Synthesis

A new mother who is learning about infant feedings asks the nurse how to manage household chores with a baby feeding on demand. Which response by the nurse best answers the client's concerns?

"Babies on demand feedings eventually set a schedule, so there should be time for you to do other things." Most average-sized infants regulate themselves to an approximate 3- to 4-hour schedule, but wide variations do exist. Some episodes of crying do not indicate that the infant is hungry; the mother will learn the difference. It is best to allow the infant to set the schedule. Although it is true that most mothers find that their babies do better with a demand-feeding system, this response does not answer the mother's question about when she will have free time.

A registered nurse teaches a nursing student about caring for a client prescribed estradiol to treat low estrogen levels. Which statement by the student indicates to the nurse a need for additional learning?

"I should avoid covering the medication with clothing after it is dried." Covering the medication with clothing after it is dried helps prevent the transfer of the medication to other individuals. The nurse would instruct the client to apply the emulsion once a day on the thighs. The nurse would educate the client about the pharmacokinetic properties of the medication to ensure the medication's safe and effective administration. The nurse would advise the client to not apply sunscreen products at the same time because this action may reduce the absorption of estradiol.

After teaching the parents of a newborn how to suction using a bulb syringe, which statement made by the parent indicates an understanding of the information?

"I will depress the bulb before suctioning the mouth or nose." The bulb syringe is depressed before suctioning the mouth or the nose. The mouth should be suctioned first. The bulb should be kept in the crib at all times. When suctioning the mouth, the tip of the bulb should be inserted into one side of the mouth to avoid stimulating the gag reflex.

Which statements by a client with hyperemesis gravidarum would confirm that the client requires further teaching? Select all that apply. One, some, or all responses may be correct.

"I'll lie down for at least 2 hours after I eat." "I'll start limiting my carbohydrates." The client should not decrease carbohydrate intake. During pregnancy the cardiac sphincter may relax, which allows food to come back up into esophagus when the client is supine. The client should not lie down for 2 hours after eating to provide time for digestion so that food is not regurgitated. Drinking protein shakes can help provide protein needed to decrease the chance of a negative nitrogen balance. The individual protein shakes, though, should be evaluated for other additive ingredients that may be not recommended in pregnancy. The client should be encouraged to drink plenty of fluids to help prevent dehydration. Hyperemesis gravidarum can be aggravated by stress and fatigue. Rest periods may reduce the client's stress level and fatigue and promote relaxation.

Immediately after the third stage of labor the nurse administers the prescribed oxytocin infusion. Which explanation would the nurse give the client for the purpose of this medication?

"It is used to help the uterus contract." Oxytocin given after the third stage of labor will stimulate the uterus to contract and remain contracted. Oxytocin does not have an analgesic effect to decrease uterine discomfort. It is administered after the placenta is expelled (third stage of labor). Prolactin, not oxytocin, stimulates milk production.

Which statement by a new mother observing her preterm infant in the neonatal intensive care nursery indicates that she has not yet begun the bonding process?

"It's such a tiny baby." By failing to acknowledge the infant as a person, the client indicates that she has not released her fantasy baby and accepted the real baby. Acknowledging the infant by using the word "he" denotes a relationship. Saying that the baby looks like her husband indicates that the mother has incorporated the infant into the family.

After an incomplete abortion, a client asks the nurse to tell her again what is meant by an "incomplete abortion." Which response by the nurse is appropriate?

"It's when the fetus is expelled but other parts of the pregnancy remain in the uterus." A correct and simple definition answers the question and fulfills the client's need to know. Telling the client not to focus on the topic anymore denies the client's right to know. The definition of a missed abortion is when the fetus dies but is retained in the uterus for at least 2 months. Telling the client to ask her primary health care provider for the answer is an abdication of the nurse's responsibility; the nurse can independently reinforce information and correct misconceptions.

A healthy couple whose child has cystic fibrosis (CF) is concerned about having another child with the disease. Knowing that this disorder has an autosomal-recessive mode of inheritance, how would the nurse respond?

"There is a 25% chance the baby will be affected and a 50% chance that the baby will be a carrier." According to Mendelian law, because both parents are carriers, this baby has a 50% chance of being a carrier, a 25% chance of having the disease, and a 25% chance of being unaffected. Because this is an autosomal-recessive gene and not X-linked, there is no difference in prevalence between male and female genetic distribution. Regardless of sex, the infant will have the same risk of being a carrier or noncarrier or having the expressive trait for CF.

