Pregnancy at risk

Transvaginal ultrasonography is often performed during the first trimester. While preparing your 6-week gestation patient for this procedure, she expresses concerns over the necessity for this test. The nurse should explain that this diagnostic test may be indicated for a number of situations (Select all that apply). A. Multifetal gestation B. Obesity C. Fetal abnormalities D. Amniotic fluid volume E. Ectopic pregnancy

A, B, C, E (Transvaginal ultrasound is useful in obese women whose thick abdominal layers cannot be penetrated with traditional abdominal ultrasound. This procedure is also used for identifying multifetal gestation, ectopic pregnancy, estimating gestational age, confirming fetal viability, and identifying fetal abnormalities. Amniotic fluid volume is assessed during the second and third trimester. Conventional ultrasound would be used.)

A woman has been admitted to the Labor and Delivery with a partial placental abruption at 30 weeks gestation. Which of the following interventions will likely be implemented? (Select all that apply): A. Administration of betamethasone (Celestone). B. Weekly NSTs C. Intermittent monitoring of the fetus D. Monitor for vaginal bleeding and contractions E. Monitor for non-reassuring FHR patterns

A. Administration of betamethasone (Celestone). B. Weekly NSTs D. Monitor for vaginal bleeding and contractions E. Monitor for non-reassuring FHR patterns

Identify the hallmark of placenta previa that differentiates it from abruptio placenta. A) Sudden onset of painless vaginal bleeding B) Board-like abdomen with severe pain C) Sudden onset of bright red vaginal bleeding D) Severe vaginal pain with bright red bleeding

A. Sudden onset of painless vaginal bleeding When the placenta attaches to the lower uterine segment near or over the cervical os, bleeding may occur without the onset of contractions or pain.

What assessment findings indicate to the nurses that a woman's preeclampsia should now be considered severe? (Select all that apply.) a. Urine output 40 mL/hour for the past 2 hours b. Serum creatinine 3.1 mg/dL c. Seeing "sparkly" things in the visual field d. Crackles in both lungs e. Soft, non-tender abdomen

ANS: B, C, D Signs of severe preeclampsia include elevated creatinine, seeing sparkles (visual disturbances), and pulmonary edema (manifested by crackles). The urine output is above the minimum requirements, and a soft non-tender abdomen is a reassuring sign.

A pregnant client is admitted to a health care facility after her laboratory results reveal elevated liver enzymes, thrombocytopenia, and low hemoglobin and hematocrit. Which assessment findings should the nurse prioritize for this client? Select all that apply. A. Watery diarrhea B. Generalized edema C. Excessive weight loss D. Nausea and vomiting E. Epigastric pain and tenderness

B. Generalized edema. D. Nausea and vomiting E. Epigastric pain and tenderness Explanation:The findings of anemia, elevated liver enzymes, and low platelets are indications of HELLP syndrome. The symptoms are similar to preeclampsia and can include epigastric or right upper quadrant pain and tenderness, nausea and vomiting, and generalized edema. Watery diarrhea and excessive weight loss are not symptoms of HELLP syndrome. Instead, weight gain may be seen in HELLP syndrome.

A client visits a health care facility reporting amenorrhea for 10 weeks, fatigue, and breast tenderness. Which assessment findings should the nurse prioritize for immediate intervention? Select all that apply. A. whitish discharge from the vagina B. hyperemesis gravidarum C. absence of fetal heart sounds D. dyspareunia E. elevated hCG levels

B. hyperemesis gravidarum C. absence of fetal heart sounds E. elevated hCG levels Explanation: This client presents with signs and symptoms suspicious for hydatidiform mole. The signs and symptoms of molar pregnancy include an elevated hCG level, absence of fetal heart sounds, and hyperemesis gravidarum. Whitish discharge from the vagina and dyspareunia (painful sexual intercourse) are seen in cases of infection. In molar pregnancy, a brownish vaginal bleeding is often seen.

