EAQ #3

The nurse is performing a physical assessment of a pregnant woman. Which factor in the client's history increases the risk for abruptio placentae? 1 Hydramnios 2 Hypertension 3 Cardiac disease 4 Diabetes mellitus

Hypertension

Two days after delivery a client has a temperature of 101° F (38.3° C), general malaise, anorexia, and chills. Which clinical finding does the nurse expect to identify on the client's laboratory report? 1 Increased hemoglobin level 2 Decreased C-reactive protein 3 Increased white blood cell (WBC) count 4 Right-shift differential WBC count

increase in WBC

A client has been receiving oxytocin to augment labor. For what adverse reaction caused by a prolonged oxytocin infusion should the nurse monitor the client?

water intoxication

During which period of pregnancy would functional disabilities in a fetus's brain occur via fetal exposure to a teratogenic agent? 1 Fetal period 2 Presomite period 3 Embryonic period 4 Preimplantation period

1. fetal period Teratogenic exposure during the fetal period may cause functional disabilities of the brain in the fetus, such as learning deficits and behavioral abnormalities. Gross malformations due to teratogenic exposure are seen in the embryonic period. Teratogenic exposure during the presomite period or preimplantation period may result in the death of the fetus.

Which statement related to breast-feeding is correct? 1 Protein soluble drugs can enter breast milk. 2 Drugs with a long half-life should be avoided. 3 Mothers should take drugs prior to breast-feeding. 4 Drug usage during lactation is safe because the drugs will not harm the baby.

2. Drugs with a long half-life should be avoided Drugs with a longer half-life stay in the body for a longer time and may enter the breast milk, which can produce unwanted pharmacologic effects in the child. Therefore drugs with a longer half-life should be avoided. Lipid soluble drugs can enter the breast milk. Mothers should take drugs immediately after breast-feeding to reduce the possibility of drugs entering the breast milk. Although the concentration of drugs entering breast milk is very low, drug usage should be minimized during lactation to prevent any unknown harmful effects on the newborn.

Which drug is contraindicated during pregnancy but can be safely used by lactating mothers? 1 Tetracycline 2 Lithium 3 Carbamazepine 4 Diethylstilbestrol

3. Carbamazepine Carbamazepine may cause neural tube defects when used during pregnancy but can be safely used by a lactating mother. Tetracycline is contraindicated in pregnant clients and in lactating clients. Lithium should not be given to either pregnant or lactating mothers. Diethylstilbestrol cannot be given for pregnant clients and lactating mothers because it may cause vaginal carcinoma and its level in the breast milk may be high.

What is the drug of choice for a client who wants to abort her pregnancy at three months of gestation? 1 Nifedipine 2 Terbutaline 3 Mifepristone 4 Methylergonovine

3. Mifepristone

Which drug has an effect opposite to that of misoprostol? 1 Nifedipine 2 Mifepristone 3 Indomethacin 4 Dinoprostone

3. indomethacin

A client with a history of endometriosis gives birth to a healthy infant. She expresses concern that the problems associated with endometriosis will return now that her pregnancy is over. What is the best response by the nurse response? A. "Pregnancy usually cures the problem." B. "Endometriosis usually causes early menopause." C. "You may need a hysterectomy if the problems recur." D. "Breastfeeding will delay the return of the endometriosis."

Breastfeeding will delay the return of endometriosis Lactating delays ovarian function during the postpartum period, therefore delaying endometriosis

While receiving betamimetic (tocolytic) therapy for preterm labor, the client begins to experience muscle tremors and exhibit signs of nervousness. She reports, "My heart is racing." The nurse identifies that the client's pulse rate is 110 beats/min and regular. What should the nurse do next?

Reassure the client that these are expected side effects of the medication. Tachycardia is a common side effect of tocolytics...should only discontinue if pulse is >120

Within minutes of giving birth to a healthy infant, the client displays symptoms of respiratory distress. An amniotic fluid embolism is suspected. In addition to respiratory distress, for what other complication should the nurse assess the client? 1 Hypertension 2 Uterine atony 3 Thrombophlebitis 4 Uncontrolled bleeding

4. uncontrolled bleeding - amniotic fluid embolism is where amniotic fluid is released into mom's blood stream - causes an anaphylactic reaction (SOB, tachypnea, hemorrhage)

Which intervention should the nurse perform when a pregnant woman is exposed to a teratogen? 1 Advise the client to terminate the pregnancy 2 Provide sufficient intravenous fluids to eliminate the teratogenic drug 3 Reassure the client that the drug-induced malformation is minimal during organogenesis 4 Determine the temporal relation between the occurrence of pregnancy and administration of the drug

4.

