De Sevo Ch.8 pg 93-111

A biophysical profile (BPP) has been performed on a full-term client with severe pre-eclampsia. Which of the following interpretations should the nurse make regarding the BPP results of 4? 1. Fetal well-being is compromised. 2. Client's blood pressure is returning to normal. 3. Client is at high risk for seizure. 4. Fetus's amniotic sac is about to rupture.

1. A BPP of 4 indicates that fetal well-being is compromised. TEST-TAKING TIP: The BPP is performed when fetal well-being is a concern. Five assessments are performed via ultrasound: fetal breathing movements, gross body movements, fetal tone, fetal heart reactivity, and amniotic fluid volume. Each assessment may receive a value of 0 or 2. A total score of 0 to 10 is possible. The lower the score, the more compromised is fetal health.

A gravid client with 4+ proteinuria and 4+ reflexes is admitted to the hospital. The nurse must closely monitor the woman for which of the following? 1. Grand mal seizure. 2. High platelet count. 3. Explosive diarrhea. 4. Fractured pelvis.

1. Clients with severe pre-eclampsia are at high risk for seizure. TEST-TAKING TIP: A client who is diagnosed with 4+ proteinuria and 4+ refl exes is severely pre-eclamptic and, therefore, at high risk for becoming eclamptic. Pre- eclamptic clients are diagnosed with eclampsia once they have had a seizure.

In anticipation of a complication that may develop in the second half of pregnancy, the nurse teaches an 18-week-gravid client to call the office if she experiences which of the following? 1. Headache and decreased output. 2. Puffy feet. 3. Hemorrhoids and vaginal discharge. 4. Backache.

1. Headache and decreased output are signs of pre-eclampsia. TEST-TAKING TIP: Although some symptoms such as puffy feet may seem significant, they are normal in pregnancy; while other symptoms such as headache, which in a nonpregnant woman would be considered benign, may be potentially very important in a pregnant woman.

A gravid client, 25 years old, is diagnosed with gallstones. She asks her nurse, "Aren't I too young to get gallstones?" The nurse bases her response on which of the following? 1. Progesterone slows emptying of the gallbladder, making gravid women at high risk for the disease. 2. Gallbladder disease has a strong genetic component, so the woman should be advised to see a genetic counselor. 3. Older women are no more prone to gallstones than are younger women. 4. Gallbladder disease is related to a high dietary intake of carbohydrates.

1. Progesterone is a hormone that relaxes smooth muscle. This action leads to the delayed emptying of the gallbladder during pregnancy. TEST-TAKING TIP: The hormones of pregnancy not only maintain the pregnancy but also affect all parts of the body. High estrogen levels can lead to nosebleeds and gingivitis, and high progesterone levels can lead to constipation and gallbladder disease.

The nurse caring for a type 1 diabetic client who wishes to become pregnant notes that the client's glycohemoglobin, or glycosylated hemoglobin (HgbA1c), result was 7% today and the fasting blood glucose result was 100 mg/dL. Which of the following interpretations by the nurse is correct in relation to these data? 1. The client has been hyperglycemic for the past 3 months and is hyperglycemic today. 2. The client has been normoglycemic for the past 3 months and is normoglycemic today. 3. The client has been hyperglycemic for the past 3 months and is normoglycemic today. 4. The client has been normoglycemic for the past 3 months and is hyperglycemic today.

1. The client has been hyperglycemic for the past 3 months and is hyperglycemic today. TEST-TAKING TIP: It is very important for a glycohemoglobin test to be performed at the same time that a fasting glucose is done to have an idea of a diabetic client's glucose control over the past 3 months in comparison to the results of the fasting test. When in a hyperglycemic environment, the red blood cell (RBC) becomes a compound molecule with a glucose group attached to it. Because the RBC lives for approximately 120 days, the healthcare practitioner can estimate the glucose control of the client over the preceding 3 months time by analyzing the glycohemoglobin. Up to 5% glycohemoglobin is considered normal. An HgbA 1c level of 7%, therefore, indicates that the client has been hyperglycemic for the past 3 months with an average daily blood glucose level of 154 mg/dL. Because her fasting blood glucose level of 100 mg/dL is above the cut level of 95 mg/dL, the nurse can deduce that the client is currently, and has been on average for the past 3 months, in poor glucose control.

The physician has ordered a nonstress test (NST) to be done on a 41-week-gestation client. During the half-hour test, the nurse observed three periods of fetal heart accelerations that were 15 beats per minute above the baseline and that lasted 15 seconds each. No contractions were observed. Based on these results, what should the nurse do next? 1. Send the client home and report positive results to the medical doctor. 2. Perform a nipple stimulation test to assess the fetal heart in response to contractions. 3. Prepare the client for induction with intravenous oxytocin. 4. Place the client on her side with oxygen via face mask.

1. The nurse should report the positive results to the doctor. TEST-TAKING TIP: This client is postdates. The NST is being performed to assess the well-being of the fetus. The results of the test—reactive NST results—are evidence that the fetus is well and will likely be well for another few days. There is no need to provide emergent care.

An ultrasound has identifi ed that a client's pregnancy is complicated by oligohydramnios. The nurse would expect that an ultrasound may show that the baby has which of the following structural defects? 1. Dysplastic kidneys. 2. Coarctation of the aorta. 3. Hydrocephalus. 4. Hepatic cirrhosis.

1. The nurse would expect that the baby has dysplastic kidneys. TEST-TAKING TIP: The majority of amniotic fluid is produced by the fetal kidneys. When a pregnancy is complicated by oligohydramnios, ultrasounds may be performed to check for defects in the fetal renal system.

A gravid woman, 36 weeks' gestation with type 1 diabetes, has just had a biophysical profile (BPP). Which of the following results should be reported to the obstetrician? 1. One fetal heart acceleration in 20 minutes. 2. Three episodes of fetal rhythmic breathing in 30 minutes. 3. Two episodes of fetal extension and flexion of 1 arm. 4. One amniotic fluid pocket measuring 3 cm.

1. There should be a minimum of 2 fetal heart accelerations in 20 minutes (approximately 1 every 10 minutes). TEST-TAKING TIP: The BPP is a comprehensive assessment geared to evaluate fetal health. In addition to the four items mentioned previously, the fetus should exhibit 3 or more discrete body or limb movements in 30 minutes.

A woman with a history of congestive heart disease is 36 weeks pregnant. Which of the following findings should the nurse report to the primary healthcare practitioner? 1. Presence of striae gravidarum. 2. Dyspnea on exertion. 3. 4-pound weight gain in a month. 4. Patellar reflexes +2.

2. A client who is complaining of dyspnea on exertion is likely going into left-sided congestive heart failure. TEST-TAKING TIP: Pregnancy is a significant stressor on the cardiac system. Women who enter the pregnancy with a history of cardiac problems must be monitored very carefully not only by the obstetric practitioner but also by an internist or cardiologist. The nurse must be vigilant in observing for signs of cardiac failure, including respiratory and systemic congestion.

A nurse is caring for four prenatal clients in the clinic. Which of the clients is at high risk for placenta previa? Select all that apply. 1. Jogger with low body mass index. 2. Primigravida who smokes 1 pack of cigarettes per day. 3. Infertility client who is carrying in-vitro triplets. 4. Registered professional nurse who works 12-hour shifts. 5. Police officer on foot patrol.

2. A smoker is at high risk for placenta previa. 3. A woman carrying triplets is at high risk for placenta previa. TEST-TAKING TIP: The placenta usually implants at a vascular site on the posterior portion of the uterine wall. Two of the women are at high risk for placenta previa. There are 3 placentas nourishing fraternal triplets. Because of the amount of space needed for the placentas, it is not unusual for one to implant near or over the cervical os. The uterine lining of women who smoke is often not well perfused, sometimes resulting in the placenta implanting on or near the cervical os. Women with vascular disease and grand multigravidas are also at high risk for placenta previa.

An ultrasound is being done on an Rh-negative woman. Which of the following pregnancy findings would indicate that the baby has developed erythroblastosis fetalis? 1. Caudal agenesis. 2. Cardiomegaly. 3. Oligohydramnios. 4. Hyperemia.

2. Cardiomegaly is one of the common signs of erythroblastosis fetalis. TEST-TAKING TIP: Erythroblastosis fetalis is the fetal condition that results when an Rh − mother who is sensitized to Rh+ blood is pregnant with an Rh+ baby. Maternal antibodies cross the placenta and destroy the fetal red blood cells. As a result, the baby becomes severely anemic. Cardiomegaly is one of the complications that occurs as a result of the severe anemia.

A woman with a diagnosis of ectopic pregnancy is to receive medical intervention rather than a surgical interruption. Which of the following intramuscular medications would the nurse expect to administer? 1. Decadron (dexamethasone). 2. Amethopterin (methotrexate). 3. Pergonal (menotropin). 4. Prometrium (progesterone).

2. Methotrexate is the likely medication. TEST-TAKING TIP: Methotrexate is an antineoplastic agent. Even if the test taker were unfamiliar with its use in ectopic pregnancy but was aware of the action of methotrexate, he or she could deduce its efficacy here. Methotrexate is a folic acid antagonist that interferes with DNA synthesis and cell multiplication. The conceptus is a ball of rapidly multiplying cells. Methotrexate interferes with that multiplication, killing the conceptus and, therefore, precluding the need for the client to undergo surgery.

A client has been admitted with a diagnosis of hyperemesis gravidarum. Which of the following orders written by the primary healthcare provider is highest priority for the nurse to complete? 1. Obtain complete blood count. 2. Start intravenous with multivitamins. 3. Check admission weight. 4. Obtain urine for urinalysis.

2. Starting an intravenous with multivitamins takes priority. TEST-TAKING TIP: Clients who are vomiting repeatedly are energy depleted, vitamin depleted, electrolyte depleted, and often dehydrated. It is essential that the client receive her IV therapy as quickly as possible. The other orders should be completed soon after the IV is started.

Prenatal teaching for a pregnant woman should include instructions to do which of the following? 1. Refrain from touching her pet bird. 2. Wear gloves when gardening. 3. Cook pork until medium well done. 4. Avoid sleeping with the dog.

2. The client should be advised to wear gloves when gardening. TEST-TAKING TIP: Clients should be advised to wear gloves when gardening because cat feces can carry the toxoplasmosis protozoa. Feral and outdoor domestic cats are nondiscriminating about where they urinate and defecate. They easily could be using the vegetable garden for a cat box. As such, it is also very important for everyone, and especially pregnant women, to wash fresh fruits and vegetables before eating them.

An ultrasound has identified that a client's pregnancy is complicated by hydramnios. The nurse would expect that an ultrasound may show that the baby has which of the following structural defects? 1. Pulmonic stenosis. 2. Tracheoesophageal fistula. 3. Ventriculoseptal defect. 4. Developmental hip dysplasia.

2. The nurse would expect to find that the baby has tracheoesophageal fistula. TEST-TAKING TIP: Babies swallow the amniotic fluid while in utero. When there is a surplus of fluid, ultrasounds may be performed to check for defects in the fetal gastrointestinal system.

The nurse is caring for a 32-week G8 P7007 with placenta previa. Which of the following interventions would the nurse expect to perform? Select all that apply. 1. Daily contraction stress tests. 2. Blood type and cross match. 3. Bedrest with passive range-of-motion exercises. 4. Daily serum electrolyte assessments. 5. Weekly biophysical profiles.

