OB Chapter 22
The maternal health nurse is performing an assessment on a 42-year-old pregnant client. Which statement(s) will the nurse use to best determine the client's family profile? Select all that apply. "How is the health of your family members?" "Do you work outside of the home?" "How do you feel about the pregnancy?" "Who do you consider your support system?" "Are you taking any medications or herbal supplements?"
"Do you work outside of the home?" "Who do you consider your support system?" The family profile is an aspect of the health history, which should be obtained with the assessment of the pregnant client. Asking the client about her source of income and support system are aspects of the family profile. The health of the woman's family members is nonessential information and may not be asked at this time. Asking the woman about how she feels about her pregnancy and the types of medications or herbs she is taking is important; however, these questions do not relate to the family profile aspect of the assessment.
A nurse is teaching a pregnant adolescent at the clinic about nutrition. Which response by the client best shows the nurse's teaching is understood? "I know, it is my responsibility to care for this baby." "I know from reading your pamphlets that there are many food choices in each nutrition group." "I know, I read the pamphlets about diet and health." "I know that you want me to limit snacks and fast food."
"I know from reading your pamphlets that there are many food choices in each nutrition group." Nutrition in teen pregnancy is a big problem. Teens typically do not eat well normally, let alone during pregnancy, mostly because of their poor knowledge about nutrition. Teens sometimes have little choice in what foods are available at home too. The nurse who educates the teen about the range of possible choices from nutritious food groups will help the teen make good selections from what is offered. Scolding the teen about the responsibility of motherhood or the intake of snacks and fast food is not therapeutic. Educating the client about diet and health is appropriate, but informing about choices to aid in nutrition is best.
The maternal health nurse is caring for a pregnant client of advanced maternal age. The client asks the nurse about preventative measures to decrease the risk of the development of varicose veins. Which teaching(s) will the nurse include? Select all that apply. "Put your prescribed support stockings on in the morning before getting out of bed." "Rest in a side-lying position to ensure adequate vein drainage." "Increase your intake of vitamin B6, which strengthens the vein walls." "Elevate your legs on a foot stool while sitting at your desk." "Sit with your legs crossed at the knees instead of the ankles."
"Put your prescribed support stockings on in the morning before getting out of bed." "Rest in a side-lying position to ensure adequate vein drainage." "Elevate your legs on a foot stool while sitting at your desk." Prevention of varicose veins in pregnancy includes various teaching for the pregnant client. The nurse should advise the client to rest in the side-lying position to ensure adequate vein drainage. The client should be told to avoid crossing the legs and to use a footstool while sitting. The nurse should advise the client to increase intake of vitamin C, which strengthens the vein walls. If the client is prescribed support stockings, the nurse should advise the client to put on the stockings in the morning before getting out of bed.
The maternal health nurse is caring for an adolescent client whose pregnancy was just confirmed at the health clinic. The client tells the nurse, "Please do not tell my mom about this." How should the nurse respond? Select all that apply. "The law protects your privacy and your mom does not need to know." "The law allows your mom access to your record if she asks for it." "Your mom should know about this so that she can help you." "If you do not want your mom to know, she does not need to." "Why don't you want your mom to know?"
"The law protects your privacy and your mom does not need to know." "If you do not want your mom to know, she does not need to." The law protects the adolescent from revealing this information to her mother. A pregnant adolescent is considered an emancipated minor and access to her health information would need approval from the adolescent. The remaining answer choices are incorrect.
A pregnant adolescent tells the school nurse, "I want to go to the doctor and have her check my baby but I don't want to tell my parents and the doctor probably won't see me without them." What is the best response by the nurse? "I am sorry that you are in this situation, but it is important to see the doctor." "You are probably correct. Why don't you tell your parents and have them take you?" "I am sure your parents will be upset when they find out that you are pregnant but they will take you for health care." "You are considered emancipated and may receive health care for you and your baby without parental consent."
