NCLEX Maternity: Antepartum
What are measures to reduce morning sickness?
- Eating several small meals during the day (ie, high in protein or carbohydrates and low in fat) - Drinking fluids (preferably clear, cold, carbonated beverages) between, rather than with, meals - Having a high-protein snack before bedtime and on awakening - Consuming foods/drinks with ginger (eg, ginger tea, ginger lollipops, ginger chews) - Consuming foods high in vitamin B6 (eg, nuts, seeds, legumes)
How many lbs per week does the mother gain in the second trimester?
1 lb per week
A client indicates the desire to become pregnant. Which of the following are important preconception education topics for the nurse to provide?
1) Aim for BMI between 18.5-24.9 2) Avoid alcohol and tobacco consumption 3) Ensure daily intake of 400 mcg of folic acid 4) Schedule dental wellness appointment 5) Obtain testing for rubella immunity
When can the FHR be detected on doppler?
10-12 weeks
At what week can gender of the fetus be determined?
12 weeks
When are first fetal movements felt?
16 - 20 weeks
When can feeling light fetal movements be expected?
16 - 20 weeks
When is the first ultrasound done to record proper fetal anatomy?
18 - 20 weeks
When are strep B cultures taken?
35-37 weeks
At what week can fetal heart tones be heard?
7 weeks
When is the screening test for PKU done?
At 2 to 3 days of life, or after enough breast milk or formula, usually after 24 hours, is ingested to allow for determination of body's ability to metabolize amino acid phenylalanine
Where is the fundus at 38-40 weeks?
At 38-40 weeks, the fetus engages into the maternal pelvis and the fundal height drops.
The nurse is providing nutrition counseling during a preconception visit to a client who does not eat green vegetables. In addition to a daily prenatal vitamin, which foods can the client add to the daily diet to decrease the risk of neural tube defects?
Black beans and rice Fortified breakfast cereal and milk Peanut butter on whole wheat toast
The nurse is reinforcing instructions to a client at 34 weeks gestation who is preparing to travel by airplane. Which of the following instructions are appropriate?
Carry a copy of your most up to take prenatal record Increase fluid intake before and during the flight Secure lap belt below the abdomen and across the hips Wear compression hose and loose fitting clothing
The nurse receives report on 4 first-trimester pregnant clients. Which client should the nurse assess first?
Client with ectopic pregnancy who reports shoulder pain
What are complications of preeclampsia?
Complications of preeclampsia include eclampsia, placental abruption, and HELLP (Hemolysis, Elevated Liver enzymes, Low Platelets) syndrome.
The nurse is obtaining a client's history during an initial prenatal visit. The client's last menstrual period was from March 1 to March 5. Unprotected intercourse occurred on March 15. Slight vaginal spotting was noted on March 23. The client's menstrual cycles are regular and 28 days long. Using the Nägele rule, what is the estimated date of birth?
December 8th - EDB = (LMP − 3 months) + 7 days.
A 37-weeks-pregnant woman comes to the emergency department with a fractured ankle. Which assessment finding is most concerning and requires the nurse to follow up?
FHR of 206 - Sustained fetal tachycardia (>160/min for >10 minutes) is a concerning finding that requires further follow-up.
The nurse is caring for a client who expresses concern about some missed birth control pill doses a few months ago. The client has resumed taking the pills as prescribed but suspects she may be pregnant. Which finding is the best indicator that the client is pregnant?
Fetal movement palpated by the provider
A client at 20 weeks gestation states that she started consuming an increased amount of cornstarch about 3 weeks ago. Based on this assessment, the nurse should anticipate that the health care provider will order which laboratory test(s)?
H and H - Pica is the constant craving for and consumption of nonfood and/or nonnutritive food substances that may occur in pregnancy. It may be accompanied by iron deficiency anemia. Hemoglobin and hematocrit levels are useful in these clients to screen for anemia.
Where is the fundus at 16 weeks?
Halfway between the symphysis pubis and the umbilicus
1 hour GTT test results
If glucose is above 140 the patient needs further testing with 2 - 3 hour GTT. If it is below 140 the patient does not need any further testing.
A couple is excited about finding out the sex of their baby during ultrasound at 14 weeks gestation. What is the nurse's best response?
If the baby is in the right position, the genitalia may be visualized on ultrasound
A nurse is caring for a pregnant client at 27 weeks gestation after a motor vehicle collision with side airbag deployment. The client's blood type is O negative. Which laboratory test should the nurse anticipate?
Indirect coombs test
When are infants born to HIV positive mothers tested again for the disease?
Infants are tested for HIV infection at birth and again at age 1 and 4 months. - Identification of HIV-negative status requires 2 consecutive negative results at age ≥1 month and ≥4 months.
The nurse is caring for a client in the first trimester during an initial prenatal clinic visit. Based on the information provided by the client, which factor places the client at an increased risk for preterm labor?
Infection (eg, periodontal disease, urinary tract infection) places pregnant clients at increased risk for preterm labor and birth. Other risk factors include history of preterm birth, previous cervical surgery, tobacco/illicit drug use, and maternal age <17 or >35.
