Maternal Child 5-6 High Risk Pregnancy

A nurse suspects that there is cephalopelvic disproportion in a client who is having difficult labor. For which test should the nurse prepare the client?

a. Ultrasound

A 38-year-old client attends the prenatal clinic for the first time. A nurse explains that several tests will be performed, one of which is the serum alpha-fetoprotein test. The client asks what the test will reveal. What should the nurse include in the reply?

c. Open neural tube defects

A patient tells a nurse in the prenatal clinic that she has vaginal straining but no pain. Her history reveals amenorrhea for the last 2 months and pregnancy confirmation after her spontaneous abortion. What type of abortion is suspected?

c. Threatened

A nurse is assessing a patient with a tentative diagnosis of hydatidiform mole. Which clinical finding should the nurse anticipate?

c. Unusual uterine enlargement

A client at 9 weeks' gestation asks the nurse in the prenatal clinic if she can have her chorionic villi sampling (CVS) done at this visit. At what week gestation should the nurse respond is the best time for this test?

b. 10 weeks and less than 12 weeks

During a routine visit to the prenatal clinic, a client listens to the fetal heartbeat for the first time. The client, commenting on how rapid it is, appears frightened and asks whether this is normal. How should the nurse respond?

a. "The heart rate is usually rapid and is in the expected range."

A patient at 37 weeks' gestation is admitted to the birthing unit from the emergency department. She had arrived by ambulance after a motor vehicle accident. Her vital signs are BP: 90/60; P: 108; R: 24. She is reporting sharp abdominal pain. What is the priority nursing intervention at this time?

a. Apply an electronic fetal monitor

A nurse is caring for a woman with cholelithiasis and obstructive jaundice. When assessing this patient, the nurse should be alert for which common clinical indicators associated with these conditions? Select all that apply.

a. Ecchymosis b. Yellow sclera e. Pain in right upper quadrant

A nurse notifies the health care provider that a patient has been admitted to the high-risk unit in her 36th week of gestation. She is bleeding, has severe abdominal pain and a rigid fundus, and is demonstrating signs of shock. For what intervention should the nurse prepare?

b. An immediate cesarean birth

A nurse is preparing a teaching plan for a pregnant patient with a history of cholelithiasis. Which information about why the ingestion of fatty foods will cause discomfort should the nurse include in the teaching plan?

b. Bile flow into the intestine is obstructed

Which clinical indicator should the nurse identify before scheduling a patient for an endoscopic retrograde cholangiopancreatography (ERCP)?

b. Bilirubin level

A patient at 37 weeks' gestation arrives at the emergency department stating that she has abdominal pain but no vaginal bleeding. The health care provider diagnosis abruptio placentae. The patient asks the nurse why it is so painful. What should the nurse consider is the initial cause of the abdominal pain before responding in language the patient will understand?

b. Concealed hemorrhage

Sonography of a primigravida who is at 15 weeks´ gestation reveals a twin pregnancy. The nurse reviews with the client the risks of multiple pregnancies that were explained by the health care provider. Which condition does the client identifier that indicates the need for further instruction about complications associated with multiple gestations?

b. Down syndrome

What assessment finding of a pregnant patient should alert the nurse to notify the health care provider?

b. Fundal height at the umbilicus at 16 weeks' gestation

A nurse is counseling a woman who was just diagnosed with multiple gestations. Why does the nurse consider this pregnancy high risk?

b. Perinatal mortality is two to three times greater in multiple than in single births

A client is a preterm labor at 35 weeks' gestation asks the nurse, "What determines whether my baby's lungs will be okay?" The nurse explains that a test of the amniotic fluid obtained through an amniocentesis will reflect fetal lung maturity. Which test should the nurse include in the discussion?

b. Phosphatidylglycerol (PG) test

A patient at 28 weeks' gestation has a sonogram. The results reveal a small-for-gestational-age (SGA) fetus and low-lying placenta. For what complication should the nurse assess this patient during the last trimester of pregnancy?

b. Placenta previa

A healthcare provider orders a contraction stress test (CST) for a client whose nonstress test (NST) was nonreactive. Which maternal complications should alert the nurse to question the order? Select all that apply.

b. Preterm labor d. Incompetent cervix e. Premature rupture of membranes

What does a nurse anticipate will be provided for a newborn of a mother with a history of long-standing diabetes?

b. Special high-risk care

A nurse is monitoring a patient with severe preeclampsia who is receiving an infusion of magnesium sulfate. Assessment reveals a pulse rate of 55/minute, respirations of 12/minute, and a flushed face. What is the next nursing action?

b. Stop the infusion and start an infusion of dextrose and water.