"You are considered emancipated and may receive health care for you and your baby without parental consent." The school nurse is most correct to provide the facts of emancipation to the student. It is also important to answer the adolescent's question. A pregnant adolescent is regarded as an emancipated minor or a mature minor—a person capable of making health care decisions—and so may sign permission for her own care. Stating that it is important to see a doctor does not answer the adolescent's question. Stating the nurse knows the reaction of her parents is not appropriate.
Why is it important for the nurse to obtain a baseline blood pressure and carefully monitor a pregnant adolescent's blood pressure carefully at each visit? Adolescents are more prone to pregnancy-induced hypertension than the average woman. Adolescents eat more junk food than the average woman. Adolescents may have low blood pressure, which is more common than in older women. Adolescents do not take prescribed antihypertensive medication on a regular basis.
Adolescents are more prone to pregnancy-induced hypertension than the average woman. Because adolescents are more prone to pregnancy-induced hypertension than the average woman, establishing a baseline blood pressure is important. It is particularly important if an adolescent has not had her blood pressure measured since a preschool or school-age checkup as long as 10 years earlier.
A 16-year-old sexually active female is being treated with isotretinoin for severe cystic acne. What instructions should the nurse give this client? Be sure to use two forms of birth control because this medication is teratogenic. Switch acne medication to a less harmful one, such as tetracycline. Make sure to use a condom to be protected from pregnancy. Isotretinoin is not harmful to a fetus if she should become pregnant.
Be sure to use two forms of birth control because this medication is teratogenic. Some adolescents take acne medication that is potentially teratogenic, such as tetracycline or isotretinoin.
A 40-year-old primipara has been in labor for 12 hours and is still only 6 centimeters dilated. What does the nurse understand may be the cause for this prolonged labor? Cervical dilation (dilatation) may not occur as spontaneously as in a younger woman. The client's uterus may be too relaxed. The client has cervical insufficiency. The client started pushing too early.
Cervical dilation (dilatation) may not occur as spontaneously as in a younger woman. Labor in an older primipara may be prolonged because cervical dilation (dilatation) may not occur as spontaneously as in a younger woman.
A client with a high thoracic spinal cord injury has just begun labor. She has an indwelling urinary catheter. Her blood pressure has skyrocketed to 300/160 mm Hg. Which of the following interventions should the nurse implement to address this complication? (Select all that apply.) Check the catheter for kinks. Anticipate the need for an antihypertensive agent. Remove the catheter. Elevate the client's head. Perform a blood glucose test. Administer an iron supplement.
Check the catheter for kinks. Anticipate the need for an antihypertensive agent. Elevate the client's head. In a woman who has a high spinal cord injury (cervical or high thoracic), observe for autonomic dysreflexia during pregnancy, labor, and the immediate postpartum period. Extreme symptoms such as severe hypertension (300/160 mm Hg), throbbing headache, flushing of the skin, and profuse diaphoresis above the level of the spinal lesion, nausea, and bradycardia may occur. Immediate action is necessary to protect against cerebrovascular accidents or intraocular damage. Elevate a woman's head to reduce cerebral pressure and locate the irritating stimulus (usually a distended bladder or bowel). If bladder distention is the cause, the woman needs bladder pressure relieved by catheterization if an indwelling catheter is not in place. If a catheter is in place, check to see why it is not draining, then encourage it to drain by unkinking or flushing to allow urine to flow freely again. Anticipate the need for an antihypertensive agent to alleviate the extreme hypertension, although as soon as the source of irritation is removed, symptoms typically fade quickly. The catheter should not be removed. Performing a blood glucose test and administering an iron supplement are not indicated in this case, as neither hyperglycemia nor anemia is evident.
A nurse is working with a pregnant adolescent with iron deficiency. The client states taking an iron supplement daily, but the client still appears pale and fatigued after 2 weeks of use. How can the nurse evaluate compliance with the medication regimen? Select all that apply. Draw a complete blood count (CBC). Take a stool sample. Draw a chemistry panel. Draw a serum reticulocyte count. Draw a total iron-binding capacity (TIBC) level.
