OB ANTEPARTUM CARE NCLEX QUESTIONS
A nurse is assisting with the development of a plan of care for a pregnant client. The interdisciplinary team determines that the client will require more frequent prenatal visits based on which data gathered? 1. Blood type O-positive 2. First pregnancy at age 33 3. History of allergy to honey bee pollen 4. Type 1 diabetes
4. Type 1 diabetes A woman with a history of diabetes has an increased risk for perinatal complications, including hypertension, preeclampsia, and neonatal hypoglycemia; therefore, she needs to be more closely monitored. The age of 33 without other risk factors doesn't necessarily increase the client's risk, nor does having type-O positive blood or environmental allergens.
A client is diagnosed with an unruptured ectopic pregnancy. Which medication does the nurse expect to administer to the client? 1. Methotrexate 2. Labetalol 3. Magnesium sulfate 4. Indomethacin
1. Methotrexate Unruptured ectopic pregnancies can be treated with medication therapy, most commonly methotrexate. Labetalol is used to treat hypertension. Magnesium sulfate is used to treat preeclampsia and eclampsia. Indomethacin would be used to slow contractions of preterm labor.
A client who is 34 weeks' pregnant arrives at the emergency department with severe abdominal pain, uterine tenderness, and increased uterine tone between contractions, but no vaginal bleeding. The external fetal monitor shows fetal distress with severe, variable decelerations. Which condition does the nurse anticipate this client will be treated for? 1. Abruptio placentae 2. Ectopic pregnancy 3. Molar pregnancy 4. Placenta previa
1. Abruptio placentae A client with severe abruptio placentae will commonly have severe abdominal pain. The uterus will start to show signs of distress, with decelerations in the heart rate or even fetal death with a large placental separation. An ectopic pregnancy, which usually occurs in the fallopian tubes, would rupture well before 34 weeks. A molar pregnancy generally would be detected before 34 weeks' gestation. Placenta previa usually involves painless vaginal bleeding without uterine contractions.
A pregnant client is visiting the clinic and reports tiny, blanched, slightly raised-end arterioles on her face, neck, arms, and chest. The nurse documents this finding on the medical record as which condition? 1. Epulis 2. Linea nigra 3. Striae gravidarum 4. Telangiectasis
4. Telangiectasias The dilated arterioles that occur during pregnancy are due to the elevated level of circulating estrogen and are called telangiectasias. An epulis is a red raised nodule on the gums that may develop at the end of the first trimester and continue to grow as the pregnancy progresses. The linea nigra is a pigmented line extending from the symphysis pubis to the top of the fundus during pregnancy. Striae gravidarum, or stretch marks, are slightly depressed streaks that commonly occur over the abdomen, breasts, and thighs during the second half of pregnancy.
A client with a history of hypertension is 15 weeks' pregnant. For which condition should the nurse closely monitor this client? 1. Abruptio placentae 2. Preterm labor 3. Spontaneous abortion 4. Anemia
1. Abruptio placentae A history of hypertension predisposes the client to developing abruptio placentae. She isn't at risk for developing preterm labor, spontaneous abortion, or anemia.
A pregnant client in the second trimester is scheduled for amniocentesis. What should the nurse do to prepare the client for the procedure? (Select all that apply) 1. Ask the client to void. 2. Have the client drink 1 L of fluid. 3. Ask the client to lie on her left side. 4. Assess fetal heart rate. 5. Insert an IV catheter. 6. Monitor maternal vital signs.
1. Ask the client to void. 4. Assess fetal heart rate. 6. Monitor maternal vital signs. To prepare a client for amniocentesis, the nurse should ask her to empty her bladder to reduce the risk of bladder perforation. Before the procedure, the nurse should also assess fetal heart rate and maternal vital signs to establish baselines. The client should be asked to drink 1 L of fluid before transabdominal ultrasound, not amniocentesis. The client should be supine during amniocentesis; afterward, she should be placed on her left side to avoid supine hypotension, promote venous return, and ensure adequate cardiac output. IV access isn't necessary for this procedure.
A client, 8 weeks' pregnant, comes to the emergency department with reports of severe, stabbing, lower abdominal pain. A ruptured ectopic pregnancy is suspected based on which signs and symptoms? (Select all that apply) 1. Thready, rapid pulse 2. Increased blood pressure 3. Scant vaginal bleeding 4. Abdominal tenderness with distention 5. Referred shoulder pain
1. Thready, rapid pulse 3. Scant vaginal bleeding 4. Abdominal tenderness with distention 5. Referred shoulder pain Signs and symptoms associated with an ectopic pregnancy include a rapid, thready pulse and decreased blood pressure due to internal bleeding, scant vaginal bleeding, abdominal tenderness with distention, and referred shoulder pain due to irritation of the phrenic nerve.
