OB Exam 1.1

The nurse is assessing a primipara's fundal height at 36 weeks' gestation and notes the funds is now located at the xiphoid process of the sternum. The client asks if this is normal. Which response to the client would be best?

"At 36 weeks' gestation, the fundus is in the normal expected location."

A nurse is teaching a class on genetic disorders for pregnant couples who have recently been told their unborn child has a genetic disorder. Which statement would be important for the nurse to include?

"Genetic disorders occur at the moment an ovum and sperm fuse." Explanation:Many parents blame themselves for genetic disorders and try to identify ways in which they could have prevented the disorder from occurring. The nurse should teach the parents that genetic disorders occur at the moment the ovum and sperm fuse or in some instances before that occurs.

A nurse at a prenatal clinic is caring for a client who is in her first trimester of pregnancy. The client tells the nurse that she is upset because, although she and her husband planned this pregnancy;bshe has been having many doubts and second thoughts about the upcoming changes in her life. Which of the following·is an appropriate response by the nurse? · a. "Ambivalent feelings are quite common for women early in pregnancy." b. "Perhaps you should see a counselor to discuss these feelings further." c. "Have you spoken to your mother about these feelings?" d. "Don't worry. You will be fine once the baby is born."

a. "Ambivalent feelings are quite common for women early in pregnancy."

The nurse instructs a pregnant client with sickle cell anemia on ways to prevent a crisis. Which client statement indicates that teaching has been effective? a. "I should drink eight glasses of water every day." b. "I should take an iron supplement every day." c. "I should make sure I stand for at least 4 hours every day." d. "I should avoid sitting with my legs elevated during the day."

a. "I should drink eight glasses of water every day."

A nurse is teaching a prenatal client with class III heart failure the signs and symptoms which should be reported to the health care provider. The nurse determines the teaching has been effective when the client states which statement? a. "I will call the clinic when I have a cough at night." b. "I will avoid dental work and other invasive procedures." c. "I will call the clinic when I get shortness of breath after exercising." d. "I will take an antibiotic throughout my pregnancy."

a. "I will call the clinic when I have a cough at night."

The nurse is preparing a female client for an emergency cesarean birth at 30 weeks' gestation. The primary health care provider prescribes a glucocorticoid injection for the client. When preparing to administer this injection, the client asks what purpose the injection serves. Which response by the nurse is accurate? a. "It promotes the formation of surfactant in the fetal lungs." b. "It promotes closing of the ductus arteriosus and ductus venosus." c. "It promotes capillary development for gas exchange in the fetal lungs" d. "It promotes cardiac muscle contraction improving cardiac output"

a. "It promotes the formation of surfactant in the fetal lungs."

A client with systemic lupus erythematous is interested in preconception counseling to discuss the desire to get pregnant. The nurse explains that it would be best if the client is symptom-free or in remission for how long before getting pregnant? a. 6months b. 3 months c. 9 months d. 12 months

a. 6months

After conducting a refresher class on possible congenital infections with a group of perinatal nurses, the nurse recognizes.the class was successful when the group identifies which congenital viral infection as the most common? a. CMV b. HIV c. HPV d. RSV

a. CMV Cytomegalovirus (CMV) is the most common congenital and perinatal viral infection in the world. Human immunodeficiency virus (HIV), human papillomavirus (HPV), and herpes simplex virus (HSV) are other potential viruses.

A woman comes to the prenatal clinic and undergoes a pelvic exam. The doctor notes a softening of the uterine isthmus. The nurse recognizes that this finding is known as what sign? a. Hegar sign b. Chadwick sign c. Quickening d. Goodell sign

a. Hegar sign

A client with hyperemesis gravidarum is admitted to the facility after being cared for at home without success. What would expect to include in the client's plan of care? a. clear liquid diet b. total parenteral nutrition c. nothing by mouth d. administration of labetalol

nothing by mouth The initial priority intervention is to explain the NPO status to the client so the vomiting may be brought into control. The next steps will depend on the severity of the hyperemesis gravidarum. Most clients are dehydrated by the time they come to the clinic or hospital for assistance, so establishing an IV line would most likely be the next step. This will also allow for administration of medication to bypass the GI tract. It is also possible the client will be on bedrest with bathroom privileges, but this is not a priority instruction.

A woman at 35 weeks' gestation with severe polyhydramnios is admitted to the hospital. The nurse recognizes that which concern is greatest regarding this client? a. preterm rupture of membranes followed by preterm bir.th b. development of eclampsia c. hemorrhaging d. development of gestational trophoblastic disease

preterm rupture of membranes followed by preterm birth

A woman has presented at the emergency department with symptoms that suggest an ectopic pregnancy. Which finding would lead the nurse to suspect that the fallopian tube has ruptured? 1- referred shoulder pain 2- vaginal spotting 3- nausea 4- breast tenderness

referred shoulder pain

A pregnant client reports chewing on ice throughout the day. Which laboratory value would the nurse evaluate? a. serum iron level b. serum potassium level c. serum glucose level d. serum sodium level

serum iron level Explanation: Pregnant clients who crave ice often have an iron deficiency. A low serum iron level needs to be checked.

Which of these cardiac variations, if found in the client who is pregnant, should the nurse recognize as a normal finding in pregnancy? a. split S1S2 b. premature ventricular contractions c. S4 (atrial gallop) d. soft systolic murmur

soft systolic murmur

The nurse is answering questions of a young pregnant woman concerning the birthing process. Which structure is able to dilate during labor and birth because it contains rugae? a. cervix b. uterus c. vagina d. vulva

vagina

A nurse in the ambulatory surgery center is providing discharge teaching to a client who had a dilation and curettage (D&C) following a spontaneous miscarriage. Which of the following should be included in the teaching? a. Vaginal intercourse can be resumed after 2 weeks. b. Products of conception will be present in vaginal bleeding. c. Increased intake of zinc-rich foods is recommended. d. Aspirin may be taken for cramps.

vaginal intercourse can be resumed after 2 weeks

A nurse is reviewing the medical records of several pregnant women who have come to the center for care. Which woman would the nurse most likely identify as being at highest risk for nutritional deficiency during pregnancy?

woman with a 1-year-old infant Feedback: Pregnancy depletes nutritional stores. A woman who enters a second pregnancy almost immediately after a first can enter the second pregnancy with nutritional shortages.

A nurse is caring for a client who is at 36 weeks of gestation and who has a suspected placenta previa. Which of the following findings support this diagnosis? a. Painless red vaginal bleeding b. Increasing abdominal pain with a nonrelaxed uterus c. Abdominal pain with scant red vaginal bleeding d .Intermittent abdominal pain following passage of bloody mucu

a. Painless red vaginal bleeding

The nurse is caring for a multigravida client at 38 weeks' gestation and is reviewing diagnostic studies that estimate 1 liter of amniotic fluid surrounding the fetus. The nonstress test is reactive with a heart rate of 142 beats/min and moderate variability .The client verbalizes lower back discomfort. Which interpretation of the fetal status will the nurse make? a. There is no concerning data. Fetal heart rate is normal and kidney function exists. b. There is limited amniotic fluid, but the fetal heart is not compromised . c. The fetal heart is stressed, with an elevated heart rate and non-stress test reactivity. d. The mother is experiencing back labor pains, causing a rupture of membranes

a. There is no concerning data. Fetal heart rate is normal and kidney function exists.

A potential complication for the mother and fetus is Rh incompatibility; therefore, ssessment should include blood typing. If the mother is Rh negative, her antibody titer should be evaluated. If treatment with Rho(D) immune globulin is indicated, the nurse would expect to administer it at which time? a. at 28 weeks b. at 32 weeks c. at 36 weeks d. only at birth

a. at 28 weeks

A high-risk pregnant client is determined to have gestational hypertension. The nurse suspects that the client has developed preeclampsia with severe features based on which finding? a. b1urred vision b. blood pressure of 150/100 mm Hg c. mild facial edema d. proteinuria of 300 mg per 24 hours

a. b1urred vision RATIONALE: Visual symptoms and blind spots suggest severe preeclampsia and preteinuria in severe preeclampsia is greater than 500mg

The nurse is assessing client status and behavior as the client attends monthly visits to the obstetrician. At which time during pregnancy does the nurse anticipate the client changing the verbiage about the fetus, from referring to an object to referring to a human pronoun? a. in the second trimester after quickening occurs . b. following confirmation of pregnancy with a positive blood test. c. when the fetus is engaged and Braxton Hicks contractions begin. d. when family is told and plans begin to incorporate the newborn into the home.

a. in the second trimester after quickening occurs .

