Complications of Pregnancy

A client with gestational hypertension is to receive magnesium sulfate to run 3g/h with normal saline to maintain the total IV rate of 125mL/h. The nurse giving the end-of-shift report stated that the client's BP's have been elevated during the night. The oncoming nurse checked the client and found magnesium sulfate running at 2g/h. Identify the nursing actions to be taking from first to last. 1. Notify the PCP of the incident 2. Assess the client's current status 3. Correct the IV rates 4. Initiate an incident report

3 2 1 4

A 38-year-old client at about 14 weeks gestation is admitted to the hospital with a dx of complete hydatidiform mole. Soon after administration, the nurse would assess the client for which S/S? A. Gestational hypertension B. Gestational diabetes C. Abdominal distension D. Chorioamnionitis

A

At 32 weeks gestation, a 15-year-old primigravida client who is 5'2 has gained a total of 20 lbs., with a 1 lb. a week gain in the last two weeks. Urinalysis reveals negative glucose and trace of protein. The nurse should advise the client which factor increases her risk for preeclampsia? A. Total weight gain B. Short stature C. Adolescent age group D. Trace proteinuria

C

The nurse is caring for a 22-year-old G2, P2 client who has DIC after delivering a dead fetus. Which finding is the highest priority to report to the HCP? A. APTT time of 30 sec B. Hgb 11.5 g/dL C. Urinary output of 25 ml/hr in the past hour D. Platelets of 140,000/mm

C

When teaching a primigravida client with diabetes about common causes of hyperglycemia during pregnancy, the nurse should include what information? A. Fetal movement B. Decreased fetal insulin C. Maternal infection D. Gestational hypertension

C

Which outcome would the nurse identify as the priority to achieve when developing the plan of care for a primigravida client at 38 weeks gestation who s hospitalized with severe preeclampsia and receiving IV magnesium sulfate? A. Decreased generalized edema within 8 hours B. Decreased urinary output during the first 24 hours C. Sedation and decreased reflex excitability within 48 hours D. Absence of any seizure activity during the first 48 hours

D

As the nurse enters the room of a newly admitted primigravida client diagnosed with severe preeclampsia, the client begins to experience a seizure. The nurse should do which in order of priority from first to last. 1. Call for immediate assistance 2. Turn the client on her side 3. Assess for ruptured membranes 4. Maintain Airway

1 2 3 4

The nurse notices that a client who has just given birth is short of breath, s ashen in color, and begins to cough. She becomes limp on the birthing table. At last assessment 30 min ago, her temperature was 98F, pulse was 78 bpm, and RR at 16 bpm. Determine the nursing actions in the order they should occur. 1. Open the airway using the head tilt-chin lift 2. Ask staff to activate emergency response 3. Establish unresponsiveness 4. Give two breaths 5. Begin compressions

3 2 5 1 4

After administering hydralazine 5 mg IV as prescribed for a primigravida client with severe preeclampsia at 39 weeks gestation, the nurse should assess the client for which complication? A. Tachycardia B. Bradypnea C. Polyuria D. Dysphagia

A

The nurse is administering IC mag sulfate as prescribed for a client 34 weeks gestation with severe preeclampsia.. What are desired outcomes of this therapy? (Select all that apply) A. Temp 98F, Pulse 72 bpm, RR 14 B. Urinary output less than 30 mL/hour C. FHR with late decelerations D. BP of less than 140/90 mmHg E. Deep tendon reflexes 2+ F. Magnesium level 5.6 mg/dL

A E F

Before surgery to remove an ectopic pregnancy and the fallopian tube, which S/S would alert the nurse no the possibility of tubal rupture? A. Amount of vaginal bleeding and discharge B. Profuse sweating C. Slow, bounding pulse rate of 80 bpm D. Marked abdominal anemia

B

A primigravida client with insulin-dependent diabetes tells the nurse that the contractions stress test performed earlier in the day was suspicious. The nurse interprets this test result as showing which fetal heart pattern? A. Frequent late decelerations B. Decreased fetal movement C. Inconsistent late decelerations D. Lack of fetal movement

C

The HCP has determined that a preterm labor client at 34 weeks gestation has no fetal fibronectin present. Based on this finding, the nurse would anticipate which other client finding within the next week? A. The client will develop preeclampsia B. The fetus will develop mature lungs C. The client will not develop preterm labor D. The fetus will not develop gestational diabetes

C

A 24-year-old client, G3, T1, P1, A1, L1 at 32 weeks gestation is admitted to the hospital because of vaginal bleeding. After reviewing the client's hx, which factor might lead to the nurse suspecting abruptio placentae? A. Severe hypotensive episodes B. Previous low transverse cesarean birth C. One induced abortion D. Hx of cocaine use