A client is 33 weeks' pregnant and has had diabetes since age 21. When checking her fasting blood glucose level, which value would indicate the client's disease is controlled? 1. 45 mg/dL (2.5 mmol/L) 2. 85 mg/dL (4.7 mmol/L) 3. 120 mg/dL (6.67 mmol/L) 4. 136 mg/dL (7.56 mmol/L)
2. 85 mg/dL (4.7 mmol/L) The recommended fasting blood glucose level in the pregnant client with diabetes is 60-95 mg/dL (3.33 - 5.28 mmol/L). A fasting blood glucose level of 45 mg/dL (2.5 mmol/L) is low and may result in symptoms of hypoglycemia. A blood glucose level above below 120 mg/dL (6.67 mmol/L) is recommended for 2-hour postprandial values. A blood glucose level above 136 mg/dL (7. 56 mmol/L) in a pregnant client indicates hyperglycemia.
A pregnant client is screened for tuberculosis during her first prenatal visit. An intradermal injection of purified protein derivative (PPD) of the tuberculin bacilli is given. The nurse determines that the result is positive based on which findings? 1. An indurated wheal under 10 mm in diameter appearing in 6-12 hours 2. An indurated wheal over 10 mm in diameter appearing in 48-72 hours 3. A flat, circumscribed area under 10 mm in diameter appearing in 6-12 hours. 4. A flat, circumscribed area over 10 mm in diameter appearing in 48-72 hours
2. An indurated wheal over 10 mm in diameter appearing in 48-72 hours A positive PPD result would be indicated by an indurated wheal over 10 mm in diameter that appears in 48-72 hours. The area must be a raised wheal, not a flat, circumscribed area, to be considered positive. The test is read in 48 to 72 hours, not 6-12 hours.
A nurse is reinforcing education for a client entering the third trimester of pregnancy. The nurse determines that the client understands the education when stating she will immediately report which symptom? 1. Hemorrhoids 2. Blurred vision 3. Dyspnea on exerction 4. Increased vaginal mucus
2. Blurred vision During pregnancy, blurred vision may be a danger sign of preeclampsia or eclampsia, complications that require immediate attention because they can cause severe maternal and fetal consequences. Although hemorrhoids may occur during pregnancy, they don't require immediate attention. Dyspnea on exertion and increased vaginal mucus are common discomforts caused by physiologic changes.
A client is receiving IV magnesium sulfate for severe preeclampsia. While monitoring the client, the nurse would immediately report which finding? 1. Anemia 2. Decreased urine output 3. Hyperreflexia 4. Increased respiratory rate
2. Decreased urine output Magnesium is excreted through the kidneys, so a decreased urine output may result in retention of magnesium, which can accumulate to toxic levels. Urine output should be monitored closely and be greater than 30 mL/hour. Anemia isn't associated with magnesium therapy. Magnesium infusions may cause depression of deep tendon reflexes. The client should be monitored for respiratory depression and paralysis when serum magnesium levels reach approximately 15 mEq/L (7.5 mmol/L)
A client with preeclampsia is scheduled to undergo a nonstress test (NST) and asks the nurse why this is being performed. When responding to the client, which condition would the nurse most likely include as the reason? 1. Anemia 2. Fetal well-being 3. Intrauterine growth restriction (IUGR) 4. Oligohydramnios
2. Fetal well-being An NST is based on the theory that a healthy fetus has transient fetal heart rate accelerations with fetal movement. Because uteroplacental circulation is compromised in clients with preeclampsia, an NST would usually show a lack of these accelerations, which indicate a nonreactive NST. An NST can't detect anemia in a fetus. Serial ultrasounds will detect IUGR and oligohydramnious in a fetus.
A pregnant client who reports painless vaginal bleeding at 28 weeks' gestation is diagnosed with placenta previa, in which the placental edge reaches the internal os. The nurse would suspect the client has which type of placenta previa? 1. Low-lying placenta previa 2. Marginal placenta previa 3. Partial placenta previa 4. Total placenta previa
2. Marginal placenta previa A marginal placenta previa is characterized by implantation of the placenta in the margin of the cervical os, not covering the os. A low-lying placenta is implanted in the lower uterine segment but doesn't reach the cervical os. A partial placenta previa is the partial occlusion of the cervial os by the placenta. The internal cervical os is completely covered by the placenta in a total placenta previa.
A nurse is reinforcing the instructions given to a client in her education plan about the signs of labor. The nurse determines that the client has an accurate understanding of the instructions when which statement is made by the client? 1. "False contractions are regular" 2. "False contractions intensify with walking." 3. "False contractions usually occur in the abdomen." 4. "False contractions move from the back to the front of the abdomen."