During pregnancy most nutritional needs can be consumed in adequate amounts through the diet. Which nutrient is the exception to this statement? a. iron b. calcium c. sodium d. vitamin D

a. iron

The nurse reviews the medication therapy regimen of a pregnant woman with chronic hypertension . Which medication would the nurse most likely expect to find? a. labetalol b. atenolol c. carvedilol d. metoprolol

a. labetalol

A nurse is assisting a client in active labor whose diabetes has been poorly controlled. Which assessment of the neonate should be prioritized after its birth? a. macrosomia p. hyperglycemia c. low birthweight d. hypobilirubinemia

a. macrosomia

The nurse is concerned that a client is not obtaining enough folic acid. Which test would the nurse anticipate being used to evaluate the fetus for potential neural tube defects? a. maternal serum alpha-fetoprotein analysis b. triple-marker screen c. Doppler flow study d. amniocentesis

a. maternal serum alpha-fetoprotein analysis

A client in the 20th week of pregnancy with _a blood pressure of 148/92 mm Hg is diagnosed with mild to moderate hypertension. Which treatment does the nurse anticipate for the client when all testing is negative for kidney and thyroid disease ? a. none b. aspirin c. nifedipine

a. none

The nursing instructor is teaching students about normal changes of pregnancy. The instructor talks about diastasis recti. What is the instructor presenting? a. separation of the muscles of the abdominal wall b. raising of the uterus into the abdomen c. relaxation of the kidneys d. movement of the bladder to the rear of the pelvis behind the uterus

a. separation of the muscles of the abdominal wall

A woman at 12 weeks' gestation comes to the clinic with vaginal bleeding .When assessing the woman further, the nurse would suspect a threatened abortion based on which finding? a. slight vaginal bleeding b. cervical dilation c. high beta human chorionic gonadotropin (hCG) level d. passage of fetal tissue

a. slight vaginal bleeding

A pregnant client asks the nurse how the fetus breathes if it is floating in the amniotic fluid. The best explanation by the nurse is: a. the fetus receives oxygen through the umbilical vein. b. the fetus breathes by receiving blood from the maternal circulation. c. the fetus breathes by exchanging gases in the lungs. d. the fetus receives oxygen through the umbilical artery.

a. the fetus receives oxygen through the umbilical vein.

The nurse is assisting a primigravida on calculating the due date of her baby using Naegele rule. The most important information provided by the mother is: a. the first day of the last menstrual period. b. the ovulation date between her periods. c. the date that intercourse occurred. d. the last day of her menstrual period.

a. the first day of the last menstrual period.

A woman's obstetrician prescribes vitamin K supplements for a client who is on antiepileptic medications beginning at 36 weeks' gestation. The mother asks the nurse why she is taking this medication. The nurse's best response would be: a. vitamin K helps in keeping the placenta healthy. b. antiepileptic therapy can lead to vitamin K-deficient hemorrhage of the newborn. c. administration of vitamin K aids in lung maturity of the fetus. d. The antiepileptic medications can cause the mother's platelets to drop.

antiepileptic therapy can lead to vitamin K-deficient hemorrhage of the newborn.

A 19-year-old woman presents to the emergency department in the late stages of active labor. Assessment reveals she received no prenatal care. As part of her examination, a rapid HIV screen indicates she is HIV positive. To reduce the perinatal transmission to her infant, which intravenous medication would the nurse anticipate administering?

antiretroviral

The nurse admitted a client in active labor to the birthing suite. During the admission assessment, the client says, "I am so afraid that my asthma will get out of control during labor." Which response will the nurse provide? a. "There is a good chance this could happen if you hyperventilate." b. "Actually, asthma symptoms tend to diminish during active labor." c. "We have a list of your medications and can treat any problem that arises." d. "As long as you have your albuterol inhaler with you, you will be fine.

b. "Actually, asthma symptoms tend to diminish during active labor."

The nurse is completing an environmental and occupational assessment at the first prenatal visit. Which client statement indicates a need for clarification? a. "I live in a one-story home." b. "I have a dog and a cat at home." c. "I drive 30 minutes to go to work." d. "I interact with many people throughout the day."

b. "I have a dog and a cat at home."

A client at 36 weeks' gestation is admitted to labor and delivery for induction of labor. The client has a history of poorly controlled type 2 diabetes. The client had a biophysical profile with an abnormal result that prompted the need for induction of labor. Which intervention does the nurse expect to implement during the induction process? a. Administer glucocorticoids to improve fetal outcomes. b. Administer and titrate an intravenous insulin infusion. c. Monitor the fetal status intermittently. d. Monitor glucose levels of the pregnant client every 6 to 8 hours .

b. Administer and titrate an intravenous insulin infusion.

Many women develop iron-deficient anemia during pregnancy. What diagnostic criteria would ttie nurse monitor for to determine anemia in the pregnant woman? a. Hemoglobin of 13 g/dl (130 g/L) or lower b. Hematocrit of 32% or less c. Blood pressure of 100/68 mm Hg d. Heart rate of 84 beats/min

b. Hematocrit of 32% or less

A nurse is caring for a pregnant client with asthma. Which intervention would the nurse perform first? a. monitoring temperature frequently b. assessing oxygen saturation c. monitoring frequency of headache d. assessing forfeeling nauseated

b. assessing oxygen saturation

A nurse is providing care to a woman who has just found out that she is pregnant. The nurse is describing the events that have occurred and the structures that are forming . When describing the trophoblast to the client, the nurse would explain that this structure forms: a. fetal membrane. b. placenta. c. zygote. d. morula.

b. placenta.

A nurse has been assigned to four antepartum clients. Which client requires immediate follow-up by the nurse? . a. the client with type 1 diabetes whose nonstress test is nonreactive b. the client with a cardiomyopathy whose respiratory rate is 32 breaths/min c. the client with sickle cell anemia whose hemoglobin level is 9.8 g/dl (98 g/1) d. the client with chronic hypertension whose blood pressure is 146/90 mm Hg

b. the client with a cardiomyopathy whose respiratory rate is 32 breaths/min

Implantation generally occurs at which place on the uterus? a. the lower anterior surface b. the upper posterior surface c. directly over the cervical os d. directly over an opening to a fallopian tube

b. the upper posterior surface Feedback: Implantation occurs most commonly on the upper posterior surface of the uterus. This position allows the fetus to deliver before the placenta.

A pregnant client who is of advanced maternal age asks if there are any ways to diagnose Down syndrome prior to birth other than an amniocentesis, which she believes is risky. Which test will the nurse discuss with the client? a. blood test b. ultrasound c. X-ray d. Doppler study

b. ultrasound

The nurse is caring for a pregnant woman in her third trimester who is HIV positive .The client voices concerns about how to prevent transmitting HIV to her infant. Which response by the nurse is most appropriate? a."Your infant will be tested after birth to determine if the virus is present and, if not, we will discuss how to avoid future transmission." b."You will not be able to breastfeed your infant once born. Your infant will need to receive formula." c."Your infant will begin receiving antiretroviral therapy immediately if tests show the infant is HIV positive." d."This is something you need to discuss with your infant's health care provider. "

b."You will not be able to breastfeed your infant once born. Your infant will need to receive formula."

Encouraging routine prenatal visits is an important function for nurses to ensure the clients avoid complications or difficulties throughout the pregnancy and birth. The nurse would prepare to screen clients for gestational diabetes at which time during the pregnancy? a. between 24 and 28 weeks' gestation b. between 20 and 24 weeks' gestation c. between 29 and 32 weeks' gestation d. between 15 and 19 weeks' gestation

between 24 and 28 weeks' gestation

The nurse is assessing the pregnant client and notice that the client appears to have nasal congestion. When asking about this condition, which statement requires further instruction? a. "I began sleeping on additional pillows to help me breathe at night." b. "I have been miserable but realize that this is a discomfort of pregnancy. " c. "I find it most helpful to use a medicated nasal spray at night." d. "I keep a humidifier in my room at night, especially when I am mouth breathnig.

c. "I find it most helpful to use a medicated nasal spray at night."

A mother is talking to the nurse and is concerned about managing her asthma while she is pregnant. Which response to the nurse's teaching indicates that the woman needs further instruction? a. "I need to be aware of my triggers and avoid them as much as possible ." b. "It is fine for me to use my albuterol inhaler if I begin to feel tight." c. "I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring." d. "I will monitor my peak expiratory flow rate regularly to help me predict when an asthma attack is coming on."

c. "I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring."

A nurse is caring for a client who is at 6 weeks of gestation with her first pregnancy and asks the nurse when she can expect to experience quickening. Which of the following responses should the nurse make? a. "This will occur during the last trimester of pregnancy." b. "This will happen by the end of the first trimester of pregnancy." c. "This will occur between the fourth and fifth months of pregnancy." d. "This will happen once the uterus begins to rise out of the pelvis."

c. "This will occur between the fourth and fifth months of pregnancy."

