antepartum

Which client statement indicates a need for additional teaching about self-care during pregnancy?

"I should sit in a hot tub for 20 minutes to relax after working."

During a prenatal visit, a pregnant client with cardiac disease and slight functional limitations reports increased fatigue. The nurse knows that the client understands the management of the disorder when the client says which of the following?

5 to 6 meals per day with protein in each meal

A charge nurse is completing client assignments for the nursing staff on the pediatric unit. Which client would the nurse refrain from assigning to a pregnant staff member?

An 8-year-old with Rubella.

A multigravid client at 38 weeks' gestation is scheduled to undergo a contraction stress test. What should the nurse include in the explanation as the purpose of this test?

assessment of fetal ability to tolerate labor

In which of the following maternal locations would the nurse place the ultrasound transducer of the external electronic fetal heart rate monitor if a fetus at 34 weeks' gestation is in the left occipitoanterior LOA position?

below the umbilicus on the left side

A nurse is providing care for a pregnant client with gestational diabetes. The client asks the nurse if her gestational diabetes will affect the birth. The nurse should know that:

labor may need to be induced early.

After instructing a pregnant client about third trimester edema, the nurse determines that the client needs further instruction when the client makes which statement?

"Swelling in my hands and face is to be expected."

At what gestational age should a primigravida expect to start feeling quickening?

18 to 20 weeks

A 34-year-old multigravida at 36 weeks' gestation is diagnosed with preterm labor. The client has experienced one infant death due to preterm birth at 28 weeks' gestation. On admission to the antenatal unit, the nurse determines that the fetal heart rate is 140 bpm. What should the nurse do next?

Continue monitoring the client and fetus.

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?

buttocks

For the client who is receiving intravenous magnesium sulfate for severe preeclampsia, which assessment findings would alert the nurse to suspect hypermagnesemia?

decreased deep tendon reflexes

When performing Leopold's maneuvers on a primigravid client at 22 weeks' gestation, the nurse performs the first maneuver to accomplish which action?

determine what is in the fundus

A client has obtained levonorgestrel as emergency contraception. After unprotected intercourse, the client calls the clinic to ask questions about taking the contraceptives. The nurse realizes the client needs further explanation when she makes which statement?

"I can wait up to 4 days after intercourse to start taking these to prevent pregnancy."

The nurse conducts the health assessment of a client who is a primigravida in the prenatal clinic. Which presumptive signs of pregnancy should the nurse expect to assess?

Amenorrhea and quickening. Presumptive signs, such as amenorrhea and quickening, are mostly subjective and may be indicative of other conditions or illnesses. Probable signs are objective, but nonconclusive indicators — for example, Chadwick's sign, Hegar's sign, a positive pregnancy test, uterine enlargement, and Braxton Hicks contractions. Positive signs and objective indicators, such as fetal outline on ultrasound confirm pregnancy.

A nurse is assisting in developing a teaching plan for a client who is about to enter the third trimester of pregnancy. The teaching plan should include identification of which danger sign that must be reported immediately? a) Blurred vision. b) Increased vaginal mucus. c) Dyspnea on exertion. d) Hemorrhoids.

Blurred vision. Correct Explanation: During pregnancy, blurred vision may be a danger sign of preeclampsia or eclampsia, complications that require immediate attention because they can cause severe maternal and fetal consequences. Although hemorrhoids may occur during pregnancy, they don't require immediate attention. Dyspnea on exertion and increased vaginal mucus are common discomforts caused by the physiologic changes of pregnancy.

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?

Pulse rate

A client treated with terbutaline (Brethine) for premature labor is ready for discharge. Which instruction should the nurse include in the discharge teaching plan?

Report a heart rate greater than 120 beats/minute to the physician. RATIONALE: Because terbutaline can cause tachycardia, the woman should be taught to monitor her radial pulse and call the physician 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 experiencing premature labor must maintain bed rest at home.

