just diagnosed with cervical cancer. Which psychosocial need would be the priority for the nurse with her client?

clear information on the disease, management, and treatment

Secondary prevention would focus on

education about the importance of receiving regular Papanicolau tests and, for women over age 30, including an HPV test to determine whether the woman has a latent high-risk virus that could lead to precancerous cervical changes.

Prolonged labor

failure to progress, occurs when labor lasts for approximately 20 hours or more in a first-time mother.

component as contributing to the pregnant woman's hypercoagulable state

increased levels of fibrin increased clotting factors increased plasma fibrinogen

McRoberts maneuve

intervention is used with a large baby who may have shoulder dystocia and requires assistance. The legs are sharply flexed by a support person or nurse, and the movement will help to open the pelvis to the widest diameter possible.

The recommendation for average weight gain

is 25 to 35 lbs (11 to 16 kilograms).

The administration of the betamethasone

is to try and hasten the maturity of the fetus's lungs for birth.

Some women experience a rupture of their membranes before going into true labor. A nurse recognizes that a woman who presents with PPROM has completed how many weeks of gestation?

less than 37 weeks

Indications for Rho(D) immune globulin include isoimmunization, ectopic pregnancy, chorionic villus sampling, amniocentesis, prenatal hemorrhage,

molar pregnancy, maternal trauma, percutaneous umbilical sampling, therapeutic or spontaneous abortion, fetal death, or fetal surgery.

optimize the Papanicolau test results. Strategies to educate would include:

no douche, no tampons, no jellies, no spermicides, no intercourse. The optimal time for testing is 2 weeks after the first day of your last menses.

A 28-year-old primigravida client with type 2 diabetes mellitus comes to the health care clinic for a routine first trimester visit reporting frequent episodes of fasting blood glucose levels being lower than normal, but glucose levels after meals being higher than normal. What should the nurse point out that these episodes are most likely related to?

normal response to the pregnancy

Hydramnios

occurs when there's too much amniotic fluid around your baby during pregnancy

epidural anesthesia

oes not enter the cerebral spinal fluid space, it is unlikely to cause a "spinal headache."

abruption placenta

painful dark red vaginal bleeding, "knife-like" abdominal pain, uterine tenderness, contractions, and decreased fetal movement.

malignant mass

painless and immobile

Probable signs of pregnancy

positive pregnancy test, Hegar sign, and uterine contractions

increasing maternal age is a risk factor for infertility and spontaneous abortions, gestational diabetes, chronic hypertension,

postpartum hemorrhage, preeclampsia, preterm labor and birth, multiple pregnancy, genetic disorders and chromosomal abnormalities, placenta previa, fetal growth restriction, low Apgar scores, and surgical births.

For which conditions should the nurse check the client before administering the epidural block?

spinal abnormality hypovolemia coagulation defects

Prodromal labor

starts and stops before fully active labor begins. The contractions are real, but they come and go, and labor does not progress.

lacental abruption. Which finding is the priority to report to the health care provider?

the client at high risk of hemorrhage. A decreased urine output indicates decreased perfusion from blood loss.

Syphilis is diagnosed

when painless chancres develop on the outer genitals or on the inner part of the vagina. A chancre may go unnoticed if it occurs inside the vagina or at the opening to the uterus (cervix).

Endocervical polyps are typically cherry red in appearance

whereas most cervical polyps are grayish-white. Vaginal discharge is typically described as mucopurulent or greenish-yellow.

Disseminated intravascular coagulation

widespread clotting and obstruction of blood flow to the tissues

Women over 40 who smoke should not take ovulation suppressants; irregular menstrual cycles make natural methods difficult;

women over 40 may have vaginal dryness, so a spermicidal suppository would not be activated.

The nurse is teaching a client with gestational diabetes about complications that can occur either following birth or at delivery for her baby. Which statement by the mother indicates that further teaching is needed by the nurse?

"If my blood sugars are elevated, my baby's lungs will mature faster, which is good."

While performing a clinical breast examination, the nurse notes a firm and rubbery nodule that is well circumscribed and moves freely. How should the nurse counsel the client?

"It's most likely a fibroadenoma, but we may need to do a biopsy."

A woman has been in labor for the past 8 hours, and she has progressed to the second stage of labor. However, after 2 hours with no further descent, the provider diagnoses an "arrested descent." The woman asks, "Why is this happening?" Which response is the best answer to this question?

