Antepartum

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A 15-year-old client who is 26 weeks pregnant has been admitted to the labor and delivery unit with reports of abdominal pain. Her parents want to speak with a nurse about her condition. How should the nurse respond? "The health care provider can give you more information without consent." "I'll need a signed consent from your daughter to give you medical information." "She will be OK. It's just a stomachache." "She is experiencing Braxton Hicks contractions and is too young to understand the difference between these contractions and labor pains."

"I'll need a signed consent from your daughter to give you medical information."

The health care practitioner uses nitrazine paper to determine whether a pregnant client's membranes have ruptured. If the membranes are ruptured, the nurse expects the paper will turn which color? Green Pink Yellow Blue

Blue

A pregnant client at 10 weeks' gestation comes to the clinic for a routine visit. During the visit, the client tells the nurse, "I am worried because I feel tired all the time and have to run to the bathroom to urinate frequently throughout the day." What is the best response by the nurse? The client needs to see the health care provider about these concerns. The client's reports are typical, early pregnancy symptoms. The client's excessive worrying is the underlying cause for these concerns. The client will need to have laboratory tests done to evaluate the reports.

The client's reports are typical, early pregnancy symptoms.

The nurse is providing dietary teaching to a pregnant client. To help meet the client's iron needs, the nurse should advise her to eat: tomatoes and fish. grains and milk. eggs and citrus fruit. spinach and beef.

spinach and beef.

A nurse is assisting with the development of a plan of care for a pregnant client. The interdisciplinary team determines that the client will require more frequent prenatal visits based on which data gathered? first pregnancy at age 33 blood type O positive type 1 diabetes history of allergy to honey bee pollen

type 1 diabetes

A client is in the eighth month of her first pregnancy when her health care provider prescribes a biophysical profile to be conducted the next day. When preparing the room for this test, which equipment would the nurse most likely gather? Select all that apply. sphygmomanometer thermometer electronic blood pressure measuring device fetal monitor ultrasound machine

ultrasound machine fetal monitor

A client comes to the clinic for her first prenatal visit. While the nurse is obtaining the client's vital signs, the client asks, "When will you be able to hear my baby's heart beat?" Which response by the nurse would be most appropriate? "We can usually hear them with a stethoscope at about 7 weeks." "At about 11 weeks, we'll be able to hear them with an ultrasound device." "We have to wait until you're about 17 weeks before we hear anything." "By 21 weeks, we can check the when you have an ultrasound."

"At about 11 weeks, we'll be able to hear them with an ultrasound device."

The nurse is caring for a client in her 34th week of pregnancy who wears an external monitor. Which statement by the client indicates an understanding of the nurse's teaching? "I'll need to lie perfectly still." "You won't need to come in and check on me while I'm wearing this monitor." "I know that the external monitor increases my risk of a uterine infection." "I can lie in any comfortable position, but I should stay off my back."

"I can lie in any comfortable position, but I should stay off my back."

The nurse is reinforcing education for a client in the first trimester of pregnancy. What statement made by the client demonstrates an understanding of the education? "I need to eat a lot of liver so that I won't become anemic." "I should begin drinking 32 ounces of whole milk daily to increase my calcium intake." "I should limit my activities during the first trimester of pregnancy so that I won't have a miscarriage." "I need to take supplemental folic acid to prevent neural tube defects."

"I need to take supplemental folic acid to prevent neural tube defects."

A 30-year-old primiparous client at 34 weeks' gestation comes to the prenatal facility concerned about the reddish streaks she has increasingly developed on her breasts and abdomen. She asks what these skin changes are and whether they're permanent. What is the best response by the nurse? "These streaks are called linea nigra; they'll fade after childbirth." "These streaks are called nevi; they'll fade after the postpartum period." "These streaks are called striae gravidarum, or stretch marks; they'll grow lighter after delivery." "These streaks are called hemangiomas; they're permanent changes resulting from pregnancy."

"These streaks are called striae gravidarum, or stretch marks; they'll grow lighter after delivery."

During a prenatal visit, the nurse measures a client's fundal height at 19 cm. The client asks what does this mean. How should the nurse respond? "This measurement indicates that the fetus has reached approximately 24 weeks." "This measurement indicates that the fetus has reached approximately 28 weeks." "This measurement indicates that the fetus has reached approximately 12 weeks." "This measurement indicates that the fetus has reached approximately 19 weeks."

"This measurement indicates that the fetus has reached approximately 19 weeks."

The nurse is discussing posture with a client who's 18 weeks pregnant. The clients asks why should she avoid the supine position. How does the nurse respond? "This position may trigger heart palpitations." "This position may cause gastroesophageal reflux." "This position promotes pregnancy-induced hypertension (PIH)." "This position impedes blood flow to the fetus."

"This position impedes blood flow to the fetus."