2. There should be blood available in the blood bank in case the woman begins to bleed. 3. The nurse would expect to keep the woman on bedrest with bathroom privileges only. Passive range-of-motion exercises will help to prevent atrophy of the woman's muscles. 5. The nurse would expect that weekly biophysical profiles would be done to assess fetal well-being. TEST-TAKING TIP: Because clients with placenta previa are at high risk for bleeding from the placental site, it is essential that they be limited in their activity and have blood on hand in case of hemorrhage. In addition, their babies must be monitored carefully for signs of fetal well-being. It would be inappropriate to stimulate contractions because dilation of the cervix would stimulate bleeding.

A client has been diagnosed with pseudocyesis. Which of the following signs/symptoms would the nurse expect to see? 1. 4+ pedal edema. 2. No fetal heartbeat. 3. Hematocrit above 40%. 4. Denial of quickening.

2. There will be no fetal heartbeat when a client has pseudocyesis. TEST-TAKING TIP: Although rare, there are some women who develop pregnancy symptoms and believe themselves pregnant but who are not actually pregnant. This is a psychiatric illness. The women may develop many of the presumptive signs of pregnancy but there will be few, if any, probable signs and no positive signs of pregnancy.

A 30-year-old gravida, G3 P1201, who is planning to become pregnant again, states that her premature baby boy, born 8 years ago, died shortly after delivery from an infection secondary to spina bifida. Which of the following interventions is most important for this client? 1. Grief counseling. 2. Nutrition counseling. 3. Infection control counseling. 4. Genetic counseling.

2. This client is in need of nutrition counseling. TEST-TAKING TIP: There is a strong association between low folic acid intake during the first trimester of pregnancy and spina bifida, a neural tube defect. It is very important that all clients, and especially clients with a family or personal history of a neural tube defect, consume adequate amounts of folic acid during their pregnancies. It is recommended that all women consume at least 600 micrograms of the vitamin per day. To that end, to prevent neural tube defects, it is recommended that pregnant women with no family history take a supplement of 400 micrograms per day, while pregnant women with a family history take a supplement that is 10 times the standard dose, or 4 mg per day.

Which of the following findings would the nurse expect to see when assessing a first-trimester gravida suspected of having gestational trophoblastic disease (hydatidiform mole) that the nurse would not expect to see when assessing a first-trimester gravida with a normal pregnancy? Select all that apply. 1. Hematocrit 39%. 2. Grape-like clusters passed from the vagina. 3. Markedly elevated blood pressure. 4. White blood cell count 8,000/mm 3. 5. Hypertrophied breast tissue.

2. Women with hydatidiform mole often expel grape-like clusters from the vagina. 3. Although signs and symptoms of pre- eclampsia usually appear only after a pregnancy has reached 20 weeks or later, pre-eclampsia is seen in the first trimester of pregnancy in women with hydatidiform mole. TEST-TAKING TIP: It is very important that the test taker know the normal values of common laboratory values, especially the complete blood count, and that the test taker be familiar with deviations from normal diagnostic signs and symptoms.

A client, 8 weeks pregnant, has been diagnosed with a bicornuate uterus. Which of the following signs should the nurse teach the client to carefully monitor for? 1. Hyperthermia. 2. Palpitations. 3. Cramping. 4. Oliguria.

3. A bicornuate uterus will predispose a client to cramping and preterm labor. TEST-TAKING TIP: If the test taker is unfamiliar with the term bicornuate, he or she could break down the word into its parts to determine its meaning: bi means "2" and cornuate means "horn." A bicornuate uterus, therefore, is a uterus that has a septum down the center, creating a 2-horned fundus. Sometimes the uterus is heart-shaped and sometimes the uterus is divided in half. Because of its shape, there is often less room for the fetus to grow. The uterus becomes irritable and predisposes the client to preterm labor.

A gravid woman has just been admitted to the emergency department subsequent to a head-on automobile accident. Her body appears to be uninjured. The nurse carefully monitors the woman for which of the following complications of pregnancy? Select all that apply. 1. Placenta previa. 2. Transverse fetal lie. 3. Placental abruption. 4. Severe pre-eclampsia. 5. Preterm labor.

3. Placental abruption may develop as a result of the auto accident. 5. The woman may go into preterm labor after an auto accident. TEST-TAKING TIP: The fetus is well protected within the uterine body. The musculature of the uterus and the amniotic fluid provide the baby with enough cushioning to withstand minor bumps and falls. A major automobile accident, however, can cause anything from preterm premature rupture of the membranes, to preterm labor, to a ruptured uterus, to placental abruption. The nurse should especially monitor the fetal heartbeat for any variations.

A woman, G5 P0311, is in the post-anesthesia care unit (PACU) after a cervical cerclage procedure. During the immediate postprocedure period, what should the nurse carefully monitor this client for? 1. Hyperthermia. 2. Hypotension. 3. Uterine contractions. 4. Fetal heart dysrhythmias.

3. Preterm labor is a complication in the immediate postprocedure period. TEST-TAKING TIP: Cerclages are inserted when clients have a history of recurring pregnancy loss related to a cervical insufficiency. Losses typically occur between 14 and 26 weeks' gestation. This client has had 5 pregnancies but only one living child. Unfortunately, with the manipulation of the cervix at the time of the cerclage, the clients may develop preterm labor. The clients should be monitored carefully with a tocometer to assess for labor contractions.

A 14-year-old woman is seeking obstetric care. Which of the following vital signs must be monitored very carefully during this woman's pregnancy? 1. Heart rate. 2. Respiratory rate. 3. Blood pressure. 4. Temperature.

3. The client's blood pressure is the most important vital sign. TEST-TAKING TIP: Adolescents who are 16 years old or younger are particularly at high risk for hypertensive illnesses of pregnancy. It is especially important for the nurse and the client's primary healthcare practitioner to determine the client's baseline blood pressure to identify any elevations as early as possible.

A 16-year-old woman is being seen for the first time in the obstetric office. Which of the following comments by the young woman is highest priority for the nurse to respond to? 1. "My favorite lunch is a burger with fries." 2. "I've been dating my new boyfriend for 2 weeks." 3. "On weekends we go out and drink a few beers." 4. "I dropped out of school about 3 months ago."

3. The nurse must respond to this comment. This young woman is repeatedly exposing her fetus to alcohol. TEST-TAKING TIP: The nurse must prioritize her care with teen clients as well as with mature clients. This young woman will eventually need to be counseled regarding diet, infection control, and her education, but the fetus is at highest risk at the present time from repeated alcohol exposure. Indeed, alcohol exposure is injurious for the unborn child throughout the entire pregnancy. The nurse must discuss this with the young woman at this time.

A 36-week-gestation client is having cultures taken to determine whether she is colonized with group B strep. Which of the following sites is being cultured? Select all that apply. 1. Throat. 2. Nipple. 3. Vagina. 4. Rectum. 5. Nostrils.

3. The vagina and rectum are cultured for group B strep. 4. The vagina and rectum are cultured for group B strep. TEST-TAKING TIP: Group B strep is a normal flora in a large number of women. Unfortunately, the bacteria can lead to severe disease in neonates, including septicemia and meningitis, Unless treated aggressively, affected babies can die. Antibiotics are administered to affected women during labor and delivery to prevent transmission to the neonate. Cultures are taken at approximately 36 weeks' gestation because cultures taken earlier can result in false-negative findings.

A woman enters the prenatal clinic accompanied by her partner. When she is asked by the nurse about her reason for seeking care, the woman looks down as her partner states, "She says she thinks she's pregnant. She constantly complains of feeling tired. And her vomiting is disgusting!" Which of the following is the priority action for the nurse to perform? 1. Ask the woman what times of the day her fatigue seems to be most severe. 2. Recommend to the couple that they have a pregnancy test done as soon as possible. 3. Continue the interview of the woman in private. 4. Offer suggestions on ways to decrease the vomiting.

3. This is the priority action. The nurse should escort the client to a location where the partner cannot follow. TEST-TAKING TIP: This couple is exhibiting classic signs of an abusive relationship. The woman is subjective, looking down and allowing her partner to respond to questions. The partner is dominant and demeaning in his description of his partner. To question the woman regarding her relationship, it is important for the nurse to interview the client in private. The women's bathroom is an excellent location for the interview.

A client who has been taking Zoloft (sertraline) for depression for 2 years is seen for a prenatal appointment. She states, "I just read that my baby is going to be really sick if I keep taking Zoloft so I have stopped taking my medication." The nurse's response is based on which of the following information? 1. There is evidence that other antidepressant medications can cause birth defects, but SSRI (selective serotonin reuptake inhibitors) medications are safe to take during pregnancy. 2. Although some evidence shows that SSRI medications can cause birth defects, the defects are easily repaired immediately following delivery. 3. Although some evidence shows that SSRI medications can cause birth defects, the health and well-being of the mother may outweigh the potential injury to the baby. 4. There is no evidence that SSRI medications are injurious prenatally, but the woman should be advised not to breastfeed her baby while taking the medication.

3. This statement is correct. Healthcare practitioners must always weigh the dangers of medication administration during pregnancy on the newborn with the potential complications that may develop if the mother were not to receive the medication. TEST-TAKING TIP: There is evidence that SSRIs, especially when taken during the 3rd trimester, can lead to PPH in the newborn. In addition, there is some evidence that children birthed to women who took SSRIs during pregnancy are at increased risk of autism. As in all preexisting maternal illnesses, however, the primary healthcare practitioner must take into consideration the health and well-being of the mother as well as the baby. In many circumstances, it would be more dangerous to stop prescribing a medication to a mother than to continue her use of the medicine.

The nurse suspects that a client is third spacing fluid. Which of the following signs will provide the nurse with the best evidence of this fact? 1. Client's blood pressure. 2. Client's appearance. 3. Client's weight. 4. Client's pulse rate.

3. Weight is the most important sign for the nurse to assess. TEST-TAKING TIP: When clients third space, they are retaining fluids. Fluid is very heavy. A sudden weight increase is, therefore, the most important assessment the nurse can make to determine whether or not a client is third spacing. Clients who are being assessed for pre-eclampsia, therefore, should be weighed daily.

The nurse should be aware that which of the following clients is at highest risk for pseudocyesis? 1. The client with lymphatic cancer. 2. The client with celiac disease. 3. The client with multiple miscarriages. 4. The client with grand multiparity.

3. Women who have had a number of miscarriages are at high risk for pseudocyesis. TEST-TAKING TIP: The prefix "pseudo" means "false" and "cyesis" means "pregnancy." Women who develop pseudocyesis are women who have an overwhelming desire to become pregnant. Those who have had multiple miscarriages may be so desperate they develop signs of pregnancy but are not really pregnant.

A client has just been diagnosed with gestational diabetes. She cries, "Oh no! I will never be able to give myself shots!!" Which of the following responses by the nurse is appropriate at this time? 1. "I am sure you can learn for your baby." 2. "I will work with you until you feel comfortable giving yourself the insulin." 3. "We will be giving you pills for the diabetes." 4. "If you follow your diet and exercise you will probably need no insulin."