Draw a complete blood count (CBC). Take a stool sample. Draw a serum reticulocyte count. Supplements such as iron pills are prescribed to enhance nutrient density in the body by providing an additional source. One way to evaluate compliance to the medication regimen is to analyze various laboratory values. The nurse is correct to correlate compliance with physiologic changes seen after ingesting iron. An elevated reticulocyte count will indicate that the client has been taking the supplement. A black tinge in the stool will also signify that the client has been taking the iron supplement. A complete blood count (CBC) measures hemoglobin, and an increase in hemoglobin would be a sign that the client has taken the supplement. A chemistry panel measures liver enzymes, kidney functioning, and electrolytes but is not reflective of ingesting an iron supplement. Total iron-binding capacity (TIBC) measures the body's capacity to carry iron, not that the iron count has elevated. Neither the TIBC nor the chemistry panel would be helpful in determining whether the adolescent is taking the iron supplement.
Several nurses in the community are forming a task force to assist with achieving the nation's goal of improving the health of women with special needs during pregnancy. What interventions can these nurses provide to help meet this goal? Select all that apply. Assist with finding the best hospital to deliver a child. Educate regarding the psychological and physical effects of teenage pregnancy. Report pregnant women whom the nurses suspect are abusing substances. Educate about the dangers of substance abuse. Educate about accident prevention.
Educate regarding the psychological and physical effects of teenage pregnancy. Educate about the dangers of substance abuse. Educate about accident prevention. Nurses can help the nation achieve this goal by teaching about accident prevention, the dangers of substance abuse, and the complications, both psychological and physical, of teenage pregnancy.
What is the priority action by a nurse who recognizes that a pregnant client with a cervical spine injury is experiencing autonomic dysreflexia? Administer an antihypertensive medication ordered by the physician. Notify the physician. Apply oxygen. Elevate the head of the bed.
Elevate the head of the bed.
What is the priority action by a nurse who recognizes that a pregnant client with a cervical spine injury is experiencing autonomic dysreflexia? Administer an antihypertensive medication ordered by the physician. Apply oxygen. Notify the physician. Elevate the head of the bed.
Elevate the head of the bed. Immediate action is necessary to protect against cerebrovascular accident or intraocular damage. Elevate the woman's head to reduce cerebral pressure and locate the irritating stimulus.
The nurse is teaching parents of a pregnant teen about the developmental tasks of adolescence. Which tasks would the nurse review? Select all that apply. Emancipate from parents. Adjust to a new body image. Choose a vocation. Establish a sense of self-worth or a value system. Bond with a life partner.
Emancipate from parents. Adjust to a new body image. Choose a vocation. Establish a sense of self-worth or a value system. The developmental tasks of the average adolescent are fourfold: to establish a sense of self-worth or a value system, to emancipate from parents, to adjust to a new body image, and to choose a vocation.
The maternal health nurse is caring for a pregnant woman with a physical disability. Which action is the nurse's priority when caring for the client? Establish the impact of the disability on the woman's lifestyle. Compare the disability with that of others with similar disabilities. Determine the length of time the woman has had the disability. Assess the severity of the disability.
Establish the impact of the disability on the woman's lifestyle. The priority of care for a pregnant client with a disability is to determine the impact of the disability on the woman's lifestyle. The remaining answer choices are not individualized for the client and it is important for the nurse to understand that disabilities vary with every person who has the disability.
A pregnant woman with a spinal cord injury is in labor and fully dilated but cannot adequately push the baby through the birth canal. What should the nurse do next? Increase the pitocin drip to strengthen the force of contraction. Prepare the client for a cesarean birth. Place the client in the knee-chest position. Apply strong fundal pressure.
Prepare the client for a cesarean birth. Women with muscle spasticity or spinal cord injury may not be able to push effectively for the second stage of labor and so may need cesarean or forceps birth.