A client is crying after undergoing dilation and curettage after an early miscarriage (spontaneous abortion). Which response would the nurse give?

"This must be a very difficult experience for you to deal with." Saying that this must be a difficult experience acknowledges the validity of the client's grief and provides the client an opportunity to talk if she wishes. Other children cannot and should not be substituted for a lost fetus. Getting pregnant is not the issue; this statement belittles the lost fetus. The nurse cannot know how the client feels. Stating that a miscarriage is for the best is patronizing and diminishes the significance of the lost fetus.

Which preexisting condition necessitates a cesarean birth?

Active genital herpes Once the membranes have ruptured, an active herpes infection ascends and can infect the fetus; because herpes does not cross the placenta, a cesarean birth prevents transfer of the virus to the fetus. Gonorrhea, Chlamydia, and chronic hepatitis are not indications for a cesarean birth; treatment is pharmacological

"When working with a client who has spontaneously aborted a pregnancy, it is important for the nurse to first deal with her or his own feelings regarding abortion, death, and loss to be able to do which?

Allow the client to express her grief The nurse can be more sensitive to the needs of the client by addressing personal emotions first. Control is not, and should not be, the goal of the nurse. The client's feelings, not the nurse's, should be the focus. A time of crisis is not the time to teach; the client is not ready to learn.

Which assessment would the nurse include in the plan of care for a postpartum client with large, painful varicose veins?

Assessing for signs of thrombophlebitis Varicose veins predispose the client to thrombophlebitis; warmth, redness, and pain in the calf are signs of thrombophlebitis. The clotting mechanism is not affected; clot formation results because of venous pooling and decreased venous return caused by the impaired vasculature. The problem is venous, not arterial, so pulses are not affected. Hemoglobin values are affected by the amount of bleeding that occurred during the birth, which usually is not severe enough to impair circulatory competency.

Which maternal complications are associated with precipitous labor and birth?

Bleeding and infection Precipitate birth is associated with an increased maternal morbidity rate, because hemorrhage and infection may occur as a result of the trauma of a rapid, forceful birth in a contaminated field. Hypertension is anticipated in a client with preeclampsia. There are not enough data to indicate that this client has preeclampsia. A low blood glucose level is not expected after a precipitous birth. Chilling and shivering are common maternal responses after all types of births because of cardiovascular and vasomotor changes.

A client is prescribed an oral contraceptive. As part of teaching, the nurse plans to inform the client of the possibility of which adverse effect?

Breakthrough bleeding Breakthrough bleeding, or midcycle bleeding, commonly occurs when women start using oral contraceptives. If it persists, the dosage should be changed. There is no evidence that cervicitis, ovarian cysts, or fibrocystic breasts are related to the use of oral contraceptives.

Which criterion would the nurse use when assessing the gestational age of a preterm infant?

Breast bud size The size of the breast buds is an indication of gestational age. Small, underdeveloped nipples reflect prematurity. Reflex stability is not a reliable indicator of gestational age; also, reflexes may be impaired in full-term infants. The simian crease is a single palm crease that is a clinical manifestation of Down syndrome, not of prematurity. Although the nails may be longer in a postterm infant, nail length is not a reliable indicator in a preterm infant.

A client is admitted at 40 weeks' gestation with her cervix dilated 5 cm and 100% effaced, the presenting part at station 0, and fetal heart tones heard just above the umbilicus. Which fetal presentation is indicated by these assessment findings?

Breech In the breech presentation, the fetal head is in the fundal portion of the uterus; the chest or back is at or above the umbilicus, where fetal heart tones can be heard. In the vertex presentation the head is the presenting part; the chest and back are in lower quadrants, where the fetal heart is heard. The brow presentation is a type of cephalic presentation in which the fetal head is partially extended; the fetal heart is heard in the lower abdomen, not above the umbilicus. In the shoulder presentation the fetal heart usually is heard in the midabdominal region.

The nurse admits a client with preeclampsia to the high-risk prenatal unit. Which is the next nursing action after the vital signs have been obtained?

Checking the client's reflexes The client is exhibiting signs of preeclampsia. The presence of hyperreflexia indicates central nervous system irritability, a sign of a worsening condition. Checking the client's reflexes will help direct the primary health care provider to appropriate interventions and alert the nurse to the possibility of seizures. Although the primary health care provider will be called, a complete assessment should be performed first to obtain the information needed. Determining the client's blood type is not necessary at this time; assessment of neurologic status is the priority. An IV may be started after the assessment.