A client in the 18th week of pregnancy is scheduled for ultrasonography. What instruction should the nurse give the client?

c. "Don't urinate for at least 3 hour before the test."

A client who is scheduled for an amniocentesis state, "I'm glad this test will be able to tell whether my baby is well or not." How should the nurse respond?

c. "This test is useful in detecting potential defects due to chromosomal errors."

A 16-year-old adolescent visits the prenatal clinic because she has missed three menstrual periods. Before her physical examination, she says, "I don't know what the problem is, but I can't be pregnant." What is the nurse's most therapeutic response?

c. "Why did you decide to come to the prenatal clinic?"

When does a nurse caring for a patient with eclampsia determine that the risk for another seizure has subsided?

c. 48 hours postpartum

What should a nurse anticipate about the insulin requirements of a woman with diabetes on her first postpartum day?

c. A sharp and sudden decrease

Which sign or symptom leads a nurse to suspect that a patient has a tubal pregnancy?

c. A sharp lower right or left abdominal pain radiating to the shoulder

What nursing intervention is specific for patients with cardiac problems who are in active labor?

c. Auscultating the lungs for crackles every 30 minutes

What nursing intervention should be included when caring for a patient with placenta previa?

c. Documentation of the amount of bleeding

A nurse is reviewing the obstetric history of a patient who had an abruptio placentae. What prenatal condition does the nurse expect the patient to have had?

c. Gestational hypertension

A nurse in the prenatal clinic is caring for a patient with heart disease who is in the second trimester. What hemodynamic of pregnancy may affect the patient at this time?

c. Heart rate acceleration in the last half of pregnancy

A patient is receiving magnesium sulfate therapy for severe preeclampsia. What initial sign of toxicity should alert the nurse to intervene?

c. Lack of the knee-jerk reflex

A patient with class 1 heart disease is admitted to the birthing suite in active labor. In what position should the nurse place the patient?

c. Left lateral with head elevated

An 18-year-old pregnant woman in her first trimester is admitted with an acute onset of right lower quadrant pain at the McBurney point. Appendicitis is suspected. For which clinical indicator should the nurse assess the patient to determine whether the pain is secondary to appendicitis?

c. Rebound tenderness

A teenager at 32 weeks' gestation is hospitalized with preeclampsia. She is anorexic and appears depressed. Which comment indicates to the nurse that further exploration of the client's emotional status is indicated?

d. "I was really happy before I got pregnant."

A client is scheduled for a nonstress test in the 37th week of gestation. A nurse explains the procedure. Which statement demonstrates that the client understands the teaching?

d. "If the heart reacts well, my baby should do okay when I give birth."

After the incomplete abortion, a patient tells a nurse that although her health care provider explained what an incomplete abortion was, she did not understand. What is the nurse's best response?

d. "This is when the fetus is expelled but other parts of the pregnancy remain in the uterus."

A patient in the prenatal clinic is diagnosed with preeclampsia. What clinical findings support this diagnosis?

d. Blood pressure more than 140 mm Hg systolic accompanied by proteinuria

A few hours after being admitted to the hospital with a diagnosis of inevitable abortion, a patient at 16 weeks' gestation begins to experience bearing-down sensations and suddenly expels the products of conception in bed. What should the nurse do first?

d. Check the patient's fundus for firmness

A patient is scheduled for a sonogram at 36 weeks' gestation. Shortly before the test, she tells the nurse that she has severe abdominal pain. Assessment reveals heavy vaginal bleeding, a drop in blood pressure, and an increased pulse rate. What complication does the nurse suspect?