A pregnant client with a history of multiple sexual partners is at highest risk for which of the following complications? A. Prelabor rupture of membranes B. Gestational diabetes C Ectopic pregnancy D Gestational hypertension

C. Ectopic pregnancy. A history of multiple sexual partners places the client at a higher risk of having contracted a sexually transmitted infection that could have ascended the uterus to the fallopian tubes and caused fallopian tube scarring and damage resulting in obstruction or blockage. This places the client at higher risk for ectopic pregnancy.

A patient is receiving magnesium sulfate for severe preeclampsia. The nurse must notify the attending physician immediately of which of the following assessment findings? A. patellar and biceps reflexes of +4 B. urinary output of 50 mL/hr C. respiratory rate of 10 breaths/min D. serum magnesium level of 5 mg/dL

C. respiratory rate of 10 breaths/min The drop in respiratory rate may indicate that the patient is suffering from magnesium toxicity. The nurse should report this finding to the physician.

A 32-year-old black woman in her second trimester has come to the clinic for an evaluation. While interviewing the client, she reports a history of fibroids and urinary tract infection. The client states, "I know smoking is bad and I have tried to stop, but it is impossible. I have cut down quite a bit though, and I do not drink alcohol." Complete blood count results reveal a low red blood cell count, low hemoglobin, and low hematocrit. When planning this client's care, which factor(s) would the nurse identify as increasing the client's risk for preterm labor? Select all that apply. A. maternal age B. history of fibroids C. cigarette smoking D. African heritage E. history of urinary tract infections F. complete blood count results

D. African heritage B. history of fibroids C. cigarette smoking E. history of urinary tract infections F. complete blood count results Explanation:For this client, risk factors associated with preterm labor and birth would include African heritage, cigarette smoking, uterine abnormalities, such as fibroids, urinary tract infection, and possible anemia based on her complete blood count results. Maternal age extremes (younger than 16 years and older than 35 years) are also a risk factor but do not apply to this client.

Which assessment findings, experienced by the client at 36 weeks' gestation, would the nurse document as diagnostic signs of severe preeclampsia? Select all that apply. A. edema B. elevated liver enzymes C. Elevated serum creatinine D. +1 proteinuria E. blood pressure of 164/110 mm Hg

E. blood pressure of 164/110 mm Hg B. elevated liver enzymes D. +1 proteinuria C. Elevated serum creatinine Explanation:Clinical manifestations of severe preeclampsia include blood pressure elevated to 160/110 mm Hg or higher, 15% increase in baseline blood pressure, +1 proteinuria, elevated liver enzymes and elevated serum creatinine. Although no longer considered a diagnostic sign of preeclampsia, edema is common in most pregnancies

The nurse is caring for a pregnant woman with diabetes mellitus. Which potential fetal complications should the nurse monitor the client for as she presents for her scheduled visits? Select all that apply. A. fetus with juvenile diabetes B. smaller than gestational age baby C macrosomia D. respiratory disorder E. congenital malformation

E. congenital malformations C. macrosomia D. respiratory disorder Explanation:Potential problems during pregnancy involving maternal diabetes mellitus include fetal death, macrosomia (oversized fetus), a fetus with a respiratory disorder, difficult labor, preeclampsia or eclampsia, polyhydramnios, and congenital malformations.

The nurse is doing meal planning with a pregnant woman with iron-deficiency anemia. What dietary recommendations would the nurse make to enhance the woman's intake of iron? Select all that apply. a. Drink orange juice with the iron supplement b Increase intake of dried beans and green leafy vegetables. c. Since fortified cereals are a poor source of iron, eat eggs or pancakes for breakfast. d. Limit intake of dried fruits, eating only fresh fruit. e. Cook food in an iron skillet, if possible.

a. Drink orange juice with the iron supplement b Increase intake of dried beans and green leafy vegetables. e. Cook food in an iron skillet, if possible. Dried fruits, fortified grains and cereals, and animal protein are all good sources of iron for a pregnant woman. Cooking in an iron skillet also will increase the amount of iron ingested. Vitamin C, like what is found in orange juice, enhances absorption of iron and is recommended to drink when taking iron supplements. Folate also increases the effectiveness of iron supplements; foods high in folate include green leafy vegetables, fortified grains and dried beans.