Which technique would the nurse employ for an obstetrical client with a foreign body airway obstruction?

Chest thrusts Chest thrusts are performed for an obstetrical client with a foreign airway body obstruction. Back blows, suprapubic thrusts, or abdominal thrusts are not used to dislodge a foreign body causing airway obstruction.

Which finding would indicate infection in a pregnant client? Select all that apply. One, some, or all responses may be correct.

Chills Fever Diarrhea Flank pain Burning on urination Findings indicative of infection include chills, fever, diarrhea, flank pain, and burning on urination. These findings would be reported to the health care provider for additional testing.

A client is taking fertility medications for the first time. Which adverse effect of the medication would the nurse inform the client about?

Constipation Constipation is seen in the clients who are treated with fertility medications for the first time. Fertility medications do not cause vaginitis or swelling of joints. Deep vein thrombosis is an adverse effect of prolonged use of fertility medications.

Which type of isolation precautions would the postpartum nurse plan to institute for a client who has delivered her infant by cesarean birth because of active genital herpes?

Contact Contact precautions include a gown, mask, and gloves to protect the nurse from the virus; the client should be in a private room. The Centers for Disease Control and Prevention guidelines for isolation precautions do not include enteric precautions as a category. Droplet and airborne precautions are not necessary for a person with genital herpes.

Which is a primary focus of teaching for a pregnant adolescent at her first prenatal clinic visit?

Encouraging her to continue regularly scheduled prenatal care It is not uncommon for adolescents to avoid prenatal care; many do not recognize the deleterious effect that lack of prenatal care can have on them and their infants. Instruction in the care of an infant can be done in the later part of pregnancy and reinforced during the postpartum period. Informing the client of the benefits of breast-feeding should come later in pregnancy but not before the client's feelings about breast-feeding have been ascertained. Advising the client to watch for danger signs of preeclampsia is necessary, but it is not the priority intervention at this time.

Immediately after birth, a newborn is dried before being placed in skin-to-skin contact with the mother. Which type of heat loss would this intervention prevent?

Evaporation Evaporative heat loss is a result of the conversion of moisture into vapor, which is avoided when the newborn is dried. Radiation is the loss of heat to colder solid surfaces that are not in direct contact. Convective heat loss is a result of contact of the exposed skin with cooler surrounding air currents. Conductive heat loss is a result of direct skin contact with a cold solid object.

Which common side effect associated with the use of a copper intrauterine device (IUD) would the nurse discuss with the client during a teaching session?

Excessive menstrual flow With use of a copper IUD there may be excessive menstrual flow. Because the IUD is a foreign body, there is an increase in the blood supply, a result of the inflammatory process. The copper IUD does not increase the risk for ectopic pregnancy overall because it is highly effective at preventing all pregnancies. However, if a client does become pregnant with a copper IUD in place, there is a higher risk that the pregnancy will be ectopic. Perforation of the uterus may occur on insertion but is uncommon. Expulsion of the device may occur, but it is not classified as a side effect, nor is it common. Perforation, expulsion, and tubal pregnancy would be classified as adverse events, not common side effects.

The nurse teaching a prenatal class is asked why infants of diabetic mothers are larger than those born to women who do not have diabetes. On which information about pregnancy and diabetes would the nurse base the response?

Extra circulating glucose causes the fetus to acquire fatty deposits. It is difficult to maintain maternal normoglycemia throughout pregnancy; excess glucose passes into the fetus, where it is converted to fat. The problem is excess glucose, which is why exogenous insulin must be administered. Although all pregnant women consume extra calories to meet the increased metabolism associated with pregnancy, fetal insulin does not pass from the fetus to the mother. Stating that fetal weight gain increases because pregnant women commonly overeat is a stereotypical statement; not all clients with diabetes overeat.

Which information would the nurse provide to the breast-feeding client asking how human milk compares with cow's milk?

Fat in human milk is easier to digest and absorb than the fat in cow's milk. Fat in human milk is easier to digest because of the arrangement of fatty acids on the glycerol molecule. Also, human milk is not heat treated, as is cow's milk when it is pasteurized. The lactose content is higher in human milk. There is less protein in human milk than in cow's milk; however, it is easier for human beings to digest. Human immunological and antiallergenic factors are found only in human milk, not in cow's milk.