During an exam, the nurse notes that the blood pressure of a client at 22 weeks' gestation is lower, and her heart rate is 12 beats per minute higher than at her last visit. How should the nurse interpret these findings? a. The heart rate increase may indicate that the client is experiencing cardiac overload. b. The blood pressure should be higher since the cardiac volume is increased. c. Both findings are normal at this point of the pregnancy. d. Combined, both of these findings are very concerning and warrant further investigation.

c. Both findings are normal at this point of the pregnancy.

A nurse is instructing a woman who is contemplating pregnancy about nutritional needs. To reduce the risk of giving birth to a newborn who has a neural tube defect which of the following information should the nurse include in the teaching? a. Limit alcohol consumption. b. Increase intake of iron-rich foods. , c. Consume foods fortified with folic acid. d. Avoid foods containing aspartame.

c. Consume foods fortified with folic acid.

A nurse is caring for a client with hyperemesis gravidarum. Which nursing action is the priority for this client? a. Administer total parenteral nutrition. b. Administer an antiemetic. c. Set up for a percutaneous endoscopic gastrostomy. d. Administer IV normal saline with vitamins and electrolytes.

d. Administer IV normal saline with vitamins and electrolytes.

A client who takes levothyroxine for hypothyroidism is having an initial prenatal visit. Which teaching will the nurse provide to this client? a. An initial blood test will be done to determine the dose of medication to prescribe. b. Blood tests will be done every 2 to 3 months during the pregnancy to adjust the medication dose. · c. A blood test will be done as a baseline prior to discontinuing the medication during the pregnancy. d. Blood tests will be done every 4 to 6 weeks during the first trimester to adjust the medication dose.

d. Blood tests will be done every 4 to 6 weeks during the first trimester to adjust the medication dose.

After a reproductive class at the local school, the public health nurse realizes more training more training is needed when the class identifies the layers of the uterus to include: a. Perimetrium b. Endometrium c. Myometrium d. Epimetrium

d. Epimetrium (Rationale: The three laters of the uterus are the endometrium, myometrium, and perimetrium. The epimetrium is not a layer of the uterus.)

A pregnant client in her 12th week of gestation has come to a health care center for a physical examination of her abdomen. Where should the nurse palpate for the fundus in this client? a. at the umbilicus b. below the ensiform cartilage c. midway between the symphysis and umbilicus d. at the symphysis pubis

d. at the symphysis pubis In the 12th week of gestation, the nurse should palpate the fundus at the symphysis pubis. The nurse should palpate for the fundus below the ensiform cartilage when the client is in the 36th week of gestation; midway between symphysis and umbilicus in the 16th week of gestation; and at the umbilicus in the 20th week of gestation.

The nurse is describing pregnancy danger signs to a pregnant woman who is in her first trimester. Which danger sign might occur at this point in her pregnancy? a. dyspnea b. lower abdominal pressure c. swelling of extremities d. excessive vomiting

d. excessive vomiting

A nurse assessing the laboratory results of a pregnant client in the second trimester notes that the client has a hemoglobin level of 11 gm/dl. What will the nurse interpret this finding to most likely indicate? a. iron-deficiency anemia b. a multiple gestation pregnancy c. greater-than-expected weight gain d. hemodilution of pregnancy

d. hemodilution of pregnancy

A nurse is assessing a pregnant woman with gestational hypertension· Which finding would lead the nurse to suspect that the client has developed severe preeclampsia? a. urine protein 300 mg/24 hours b. blood pressure 150/96 mm Hg c. mild facial edema d. hyperreflexia

d. hyperreflexia Severe preeclampsia is characterized by blood pressure over 160/110 mm Hg, urine protein levels greater than 500 mg/24 hours and hyperreflexia. Mild facial edema is associated with mild preeclampsia.

A client comes to the prenatal clinic for her first visit. when determining the client's estimated due date, the nurse understands which method is the most accurate? a. gestational wheel b. birth calculator c. Nagele's rule d. ultrasound

d. ultrasound

A nurse is assessing a pregnant client for the possibility of preexisting conditions that could lead to complications during pregnancy. The nurse suspects that the woman is at risk for hydramnios based on which preexisting condition? a. diabetes b. hypertension c. late maternal age d. isoimmunization

diabetes

The nurse is preparing to assess a young woman's external genitalia. The nurse predicts the client is currently in the most fertile phase of the menstrual cycle based on which assessment finding of the vaginal mucus drainage? a. distensible, stretchable quality b.clear and oily c.yellow, tacky, and crumbly d.raw egg white consistency

distensible, stretchable quality At the peak of fertility (i.e., during ovulation), the mucus has a distensible, stretchable quality called spinnbarkeit. During the proliferative phase, the mucus is yellow, tacky, and crumbly. Close to the time of ovulation, the mucus will appear clear and oily with a raw egg white consistency.

The nurse is required to assess a client for HELLP syndrome. Which are the signs and symptoms of this condition? Select all that apply. a. blood pressure higher than 160/110 mm Hg b. epigastric pain c. oliguria d. upper right quadrant pain e. hyperbilirubinemia

epigastric pain upper right quadrant pain hyperbilirubinemia

A pregnant client has been admitted with reports of brownish vaginal bleeding. On examination, there is an elevated human chorionic gonadotropin (hCG) level, absent fetal heart sounds, and a discrepancy between the uterine size and the gestational age. The nurse interprets these findings to suggest which condition? a. ectopic pregnancy b. placenta previa c. gestational trophoblastic disease d. placental abruption (abruption placentae)

gestational trophoblastic disease

A nurse is documenting the obstetric history for a pregnant woman who has previously given birth to two infants at term and had one abortion at 12 weeks' gestation. How would the nurse document this information?

gravida 4, para 2 Gravida refers to the total number of pregnancies (including current), para to the number of births. The abortion would be noted as an "A" if using the full "GTPAL."

A client at 25 weeks' gestation presents with a blood pressure of 152/99 mm Hg, pulse 78 beats/min, no edema, and urine negative for protein. What would the nurse do next? a. Notify the health care provider b. Provide health education c. Assess the client for ketonuria d. Document the client's blood pressure

Notify the health care provider The client is exhibiting a sign of gestational hypertension, elevated blood pressure greater than or equal to 140/90 mm Hg that develops for the first time during pregnancy. The health care provider should be notified to assess the client. Without the presence of edema or protein in the urine, the client does not have preeclampsia.

A client comes to the clinic with concerns about her pregnancy. She is in her first trimester and is now experiencing moderate abdominal pain on the right sid.e What would be the nurse's first action? a. Recommend an abdominal ultrasound to the doctor since this may be ectopic pregnancy. b. Reassure the mother that this is normal as the baby is implanting into the uterus. c. Obtain a detailed 24-hour intake to determine if the pain is related to what she has eaten. d. Encourage her to ambulate since gas pains are common in early pregnancy.

Recommend an abdominal ultrasound to the doctor since this may be ectopic pregnancy. The nurse should recognize that abdominal pain is not normal during pregnancy and warrants investigation since ectopic pregnancy is a distinct possibility. An abdominal ultrasound would be best practice for this complaint. Dismissing her reports as normal is not a wise choice.

Hyperemesis Gravidarum

Risk factors: -maternal age younger than 30 years -multifetal gestation -gestational trophoblastic disease -diabetes -GI disorders -family history -clinical hyperthyroid disorders -high levels of emotional stress Expected assessment findings: -excessive vomiting for prolonged periods -dehydration with possible electrolyte imbalance -weight loss -increased pulse rate -decreased blood pressure -poor skin turgor and dry mucous membranes Nursing care associated with the condition: -monitor I&O -Monitor vital signs -Monitor weight -Have client maintain NPO until vomiting stops -Monitor skin turgor and mucous membranes Lab tests/Diagnostics: -Urinalysis for ketones and acetones (breakdown of protein and fat) -elevated urine specific gravity -electrolyte imbalances -elevated Hct -hyperthyroidism Procedures/treatment: -IV lactated ringer's solution for hydration -Antiemetic cautiously -Corticosteroids -Vitamin B6

Placenta Previa

Risk factors: -previous occurrence -uterine scarring maternal age greater than 35 years Multifetal gestation -Multiple gestations -smoking Expected assessment findings: -painless, bright red vaginal bleeding during second or third trimester -uterus soft, relaxed and non-tender with normal tone -fundal height greater than expected for gestation age -fetus in breech, oblique or transverse position -Reassuring FHR -Vital signs within normal limits -Decreasing urinary output due to blood loss Nursing care associated with the condition: -Assess for bleeding , leakage or contractions -assess fundal height -refrain from performing vaginal exams -administer IV fluids, blood products, and medications. Betamethasone for fetal lung maturity if early delivery is indicated. -have oxygen equipment available incase of fetal distress. -client adhere to bed rest -client do not insert anything in the vagina as it could worsen bleeding Lab tests/Diagnostics: -Transabdominal or transvaginal ultrasound for placement of placenta -Fetal monitoring -Hgb & Hit for blood loss assessments -CBC -blod type and Rh -Coagulation profile -Kleihauer-Betke test to detect fetal blood in maternal circulation Procedures/treatment: -Bed rest -Vaginal rest -early delivery (Cesarean birth)

After teaching a group of women about the signs of pregnancy, the nurse understands that teaching was successful if the group makes which statement about positive signs? a. "They will be able to hear the fetal heart rate on auscultation." b. "The woman will have amenorrhea." c. "There will be a positive Hegar's sign." d. "The client will experience quickening."