3. "False contractions usually occur in the abdomen." False labor contractions are usually felt in the abdomen, are irregular, and are typically relieved by walking. True labor contractions move from the back to the front of the abdomen, are regular, and aren't relieved by walking.
A client hospitalized for premature labor tells the nurse she's having occasional contractions. Which nursing intervention would be most appropriate? 1. Inform the client about the possible complications of premature birth 2. Tell the client to walk around to see if she can get rid of contractions. 3. Give IV and oral fluids, encouraging her to empty her bladder 4. Notify the anesthesia department for immediate epidural placement for pain relief.
3. Give IV and oral fluids, encouraging her to empty her bladder An empty bladder and adequate hydration may help decrease or stop labor contractions. Educating the client on potential complications is likely to increase her anxiety rather than help her relax. Walking may encourage contractions to become stronger. It would be inappropriate to call the anesthesia department to have an epidural placed because further assessment of the contractions is necessary.
A nurse is discussing nutrition with a primigravida. The client states that she knows that calcium is important during pregnancy but that she and her family don't consume many milk or dairy products. What advice should the nurse give? 1. "The prenatal vitamins that are recommended will satisfy all dietary requirements." 2. "You could supplement your diet with 1,800 mg of over-the-counter calcium tablets." 3. "You should consumer other nondairy foods that are high in calcium." 4. "After the first trimester, calcium isn't as important since all fetal organ structures are formed."
3. "You should consumer other nondairy foods that are high in calcium." Food is considered the ideal source of nutrients. However, milk and dairy aren't the only food sources of calcium. The client should consume other nondairy foods that are high in calcium, such as dark green leafy vegetables. While prenatal vitamins are generally recommended, they don't satisfy all requirements. The calcium requirement for pregnancy is 1,300 mg/day. Over-the-counter supplements aren't always safe and should be specifically recommended by the health care provider. While it's true that all fetal organs are formed by the end of the first trimester, development continues throughout pregnancy. Calcium requirements remain at 1,300 mg/day throughout pregnancy.
When assisting with the education of an antepartum client on the passage of the fetus through the birth canal during labor, the nurse describes the cardinal mechanisms of labor. Places these events in the proper ascending chronological order. 1. Flexion 2. External rotation 3. Descent 4. Expulsion 5. Internal rotation 6. Extension
3. Descent 1. Flexion 5. Internal rotation 6. Extension 2. External rotation 4. Expulsion The fetus moving through the birth canal changes position to ensure that the smallest diameter of the fetal head always presents to the smallest diameter of the birth canal. Termed the cardinal mechanisms of labor, these position changes occur in this sequence: descent, flexion, internal rotation, extension, external rotation, and expulsion.
A client in her third trimester has come to the clinic for a routine check-up. The nurse reinforces the importance of lying on the left side when resting or sleeping. Which rationale should the nurse give to the client for this position? 1. It will relieve heartburn 2. It will facilitate bladder emptying 3. It will prevent compression of the vena cava 4. It will prevent the development of fetal anomalies
3. It will prevent compression of the vena cava The weight of the pregnant uterus is sufficiently heavy to compress the vena cava, which could impair blood flow to the uterus, and subsequently interfere with supplying sufficient oxygen to the fetus. The side-lying position, especially the left side-lying position, helps to prevent compression, thereby ensuring adequate blood flow and oxygenation to the fetus. The side-lying position hasn't been shown to prevent fetal anomalies, nor does it facilitate bladder emptying or heartburn.
A pregnant client at term is in early labor. Over the past 12 hours, she has been experiencing contractions every 10-12 minutes and has not progressed. The nurse would anticipate which medication as being prescribed to help stimulate uterine contractions? 1. Estrogen 2. Fetal cortisol 3. Oxytocin 4. Progesterone
3. Oxytocin Oxytocin is the hormone responsible for stimulating uterine contractions and may be given to clients to induce or augment uterine contractions. Although estrogen has a role in uterine contractions, it isn't given to help uterine contractility. Fetal cortisol is believed to slow the production of progesterone by the placenta. Progesterone has a relaxing effect on the uterus.
A nurse is collecting data as part of an initial history on a pregnant client. The client asks about the chances of having dizygotic twins. Which statement by the nurse would be most accurate? 1. They occur most frequently in Asian women. 2. There's a decreased risk with increased parity. 3. There's an increased risk with increased maternal age. 4. Use of fertility drugs poses no additional risk.
3. There's an increased risk with increased maternal age. Dizygotic twinning is influenced by race (most frequent in black women and least frequent in Asian women), age (increased risk with increased maternal age), parity (increased risk with increased with parity), and fertility drugs (increased risk with the use of fertility drugs, especially ovulation-inducing drugs). The incidence of monosygotic twins isn't affected by rave, age, parity, heredity, or fertility medications.