Clomiphene citrate is prescribed to a client with anovulatory cycles. The nurse would instruct the client to take clomiphene during which part of her cycle?

Fifth day of her cycle The objective is to stimulate ovulation near the 14th day of the menstrual cycle, and this is achieved by taking the medication on the 5th through the 9th days; there is an increase in 2 pituitary gonadotropins, luteinizing hormone and follicle-stimulating hormone, with subsequent ovarian stimulation. The last day of her period does not always coincide with day 5 of her cycle. The 16th day of the cycle is also too late for clomiphene to be effective. On the 3rd day after the cycle there are insufficient hormones for clomiphene to be effective.

Which is a gastrointestinal manifestation of infection in the newborn? Select all that apply. One, some, or all responses may be correct.

Glucose instability Glucose instability is a gastrointestinal manifestation of newborn infection. Lethargy and irritability are central nervous systems changes associated with infection. Nasal flaring is a respiratory manifestation of infection. Poor perfusion is a cardiovascular manifestation of infection

Which disease would the nurse suspect in a 16-year-old client with a history of multiple sexual partners who is complaining of increased vaginal discharge, intermittent vaginal bleeding, excessive bleeding during menstruation, and pain in the lower abdomen?

Gonorrhea The client has signs and symptoms indicative of pelvic inflammatory disease, which is a complication of gonorrhea. Herpes is noted for its painful genital lesions; there are no data to indicate the presence of these lesions. The client does not have the signs and symptoms associated with syphilis, which is characterized by a painless chancre, or those associated with toxoplasmosis, which is not a sexually transmitted infection.

Several hours after delivery, a new mother expresses ambivalence regarding her infant. How will the nurse promote bonding between this mother and her newborn?

Having the mother feed the infant Feeding the infant promotes bonding through physical interaction, and positioning the infant in a face-to-face position facilitates eye contact. Removing the infant decreases the pair's time together. Positioning the infant on the mother's shoulder prevents the face-to-face contact that promotes bonding. It is important to have the parent and infant interact as soon as possible after birth to promote bonding.

Which intervention would the nurse initiate when a fetal heart pattern signifying uteroplacental insufficiency occurs?

Helping the client turn to the side-lying position Assisting the client to turn to the side-lying position will improve uterine blood flow, and fetal oxygenation will increase. Inserting a urinary catheter is unnecessary; in addition, it requires a primary health care provider's prescription. Oxygen may be administered eventually if necessary, but this is not the first intervention. Encouraging the client to pant with her next contraction will not increase uterine blood flow or oxygen to the fetus.

A neonate born at 39 weeks' gestation is small for gestational age. Which commonly occurring problem would the nurse anticipate when planning care for this infant?

Hypoglycemia Hypoglycemia is common in newborns who are small for gestational age because of malnutrition in utero; the nurse can detect this with a blood glucose test and notify the primary health care provider. Polycythemia, not anemia, is more likely to occur. Although a protein deficiency may occur, it is not life threatening at this time. Although hypocalcemia may occur, it is not as common as hypoglycemia.

For which complication would the nurse closely monitor a client with a diagnosis of abruptio placentae?

Hypovolemic shock With abruptio placentae, uterine bleeding can result in massive internal hemorrhage, causing hypovolemic shock. A cerebral hemorrhage may occur with a dangerously high blood pressure; there is no information indicating the presence of a dangerously high blood pressure. Pulmonary edema may occur with severe preeclampsia or heart disease, and seizures are associated with severe preeclampsia; there is no information indicating the presence of these conditions.

Which situation is an indication for the nurse to anticipate administering an oxytocin infusion to a pregnant client?

Induction of labor at full term Oxytocin induces labor at full-term gestation, which stimulates uterine contractions and helps the woman have an easy delivery. Oxytocin is contraindicated in hypertonic uterus, pelvic inflammatory disease, and cervical stenosis.

When caring for a newly delivered newborn with a heart rate of 76 and gasping, which priority action would the nurse take?

Initiate positive-pressure ventilation. Following the neonatal resuscitation algorithm, the nurse will initiate positive-pressure ventilation and monitor the newborn's SpO2. Clearing the airway delays respiratory support. It is unnecessary to initiate chest compressions or prepare for intubation.

