NU472 Week 7 EAQ Evolve Elsevier: Optional/Practice for HESI Maternity Exam

Which symptom of mild anxiety would the nurse expect from the client at 6 weeks' gestation who appears mildly anxious as she waits for her first obstetric appointment? o Dizziness o Breathlessness o Abdominal cramps o Increased alertness

o Increased alertness · Increased alertness is an expected common behavior that occurs in new or different situations when a person is mildly anxious. Dizziness, breathlessness, and abdominal cramps are all common signs of moderate to severe anxiety.

A client is scheduled to have breast augmentation surgery in the outpatient surgical unit. Which discharge instructions would the nurse provide? Select all that apply. One, some, or all responses may be correct. o "Avoid taking aspirin or other nonsteroidal anti-inflammatory drugs (such as ibuprofen) for pain relief." o "Sleep with your head and torso elevated for at least 1 week." o "Sleep on your back or sides but not on your stomach." o "Begin slowly raising your arms over your head after the first week." o "Take your temperature daily and notify the clinic if it goes above 99.6°F (37.6°C)."

o "Avoid taking aspirin or other nonsteroidal anti-inflammatory drugs (such as ibuprofen) for pain relief." o "Sleep with your head and torso elevated for at least 1 week." o "Take your temperature daily and notify the clinic if it goes above 99.6°F (37.6°C)." · Nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided because of their anticoagulant effects. Elevating the head and torso will reduce edema at the surgical site. Checking the temperature will help identify the presence of infection. The side-lying position may be traumatic to the surgical area; the client should sleep on her back. Raising the arms above the head may cause movement of the pectoralis muscle and could result in trauma to the surgical area; the arms should not be raised above the head for a minimum of 3 weeks.

Which instruction would the nurse give to the pregnant client with anemia? o Take an iron and calcium supplement together daily. o Drink orange juice with an iron supplement. o Include fresh fruit at every meal. o Include 4 servings of calcium-rich foods daily.

o Drink orange juice with an iron supplement. · The vitamin C in orange juice aids in absorption of iron, which is used to treat anemia. Taking calcium at the same time as iron will reduce absorption of the iron. Fresh fruits are recommended in pregnancy but are not a primary source of iron. Including calcium-rich foods is also recommended, but this does not address anemia.

Which would the nurse plan to monitor in the newborn with a cephalohematoma? o Hyperbilirubinemia o Caput succedaneum o Subgaleal hemorrhage o Acute bilirubin encephalopathy

o Hyperbilirubinemia · A cephalohematoma is a collection of blood between a skull bone and its periosteum. As a hematoma resolves, hemolysis of the red blood cells (RBCs) occurs, which can contribute to hyperbilirubinemia. Caput succedaneum is generalized, easily identified edema most commonly found on the occiput. A subgaleal hemorrhage is bleeding into the subgaleal compartment as a result of traction or the application of shearing forces to the scalp. Acute bilirubin encephalopathy occurs as a result of increased levels of unconjugated bilirubin left untreated.

On the first postpartum day, a client whose infant is rooming in asks the nurse to return her baby to the nursery and bring the baby to her only at feeding times. Which response would the nurse provide? o "It seems that you've changed your mind about rooming in." o "I think you're having difficulty caring for the baby." o "All right. I'll inform the other nurses of your decision." o "You must be tired. I'll bring the baby back at feeding time."

o "It seems that you've changed your mind about rooming in." · Stating that it seems that the client has changed her mind opens communication and allows the client to verbalize her thoughts and feelings. Stating that the client is having difficulty caring for the baby is judgmental; there is not enough information for the nurse to make this assumption. Stating the intention of informing the other nurses of the client's decision does not give the client the opportunity to verbalize her feelings and needs. Although the client may be tired, stating as much ignores the client's needs and cuts off communication.

A pregnant client tells the nurse, "I'm sticking to my diet, and I don't eat anything containing salt." How would the nurse respond? o "You're doing fine. Just keep up the good work." o "A low-salt diet will protect you from getting swollen feet." o "We now encourage pregnant women to increase their salt intake because of changes in the circulation." o "Salt is necessary in your diet. Use a little when you're cooking, but avoid processed meats and canned foods with salt."

o "Salt is necessary in your diet. Use a little when you're cooking, but avoid processed meats and canned foods with salt." · Sodium is important in the diet of a pregnant woman and so she is counseled to continue moderate sodium intake. Blood volume increases during pregnancy; sodium is required to maintain physiological edema in interstitial spaces so blood volume is not depleted. High-sodium processed meats and canned foods with added salt are discouraged in diets for all adults, not just pregnant women. Telling the client that she is doing fine is false reassurance. Salt restriction does not prevent swollen feet, other peripheral edema, or preeclampsia. Increasing salt intake during pregnancy is unnecessary, as there is enough salt in the average diet to meet the increased sodium needs of pregnant women.