The nurse is caring for a pregnant client considered at high-risk for pregnancy complications. What nursing action(s) included in the plan of care help achieve a positive outcome? Select all that apply. Provide time for the client and support person to ask questions. Stress the importance of attending monthly health care provider appointments. Provide educational pamphlets on topics such as nutrition and exercise. Make sure the client maintains bed rest for the duration of the pregnancy. Inform the client of consequences and potential negative outcomes.
Provide time for the client and support person to ask questions. Stress the importance of attending monthly health care provider appointments. Provide educational pamphlets on topics such as nutrition and exercise. Interventions for the high-risk pregnant client include promoting a healthy pregnancy and preventing pregnancy complications. Care focuses on teaching, maintaining appointments, and encouraging a client with any special needs to determine how best to manage the pregnancy according to the client's situation. Providing educational pamphlets on related topics allows the client to review information at home. Maintaining health care appointments is essential in monitoring the progress of the client and fetus. Allowing the opportunity to ask questions clarifies any misconceptions. Discussing consequences and potential negative outcomes may be considered punitive and close communication. Bed rest during pregnancy is not encouraged unless medically necessary. Exercise throughout pregnancy is more common.
A young client who has just learned that she is pregnant admits that she is a frequent heroin user. Which of the following interventions would be the most effective for this client? Refer the client to a methadone maintenance program. Urge the client to discontinue all use of the drug immediately. Recommend that the client maintain her current level of use to prevent abstinence symptoms in the fetus. Recommend that the client reduce her intake of the drug.
Refer the client to a methadone maintenance program. If possible, an opiate-dependent woman should be enrolled in a methadone maintenance program during pregnancy. Infants of women taking methadone do not escape abstinence symptoms at birth, and some infants appear to have more severe reactions to methadone abstinence than to heroin. Because a woman is being provided an oral drug legally, however, a fetus is at least ensured better nutrition, better prenatal care, and less exposure to pathogens such as hepatitis B and HIV. Because heroin is so strongly addictive, simply recommending that the client reduce her intake of the drug or discontinue her use altogether would likely not be effective. Moreover, recommending that she maintain her current level of use would not be advisable due to the severe complications that such drug use during pregnancy can cause.
What is the best way for a woman with a spinal cord injury who cannot feel labor contractions to know that she is in labor? She will be monitored daily with a tocometer. She will be induced at 39 weeks because she is unable to determine whether she is in labor. She will have a cesarean birth at 38 weeks. She will be able to palpate her contractions with her hand.
She will be able to palpate her contractions with her hand. A woman who is unable to feel pain in her uterus will be able to palpate her contractions by hand. She should periodically check her fundus once she is in her 9th month for rhythmic uterine contractions signaling that she is in labor.
If a woman has a hip contracture, which position would be best for a vaginal delivery? semi-Fowler Sims lithotomy knee-chest
Sims A woman with a hip contracture would be unable to perform the lithotomy position. The best position for her for delivery would be Sims, or the dorsal recumbent position.
The nurse is preparing information regarding adolescent pregnancy for a group of community members who work with at risk adolescents. Which developmental characteristic(s) of adolescence will be stressed as contributing to the adolescent pregnancy? Select all that apply. Adolescents want to be different from their peers. Some adolescents desire to have a child. Adolescents exhibit curiosity with different types of contraceptives. Adolescence is when menarche begins. Sexual activity increases among adolescents.
Some adolescents desire to have a child. Adolescence is when menarche begins. Sexual activity increases among adolescents. The adolescent years are a period of physiologic growth and change along with the Erikson developmental stage of identity. Reasons for the high number of adolescent pregnancies include that it is the age of menarche (the average age is 12.4 years; many clients begin menstruating at age 9 and so are ovulating and able to conceive by age 11); increase in the rate of sexual activity among adolescents related to fluctuating hormones; a curiosity about (or failure to use) contraceptives or abstinence; and a desire by young clients to have a child. Adolescents strive to be their own person but want to fit in with peers.