D

A multigravida client dx with a probable ruptured ectopic pregnancy is scheduled for emergency surgery. In additon to monitoring the client's BP before surgery, which factor is the most important for the nurse to assess? A. Uterine cramping B. Marijuana use during pregnancy C. Episodes of pelvic inflammatory disorders D. Pulse rate

D

At 38 weeks gestation, a primigravida client with poorly controlled diabetes and severe preeclampsia is admitted for a cesarean birth. The nurse explains to the client that birth helps to prevent complications? A. Neonatal hyperbilirubenemia B. Congenital Anomalies C. Perinatal asphyxia D. Stillbirth

D

When the nurse is preparing the room for admission of a multigravida client at 36 weeks gestation dx with severe preeclampsia, which item is most important for the nurse to obtain? A. Oxytocin infusion solution B. Disposable tongue blade C. Portable ultrasound machine D. Padding for the side rails

D

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

B C F

Which action should the nurse take first when admitting a multigravida client at 36 weeks gestation with a probable diagnosis of abruptio placentae? A. Prepare the client for a vaginal examination B. Obtain a brief hx from the client C. Insert a large-gauge IV catheter D. Prepare the client for ultrasound scan

C

A client presenting to the OB triage unit with no prenatal care and painless, bright red vaginal bleeding. Which interventions are most indicated? A. Applying an external fetal monitor and completing a physical assessment B. Applying an external fetal monitor and completing a physical exam C. Obtaining a fundal height physical exam on the client D. Obtaining fundal height and a sterile vaginal exam

A

A client who is 34 weeks pregnant us admitted to the labor and birth room with the dx of preeclampsia. The pts VS are BP (149/92), Pulse 62 bpm, RR 18, Temp 98.4. What is the primary intervention? A. Encourage the client to lie in a lateral position B. Administer an antihypertensive agent C. Notify the HCP of the client's BP D. Check the cervix

A

A laboring client a -2 station has a spontaneous rupture of the membranes, and a cord immediately from the vagina. What should the nurse do first? A. Place gentle pressure upward on the fetal head B. Place the cord back into the vagina to keep it moist C. Begin oxygen by face mask 8-10 L/min D. Turn the client on her left side

A

A multigravida client at 34 weeks gestation with PROM tests positive for group B streptococcus. The client is having contractions every 4-6 minutes. Her VS are BP (120/80 mmHg), Temp (100F), Pulse (100 bpm), and RR (18 bpm). Which medication would the nurse expect the PCP to prescribe? A. IV penicillin B. IV gentamicin sulfate C. IM betamethasone D. IM cofactor

A

On arrival at the ED, a client tells the nurse that she suspects that she may be pregnant but has been having a small amount of bleeding and has severe pain in the lower abdomen. The client's BP is 70/50 mmHg, and her pulse is 120 bpm. The nurse notifies the PCP immediately because of the possibility of which complication? A. Ectopic pregnancy B. Abruptio pregnancy C. Gestational trophoblastic disease D. Complete abortion

A

Soon after admission of a primigravida client at 38 weeks gestation with severe preeclampsia, the PCP prescribes a continuous IV infusion of 5% dextrose in Ringer's solution and 4 g of magnesium sulfate. While the medication is being administered which assessment finding should the nurse report? A. RR 12 bpm B. Patellar reflex of 2+ C. BP of 160/88 mmHg D. Urinary output exceeding intake

A

When developing the collaborative plan of care with the HCP for a multigravida client at 10 weeks gestation with a hx of cardiac disease who is being treated with digitalis therapy before pregnancy, the nurse should instruct the client about which modifications regarding the client's drug therapy regimen? A. Possible need for increased dosage B. Need for weekly drug level monitoring C. Switching to a different medication D. Addition of a diuretic to the regimen

A

When the nurse is assessing a 34-year-old multigravida client at 34 weeks gestation experiencing moderate vaginal bleeding, which symptom would most likely alert the nurse that placenta previa is present? A. Painless vaginal bleeding B. Uterine tetany C. Intermittent pain with spotting D. Dull lower back pain

A

Which anticoagulants would the nurse expect to administer when caring for a primigravida client at 12 weeks gestation who has class II cardiac disease due to mitral valve stenosis? A. Heparin B. Warfarin C. Enoxaparin D. Ardeparin

A

A client has just had a cesarean section for a prolapsed cord. In reviewing the client's hx which factors place a client at risk for cord prolapse? A. -2 station B. Low-birth-weight infant C. Rupture of membranes D. Breech position E. Prior abortion F. Low-lying placenta