Which drug should be excluded from the prescription of a lactating mother being treated for heart problems? 1 Tenormin 2 Labetalol 3 Metoprolol 4 Propranolol

1. Tenormin Propanolol is the beta blocker of choice in breastfeeding. Metoprolol is considered a low risk. atenolol is favored least

Intravenous magnesium sulfate therapy is instituted for a client with severe preeclampsia who has a blood pressure of 170/110 mm Hg, a pulse of 108 beats/min, and a respiratory rate of 24 breaths/min. Eight hours later her blood pressure is 150/110 mm Hg, the pulse is 98 beats/min, the respiratory rate is 10 breaths/min, and the knee-jerk reflex is absent. What should the nurse do next? 1 Stop the infusion of magnesium sulfate and notify the primary healthcare provider. 2 Administer calcium gluconate, because it is an antidote to magnesium sulfate. 3 Continue the magnesium sulfate infusion, because the blood pressure is still high. 4 Check vital signs and reflexes in 1 hour and then discontinue the infusion if necessary.

1. stop the infusion and inform the provider - stop mag sulf if resp <12, UOP <100 mL/4 hrs, absent DTRs (knee-jerk reflexes)

A registered nurse teaches a nursing student about the effects of aspirin in pregnant women. Which statement made by the nursing student indicates a need for further teaching? 1 "Aspirin may reduce a fever." 2 "Aspirin may cause Reye syndrome." 3 "Aspirin may increase the risk of bleeding." 4 "Aspirin may suppress labor contractions."

2. aspirin may cause reye syndrome

What is the action of oxytocin in a pregnant client at term? 1 Ejection of milk 2 Induction of labor 3 Induction of abortion 4 Control of uterine bleeding

2. induction of labor

A nurse withholds methylergonovine maleate from a postpartum client. What clinical finding supports the withholding of the medication? 1 Urine output of 50 mL/hr 2 Third-degree perineal laceration 3 Blood pressure of 160/90 mm Hg 4 Respiratory rate of 12 breaths/min

3. Hypertension *HTN is an adverse effect of methergine (used for uterine atony >> stop bleeding)

A pregnant client has labor pains. However, the nurse finds that the client's cervix is not dilated. Which drug should be administered to the client to promote labor? 1 Oxytocin 2 Nifedipine 3 Dinoprostone 4 Methylergonovine

3. dinoprostone Dinoprostone induces cervical ripening. This action helps in the induction of labor at term. Oxytocin enhances labor when uterine contractions are weak and ineffective. Nifedipine is a calcium channel blocker used to maintain pregnancy during preterm labor. Methylergonovine reduces postpartum hemorrhage.

A 31-year-old client is seeking contraceptive information. Before responding to the client's questions about contraceptives, the nurse obtains a health history. What factor in the client's history indicates to the nurse that oral contraceptives are contraindicated? 1 Older than 30 years 2 Current hypothyroidism 3 Two multiple pregnancies 4 Blood pressure 162/110

4. Blood pressure 162/110

The nurse is caring for a pregnant client with type 1 diabetes. Which complication is the result of type 1 diabetes? A) Increased risk of hypertensive states B) Abnormal placental implantation C) Excessive weight gain because of increased appetite D) Decreased amount of amniotic fluid as the pregnancy progresses

A. increased risk of hypertensive states likelihood of gestational hypertension increases fourfold with patients with DM

In her 37th week of gestation, a client with type 1 diabetes has undergone an amniocentesis to determine fetal lung maturity. The lecithin/sphingomyelin ratio is 2:1, phosphatidylglycerol is present, and creatinine is 2 mg/dL (180 mcmol/L). What conclusion should the nurse draw from this information? 1 A cesarean birth will be scheduled. 2 A birth must take place immediately. 3 The fetus need not be monitored any longer. 4 The newborn should be free from respiratory problems.

Newborn should be free from respiratory problems

A client at 26-weeks' gestation arrives at the clinic for her scheduled examination. Her blood pressure is 150/86 mm Hg. She tells the nurse that she has gained 5 lb (2.3 kg) in the last 2 weeks. What is the priority nursing action? 1 Testing the client's urine for albumin 2 Taking the client's body temperature 3 Preparing the client for a vaginal examination 4 Scheduling the client for an appointment in a week

Testing the client's urine for albumin Protein in the urine is an indication of preclampsia, as well as weight gain of more than 2lbs per week and increased blood pressure

A 29-weeks pregnant client reports dull backache pain and abdominal cramps. Which condition does the nurse suspect? 1 Preterm labor 2 Uterine atony 3 Uterine fibroids 4 Pelvic inflammatory disease

preterm labor

What is the priority for nursing care following an amniocentesis? 1 Giving perineal care after the procedure 2 Encouraging lots of fluids every hour 3 Changing the abdominal dressing 4 Monitoring for signs of uterine contractions

4. monitoring for uterine contractions -It is possible that stimulation of the uterus resulting from the amniocentesis will cause uterine contractions. Perineal care is not necessary because an amniocentesis is not done by way of the vagina.

Which oxytocic drug may help to control uterine bleeding post-delivery and promote milk ejection?

oxytocin