"They will be able to hear the fetal heart rate on auscultation."

A pregnant woman asks the nurse about using herbal rememdies while she is pregnant. The nurse recommends that the woman talk with her health care provider about their use based on which understanding? 1- They are not rated with regard to safety during pregnancy. 2- They can create nutritional deficiencies in the mother and fetus. 3- They are known to cause teratogenic effects in the fetus. 4- They have been proven to cause early labor.

1- They are not rated with regard to safety during pregnancy.

A nurse is assessing a client who may be pregnant. The nurse reviews the client's history for presumptive signs. Which sign would the nurse most likely note? Select all that apply. A) amenorrhea B) nausea C) abdominal enlargement D) Braxton-Hicks contractions E) fetal heart sounds

A) amenorrhea B) nausea

A nurse in a clinic is assessing a client who is at 8 weeks of gestation and has hyperemesis gravidarum. Which of the following findings should the nurse expect? (Select all that apply.) A. History of migraines B. Nulliparous C. Twin gestations D. History of gestational hypertension E. Oligohydramnios

A. History of migraines B. Nulliparous C. Twin gestations

A nurse is reviewing the obstetric history of a pregnant woman who has come to the clinic for a visit. The history reveals that the woman is "gravida 3, para 2". Which interpretation by the nurse would be appropriate?

Two previous pregnancies, two children born at term, and currently pregnant

A antepartum client learns that the fetus has a genetic anomaly that will affect cognitive and musculoskeletal development. The client is discussing this with the spouse and the nurse. The client and spouse want to know what options are available to them. What is the first thing that the nurse needs to do to help this couple with decision making? a. Suggest routes to terminate pregnancy . b. Assist the couple in identifying their values. c. Analyze the opinions of close family members. d. Explain health care options for the neonate going forward.

Assist the couple in identifying their values.

A nurse is caring for a client at the first prenatal visit who has a BMI of 26. 5 The client asks how much weight she should gain during pregnancy. Which of the following responses should the nurse make? A. "It would be best if you gained about 11 to 20 pounds." B. "The recommendation for you is about 15 to 25 pounds." C. " A gain of about 25 to 35 pounds is recommended for you." D. "A gain of about 1 pound per week is the best pattern for you."

B. "The recommendation for you is about 15 to 25 pounds." i: Clients who are overweight, having a BMI of 25 to 29.9, should be advised that the recommended weight gain is 7 to 11.5 kg (15 to 25 lb). The pattern of weight gain is also important, with minimal gain in the first trimester.

A nurse in a hospital is caring for a client who is at 38 weeks of gestation and has a large amount of painless, bright red vaginal bleeding. The client is placed on a fetal monitor indicating a regular fetal heart rate of 138/min and no uterine contractions. The client's vital signs are: blood pressure 98/52 mm Hg, heart rate 118/min, respiratory rate 24/rnin, and temperature 36.4° C (97.6° F). Which of the following is the priority nursing action? a. Insert an indwelling urinary catheter. b. Initiate IV access. c. Witness the signature for informed consent for surgery. d. Prepare the abdominal and perineal areas.

B. Insertion of a large-bore IV catheter is the priority nursing action. The client is losing blood rapidly, has hypotension, and tachycardia. IV access will allow IV fluids and blood to be administered quickly if hypovolemia develops.

A nurse is preparing to measure the fundal height of a client who is at 22 weeks of gestation. At which location should the nurse expect to palpate the fundus? A. 3 cm above the umbilicus B. Slightly above the umbilicus C. Slightly below the umbilicus D. 3 cm below the umbilicus

B. Slightly above the umbilicus

A nurse is working with a pregnant client to schedule follow-up visits for the pregnancy. Which statement by the client indicates that she understands the scheduling? a. "I need to make visits every 2 months until I am 36 weeks' pregnant." b. "Once I get to 28 weeks' pregnant, I have to come twice a month." c. "From now until I am 28 weeks' pregnant, I will be coming once a month." d. "I will make sure to get a day off every 2 weeks to make my visits."

C) "From now until I'm 28 weeks, I'll be coming once a month." Continuous prenatal care is important for asuccessful pregnancy outcome. Therecommended follow-up visit schedule for ahealthy pregnant woman is as follows: every4 weeks up to 28 weeks (7 months); every 2weeks from 29 to 36 weeks; every week from37 weeks to birth.

A client who is 16 weeks pregnant has a lower blood pressure than that of prepregnancy levels. What should the nurse realize as being the cause for this lower blood pressure? a. Prepregnancy blood pressure measurements were inaccurate. b. Blood pressure progressively decreases throughout the entire pregnancy. c. A decrease in the second trimester may occur because of placental growth. d. Dehydration because blood pressure increases steadily throughout pregnancy .

C) A decrease in the second trimester may occur because of placental growth. In some women, blood pressure actually decreases slightly during the second trimester because the expanding placenta causes peripheral resistance to circulation to lower. The lower blood pressure is not because prepregnancy blood pressure measurements were inaccurate. Blood pressure does not normally decrease throughout the entire pregnancy. There is no enough information to determine if the patient is dehydrated; however, this is not the reason for the blood pressure to be lower in the second trimester of pregnancy.

After an examination, an advanced practice nurse confirms that a patient is pregnant. What did the nurse assess in this patient? (Select all that apply. A) Painful breast tissue B) Positive pregnancy test C) Fetal movements felt by the nurse D) Visualization of the fetus by ultrasound E) Fetal heart rate separate from the patient's

C) Fetal movements felt by the nurse D) Visualization of the fetus by ultrasound E) Fetal heart rate separate from the patient's There are only three documented or positive signs of pregnancy—demonstration of a fetal heart separate from the mother's, fetal movements felt by an examiner, and visualization of the fetus by ultrasound. Painful breast tissue is a presumptive sign of pregnancy. A positive pregnancy test is a probably sign of pregnancy.

The nurse is assessing a pregnant woman in her second trimester. Which tasks would indicate to the nurse that the client is successfully incorporating the maternal role into her personality? a. The woman demonstrates concern for herself and her fetus as a unit. b. The client identifies what she must give up to assume her new role. c. The woman acknowledges the fetus as a separate entity within her. d. The client demonstrates unconditional acceptance without rejection.

C) The woman acknowledges the fetus as a separate entity within her. Incorporation of the maternal role into her personality indicates acceptance by the pregnant woman. In doing so, the woman becomes able to identify the fetus as a separate individual. Demonstrating concern for herself and her fetus as a unit is associated with introversion and more commonly occurs during the third trimester. Identification of what the mother must give up to assume the new role occurs during the first trimester. Demonstrating unconditional acceptance without rejection occurs during the third trimester.

The nurse is caring for a client with a retroverted uterus. The nurse would explain that this means her: A) uterus is bent sharply backward at the cervix. B) cervix is located behind the Douglas cul-de-sac. C) entire uterus is tipped backward. D) uterus is anterior to the bladder.

C) entire uterus is tipped backward.

A nurse in a prenatal clinic is completing a skin assessment of a client who is in the second trimester. Which of the following findings should the nurse expect? (Select all that apply.) A. Eczema B. Psoriasis C. Linea nigra D. Chloasma E. Striae gravidarum

C, D, E. Eczema is incorrect. Eczema manifests as red, swollen, and itchy skin and is not an expected finding during pregnancy.Psoriasis is incorrect. Psoriasis manifests as thick red patches or plagues covered by silver scales on the skin and is not an expected finding during pregnancy. Linea nigra is correct. Linea nigra manifests as a line of pigmentation extending from the symphysis pubis to the top of the fundus and is an expected finding during pregnancy. Chloasma is correct. Chloasma, or the mask of pregnancy, manifests as blotchy, brownish hyperpigmentation of the skin over the forehead, nose, and cheeks and is an expected finding during pregnancy.Striae gravidarum is correct. Striae gravidarum, or stretch marks, occur because of the separation of underlying connective tissue on the breasts, thighs, and abdomen. They are an expected finding during pregnancy.