Which of the following signs or symptoms would the nurse expect to see in a women with concealed abruptio placentae? a. increasing abdominal girth measurements b. profuse vaginal bleeding c. bradycardia with an aortic thrill d. hypothermia with chills

a. increasing abdominal girth measurements

The nurse who works at the local health department is preparing to give a talk on post-term pregnancies. She wants to include the fetal risks. Which risks should she include? Select all that apply. a. macrosomia b. brachial plexus injuries c. shoulder dystocia d. failure to thrive e. cephalopelvic disproportion

a. macrosomia c. shoulder dystocia b. brachial plexus injuries e. cephalopelvic disproportion Explanation:Fetal risks associated with a postterm pregnancy include macrosomia, shoulder dystocia, brachial plexus injuries, and cephalopelvic disproportion. Failure to thrive is more frequently associated with newborns who are of a low birth weight.

The nurse is preparing the plan of care for a woman hospitalized for hyperemesis gravidarum. Which interventions would the nurse most likely include? Select all that apply. a. preparing the woman for insertion of a feeding tube b obtaining baseline blood electrolyte levels c maintaining NPO status for the first day or two d. administering antiemetic agents e monitoring intake and output

c maintaining NPO status for the first day or two d. administering antiemetic agents b obtaining baseline blood electrolyte levels e monitoring intake and output

A nurse is monitoring a client in the third trimester of pregnancy who has a diagnosis of severe preeclampsia. Which finding would prompt the nurse to contact the physician? A. complaint of feeling hot b. enlargement of the breasts c. diaphoresis and tachycardia d. periods of fetal movement followed by quiet periods.

c. diaphoresis and tachycardia

The nurse knows that the term to describe a woman at 26 weeks gestation with a history of elevated blood pressure who presents with a urine showing 2+ protein (by dipstick) is: A. preeclampsia B. chronic hypertension c. gestational hypertension d. chronic hypertension with superimposed preeclampsia

d. chronic hypertension with superimposed preeclampsia. Criteria for chronic hypertension with superimposed preeclampsia: History of hypertension prior to pregnancy without proteinuria. New-onset proteinuria after 20 weeks gestation.

A nursing instructor is conducting a session exploring the signs and symptoms of eclampsia to a group of student nurses. The instructor determines the session is successful after the students correctly choose which signs indicating eclampsia? Select all that apply. a. auditory hallucinations b. hyperglycemia c. blurring of vision d. proteinuria e. hyperreflexia

d. proteinuria e. hyperreflexia c. blurring of vision Explanation: Eclampsia is usually preceded by an acute increase in blood pressure as well as worsening signs of multiorgan system failure seen as increasing liver enzymes, proteinuria, and symptoms such as blurred vision and hyperreflexia. Hyperglycemia and auditory hallucinations are not seen with an acute increase in maternal blood pressure or eclampsia.

The nurse who suspects that a patient has early signs of ectopic pregnancy should be observing her for which symptoms? (Select all that apply.) a. Pelvic pain b. Abdominal pain c. Unanticipated heavy bleeding d. Vaginal spotting or light bleeding e. Missed period

ANS: A, B, D, E Early signs of ectopic pregnancy include pelvic pain, abdominal pain, spotting or light bleeding, and a woman's report of a "missed period." Heavy bleeding is a later sign and occurs after the tube has ruptured.

A pregnant client with preterm premature rupture of the membranes is being discharged home. A nurse is preparing the client's discharge teaching plan. Which instructions would the nurse include? Select all that apply. "Take tub baths instead of showers." "Gently massage your breasts at least once each day." "If you notice your belly starting to tighten, call your health care provider." "Check your temperature each day, reporting any increase immediately." "Be sure to perform fetal kick counts about once every 3 days."