During a health-teaching session, a pregnant client asks the nurse how soon the fertilized ovum becomes implanted in the endometrium. Which timeframe should the nurse appropriately supply? 7 days after fertilization 21 days after fertilization 14 days after fertilization 28 days after fertilization

7 days after fertilzation

A client who's 5 weeks pregnant reports nausea and vomiting. The nurse reassures the client that these symptoms probably will subside by: 14 to 17 weeks' gestation. 5 to 8 weeks' gestation. 9 to 12 weeks' gestation. 18 to 22 weeks' gestation.

9 to 12 weeks' gestation

A client diagnosed with gestational hypertension must have weekly blood pressure checks and urine testing at a clinic. She does not have transportation. How can the nurse help this client be compliant with her care? Do nothing. It's the client's responsibility to find a way to get to the clinic. Ask the clinic case manager to speak with the client. Ask the client to find a friend to help her. Set up cab service.

Ask the clinic case manager to speak with the client.

A nurse is evaluating a pregnant client's fundal height. In which way should the nurse stretch the measuring tape to measure it? Across the abdomen laterally From the symphysis pubis notch to the highest level of the fundus From the symphysis pubis notch to the umbilicus With a pelvimeter designed to measure fundal height

From the symphysis pubis notch to the highest level of the fundus

The nurse is providing care to a pregnant adolescent client in the first trimester. Which intervention would the nurse identify as the highest priority? Teach the client that there is increased risk for having a macrosomic neonate. Schedule the client for a screening glucose tolerance test. Make sure the client receives nutritional counseling and reinforce the education. Monitor the client for signs and symptoms of placenta previa.

Make sure the client receives nutritional counseling and reinforce the education.

A nurse is caring for a 15-year-old pregnant adolescent who is taking an iron supplement. After reviewing instructions for taking the iron supplement, the nurse determines that the teaching was successful when the client tells the nurse that she will take the supplement with which fluid to help increase the absorption of iron? a glass of milk a glass of orange juice a cup of hot tea a liquid antacid

a glass of orange juice

The nurse is reinforcing education about growth and development during pregnancy with a client. The nurse determines that the client has understood the information when stating that the single-chambered heart begins to beat and pump its own blood cells through main blood vessels at what gestational age? approximately 24 days approximately 5 weeks approximately 60 days approximately 8 weeks

approximately 24 days

A pregnant client is receiving heparin. While the client is receiving this drug, which data would the nurse immediately report to the supervising nurse? increase in blood pressure and temperature change in uterine contraction intensity change in fetal activity and position bleeding from an orifice

bleeding from an orifice

The nurse is reinforcing dietary teaching to a pregnant client. Which food selections should the nurse advise the client to eat to help meet the need for iron? Select all that apply. eggs and citrus fruit broccoli and pork tomatoes and fish spinach and beef grains and milk

broccoli and pork spinach and beef

Which intervention would the nurse recommend to a client having severe heartburn during pregnancy? Drink a preparation of salt and vinegar. Drink orange juice frequently during the day. Eat crackers on waking every morning. Eat several small meals daily.

eat several small meals daily

A client at 32 weeks of gestation has mild preeclampsia. The client is discharged home with instructions to remain on bed rest and to call the health care provider if the client experiences which symptoms? Select all that apply. increased urine output blurred vision epigastric pain headache severe nausea and vomiting difficulty sleeping

headache blurred vision epigastric pain severe nausea and vomiting

A nurse is assisting the health care team to develop a plan of care for a 16-year-old client in the prenatal clinic. The client is at highest risk for which complication that should be addressed by the team? gestational diabetes varicosities iron deficiency anemia nausea and vomiting

iron deficiency anemia

A client is pregnant with triplets and is at greater risk for complications. The nurse reinforces education about the signs and symptoms of which conditions? Select all that apply. hydatidiform mole preterm labor hypertension of pregnancy placenta previa anemia

placenta previa preterm labor anemia hypertension of pregnancy

A nurse receives the result of a pregnant client's human immunodeficiency virus (HIV) testing. When the nurse attempts to notify the client of the results, the client can't be located. The nurse should: give the results to the client's significant other. send a letter informing the client of the test results. send a registered letter asking the client to contact the clinic. leave a message on the answering machine at the client's home.

send a registered letter asking the client to contact the clinic.

A primigravida client in the fifth month of pregnancy has been receiving regular prenatal care since week 8. During a routine visit, the client reports feeling dizzy, breathless, and clammy when arising from bed in the morning. The nurse should obtain data relevant to which condition? supine hypotension shock fainting hemorrhage

supine hypotension

The nurse is caring for a client who is 39 weeks' pregnant and reports she has been leaking fluid from her vagina for 3 days. The nurse knows that this client is most at risk for what? cord prolapse excess amniotic fluid uterine infection postpartum hemorrhage

uterine infection

A 35-year-old client who is 28 weeks' pregnant is admitted for testing. After reading the nursing notes, which rationale best explains why a pregnant client should lie on the left side when resting or sleeping in the later stages of pregnancy? to prevent compression of the vena cava to prevent development of fetal anomalies to facilitate bladder emptying to facilitate digestion

to prevent compression of the vena cava

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 slow the delivery process to relieve pressure on the umbilical cord to rupture the membranes to reinsert the umbilical cord

to relieve pressure on the umbilical cord

The nurse is assessing a client whose membranes ruptured prematurely 12 hours ago. Which is the nurse's highest priority to evaluate when collecting data on this client? Maternal vital signs and fetal heart rate (FHR) Frequency and duration of contractions Cervical effacement and dilation White blood cell (WBC) count