Human papillomavirus (HPV) can cause condylomata acuminata that can develop in clusters on the vulva, within the vagina, on the cervix, or around the anus. What is their risk? a. neonatal auricular papillomas b. block a vaginal birth c. heavy bleedingduring vaginal birth d. neonatal hemorrhage

Correct response: B block a vaginal birth Explanation:Genital warts have a tendency to increase in size during pregnancy. These warts may grow large enough to block a vaginal birth. The pregnant woman can pass HPV to her fetus during the birth process. In rare instances, neonatal HPV infection can result in life-threatening laryngeal papillomas. HPV infection transmitted to the infant may not appear for as long as 10 years after birth.

While caring for a pregnant woman of Middle Eastern descent a nurse attempts to mold the patient's choices to fit what she calls the "American Way." When questioned, she reports it is best and easier to plan and deliver care this way. Based upon your knowledge you recognize this as:

Cultural destructiveness

Which question should the nurse include when conducting a review of systems with a client during the first prenatal visit? a. "Do you have a peptic ulcer?" b. " Have you ever had a heart attack?" c. "Have you had any neurologic diseases?" d. "Have you had any urinary tract infections?"

D) "Have you had any urinary tract infections? "Urinary tract infections are associated with preterm birth. If the patient has a history of this type of infection, then interventions can be directed to help the patient avoid a urinary tract infection while pregnant. Although a part of the review of systems, asking about peptic ulcers, heart attacks, and neurologic diseases may not have as significant an impact on the developing fetus as having urinary tract infections.

The nurse is concerned that a pregnant client is experiencing abruptio placentae . What did the nurse assess in this client? a. increased blood pressure and oliguria b. pain in a lower quadrant and increased pulse rate c. painless vaginal bleeding and a fall in blood pressure d. sharp fundal pain and discomfort between contractions

D) Sharp fundal pain and discomfort between contractions Abruptio placentae is characterized by a sharp, stabbing pain high in the uterine fundus as the initial separation occurs. Manifestations of abruptio placentae do not include increased blood pressure, oliguria, pain in the lower quadrant, increased pule rate, painless vaginal bleeding, or a fall in blood pressure.

A nurse in a prenataI clinic is caring for a client who is suspected of having a hydatidiform mole. Which of the following findings should the nurse expect to observe in this client? a. Rapid decline in human chorionic gonadotropin (hCG) levels b. Profuse, clear vaginal discharge c.. Irregular fetal heart rate d. Excessive uterine enlargement

Excessive uterine enlargement

A nurse in a prenatal clinic is teaching a client who is in her second trimester and has a new diagnosis of gestational diabetes. Which of the following statements by the client indicates a need for further teaching? A."I should limit my carbohydrates to 50% of caloric intake ." B. "I will reduce my exercise schedule to 3 days a week." C. "I will take my glyburide daily with breakfast." D. "I know I am at increased risk to develop type 2 diabetes ."

I will reduce my exercise schedule to 3 days a week

A pregnant client in the first trimester comes to the clinic for a visit. Which statement leads the nurse to suspect that the woman is experiencing a complication of pregnancy that requires additional follow-up? a. "I am so tired. As soon as I get home from work, I go to bed. I used to go to bed at 10:00 pm and now I have to go to bed at 8:00 pm." b. "When I get up in the morning, I feel good, but throughout the day, my palms get red and itchy," c. "When I first urinate in the morning, I notice a burning sensation, but then as I'm constantly going throughout the day, it goes away." d. "Last night, I woke up in the middle of the night with this intense leg pain that subsided after a few seconds. Today , my leg still feels sore."

"When I first urinate in the morning, I notice a burning sensation, but then as I'm constantly going throughout the day, it goes away." Explanation: Urinary tract infections in pregnancy are common and warrant treatment. Often a pregnant woman will have no symptoms or very mild symptoms of a UTI. Fatigue, palmar erythema, and muscle cramps are common discomforts in the first trimester.

When providing preconception care to a client, which instruction will the nurse to provide about medications during pregnancy?

"You need to talk with your health care provider about using all prescription, over-the-counter, and herbal medications."

A nurse in a prenatal clinic is caring for a client who is pregnant and asks the nurse for her estimated date of birth (EDB). The client's last menstrual period began on July 27. What is the client's EDB? (State the date in MMDD. For example, July 27 is 0727)

0504. Using Nägele's rule, the nurse subtracts three months from the date of the last menstrual period, then adds 7 days. July minus 3 months equals April. There are 30 days in April, so 27 + 7 = May 4. The client's EDB is May 4, which would be written as 0504 in the MMDD format.

The nurse is reviewing client data following regular monthly appointment at 6 months' gestation. Which fundal height requires no further intervention? a. 18 cm b. 24 cm c. 30 cm d. 32 cm

24 cm An anticipated fundal height for 24 weeks' gestation (6 months) is 24 cm. Between 18 and 32 weeks' gestation, the fundal height in centimeters should match the gestational age. All of the other measurements would require further intervention.

At which gestational age will the nurse no longer associate fundal height directly with week's gestation?

36 weeks The nurse is correct to no longer anticipate that the client's fundal height will equal the gestation age of the fetus following 36 weeks' gestation. This is due to variances in fetal growth. Up until that point, fundal height is a good predictor of where growth should be.

A nurse is caring for a client during the first trimester of pregnancy. After reviewing the client's blood work, the nurse notices she does not have immunity to rubella. Which of the following times should the nurse understand is recommended for rubella immunization? a. Shortly after giving birth b. In the third trimester c. Immediately d. During her next attempt to get pregnant

A. Shortly after giving birth The rubella immunization should be offered to the client following birth, preferably prior to discharge from the hospital. This prevents the client from contracting rubella during the current or subsequent pregnancies, which would put her fetus at risk for rubella syndrome.

A child is diagnosed with an X-linked dominant inheritance disorder. What should the nurse explain to the parents about this disorder? A) It only affects male offspring. B) It appears in every generation. C) All children of the couple will be affected. D) Diseases caused by this disorder are not life threatening.

Ans: B Feedback: X-linked dominant inheritance disorders appear in every generation. The pattern of inheritance is through the X chromosome and affects female offspring. All children will not be affected. It is unclear if the diseases caused by this disorder are life threatening.

A woman is aware that she is the carrier of a sex-linked recessive disease (hemophilia A); her husband is free of the disease. What frequency of this disease could she expect to see in her children? A) All male children will inherit it. B) All female children will be carriers like she is. C) There is a 50% chance her male children will inherit the disease. D) There is a 50% chance her female children will inherit the disease.

Ans: C Feedback: With X-linked inheritance, there is a 50% chance male children will be affected. There is a 50% chance female children will be carriers of the disease.

A nurse is caring for a client who is having a nonstress test performed. The fetal heart rate (FHR) is 130 to 150/min, but there has been no fetal movement for 15 min. Which of the following actions should the nurse perform? a. Immediately report the situation to the client's provider and prepare the client for induction of labor. b. Encourage the client to walk around without the monitoring unit for 10 min, then resume monitoring. c. Offer the client a snack of orange juice and crackers. d. Turn the client onto her left side.

C. Offer the client a snack of orange juice and crackers. i: A nonstress test depends upon fetal movement, and this fetus is most likely asleep. Most fetuses are more active after meals due to the increase in the mother's blood sugar. Giving the mother a snack will promote fetal movement.

A nurse is completing discharge teaching to a client in her 35th week of pregnancy who has mild preeclampsia. Which of the following information about nutrition should be included in the teaching? A. Consume 40 to 50 g of protein daily. B. Avoid salting of foods during cooking. C. Drink 48 to 64 ounces of water daily. D.Limit intake of whole grains , raw fruits and vegetables

C. The client who has preeclampsia is encouraged to drink six to eight 8-ounce glasses of water (48 to 64 ounces) per day. She should avoid alcohol and limit intake of caffeinated beverages.

A nurse is caring fora client who has a suspected ectopic pregnancy at 8 weeks of gestation. Which of the following manifestations should the nurse expect to identify as consistent with the diagnosis? A. Severe nausea and vomiting B. Large amount of vaginal bleeding C. Unilateral, cramp-like abdominal pain D. Uterine enlargement greater than expected for gestational age

C. Unilateral, cramp-like abdominal pain

A woman in her 20s has experienced a spontaneous abortion (miscarriage) at 10 weeks' gestation and asks then nurse at the hospital what went wrong. She is concerned that she did something that caused her to lose her baby.The nurse can reassure the woman by explaining that the most common cause of miscarriage in the first trimester is related to which factor? a. Exposure to chemicals or radiation b. Advanced maternal age c. Chromosomal defects in the fetus d. Faulty implantation

Chromosomal defects in the fetus. Fetal factors are the most common cause of early miscarriages, with chromosomal abnormalities in the fetus being the most common reason. This client fits the criteria for early spontaneous abortion since she was only 10 weeks' pregnant and early miscarriage occurs before 12 weeks.