A pregnant client is concerned about lack of fetal movement. Which response by the nurse would be most therapeutic? 1. "You need to start taking additional prenatal vitamins." 2. "Try taking a warm bath to facilitate fetal movement." 3. "Eat foods that contain a high sugar content to stimulate the fetus." 4. "Lie down once a day and count the number of fetal movements for 15-30 minutes."
4. "Lie down once a day and count the number of fetal movements for 15-30 minutes." Instructing the client to lie down once during the day will allow her to concentrate on detecting fetal movement, making it easier to accomplish. The ability to feel fetal movement is reassuring and comforting to the mother. The mother who is up and actively walking around tends to soothe the fetus, resulting in sleep promotion. Instructing her to take an additional prenatal vitamin is beyond the nurse's scope of practice and isn't recommended because vitamins can be toxic. Taking a warm bath is likely to soothe and relax the fetus. There's also a risk for hyperthermia if the water is too warm or the client is immersed too long. Eating additional sugary foods isn't recommended because some pregnant clients are more susceptible to cavities. The additional sugar intake is not associated with stimulating fetal activity.
A client has just been diagnosed with having a hydatidiform mole. When reviewing the client's medical record, what is the most significant risk factor? 1. Age in 20s or 30s 2. High socioeconomic status 3. Primigravida 4. Prior molar gestation
4. Prior molar gestation A previous molar gestation increases a woman's risk for developing a subsequent molar gestation by four to five times. Adolescents and women age 40 years and older are at increased risk for molar pregnancies. Multigravidas, especially women with a prior pregnancy loss, and those with lower socioeconomic status are at an increased risk for this problem.
The nurse is gathering information from the chart of a pregnant client. Which finding would the nurse determine does not require intervention? 1. Cardiac tamponade 2. Heart failure 3. Endocarditis 4. Systolic murmur
4. Systolic murmur Systolic murmur is heard in up to 90% of pregnant clients, and the murmur disappears soon after the birth. Cardiac tamponade, which causes effusion of fluid into the pericardial sac, isn't normal during pregnancy. Despite the increases in intravascular volume and workload of the heart associated with pregnancy, heart failure isn't normal in pregnancy. Endocarditis is most commonly associated wtih IV drug use and isn't a normal finding in pregnancy.
A client with painless vaginal bleeding is suspected of having placenta previa. The nurse will assist in preparing the client for which procedure? 1. Amniocentesis 2. Speculum examination 3. External fetal monitoring 4. Ultrasound
4. Ultrasound When the mother and fetus are stabilized, ultrasound evaluation of the placenta should be done to determine the cause of bleeding. Amniocentesis is contraindicated in placenta previa. A digital or speculum examination shouldn't be done, as this may lead to severe bleeding or hemorrhage. External fetal monitoring won't detect a placenta previa, although it will detect fetal distress, which may result from blood loss or placental separation.
A nurse is teaching a group of pregnant adolescents about the anatomy and physiology of reproduction. The nurse determines that the teaching was effective when the adolescents identify the area where fertilization occurs. Which area is identified?
After ejaculation, the sperm travel by flagellar movement through the fluids of the cervical mucus into the fallopian tube to meet the descending ovum in the ampulla, where fertilization occurs.
The nurse is caring for a client suspected of having a hydatidiform mole. Which signs and symptoms would confirm this diagnosis? 1. Heavy, bright red bleeding every 21 days 2. Fetal cardiac motion after 6 weeks' gestation 3. Benign tumors found in the smooth muscle of the uterus 4. "Snowstorm" pattern on ultrasound with no fetus or gestational sac
4. "Snowstorm" pattern on ultrasound with no fetus or gestational sac Ultrasound is the technique of choice in diagnosing a hydatidiform mole. The chorionic villi of a molar pregnancy resemble a "snowstorm" pattern on ultrasound. Bleeding with a hydatidiform mole is usually dark brown and may occur erratically for weeks or months. There's no cardiac activity because there's no fetus. Benign tumors found in the smooth muscle of the uterus are leiomyomas or fibroids.
During an examination, a client who's 32 weeks' pregnant becomes dizzy, light-headed, and pale while supine. What should the nurse do first? 1. Listen to fetal heart tones. 2. Take the client's blood pressure 3. Ask the client to breathe deeply 4. Turn the client on her left side.
4. Turn the client on her left side. As the enlarging uterus increases pressure on the inferior vena cava, it compromises venous return, which can cause dizziness, light-headedness, and pallor when the client is supine. The nurse can relieve these symptoms by turning the client on her left side, which relieves pressure on the vena cava and restores venous return. Although they're valuable assessments, fetal heart tone and maternal blood pressure measurements don't correct the problem. Because deep breathing has no effect on venous return, it can't relieve the client's symptoms.