"More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal."

Why is it important for the nurse to thoroughly assess maternal bladder and bowel status during labor?

A full bladder or rectum can impede fetal descent.

Fibroids are dependent on estrogen and grow rapidly during the childbearing years unless menopause occurs.

Abnormal uterine bleeding is a clinical manifestation.

Fetal bradycardia occurs when the FHR is below 110 bpm and lasts 10 minutes or longer. It can be the initial response of a healthy fetus to asphyxia.

Causes of fetal bradycardia might include fetal hypoxia, prolonged maternal hypoglycemia, .

Isoimmunization

If fetal Rh-positive blood leaks into the Rh-negative mother's circulation, her body may respond by making antibodies to destroy the Rh-positive erythrocytes.

mammary duct ectasia

Inflammation with dilation (ectasia) of the subareolar ducts

Bacterial vaginosis causes a "stale fish" vaginal odor. Cottage cheese-like discharge is seen in candidiasis and not in bacterial vaginosis, in which the discharge is thin and gray-white.

Intense itching of the vulva is associated with candidiasis, not vaginosis. Warts in the vulva and labia are seen in human papillomavirus infection, not in vaginosis.

The nurse is caring for a client suspected to have a uterine rupture. The nurse predicts the fetal monitor will exhibit which pattern if this is true?

Late decelerations

Endometrial cancer risk factors

Obesity, infertility, and hypertension

contraindication for oxytocin administration

Overdistended uterus

With endometriosis, endometrial tissue migrates into the fallopian tubes and peritoneum or other sites outside of the uterus.

Ovulation occurs, but the egg may be trapped by the misplaced tissue

Prolactin is the hormone responsible for the initiation of lactation, the production of breast milk.

Oxytocin is responsible for the letdown of milk and uterine contractions enabling the infant to be born, and

Induced discharge is an indication of benign breast conditions, which are noncancerous. Cancer involves spontaneous nipple discharge.

Papillomas and palpable mobile cysts are characteristics of fibroadenomas, intraductal papilloma, and mammary duct ectasia, which are benign breast conditions and are noncancerous.

The nurse is assessing a woman with Class III heart disease who is in for a prenatal visit. What would be the first recognizable sign that this client is in heart failure?

Persistent rales in the bases of the lungs

The nurse is admitting a client at 23 weeks' gestation in preparation for induction and delivery after it was determined the fetus had died secondary to trauma. When asked by the client to explain what went wrong, the nurse can point out which potential cause for this loss?

Placental abruption

fibroadenoma

a 30-year-old with a mobile, rubbery, firm, well-circumscribed, nontender lump

A nurse is assessing pregnant clients for the risk of placenta previa. Which client faces the greatest risk for this condition?

a client who had a myomectomy to remove fibroids age over 30

Disseminated intravascular coagulation

abruptio placenta, amniotic fluid embolism, intrauterine fetal death with prolonged retention of the fetus, severe preeclampsia, HELLP syndrome, septicemia, and hemorrhage.

classification of abruptio placentae grade 3 (severe) - absent to moderate bleeding (more than 1,500 mL), more than 50% separation, profound shock, dark vaginal bleeding,

agonizing abdominal pain, decreased blood pressure, significant tachycardia, and development of disseminated intravascular coagulopathy.

The early development of gestational hypertension/preeclampsia, hyperemesis gravidarum,

and the absence of a FHR are suspicious for gestational trophoblastic disease.

Risk factors for developing thromboembolic conditions

anemia, diabetes, cigarette smoking, obesity, preeclampsia, hypertension, varicose veins, pregnancy, cesarean section, multiparity, inactivity, and advanced maternal age.

common causes of infertility?

anovulation, inadequate corpus luteum, PID, fallopian scarring In women, ovarian dysfunction and tubal/pelvic pathology are the primary contributing factors to infertility.

mastitis

applying warm compresses to the affected breast and wearing a supportive bra 24 hours a day

Intraductal papilloma

benign tumor of lactiferous duct/sinus, MCC bloody nipple discharge in <50.

PROM (premature rupture of membranes) refers to a woman who is

beyond 37 weeks' gestation, has presented with spontaneous rupture of the membranes, and is not in labor.

