chap 19 prep-u questions

A student nurse asks the instructor what percentage of clinically recognized pregnancies end in miscarriages during the first trimester. Which response from the nurse is the most accurate? A. 5% to 10% B. 15% to 20% C. 21% to 30% D. 31% to 40%

B. 15% to 20% rationale: During the first trimester, 15% to 20% of all clinically recognized pregnancies end in miscarriage.

Some women experience a rupture of their membranes before going into true labor. A nurse recognizes that a client who presents with preterm premature rupture of membranes (PPROM) has completed how many weeks of gestation? A. less than 37 weeks B. less than 38 weeks C. less than 39 weeks D. less than 40 weeks

A. less than 37 weeks

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. monitoring intake and output B. obtaining baseline blood electrolyte levels C. maintaining NPO status for the first day or two D. administering antiemetic agents E. preparing the woman for insertion of a feeding tube

A. monitoring intake and output B. obtaining baseline blood electrolyte levels C. maintaining NPO status for the first day or two D. administering antiemetic agents rationale: Total parenteral nutrition or a feeding tube is used to prevent malnutrition only if the client does not improve with these interventions.

The nurse is assessing a new client who is being admitted with gestational hypertension. Which nursing diagnosis should the nurse prioritize for this client? A. Decreased reflexes due to medication administration B. Deficient fluid volume related to vasospasm of arteries C. Risk for injury related to fetal distress D. Imbalanced nutrition related to decreased sodium levels

B. Deficient fluid volume related to vasospasm of arteries rationale: Gestational hypertension is caused by vasospasms of the arteries. This leads to increased blood pressure and edema. Extensive edema leads to a deficiency of fluid volume

What special interventions would the nurse implement in a client who is carrying twin fetuses? A. Schedule non-stress tests (NST) starting at 16 weeks. B. Remind the client to monitor her intake since she does not need any more food for a multiple pregnancy than she would ingest for a singleton pregnancy. C. Demonstrate to the client how to perform fetal movement (kick) counts after 32 weeks. D. Assist the physician on doing uterine ultrasounds every 2 weeks to monitor fetal size and placental information.

C. Demonstrate to the client how to perform fetal movement (kick) counts after 32 weeks. rationale: A woman carrying a multiple gestation needs to keep up with how her fetuses are doing, and an excellent way to do that is by doing fetal movement (kick) counts. This starts at around 32 weeks' gestation for an uncomplicated pregnancy and continues until birth. Weekly or biweekly NSTs begin after 32 weeks. Obstetrical ultrasounds are done every 4 to 6 weeks after confirmation of a multiple fetal pregnancy. The client needs to increase her intake, along with her iron and folic acid intake, to provide adequate nutrition for both fetuses.

A nurse is taking a history of a client at 5 weeks' gestation in the prenatal clinic; however, the client is reporting dark brown vaginal discharge, nausea, and vomiting. Which diagnosis should the nurse suspect? A. hyperemesis gravidarum B. pregnancy-induced depression C. placenta previa D. gestational trophoblastic disease

D. gestational trophoblastic disease rationale: This client has risk factors of a "molar" pregnancy: nausea and vomiting at an early gestational week and dark brown vaginal discharge. The early nausea/vomiting can be due to a high hCG level, which is a sign of gestational trophoblastic disease. There is only one sign/symptom of hyperemesis gravidarum. Placenta previa is marked by bright red bleeding and tends to happen later in gestation.

A 28-year-old primigravida client with type 2 diabetes comes to the health care clinic for a routine first trimester visit reporting frequent episodes of fasting blood glucose levels being lower than normal, but glucose levels after meals being higher than normal. What should the nurse point out that these episodes are most likely related to? A. insulin resistance is starting to decrease B. using too much insulin at this stage of the pregnancy C. tissue sensitivity to insulin increases D. normal response to the pregnancy

D. normal response to the pregnancy rationale: This is a normal response to the pregnancy. During pregnancy, tissues become resistant to insulin to provide sufficient levels of glucose for the growing fetus.