A client at 28 weeks' gestation is seen during a prenatal visit. The nurse notes that the client's most recent hemoglobin level is 10.9 g/dl (109 g/1). Which is an appropriate action for the nurse to take? a. Refer the client for additional laboratory testing. b. Notify the health care provider of the finding. c. Instruct the client to increase the daily iron intake. d. Continue with routine prenatal assessments .

Continue with routine prenatal assessments .

A nurse in a prenatal clinic is caring for a client who is at 7 weeks of gestation. The client reports urinary frequency and asks if this will continue until delivery. Which of the following responses should the nurse make? a. "It's a minor inconvenience, which you should ignore." b. "In most cases it only lasts until the 12th week, but it will continue if you have poor bladder tone." c. "There is no way to predict how long it will last in each individual client." d. "It occurs during the first trimester and near the end of the pregnancy."

D. "It occurs during the first trimester and near the end of the pregnancy." Urinary frequency is due to increased bladder sensitivity during the first trimester and recurs near the end of the pregnancy as the enlarging uterus places pressure on the bladder.

A nurse is providing teaching about nutrition to a client at her first prenatal visit. Which of the following statements by the nurse should be included in the teaching? A. "You will need to increase your calcium intake during breast feeding." B. Prenatal vitamins will meet your need for increased vitamin D during pregnancy." C. "Vitamin E requirements decline during pregnancy due to increase in body fat." D. "You will need to double your intake of iron during pregnancy. "

D. "You will need to double your intake of iron during pregnancy." i: During pregnancy, the need for iron increases to allow transfer of the appropriate amounts to the fetus and to support expansion of the client's red blood cell volume.

A nurse is caring for a client who has a positive pregnancy test. The nurse is teaching the client about common discomforts in the first trimester of pregnancy as well as warning signs of potential danger. The nurse should instruct the client to call the clinic if she experiences which of the following manifestations? A. Leukorrhea B. Urinary frequency C. Nausea and vomiting D. Facial edema

D. Facial edema is a warning sign of a hypertensive condition or preeclampsia and should be reported immediately to the provider.

A nurse in a prenatal clinic is caring for a client who is at 12 weeks gestation. The client asks about the cause of her heartburn. Which of the following responses should the nurse make? a. Retained bile in the liver results in delayed digestion. b. Increased estrogen production causes increased secretion of hydrochloric acid. c. Pressure from the growing uterus displaces the stomach. d. Increased progesterone production causes decreased motility of smooth muscle.

D. Increased progesterone production causes decreased motility of smooth muscle. increase progesterone production causes a relaxation of the cardiac sphincter of the stomach and delayed gastric emptying which can result in heartburn

A nurse is caring for an adolescent client who is gravida 1 and para 0. The client was admitted to the hospital at 38 weeks of gestation with a diagnosis of preeclampsia. Which of the following findings should the nurse identify as inconsistent with preeclampsia? A. 1 + pitting sacral edema b. 3+ protein in the urine c. Blood pressure 148/98 mm Hg d. Deep tendon reflexes of +1

Deep tendon reflexes of +1 Deep tendon reflexes of +1 are decreased. In a client who has preeclampsia, the nurse should expect to find an increased, rather than a decreased, deep tendon reflex.

A nurse is caring for a client who has preeclampsia and is being treated with magnesium sulfate. The client's respiratory rate is 10/min and deep tendon reflexes are absent. Which of the following actions should the nurse take? A.Discontinue the medication infusion . B. Prepare for an emergency cesarean birth. C. Assess maternal blood glucose. D Place the client in Trendelenburg position.

Discontinue the medication infusion

A pregnant client with deep vein thrombosis has been diagnosed as having systemic lupus erythematosus (SLE). The nurse would monitor the client closely for the development of which complication?

Fetal malnutrition Explanation: SLE is an autoimmune disorder in which there is deposition of immune complexes in the capillaries and visceral structures. Clients with SLE who become pregnant are at an increased risk of fetal malnutrition due to decreased placental circulation. Pregnancy-related problems in SLE include prematurity, stillbirth, decreased placental weight and thinner placental villi. In clients with SLE there is preterm birth and decreased placental weight. Fetal macrosomia is seen in clients having gestational diabetes, not SLE.

The nurse is documenting a non-pregnant client's obstetric history. The client informed the nurse she has 4 children living at home. She birthed one child at 34 weeks' gestation, one child at 37 weeks' gestation, one at 38 weeks' gestation, and one at 39 weeks' gestation. The client has had one abortion. Using the GTPAL format, how will the nurse document the client's obstetric history? a. G5, T2, P1, A1, L3 b. G4, T3, P0, A1, L3 c. G5, T2, P2, A1, L4 d. G4, T3, P1, A1, L4

G5, T2, P2, A1, L4

A student nurse is preparing for a presentation that will illustrate the various physiologic changes in the woman's body during pregnancy. Which cardiovascular changes up through the 26th week should the student point out? a. Decreased pulse rate and increased blood pressure b. Increased pulse rate and decreased blood pressure c. Increased pulse rate and blood pressure d. No change in pulse rate or blood pressure

Increased pulse rate and decreased blood pressure Pulse rate frequently increases during pregnancy, although the amount varies from a slight increase to 10 to 15 beats per minute. Blood pressure generally decreases slightly during pregnancy, reaching its lowest point during the second trimester.

A nurse is conducting a routine well-check assessment on an 18-year-old female who is experiencing normal menstrual cycles. When the client questions the nurse concerning the menstrual process, the nurse can point out which hormone is primarily responsible for ovulation?

Luteinizing hormone.

An Infant was born at term but has intrauterine growth restriction (IUGR). What findings in the infant's history would contribute to this problem? Select all that apply. a. maternal heartburn b. parents small in stature c. maternal smoking d. intrauterine infection of the fetus e. daily maternal exercise

Maternal smoking Intrauterine infection of the fetus There are a number of contributory causes for IUGR in a fetus, including maternal smoking or drug/alcohol use, infections such as cytomegalovirus and rubella, maternal hypertension, and chronic maternal diseases such as sickle cell disease or renal disease. Maternal heartburn is a normal maternal complaint and does not affect the fetal well being Small parents could cause a fetus to be small, but would not cause IUGR. Maternal exercise does not cause IUGR.

Which statement should be incorporated into the teaching plan developed to present instruction about the female menstrual cycle to nursing students? a.Progesterone influences the growth of endometrial lining. b. Estrogen is the dominant hormone during the luteal phase. c.Menses ensues when the levels of estrogen and progesterone fall. d.The follicular phase is dominated by progesterone and testosterone.

Menses ensues when the levels of estrogen and progesterone fall. Explanation: Menstruation depends on the interplay of various hormones. The hypothalamus secretes gonadotropin-releasing hormone, which stimulates the pituitary gland to secrete follicle-stimulating hormone and luteinizing hormone. These hormones stimulate the ovaries to produce estrogen and progesterone, which are necessary for stimulation of the target organs (vagina, breast, uterus) in preparing for pregnancy.

A client with a multiple gestation has come to a health care facility for a regular antenatal check-up. When educating the client on pregnancy, about which complication should the nurse inform the client? a. hypotension b. fetal macrosomia c. frequent diarrhea d. placental dysfunction

Placental dysfunction The nurse should inform the client that placental dysfunction might occur as a complication of multiple pregnancies. Other complications of multiple pregnancies include preterm labor, hypertension, anemia, cord abnormalities, congenital anomalies, intrauterine growth restriction, and low birth weight. Hypertension, and not hypotension, is seen in multiple pregnancies. Fetal macrosomia is not seen in cases of multiple gestation. Constipation, and not diarrhea, is also seen as a complication of multiple pregnancies. This is due to the decreased functioning of the gastrointestinal system in multiple pregnancy.

The nurse is caring for an intrapartum mother whose fetus has asymmetrical intrauterine growth restriction (IUGR) after the 24th week of gestation. Which nursing action is best? a. Provide emotional support to the mother and support person as the neonate has anomalies. b. Regular assessment of the fetal monitor tracings and preparation for a cesarean birth, if needed. c. Anticipate a precipitous delivery since the neonate is small for gestational age. d. Use regular assessment techniques as an uncomplicated delivery is anticipated

Regular assessment of the fetal monitor tracings and preparation for a cesarean birth, if needed. The fetus with asymmetrical intrauterine growth restriction is compromised in some manner; thus, regular assessment of the fetal monitor tracings can indicate if the fetus is in distress (a common occurrence). If the fetus is in distress due to the work of birth, be prepared for a cesarean section. A congenital anomaly nor a precipitous delivery is not always present with IUGR. Since there is a complication causing IUGR, a complicated delivery is anticipated.