A pregnant client comes in for a routine first prenatal examination. According to the last menstrual period, the estimated gestational age is 12 weeks. Where would the nurse expect to palpate the uterine fundus in this client?
Just above the symphisis pubis
The nurse performs initial assessments of four clients in a prenatal clinic. Which client findings are abnormal and require further assessment?
Patient at 20 weeks gestation with an increase in diastolic pressure of 15 - An increase in BP of ≥30 mm Hg systolic or ≥15 mm Hg diastolic over pre/early-pregnancy measurements requires further assessment.
The clinic nurse is collecting data on a pregnant client in the first trimester. Which finding is most concerning and warrants priority intervention?
Patient is taking lisinopril to control HTN - Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are teratogenic and need to be discontinued when planning pregnancy.
What is cervical cerclage?
Placed to prevent preterm delivery, usually in clients with histories of second trimester loss or premature birth. A heavy suture is placed transvaginally or transabdominally to keep the internal cervical os closed.
The nurse is counseling a pregnant client who is HIV positive. Which information is appropriate to discuss?
Prescribed ART should be taken during pregnancy
A client who is 8 weeks pregnant reports morning sickness. What is the most appropriate response by the nurse?
Suggest client eat high protein snacks upon waking
Do newborns receive ART after birth?
Yes, for at least 4-6 weeks after birth to reduce the chance of developing HIV infection.
A pregnant client in the first trimester tells the clinic nurse she will be traveling to an area with a known Zika virus outbreak and expresses concern regarding disease transmission. Which statement by the nurse is most appropriate?
You should consider postponing the trip until after you have the baby
Guidlines for 1 hr GTT
can be done nay time of day does not require fasting occurs at 24-28 weeks gestation
What does HELLP syndrome stand for?
hemolysis, elevated liver enzymes, low platelets
What weight gain should be expected during the first trimester?
Weight gain during the first trimester should be approximately 1.1-4.4 lb (0.5-2.0 kg). A 10 lb (4.5 kg) weight gain during the first three months of pregnancy would be excessive for any client.
When triaging 4 pregnant clients in the obstetric clinic, the nurse should alert the health care provider to see which client first?
3rd trimester client with RUQ pain and nausea - This is an indicator of HELLP syndrome
The obstetric nurse is reviewing phone messages. Which client should the nurse call first?
The patient who is taking ibuprofen for moderate back pain - Nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in the third trimester due to risk of premature closure of the fetal ductus arteriosus. NSAIDs should be taken only under the direction and supervision of a health care provider during the first and second trimesters.
The graduate nurse (GN) is caring for a client at 20 weeks gestation with secondary syphilis. The client reports an allergic reaction to penicillin as a child but does not know what kind of reaction occurred. When discussing the client's potential treatment plan with the precepting nurse, which statement by the GN indicates an appropriate understanding?
The patient will require penicillin desensitization to receive appropriate treatment
What is the therapeutic range for magnesium in preeclampsia?
The therapeutic level of magnesium for pre-eclampsia/eclampsia treatment is 4-7 mEq/L (2.0-3.5 mmol/L).
A pregnant client at 39 weeks gestation is brought to the emergency department in stable condition following a motor vehicle collision. The client, who is secured supine on a backboard, suddenly becomes pale with a blood pressure of 88/50 mm Hg. Which action should the nurse take first?
Tilt the backboard to one side - During stabilization of a pregnant client after trauma, uterine displacement is the first step to prevent/correct supine hypotension and promote blood circulation to the fetus. - A lateral tilt of the backboard can correct aortocaval compression while protecting the client from further spinal injury.
What drugs are used to suppress uterine contractions? (tocolytics)
nifedipine indomethacin terbutaline magnesium sulfate
When is Rhogam given?
o Given at 28 weeks and also within 72 hours of delivery o Also given after abortion, ectopic pregnancy, amniocentesis
A 14-year-old client confides to the school nurse that she is about 22 weeks pregnant and has not had prenatal care. Which topics are most important and priorities for the nurse to discuss with the client in anticipation of referral for prenatal care?
sexual abuse family and social support nutrition and prenatal vitamins
Where is the fundus at 20 - 22 weeks?
umbilicus
Where is the fundus at 36 weeks?
xiphoid process
When is screening for gestational diabetes done?
24 - 28 weeks
What is required for 2-3 hour GTT?
A 2- or 3-hour GTT requires the nurse to obtain fasting and hourly blood samples.
What are the 2 main complications for oligohyrdaminios?
1) Pulmonary hypoplasia - due to the lack of normal alveolar distension by aspirated amniotic fluid. Therefore, additional neonatal personnel should attend the birth in anticipation of possible resuscitation. 2) Umbilical cord compression - continuous (not intermittent) fetal monitoring should be applied to monitor for variable decelerations.
A client at 35 weeks gestation is admitted to the labor and delivery unit for severe pre-eclampsia. She is started on IV magnesium sulfate for seizure prophylaxis. Which of the following signs indicate that the client has developed magnesium sulfate toxicity?