"If you notice your belly starting to tighten, call your health care provider." "Check your temperature each day, reporting any increase immediately."

The nurse is caring for a patient at risk for preterm labor. Which are risk factors for preterm labor? Select all that apply .1. Multiple gestation 2. History of preterm birth 3. Maternal smoking 4. Maternal age of 18 to 25 5. Decreased fetal movement

.1. Multiple gestation 2. History of preterm birth 3. Maternal smoking

A patient who is obese is planning a pregnancy and asks the clinic nurse what the risks are if she were to get pregnant now. Which pregnancy complications are related to obesity? Select all that apply .1. Preeclampsia 2. Gestational diabetes 3. Congenital anomalies 4. Cystic fibrosis of the newborn 5. Sickle cell trait of the newborn

.1. Preeclampsia 2. Gestational diabetes 3. Congenital anomalies

The nurse is teaching a group of pregnant women about the risks of venous thromboembolism (VTE). Which statements would the nurse include in the education? Select all that apply. 1. All pregnant women are at an increased risk because pregnancy is a state of hypercoagulability .2. Women should report any abrupt unilateral leg pain right away. 3. Heparin is not considered safe during pregnancy, so it should be avoided. 4. Pregnant women should avoid sitting for long periods of time to avoid venous stasis in the lower extremities. 5. A prior history of having a blood clot is not significant and does not put a patient at higher risk during pregnancy.

1. All pregnant women are at an increased risk because pregnancy is a state of hypercoagulability .2. Women should report any abrupt unilateral leg pain right away. 4. Pregnant women should avoid sitting for long periods of time to avoid venous stasis in the lower extremities.

The nurse is caring for a patient with congenital heart disease who is beginning her prenatal care. Which normal cardiac changes during pregnancy can exacerbate cardiac disease during pregnancy? Select all that apply. 1. Increase in total blood volume from 30 to 50% 2. Decrease in heart rate by 10 to 20 beats per minute 3. The weight of the gravid uterus can lie on the inferior vena cava 4. Increased peripheral vascular resistance 5. Increased cardiac output

1. Increase in total blood volume from 30 to 50% 3. The weight of the gravid uterus can lie on the inferior vena cava 5. Increased cardiac output

The nurse is caring for a gravid patient with iron-deficiency anemia. Which assessment findings are associated with this diagnosis? Select all that apply. 1. Pallor 2. Fatigue 3. Rales heard on auscultation 4. Hemoglobin below 10 to 11 g/dL 5. Bruising easily

1. Pallor 2. Fatigue 4. Hemoglobin below 10 to 11 g/dL

The nurse is caring for a gravid patient who is carrying twins. Which complications would the nurse monitor the patient for? Select all that apply. 1. Preeclampsia 2. Gestational diabetes 3. Abruptio placentae 4. Sickle cell anemia 5. Cardiomyopathy

1. Preeclampsia 2. Gestational diabetes 3. Abruptio placentae 5. Cardiomyopathy

The nurse taking a patient's history at her initial prenatal appointment assesses her risk factors for high-risk pregnancy. Which finding increases her risk for pregnancy complications? Select all that apply. 1. Prior pregnancy complications 2. Current hypertension 3. Father with hypertension 4. Smoking 5. Maternal aunt with breast cancer

1. Prior pregnancy complications 2. Current hypertension 4. Smoking

The nurse is caring for a patient with placenta previa. Which would be included in the plan of care? Select all that apply. 1. Promptly report any increase in vaginal bleeding. 2. Assess fetal heart rate continuously with fetal scalp electrode. 3. Limit vaginal exams to once a shift. 4. Establish and maintain intravenous (IV) access. 5. Ensure the availability of blood products.