A nurse is preparing to administer magnesium sulfate IV to a client who is experiencing preterm labor. Which of the following is the priority nursing assessment for this client? A. Temperature b.Fetal heart rate (FHR) c.Bowel sounds d. Respiratory rate

Respiratory rate

Placental abruption

Risk factors: - maternal hypertension -blunt external abdominal trauma -cocaine use resulting in vasoconstriction -previous incidents -cigarette smoking or nicotine use -PROM -Multifetal pregnancy Expected assessment findings: - sudden onset of intense localized uterine pain with dark red vaginal bleeding -are of uterine tenderness can be localized or diffuse over uterus and board-like -contractions with hypertonicity -fetal distress -clinical findings of hypovolemic shock Nursing care associated with the condition: - palpate the uterus for tenderness and tone -perform serial monitoring of fundal height -assess FHR pattern -Immediate birth is the key -Administer IV fluids, blood products and medications as prescribed -Administer oxygen 8 to 10 L/min via face mask. -Monitor maternal vital signs, observe for declining hemodynamic status -Perform fetal continuous monitoring -Assess urinary output and monitor fluid balance -Provide emotional support Lab tests/Diagnostics: -Ultrasound -biophysical profile -Kleihauer-Betke test to detect fetal blood in maternal circulation -cross and type match for possible blood transfusions -clotting defects, e.g., DIC -Hgb & Hit decreased Procedures/treatment: immediate birth

Gestational Trophoblastic disease

Risk factors: -Prior molar pregnancy -client in early teenage years or older than age 40 Expected assessment findings: - excessive vomiting (hyperemesis gravidarum) due to elevated hCG levels. -Rapid uterine growth more than expected for the duration of pregnancy -Bleeding that is often dark brown resembling prune juice or bright red that is either scant or profuse and continues a few days or intermittently for a few weeks -anemia from blood loss -clinical findings of preeclampsia that occur prior t 24 weeks of gestation. Nursing care associated with the condition: -measure fundal height -assess vaginal bleeding and discharge -assess GI status and appetite -Monitor for manifestations of preeclampsia -Administer medication prescribed; Rho immune globulin for RH-negative mums, and chemo for malignant cells -advice client to save tissue or clots for evaluation Lab tests/Diagnostics: -serum hCG is persistently high compared to expected decline after 10 to 12 weeks of pregnancy. -ultrasound Procedures/treatment: -Suction curettage to evacuate mole -Serum hCG analysis following molar pregnancy to be done weekly for 3 weeks, then monthly for 6 months up to 1 yer to detect GTD

Spontaneous abortion

Risk factors: -chromosomal abnormalities -advanced maternal age -maternal illness e.g., type 1 diabetes mellitus -premature cervical dilation -chronic maternal infections -maternal malnutrition -trauma or injury -anomalies in fetus or placenta -substance abuse Expected assessment findings: -abdominal cramping or pain -rupture of membranes - dilation of cervix -fever -manifestations of hemorrhage e.g., hypotension; tachycardia. Nursing care associated with the condition: -observe color and amount of bleeding -maintain client on bed rest -avoid vaginal exams -assist with ultrasound -administer blood products and medications as prescribed -determine how much tissue is passed and save tissue for examination -assist with termination of pregnancy e.g., D&C, D&E, prostaglandin administration -use the term miscarriage not abortion -provide client education and emotional support -referral to pregnancy loss support groups Lab tests/Diagnostics: ultrasound clotting factors to monitor for DIC which occurs with retained products Hgb & Hct - considerable blood loss WBC - suspected infection Procedures/treatment: D&C, D&E, prostaglandin, oxytocin, Rho immune globulin for Rh- mother, broad-spectrum antibiotics for septic abortion

Premature Rupture of Membranes

Risk factors: -infection -prior preterm birth -shortening of the cervix -second/third trimester bleeding -pulmonary or connective tissues disorder -low BMI -copper or ascorbic acid deficiencies -tobacco or substance disorders Expected assessment findings: -presence of clear fluid -patient reports gush of fluid Nursing care associated with the condition: -prepare for birth if indicated -obtain vaginal or rectal cultures for streptococcus betahemolytic -obtain vaginal cultures for chlamydia and gonorrhoeae -limit vaginal exams -assess vital signs every 2 hours; notify provider of temp greater than 100 degrees F -Monitor FHR and uterine contractions -encourage hydration -obtain CBC Lab tests/Diagnostics: - a positive nitrazine paper test or positive ferning test Procedures/treatment: -ampicillin - chorioamnionitis -betamethasone - fetal lung maturity

Preterm Labor

Risk factors: -infections of urinary tract or vagina, HIV, active herpes infection, or chorioamnionitis -previous preterm birth -multifetal pregnancy -oligohydramnios -hydramnios -advanced maternal age -smoking -substance abuse -violence or abuse -history of multiple miscarriages or abortions -diabetes mellitus - chronic hypertension -preeclampsia -lack of prenatal care -recurrent premature dilation of the cervix -placenta previa or abruptio placentae -PPROM -Uterine abnormalities -second trimester bleeding -low prepregnancy weight -congenital fetal anomalies Expected assessment findings: -regular uterine contractions -pressure in pelvis and menstrual like cramping -persistent low backache -GI cramping sometimes with diarrhea -urinary frequency -vaginal discharge -change in cervical dilation -premature rupture of membranes Nursing care associated with the condition: -activity restriction -modified bed rest with bathroom privileges -avoid intercourse -rest in left lateral position -ensuring hydration -identifying and treating infection -monitor FHR and contraction pattern -fetal tachycardia associated with infection with preterm labor Lab tests/Diagnostics: -fetal fibronectin in vaginal swab -cervical cultures -CBC -Urinalysis - ultrasound to determine cervical shortening Procedures/treatment: -nifedipine - calcium channel blocker to suppress contractions. -magnesium sulfate - suppress contractions; contraindicated after 34 weeks - terbutaline - inhibits uterine activity -indomethacin - suppress preterm labor by blocking production of prostaglandins. Used for fetuses under 32 weeks. -betamethasone - lung maturity 24 - 34 weeks gestation

Iron-deficiency anemia

Risk factors: -less than 2 years between pregnancies -heavy menses -diet low in iron -unhealthy weight loss programs Expected assessment findings: -fatigue and weakness -craving unusual food (pica) Nursing care associated with the condition: -The recommended iron intake for pregnant clients is 27mg/day. Prenatal vitamins typically contain 30 mg iron. If maternal iron deficiency anemia is present increased dosages of 60 to 120 mg/day can be required. -Increase dietary intake of foods rich in iron (legumes, dried fruit, dark green leafy vegetables, and meat.) -Educate client ways to minimize adverse GI effects. Lab tests/Diagnostics: -Hgb less than 11 mg/dl in first and third trimesters and less than 10.5 mg/dl in the second trimester -Hct less than 33.0% -Blood ferritin less than 12 mcg/L in presence of low Hgb Procedures/treatment: Ferrous sulfate iron supplements: educated client to take on an empty stomach and take with orange juice to increase absorption; increase roughage and fluid intake to assist in discomforts of constipation. Parenteral iron therapy - for severe anemic clients

Gestational Hypertension

Risk factors: -maternal age younger than 19 or older than 40 -first pregnancy -extreme obesity -multifetal gestation -chronic renal disease -chronic hypertension -family history of preeclampsia -diabetes mellitus -rheumatoid arthritis -SLE Expected assessment findings: -Severe continuos headache -nausea -blurring of vision -flashes of light or dots before eyes -proteinuria -periorbital, facial, hand and abdominal edema -pitting edema in lower extremities -oliguria -hyperreflexia -scotoma -epigastric pain -right upper quadrant pain - dyspnea -diminished breath sounds - seizures -jaundice Nursing care associated with the condition: -assess LOC -Obtain pulse oximetry -monitor urine output -obtain daily weights -monitor vital signs especially BP -encourage lateral positioning -perform NST and daily kick counts -instruct client to monitor I&O Lab tests/Diagnostics: -Liver enzymes -blood creatinine, BUN, Uric acid -CBC -Clotting studies -chemistry profile -dipstick testing of urine for proteinuria -Non-stress test, contraction stress test, biophysical profile, and serial ultrasounds to assess fetal status -doppler blood flow analysis -daily kick counts Procedures/treatment: -antihypertensives -magnesium sulfate