Which intervention would the nurse include in the plan of care for a client with breast cancer who received doxorubicin and cyclophosphamide 12 days ago and now has a white blood cell (WBC) count of 1.4 cells/mm 3 and reports shortness of breath and activity intolerance? Select all that apply. One, some, or all responses may be correct.

Institute neutropenic precautions. Doxorubicin and cyclophosphamide can lower the client's blood cell counts. Clients with low WBC counts need interventions to prevent infection, which include instituting neutropenic precautions. The nurse would instruct the client to use an electric razor if the platelet count was less than 50,000 cells/µL. Airborne precautions would be indicated if the client was ill with an infectious disease. The nurse would transfuse RBCs for a client with anemia (if prescribed by the health care provider). Nursing staff would wear dosimeter badges when caring for a client receiving internal radiation (brachytherapy).

Which method of swaddling could cause risk for injury?

Legs extended Swaddling an infant tightly with the legs extended is associated with an increased risk for hip dislocation. The correct way to swaddle an infant is with the hips in slight flexion and abducted and allowing for freedom of movement of the knees. Swaddling the infant with the arms either flexed or extended does not place the newborn at risk for injury.

Which is the priority nursing intervention during the admission of a primigravida in labor?

Monitoring the fetal heart rate Determining fetal well-being supersedes all other measures; if the fetal heart rate is absent or persistently decelerating, immediate intervention is required. The health history, including the client's last meal and whether the membranes have ruptured, may be taken once fetal well-being has been established.

A pregnant client's blood test reveals an increased alpha-fetoprotein (AFP) level. Which condition is indicated with this result?

Neural tube defect Increased levels of alpha-fetoprotein in pregnant women have been found to reflect open neural tube defects such as spina bifida and anencephaly. Cystic fibrosis is a genetic defect that is not associated with the AFP level. A Guthrie test soon after ingestion of formula can determine whether an infant has phenylketonuria. Down syndrome is a chromosomal defect that is associated with a low AFP level.

Which client is at increased risk for postpartum hemorrhage?

One who gives birth to an infant weighing 9 lb 8 oz (4366 g) The risk for a postpartum hemorrhage is greater with large infants, because the uterine musculature has been stretched excessively, thus impairing the ability of the uterus to contract after the birth. Early breast-feeding stimulates uterine contractions and lessens the chance of hemorrhage. Having a pudendal block for the birth does not contribute to the risk for postpartum hemorrhage, because the anesthetic for a pudendal block does not affect uterine contractions. A third stage of labor lasting less than 10 minutes is a short third stage; a prolonged third stage of labor, 30 minutes or longer, could increase the risk of postpartum hemorrhage.

Which problem is suggested when a client at 37 weeks' gestation experiences a sudden sharp pain in her abdomen with a period of fetal hyperactivity followed by fundal tenderness and a small amount of dark-red bleeding?

Partial abruptio placentae Typical manifestations of abruptio placentae are sudden sharp localized pain and small amounts of dark-red bleeding caused by some degree of placental separation. True labor begins with regular contractions, not sharp localized pain. There is no pain with placenta previa, just the presence of bright-red bleeding. There are no data to indicate that the client sustained an injury.

Which intervention would the nurse initiate when a fetal heart pattern signifying uteroplacental insufficiency occurs?

Patent ductus arteriosus A client with patent ductus arteriosus has the lowest risk for maternal mortality. A client with aortic stenosis has a higher risk of maternal mortality. A client with endocarditis or pulmonary hypertension has the highest risk of maternal mortality.

Why is a multiple-gestation pregnancy considered a high risk?

Perinatal mortality is two to three times more likely in multiple than in single births. Perinatal morbidity and mortality rates are higher with multiple-gestation pregnancies, because the greater metabolic demands and the possibility of malpositioning of one or more fetuses increase the risk for complications. Although postpartum hemorrhage does occur more frequently after multiple births, it is not an expected occurrence. Adjustment to a multiple gestation and birth is individual; the time needed for adjustment does not place the pregnancy at high risk. Maternal mortality during the prenatal period is not increased in the presence of a multiple gestation.

Which is the most important factor for the nurse to consider when selecting nursing measures to help parent-child relationships during the immediate postpartum period?

Physical status of the infant Attachment between parent and infant is most successful when interaction is possible immediately after birth; if the infant is ill, contact is limited. Although the duration and difficulty of labor, the effect of anesthesia, and health and emotional status during pregnancy are all factors, the most important factor after the birth is the physical condition of the infant.