A client at 36 weeks' gestation, begins to exhibit signs of labor after an eclamptic seizure. The nurse should assess the client for:

abruptio placentae

A multiparous client thought to be at 14 weeks' gestation based on uterine size has such severe morning sickness that she has "not been able to keep anything down for a week." The nurse should review the results of the urinalysis for:

ketones

A newly pregnant woman tells the nurse that she hasn't been taking her prenatal vitamins because they make her nauseated. In addition to telling the client how important taking the vitamins are, the nurse should advise her to:

take the vitamin on a full stomach.

A client who is 10 weeks pregnant develops spotting; however, the cervix remains closed. The nurse should suspect which of the following? a) Ectopic pregnancy b) Threatened abortion c) Missed abortion d) Inevitable abortion

threatened abortion

A pregnant client arrives in the emergency department and states, "My baby is coming." The nurse sees a portion of the umbilical cord protruding from the vagina. Why should the nurse apply manual pressure to the baby's head?

to relieve pressure on the umbilical cord

A client undergoes an amniotomy. Shortly afterward, the nurse detects large variable decelerations in the fetal heart rate (FHR) on the external electronic fetal monitor (EFM). These findings signify:

umbilical cord prolapse. Explanation: After an amniotomy, a significant change in the FHR may indicate umbilical cord prolapse; an EFM may show large variable decelerations during cord compressions. Infection, the start of the second stage of labor, and the need for labor induction aren't associated with FHR changes. An infection causes temperature elevation. The second stage of labor starts with complete cervical dilation. Labor induction is indicated if the client's labor fails to progress.

While assisting the physician with an amniocentesis on a multigravid client at 38 weeks' gestation, the nurse observes that the fluid is very cloudy and thick. The nurse interprets this finding as indicating which of the following?

intrauterine infection

The nurse has discussed sexuality issues during the prenatal period with a primigravida who is at 32 weeks' gestation. She has had one episode of preterm labor. The nurse determines that the client understands the instructions when she says:

b. "I should not get sexually aroused or have any nipple stimulation." Reason: This client has already had one episode of preterm labor at 32 weeks' gestation. Sexual intercourse, arousal, and nipple stimulation may result in the release of oxytocin which can contribute to continued preterm labor and early delivery. The client should be advised to refrain from these activities until closer to term, which is 6 to 8 weeks later. Telling the client that intercourse is acceptable after the bleeding stops is incorrect and may lead to early delivery of a preterm neonate. The client should not have intercourse for at least 6 weeks because of the danger of inducing labor. There is no indication when the client's next prenatal visit is scheduled.

A cerclage procedure is performed on a client at 20 weeks' gestation who is diagnosed with cervical incompetence. When preparing the discharge teaching plan, the nurse should expect to instruct the client to monitor herself for which problem?

symptoms of infection Explanation: Placement of a cerclage or purse string suture may be used to maintain cervical closure for women with cervical incompetence. Because of the risk of maternal infection, the client should be taught to contact the health care provider if she experiences pain, fever, or changes in the vaginal discharge. Braxton Hicks contractions are normal during pregnancy and nonthreatening to the fetus. Nausea and vomiting usually are not associated with cerclage. Transient hypotension usually is not associated with cerclage.

During a prenatal visit, a pregnant client with cardiac disease and slight functional limitations reports increased fatigue. To help combat this problem, the nurse should advise her to: exercise 1 hour before each meal. take a vitamin and mineral supplement. eat three well-balanced meals per day. divide daily food intake into five or six meals.

divide daily food intake into five or six meals

After teaching a pregnant client about potential complications of amniocentesis that must be reported immediately, the nurse determines that the client understands the instruction when she says that she will report:

Vaginal bleeding. Possible complications associated with amniocentesis include hemorrhage from penetration of the placenta, infection of the amniotic fluid, possible puncture of the fetus, and uterine irritation leading to premature labor. Therefore, after amniocentesis, the client should promptly report any vaginal discharge or bleeding, a decrease in fetal movement, or uterine contractions. Typically nausea is not a complication of amniocentesis. Urinary frequency is not a complication of amniocentesis. Irregular painless uterine tightness (Braxton-Hicks contractions) is not a complication of amniocentesis

The health care provider (HCP) 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?

neural tube defects Explanation: 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. An 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 25-year-old client tells the nurse that she would like to become pregnant, but she has been diagnosed with blocked fallopian tubes due to pelvic inflammatory disease. When helping the client explore infertility treatment options, which of the following is most appropriate for this client?