A nurse working with a woman in preterm labor receives a telephone report for the fetal fibronectin test done 10 hours ago. The report indicates an absence of the protein, which the nurse knows indicates:

birth is unlikely within the 2 next weeks. Fetal fibronectin is a protein that helps the placenta and fetal membranes adhere to the uterus during pregnancy

HYPOGLYCEMIA

blood glucose level of less than 30 mg/dL or a plasma concentration of less than 40 mg/dL in the first 72 hours

Typical newborn findings include length of 45 to 55 cm, weight of 2,700 to 4,000 grams, head circumference of 33 to 35 cm,

chest circumference of 30 to 33 cm, temperature of 97.7° F to 99.5° F (36.5° C to 37.5° C), and apical pulse rate of 120 to 160 beats/minute.

Cryotherapy

cold therapy

When providing nutritional counseling to a pregnant woman with diabetes, the nurse would urge the client to obtain most of her calories from which source?

complex carbohydrates The pregnant woman with diabetes is encouraged to eat three meals a day plus three snacks, with 40% of calories derived from good-quality complex carbohydrates, 35% of calories from protein sources, and 35% of calories from unsaturated fats.

Variable decelerations

cord compression

variable decelerations

cord compression, oligohydramnios (decreased amniotic fluid), postmaturity, preterm labor with rupture of the membranes, and thick meconium fluid.

peripartum cardiomyopathy

definition begins sometime during the final month of pregnancy through about five months after delivery, without any other known cause.

A nurse is assessing a pregnant client for the possibility of preexisting conditions that could lead to complications during pregnancy. The nurse suspects that the woman is at risk for hydramnios based on which preexisting condition?

diabetes

A nurse is monitoring a client with PROM who is in labor and observes meconium in the amniotic fluid. What does the observation of meconium indicate?

fetal distress related to hypoxia When meconium is present in the amniotic fluid, it typically indicates fetal distress related to hypoxia.

multiple small, round, and smooth lesions on both breasts that are painful during menstruation

fibrocystic breast changes.

A pregnant client has been admitted with reports of brownish vaginal bleeding. On examination there is an elevated hCG level, absent fetal heart sounds, and a discrepancy between the uterine size and the gestational age. The nurse interprets these findings to suggest which condition?

gestational trophoblastic disease

The classifications for abruptio placentae are: grade 1 (mild) - minimal bleeding (less than 500 mL), 10% to 20% separation, tender uterus, no coagulopathy, signs of shock or fetal distress;

grade 2 (moderate) - moderate bleeding (1,000 to 1,500 mL), 20% to 50% separation, continuous abdominal pain, mild shock, normal maternal blood pressure,maternal tachycardia

placenta

hCG, hPL, relaxin, progesterone, and estrogen.

McRoberts maneuver for shoulder dystocia

head of bed flat, exaggerated flexion of maternal legs

HELLP

hemolysis, elevated liver enzymes, and low platelets.

Chlamydia

is called a "silent" or "invisible" infection because it shows almost no external symptoms but internally may cause a mucopurulent cervical discharge and slight cervical redness.

Zavanelli maneuver

is performed when the practitioner pushes the fetal head back in the birth canal and performs an emergency cesarean birth.

magnesium sulfate

is to relax the skeletal muscles and raise the threshold for a seizure.

precipitous labor.

less than 3 hours

Primary prevention is aimed at p

preventing the disease or condition before it occurs, so giving the HPV vaccine would be a primary prevention activity.

fibronectin test

protein produced by the fetal membranes that can leak into vaginal secretions if uterine activity infection or cervical effacement occurs

A woman is experiencing dystocia that appears related to psyche problems. Which intervention would be most appropriate for the nurse initiate?

providing a comfortable environment with dim lighting

relax the joints.

relaxin, estrogen, and progesterone Within 6 to 8 weeks after delivery, joints are completely stabilized and return to normal.

The women who is underweight with a low BMI

should gain 28 to 40 pounds (13 to 18 kilograms). Less than 28 pounds (13 kilograms) may hinder fetal development, and weight gain over 40 pounds (18 kilograms) may be dangerous to the mother.