4. It is unlikely that this client will need any medication. If the client follows her diet and exercises regularly, she will probably control the diabetes. TEST-TAKING TIP: The client should be reminded that if she follows her diet and exercises regularly she will likely be able to manage her diabetes without medication. She should also be encouraged to continue the diet and exercise after delivery to prevent the development of type 2 diabetes later in life.

The nurse is providing health teaching to a group of women of childbearing age. One woman who states that she is a smoker asks about smoking's impact on the pregnancy. The nurse responds that which of the following fetal complications can develop if the mother smokes? 1. Genetic changes in the fetal reproductive system. 2. Extensive central nervous system damage. 3. Addiction to the nicotine inhaled from the cigarette. 4. Fetal intrauterine growth restriction.

4. Smoking in pregnancy does cause fetal intrauterine growth restriction. TEST-TAKING TIP: When someone smokes, there is a vasoconstrictive effect that occurs in the body. This vasoconstrictive effect is also seen at the placental site. Placentas of women who smoke are much smaller than those of nonsmoking women; because of this, babies receive less oxygen and nutrients via the placenta. As a result, their growth is restricted.

Which of the following statements is appropriate for the nurse to say to a patient with a complete placenta previa? 1. "During the first phase of labor you will do slow chest breathing." 2. "You should ambulate in the halls at least two times each day." 3. "The doctor will deliver you once you reach 25 weeks' gestation." 4. "It is important that you inform me if you become constipated."

4. Straining at stool can result in enough pressure to result in placental bleeding. TEST-TAKING TIP: Clients diagnosed with complete placenta previa are usually maintained on bedrest. Because one of the many complications of bedrest is constipation, these clients must be monitored carefully. Many primary healthcare providers order Colace (docusate sodium), a stool softener, to prevent this complication.

Nurses working in obstetric clinics know that, in general, teen pregnancies are high risk because of which of the following? 1. High probability of chromosomal anomalies. 2. High oral intake of manganese and zinc. 3. High numbers of post-term deliveries. 4. High incidence of late prenatal care registration.

4. Teens are likely to delay entry into the healthcare system. TEST-TAKING TIP: Late entry into prenatal care is particularly problematic for teen pregnancies. Because organogenesis occurs during the first trimester, by the time many teens acknowledge that they are pregnant and seek care, they are already past this critical period. They are likely to have consumed damaging substances or, at the very least, consumed inadequate quantities of essential nutrients such as folic acid.

A client has been admitted with a diagnosis of hyperemesis gravidarum. Which of the following laboratory values would be consistent with this diagnosis? 1. PO2 90, PCO2 35, HCO 3 19 mEq/L, pH 7.3. 2. PO2 100, PCO2 30, HCO 3 21 mEq/L, pH 7.5. 3. PO2 60, PCO2 50, HCO 3 28 mEq/L, pH 7.3. 4. PO2 90, PCO2 45, HCO 3 30 mEq/L, pH 7.5.

4. This client is in metabolic alkalosis. This is consistent with a diagnosis of hyperemesis gravidarum. TEST-TAKING TIP: The test taker must not panic when confronted with blood gas data. If assessed methodically, the test taker should have little trouble determining the correct answer. The first action is to determine what the results should show. If a woman is vomiting repeatedly, one would expect her to have lost acid from the stomach. She would, therefore, be in metabolic alkalosis. The test taker should then look at the pH levels—they should be elevated—and the O 2 levels—they should be normal—to begin to determine which response is correct.

During a prenatal examination, the nurse notes scarring on and around the woman's genitalia. Which of the following questions is most important for the nurse to ask in relation to this observation? 1. "Have you ever had vaginal or clitoral surgery?" 2. "Have you worn any piercings in your genital area?" 3. "Have you had a tattoo removed from your genital area?" 4. "Have you ever been forced to have sex?"

4. This is an essential question for the nurse to ask. TEST-TAKING TIP: The nurse should question all obstetric clients about a possible history of physical abuse and/or sexual abuse. Women are especially high risk for abusive injuries during the pregnancy period. Any gravida who exhibits trauma to the genital area, therefore, must be viewed as a possible victim of sexual abuse.

A gravid woman has sickle cell anemia. Which of the following situations could precipitate a vaso-occlusive crisis in this woman? 1. Hypoxia. 2. Alkalosis. 3. Fluid overload. 4. Hyperglycemia.

1. Vaso-occlusive crises are precipitated by hypoxia in pregnant as well as nonpregnant sickle cell clients. TEST-TAKING TIP: Sickle cell anemia is an autosomal recessive disease. The hemoglobin in the red blood cells of sickle cell clients becomes misshapen when the clients are hypoxic, acidotic, and/or dehydrated. This is a very serious state for the pregnant woman and her fetus. These clients must be cared for immediately with intravenous fluids and methods to reverse the hypoxia and acidosis. In addition, because sickle crises are so painful, narcotic analgesics will be required.

A gravid client, 27 weeks' gestation, has been diagnosed with gestational diabetes. Which of the following therapies will most likely be ordered for this client? 1. Oral hypoglycemic agents. 2. Diet control with exercise. 3. Regular insulin injections. 4. Inhaled insulin.

2. About 95% of gestational diabetic clients are managed with diet and exercise alone. TEST-TAKING TIP: Gestational diabetic clients are first counseled regarding proper diet and exercise as well as blood glucose assessments. The vast majority of women are able to regulate their glucose levels with this intervention. If the glucose levels do not stabilize, the obstetrician will determine whether to order oral hypoglycemics or injectable insulin.

An insulin-dependent diabetic, G3 P0200, 38 weeks' gestation, is being seen in the labor and delivery suite in metabolic disequilibrium. The nurse knows that which of the following maternal blood values is most high risk to her unborn baby? 1. Glucose 150 mg/dL. 2. pH 7.25. 3. PCO2 34 mm Hg. 4. Hemoglobin A1c 6%.

2. Acidosis is fatal to the fetus. This is the most important finding. TEST-TAKING TIP: Acidosis is life threatening to the fetus. It is essential that the nurse monitor clients for situations that would put the fetus in jeopardy of being in an acidotic environment, including maternal hypoxia and diabetic ketoacidosis.

Which of the following pregnant clients is most high risk for preterm premature rupture of the membranes (PPROM)? Select all that apply. 1. 31 weeks' gestation with prolapsed mitral valve (PMV). 2. 32 weeks' gestation with urinary tract infection (UTI). 3. 33 weeks' gestation with twins post-in vitro fertilization (IVF). 4. 34 weeks' gestation with gestational diabetes (GDM). 5. 35 weeks' gestation with deep vein thrombosis (DVT).

2. Clients with UTIs are at high risk for PPROM. 3. Clients carrying twins, whether spontaneous or post-IVF, are at high risk for PPROM. TEST-TAKING TIP: Although the exact mechanism is not well understood, clients who have urinary tract infections are at high risk for PPROM. This is particularly important because pregnant clients often have urinary tract infections that present either with no symptoms at all or only with urinary frequency, a complaint of many pregnant clients. Also, clients carrying twins are at high risk for PPROM.

An obese gravid woman is being seen in the prenatal clinic. The nurse will monitor this client carefully throughout her pregnancy because she is at high risk for which of the following complications of pregnancy? Select all that apply. 1. Placenta previa. 2. Gestational diabetes. 3. Deep vein thrombosis. 4. Pre-eclampsia. 5. Chromosomal defects.

2. Obese clients are at high risk for gestational diabetes. 3. Obese clients are at high risk for deep vein thrombosis. 4. Obese clients are at high risk for pre-eclampsia. TEST-TAKING TIP: Because clients who enter pregnancy obese are at high risk for type 2 diabetes, many obstetricians schedule an oral glucose tolerance test early in pregnancy rather than waiting until after 24 weeks' gestation. As a result, the complication is discovered much earlier and intervention can begin much earlier. The patients are also carefully monitored for signs and symptoms of pre-eclampsia and deep vein thrombosis .

The nurse is caring for a client who was just admitted to the hospital to rule out ectopic pregnancy. Which of the following orders is the most important for the nurse to perform? 1. Take the client's temperature. 2. Document the time of the client's last meal. 3. Obtain urine for urinalysis and culture. 4. Assess for complaint of dizziness or weakness.

4. It is most important for the nurse to assess for complaints of dizziness or weakness. TEST-TAKING TIP: The nurse must prioritize care. When the question asks the test taker to decide which action is most important, all four possible responses are plausible actions. The test taker must determine which is the one action that cannot be delayed. In this situation, the most important action for the nurse to perform is to assess for complaints of dizziness or weakness. These symptoms are seen when clients develop hypovolemia from internal bleeding. Internal bleeding will be present if the client's fallopian tube has ruptured.

A 26-week-gestation woman is diagnosed with severe pre-eclampsia with HELLP syndrome. The nurse will assess for which of the following signs/symptoms? 1. Low serum creatinine. 2. High serum protein. 3. Bloody stools. 4. Epigastric pain.

4. Epigastric pain is associated with the liver involvement of HELLP syndrome. TEST-TAKING TIP: The acronym, HELLP, stands for the following signs/symptoms: hemolysis, elevated liver enzymes, and low platelets. When the liver is deprived of sufficient blood supply, as can occur with severe pre-eclampsia, the organ becomes ischemic and liver enzymes become elevated. In addition, the client experiences pain at the site of the liver as a result of the hypoxia in the liver.

A child has been diagnosed with rubella. What must the pediatric nurse teach the child's parents to do? 1. Notify any exposed pregnant friends. 2. Give oral penicillin every 6 hours for 10 full days. 3. Observe the child for signs of respiratory distress. 4. Administer diphenhydramine every 4 hours as needed.

1. Rubella is a teratogenic disease. The parents should notify any pregnant friends. TEST-TAKING TIP: Of all of the communicable illnesses, rubella is the most potentially teratogenic. If mothers contract the disease during the first trimester, up to 50% of the fetuses will develop congenital defects. The incidence of disease does drop with each successive week, but older fetuses are still at high risk for injury. The most common defects from rubella are deafness, cataracts, and cardiovascular disease.

A client, G8 P3406, 14 weeks' gestation, is being seen in the prenatal clinic. During the nurse's prenatal teaching session, the nurse will emphasize that the woman should notify the obstetric office immediately if she notes which of the following? 1. Change in fetal movement. 2. Signs and symptoms of labor. 3. Swelling of feet and ankles. 4. Appearance of spider veins.

2. The nurse should emphasize the need for the client to notify the office of signs of preterm labor. TEST-TAKING TIP: The test taker must be able to interpret a client's gravidity and parity. The letter "G" stands for gravid, or the number of pregnancies. The letter "P" stands for para, or the number of deliveries. The delivery information is further distinguished by 4 separate numbers: The first refers to the number of full-term pregnancies the client has had, the second refers to the number of preterm pregnancies the client has had, the third refers to the number of abortions the client has had (any pregnancy loss before 20 weeks' gestation), and the fourth refers to the number of living children that the client currently has. The client in the scenario, therefore, has had 8 pregnancies (she is currently pregnant) with 3 full-term deliveries, 4 preterm deliveries, and no abortions, and she currently has 6 living children.

A woman, G4 P0210 and 12 weeks' gestation, has been admitted to the labor and delivery suite for a cerclage procedure. Which of the following long-term outcomes is appropriate for this client? 1. The client will gain less than 25 pounds during the pregnancy. 2. The client will deliver after 38 weeks' gestation. 3. The client will have a normal blood glucose throughout the pregnancy. 4. The client will deliver a baby who is appropriate for gestational age.