In vitro fertilization (IVF). Because this client's tubes are blocked, IVF would be the most appropriate. After ova are removed surgically from the client and fertilized outside the uterus, the fertilized ova are introduced vaginally through a special tube through the cervix to the uterus for implantation, completely bypassing the fallopian tubes. Gamete intrafallopian transfer, the transfer of ova into a patent fallopian tube for fertilization, would be inappropriate for client with blocked fallopian tubes. Zygote intrafallopian transfer involves oocyte retrieval then fertilization. After fertilization, the fertilized eggs are transferred into the client's fallopian tubes. This is not an option for a client who has blocked tubes. Menotropins therapy would be appropriate if the client was experiencing ovarian dysfunction.

A client is a 43-year-old G2 P1 at 16 weeks' gestation that has completed prenatal testing for chromosomal abnormalities. The results reveal the infant is a female with Down syndrome. The parents are seeking information about this syndrome. What should the nurse tell the parents? Select all that apply.

• Down syndrome can occur in mothers of any age. • Down syndrome occurs more frequently with advanced maternal age. • Down syndrome results from a trisomy of chromosome 21.

Following an eclamptic seizure, the nurse should assess the client for which complication?

uterine contractions

A client has a cerclage placed at 16 weeks' gestation. She has had no contractions and her cervix is dilated 2 cm. The nurse is preparing the client for discharge. Which statement by the client should indicate to the nurse that the client needs further instruction?

B) "I can have sex again in about 2 weeks." Intercourse commonly stimulates uterine contractions. The prostaglandins found in semen can also initiate contractions. After placement of a cerclage for advanced dilation and contractions, the client is considered at high risk for preterm birth and should be seen by her health care provider (HCP) more frequently. The client should call the HCP immediately if she sees signs of complications, such as leaking fluid (rupture of membranes), vaginal bleeding, and contractions (particularly with a cerclage in place). Anything in the vagina may initiate contractions and the labor process.

A nurse is caring for a client after evacuation of a hydatidiform mole. The nurse should tell the woman to:

use birth control for at least 1 year

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?" The nurse instructs the client that she can occasionally take which over-the-counter medication? A) naproxen B) aspirin C) ibuprofen D) acetaminophen

D) acetaminophen 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 her 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 of 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.

A client is a long-distance runner and is 8 weeks pregnant with her first baby. The client tells the nurse that she would like to continue running throughout the pregnancy and asks the nurse if there are any safety risks. Which response by the nurse correctly identifies musculoskeletal changes in pregnancy that may be a safety risk to the client?

"The joints of the pelvis relax."

A primigravid client in a preparation for parenting class asks how much blood is lost during an uncomplicated vaginal birth. The nurse should tell the woman:

"The maximum blood loss considered within normal limits is 500 ml." Explanation: 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 childbirth is almost always estimated because it provides a valuable indicator for possible hemorrhage. A blood loss of 1,000 mL is considered hemorrhage.

A nurse is using Doppler ultrasound to assess a pregnant woman. When should the nurse expect to hear fetal heart tones?

2. 11 weeks Using Doppler ultrasound, fetal heart tones may be heard as early as the 11th week of pregnancy. Using a stethoscope, fetal heart tones may be heard between 17 and 20 weeks of gestation.

Early detection of an ectopic pregnancy is paramount in preventing a life-threatening rupture. Which symptoms should alert the nurse to the possibility of an ectopic pregnancy?

Abdominal pain, vaginal bleeding, and a positive pregnancy test.