The nurse is teaching a client who is diagnosed with preeclampsia how to monitor her condition. The nurse determines the client needs more instruction after making which statement? A. "If I have changes in my vision, I will lie down and rest." B. "I will count my baby's movements after each meal." C. "I will weigh myself every morning after voiding before breakfast." D. "If I have a severe headache, I'll call the clinic."

A. "If I have changes in my vision, I will lie down and rest." rationale: Changes in the visual field may indicate the client has moved from preeclampsia to severe preeclampsia and is at risk for developing a seizure due to changes in cerebral blood flow. The client would require immediate assessment and intervention. Gaining weight is not necessarily a sign of worsening preeclampsia. The other choices are instructions which the client may be given to follow.

A client experiencing a threatened abortion is concerned about losing the pregnancy and asks what she can do to help save her baby. What is the most appropriate response from the nurse? A. "Restrict your physical activity to moderate bed rest." B. "Carry on with the activity you engaged in before this happened." C. "Strict bed rest is necessary so as not to jeopardize this pregnancy." D. "There is no research evidence that I can recommend to you."

A. "Restrict your physical activity to moderate bed rest." rationale: With a threatened abortion, moderate bedrest, light activities, and supportive care are recommended. Regular physical activity may increase the chances of miscarriage. Strict bedrest is not necessary and may hide additional bleeding as it pools in the vagina, only to begin again as the woman ambulates. Activity restrictions are part of standard medical management.

During pregnancy a woman's blood volume increases to accommodate the growing fetus to the point that vital signs may remain within normal range without showing signs of shock until the woman has lost what percentage of her blood volume? A. 40% B. 30% C. 20% D. 50%

A. 40% rationale: Vital signs can be within normal range, even with significant blood loss, because a pregnant woman can lose up to 40% of her total blood volume without showing signs of shock.

A pregnant client is admitted to a health care unit with disseminated intravascular coagulation (DIC). Which prescription is the nurse most likely to receive regarding the therapy for such a client? A. Administer cryoprecipitate and platelets. B. Give each unit of blood to raise the hematocrit by 3 g/dl (30 g/L). C. Aim at keeping the client's hematocrit above 20%. D. Administer a ratio of 1 unit of blood to 4 units of frozen plasma.

A. Administer cryoprecipitate and platelets. rationale: In a pregnant client with DIC, the nurse may be told to administer cryoprecipitate and platelets. Whole blood does not contain clotting factors. Therefore, a ratio of 4 units of blood to 1 unit of fresh frozen plasma, and not 1 unit of blood to 4 units of frozen plasma, should be considered. The nurse should aim at maintaining the client's hematocrit above 30% and not just 20%. The nurse should expect one unit of blood to increase the hematocrit by 1.5 g/dl (15 g/L) not 3g/dl (30 g/L).

The nurse recognizes that documenting accurate blood pressures is vital in the diagnosing of preeclampsia, severe preeclampsia and eclampsia. The nurse suspects preeclampsia based on which finding? A. BP of 140/90 mm Hg last week and at current visit after 20 weeks' gestation B. BP of 130/90 mm Hg on three occasions 3 hours apart C. BP of 160/110 mm Hg on two occasions after 28 weeks' gestation D. BP of 120/90 mm Hg on three occasions after 20 weeks' gestation

A. BP of 140/90 mm Hg last week and at current visit after 20 weeks' gestation rationale : Gestational hypertension is diagnosed when systolic blood pressure is over 140 mm Hg and/or diastolic pressure is over 90 mm Hg on at least two occasions at least 4 to 6 hours apart after the 20th week of gestation

Which measure would the nurse include in the plan of care for a woman with prelabor rupture of membranes if her fetus's lungs are mature? A. labor induction B. observation for signs of infection C. reduction in physical activity level D. administration of corticosteroids

A. labor induction rationale: With prelabor rupture of membranes (PROM) in a woman whose fetus has mature lungs, induction of labor is initiated. Reducing physical activity, observing for signs of infection, and giving corticosteroids may be used for the woman with PROM when the fetal lungs are immature.