2. This client is at high risk for pregnancy loss. This is an appropriate long-term goal. TEST-TAKING TIP: This question requires the test taker to know why a client may have cervical cerclage placed—namely, because of multiple pregnancy losses from cervical insufficiency (incompetent cervix). The gravidity and parity information provides an important clue to the question. The client has had four pregnancies—with two preterm births and one abortion, but she has no living children. The goal for the therapy, therefore, is that the pregnancy will go to term.

A 29-week-gestation woman diagnosed with severe pre-eclampsia is noted to have blood pressure of 170/112, 4+ proteinuria, and a weight gain of 10 pounds over the past 2 days. Which of the following signs/symptoms would the nurse also expect to see? 1. Fundal height of 32 cm. 2. Papilledema. 3. Patellar reflexes of +2. 4. Nystagmus.

2. The nurse would expect to see papilledema. TEST-TAKING TIP: Increased intracranial pressure (ICP) is present in a client with severe pre-eclampsia because she is third spacing large quantities of fluid. As a result of the elevated ICP, the optic disk swells and papilledema is seen when the disk is viewed through an ophthalmoscope.

Which finding should the nurse expect when assessing a client with placenta previa? 1. Severe occipital headache. 2. History of thyroid cancer. 3. Previous premature delivery. 4. Painless vaginal bleeding.

4. Painless vaginal bleeding is often the only symptom of placenta previa. TEST-TAKING TIP: There are three different forms of placenta previa: low- lying placenta—one that lies adjacent to, but not over, the internal cervical os; partial—one that partially covers the internal cervical os; and complete—a placenta that completely covers the internal cervical os. There is no way to deliver a live baby vaginally when a client has a complete previa, although there are cases when live babies have been delivered when the clients had low-lying or partial previas.

A client who works as a waitress and is 35 weeks' gestation telephones the labor suite after getting home from work and states, "I am feeling tightening in my groin about every 5 to 6 minutes." Which of the following comments by the nurse is appropriate at this time? 1. "Please lie down and drink about four full glasses of water or juice." 2. "You are having false labor pains so you need not worry about them." 3. "It is essential that you get to the hospital immediately." 4. "That is very normal for someone who is on her feet all day."

1. The first intervention for preterm labor is hydration. Clients who are dehydrated are at high risk for preterm labor. TEST-TAKING TIP: Preterm cramping should never be ignored. To assess whether or not a client is in true labor, clients are encouraged to improve their hydration. The client is encouraged to drink about 1 quart of fluid and to lie on her side. If the contractions do not stop, she should proceed to the hospital to have her cervix assessed. If the cervix begins to dilate or efface, a diagnosis of preterm labor would be made. If the contractions stop, clients are usually allowed to begin light exercise. But if the contractions restart, the woman should proceed to the hospital to be assessed.

It is discovered that a 28-week-gestation gravid is leaking amniotic fluid. Before the client is sent home on bedrest, the nurse teaches her which of the following? 1. Perform a nitrazine test every morning upon awakening. 2. Immediately report any breast tenderness to the primary healthcare practitioner. 3. Abstain from engaging in vaginal intercourse for the rest of the pregnancy. 4. Carefully weigh all of her saturated peripads.

3. This client must abstain from vaginal intercourse for the remainder of the pregnancy. TEST-TAKING TIP: Once the membranes are ruptured, the barrier between the vagina and the uterus is broken. As a result, the pathogens in the vagina and the external environment are potentially able to ascend into the sterile uterine body. In addition, once the membranes are ruptured, the client is at high risk for preterm labor. Intercourse must be curtailed for both of these reasons.

During a prenatal interview, a client tells the nurse, "My mother told me she had toxemia during her pregnancy and almost died!" Which of the following questions should the nurse ask in response to this statement? 1. "Does your mother have a family history of cancer?" 2. "Did your mother tell you what she was toxic from?" 3. "Does your mother have diabetes now?" 4. "Did your mother say whether she had a seizure or not?"

4. This is the appropriate question. The nurse is asking whether or not the client's mother developed eclampsia. TEST-TAKING TIP: The hypertensive illnesses of pregnancy used to be called toxemia of pregnancy as well as pregnancy-induced hypertension. The term toxemia is still heard in the community because the mothers and grandmothers of clients were told that they had toxemia of pregnancy. Because daughters of clients who have had pre-eclampsia are at high risk for hypertensive illness, it is important to find out whether or not the client's mother had developed eclampsia.

A Latina client, BMI 31.2, is seen for her first prenatal visit at 7 weeks' gestation. The nurse requests an order from the primary healthcare practitioner for which of the following tests? 1. Electroencephalogram. 2. Oral glucose tolerance test. 3. Biophysical profi le. 4. Lecithin/sphingomyelin ratio.

2. The nurse should request an order of an oral glucose tolerance test. TEST-TAKING TIP: Clients from a number of ethnic groups, for example, Hispanics, Native Americans, Asian Americans, and others are at high risk for type 2 diabetes. In addition, obese clients are at high risk for the disease. Instead of waiting until 24 weeks' gestation to have previously healthy pregnant clients undergo oral glucose tolerance testing, it is recommended by the American Diabetes Association that women in high-risk groups be tested early in their pregnancies. Those with abnormal results will be diagnosed with type 2 diabetes rather than gestational diabetes.

A hospitalized gravida's blood work is: hematocrit 30% and hemoglobin 10 gm/dL. In light of the laboratory data, which of the following meal choices should the nurse recommend to this patient? 1. Chicken livers, sliced tomatoes, and dried apricots. 2. Cheese sandwich, tossed salad, and rice pudding. 3. Veggie burger, cucumber salad, and wedge of cantaloupe. 4. Bagel with cream cheese, pear, and hearts of lettuce.

1. This meal choice is high in iron and ascorbic acid. It would be an excellent lunch choice for this client who has a below normal hematocrit and hemoglobin. TEST-TAKING TIP: The client in the scenario is anemic. Although a hematocrit of 32% in pregnancy is acceptable, it is recommended that the value not drop below that level. The nurse, having evaluated the laboratory statement, should choose foods that are high in iron. Liver and dried fruits are good iron sources. Tomatoes are high in vitamin C, which promotes the absorption of iron.

A pregnant woman mentions to the clinic nurse that she and her husband enjoy working together on projects around the house and says, "I always wear protective gloves when I work." The nurse should advise the woman that even when she wears gloves, which of the following projects could be high risk to the baby's health? 1. Replacing a light fixture in the nursery. 2. Sanding the paint from an antique crib. 3. Planting tulip bulbs in the side garden. 4. Shoveling snow from the driveway.

2. Antique cribs are often painted with lead-based paint. This is a dangerous activity. TEST-TAKING TIP: It is very important that clients stay away from aerosolized lead that can develop when lead paint is being sanded. Lead can enter the body through the respiratory tract as well as through the gastrointestinal tract. Once it is ingested, the lead enters the vascular tree and is transported across the placenta to the unborn baby. The baby, especially the baby's central nervous system, can be severely adversely affected by the lead.

A client is seen at 8 weeks' gestation for her first prenatal visit. During her last gynecological visit, the client's blood pressure was 100/60. Her blood pressure is now 150/90. For which of the following pregnancy-related illnesses should this client be assessed? 1. Hyperemesis gravidarum. 2. Hydatidiform mole. 3. Pre-eclampsia. 4. Gestational diabetes.

2. Unless the pregnant client developed chronic hypertension during her pregnancy, hydatidiform mole is the most likely cause of her high blood pressure. TEST-TAKING TIP: There is no viable fetus in a pregnancy complicated by hydatidiform mole. Rather, the trophoblastic layer, that is, the portion of the fertilized ovum that should become the fetal portion of the placenta, proliferates. The hyperproliferation of the placental tissue often results in the pregnant client developing pre-eclamptic symptoms during the fi rst trimester.

A pregnant woman, 24 weeks' gestation, who has been diagnosed with severe choledocholithiasis is scheduled for a cholecystectomy under general anesthesia. In addition to routine surgical and postsurgical care, the nurses should pay special attention to which of the following? Select all that apply. 1. The circulating nurse should place the woman supine and slightly tilted to the left during the surgical procedure. 2. The circulating and post-anesthesia care nurses should assess the fetal heart rate regularly following the surgery. 3. The post-anesthesia care nurse should monitor the client's lochia and the fi rmness of her fundus. 4. The post-anesthesia care nurse should monitor the woman carefully for nausea and vomiting. 5. The post-anesthesia care nurse should place antiembolic stockings on the woman's legs.

1. This response is correct. The woman should be maintained in the lateral recumbent position during the surgery because, if laid fl at, the gravid uterus would compress the great vessels and impede the return of blood to the heart. 2. This response is correct. The fetal heart should be monitored frequently during the postsurgical period. In addition, the client should be monitored carefully for any signs of preterm labor. 4. The woman would be at high risk for postoperative vomiting and for postoperative gas pains for 2 reasons: Progesterone slows gastric motility and the stomach and intestines are displaced by the gravid uterus. In addition, nausea and vomiting are complications of general anesthesia. 5. This response is correct. After the surgery, antiembolic stockings should be placed on the client for the entire time that she is immobile. TEST-TAKING TIP: Surgery is performed on a pregnant woman only when absolutely necessary. When it is performed, however, the client's pregnancy hormone levels, the cardiovascular changes of pregnancy, and the size of the gravid uterus all place the client at risk of complications. In addition, of course, the maintenance of the pregnancy itself is at risk because of the surgery.

A gravid client is admitted with a diagnosis of third-trimester bleeding. It is priority for the nurse to assess for a change in which of the following vital signs? 1. Temperature. 2. Pulse. 3. Respirations. 4. Blood pressure.

2. The pulse is the highest priority in this situation. . TEST-TAKING TIP: The key to answering this question is the fact that the nursing care plan is for a client with third- trimester bleeding. By the end of the second trimester, pregnant women have almost doubled their blood volume. Because of this, if they bleed, they are able to maintain their blood pressure for a relatively long period of time. Their pulse rate, however, does rise. Nurses, therefore, must carefully attend to the pulse rate of pregnant women who have been injured or who are being observed for third-trimester bleeding. A drop in blood pressure is a very late and ominous sign.

A client is being admitted to the labor suite with a diagnosis of eclampsia. The fetal heart rate tracing shows moderate variability with early decelerations. Which of the following actions by the nurse is appropriate at this time? 1. Tape a tongue blade to the head of the bed. 2. Pad the side rails and head of the bed. 3. Provide the client with needed stimulation. 4. Provide the client with grief counseling.

2. This is appropriate. The side rails and the headboard should be padded. TEST-TAKING TIP: When a client has been diagnosed with eclampsia, she has already had at least one seizure. The nurse, therefore, must be prepared to care for the client during another seizure. The most important action during the seizure is to protect the client from injury. Padding the side rails and headboard will provide that protection. This client's fetus is exhibiting a normal heart rate pattern.