A client with diabetes in the late third trimester has a nonstress test (NST) twice weekly. The 20-minute test showed three fetal heart rate accelerations that exceeded the baseline by 15 beats/minute and lasted longer than 15 seconds. The nurse knows these results are consistent with which interpretation of a nonstress test? 1. Reactive test 2. Nonreactive test 3. Positive test 4. Negative test
1. Reactive test The nonstress test is the preferred anterpartum heart rate screening test for pregnant clients with diabetes. A reactive nonstress test is two or more fetal heart rate accelerations that exceed baseline by at least 15 beats/minute and last longer than 15 seconds within a 20-minute period. A nonreactive nonstress test lacks accelerations in the fetal heart rate with fetal movement. The terms positive and negative aren't used to describe the interpretation of nonstress tests.
The nurse is providing care to a pregnant adolescent client in her first trimester. Which intervention would the nurse identify as the highest priority? 1. Schedule the client for a screening glucose tolerance test 2. Make sure the client receives nutritional counseling and reinforce the education 3. Teach the client that she's at increased risk for having a macrosomic neonate 4. Monitor the client for signs and symptoms of placenta previa
2. Make sure the client receives nutritional counseling and reinforce the education Nutritional counseling must be emphasized as part of the prenatal care for adolescent clients. Adolescents need to meet nutritional needs for this rapid period of growth and development. The needs are further increased due to the pregnancy. Adolescents aren't at increased risk for developing gestational diabetes or placenta previa. Adolescent clients are at risk for developing low-birth-weight neonates, not macrosomic neonates.
A pregnant client at 12 weeks' gestation comes to the clinic for a follow up visit and tells the nurse that she is "feeling really constipated." Which suggestion would be appropriate for the nurse to give the client? (select all that apply) 1. "Make sure that you attempt to move your bowels regularly." 2. "Try increasing the amount of fruits and vegetables in your diet." 3. "Be sure to increase the amount of fluids that you drink each day." 4. "Use mineral oil as a gentle laxative to get things moving." 5. "An enema once a week should give you adequate relief."
1. "Make sure that you attempt to move your bowels regularly." 2. "Try increasing the amount of fruits and vegetables in your diet." 3. "Be sure to increase the amount of fluids that you drink each day." For constipation during pregnancy, appropriate suggestions would include making sure to attempt to move one's bowels regularly (i.e., making time to have a bowel movement), ingesting an increase in foods high in fiber (such as fruits and vegetables), and increasing the amount of fluid ingested each day. Mineral oil interferes with the absorption of fat-soluble vitamins and should be avoided. Enemas also should be avoided because they can stimulate labor.
A client with preeclampsia is prescribed magnesium sulfate to prevent seizure activity. The nurse is reviewing the results of the client's serum magnesium level and determines that the client's level is therapeutic based on which result? 1. 6.8 mEq/L (3.4 mmol/L) 2. 9.2 mEq/L (4.6 mmol/L) 3. 11.5 mEq/L (5.75 mmol/L) 4. 16 mEq/L (8 mmol/L)
1. 6.8 mEq/L (3.4 mmol/L) The therapeutic level of magnesium for clients with preeclampsia ranges 4-8 mEq/L (2-4 mmol/L). A serum magnesium level of 8-10 mEq/L (4-5 mmol/L) may cause the absence of reflexes in the client. Serum levels of 10-12 mEq/L (5-6 mmol/L) may cause respiratory depression, and a serum level of magnesium greater than 15 mEq/L (7.5 mmol/L) may result in respiratory paralysis.
A client with severe preeclampsia is receiving an intravenous infusion of magesium sulfate. The client is exhibiting signs and symptoms of magnesium toxicity. Which medication would the nurse expect to be given? 1. Calcium gluconate 2. Hydralazine 3. Naloxone 4. Rho(D) immune globulin
1. Calcium gluconate Calcium gluconate is the antidote for magnesium toxicity. Ten milliliters of 10% calcium gluconate is given by IV push over 3-5 minutes. Hydralazine is given for sustained elevated blood pressure in clients with preeclampsia. Naloxone is used to correct narcotic toxicity. Rho(D) immune globulin is given to women with Rh-negative blood to prevent antibody formation from Rh-positive conceptions.
A client has gestational diabetes. When assisting with developing the plan of care for this client, which therapy would the nurse most likely identify as important for this client to manage her glucose levels? 1. Diet 2. Long-acting insulin 3. Oral hypoglycemic drugs 4. Glucagon
1. Diet Clients with gestational diabetes are usually managed by diet alone to control their glucose intolerance. Long-acting insulin usually isn't needed for blood glucose control in the client with gestational diabetes. Oral hypoglycemic drugs are contraindicated in pregnancy. Glucagon raises blood glucose and is used to treat hypoglycemic reactions.