A B C D

The nurse is assessing a multigravida client at 12 weeks gestation who has been admitted to the ER with sharp right-sided abdominal pain and vaginal spotting. Which information should the nurse obtain about the client's history? (Select all that apply) A. Hx of STI's B. Number of sexual partners C. Last menstrual period D. Cesarean section E. Contraceptive use

A B C E

A 30-year-old multiparous woman at 8 weeks gestation has had a hx of insulin-dependent diabetes since age 20. When explaining the importance of blood glucose control during pregnancy, the nurse should tell the client what will occur regarding the client's insulin needs during the first trimester? A. They will increase B. They will decrease C. They will remain constant D. They will be unpredictable

B

A multigravida client is admitted at 16 weeks gestation with a dx of hyperemesis gravidarum. The nurse should explain to the client that hyperemesis gravidarum is thought to be r/t high levels of what hormone? A. Progesterone B. Estrogen C. Somatotropin D. Aldosterone

B

A primigravida client at 38 weeks gestation dx with mild preeclampsia calls the clinic nurse to say she has had a continuous headache for the past 2 days accompanied by nausea. The client does not want to take aspirin. What should the nurse tell the client? A. Take two acetaminophen tablets. They are not as likely to upset your stomach. B. I think your HCP should see you today. Can you come to the clinic first thing in he morning. C. You need to lie down and rest. Have you tried placing a cool compress over your head? D. I will ask the HCP to call in a prescription for nausea meds. What is your pharmacy's number?

B

A woman is diagnosed with complete molar pregnancy. The nurse understands that the woman requires more teaching when she makes which statement? A. I need to make follow-up appointments to have my hormones checked B. I know the placenta caused problems, and my baby died in my uterus C. I plan to get pregnant again next year D. I understand I may develop a serious type of cancer

B

A woman who is Rh negative has given birth to an Rh-positive infant. The nurse explains to the client that she will receive Rho Immune globulin. The nurse determines that the client understands the purpose of the treatment when she reports that the purpose of the treatment is what? A. Protecting her next baby if it is Rh negative B. Preventing antibody formation in her blood C. Preventing antigen formation in her baby's blood D. Preventing jaundice in her baby

B

Which statement by the client indicates an understanding of the teaching regarding the use of corticosteroids during preterm labor? A. I will be taking corticosteroids until my baby's due date so that he or she will have the best chance of doing well B. The corticosteroids may help my baby's lungs mature C. The goal of the corticosteroids is to stop contractions and help me get to my due date D. If I take corticosteroids, my baby will not have to spend any time in the neonatal ICU when he or she is born

B

A client at 28 weeks gestation presents to the ER with a splitting headache. Which actions are indicated by the nurse at this time? (Select all that apply) A. Reassure the client that headaches are a normal part of pregnancy B. Assess the client for vision changes or epigastric pain C. Obtain a nonstress test D. Assess the client's reflexes and presence of clonus E. Determine if the client has a documented ultrasound for this pregnancy

B C D

A 16-year-old primigravida client at 37 weeks gestation with severe preeclampsia is in early active labor. The clients BP is 164/110 mmHg. Which finding would alert the nurse that the client may be about to experience a seizure? A. Decreased contraction contraction intensity B. Decreased temperature C. Epigastric pain D. Hyporeflexia

C

A multigravida client at 34 weeks gestation visits the hospital because she suspects that her water has broken. After testing the leaking fluid with nitrazine paper, the nurse confirms the client's membranes have ruptured when the paper turns what color? A. Yellow B. White C. Blue D. Red

C

A multigravida client is admitted to the hospital with a dx of ectopic pregnancy. The nurse anticipates that because the client's fallopian tube has not yet ruptured, which medication may be prescribed? A. Progestin contraceptives B. Medroxyprogesterone C. Methotrexate D. Dyphylline

C

A woman with preeclampsia is receiving magnesium sulfate via infusion pump at 1g/hr. The nurse's assessment includes temp (36.7C), pulse (78), RR (12), BP (128/82), urinary output 90 mL in last 4 hours via catheter, patellar-tendon reflex absent, ankle clonus absent, FHR 120 bpm, cervix 4 cm dilated, 80% effaced, station -1. What is the most appropriate action for the nurse to take? A. Assess the urinary catheter for kinks in the drainage tubing, and obtain a urine sample B. Document findings, and continue to monitor her progress in labor C. D/C the magnesium sulfate and notify the HCP D. Increase IV fluids and measure I&O