A woman has presented to the emergency department with symptoms that suggest an ectopic pregnancy. Which finding would lead the nurse to suspect that the fallopian tube has ruptured? A. referred shoulder pain B. breast tenderness C. vaginal spotting D. nausea

A. referred shoulder pain rationale: Referred pain to the shoulder area indicates bleeding into the abdomen caused by phrenic nerve irritation when a tubal pregnancy ruptures. Vaginal spotting, nausea, and breast tenderness are typical findings of early pregnancy and an unruptured ectopic pregnancy.

A 35-year-old client is seen for her 2-week postoperative appointment after a suction curettage was performed to evacuate a hydatidiform mole. The nurse explains that the human chorionic gonadotropin (hCG) levels will be reviewed every 2 weeks and teaches about the need for reliable contraception for the next 6 months to a year. The client states, "I'm 35 already. Why do I have to wait that long to get pregnant again?" What is the nurse's best response? A. "Since you are at the end of your reproductive years, it is suggested that you don't try to have any more pregnancies." B. "A contraceptive is used so that a positive pregnancy test resulting from a new pregnancy will not be confused with the increased level of hCG that occurs with a developing malignancy." C. "You may need chemotherapy, so we don't want to risk pregnancy." D. "After a curettage procedure, it is recommended that you give your body some time to build up its stores."

B. "A contraceptive is used so that a positive pregnancy test resulting from a new pregnancy will not be confused with the increased level of hCG that occurs with a developing malignancy." rationale: The woman is cautioned to avoid pregnancy during this time because the increasing B-hCG levels associated with pregnancy would cause confusion as to whether cancer had developed. If after a year B-hCG serum titers are within normal levels, a normal pregnancy can be achieved.

A nurse is providing discharge teaching for a pregnant client with preeclampsia who will be managed at home on bedrest. The nurse determines that the teaching was successful based on which client statement? A. "I should lie on my back as much as I can." B. "I need to drink about 8 glasses of water a day." C. "I will check how often my baby kicks once per week." D. "I should check my blood pressure about 3 times per week."

B. "I need to drink about 8 glasses of water a day."

A pregnant women calls the clinic to report a small amount of painless vaginal bleeding. What response by the nurse is best? A."Lie on your left side and drink lots of water and monitor the bleeding." B. "Please come in now for an evaluation by your health care provider." C. "Bleeding during pregnancy happens for many reasons, some serious and some harmless." D. "If the bleeding lasts more than 24 hours, call us for an appointment."

B. "Please come in now for an evaluation by your health care provider." rationale: Bleeding during pregnancy is always a deviation from normal and should be evaluated carefully. It may be life-threatening or it may be something that is not a threat to the mother and/or fetus. Regardless, it needs to be evaluated quickly and carefully. Telling the client it may be harmless is a reassuring statement, but does not suggest the need for urgent evaluation. Having the mother lay on her left side and drink water is indicated for cramping.

A primipara at 36 weeks' gestation is being monitored in the prenatal clinic for risk of preeclampsia. Which sign or symptom should the nurse prioritize? A. Weight gain of 1.2 lb (0.54 kg) during the past 1 week B. A dipstick value of 2+ for protein C. Pedal edema D. A systolic blood pressure increase of 10 mm Hg

B. A dipstick value of 2+ for protein rationale: The increasing amount of protein in the urine is a concern the preeclampsia may be progressing to severe preeclampsia.

A client reporting she recently had a positive pregnancy test has reported to the emergency department stating one-sided lower abdominal pain. The health care provider has prescribed a series of tests. Which test will provide the most definitive confirmation of an ectopic pregnancy? A. Quantitative human chorionic gonadotropin (hCG) test B. Abdominal ultrasound C. Pelvic examination D. Qualitative human chorionic gonadotropin (hCG) test

B. Abdominal ultrasound rationale: . A quantitative hCG level may be completed in the diagnostic plan. hCG levels in an ectopic pregnancy are traditionally reduced. While this would be an indication, it would not provide a positive confirmation. The qualitative hCG test would provide evidence of a pregnancy, but not the location of the pregnancy. A pelvic exam would be included in the diagnostic plan of care. It would likely show an enlarged uterus and cause potential discomfort to the client but would not be a definitive finding.