A 37-year-old G3P2001 client with hypertension and type 1 diabetes with good glycemic control is seen in the antepartum testing unit for a nonstress test (NST) at 36 weeks. Her obstetric (OB) history includes an intrauterine fetal death at 38 weeks. What risk factors in the client's history indicate the need for an NST? Select all that apply. One, some, or all responses may be correct. o Age older than 35 years o The risk for placenta previa o The risk for placental insufficiency o A history of stillbirth from her last pregnancy o Hypertension o Type 1 diabetes

o Age older than 35 years o The risk for placental insufficiency o A history of stillbirth from her last pregnancy o Hypertension o Type 1 diabetes · This client has multiple risk factors that would indicate the need for an NST to evaluate fetal status. Maternal age over 35 is considered advanced maternal age and is associated with a slightly increased risk of stillbirth and fetal growth restriction. The history of a prior stillbirth increases her risk of stillbirth in the current pregnancy. This client also has diabetes and hypertension, both of which put her at risk for placental insufficiency. Although advanced maternal age increases the risk of placenta previa, it is not the primary reason for having an NST.

A neonate born at 35 weeks' gestation has Apgar scores of 8 and 9. At 4 hours of age, the newborn begins to experience respiratory distress, has a below-normal temperature in a warm environment, and has a low blood glucose level. Which condition is the nurse concerned about based on these findings? o Hypoglycemia o Bacterial sepsis o Cocaine withdrawal o Meconium aspiration

o Bacterial sepsis · Preterm neonates react to infection with respiratory distress and subnormal temperatures. Although hypothermia is one sign of hypoglycemia, the newborn is not exhibiting other signs, such as tremors and lethargy. Four hours of age is too early for signs of cocaine withdrawal to occur. The data do not indicate that meconium was present at birth.

The nurse is assessing a client who is being admitted for surgical repair of a rectocele. Which signs or symptoms would the nurse expect the client to report? Select all that apply. One, some, or all responses may be correct. o Painful intercourse o Crampy abdominal pain o Bearing-down sensations o Urinary stress incontinence o Recurrent urinary tract infections

o Painful intercourse o Bearing-down sensations · The posterior vaginal wall is pushed forward by the herniation of the rectum; this protrusion causes painful intercourse, increases rectal pressure, and causes the bearing-down sensation. A rectocele is not accompanied by abdominal pain. Urinary stress incontinence is the primary sign of a cystocele. A cystocele, not a rectocele, is associated with urinary tract infections.

Which is the most common complication for which the nurse must monitor preterm infants? o Hemorrhage o Brain damage o Respiratory distress o Aspiration of mucus

o Respiratory distress · Immaturity of the respiratory tract in preterm infants is evidenced by a lack of functional alveoli, smaller lumina with increased possibility of collapse of the respiratory passages, weakness of respiratory musculature, and insufficient calcification of the bony thorax, leading to respiratory distress. Hemorrhage is not a common occurrence at the time of birth unless trauma has occurred. Brain damage is not a primary concern unless severe hypoxia occurred during labor; it is difficult to diagnose at this time. Aspiration of mucus may be a problem, but generally the air passageway is suctioned as needed.

The mammography results for a 37-year-old client with a breast mass are inconclusive. The client is undergoing further diagnostic tests to determine whether the mass is malignant. Which information would the nurse take into consideration before planning health teaching for this client? o Squamous cell carcinomas are neoplasms arising from glandular tissues. o Results of a biopsy are necessary before a specific form of therapy is selected. o Mammograms should be repeated to confirm the presence of malignancies. o Waiting for several weeks before receiving confirmation of cancer is helpful to the client.

o Results of a biopsy are necessary before a specific form of therapy is selected. · The therapy selected depends on whether there is a malignancy and, if so, the type of cancer cells, the extent of nodal involvement, and the presence and extent of metastasis. Adenocarcinomas, not squamous cell carcinomas, arise from glandular tissue; squamous cell carcinomas arise from epithelial tissue. Repeating a mammogram would only delay diagnosis. Only a biopsy will confirm the diagnosis of a malignancy. Waiting several weeks for a diagnosis is not advisable; an extended waiting period increases the client's stress and anxiety.

The electronic fetal monitor on a client receiving an infusion of oxytocin (Pitocin) displays contractions every 2 minutes and lasting 95 seconds. Which is the appropriate nursing action? o Stop the oxytocin (Pitocin) infusion. o Administer oxygen at 8 to 10 L/min. o Increase the main line fluid delivery rate to 150 mL/hr. o Prepare the client for insertion of an intrauterine pressure catheter.

o Stop the oxytocin (Pitocin) infusion. · The contraction pattern indicates hyperstimulation of the uterus. Stopping the oxytocin (Pitocin) infusion permits relaxation of the uterus and perfusion of the placenta. Oxygen cannot reach the placenta until the uterus is relaxed, so administering oxygen will not help. Increasing the rate of delivery of the main line fluid does not affect hyperstimulation of the uterus. Insertion of an intrauterine pressure catheter will only provide measurement of the internal uterine pressure and will not affect uterine contractions.