The nurse teaches a client who is about to undergo an amniocentesis that ultrasonography will be performed just before the procedure to determine which?

Position of the fetus and the placenta The position of the fetus and placenta is located by means of ultrasonography to assist in preventing trauma from the needle during the amniocentesis. Although ultrasonography can be used to determine gestational age, this is not its purpose before an amniocentesis. Determining the amount of fluid in the amniotic sac is not the purpose of ultrasonography just before an amniocentesis. The position of the placenta and fetus, not just the cord and the placenta, is needed for safe introduction of the needle.

Which teratogenic effect would the nurse expect to see in a newborn who was exposed to indomethacin during the third trimester of pregnancy?

Premature closure of the ductus arteriosus Indomethacin is a nonsteroidal anti-inflammatory medication that may cause premature closure of the ductus arteriosus in newborns receiving long-term maternal dosing. Neural tube defects cannot be expected because the medication is taken in the third trimester. Neonatal hypoglycemia is caused only by oral hypoglycemic medications. Cleft lip with cleft palate is an expected teratogenic effect of indomethacin when administered within 8 weeks of gestation, and not in the third trimester.

The nurse weighs a neonate who is born at 29 weeks' gestation. The weight is 3 lb 9 oz (1616 g). In light of this weight and gestational age, how would this infant be classified?

Preterm Preterm describes a neonate born at 37 weeks' gestation or sooner, regardless of weight. There is no classification called immature. Small for gestational age means that the weight is below the 10th percentile at any week of gestation. Although this infant's weight is appropriate for gestational age, the use of this term implies a healthy full-term infant.

A primigravida in the first trimester tells the nurse that she has heard that hormones play an important role in pregnancy. Which hormone would the nurse tell the client maintains pregnancy?

Progesterone Produced by the ovaries and placenta, progesterone is a female sex hormone that prepares the endometrium for implantation of the fertilized ovum, maintains pregnancy, and plays a role in the development of the mammary glands. Prolactin is secreted by the anterior lobe of the pituitary gland; it is responsible for initiating and maintaining milk secretion from the mammary glands. Estrogen is a female sex hormone that starts to prepare the endometrium for implantation and promotes development of secondary sex characteristics. Somatotropin is a growth hormone secreted by the anterior pituitary gland.

Which risk to the fetus is associated with a maternal diagnosis of chorioamnionitis? Select all that apply. One, some, or all responses may be correct.

Sepsis Bacteremia Pneumonia Cerebral palsy (CP) Respiratory distress syndrome (RDS) If a pregnant client is diagnosed with chorioamnionitis, risks to the fetus include sepsis, bacteremia, pneumonia, CP, and RDS.

.Assessment of a primigravida at 32 weeks' gestation shows a blood pressure of 170/110 mm Hg, 4+ proteinuria, and edema of the face and extremities. With which complication are these findings consistent?

Severe preeclampsia With severe preeclampsia, arteriolar spasms result in hypertension and decreased arterial perfusion of the kidneys. This in turn causes an alteration in the glomeruli, resulting in oliguria and proteinuria, retention of sodium and water, and edema. Eclampsia is characterized by seizures; there are no data to indicate that the client is having or has had seizures. Chronic hypertension is hypertension diagnosed before pregnancy or before 20 weeks' gestation. Hypertension that is first diagnosed during pregnancy that persists beyond the postpartum period is also considered chronic hypertension. Gestational hypertension is hypertension that first occurs during midpregnancy without proteinuria; it is definitively diagnosed when the hypertension resolves 12 weeks after delivery.

Which finding in a menopausal client's health history would prevent the health care provider from prescribing hormone replacement therapy? Select all that apply. One, some, or all responses may be correct.

Smoking Cirrhosis Cholecystitis Breast cancer Deep vein thrombosis Use of estrogens can have major side effects, especially if the client smokes. The nurse would provide information to the client about smoking cessation. Clients with cirrhosis have a decreased ability to break down medications, especially estrogen. Cholecystitis can worsen in clients taking estrogen. Clients at risk for breast and endometrial cancer should not take estrogen because it can further increase the risk. Estrogens can lead to deep vein thrombosis.

Which is included in the care of a newborn infant whose mother has had untreated syphilis since the second trimester of pregnancy?