A client, 37 weeks' gestation, has been advised that she is positive for group B streptococci. Which of the following comments by the nurse is appropriate at this time? 1. "The doctor will prescribe intravenous antibiotics for you. A visiting nurse will administer them to you in your home." 2. "You are at very high risk for an intrauterine infection. It is important for you to check your temperature every day." 3. "The bacteria are living in your vagina. They will not hurt you but we will give you medicine in labor to protect your baby from getting sick." 4. "The bacteria cause scarlet fever. If you notice that your tongue becomes very red and that you feel feverish you should call the doctor immediately."

3. This answer is correct. Exposure to group B strep is very dangerous for neonates. TEST-TAKING TIP: Group B strep can cause serious neonatal disease. Babies are at high risk for meningitis, sepsis, pneumonia, and even death. IV antibiotics are administered to the laboring mother every 4 hours to decrease the colonization in the mother's vagina and rectum. In addition, the antibiotics cross the placenta and act as a prophylaxis for the baby.

A 32-week-gestation client states that she "thinks" she is leaking amniotic fluid. Which of the following tests could be performed to determine whether the membranes had ruptured? 1. Fern test. 2. Biophysical profile. 3. Amniocentesis. 4. Kernig assessment.

1. A fern test is performed to assess for the presence of amniotic fluid. TEST-TAKING TIP: The fern test was so named because when amniotic fluid is viewed under a microscope, it appears as a fern-like image. The image is a reflection of the high estrogen levels in the fluid that create a crystalline pattern. When the fern appears, the nurse can be assured that amniotic fluid is leaking from the amniotic sac.

A 32-week-gestation client was last seen in the prenatal client at 28 weeks' gestation. Which of the following changes should the nurse bring to the attention of the certified nurse midwife? 1. Weight change from 128 pounds to 138 pounds. 2. Pulse rate change from 88 bpm to 92 bpm. 3. Blood pressure change from 120/80 to 118/78. 4. Respiratory rate change from 16 rpm to 20 rpm.

1. A weight gain of 10 pounds in a 4-week period is worrisome. The recommended weight gain during the second and third trimesters is approximately 1 pound per week. TEST-TAKING TIP: A weight gain above that which is recommended can be related to a few things, including pre-eclampsia, excessive food intake, or multiple gestations. The midwife should be advised of the weight gain to identify the reason for the increase and to intervene accordingly.

A nurse works in a clinic with a high adolescent pregnancy population. The nurse provides teaching to the young women to prevent which of the following high-risk complications of pregnancy? 1. Preterm birth. 2. Gestational diabetes. 3. Macrosomic babies. 4. Polycythemia.

1. Adolescents are at high risk for preterm labor. TEST-TAKING TIP: It is very important that pregnant teens learn the telltale signs of preterm labor, such as intermittent backache, cramping, discomfort low in the pelvic area, and the like. Because of their lifestyle choices, pregnant teens are at high risk for low-birth-weight, preterm births.

A nurse is about to inject RhoGAM into an Rh-negative mother. Which of the following is the preferred site for the injection? 1. Deltoid. 2. Dorsogluteal. 3. Vastus lateralis. 4. Ventrogluteal.

1. Although the dosage can be administered in the gluteal muscles, the deltoid is the preferred site of the RhoGAM injection. TEST-TAKING TIP: Whenever possible, it is preferable to inject the antibodies into the recommended injection site. The antibodies are absorbed optimally from that site and, therefore, are more apt to suppress the mother's immune response.

A nurse remarks to a 38-week-gravid client, "It looks like your face and hands are swollen." The client responds, "Yes, you're right. Why do you ask?" The nurse's response is based on the fact that the changes may be caused by which of the following? 1. Altered glomerular fi ltration. 2. Cardiac failure. 3. Hepatic insufficiency. 4. Altered splenic circulation.

1. Altered glomerular filtration leads to protein loss and, subsequently, to fluid retention, which can lead to swelling in the face and hands. TEST-TAKING TIP: The hypertension associated with pre-eclampsia results in poor perfusion of the kidneys. When the kidneys are poorly perfused, the glomerular filtration is altered, allowing large molecules, most notably the protein albumin, to be lost through the urine. With the loss of protein, the colloidal pressure drops in the vascular tree, allowing fluid to third space. The body gets the message to retain fluids, exacerbating the problem. One of the early signs of the third spacing is the swelling of a client's hands and face.

On ultrasound, it is noted that the pregnancy of a hospitalized woman who is carrying monochorionic twins is complicated by twin-to-twin transfusion. The nurse should carefully monitor this client for which of the following? 1. Rapid fundal growth. 2. Vaginal bleeding. 3. Projectile vomiting. 4. Congestive heart failure.

1. Fundal growth is often accelerated. TEST-TAKING TIP: Fundal growth is accelerated for two reasons: (a) With two babies in utero, uterine growth is increased and (b) the recipient twin—the twin receiving blood from the other twin—often produces large quantities of urine, resulting in polyhydramnios.

The fetus of a 38-week-gestation client has been diagnosed with intrauterine growth restriction (IUGR). The nurse would expect that which of the following diagnostic assessments would be appropriate for the primary healthcare practitioner to order at this time? Select all that apply. 1. Biophysical profi le. 2. Nonstress test. 3. Umbilical arterial Doppler assessment. 4. Chorionic villus sampling. 5. Human chorionic gonadotropin test.

1. It would be appropriate to perform a biophysical profi le (BPP). 2. It would be appropriate to perform a nonstress test (NST). 3. It would be appropriate to perform an umbilical arterial Doppler assessment (UA). TEST-TAKING TIP: A fetus with IUGR is growing more slowly than expected. The restricted growth may be caused by poor placental blood fl ow. The UA is performed to assess the blood fl ow. The NST and BPP are performed to provide additional information regarding the health and well-being of the fetus.

A woman is to receive methotrexate IM for an ectopic pregnancy. The nurse should teach the woman about which of the following common side effects of the therapy? Select all that apply. 1. Nausea and vomiting. 2. Abdominal pain. 3. Fatigue. 4. Light-headedness. 5. Breast tenderness.

1. Nausea and vomiting are common side effects. 2. Abdominal pain is a common side effect. The pain associated with the medication needs to be carefully monitored to differentiate it from the pain caused by the ectopic pregnancy itself. 3. Fatigue is a common side effect. 4. Light-headedness is a common side effect. TEST-TAKING TIP: Because methotrexate is an antineoplastic agent, the nurse would expect to see the same types of complaints that he or she would see in a patient receiving chemotherapy for cancer. It is very important that the abdominal pain seen with the medication not be dismissed because a common complaint of women with ectopic pregnancies is pain. The source of the pain, therefore, must be clearly identified.

A client, 32 weeks' gestation with placenta previa, is on total bedrest. The physician expects her to be hospitalized on bedrest until her cesarean section, which is scheduled for 38 weeks' gestation. To prevent complications while in the hospital, the nurse should do which of the following? Select all that apply. 1. Perform passive range-of-motion exercises. 2. Restrict the fluid intake of the client. 3. Decorate the room with pictures of family. 4. Encourage the client to eat a high-fiber diet. 5. Teach the client deep-breathing exercises.

1. Passive range-of-motion will help to decrease the potential for muscle atrophy and thrombus formation. 3. This client is separated from family. The separation can lead to depression. Decorating the room and enabling family to visit freely is very important. 4. A high-fiber diet will help to maintain normal bowel function. 5. Deep breathing exercises are important to maintain the client's respiratory function. TEST-TAKING TIP: Although bedrest is often used as therapy for antenatal clients, it does not come without its complications—constipation, depression, respiratory compromise, and muscle atrophy, to name but a few. The nurse must provide preventive care to maintain the health and well-being of the client as much as possible.

A nurse who is caring for a pregnant type I diabetic should carefully monitor the client for which of the following? Select all that apply. 1. Urinary tract infection. 2. Multiple gestation. 3. Metabolic acidosis. 4. Pathological hypotension. 5. Hypolipidemia.

1. Pregnant diabetic clients are particularly at high risk for urinary tract infections. 3. Pregnant type I diabetic clients are at high risk for acidosis. TEST-TAKING TIP: It is very important for the test taker to read each response carefully. If the test taker were to read the responses to the preceding question very quickly, he or she might choose incorrect answers. For example, the test taker might pick pathological hypotension, assuming that it says "hypertension." Pregnant type I diabetics are at high risk for UTIs because they often excrete glucose in their urine. The glucose is an excellent medium for bacterial growth. They also should be assessed carefully for acidosis because an acidotic environment can be life threatening to a fetus.

A woman, G1 P0000, is 40 5/7 weeks' gestation. Her Bishop score is 4. Which of the following complementary therapies do midwives frequently recommend to clients in similar situations? Select all that apply. 1. Sexual intercourse. 2. Aromatherapy. 3. Breast stimulation. 4. Ingestion of castor oil. 5. Aerobic exercise.

1. Sexual intercourse has been recommended to women as a means of stimulating labor. 3. Midwives have recommended that women employ breast stimulation as a means of stimulating labor. 4. Midwives have recommended that women ingest castor oil as a means of increasing their Bishop score. TEST-TAKING TIP: There are many interventions that have been used to increase women's Bishop scores and/or to stimulate labor. Because oxytocin is produced during orgasm and when the breasts are stimulated, intercourse and breast stimulation both can be used as complementary methods of stimulating labor. Castor oil stimulates the bowels. Prostaglandins, which ripen the cervix, are produced as a result of gastrointestinal stimulation. In addition, when ingested, primrose oil converts to prostaglandin in the body. If there is any indication that the baby may be unable to withstand labor, however, these means should not be employed.

A client has just done a fetal kick count assessment. She noted 6 movements during the past hour. If taught correctly, what should her next action be? 1. Nothing, because further action is not warranted. 2. Call the doctor to set up a nonstress test. 3. Redo the test during the next half hour. 4. Drink a glass of orange juice and redo the test.

1. She should do nothing because the woman should feel 3 or more counts in 1 hour. TEST-TAKING TIP: Fetal kick counting is a valuable, noninvasive means of monitoring fetal well-being. Mothers are taught to consciously count the numbers of times they feel their baby kick during one or more 60-minute periods during the day. If the baby kicks 3 or more times, the woman can be reassured that the baby is healthy. If the baby kicks fewer times, the woman should notify her healthcare practitioner, who will likely perform either a nonstress test or, in some situations, a more sophisticated fetal assessment test.

The laboratory reported the L/S ratio results from an amniocentesis as 1:1. How should the nurse interpret the result? 1. The baby is premature. 2. The mother is at high risk for hemorrhage. 3. The infant has kernicterus. 4. The mother is at high risk for eclampsia.

1. The baby is preterm. TEST-TAKING TIP: The amount of lecithin must be 2 times the amount of sphingomyelin before the practitioner can be assured that the fetal lungs are mature. The ratio in the scenario—1:1—indicates that the surfactant is insufficient for extrauterine respirations.

A 12-week-gravid client presents in the emergency department with abdominal cramps and scant dark red bleeding. Which of the following signs/symptoms should the nurse assess this client for? Select all that apply. 1. Tachycardia. 2. Referred shoulder pain. 3. Headache. 4. Fetal heart dysrhythmias. 5. Hypertension.