1. Promptly report any increase in vaginal bleeding. 4. Establish and maintain intravenous (IV) access. 5. Ensure the availability of blood products.

A gravid woman has been admitted with preeclampsia. The nurse knows to watch for signs of potential eclampsia. Which signs or symptoms might indicate impending eclampsia? Select all that apply. 1. Severe headache 2. Clonus 3. Seeing flashes of light 4. Epigastric pain 5. Deep tendon reflex (DTR) +2

1. Severe headache 2. Clonus (CNS irritability) 3. Seeing flashes of light 4. Epigastric pain

The nurse is caring for a woman with preterm premature rupture of membranes, not in active labor. Which of the following nursing actions would be included in the plan of care for this patient? Select all that apply. 1. Digital vaginal exams every four hours 2. Assess for signs of infection 3. Assess fetal heart rate with internal fetal scalp electrode 4. Report maternal fever to provider 5. Placement of a Foley catheter

2. Assess for signs of infection 4. Report maternal fever to provider

The nurse is teaching a childbirth preparation class about pregnancy complications after cesarean (c-section) births. Which pregnancy complications can result from prior cesarean births? Select all that apply. 1. Preeclampsia 2. Placenta previa 3. Placenta accreta 4. Placenta abruption 5. Hyperemesis gravidarum

2. Placenta previa 3. Placenta accreta 4. Placenta abruption

The nurse is assessing a patient who has been admitted for preeclampsia. Which findings would indicate severe features of preeclampsia? Select all that apply. 1. Blood pressure 158/98 mmHg 2. Platelet count of 90,000/mm3 3. Severe headache 4. Visual changes 5. Non-pitting edema of lower extremities

2. Platelet count of 90,000/mm3 3. Severe headache 4. Visual changes

The nurse is monitoring a patient who is receiving magnesium sulfate for preeclampsia. Which assessment findings might indicate magnesium toxicity? Select all that apply. 1. Deep Tendon Reflex (DTR) +4 2. Respiratory rate 10 breaths/minute 3. Urine output 15 mL/hour 4. Patient reports nausea 5. Patient reports feeling flushed

2. Respiratory rate 10 breaths/minute 3. Urine output 15 mL/hour

A woman experiencing preterm labor has an order to receive betamethasone. Which statement is correct regarding antenatal corticosteroids? Select all that apply 1. They reduce the risk of GBS sepsis in the newborn. 2. They are most beneficial from 24 to 34 weeks' gestation. 3. They accelerate fetal lung maturity. 4. They reduce the risk of necrotizing enterocolitis in the neonate. 5. They decrease the contractility of the uterus.

2. They are most beneficial from 24 to 34 weeks' gestation. 3. They accelerate fetal lung maturity. 4. They reduce the risk of necrotizing enterocolitis in the neonate.

A patient is on magnesium sulfate via IV pump for pre-eclampsia. Which of the following should the nurse perform to monitor the patient for early signs of toxicity? (Select all that apply). A. Maternal vital signs B. Patellar reflexes C. Speech D. Level of consciousness E. Kernig's assessments

A. Maternal vital signs B. Patellar reflexes C.Speech D. Level of consciousness

Intrauterine growth restriction (IUGR) is associated with numerous pregnancy-related risk factors (Select all that apply). A. Poor nutrition B. Maternal collagen disease C. Gestational hypertension D. Premature rupture of membranes E. Smoking

A, B, C, E( Poor nutrition, maternal collagen disease, gestational hypertension, and smoking all are risk factors associated with IUGR. Premature rupture of membranes is associated with preterm labor, not IUGR.)