Maternal vital signs and fetal heart rate (FHR)

During an examination, a pregnant client at 32 weeks' gestation becomes dizzy, light-headed, and pale while supine. Which action would the nurse do first? Take the client's blood pressure. Ask the client to breathe deeply. Turn the client to the left side. Listen to fetal heart tones.

Turn the client to the left side.

A nurse instructs a pregnant client about the importance of doing frequent Kegel exercises. Kegel exercises are important for which reason? They help maintain good perineal muscle tone by tightening the pubococcygeus muscle. They minimize leg cramps by strengthening the calf muscles. They prepare the mother for pushing by strengthening the abdominal muscles. They promote better breathing by strengthening the diaphragm muscle.

They help maintain good perineal muscle tone by tightening the pubococcygeus muscle.

The nurse observes many cuts and bruises on the back, arms, and legs of a pregnant client. The client tells the nurse, "I was cleaning and a box of supplies fell on me." Which response by the nurse is most appropriate? "Make sure you let your health care provider know about the accident." "It really looks like someone beat you up." "That must have been a very big box!" "It's our responsibility to maintain your confidentiality and ensure your safety."

"It's our responsibility to maintain your confidentiality and ensure your safety."

The nurse is providing care for a pregnant 16-year-old client. The client says that she's concerned she may gain too much weight and wants to start dieting. The nurse should respond by saying: "The prenatal vitamins should ensure that the baby gets all the necessary nutrients." "Nutrition is important because depriving your baby of nutrients can cause developmental and growth problems." "Let's explore your feelings further." "Now isn't a good time to begin dieting because you are eating for two."

"Nutrition is important because depriving your baby of nutrients can cause developmental and growth problems."

An adolescent who is 14 weeks pregnant comes to the clinic for a prenatal examination. During the examination, the client says to the nurse, "I'm still not sure if I want to keep my baby." Which response by the nurse is best? "You will need to discuss this with your health care provider." "Tell me why you do not want to keep the baby." "Tell me more about how you are feeling about the baby." "I will have the social worker talk to you about adoption."

"Tell me more about how you are feeling about the baby."

The nurse has a client at 30 weeks gestation who has tested positive for the human immunodeficiency virus (HIV). What should the nurse tell the client when the client says that she wants to breastfeed her baby? Encourage breastfeeding because it's healthier for the baby. Encourage breastfeeding to prevent mastitis. Discourage breastfeeding because HIV will decrease her ability to produce breast milk. Discourage breastfeeding because HIV can be transmitted through breast milk.

Discourage breastfeeding because HIV can be transmitted through breast milk.

A pregnant client is concerned about lack of fetal movement. Which response by the nurse would be most therapeutic? "Eat foods that contain a high sugar content to stimulate the fetus." "Try taking a warm bath to facilitate fetal movement." "You need to start taking additional prenatal vitamins." "Lie down once a day and count the number of fetal movements for 15 to 30 minutes."

"Lie down once a day and count the number of fetal movements for 15 to 30 minutes."

A pregnant client asks the nurse whether she can take castor oil for her constipation. How should the nurse respond? "Yes, it produces no adverse effects." "No, it can promote sodium retention." "No, it can lead to increased absorption of fat-soluble vitamins." "No, it can initiate premature uterine contractions."

"No, it can initiate premature uterine contractions."

A client who's 2 months pregnant reports urinary frequency and says she gets up several times at night to go to the bathroom. She does not have other urinary symptoms. What is the best nursing intervention? Refer the client to a urologist for further investigation. Explain that urinary frequency is expected during the first trimester. Explain that urinary frequency is not a sign of urinary tract infection (UTI). Advise the client to decrease her daily fluid intake.

Explain that urinary frequency is expected during the first trimester.

As a client progresses through pregnancy, she develops constipation. Which factor, if asked, would the nurse state is the primary cause of this problem during pregnancy? Reduced intestinal motility Prolonged gastric emptying Inadequate fluid intake Decreased appetite

Reduced intestinal motility

The labor and delivery unit has 10 clients in varying stages of labor. Staffing for the upcoming shift consists of four registered nurses (RNs) and one licensed practical nurse (LPN). Which client care assignment is best? Each nurse should care for two clients. The stable clients in the early stages of labor should be assigned to the LPN. The LPN should be allowed to go home because the unit is overstaffed. Each RN should care for one client and assist the LPN with the care of the remaining six clients.

The stable clients in the early stages of labor should be assigned to the LPN.


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