1. The client should be assessed for tachycardia, which could indicate that the client is bleeding internally. 3. This client's signs and symptoms are consistent with both spontaneous abortion and hydatidiform mole. Although this client is only at 12 weeks' gestation, if she has a hydatidiform mole, she may be exhibiting signs of pre-eclampia, including headache and hypertension. 4. This client's signs and symptoms are consistent with both spontaneous abortion and hydatidiform mole. To determine whether or not the patient is carrying a viable fetus, the nurse should check the fetal heart rate. 5. This client's signs and symptoms are consistent with both spontaneous abortion and hydatidiform mole. Although this client is only 12 weeks' gestation, if she has a hydatidiform mole, she may be exhibiting signs of pre-eclampia, including headache and hypertension. TEST-TAKING TIP: It is essential that the test taker carefully read the weeks of gestation when answering pregnancy- related questions. If the client had been earlier in the first trimester of her pregnancy, the signs and symptoms would also have been consistent with an ectopic pregnancy. It would then have been appropriate to assess for referred shoulder pain as well.

A type 1 diabetic gravida has developed polyhydramnios. The client should be taught to report which of the following? 1. Uterine contractions. 2. Reduced urinary output. 3. Marked fatigue. 4. Puerperal rash.

1. The client should be taught to observe for signs of preterm labor. TEST-TAKING TIP: Clients with polyhydramnios (also called hydramnios) have excessive quantities of amniotic fluid in their uterine cavities. The excessive quantities likely result from increased fetal urine production, caused by the mother's having periods of hyperglycemia. When the uterus is overextended from the large quantities of fluid, these women are at high risk for preterm labor.

A 39-year-old, 16-week-gravid woman has had an amniocentesis. Before discharge, the nurse teaches the woman to call her doctor if she experiences which of the following side effects? Select all that apply. 1. Fever or chills. 2. Lack of fetal movement. 3. Abdominal pain. 4. Rash or pruritus. 5. Vaginal bleeding.

1. The client should call her practitioner if she experiences fever or chills. 2. Albeit rare, because the fetus can be injured during an amniocentesis, the client should report either a decrease or an increase in fetal movement. 3. The client should report abdominal pain or cramping. An amniocentesis can precipitate preterm labor. 5. The client should report any vaginal loss—blood or amniotic fluid. The placenta may become injured or the membranes may rupture during an amniocentesis. TEST-TAKING TIP: During an amniocentesis, the amniotic sac is entered with a large needle. As a result of the procedure, a number of complications can develop, including infection, preterm labor, rupture of the membranes, and/or fetal injury. Although the incidence of complications is small, it is very important for the nurse to advise the client of the signs of each of these problems.

A pregnant diabetic has been diagnosed with hydramnios. Which of the following would explain this finding? 1. Excessive fetal urination. 2. Recurring hypoglycemic episodes. 3. Fetal sacral agenesis. 4. Placental vascular damage.

1. The hydramnios is likely a result of excessive fetal urination. TEST-TAKING TIP: The majority of amniotic fluid is created as urine by the fetal kidneys. Fetuses of diabetic mothers often experience polyuria as a result of hyperglycemia. If the mother's diabetes is out of control, excess glucose diffuses across the placental membrane, resulting in the fetus becoming hyperglycemic. As a result, the fetus exhibits the classic sign of diabetes—polyuria. If the mother's serum glucose levels are very high during the first trimester, it is likely that the fetus will develop structural congenital defects. Sacral agenesis is one of the most severe of these defects.

A patient, 32 weeks pregnant with severe headache, is admitted to the hospital with pre-eclampsia. In addition to obtaining baseline vital signs and placing the client on bedrest, the physician ordered the following four items. Which of the orders should the nurse perform first? 1. Assess deep tendon reflexes. 2. Obtain complete blood count. 3. Assess baseline weight. 4. Obtain routine urinalysis.

1. The nurse should check the client's patellar reflexes. The most common way to assess the deep tendon reflexes is to assess the patellar reflexes. TEST-TAKING TIP: Pre-eclampsia is a very serious complication of pregnancy. The nurse must assess for changes in the blood count, for evidence of marked weight gain, and for changes in the urinalysis. By assessing the patellar reflexes first, however, the nurse can make a preliminary assessment of the severity of the pre-eclampsia. For example, if the reflexes are +2, the client would be much less likely to become eclamptic, that is, have a seizure, than a client who has +4 reflexes with clonus.

A gravid woman has been diagnosed with listeriosis. She eats rare meat and raw smoked seafood. Which of the following signs/symptoms would this woman exhibit? 1. Fever and muscle aches. 2. Rash and thrombocytopenia. 3. Petechiae and anemia. 4. Amnionitis and epistaxis.

1. The symptoms of listeriosis are similar to symptoms of the flu and include fever and muscle aches. TEST-TAKING TIP: Even though the adult disease is relatively mild, if listeriosis is contracted during pregnancy, it can lead to serious fetal and neonatal complications. It is important for the nurse to provide the client with needed dietary education to prevent antepartal disease.

Which of the following clients is at highest risk for developing a hypertensive illness of pregnancy? 1. G1 P0000, age 41 with history of diabetes mellitus. 2. G2 P0101, age 34 with history of rheumatic fever. 3. G3 P1102, age 27 with history of scoliosis. 4. G3 P1011, age 20 with history of celiac disease.

1. This primigravid client—age 41and with a history of diabetes—is at very high risk for pre-eclampsia. TEST-TAKING TIP: Pre-eclampsia is a vascular disease of pregnancy. Although any woman can develop the syndrome, women who are at highest risk for the disease are primigravidas, those with multiple gestations, women who are younger than 17 or older than 34, those who had pre-eclampsia with their first pregnancy, and women who have been diagnosed with a vascular disease such as diabetes mellitus or chronic hypertension.

A 30-week-gestation multigravida, G3 P1011, is admitted to the labor suite. She is contracting every 5 minutes × 40 seconds. Which of the comments by the client would be most informative regarding the etiology of the client's present condition? 1. "For the past day I have felt burning when I urinate." 2. "I have a daughter who is 2 years old." 3. "I jogged 11⁄2 miles this morning." 4. "My miscarriage happened a year ago today."

1. This is the most important statement made by the client. TEST-TAKING TIP: Preterm labor is strongly associated with the presence of a urinary tract infection. Whenever an infection is present in the body, the body produces prostaglandins. Prostaglandins ripen the cervix and the number of oxytocin receptor sites on the uterine body increase. Preterm labor can then develop.

Which of the following long-term goals is appropriate for a client, 10 weeks' gestation, who is diagnosed with gestational trophoblastic disease (hydatidiform mole)? 1. Client will be cancer-free 1 year from diagnosis. 2. Client will deliver her baby at full term without complications. 3. Client will be pain-free 3 months after diagnosis. 4. Client will have normal hemoglobin and hematocrit at delivery.

1. This long-term goal is appropriate. TEST-TAKING TIP: When nurses plan care, they have in mind short-term and long- term goals that their clients will achieve. Short-term goals usually have a time frame of a week or two and often are specific to the client's current hospitalization. Long-term goals are expectations of client achievement over extended periods of time. It is important for nurses to develop goals to implement appropriate nursing interventions.

A type 1 diabetic is being seen for preconception counseling. The nurse should emphasize that during the first trimester the woman may experience which of the following? 1. Need for less insulin than she normally injects. 2. An increased risk for hyperglycemic episodes. 3. Signs and symptoms of hydramnios. 4. A need to be hospitalized for fetal testing.

1. Type 1 diabetics often need less insulin during the first trimester than they did preconception. TEST-TAKING TIP: Nausea and vomiting are common complaints of gravid clients during the first trimester. As a result, women, including diabetic women, consume fewer calories than they did before becoming pregnant. Their need for insulin drops commensurately. Therefore, it is very important that the women monitor their blood glucose regularly upon awakening and throughout the day.

The nurse is evaluating the effectiveness of bedrest for a client with mild pre-eclampsia. Which of the following signs/symptoms would the nurse determine is a positive finding? 1. Weight loss. 2. 2+ proteinuria. 3. Decrease in plasma protein. 4. 3+ patellar refl exes.

1. Weight loss is a positive sign. TEST-TAKING TIP: The key to answering this question is the test taker's ability to interpret the meaning of mild pre- eclampsia and to realize that this is an evaluation question. There are two levels of pre-eclampsia. Mild pre-eclampsia is characterized by the following signs/ symptoms: blood pressure 140/90, urine protein +2, patellar reflexes +3, and weight gain. As can be seen, the values included in answers 2 and 4 are the same as those in the diagnosis. They, therefore, are not signs that the pre-eclampsia is resolving. Similarly, loss of protein is not a sign of resolution of the disease.

A nurse is interviewing a prenatal client. Which of the following factors in the client's history should the nurse highlight for the healthcare practitioner? 1. That she is eighteen years old. 2. That she owns a cat and a dog. 3. That she eats peanut butter daily. 4. That she works as a surgeon.

2. Cat feces are a potential source of toxoplasmosis. TEST-TAKING TIP: The nurse must be familiar with any possible circumstances that place antepartal clients and their fetuses at high risk. Toxoplasmosis is an illness caused by a protozoan. The organism can be contracted in a number of ways, including eating rare or raw meat, drinking unpasteurized goat milk, and coming in contact with cat feces. When contracted by the mother during pregnancy, it can cause serious fetal and neonatal disease.

A 15-year-old client is being seen for her first prenatal visit. Because of this client's special nutritional needs, the nurse evaluates the client's intake of: 1. Protein and magnesium. 2. Calcium and iron. 3. Carbohydrates and zinc. 4. Pyroxidine and thiamine.

2. Pregnant adolescents' diets are often deficient in calcium and iron. TEST-TAKING TIP: Adolescents are in need of higher levels of both calcium and iron during their pregnancies than are adult women. These nutrients are needed because many of the teens who become pregnant have not completed their own growth. Calcium is, of course, needed for the teen's own bone growth as well as for the bone growth of the fetus. Similarly, iron is needed for the teen's hematological function as well as the baby's blood supply.

At 28 weeks' gestation, an Rh-negative woman receives RhoGAM. Which of the following would indicate that the medication is effective? 1. The baby's Rh status changes to Rh-negative. 2. The mother produces no Rh antibodies. 3. The baby produces no Rh antibodies. 4. The mother's Rh status changes to Rh-positive.

2. That the mother produces no Rh antibodies is the goal of RhoGAM administration. TEST-TAKING TIP: The test taker should review the immune response to an antigen. In this situation, the antigen is the baby's Rh+ blood. It can leak into the maternal bloodstream from the fetal bloodstream at various times during the pregnancy. Most commonly it happens at the time of placental delivery. Because the mother is antigen negative—that is, Rh-, when exposed to Rh+ blood, her immune system develops antibodies. RhoGAM is composed of Rh+ antibodies. It acts as passive immunity. Because antibodies are already present in the mother's bloodstream, her immune system is suppressed and fails to develop antibodies via the active immune response.

A lecithin/sphingomyelin (L/S) ratio has been ordered by a pregnant woman's obstetrician. Which of the following data will the nurse learn from this test? 1. Coagulability of maternal blood. 2. Maturation of the fetal lungs. 3. Potential for fetal development of erythroblastosis fetalis. 4. Potential for maternal development of gestational diabetes.

2. The L/S ratio indicates the maturity of the fetal lungs. TEST-TAKING TIP: Lecithin and sphingomyelin are two components of surfactant, the slippery substance that lines the alveoli. The fetal lungs have usually reached maturation when the ratio of the substances is 2:1 or higher. To perform the test, the obstetrician must obtain amniotic fluid during an amniocentesis. A quick test, called a shake or foam test, can also be performed on the amniotic fluid to assess fetal lung maturation.