The nurse is orientating in the Labor and Delivery unit and asks her preceptor how to differentiate a client with preeclampsia from one with eclampsia. Which symptoms would the preceptor describe to the new nurse as indicative of severe preeclampsia? Select all that apply. A. Hyperactive deep tendon reflexes B. Nondependent edema C. Glycosuria D. Seizure E. Blood pressure above 160/110 mm Hg

A. Hyperactive deep tendon reflexes B. Nondependent edema E. Blood pressure above 160/110 mm Hg Explanation: Preeclampsia occurs when a pregnant woman develops hypertension occurring after 20 weeks' gestation and only resolves after the fetus is delivered. Preeclampsia is exhibited by 2+ or more proteinuria, nondependent edema, blood pressure greater than 140 mm Hg systolic and above 90 mm Hg diastolic, and CNS irritability demonstrated by hyperactive deep tendon reflexes. If the client has a seizure, she has moved to eclampsia. Glycosuria is not associated with preeclampsia.

A woman with known cardiac disease from childhood presents at the obstetrician's office 6 weeks' pregnant. What recommendations would the nurse make to the client to address the known cardiac problems for this pregnancy? Select all that apply. A. Plan periods of rest into the workday. B Receive pneumococcal and influenza vaccines. C. Continue taking the scheduled warfarin. D. Increase the amount of sodium in your diet to compensate for the expanding fluid needs of the fetus. E Let the physician know if you become short of breath or have a nighttime cough.

A. Plan periods of rest into the workday. B Receive pneumococcal and influenza vaccines. E Let the physician know if you become short of breath or have a nighttime cough. Explanation: Women with known heart conditions need to be closely followed by both the obstetrician and a cardiologist. Recommendations would include rest periods, reduction of stress, getting immunizations, and monitoring for heart failure as demonstrated by a nighttime cough and shortness of breath. Consuming more sodium in the diet is not recommended due of the potential of developing hypertension. Warfarin is contraindicated during pregnancy since it crosses the placental barrier and can cause spontaneous abortion, stillbirth or preterm birth

A nurse is conducting a class on the effects of nicotine during pregnancy. Which complications will the nurse include in the teaching? Select all that apply. A. Spontaneous abortion B. Spontaneous rupture of membranes C. Placenta previa D. Tubal ectopic pregnancy E. Preterm labor and birth

A. Spontaneous abortion C. Placenta previa E. Preterm labor and birth D. Tubal ectopic pregnancy B. Spontaneous rupture of membranes Explanation:Smoking during pregnancy increases the risk of spontaneous abortion, preterm labor and birth, maternal hypertension, placenta previa, and abruptio placenta. It has also been considered an important risk factor for low birth weight, sudden infant death syndrome, and cognitive defects.

A home health care nurse is visiting a pregnant client with preeclampsia who is being managed at home. The nurse is reviewing the situations for which the client should contact the nurse. The nurse determines that the client demonstrates understanding when identifying which situation(s) as needing to be reported? Select all that apply. A. sinus headache B. excessive heartburn C. increased urination D. dizziness E. blurred vision

A. excessive heartburn B. dizziness C. blurred vision Explanation:The client should contact the home health nurse if any of the following occurs: increase in blood pressure; burning or frequency on urination; decrease in fetal activity or movement; headache in the forehead or posterior neck region (not a sinus headache); dizziness or visual disturbances such as blurred vision; stomach pain, excessive heartburn, or epigastric pain; decreased or infrequent urination; contractions or low back pain; easy or excessive bruising; a sudden onset of abdominal pain; or nausea and vomiting.

A pregnant 36-year-old woman has presented to the emergency department with vaginal bleeding. While reviewing the client's history, the nurse suspects placenta previa when which risk factors are found in her record? Select all that apply. A. infertility treatment B. smoking C. hypotension D. previous induced surgical abortion E. advancing maternal age

A. infertility treatment B. smoking D. previous induced surgical abortion E. advancing maternal age Explanation: Research has identified certain risk factors for placenta previa. They include advancing maternal age (more than 35 years), previous cesarean birth, multiparity, uterine insult or injury, cocaine/methamphetamine use, previous D&C, prior placenta previa, infertility treatment, Asian ethnic background, endometrial ablation, multiple gestations, previous induced surgical abortion, smoking, previous myomectomy to remove fibroids, short interval between pregnancies, and hypertension or diabetes.