A client is pregnant with triplets and is at greater risk for complications. The nurse reinforces education about the signs and symptoms of which conditions? (Select all that apply) 1. Placenta previa 2. Preterm labor 3. Anemia 4. Hypertension of pregnancy 5. Hydatidiform mole
1. Placenta previa 2. Preterm labor 3. Anemia 4. Hypertension of pregnancy Women with multifetal preganancies are at greater risk for complications such a hypertension of pregnancy, placenta previa, preterm labor, and anemia. They are not considered to be a greater risk for the development of a hydatidiform mole.
A client arrives at the clinic for a scheduled amniocentesis. Which question should the nurse ask? 1. "Have you had at least 1 L of water to drink?" 2. "Have you emptied your bladder?" 3. "Did you fast for the last 12 hours?" 4. "Do you have any problems lying on your left side?"
2. "Have you emptied your bladder?" Before amniocentesis, the client should void to empty the bladder, reducing the risk of bladder perforation. The client doesn't need to drink fluids before amniocentesis nor does she need to fast. The client should be placed in a supine position for the procedure.
A pregnant client at 26 weeks' gestation undergoes a glucose tolerance test. The nurse identifies the need for further action based on which results? 1. A glucose level of 120 mg/dL (6.67 mmol/L) during a 1-hour glucose tolerance test 2. A 1-hour glucose level of 160 mg/dL (8.88 mmol/L) during a 3-hour glucose tolerance test 3. A 2-hour glucose level of 150 mg/dL (8.32 mmol/L) during a 3-hour glucose tolerance test 4. A 3-hour glucose level of 130 mg/dL (7.22 mmol/L) during a 3-hour glucose tolerance test
2. A 1-hour glucose level of 160 mg/dL (8.88 mmol/L) during a 3-hour glucose tolerance test Gestational diabetes is diagnosed when a 3-hour glucose tolerance test has a 1-hour glucose level of 140 mg/dL (7.78 mmol/L) or greater. Other diagnostic test indications of gestational diabetes include a 2-hour glucose level 165 mg/dL (9.16 mmol/L) during a 3-hour tolerance test; a 1-hour glucose test greater than 140 mg/dL (7.78 mmol/L); a 3-hour glucose tolerance test with a 2-hour glucose level of 165 mg/dL (9.16 mmol/L) or greater; or a 3-hour glucose tolerance test with a 3-hour glucose level of 145 mg/dL (8.06 mmol/L) or greater.
A client arrives at the emergency department reporting cramping, abdominal pain, and mild vaginal bleeding. Pelvic examination shows a left adnexal mass that's tender when palpated. Culdocentesis shows blood in the cul-de-sac. The nurse would suspect which condition? 1. Abruptio placentae 2. Ectopic pregnancy 3. Hydatidiform mole 4. Pelvic inflammatory disease
2. Ectopic pregnancy Most ectopic pregnancies don't appear as obvious life-threatening medical emergencies. Ectopic pregnancies must be considered in any woman of childbearing age who reports menstrual irregularity, cramping abdominal pain, and mild vaginal bleeding. Blood in the cul-de-save is typically not seen with pelvic inflammatory disease, abruptio placentae, and hydatidiform mole
A client, 6 weeks' pregnant, is diagnosed with hyperemesis gravidarum. The nurse should monitor the client for the development of which condition? 1. Bowel perforation 2. Electrolyte imbalance 3. Miscarriage 4. Gestational hypertension
2. Electrolyte imbalance Excessive vomiting in clients with hyperemesis gravidarum commonly causes weight loss and fluid, electrolyte, and acid-base imbalances. Gestational hypertension and bowel perforation aren't related to hyperemesis. The effects of hyperemesis on the fetus depend on the severity of the disorder. Clients with severe hyperemesis may have a low-birth-weight infant, but the disorder isn't generally life-threatening
A client's prenatal history shows her to be a 23-year-old gravida 4, para 2. The nurse has correctly interpreted this information when she makes this statement? 1. The client has been pregnant four time and had two miscarriages. 2. The client has been pregnant four times and delivered two live-born children. 3. The client has been pregnant four times and had two cesarean deliveries. 4. The client has been pregnant four times and had two spontaneous abortions.
2. The client has been pregnant four times and delivered two live-born children. Gravida refers to the number of times a client has been pregnant; para refers to the number of viable children born. Therefore, the client who's gravida 4, para 2 has been pregnant four times and delivered two live-born children.