The maternal health nurse is caring for a 13-year-old pregnant client who arrives to the outpatient maternal health clinic accompanied by her mother. During the visit, the nurse notes that the client's mother is trying to convince her daughter to make various health decisions. Which concept(s) does the nurse understand is true? Select all that apply. The adolescent is considered an adult when pregnant. The adolescent is considered an emancipated minor when pregnant. The mother may make decisions regarding her daughter's pregnancy because her daughter is not old enough. The adolescent is responsible for the health care decisions regarding her pregnancy. The mother may be entitled to access of her daughter's health record.
The adolescent is considered an emancipated minor when pregnant. The adolescent is responsible for the health care decisions regarding her pregnancy. A pregnant minor is considered an emancipated minor due to pregnancy and is responsible for the health care decisions regarding the pregnancy. The adolescent's mother does not have rights to the adolescent's health care record and cannot make health care decisions for the adolescent.
A mother and her 17-year-old daughter, who is in her first trimester, arrive for the daughter's first prenatal visit. The daughter will turn 18 in 2 weeks. The mother is visibly upset about her daughter's pregnancy and interrupts her daughter to answer the nurse's questions that were addressed to the daughter. The nurse says that she would like to talk with the daughter alone. The mother objects. Which of the following should the nurse mention to the mother? The daughter is an emancipated minor and has the right to speak with the nurse confidentially. If the daughter acquires permission from her father, she can speak with the nurse confidentially without the mother's permission. The daughter can simply return in 2 weeks, when she is 18, and speak with the nurse confidentially without the mother's permission. Because the daughter is still a minor, the nurse may not speak with her alone without the mother's permission.
The daughter is an emancipated minor and has the right to speak with the nurse confidentially. Parents may have difficulty allowing a daughter to make her own health care decisions. Soon, however, she will be caring for an infant, so she needs this practice in independence and responsibility. You may need to remind parents a pregnant adolescent is regarded as an emancipated minor or a mature minor—a person capable of making health care decisions—and so may sign permission for her own care. The protection of confidentiality for adolescents is based on recognition some minors would not seek needed health care for such concerns as sexual activity, pregnancy, HIV, sexually transmitted infections (STIs), substance abuse or mental health if they could not receive it confidentially. The client in this case need not return to the office when she is 18 or obtain permission from her father to speak with the nurse confidentially.
A nurse in the prenatal clinic is taking a history of a female client who admits to heroin use during the current pregnancy. Which of the following interpretations by the nurse of the client's reasoning for seeking care would be appropriate? The female client understands the need for pregnancy care. The female client will lack good parenting skills. The female client is ready to stop abusing drugs. The female client should be reported to proper authorities.
The female client understands the need for pregnancy care. At a prenatal clinic, nurses can offer support and a caring response to a client with substance abuse problems by interpreting care seeking as the client's apparent realization that she and her baby need care. The nurse would be unrealistic in believing the client will stop abusing substances and would be judgmental in thinking that the client will necessarily lack good parenting skills. The nurse should not report the client to authorities because the client may then not return for future care.
A nurse in the prenatal clinic is taking a history of a female client who admits to heroin use during the current pregnancy. Which of the following interpretations by the nurse of the client's reasoning for seeking care would be appropriate? The female client will lack good parenting skills. The female client should be reported to proper authorities. The female client understands the need for pregnancy care. The female client is ready to stop abusing drugs.
The female client understands the need for pregnancy care. At a prenatal clinic, nurses can offer support and a caring response to a client with substance abuse problems by interpreting care seeking as the client's apparent realization that she and her baby need care. The nurse would be unrealistic in believing the client will stop abusing substances and would be judgmental in thinking that the client will necessarily lack good parenting skills. The nurse should not report the client to authorities because the client may then not return for future care.
A pregnant woman is in an automobile accident and does not survive the trauma. The spouse requested that the physician do an emergency postmortem cesarean birth. Which conditions would most promote infant survival? The fetus is past 20 weeks and no more than 30 minutes have passed since the mother died. The fetus is past 24 weeks and no more than 5 minutes have passed since the mother died. The fetus is past 24 weeks and no more than 30 minutes have passed since the mother died. The fetus is past 32 weeks and no more than 45 minutes have passed since the mother died.