A pregnant client is brought to the health care facility with signs of prelabor rupture of the membranes (PROM). Which conditions and complications are associated with PROM? Select all that apply. A. prolapsed cord B. spontaneous abortion C. preterm labor D. placenta previa E. abruptio placenta

A. prolapsed cord C. preterm labor E. abruptio placenta Explanation:The associated conditions and complications of premature rupture of the membranes are infection, prolapsed cord, abruptio placenta, and preterm labor. Spontaneous abortion and placenta previa are not associated conditions or complications of premature rupture of the membranes. HOWEVER: assessment findings of an inevitable abortion can include a rupture of membranes, take into consideration gestational age, additional assessment findings, and the clinical picture of your patient. (see table 19.1 categories of abortion page 663)

A woman has several relatives who had gestational hypertension and wants to decrease her risk for it. What information does the nurse provide this woman? (Select all that apply.) a. There is no way to reduce risk factors for gestational hypertension. b. Losing weight before you get pregnant will help prevent it .c. Eating a diet high in protein and iron may help prevent it. d. The father contributes no risk factors for hypertension in pregnancy e. Waiting until you are 35 to get pregnant cuts the risk in half.

ANS: B, C There are many risk factors for gestational hypertension, including obesity and anemia. The woman can take action to address these factors prior to becoming pregnant. The father's risks include the first baby and having fathered other preeclamptic pregnancies. Maternal age >35 increases the risk.

A client reports bright red, painless vaginal bleeding during her 32nd week of pregnancy. A sonogram reveals that the placenta has implanted low in the uterus and is partially covering the cervical os. Which immediate care measures are initiated? Select all that apply. A. Place the woman on bed rest maintaining the supine position. B. Attach external monitoring equipment to record fetal heart sounds and kick counts. C. Assist the client in stirrups and perform a pelvic examination. D. Determine the time the bleeding began and about how much blood has been lost. E. Obtain baseline vital signs and compare to those vital signs previously obtained.

B. Attach external monitoring equipment to record fetal heart sounds and kick counts. D. Determine the time the bleeding began and about how much blood has been lost. E. Obtain baseline vital signs and compare to those vital signs previously obtained. Explanation: Assessment is a priority in the immediate care period. Determining the extent of the blood loss, obtaining vital signs and monitoring the fetus provides data. With the exception of performing a pelvic examination and placing the client in the supine position, all of the answers are appropriate immediate care measures. The nurse should never attempt a pelvic or rectal examination with painless bleeding late in pregnancy because any agitation of the cervix might tear the placenta further and initiate massive hemorrhage, which is possibly fatal to both mother and child. The nurse should not place the client in the supine position for extended periods due to the possibility of supine hypotension. Left side lying is suggested

A client comes to the clinic reporting swelling in the hands and feet, blurred vision, a pounding headache and nausea and vomiting. The client had a positive pregnancy test 15 weeks ago, but has had no prenatal care. This is the client's third pregnancy, and she says that her uterus never grew this big or this fast with the previous pregnancies. Based on the client's reason for seeking care, the nurse would collect additional data to rule out the presence of which conditions? Select all that apply. A. Missed abortion B. Preeclampsia C. Molar pregnancy D. Placental abruption (abruptio placentae) E. Ectopic pregnancy

B. Preeclampsia C. Molar pregnancy Explanation: Given the timing of the positive pregnancy test, the client's presenting report is consistent with preeclampsia; however, she is too early in gestation for the typical onset of the disorder. In addition, the client has nausea and vomiting, which combined with the early-onset preeclampsia means the presence of a molar pregnancy needs to be considered. A placental abruption (abruptio placentae) occurs in the second half of pregnancy and characteristic presenting signs are acute abdominal pain and a boardlike abdomen. A missed abortion is associated with the disappearance of pregnancy symptoms, because the hormones of pregnancy are no longer being produced. An ectopic pregnancy is in the fallopian tube; therefore, uterine enlargement is not evident.