A woman who is 10 weeks' pregnant calls the physician's office reporting "morning sickness" but, when asked about it, tells the nurse that she is nauseated and vomiting all the time and has lost 5 pounds. What interventions would the nurse anticipate for this client? A. Since morning sickness is a common problem for pregnant women, the nurse will suggest the woman drink more fluids and eat crackers. B. Lab work will be drawn to rule out acid-base imbalances. C. An ultrasound will be done to reassess the correctness of gestational dates. D. The nurse will encourage the woman to lie down and rest whenever she feels ill.

B. Lab work will be drawn to rule out acid-base imbalances. rationale: Morning sickness that lasts all day and is severe is called hyperemesis gravidarum. It is much more serious than "morning sickness" and can lead to significant weight loss and electrolyte imbalance. Lab work needs to be drawn to determine the extent of electrolyte loss and acid-base balance.

A nurse is describing the use of Rho(D) immune globulin as the therapy of choice for isoimmunization in Rh-negative women and for other conditions to a group of nurses working at the women's health clinic. The nurse determines that additional teaching is needed when the group identifies which situation as an indication for Rho(D) immune globulin? A. molar pregnancy B. STIs C. amniocentesis D. maternal trauma

B. STIs rationale: Indications for Rho(D) immune globulin include isoimmunization, ectopic pregnancy, chorionic villus sampling, amniocentesis, prenatal hemorrhage, molar pregnancy, maternal trauma, percutaneous umbilical sampling, therapeutic or spontaneous abortion, fetal death, or fetal surgery.

A pregnant woman at 12 weeks' gestation comes to the office reporting she has begun minimal fresh vaginal spotting. She is distressed because her primary care provider indicates after examining her that they will "wait and see." Which response would be most appropriate from the nurse in answering this client's concerns? A. Advise her to ask for a second care provider opinion. B. Tell her that medication to prolong a 12-week pregnancy usually is not advised. C. Explain that "wait and see" means that her care provider wants her to maintain strict bed rest. D. Suggest she take an over-the-counter tocolytic just to feel secure.

B. Tell her that medication to prolong a 12-week pregnancy usually is not advised. rationale: Because many early pregnancy losses occur as the result of chromosome abnormalities, an aggressive approach to prolong these is not usually recommended. It would not be appropriate for the nurse to suggest an over-the-counter tocolytic, nor to tell the client that the care provider meant something else such as maintaining strict bed rest. Advising the client to seek a second opinion would not change the end results.

A young client gives birth to twin boys who shared the same placenta. What serious complication are they at risk for? A. ABO incompatibility B. Twin-to-twin transfusion syndrome (TTTS) C. TORCH syndrome D. HELLP syndrome

B. Twin-to-twin transfusion syndrome (TTTS) * this would be mono-mono rationale: When twins share a placenta, a serious condition called twin-to-twin transfusion syndrome (TTTS) can occur.

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. beta-human chorionic gonadotropin (hCG) level C. urine for protein D. transvaginal ultrasound E. complete blood count

B. beta-human chorionic gonadotropin (hCG) level D. transvaginal ultrasound rationale: 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. 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 an ectopic pregnancy.

The nurse is assessing a client at 12 weeks' gestation at a routine prenatal visit who reports something doesn't feel right. Which assessment findings should the nurse prioritize? A. visible fetal skeleton on ultrasound, absence of quickening, enlarged abdomen B. gestational hypertension, hyperemesis gravidarum, absence of FHR C. elevated hCG levels, enlarged abdomen, quickening D. vaginal bleeding, increased hPL levels

B. gestational hypertension, hyperemesis gravidarum, absence of FHR rationale: The early development of gestational hypertension/preeclampsia, hyperemesis gravidarum, and the absence of FHR are suspicious for gestational trophoblastic disease. The elevated levels of hCG lead to the severe morning sickness. There is no fetus, so FHR, quickening, and evidence of a fetal skeleton would not be seen. The abdominal enlargement is greater than expected for pregnancy dates, but hCG, not hPL, levels are increased.