C

As the nurse enters the room of a newly admitted primigravida client diagnosed with severe preeclampsia, the client begins to experience a seizure. Which action should the nurse take first? A. Insert an airway to improve oxygenation B. Note the time the seizure begins and ends C. Call for immediate assistance D. Turn the client to the left side

C

Following a cesarean birth for abruptio placentae, a multigravid client tells the nurse, "I feel like such a failure. None of my other childbirths were like this." The nurse's response to the client is based on the understanding which of the following? A. The client will most likely have postpartum blues B. Maternal-infant bonding is likely to be difficult C. The client's feeling of grief is normal D. This type of birth was necessary to save the client's life

C

Several pregnant clients are waiting to be seen in the triage area of the obstetrical unit. What client should the nurse see first? A. A client at 13 weeks gestation who is experiencing nausea and vomiting three times a day with ketones in her urine B. A client with 37 weeks gestation who is an insulin-dependent diabetic and experiences 3-4 fetal movements a day C. Client at 32 weeks gestation who has preeclampsia and 3+ proteinuria and who is returning for an evaluation of epigastric pain D. A client at 17 weeks gestation who is not feeling fetal movement at this point in her pregnancy

C

The nurse is planning care for a multigravida client hospitalized at 36 weeks gestation with confirmed rupture of membranes and no evidence of labor. Which prescription would the nurse anticipate? A. Frequent assessments of cervical dilation B. Intravenous oxytocin administration C. Vaginal cultures for Neisseria Gonorrhoeae D. Sonogram for amniotic fluid volume index

C

When teaching a multigravida client diagnosed with mild preeclampsia about nutritional needs, the nurse should discuss which type of diet? A. High-residue diet B. Low-sodium diet C. Regular diet D. High-protein diet

C

A 27-year-old primigravida client with insulin-dependent diabetes at 34 weeks gestation undergoes a nonstress test, the results of which are documented as reactive. What should the nurse tell the client the results indicate? A. A contraction stress test is necessary B. The nonstress test should be repeated C. Chorionic villus sampling is necessary D. There is evidence of well-being

D

A client in sickle cell crisis has been hospitalized during her pregnancy. After giving discharge instructions, the nurse determines the client needs further teaching when she makes which statement? A. I will need more frequent appointments during the remainder of the pregnancy B. Signs of any type of infection must be reported immediately C. At the earliest signs of a crisis, I need to seek treatment D. I will need to take an iron supplement even if my lab values are normal

D

A primigravida client with a severe preeclampsia exhibits hyperactive, very brisk patellar reflexes with two beats of ankle clonus is present. How does the nurse document the patellar reflexes? A. 1+ B. 2+ C. 3+ D. 4+

D

A primigravida client with class II heart disease who is visiting the clinic at 8 weeks gestation tells the nurse that she has been maintaining a low-sodium, 1800-calorie diet. Which instruction should the nurse give the client? A. Avoid folic acid supplements to prevent megaloblast anemia B. Severely restrict sodium intake throughout the pregnancy C. Take iron supplements with milk to enhance absorption D. Increase caloric intake to 2200 calories daily to promote fetal growth

D

The nurse instructs a preeclampsia client about monitoring the movements of her fetus to determine well-being. Which statement by the client indicates that she needs further instruction about when to call the HCP concerning fetal movement? A. If the fetus is becoming less active than before B. If it takes longer each day for the fetus to move ten times C. If the fetus stops moving for 12 hours D. If the fetus moves more often than three times an hour

D

The nurse is receiving shift reports on four clients on the antenatal unit. The four clients are a 35-week-gestation mother with severe preeclampsia started on a maintenance dose of magnesium sulfate 1 hour ago, a 30-week-gestation client with preterm labor on oral tocolytic snd having no contractions in 6 hours, a hyperemesis client with emesis four times in the past 12 hours, and a 33-week-gestation client with placenta previa who began to feel pelvic procedure during change of shift report. Which actions should the nurse take first? A. Evaluate the client with preeclampsia for maternal and fetal tolerance of magnesium sulfate and labor pattern B. Assess the client with preterm labor for tolerance of tocolytics and the labor pattern C. Assess the client with hyperemesis for nausea, further emesis, or dehydration D. Evaluate the client with placenta previa w/o an exam

D

The nurse is working with four clients in the obstetrical unit. Which client will be the highest priority for a cesarean section? A. A client at 40 weeks gestation whose fetus weighs 8lbs by ultrasound estimate B. Client at 37 weeks gestation with fetus in the right occiput posterior position C. Client at 32 weeks gestation with fetus in breech position D. Client at 38 weeks gestation with active herpes lesions

D