A nurse is conducting a teaching program for pregnant woman who are older than age 35. The nurse explains that although most women in their age group have healthy pregnancies and healthy newborns, they are at increased risk for possible complications. Which complications would the nurse include? Select all that apply. A. type 1 diabetes. B. preeclampsia C. abruptio placentae D. postpartum hemorrhage E. preterm labor

B. preeclampsia C. abruptio placentae E. preterm labor Explanation: Numerous studies have shown that increasing maternal age is a risk factor for infertility and spontaneous abortions, gestational diabetes, chronic hypertension, postpartum hemorrhage, preeclampsia, preterm labor and birth, multiple pregnancy, genetic disorders and chromosomal abnormalities, placenta previa, fetal growth restriction, low Apgar scores, and surgical births.

Which of the following laboratory values is most concerning in a client with gestational hypertension? A. total urine protein of 200 mg/dL B. total platelet count of 40,000 C. uric acid level of 8 mg/dL D. BUN of 24 mg/dL

B. total platelet count of 40,000. This is a critical value and should be reported to the health care provider immediately. The client is at increased risk for hemorrhage. Uric acid and BUN are only slightly elevated. Proteinuria is a concern, but the platelet count is more concerning due to risk for hemorrhage.

While reviewing the ultrasound reports of a patient, the nurse notices a floating fetus in the scanned image. What potential fetal risks should the nurse interpret from this finding? Select all that apply: A. Renal agenesis B. Growth restriction C. Neural tube defects D. Gastrointestinal obstruction E. Cardiac disease.

C, D (A floating fetus is seen in cases of elevated amniotic fluid volume, or polyhydramnios. Polyhydramnios is associated with neural tube defects and gastrointestinal obstruction. Renal agenesis and severe intrauterine growth restriction are associated with oligohydramnios, or low amniotic fluid volume. A low amount of fluid may not result in a floating fetus in the scanned image. The amniotic fluid level is unrelated to cardiac disease in the fetus.)

A client on 2g/hr of magnesium sulfate has decreased deep tendon reflexes. Identify the priority nursing assessment to ensure client safety. A. Assess uterine contractions continuously B. Assess fetal heart rate continuously C Assess urine output D. Assess respiratory rate

D. Assess respiratory rate Respiratory effort and DTRs are involuntary, and a decrease in DTRs could indicate the risk of magnesium sulfate toxicity and the risk for decreased respiratory effort.

A client who is 8 weeks' pregnant comes to the emergency department reporting abdominal pain and spotting. The client also reports breast tenderness and fatigue. Additional assessment suggests a possible ectopic pregnancy and diagnostic evaluation is scheduled. The nurse would prepare the client for which test(s) to aid in confirming this diagnosis? Select all that apply. A. platelet level B. urine for protein C. complete blood count D. transvaginal ultrasound E. beta-human chorionic gonadotropin (hCG) level

D. transvaginal ultrasound E. beta-human chorionic gonadotropin (hCG) level Explanation:The use of transvaginal ultrasound to visualize the misplaced pregnancy and low levels of serum beta-hCG assist in diagnosing an ectopic pregnancy. The ultrasound determines whether the pregnancy is intrauterine, assesses the size of the uterus, and provides evidence of fetal viability, and to visualize the misplaced pregnancy. The visualization of an adnexal mass and the absence of an intrauterine gestational sac are diagnostic of ectopic pregnancy. In a normal intrauterine pregnancy, beta-hCG levels typically double every 2 to 4 days until peak values are reached 60 to 90 days after conception. Concentrations of hCG decrease after 10 to 11 weeks and reach a plateau at low levels by 100 to 130 days. Therefore, low beta-hCG levels are suggestive of an ectopic pregnancy. Urine for protein, platelet level, and complete blood count would provide no information about confirmation of an ectopic pregnancy