Testing for congenital syphilis Because physical signs of congenital syphilis are difficult to detect at birth, the infant should be tested immediately to determine whether treatment is necessary. Cleft palate is a congenital defect that occurs in the first trimester; Treponema pallidum does not affect a fetus before the sixteenth week of gestation. Muscle hypotonicity is found in children with Down syndrome, not those with congenital syphilis. Maculopapular lesions of the soles do not manifest in the infant with congenital syphilis until about 3 months of age.

The nurse in the emergency department is assessing a client who has been physically and sexually assaulted. What is the nurse's priorityduring assessment?

The client's ability to cope with the situation The situation is so traumatic that the individual may be unable to use past coping behaviors to comprehend what has occurred. Assessing emotions that occur in response to news of the attack will occur later. The client should be the focus of care at this time, not the family. Social isolation is not an immediate concern. Coping skills, not thought processes, are challenged at this time.

Which plan of care would the nurse encourage for the parents who have had an at-risk infant who is in the neonatal intensive care unit?

The mother should be reunited with her infant as soon as possible to enhance adjustment. The mother should be reunited with her newborn at the first opportunity after she is emotionally prepared. There is no magic about the first 24 hours; some mothers are too ill or both parents may be too frightened to see their baby that soon. Grief work will go on for an extended period and has no relationship to when the infant is seen. Some parents may be too frightened to ask to see their baby; the nurse can prepare the parents and then suggest a visit.

A client has delivered her infant by cesarean birth. The nurse monitors the newborn's respiration closely, because infants born via the cesarean method are prone to atelectasis. Why does this occur?

The ribcage is not compressed and released during birth. The release after compression of the chest during a vaginal birth is the mechanism for expansion of the newborn's lungs; because this does not occur during a cesarean birth, lung expansion may be incomplete, and atelectasis may result. Temperature change is not implicated in aspiration. The infant is monitored closely to prevent oxygen deprivation. The newborn's head may be held lower than the chest to allow gravity to promote drainage from the lungs after a cesarean birth.

Cramping and vaginal spotting occurring at 12 weeks' gestation in conjunction with a closed cervix is characteristic of which problem?

Threatened abortion Because the cervix is closed, this is considered a threatened abortion. The lifeless products of conception are retained in a missed abortion. Once the cervix is dilated abortion is inevitable. Portions of the products of conception will have to be passed for a diagnosis of incomplete abortion

Which test is used to confirm cephalopelvic disproportion?

Ultrasound A sonogram of the pelvis is an accurate and safe test for cephalopelvic disproportion. Fetal scalp pH is performed to assess fetal well-being. Amniocentesis is a test of the components of the amniotic fluid; it does not reveal the size of the fetus or the diameter of the pelvis. Digital pelvimetry is an external measurement obtained by the primary health care provider; it is an estimate, not an accurate assessment, and is used less commonly than ultrasound.

A client at 36 weeks' gestation has a blood pressure of 140/90. Which additional sign of preeclampsia would the nurse assess for?

Urine dipstick positive for protein Preeclampsia is characterized by increased blood pressure and proteinuria. Mild ankle edema, known as physiological edema, is commonly seen in the third trimester. Although no longer a diagnostic criterion for preeclampsia, edema evidenced by excessive weight gain or edema of the hands and face may support the diagnosis. Episodes of dizziness on arising may occur in the third trimester because the enlarged uterus impedes venous return, causing supine hypotension. Weight gain of 2 lb in 2 weeks is expected during the third trimester.

Why is it important for the nurse to encourage a client with preeclampsia to lie in the left-lateral recumbent position?

Uterine and kidney perfusion are maximized, and compression of the major vessels is relieved. In the left-lateral position the gravid uterus no longer compresses major vessels; cardiac output is maintained; glomerular filtration and uterine perfusion rates increase. Maximizing intra-abdominal pressure on the iliac veins will decrease, not increase, blood flow to the pelvic area. Maximizing aortic compression will decrease, not increase, uterine blood flow. Hemoconcentration occurs and uterine perfusion decreases in the standing and sitting positions.

Which condition is most commonly associated with late decelerations of the fetal heart rate?

Uteroplacental insufficiency Late decelerations, suggestive of fetal hypoxia, occur in the setting of uteroplacental insufficiency. Head compression results in early decelerations; this finding is considered benign. Hypothyroidism is unrelated to late decelerations. Umbilical cord compression results in variable decelerations.