Recent research outlines five things (the five "S") that parents can do to calm a fussy infant: swaddling tightly; using the side/stomach position on the lap of the caretaker;

shushing loudly or continuous white noise; swinging using any rhythmic movement; and sucking

managing her asthma

taking her inhalers and other asthma medications to prevent an acute asthma attack. She needs to understand that it is far more dangerous to not take the medications and have an asthma attack

Genital warts when treated chemically will most likely be eradicated after three to six cycles of treatment. Eradication does not mean the condition is cured;

the person is temporarily noncontagious once the warts are destroyed. All sexual contacts of the client need to be examined and treated.

Preterm premature rupture of membranes (PPROM) is defined as

the rupture of the membranes prior to the onset of labor in a woman who is less than 37 weeks' gestation.

The woman can be encouraged to sip fluid, ice chips, or suck on hard candy if they become thirsty or nauseated by labor. It also helps to supply extra fluid. Although many hospital protocols dictate that women who present in labor should not partake of oral nutrition,

there is little evidence to support this restrictive practice. However, if women are kept NPO during labor, they can be administered anesthesia safely in an emergency.

Fibrocystic breast disease and fibroadenoma

two benign breast conditions that occur usually in premenopausal woman.

Cervical cancer has several risk factors: early age of first intercourse (in first year of menarche), lower socioeconomic status,

unprotected sex, family history of cervical cancer, exposure to DES in utero, HIV, use of oral contraceptives, HPV, and multiple male partners.

Increased levels of fibrinogen make pregnancy a hypercoagulable state. Clotting times and bleeding times are unchanged

however. The pregnant woman does run the risk of development of a venous thrombosis as the uterus enlarges and inhibits venous return from the lower extremities due to the hypercoagulable state and venous stasis.

A physician usually recommends beginning a woman with gestational diabetes on insulin therapy when exercise and diet are ineffective and

if she is unable to keep her fasting blood sugar levels below 95 mg/dL or her 2-hour postprandial glucose levels below 120 mg/dL.

Labor dystocia is an abnormal progression of labor. It is the most common cause of primary cesarean birth. When is it most common for labor dystocia to occur?

in active labor or when she reaches the second stage of labor.

fetal tachycardia causes

maternal factors - infection, fever, illicit drug use, hypoxia, dehydration, sever anemia fetal factors-hypoxia, anemia, fetal tachyarrhythias (SVT), infection, prolonged fetal activity, cardiac anomolies

Causes of fetal bradycardia fetal acidosis, administration of analgesic drugs to the mother, hypothermia, anesthetic agents (epidural),

maternal hypotension, fetal hypothermia, prolonged umbilical cord compression, and fetal congenital heart block

The dietary reference intakes as per the Institute of Medicine are for 27 mg of ferrous iron and

400 to 800 mcg of folic acid per day. Women with a previous history of fetus with a neural tube defect are often prescribed a higher dose.

eclampsia

>160/110 mm Hg Marked proteinuria Severe headache Generalized edema RUQ or epigastric pain Visual disturbances Cerebral hemorrhage Renal failure HELLP

Individuals with a high BMI should gain 15 to 25 pounds (7 to 11 kilograms).

A weight gain of less than 16 pounds (7.25 kilograms) may result in a low-birth weight infant and gains over 30 pounds (14 kilograms) may necessitate a cesarean section.

hypertonic uterine dysfunction

An amniotomy may be used with hypertonic uterine dysfunction to augment labor.

Upon assessment, the nurse notes a postpartum client has increased vaginal bleeding. The client had a forceps birth that resulted in lacerations 4 hours ago. What should the nurse do next?

Assess for uterine contractions.

A nurse in the maternity triage unit is caring for a client with a suspected ectopic pregnancy. Which nursing intervention should the nurse perform first?

Assess the client's vital signs. A suspected ectopic pregnancy can put the client at risk for hypovolemic shock.

A nurse in the maternity triage unit is caring for a client with a suspected ectopic pregnancy. Which nursing intervention should the nurse perform first?

Assess the client's vital signs. A suspected ectopic pregnancy can put the client at risk for hypovolemic shock. The assessment of vital signs should be performed first, followed by any procedures to maintain the ABCs. Providing emotional support would also occur, as would obtaining a surgical consent, if needed, but these are not first steps.

A pregnant woman is concerned about the recent onset of a midline swelling that is soft and nontender. The nurse should point out this is most likely related to which condition?

Diastasis recti

A woman is being closely monitored and treated for severe preeclampsia with magnesium sulfate. Which finding would alert the nurse to the development of magnesium toxicity in this client?