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. hyperglycemia B. hyperreflexia C. blurring of vision D. proteinuria E. auditory hallucinations

B. hyperreflexia C. blurring of vision D. proteinuria rationale: 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.

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

B. observation for bleeding rationale: 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.

A pregnant client with preeclampsia is to receive magnesium sulfate IV. Which assessment should the nurse prioritize before administering a new dose? A. anxiety level B. patellar reflex C. blood pressure D. heart rate

B. patellar reflex rationale: A symptom of magnesium sulfate toxicity is loss of deep tendon reflexes. Assessing for the patellar reflex or ankle clonus before administration is assurance the drug administration will be safe. Assessing the blood pressure, heart rate, or anxiety level would not reveal a potential magnesium toxicity.

During a routine prenatal visit, a client is found to have 1+ proteinuria and a blood pressure rise to 140/90 mm Hg with mild facial edema. The nurse recognizes that the client has which condition? A. gestational hypertension B. preeclampsia without severe features C. preeclampsia with severe features D. eclampsia

B. preeclampsia without severe features rationale: A woman is said to have preeclampsia without severe features when she has proteinuria and a blood pressure rise to 140/90 mm Hg, taken on two occasions at least 6 hours apart and mild facial or extremity edema. A woman has progressed to preeclampsia with severe features when her blood pressure rises to 160 mm Hg systolic and 110 mm Hg diastolic or above on at least two occasions 6 hours apart at bed rest (the position in which blood pressure is lowest) or her diastolic pressure is 30 mm Hg above her prepregnancy level. Marked proteinuria, 3+ or 4+ on a random urine sample or more than 5 g in a 24-hour sample, and extensive edema are also present.

A client has been admitted to the hospital with a diagnosis of preeclampsia with severe features. Which nursing intervention is the priority? A. Keep the client on her side so that secretions can drain from her mouth. B. Check for vaginal bleeding every 15 minutes. C. Confine the client to bed rest in a darkened room. D. Administer oxygen by face mask.

C. Confine the client to bed rest in a darkened room. rationale: With preeclampsia with severe features, most women are hospitalized so that bed rest can be enforced and a woman can be observed more closely than she can be on home care. The nurse should darken the room if possible because a bright light can also trigger seizures. The other interventions listed pertain to a client who has experienced a seizure and has thus progressed to eclampsia.

The nurse is caring for a woman at 32 weeks' gestation with severe preeclampsia. Which assessment finding should the nurse prioritize after the administration of hydralazine to this client? A. Halos around lights B. Gastrointestinal bleeding C. Tachycardia D. Sweating

C. Tachycardia rationale: Hydralazine reduces blood pressure but is associated with adverse effects such as palpitation, tachycardia, headache, anorexia, nausea, vomiting, and diarrhea. It does not cause gastrointestinal bleeding, blurred vision (halos around lights), or sweating. Magnesium sulfate may cause sweating.

A young woman presents at the emergency department reporting lower abdominal cramping and spotting at 12 weeks' gestation. The primary care provider performs a pelvic examination and finds that the cervix is closed. What does the care provider suspect is the cause of the cramps and spotting? A. Habitual abortion B. Ectopic pregnancy C. Threatened abortion D. Cervical insufficiency

C. Threatened abortion rationale: Spontaneous abortion (miscarriage) occurs along a continuum: threatened, inevitable, incomplete, complete, missed. The definition of each category is related to whether or not the uterus is emptied, or for how long the products of conception are retained.

A pregnant client with multiple gestation arrives at the maternity clinic for a regular antenatal check up. The nurse would be aware that client is at risk for which perinatal complication? A. fetal nonimmune hydrops B. maternal hypotension C. congenital anomalies D. postterm birth

C. congenital anomalies rationale: Multiple gestation involves two or more fetuses. The perinatal complications associated with multiple pregnancy include preterm birth, maternal hypertension and congenital anomalies. Fetal nonimmune hydrops occurs in the infection of pregnant clients with parvovirus. Postterm birth, maternal hypotension, and fetal nonimmune hydrops are not seen as complications of multiple pregnancy.

The nurse is appraising the medical record of a pregnant client who is resting in a darkened room and receiving oxytocin and magnesium sulfate. The nurse will continue to monitor this client for progression to which condition? A. mild preeclampsia B. severe preeclampsia C. eclampsia D. gestational hypertension

C. eclampsia rationale: This woman is in severe preeclampsia and must be monitored for progression to eclampsia. The administration of magnesium sulfate is to relax the skeletal muscles and raise the threshold for a seizure.