The fetus is past 24 weeks and no more than 5 minutes have passed since the mother died. If a pregnant woman does not survive serious trauma, it may still be possible for her child to be born safely by a postmortem cesarean birth. This is usually attempted if the fetus is past 24 weeks and fewer than 20 minutes have passed since the mother died. Infant survival is best in these circumstances if no more than 5 minutes have passed.
Which of the following statements is true regarding trauma in pregnancy? The uterus is a peripheral organ and will see severely decreased blood flow in the event of trauma. In the event of trauma, a woman's body will maintain hemostasis of the fetus over that of her own body. Pregnant women should wear only lap seat belts and should avoid shoulder restraints. Trauma is most likely to occur in the 1st trimester.
The uterus is a peripheral organ and will see severely decreased blood flow in the event of trauma. During trauma, a woman's body will vasoconstrict the peripheral organs, including the uterus. Trauma is most likely to occur in the 2nd trimester. Pregnant women should wear shoulder restraint seat belts. In the event of trauma, a woman's body will maintain her own hemostasis over that of the fetus.
Why is a young adolescent at higher risk for postpartum hemorrhage? A young adolescent has a higher likelihood of cephalopelvic disproportion (CPD). Because of inadequate protein intake, her body tissue integrity is weak and feeble. The uterus may not be fully developed and may become overdistended. A young adolescent is more likely to be iron deficient.
The uterus may not be fully developed and may become overdistended. An overdistended uterus will have a more difficult time involuting. Uterine atony (failure of the uterus to involute) is the number one cause of postpartum hemorrhage. Because of the client's age, her body tissue usually would be very healthy. CPD is not related to postpartum hemorrhage. Iron deficiency is not more likely to cause postpartum hemorrhage, but it can make for a more complicated course if postpartum hemorrhage does occur.
The nurse manager is orienting a new nurse in a clinic at the local prison. Which statements should the nurse manager include regarding the care of incarcerated pregnant clients? Select all that apply. Women who are incarcerated are more likely to have a high-risk pregnancy . The food served by the corrections facility may need to be adjusted for the pregnancy. The nurse should discuss contraception as part of prenatal care. Incarcerated pregnant women need to be screened for the use of tobacco, drugs, and alcohol. Comprehensive prenatal care will be provided by the correctional facility health care team. Incarcerated pregnant women need to be screened for sexually transmitted infections, including HIV.
Women who are incarcerated are more likely to have a high-risk pregnancy . The food served by the corrections facility may need to be adjusted for the pregnancy. The nurse should discuss contraception as part of prenatal care. Incarcerated pregnant women need to be screened for the use of tobacco, drugs, and alcohol. Incarcerated pregnant women need to be screened for sexually transmitted infections, including HIV. All of these are true, with the exception that comprehensive prenatal care is not provided by the correctional facility health care team. On-site medical staff, including nurses and other health care providers, often do not provide any prenatal care or provide only limited prenatal care, with ultrasounds and management of high-risk pregnancies occurring off-site. Care provided outside of the correctional facility is arranged in coordination with prison officers and on-site staff. Women who are incarcerated are more likely to have a high-risk pregnancy due to a higher incidence of current and past trauma, drug or alcohol use disorder, chronic illness, infections, smoking, and poor prenatal care and a lower socioeconomic status. As when caring for other pregnant women, the nurse regularly screens incarcerated pregnant women for sexually transmitted infections, including HIV, and the use of tobacco, drugs, and alcohol. The food made available by the corrections facility may need to be adjusted to exclude food that is unpasteurized as well as cold cuts or undercooked meat, which may contain pathogens dangerous in pregnancy. As with all pregnant women, the nurse should discuss contraception as part of prenatal care. Women are up to 15 times more likely to start contraception if it is offered during incarceration instead of delayed until it can be obtained in the community after release. Approximately half of incarcerated women become pregnant within 3 months of release from prison, making the provision of contraception prior to release particularly important.