A client in her fifth month of pregnancy is having a routine clinic visit. When gathering data from the client, the nurse would be alert for which common second trimester condition? 1. Mastitis 2. Metabolic alkalosis 3. Physiologic anemia 4. Respiratory acidosis
3. Physiologic anemia Hemoglobin level and hematocrit decrease during pregnancy as the increase in plasma volume exceeds the increase in red blood cell production. The result is physiologic anemia. Mastitis is an infection in the breast characterized by a swollen, tender breast and flulike symptoms. This condition is most commonly seen in breast-feeding clients. Alterations in acid-base balance during pregnancy result in a state of respiratory alkalosis, compensated by mild metabolic acidosis.
A pregnant client comes to the clinic for a follow-up visit and reports swelling in her feet and ankles. Which recommendation would be most appropriate for the nurse to suggest? 1. Limit oral fluid intake. 2. Buy a good pair of walking shoes. 3. Sit and elevate the feet at least twice daily. 4. Start taking a diuretic as needed daily.
3. Sit and elevate the feet at least twice daily. Sitting down and putting the feet up at least twice daily helps to promote venous return in the pregnant client and, therefore, decreases edema. Limiting fluid intake isn't recommended unless there are additional medical complications such as heart failure. Walking shoes won't necessarily decrease edema. Diuretics aren't recommended during pregnancy because it's important to maintain an adequate circulatory volume.
The nurse is providing care to a pregnant client with preeclampsia. Magnesium sulfate has been ordered. The nurse understands that this drug is being given to prevent which condition? 1. Hemorrhage 2. Hypertension 3. Hypomagnesemia 4. Seizures
4. Seizures For clients with preeclampsia, magnesium sulfate is believed to depress seizure foci in the brain and peripheral neuromuscular blockage, thus preventing eclampsia. Magnesium doesn't help prevent hemorrhage in clients with preeclampsia. Antihypertensive drugs other than magnesium are preferred for sustained hypertension. Hypomagnesemia isn't a complication of preeclampsia.
A nurse is assisting with the education of a client who receives a dose of human Rho(D) immune globulin at 28 weeks' gestation to prevent Rh isoimmunization. What should the nurse inform the client regarding the reason for administering the medication? 1. Rh-Positive maternal blood crosses into fetal blood, stimulating fetal antibodies. 2. Rh-Positive fetal blood crosses into maternal blood, stimulating maternal antibodies. 3. Rh-negative fetal blood crosses into maternal blood, stimulating maternal antibodies. 4. Rh-negative maternal blood crosses into fetal blood, stimulating fetal antibodies.
2. Rh-Positive fetal blood crosses into maternal blood, stimulating maternal antibodies. Rh isoimmunization occurs when Rh-positive fetal blood cells cross into the maternal circulation and stimulate maternal antibody production. In subsequent pregnancies with Rh-positive fetuses, maternal antibodies may cross back into the fetal circulation and destroy the fetal blood cells.
A client who is 27 weeks' pregnant arrives at her health care provider's office reporting fever, nausea, vomiting, malaise, unilateral flank pain, and costovertebral angle tenderness. About which condition does the nurse anticipate reinforcing education? 1. Asymptomatic bacteriuria 2. Bacterial vaginosis 3. Pyelonephritis 4. Urinary tract infection (UTI)
3. Pyelonephritis The symptoms indicate acute pyelonephritis, a serious condition in a pregnant client. Asymptomatic bacteriuria doesn't cause symptoms. Bacterial vaginosis causes milky-white vaginal discharge but no systemic symptoms. UTI symptoms include dysuria, urgency, frequency, and suprapubic tenderness.
A client in her early second trimester tells the nurse that she is experiencing a significant amount of heartburn. Which suggestion would be most appropriate for the nurse to make? (Select all that apply.) 1. Eat small, frequent meals throughout the day 2. Eat crackers on waking every morning. 3. Drink a preparation of salt and vinegar 4. Drink orange juice frequently during the day. 5. Keep the head of the bed elevated
1. Eat small, frequent meals throughout the day 5. Keep the head of the bed elevated Eating small, frequent meals and keeping the head of the bed elevated place less pressure on the esophageal sphincter, reducing the likelihood of the regurgitation of stomach contents into the lower esophagus. Eating crackers, drinking a salt and vinegar solution, or drinking orange juice have not been shown to decrease heartburn.
A pregnant client develops iron-deficiency anemia and is prescribed supplemental iron along with prenatal vitamins. After reviewing possible adverse effects of iron supplementation with the client, the nurse determines that the education was successful when the client identifies which adverse effect? (Select all that apply) 1. Gastric upset 2. Bright red blood in stools 3. Constipation 4. Anorexia 5. Metallic taste
1. Gastric upset 3. Constipation 4. Anorexia 5. Metallic taste Adverse effects of iron supplementation include gastric upset, nausea, vomiting, anorexia, diarrhea, metallic taste, and constipation. Typically, iron makes stools appear black and tarry. Bright red blood in the stools is not associated with iron therapy.