A pregnant client diagnosed with hyperemesis gravidarum is prescribed intravenous fluids for rehydration. When preparing to administer this therapy, which solution would the nurse anticipate being prescribed initially? A. albumin B. 0.45% sodium chloride C. normal saline D. dextrose 5% and water

C. normal saline rationale: The first choice for fluid replacement is generally isotonic, such as normal saline, which aids in preventing hyponatremia, with vitamins (pyridoxine, or vitamin B6) and electrolytes added. Dextrose 5% and water and 0.45% sodium chloride are hypotonic solutions that would cause the cells to swell and possibly burst. Albumin could lead to fluid overload.

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

C. prolapsed cord E. placental abruption (abruptio placentae) D. preterm labor rationale: The associated conditions and complications of premature rupture of the membranes are infection, prolapsed cord, placental abruption (abruptio placentae), and preterm labor. Spontaneous abortion (miscarriage) and placenta previa are not associated conditions or complications of premature rupture of the membranes.

The nurse is teaching a prenatal class on potential problems during pregnancy to a group of expectant parents. The risk factors for placental abruption (abruptio placentae) are discussed. Which comment validates accurate learning by the parents? A. "I need a cesarean section if I develop this problem." B. "Since I am over 30, I run a much higher risk of developing this problem." C. "If I develop this complication, I will have bright red vaginal bleeding," D. "Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain."

D. "Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain." rationale: Placental abruption (abruptio placentae) occurs when there is a spontaneous separation of the placenta from the uterine wall. It can occur anywhere on the placenta and will cause painful, dark red vaginal bleeding.

A client in her first trimester arrives at the emergency room with reports of severe cramping and vaginal spotting. On examination, the health care provider informs her that no fetal heart sounds are evident and orders a dilatation and curettage (D&C). The client looks frightened and confused and states that she does not believe in induced abortion (medical abortion). Which statement by the nurse is best? A. "I know that it is sad but the pregnancy must be terminated to save your life." B. "You have experienced an incomplete abortion (miscarriage) and must have the placenta and any other tissues cleaned out." C. "The choice is up to you but the health care provider is recommending an induced abortion (medical abortion). D. "Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications."

D. "Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications."

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

D. Administer IV normal saline with vitamins and electrolytes. rationale: The first choice for fluid replacement is generally normal saline with vitamins and electrolytes added. If the client does not improve after several days of bed rest, "gut rest," IV fluids, and antiemetics, then total parenteral nutrition or percutaneous endoscopic gastrostomy tube feeding is instituted to prevent malnutrition.

A nurse is assessing pregnant clients for the risk of placenta previa. Which client faces the greatest risk for this condition? A. a client with a structurally defective cervix B. a 23-year-old multigravida client C. a client with a history of alcohol use disorder D. a client who had a myomectomy to remove fibroids

D. a client who had a myomectomy to remove fibroids rationale: A previous myomectomy to remove fibroids can be associated with the cause of placenta previa. Risk factors also include maternal age greater than 30 years. A structurally defective cervix cannot be associated with the cause of placenta previa. However, it can be associated with the cause of cervical insufficiency. Alcohol ingestion is not a risk factor for developing placenta previa but is associated with placental abruption (abruptio placentae).

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. placenta previa B. ectopic pregnancy C. placental abruption (abruption placentae) D. gestational trophoblastic disease

D. gestational trophoblastic disease rationale: The signs and symptoms of molar pregnancy include brownish vaginal bleeding, elevated hCG levels, discrepancy between the uterine size and the gestational age, and absent fetal heart sounds.

The nurse is admitting a G3 P2 client at 38 weeks' gestation who arrived reporting painless bleeding from the vagina leading to the diagnosis of placenta previa. When questioned by the client as to what caused this, which most likely factor should the nurse point out in her answer? A. living in coastal areas B. morbidly obese C. maternal age more than 30 years D. previous cesarean birth

D. previous cesarean birth rationale: The risk of placenta previa is greatly increased when a woman has had a previous cesarean delivery due to the scarring of the endometrial lining.