The maternal health nurse is assisting the health care provider to perform a pelvic exam on a pregnant client who is hard of hearing. Where should the nurse stand to ensure the client understands what is going on with the procedure? at the head of the bed next to the health care provider directly in front of the client at the bedside computer
at the head of the bed The nurse should stand at the head of the bed to ensure that the client can hear the nurse, who will interpret what is going on during the procedure. Standing directly in front of the client, next to the health care provider, or at the bedside computer does not allow the client to be close to the nurse to hear what is going on.
When caring for a woman in labor with a spinal cord injury, you notice a drop in her heart rate accompanied by a sudden onset of severe hypertension. What would you most likely suspect? eclampsia autonomic dysreflexia pulmonary embolism hyperemesis
autonomic dysreflexia Autonomic dysreflexia is an exaggerated autonomic response to stimuli such as labor contractions. Symptoms usually include a pounding headache, facial flushing, diaphoresis, nausea, and bradycardia.
A pregnant adolescent is in the early stage of gestational hypertension with a blood pressure of 162/88. The best treatment initially would be: blood pressure assessed every 2 hours. a calorie-controlled diet. increased fluids and daily exercise. bed rest, particularly the left lateral position.
bed rest, particularly the left lateral position. Bed rest is the best initial treatment for gestational hypertension in an adolescent. The left lateral position is best because it decreases the workload on the heart. Taking a blood pressure every 2 hours is not realistic and not needed as the blood pressure is not at a critical level. A calorie-controlled diet with no increase in fluids will not produce a substantial decrease in blood pressure.
The maternal health nurse is caring for a pregnant client who has used cocaine during the pregnancy. Which clinical finding will the nurse associate with the illicit drug use? blood pressure of 172/110 mm Hg heart rate of 48 beats/minute oxygen saturation 88% (0.88) on room air increased fetal heart rate variability
blood pressure of 172/110 mm Hg Cocaine is exceptionally harmful during pregnancy because it causes extreme vasoconstriction. Hypertension is a manifestation of vasoconstriction. The remaining answer choices are not associated with cocaine use.
Use of which drug is associated with the highest risk of placental abruption (abruption placentae)? marijuana alcohol heroin cocaine
cocaine Because cocaine is a potent vasoconstrictor, it can cause the placenta to prematurely separate from the wall of the uterus, causing placental abruption.
The nurse is caring for a pregnant client with multiple sclerosis (MS) complicated by spasticity. Which labor position will the nurse suggest? Semi-Fowler's lithotomy dorsal recumbent High-Fowler's
dorsal recumbent Birth from a Sims or dorsal recumbent position is usually best, as this avoids a lithotomy position. This optimizes the ability to push effectively for the woman with multiple sclerosis and muscle spasticity. The remaining answer choices are incorrect.
Which lab value in a pregnant woman at term might indicate trauma? elevated liver enzymes hematocrit of 29% (0.29) a three- to four-fold increase in alkaline phosphatase WBC of 19,000/mm3
elevated liver enzymes Liver enzymes remain constant throughout pregnancy. An elevation may be a sign of trauma to the liver. A WBC can be as high as 20,000/mm3, and because of the placenta, alkaline phosphatase is highly elevated at term.
A woman over age 40 is less likely than a younger woman to enter pregnancy with a previously diagnosed condition, such as hypertension, varicosities, or hemorrhoids. true false
false A woman over age 40 is more likely than a younger woman to enter pregnancy with a previously diagnosed condition, such as hypertension, varicosities, or hemorrhoids.
Which of the following is a typical adolescent developmental task? joining school activities arranging for dates and after-prom activities learning to drive a car gaining freedom and more independence from parents
gaining freedom and more independence from parents Teenagers need to gain independence from parents during the adolescent years. This can be difficult during pregnancy.