During a routine visit to the clinic, a client tells the nurse that she thinks she may be pregnant. Which pregnancy test result would the nurse identify as most accurate in confirming pregnancy? 1. Increase in human chorionic gonadotropin (HCG) 2. Decrease in HCG 3. Increase in luteinizing hormone (LG) 4. Decrease in LH
1. Increase in human chorionic gonadotropin (HCG) HCG increases in a woman's blood an uterine to fairly large concentrations until the 15th week of pregnancy. The other hormone values aren't indicative of pregnancy.
A client in her 24th week of pregnancy is exhibiting signs and symptoms of preeclampsia. The nurse would be alert for which finding indicating that the client has developed eclampsia? 1. Seizures 2. Headaches 3. Blurred vision 4. Weight gain
1. Seizures The primary difference between preeclampsia and eclampsia is the occurrence of seizures, which occur when the client develops eclampsia. Headaches, blurred vision, weight gain, increased blood pressure, and edema of the hands and feet are all indicative of preeclampsia.
Antepartum testing from a client pregnant with twins reveals a twin-to-twin transfusion syndrome. The nurse is assisting with development of a plan of care. Which condition will the nurse likely provide interventions for? 1. Anemia 2. Oligohydramnios 3. Polycythemia 4. Small size
3. Polycythemia the recipient twin in twin-to-twin transfusion syndrome (also known as twin-twin transfusion syndrome) is transfused by the other twin. The recipient twin then becomes polycythemic and commonly as heart failure due to circulatory overload. The donor twin becomes anemic. The recipient twin has polyhydramnios, not oligohydramnios. The recipient twin is usually large, whereas the donor twin is usually small in size.
A pregnant client is obese. The nurse is working as part of the interdisciplinary team developing the client's plan of care. Based on the understanding of potential complications, the nurse would expect to monitor the client closely for which condition on follow-up visits? 1. Mastitis 2. Placenta previa 3. Preeclampsia 4. Rh isoimmunization
3. Preeclampsia The incidence of preeclampsia in obese clients is significantly greater than in a pregnant client who is not obese. Placenta previa, mastitis, and Rh isoimmunization aren't associated with increased incidence in pregnant clients who are obese.
A client is diagnosed with placenta previa at 28 weeks' gestation. Which procedure should the nurse prepare the client for? 1. Stat culture and sensitivity 2. Antenatal steroids after 34 weeks' gestation 3. Ultrasound examination every 2-3 weeks 4. Scheduled birth of the fetus before fetal maturity
3. Ultrasound examination every 2-3 weeks Fetal surveillance through ultrasound examination every 2-3 weeks is indicated to evaluate fetal growth, amniotic fluid, and placental location in clients with placenta previa being expectantly managed. A stat culture and sensitivity would be done for severe bleeding, or maternal or fetal distress, and isn't part of expectant management. Antenatal steroids may be given to clients between 26-32 weeks' gestation to enhance fetal lung maturity. In a hemodynamically stable mother, birth of the fetus should be delayed until fetal lung maturity is attained.
A pregnant client has a contraction stress test (CST). Which findings would the nurse interpret as indicative of a negative CST result? 1. Persistent late decelarations in fetal heartbeat occurred, with at least three contractions in a 10-minute window. 2. Accelerations of fetal heartbeat occurred, with at least 15 beats/minute, lasting 15 to 30 seconds in a 20-minute window. 3. Accelerations of fetal heartbeat were absent or didn't increase by 15 beats/minute for 15 to 30 seconds in a 20-minute period. 4. There was moderate fetal heart rate variability, and no decelerations from contraction, in a 10-minute period in which there were three contractions.
4. There was moderate fetal heart rate variability, and no decelerations from contraction, in a 10-minute period in which there were three contractions. A CST measures the fetal response to uterine contractions. A client must have three contractions in a 10-minute period. A negative CST shows moderate fetal heart rate variability with no decelerations from uterine contractions. Persistent late decelerations with contractions is a positive CST. Reactive nonstress test (NSTs) show accelerations in the fetal heartbeat of at least 15 beats/minute, lasting 15-30 seconds in a 20-minute period. No accelerations in the heartbeat of at least 15 beats/minute, for 15 to 30 seconds in a 20-minute period, indicate a nonreactive NST.
A client is diagnosed with hyperemesis gravidarum after coming to the antepartum unit with persistent vomiting, weight loss, and hypovolemia. While gathering data from the client, which information is most significant? 1. Trophoblastic disease 2. Maternal age older than 35 years 3. Malnutrition 4. Low levels of human chorionic gonadotropin (HCG)
1. Trophoblastic disease Trophoblastic disease is associated with hyperemesis gravidarum. Obesity and maternal age younger than 20 years are risk factors for developing hyperemesis gravidarum. High levels of estrogen and HCG have been associated with hyperemesis.