Diminished or absent reflexes occur when a client develops magnesium toxicity. A serum magnesium level of 6.5 mEq/L would fall within the therapeutic range of 4 to 7 mEq/L.

About which childhood communicable disease should the nurse question the male client who is seeking information about subfertility?

Diseases such as mumps orchitis (testicular inflammation and scarring because of the mumps virus) can result in obstruction.

diagonal conjugate

Distance from the lower posterior border of the symphysis pubis to the sacral promontory; may be obtained by manual measurement.

A nurse is client teaching with a 30-year-old gravida 1 who has sickle cell anemia. Providing education on which topic is the highest nursing priority?

Maintaining adequate hydration, avoiding infection, getting adequate rest, and eating a balanced diet are all common-sense strategies that decrease the risk of a crisis.

The nurse would prepare a client for amnioinfusion when which action occurs?

Severe variable decelerations occur and are due to cord compression.

syphilis.

Single-dose therapy is preferred for ease of use of azithromycin (Zithromax, Z-Pak) 1 g orally once; ceftriaxone (Rocephin) 250 mg IM once; ciprofloxacin (Cipro) 500 mg orally twice a day for 3 days; or erythromycin base 500 mg orally three times a day for 7 days. Penicillin G benzathine 2.4 million units IM weekly for 3 weeks can also be used for treatment,

The nurse assesses a newborn and notes tachycardia. The nurse notifies the health care provider based on the understanding that further assessment is necessary for which condition?

Tachycardia may be found with volume depletion, cardiorespiratory disease, drug withdrawal, and hyperthyroidism

tertiary prevention examples

Treatment of major depression, reducing disruption of family processes, and suicide prevention, rehabilitation

Lymphedema

breast cancer surgery. It causes disfigurement and increases the lifetime potential for infection and poor healing.

latent or early phase

cervix dilates from 0 to 3 cm. Contractions usually occur every 5 to 10 minutes, last 30 to 45 seconds,nulliparous woman, the latent phase typically lasts about 9 hours; in the multiparous woman, it lasts about 6 hours

Severe Preeclampsia

BP 160/100 or greater, proteinuria greater than 3+, oliguria, elevated serum creatinine- 1.2+, cerebral or visual disturbances (headache or blurred vision), hyperreflexia with ankle clonus, peripheral edema, hepatic dysfunction, RUQ pain, and thrombocytopenia

nonstress test

Client presses a button whenever they feel fetal movement which allows nurse to assess FHR in relationship to the fetal movement

active phase of labor 4 to 7 cm, with 40% to 80% effacement taking place. This phase can last up to 6 hours for the nulliparous woman and 4.5 hours for the multiparous woman .

The fetus descends farther in the pelvis. Contractions become more frequent (every 2 to 5 minutes) and increase in duration (45 to 60 seconds).nulliparous woman is 1.2 cm/hr; for the multiparous woman, it is 1.5 cm/hr

During the early postpartum period, the perineal tissue surrounding the episiotomy is typically edematous and slightly bruised.

The normal episiotomy site should not have redness, bleeding or discharge.

A woman with cardiac disease at 32 weeks' gestation reports she has been having spells of light-headedness and dizziness every few days. Which instruction should the nurse prioritize?

Decrease activity and rest more often.

A pregnant client comes to the prenatal clinic complaining of urinary frequency and lower back pain on the right, stating that this has never happened before. An exam validates the diagnosis of pyelonephritis. What factors would contribute to this condition?

Decreased peristalsis of urinary tract Renal and ureteral dilation occurs due to hormonal changes during pregnancy. This dilation causes the kidney size to increase, especially on the right. Additionally, peristalsis decreases in the urinary tract, leading to urinary stasis and increased risk of infection.

candidiasis.

Miconazole

Clinical studies have confirmed that HPV is the cause of essentially all cases of cervical cancer, which is the fourth most common cancer in women in the United States.

Up to 95% of cervical squamous cell carcinomas and nearly all preinvasive cervical neoplasms are caused by the HPV.

hypotonic uterine contractions

With hypotonic uterine contractions, the number of contractions is unusually infrequent (not more than two or three occurring in a 10-minute period). The resting tone of the uterus remains less than 10 mm Hg, and the strength of contractions does not rise above 25 mm Hg.