The nurse is caring for a newborn who was born to a mother who used methamphetamine during pregnancy. Which newborn clinical symptom does the nurse associate with the mother's drug use? growth restriction muscle flaccidity intracranial hemorrhage severe jaundice
growth restriction Maternal methamphetamine use is linked to fetal growth restriction. The remaining answer choices are not linked to methamphetamine use.
The maternal health nurse is developing the plan of care for an adolescent client who is pregnant. Which risk will the nurse prioritize in the care plan? imbalanced nutrition social isolation disruption of social interactions fetal injury
imbalanced nutrition A pregnant adolescent is at increased risk for imbalanced nutrition due to the increased nutritional demands of both pregnancy and adolescence. The remaining answer choices represent appropriate risks to address in the client's plan of care; however, these are not the priority for the pregnant client who is an adolescent.
Which postpartum complication is the nurse most likely to see in a mother who abuses marijuana? postpartum hemorrhage infection hemorrhoids inadequate milk production
inadequate milk production A woman who frequently uses marijuana may have a reduction in milk production. She is no more likely than any other woman to have postpartum hemorrhage, infection, or hemorrhoids.
A nurse is caring for a 42-year-old client in the postpartum period. Which nursing intervention will decrease the risk of postpartum hemorrhage following childbirth? continuous massage of the fundus maintaining a straight Foley catheter placing in Trendelenburg position administration of a tocolytic drug
maintaining a straight Foley catheter The nurse realizes that the client older than 40 years of age may not contract as readily in the postpartum period, putting the client at higher risk for postpartum hemorrhage. A full bladder in a postpartum client may interfere with uterine contractions, which can cause uterine atony and increased lochia flow. Maintaining the straight Foley catheter eliminates bladder distention and also can be used to monitor output in the event of a postpartum hemorrhage. Excessive massaging of the fundus can lead to uterine atony. The Trendelenburg position can decrease lung expansion and thus affect cardiac function. A tocolytic drug relaxes the uterus, which would not be appropriate in this scenario.
The maternal health nurse is caring for a pregnant client of advanced maternal age. Which complication(s) will the nurse recognize as being increased in incidence in this population? Select all that apply. failure to progress abnormal fetal positioning ineffective uterine contractions premature rupture of membranes prolonged labor
prolonged labor failure to progress Labor may be prolonged and the client may fail to progress during labor because cervical dilation does not seem to occur as spontaneously as it does in younger women. The remaining answer choices do not reflect increased incidences among advanced maternal age pregnancies.
A young client with cerebral palsy has just learned that she is pregnant. She spends most of her time at home because of her disability. Which of the following interventions should the nurse specifically implement for this client, given her condition? assessment for cephalopelvic disproportion recommendation of a prenatal vitamin containing vitamin D blood pressure assessment chromosomal testing for Down syndrome
recommendation of a prenatal vitamin containing vitamin D If a woman is housebound, be certain she is prescribed a prenatal vitamin containing vitamin D and can obtain refills as she is probably not receiving as much sun exposure as those who spend some time outside. The client is at no greater risk for gestational hypertension, cephalopelvic disproportion, or for having a child with Down syndrome.
A 22-year-old woman has given birth to an infant who exhibits the signs and symptoms of maternal cocaine use during pregnancy. These signs and symptoms are a result of what pathophysiologic effect of stimulate use during pregnancy? vasoconstriction leading to reduced placental blood flow impaired maternal nutrition as a result of stimulant use changes in blood chemistry as a result of nephrotoxicity and hepatotoxicity hypoxia as a result of a prolonged second stage of labor
vasoconstriction leading to reduced placental blood flow Cocaine use during pregnancy has disastrous effects on the fetus; it causes potent vasoconstriction that reduces placental blood flow by about 50%. This reduction results in fetal hypoxia and alters the maternal-fetal nutrient exchange. The deleterious effects on the infant are not primarily a result of toxins, impaired maternal nutrition, or changes in the process of labor.