A gestational diabetic who requires insulin therapy to control her blood glucose levels telephones the triage nurse complaining of dizziness and headache. Which of the following actions should the nurse take at this time? 1. Have the client proceed to the office to see her physician. 2. Advise the client to drink a glass of juice and then call back. 3. Instruct the client to inject herself with regular insulin. 4. Tell the client immediately to telephone her medical doctor.

2. The client should drink a 4-ounce glass of juice. TEST-TAKING TIP: Because the signs and symptoms of hyperglycemia and hypoglycemia are very similar, it is important for the nurse to err on the side of caution. If the client should be hypoglycemic, this is a medical emergency. Drinking a glass of orange juice, or other simple carbohydrate, will stabilize the glucose in the woman's body. If she is hyperglycemic, the glucose source may increase the glucose levels but not significantly. A blood glucose assessment can be done and insulin can be administered, if needed, shortly after consuming the glucose.

A client, G2 P1001, telephones the gynecology office complaining of left-sided pain. Which of the following questions by the triage nurse would help to determine whether the one-sided pain is due to an ectopic pregnancy? 1. "When did you have your pregnancy test done?" 2. "When was the first day of your last menstrual period?" 3. "Did you have any complications with your first pregnancy?" 4. "How old were you when you first got your period?"

2. The date of the last menstrual period will assist the nurse in determining how many weeks pregnant the client is. TEST-TAKING TIP: The date of the last menstrual period is important for the nurse to know. Ectopic pregnancies are usually diagnosed between the 8th and the 9th week of gestation because, at that gestational age, the conceptus has reached a size that is too large for the fallopian tube to hold.

In analyzing the need for health teaching in a client, G5 P4004 with gestational diabetes, the nurse should ask which of the following questions? 1. "How old were you at your first pregnancy?" 2. "Do you exercise regularly?" 3. "Is your partner diabetic?" 4. "Do you work outside of the home?"

2. The likelihood of developing either gestational or type 2 diabetes is reduced when clients exercise regularly. TEST-TAKING TIP: There are a number of issues that the nurse should discuss with a client who has been diagnosed with gestational diabetes. The need for exercise is one of those topics. Other topics are diet, blood glucose testing, treatment for hypoglycemic episodes, and the like.

A 24-week-gravid client is being seen in the prenatal clinic. She states, "I have had a terrible headache for the past 2 days." Which of the following is the most appropriate action for the nurse to perform next? 1. Inquire whether or not the client has allergies. 2. Take the woman's blood pressure. 3. Assess the woman's fundal height. 4. Ask the woman about stressors at work.

2. The nurse should assess the client's blood pressure. TEST-TAKING TIP: Headache is a symptom of pre-eclampsia. Pre-eclampsia, a serious complication, is a hypertensive disease of pregnancy. To determine whether or not the client is pre-eclamptic, the next action by the nurse would be to assess the woman's blood pressure.

A client's 32-week clinic assessment was: BP 90/60; TPR 98.6°F, P 92, R 20; weight 145 lb; and urine negative for protein. Which of the following findings at the 34-week appointment should the nurse highlight for the certified nurse midwife? 1. BP 110/70; TPR 99.2°F, 88, 20. 2. Weight 155 lb; urine protein +2. 3. Urine protein trace; BP 88/56. 4. Weight 147 lb; TPR 99°F, 76, 18.

2. There has been a 10-lb weight gain in 2 weeks and a significant amount of protein is being spilled in the urine. This client should be brought to the attention of the primary caregiver. TEST-TAKING TIP: There is a great deal of information included in this question. The test taker must methodically assess each of the pieces of data. Important things to attend to are the timing of the appointments—2 weeks apart; changes in vital signs—it is normal for pulse and respiratory rates to increase slightly and BP to drop slightly; changes in urinary protein—trace is normal, +2 is not normal; and changes in weight—2-lb increase over 2 weeks is normal, a 10-lb increase is not normal.

A client being seen in the ED has an admitting medical diagnosis of: third- trimester bleeding/rule out placenta previa. Each time a nurse passes by the client's room, the woman asks, "Please tell me, do you think the baby will be all right?" Which of the following is an appropriate nursing diagnosis for this client? 1. Hopelessness related to possible fetal loss. 2. Anxiety related to inconclusive diagnosis. 3. Situational low self-esteem related to blood loss. 4. Potential for altered parenting related to inexperience.

2. This client is very anxious. TEST-TAKING TIP: Situational crises arise when problems occur unexpectedly. And crises are often intensified when information is lacking. In this situation, the exact diagnosis is unknown. The client is exhibiting her fright and concern by repeatedly asking the nurse his or her opinion of the baby's health.

Which of the following would be the best approach to take with an unmarried 14-year-old girl who tells the nurse that she is undecided whether or not to maintain an unplanned pregnancy? 1. "You should consider an abortion since you are so young." 2. "It is a difficult decision. What have you thought about so far?" 3. "Studies show that babies living with teen mothers often become teen parents." 4. "Why don't you keep the pregnancy? You could always opt for adoption later."

2. This is an excellent response. The question opens the door for the teenager to discuss her feelings and thoughts. TEST-TAKING TIP: It is very important that nurses working in the obstetric area come to terms with their role and with their own beliefs and biases. One's personal belief system should not influence the nurse's teaching and counseling roles. The nurse must be truthful and unbiased when counseling any prenatal client, including the pregnant teen.

A client is being taught fetal kick counting. Which of the following should be included in the patient teaching? 1. The woman should choose a time when her baby is least active. 2. The woman should lie on her side with her head elevated about 30 degrees. 3. The woman should report fetal kick counts of greater than 10 in an hour. 4. The woman should refrain from eating immediately before counting.

2. This is the best position for perfusing the placenta. TEST-TAKING TIP: Because the goal of fetal kick counting is to monitor fetal well- being, it is best to do the test when the baby is most active and is most likely to be well nourished and well oxygenated. Many women find that the best time for the assessment is immediately after a meal.

The nurse is grading a woman's reflexes. Which of the following grades would indicate reflexes that are slightly brisker than normal? 1. +1. 2. +2. 3. +3. 4. +4.

3. +3 reflexes are defined as slightly brisker than normal or slightly hyperreflexic. TEST-TAKING TIP: Although, as seen previously, a clear categorization of reflex assessment exists, the value assigned to a reflex by a clinician does have a subjective component. Therefore, it is recommended that at the change of shift both the new and departing nurses together assess the reflexes of a client who has suspected abnormal reflexes. A common understanding of the reflex assessment can then be determined.

A woman is to receive RhoGAM at 28 weeks' gestation. Which of the following actions must the nurse perform before giving the injection? 1. Validate that the baby is Rh-negative. 2. Assess that the direct Coombs test is positive. 3. Verify the identity of the woman. 4. Reconstitute the globulin with sterile water.

3. Although this is an important action that must be taken before the administration of any medication, it is especially critical in this situation. TEST-TAKING TIP: When RhoGAM is given, the nurse is administering Rh antibodies to Rh − mothers. If the nurse should make a mistake and administer the dosage to an Rh+ mother, the client would then have been injected with antibodies that would act to destroy her own blood.

A client with mild pre-eclampsia who has been advised to be on bedrest at home asks why doing so is necessary. Which of the following is the best response for the nurse to give the client? 1. "Bedrest will help you to conserve energy for your labor." 2. "Bedrest will help to relieve your nausea and anorexia." 3. "Reclining will increase the amount of oxygen that your baby gets." 4. "The position change will prevent the placenta from separating."

3. Bedrest, especially side-lying, helps to improve perfusion to the placenta. TEST-TAKING TIP: This question requires the nurse to have a clear understanding of the pathology of pre-eclampsia. Only with an understanding of the underlying disease can the test taker be able to remember the rationale for many aspects of client care. The vital organs of pre- eclamptic clients are being poorly perfused as a result of the abnormally high blood pressure. When a woman lies on her side, blood return to the heart is improved and the cardiac output is also improved. With improved cardiac output, perfusion to the placenta and other organs is improved.

The nurse has assessed four primigravid clients in the prenatal clinic. Which of the women would the nurse refer to the nurse midwife for further assessment? 1. 10 weeks' gestation, complains of fatigue with nausea and vomiting. 2. 26 weeks' gestation, complains of ankle edema and chloasma. 3. 32 weeks' gestation, complains of epigastric pain and facial edema. 4. 38 weeks' gestation, complains of bleeding gums and urinary frequency.

3. Epigastric pain and facial edema are not normal. This client should be referred to the nurse midwife. TEST-TAKING TIP: This question requires the test taker to differentiate between normal signs and symptoms of pregnancy at a variety of gestational ages and those that could indicate a serious complication of pregnancy.

A woman is recovering at the gynecologist's office following a late first-trimester spontaneous abortion. At this time, it is essential for the nurse to check which of the following? 1. Maternal varicella titer. 2. Past obstetric history. 3. Maternal blood type. 4. Cervical patency.

3. It is essential that the woman's blood type be assessed. TEST-TAKING TIP: If the woman is found to be Rh-, even though the fetal blood type is unknown, the woman must receive a dose of RhoGAM within 72 hours of the abortion. If the fetus were Rh+ and the woman were not to receive RhoGAM, the woman's immune system might be stimulated to produce antibodies against Rh+ blood. Any future Rh+ fetus would be in danger of developing erythroblastosis fetalis. It is also important for the nurse to check the woman's rubella titer. If the woman is nonimmune to rubella, she should receive the MMR vaccine prior to discharge.

A nurse is counseling a pre-eclamptic client about her diet. Which should the nurse encourage the woman to do? 1. Restrict sodium intake. 2. Increase intake of fluids. 3. Eat a well-balanced diet. 4. Avoid simple sugars.

3. It is important for the client to eat a well-balanced diet. TEST-TAKING TIP: Clients with pre- eclampsia are losing albumin through their urine. They should eat a well-balanced diet with sufficient protein to replace the lost protein. Even though pre-eclamptic clients are hypertensive, it is not recommended that they restrict salt—they should have a normal salt intake—because during pregnancy the kidney is salt sparing. When salt is restricted, the kidneys become stressed.

A 14-year-old woman is seeking obstetric care. Which of the following is an appropriate nursing care goal for this young woman? The young woman will: 1. Bring her partner to all prenatal visits. 2. Terminate the pregnancy. 3. Continue her education. 4. Undergo prenatal single gene analysis.

3. It is important for the young woman to work toward completing the tasks of adolescence at the same time that she is engaged in maintaining a healthy pregnancy. She should continue her education. TEST-TAKING TIP: Working with adolescents can be exciting as well as challenging. The nurse is likely to be the young woman's most important support system during the early weeks of the pregnancy. Slowly, with the nurse's help, it is hoped that the young woman will make healthy choices, including eating well, refraining from drinking alcohol and using drugs, and staying in school.

A nurse is performing an assessment on four 22-week-pregnant clients. The nurse reports to the obstetrician that which of the clients may be carrying twins? 1. The client whose progesterone levels are elevated. 2. The client with a weight gain of 13 pounds. 3. The client whose fundal height measurement is 26 cm. 4. The client whose alpha-fetoprotein level is one-half normal.