1) patellar reflexes 0/4 2) respirations of 10 3) serum mag level of 8.0
The nurse is admitting a client at 41 weeks gestation for induction of labor due to oligohydraminios. Considering the client's indication for induction, what should the nurse anticipate?
Additional neonatal personnel for birth - this is due to the complications of oligohydraminios
How should fundal height correlate with the number of weeks a women is pregnant?
After 20 weeks gestation, the fundal height measurement in centimeters should correlate closely with the number of weeks pregnant (eg, 24 cm = 24 weeks).
What is the general rule for correlation of fundal height in centimeters and weeks?
After 20 weeks gestation, the fundal height, measured in centimeters from the symphysis pubis to the top of the fundus, correlates closely to the weeks of gestation.
The nurse is preparing a nutritional teaching plan for a client planning to become pregnant. Which foods would best prevent neural tube defects?
Fortified cereals - Women who are planning to become pregnant should consume 400-800 mcg of folic acid daily to prevent neural tube defects (eg, spina bifida, anencephaly). Food options that are rich in folic acid include fortified grain products (eg, cereals, bread, pasta) and green, leafy vegetables.
The nurse is caring for a client with intense nausea and occasional vomiting during an initial prenatal visit. The client is at 12 weeks gestation based on the last menstrual period. Which additional finding is most important to report to the health care provider?
Fundus is palpable between the symphysis pubis and the umbilicus (should be this at 16 weeks) - A fundal height that does not match the expected height for a particular gestational age may indicate an incorrect gestational age, multifetal gestation (eg, twins), or molar pregnancy and requires priority assessment by the health care provider
A pregnant client provides the following obstetric history to the nurse at the first prenatal visit: Elective abortion at age 17; a 5-year-old daughter born at 40 weeks gestation; and 3-year-old twin boys born at 34 weeks gestation. Using the GTPAL system, which option is correct?
G4 T1 P1 A1 L3 - G - gravida indicates the number of pregnancies, delivered or undelivered; T - term deliveries are from 37 wk 0 days and beyond; P - preterm deliveries are from 20 wk 0 days to 36 wk 6 days gestation; A - abortions (spontaneous or elective) occur prior to 20 wk 0 days gestation; and L - living children are counted individually regardless of multiple birth status
What discharge teaching should the nurse give after cervical cerclage?
Following cerclage placement, discharge teaching includes recognizing and reporting signs of preterm labor (eg, low back aches, contractions, pelvic pressure) or rupture of membranes and understanding activity restrictions (eg, bed rest for a short time after placement).
The nurse is assessing a client at 36 weeks gestation during a routine prenatal visit. Which statement by the client should the nurse investigate first?
I have noticed decreased kicking movements as the baby grows bigger
The nurse is teaching a client, gravida 1 para 0, at 8 weeks gestation about expected weight gain during pregnancy. The client's pre-pregnancy BMI is 21 kg/m2. Which statement by the client indicates an appropriate understanding about weight gain?
I will expect to gain about 30 lbs during pregnancy
The nurse provides discharge instructions to a client at 14 weeks gestation who has received a prophylactic cervical cerclage. Which client statement indicates an understanding of teaching?
I will notify my HCP if I have lower back aches
A nurse is measuring a uterine fundal height for a client who is at 36 weeks gestation in supine position. The client suddenly reports dizziness and the nurse observes pallor and damp, cool skin. What should the nurse do first?
Place patient in lateral position - Supine hypotensive syndrome is usually seen in the third trimester of pregnancy when the weight of the uterine contents compresses the inferior vena cava. The resultant maternal hypotension is best treated initially by turning the client to the right or left side to relieve pressure on the vena cava.
When does placement of cervical cerclage occur if needed?
Placement occurs at 12-14 weeks gestation for clients with a history of cervical insufficiency (ie, painless, premature cervical dilation and miscarriage or preterm delivery) or up to 23 weeks gestation if signs of cervical insufficiency (eg, short cervix) are noted.
Pregnant patient who has low H and H
Pregnant women experience an increase in total blood volume to meet the increased oxygen demand and nutritional needs of the growing fetus and maternal tissues. The increase in plasma volume is greater than the increase in red blood cells, creating a hemodiluted state termed physiologic anemia of pregnancy, which is reflected in decreased hemoglobin (>11.0 g/dL [>110 g/L]) and hematocrit (>33% [0.33]) values.
A pregnant client at 30 weeks gestation comes to the prenatal clinic. Which vaccines may be administered safely at this prenatal visit?
TDAP and IM flu - live virus vaccines are contraindicated during pregnancy (influenza nasal spray; measles, mumps, and rubella (MMR) vaccine; and varicella)
What is an indirect coombs test?
detects antibodies that *can* adhere to *other person's* RBCs (e.g., test an Rh - woman for Rh + antibodies). Indirect Coombs testing screens for Rh sensitization in Rh-negative mothers.
How is fundal height measured?
in centimeters from the top of the symphysis pubis to the top of the fundus - Empty bladder before measuring