A pregnant woman states that she frequently ingests laundry starch. The nurse should assess the client for:

Anemia All pregnant clients should be screened for pica, or the ingestion of nonfood substances, such as clay, dirt, or laundry starch. Commonly, clients who practice pica are anemic. Muscle spasms are not associated with the ingestion of laundry starch. However, they may be related to seizure disorder or seizure activity or a calcium deficiency. Lactose intolerance is not associated with the ingestion of laundry starch. Lactose intolerance would occur when the client ingests milk or milk products. Diabetes mellitus is not associated with the ingestion of laundry starch. Diabetes mellitus is associated with abnormal glucose levels, excessive thirst, and frequent voiding.

When should a client who's Rh(D)-negative and D-negative and who hasn't already formed Rh antibodies receive RHO(D) immune globulin (RhoGAM) to prevent isoimmunization?

At about 28 weeks' gestation and again within 72 hours after birth

A client with pregnancy-induced hypertension is to receive magnesium sulfate to run at 3 g/h with normal saline to maintain the total IV rate at 125 mL/hour. The nurse giving the end-of-shift report stated the client's blood pressures have been elevated during the night. The oncoming nurse checked the client and found magnesium sulfate running at 2 g/h. Identify the nursing actions to be taken from first to last. All options must be used.

Correct the IV rates. Assess the client's current status. Notify the primary health care provider (HCP) of the incident. Initiate an incident report.

A nurse is relieving the triage nurse in the labor and birth unit who is going to lunch. The report indicates that there are three clients having their vital signs assessed and a fourth client is on her way to the unit from the emergency department. In which order of priority from first to last should the nurse manage these clients? All options must be used.

First, the nurse should assess the client from the emergency department who is screaming because she may be anywhere along the labor continuum and her status will be unknown until she has a vaginal exam to determine cervical effacement and dilation. The nurse should next assess the client with right lower quadrant pain as she may be experiencing an ectopic pregnancy or appendicitis and may need further evaluation by the health care provider. The client with clear vesicles and brown vaginal discharge is experiencing a molar pregnancy and will need to have a D&C to evacuate the vesicles; this condition will not jeopardize the life of the mother if no intervention occurs within an hour. The client who is at term without fetal movement is a priority from an emotional concern if there is no heart beat when she is evaluated, but the physical status of the fetus with no fetal movement for 2 days will not change if not seen within the next half hour and the nurse can see this client last. The emotional care for this client will be extensive if there is a diagnosis of fetal demise and the nurse should plan the time to be available to support this client as needed.

During the first 3 months, which hormone is most responsible for maintaining pregnancy? Estrogen Relaxin Progesterone Human chorionic gonadotropin (hCG)

Human chorionic gonadotropin (hCG)

A woman at 22 weeks' gestation has right upper quadrant pain radiating to her back. She rates the pain as 9 on a scale of 1 to 10 and says that it has occurred 2 times in the last week for about 4 hours at a time. She does not associate the pain with food. Which nursing measure is the highest priority for this client?

Refer the client to her health care provider for evaluation and treatment of the pain.

A primigravid client at 35 weeks' gestation is scheduled for a biophysical profile. After instructing the client about the test, which client statement about what the test measures indicates effective teaching? placement of the placenta amniotic fluid volume amniotic fluid color fetal gestational age

amniotic fluid volume

A client, 11 weeks pregnant, is admitted to the facility with hyperemesis gravidarum. She tells the nurse she has never known anyone who had such severe morning sickness. The nurse understands that hyperemesis gravidarum results from:

an unknown cause

When teaching a group of pregnant adolescents about reproduction and conception, the nurse is correct when stating that fertilization occurs: when the ovum is released. in the first third of the fallopian tube. in the uterus. near the fimbriated end.

in the first third of the fallopian tube

A pregnant client's hepatitis B report reads "HBsAg = positive." Which of the following correctly describes the client's hepatitis B status?

infected

A pregnant client calls the nurse at 22 weeks gestation to report that she is experiencing some edema of her face and hands, with puffiness in her eyelids in the morning. What is the priority action by the nurse?

refer the client to the physician