Gestational Diabetes

Risk factors: -obesity -hypertension -glycosuria -maternal age over 25 years -family history -previous large baby or stillborn Expected assessment findings: -hypoglycemia; nervousness, headache, weakness, irritability, hunger, blurred vision. -hyperglycemia; polydipsia, polyphagia, polyuria, nausea, abdominal pain, flushed dry skin, fruity breath. Nursing care associated with the condition: - monitor client's blood glucose - monitor fetus Lab tests/Diagnostics: - 1-hr glucose tolerance test at 24-28 weeks gestation; positive 130 to 140 mg/dl or greater. - 3-hr oral glucose tolerance test; glucose levels determined at 1, 2 and 3 hour mark. -presence of ketones in urine. Procedures/treatment: -diet and exercise - insulin for persistent high blood sugars -glyburide

Ectopic Pregnancy

Risk factors: Any factor that compromises tubal latency e.g., STIs, tubal surgery, IUDs, assisted reproductive technologies Expected assessment findings: -Unilateral stabbing pain and tenderness in the lower abdominal quadrant. -menses that is delayed 1 to 2 weeks , lighter than usual or irregular. -Scant, dark red, brown vaginal spotting 6 to 8 weeks after last normal menses ; red vaginal bleeding if rupture has occured. -referred shoulder pain due to blood in the peritoneal cavity irritating the diaphragm or phrenic nerve after tubal rupture. -Findings of hemorrhage and shock (hypotension, tachycardia, pallor, dizziness) if large amount of bleeding has occurred. Nursing care associated with the condition: -replace fluids and maintain electrolyte balance -provide client education and psychological support -administer medications as prescribed. -prepare client for surgery and post-operative nursing care -Provide referral to pregnancy loss support group -obtain serum hCG and progesterone levels, liver and renal function studies , CBC and type and Rh. Lab tests/Diagnostics: - ultrasound shows empty uterus Procedures/treatment: -medical management if tube has not ruptured and tube preservation is desired -Methotrexate inhibits cell division and embryo enlargement, dissolving the pregnancy - Salpingostomy is done to salvage Fallopian tube if it is not ruptured. - Laparoscopic salpingectomy (removal of tube) is done when tube is ruptured.

Cervical Insufficiency

Risk factors: -History of cervical trauma, short labors, pregnancy loss in early gestation or advanced cervical dilation at earlier weeks of gestation. -Congenital structural defects of the uterus or cervix Expected assessment findings: -Increase in pelvic pressure or urge to push -Pink-stained vaginal discharge or bleeding -possible gush of fluid -uterine contractions with expulsion of fetus Nursing care associated with the condition: -Assess vaginal discharge -Monitor client reports of pressure and contractions -Check vital signs -Evaluate client's support systems or availability of assistance if activity or bed restrictions are prescribed Lab tests/Diagnostics: -Ultrasound showing a short cervix, presence or cervical funneling or effacement of the cervix. Procedures/treatment: -Cervical cerclage placed at 12-14 weeks and removed at 37 - 38 weeks. -Avoid intercourse -Increased hydration for a more relaxed uterus -Activity restriction or bed rest.

When describing the role of a doula to a group of pregnant women, the nurse would include which information? a. The doula primarily focuses on providing continuous labor support. b. The doula is a professionally trained nurse hired to provide physical and emotional support. c. The doula can perform any necessary clinical procedures. d. The doula is capable of handling high-risk births and emergencies

The doula primarily focuses on providing continuous labor support. Doulas provide the woman with continuous support throughout labor. The doula is a laywoman trained to provide women and families with encouragement, emotional and physical support, and information through late pregnancy, labor, and birth. A doula does not perform any clinical procedures and is not trained to handle high-risk births and emergencies.

A client experiencing contractions presents at a health care facility. Assessment conducted by the nurse reveals that the client has been experiencing Braxton Hicks contractions. The nurse has to educate the client on the usefulness of Braxton Hicks contractions. Which role do Braxton Hicks contractions play in aiding labor? a. These contractions help in softening and ripening the cervix. b. These contractions increase the release of prostaglandins. c. These contractions increase oxytocin sensitivity. d. These contractions make maternal breathing easier.

These contractions help in softening and ripening the cervix. Braxton Hicks contractions assist in labor by ripening and softening the cervix and moving the cervix from a posterior position to an anterior position. Prostaglandin levels increase late in pregnancy secondary to elevated estrogen levels; this is not due to the occurrence of Braxton Hicks contractions. Braxton Hicks contractions do not help in bringing about oxytocin sensitivity. Occurrence of lightening, not Braxton Hicks contractions, makes maternal breathing easier.

The nurse is appraising the laboratory results of a pregnant client who is in her second trimester and notes the following: thyroid stimulating hormone (TSH) slightly elevated, glucose in the urine, complete blood count (CBC) low normal, and normal electrolytes. The nurse prioritizes further testing to rule out which condition? a. Preeclampsia b. Anemia c. Hyperthyroidism d. Gestational diabetes

`Gestational diabetes Glycosuria, glucose in the urine, may occur normally during pregnancy, however if it appears in the urine, the patient should be sent for test to rule out gestational diabetes. Preeclampsia, anemia, and hypothyroidism are not related to glucose nor to renal function. A slightly elevated TSH would indicate possible hyperthyroidism instead of hypothyroidism. Anemia would be indicated by below normal hematocrit. If the client's CBC is low normal than the nurse should monitor future results to ensure the client's counts are not dropping. It would also be appropriate for the nurse to investigate possible dietary issues. Preeclampsia would be best monitored by the blood pressure readings.

What would the nurse recommend to a pregnant client at 35 weeks' gestation who reports irregular contractions and lower backache? a) Lie down and rest and see if the contractions stop and pain subsides. b) Ask her if she is having urinary frequency that may indicate an infection. c) Suggest that she try some isometric exercises to relieve the back pain. d) Have a family member rub her back and place moist heat on it.

a) Lie down and rest and see if the contractions stop and pain subsides. If a client is less than 37 weeks and having contractions that will not go away, she may be in preterm labor and this needs to be reported. The first thing for her to do is lie down and rest to see if the contractions go away. Lower backache and cramping or pain need to be taken seriously and reported to the health care provider if they persist.

A pregnant client with preeclampsia with sever features has developed HELLP syndrome. In addition to the observations necessary for preeclampsia, what other nursing intervention is critical for this client? a. observation for bleeding b. maintaining a patent airway . c. administration of a tocolytic, if prescribed d. monitoring for infection

a) observation for bleeding Because of the low platelet count associated with this condition, women with HELLP syndrome need extremely close observation for bleeding, in addition to the observations necessary for preeclampsia. Maintaining a patent airway is a critical intervention needed for a client with eclampsia while she is having a seizure. Administration of a tocolytic would be appropriate for halting labor. Monitoring for infection is not a priority intervention in this situation.

As part of a 31-year-old client's prenatal care, the nurse is assessing immunization history. Which immunization is most relevant to ensuring a healthy fetus? a) rubella b) hepatitis A and B c) measles d) diphtheria, tetanus, and pertussis

a) rubella Maternal exposure to rubella during pregnancy poses a particular fetal risk that supersedes the significance of hepatitis, measles, diphtheria, tetanus, or pertussis.

A physician has prescribed magnesium sulfate for a client with premature labor. Data collection reveals the client's respiratory rate is 12 breaths/minute, and urine output is 30 ml/hour. The magnesium sulfate serum levels are 7 mg/dl. When questioned, the client reports feeling warm and flushed. Based upon the nurse's understanding of magnesium sulfate, what action is most appropriate? a. The client is demonstrating early signs of toxicity and the dosage should be reduced. b. The client is demonstrating an allergic reaction and the medication should be discontinued immediately. c. The client's response is appropriate and within normal limits; therefore, no action is necessary. d. The client is demonstrating potential complications and the physician should be notified.

c. The client's response is appropriate and within normal limits; therefore, no action is necessary.

A nurse working in an OB clinic meets a female who is 4 to 6 weeks pregnant. Lab results reveal she is positive for syphilis, so she is treated with IM penicillin. Later in the pregnancy, she is retested, and her serum titer results continue to increase. How should the nurse interpret these results? a. The initial IM penicillin did not treat the syphilis. b. The female's syphilis is immune to the usual penicillin treatment. c. The female has been reinfected with syphilis. d. The serum titer usually rema ins high for up to a year, so no further treatment is required.

c. The female has been reinfected with syphilis.

A nurse is monitoring for signs of cardiac decompensation in a client who is laboring and who has a history of cardiovascular disease. The nurse should be especially , vigilant at which point during the labor and birth process? a first stage of labor b. second stage of labor c. immediate postpartum d. 4 hours postpartum

c. immediate postpartum