d. Complete abruptio placentae

A patient admitted with preeclampsia is receiving magnesium sulfate. Which assessment indicates that a therapeutic level of the medication has been reached?

d. Deep tendon reflexes of +2

What is the initial responsibility of a nurse when teaching the pregnant adolescent?

d. Encouraging her to continue regularly scheduled prenatal care

A patient who had a severe abruptio placentae asks the nurse why there was so much bleeding. What should the nurse consider is the cause of the heavy bleeding before responding in language the patient will understand?

d. Hypofibrinogenemia

A 42-year-old client has an amniocentesis during the 16th week of gestation because of concern about Down syndrome. What additional information about the fetus will examination of the amniotic fluid reveal at this time?

d. Neural tube defect

A nurse is monitoring a patient with severe preeclampsia for the onset of eclampsia. What clinical finding indicates an impending seizure?

d. Rolling of the eyes to one side with a fixed stare

A patient is admitted to the birthing suite with a blood pressure of 150/90 mm Hg. 3+ proteinuria, and edema of the hands and face. A diagnosis of severe preeclampsia is made. What other clinical findings support this diagnosis? Select all that apply.

a. Headache c. Abdominal pain e. Visual disturbance

A nurse is caring for a patient who had a spontaneous abortion. For what complication should the nurse assess this patient?

a. Hemorrhage

A nurse anticipates that newborns of mothers who have diabetes often have tremors, periods of apnea, cyanosis, and poor sucking ability. With what complication are these signs associated?

a. Hypoglycemia

The nurse is counseling a pregnant patient with type 1 diabetes about medication changes as the pregnancy progresses. Which medication will be needed in increased dosages during the second half of her pregnancy?

a. Insulin

A pregnant patient with a history of rheumatic heart disease since childhood is concerned about the birth of her baby and asks what to expect. What should a nurse explain about birth? Select all that apply.

a. Labor may be induced c. Birth may be vacuum extraction assisted d. Regional anesthesia may be administered

A patient with the diagnosis of severe preeclampsia is admitted to the hospital from the emergency department. What precaution should the nurse initiate?

a. Pad the side rails on the bed

A patient arrives at the hospital at 38 weeks' gestation with profuse vaginal bleeding. She states that it occurred suddenly without any contractions. Which condition may the patient be experiencing that requires immediate notification of the health care provider?

a. Placenta previa

Which woman should the nurse identify is at risk for developing a hypertensive disorder of pregnancy?

a. Primigravida who is obese

A nurse in the birthing unit is caring for several clients. Which factor should the nurse anticipate will increase the risk for hypotonic uterine dystocia?

a. Twin gestation

A client pregnant with twins is told by the health care provider that she is at risk for postpartum hemorrhage. Later, the client asks the nurse why she is at risk for hemorrhage. What should the nurse consider is the cause of the postpartum hemorrhage before responding in language the client will understand?

a. Uterine atony

A nurse is obtaining the health history from a patient with a diagnosis of a ruptured tubal pregnancy. At what point in the pregnancy does the nurse expect the patient to state when the low abdominal pain and vaginal bleeding started?

b. About the sixth week of pregnancy

A pregnant patient with class II heart disease is concerned that her pregnancy will be an added burden on her already compromised heart. A nurse explains that during pregnancy the cardiac system is most compromised during the what?

d. First 2 days after the birth

A couple who recently emigrated from Israel tells a nurse in the prenatal clinic that they are concerned about a genetic disease that is prevalent among Jewish people. Which genetic test should the nurse recommend to determine the possibility of their child inheriting the disease?

d. Tay-Sachs disease

How should a nurse screen a newborn of a diabetic mother for hypoglycemia?

d. Test heel blood with a glucose-oxidase strip

When caring for a woman who had a positive contraction stress test (CST), what complication does the nurse suspect?

d. Uteroplacental insufficiency

A nurse is caring for a patient who had a spontaneous abortion. The patient asks why spontaneous abortions occur. The nurse responds that they are most commonly caused by what?

d. subinvolution