3. It is possible that this client is carrying twins. TEST-TAKING TIP: After 20 weeks' gestation, the nurse would expect the fundal height to be equal to the number of weeks of the woman's gestation. Because the fundal height is 4 cm above the expected 22 cm, it is likely that the woman is either having twins or has polyhydramnios.

A woman has been diagnosed with a ruptured ectopic pregnancy. Which of the following signs/symptoms is characteristic of this diagnosis? 1. Dark brown rectal bleeding. 2. Severe nausea and vomiting. 3. Sharp unilateral pain. 4. Marked hyperthermia.

3. Sharp unilateral pain is a common symptom of a ruptured ectopic. TEST-TAKING TIP: The most common location for an ectopic pregnancy to implant is in a fallopian tube. Because the tubes are nonelastic, when the pregnancy becomes too big, the tube ruptures. Unilateral pain can develop because only one tube is being affected by the condition, but some women complain of generalized abdominal pain.

A gravid client, G6 P5005, 24 weeks' gestation, has been admitted to the hospital for placenta previa. Which of the following is an appropriate long-term goal for this client? 1. The client will state an understanding of need for complete bedrest. 2. The client will have a reactive nonstress test on day 2 of hospitalization. 3. The client will be symptom-free until at least 37 weeks' gestation. 4. The client will have normal vital signs on admission.

3. That the client be symptom-free until at least 37 weeks' gestation is a long-term goal. TEST-TAKING TIP: Each and every one of the goals is appropriate for a client with placenta previa. Only the statement that projects the client's response into the future is, however, a long-term goal.

Which of the following findings should the nurse expect when assessing a client, 8 weeks' gestation, with gestational trophoblastic disease (hydatidiform mole)? 1. Protracted pain. 2. Variable fetal heart decelerations. 3. Dark brown vaginal bleeding. 4. Suicidal ideations.

3. The condition is usually diagnosed after a client complains of brown vaginal discharge early in the "pregnancy." TEST-TAKING TIP: The most important thing to remember when answering questions about hydatidiform mole is the fact that, even though a positive pregnancy test has been reported, there is no "pregnancy." The normal conceptus develops into two portions—a blastocyst, which includes the fetus and amnion, and a trophoblast, which includes the fetal portion of the placenta and the chorion. In gestational trophoblastic disease (hydatidiform mole), only the trophoblastic layer develops; no fetus develops. With the proliferation of the chorionic layer, the client is at high risk for gynecological cancer.

A gravid woman who is 42 weeks' gestation has just had a 20-minute nonstress test (NST). Which of the following results would the nurse interpret as a reactive test? 1. Moderate fetal heart baseline variability. 2. Maternal heart rate accelerations to 140 bpm lasting at least 20 seconds. 3. Two fetal heart accelerations of 15 bpm lasting at least 15 seconds. 4. Absence of maternal premature ventricular contractions.

3. This is the defi nition of a reactive nonstress test—there are two fetal heart accelerations of 15 bpm lasting 15 or more seconds during a 20-minute period. TEST-TAKING TIP: When a practitioner notes a reactive nonstress test, he or she can be fairly confi dent that the fetus is well and will probably remain well for at least 3 to 4 days. NSTs, therefore, are usually performed twice weekly. A nonreactive nonstress test, when the fetal heart fails to show 2 accelerations of 15 bpm lasting 15 or more seconds during a 20-minute period, is very hard to interpret. Usually practitioners order more extensive testing to determine the well-being of the baby after a nonreactive NST.

A client is admitted to the hospital with severe pre-eclampsia. The nurse is assessing for clonus. Which of the following actions should the nurse perform? 1. Strike the woman's patellar tendon. 2. Palpate the woman's ankle. 3. Dorsiflex the woman's foot. 4. Position the woman's feet fl at on the floor.

3. To assess clonus, the nurse should dorsiflex the woman's foot. TEST-TAKING TIP: When clients have severe pre-eclampsia, they are often hyperrefl exic and develop clonus. To assess for clonus, the nurse should dorsifl ex the foot and then let the foot go. The nurse should observe for and count any pulsations of the foot. The number of pulsations is documented. The higher the number of pulsations there are, the more irritable the woman's central nervous system is.

A patient who is 24 weeks pregnant has been diagnosed with syphilis. She asks the nurse how the infection will affect the baby. The nurse's response should be based on which of the following? 1. She is at high risk for premature rupture of the membranes. 2. The baby will be born with congenital syphilis. 3. Penicillin therapy will reduce the risk to the fetus. 4. The fetus will likely be born with a cardiac defect.

3. Usually a single shot of penicillin administered to the mother will cure her and protect the baby. TEST-TAKING TIP: Clients are assessed for sexually transmitted infections during the pregnancy—usually at the first prenatal visit and shortly before the expected date of delivery. It is important to test all women, even those who have an apparently low probability of diseases including married women and women from the upper socioeconomic strata. Infections, including those that are sexually transmitted, can be contracted by anyone.

A gravid woman with sickle cell anemia is admitted in vaso-occlusive crisis. Which of the following is the priority intervention that the nurse must perform? 1. Administer narcotic analgesics. 2. Apply heat to swollen joints. 3. Place on strict bedrest. 4. Infuse intravenous solution.

4. Administering intravenous fluids is the priority action. TEST-TAKING TIP: Although this question is not directly related to pregnancy, the nurse must be able to translate information from another medical discipline into the obstetric area. The priority action is to improve perfusion to the client's organs. By providing intravenous fluids, the blood can fl ow through the vessels and perfuse the organs, including the placenta. When the client is dehydrated, the sickled red blood cells clump together, inhibiting perfusion.

A 25-year-old client is admitted with the following history: 12 weeks pregnant, vaginal bleeding, no fetal heartbeat seen on ultrasound. The nurse would expect the doctor to write an order to prepare the client for which of the following? 1. Cervical cerclage. 2. Amniocentesis. 3. Nonstress testing. 4. Dilation and curettage.

4. Dilation and curettage (D&C) is performed on a client with an incomplete abortion. TEST-TAKING TIP: This client is experiencing an incomplete abortion. The baby has died—there is no fetal heartbeat—and she has expelled some of the products of conception, as evidenced by frank vaginal bleeding. It is important for the remaining products of conception to be removed to prevent hemorrhage and infection. A D&C in which the physician dilates the cervix and scrapes the lining of the uterus with a curette is one means of completing the abortion. Another method of completing the abortion is by administering an abortifacient medication.

An insulin-dependent diabetic woman will require higher doses of insulin as which of the following pregnancy hormones increases in her body? 1. Estrogen. 2. Progesterone. 3. Human chorionic gonadotropin. 4. Human placental lactogen.

4. Human placental lactogen is an insulin antagonist, so the client will require higher doses of insulin as the level of placental lactogen increases. TEST-TAKING TIP: During the first trimester, the insulin needs of a woman with type 1 diabetes are usually low. Once the diabetic client enters the second trimester, however, insulin demands increase. One of the most important reasons that insulin demands increase is the increasingly higher levels of human placental lactogen produced by the placenta that are found in the mother's bloodstream. 66. 1. It is unlikely that

A woman, 8 weeks pregnant, is admitted to the obstetric unit with a diagnosis of threatened abortion. Which of the following tests would help to determine whether the woman is carrying a viable or a nonviable pregnancy? 1. Luteinizing hormone level. 2. Endometrial biopsy. 3. Hysterosalpingogram. 4. Serum progesterone level.

4. Serum progesterone will provide information on the viability of a pregnancy. TEST-TAKING TIP: When a previously gravid client is seen by her healthcare practitioner with a complaint of vaginal bleeding, it is very important to determine the viability of the pregnancy as soon as possible. Situational crises are often exacerbated when clients face the unknown. One relatively easy way to determine the viability of the conceptus is by performing a serum progesterone test; high levels indicate a viable baby, whereas low levels indicate a pregnancy loss. Ultrasonography to assess for a beating heart and serum human chorionic gonadotropin levels may also be performed.

A pregnant Latina is being seen in the prenatal clinic with diarrhea, fever, stiff neck, and headache. Upon inquiry, the nurse learns that the woman drinks unpasteurized milk and eats soft cheese daily. For which of the following bacterial infections should this woman be assessed? 1. Staphylococcus aureus. 2. Streptococcus albicans. 3. Pseudomonas aeruginosa. 4. Listeria monocytogenes.

4. The client is likely suffering from listeriosis, an infection caused by Listeria monocytogenes bacteria. TEST-TAKING TIP: Latin women are especially at high risk for listeriosis because of their dietary patterns. They often eat soft cheeses and are unlikely to fear drinking unpasteurized milk. It is important that the nurse communicate to all pregnant women the need to refrain from consuming those substances with a clear rationale for the warning.

Which of the following nursing diagnoses would be most appropriate for a 15-year-old woman who is in her first trimester of pregnancy? 1. Sleep pattern disturbance related to discomforts of pregnancy. 2. Knowledge deficit related to care of infants. 3. Anxiety related to fear of labor and delivery. 4. Ineffective individual coping related to developmental level.

4. The developmental tasks of adolescence are often in conflict with the tasks of pregnancy. This nursing diagnosis is the most appropriate. TEST-TAKING TIP: The major developmental tasks of adolescence— completing her education, developing abstract thinking, and developing skills that foster independence—can be in conflict with those of pregnancy. Adolescents often test rules, use drugs, and drink alcohol, all of which are detrimental to the developing fetus. At the very least, teens socialize with friends, often eating at fast-food restaurants where a well-balanced high-calcium, high-iron diet is hard to obtain.

A client has severe pre-eclampsia. The nurse would expect the primary healthcare practitioner to order tests to assess the fetus for which of the following? 1. Severe anemia. 2. Hypoprothrombinemia. 3. Craniosynostosis. 4. Intrauterine growth restriction.

4. The fetus should be assessed for intrauterine growth restriction. TEST-TAKING TIP: Perfusion to the placenta drops when clients are pre-eclamptic because the client's hypertension impairs adequate blood fl ow. When the placenta is poorly perfused, the baby is poorly nourished. Without the nourishment provided by the mother through the umbilical vein, the fetus's growth is affected.

A nurse is caring for a 25-year-old client who has just had a spontaneous first trimester abortion. Which of the following comments by the nurse is appropriate? 1. "You can try again very soon." 2. "It is probably better this way." 3. "At least you weren't very far along." 4. "I'm here to talk if you would like."

4. This statement is appropriate. The nurse is offering his or her assistance to the client. TEST-TAKING TIP: Clients during the first trimester are often ambivalent about pregnancy. Those who abort at this time express a variety of feelings from intense sorrow to joy. The nurse should offer assistance to the client without making any assumptions about the client's feelings toward the pregnancy loss. Speaking platitudes is completely inappropriate.

The nurse is educating a client who has been diagnosed with gestational diabetes how to perform home blood glucose testing. Which of the following information should be included in the teaching session? 1. When pricking the fingertip, always prick the center of the fingertip. 2. One-hour postprandial glucose values should be 146 mg/dL or lower. 3. Blood glucose testing should be performed 2 times per day—before breakfast and before bedtime. 4. All blood glucose results should be kept in a log for evaluation by the nurse and primary healthcare provider.

4. This statement is correct. All blood glucose results should be kept in a log for evaluation by the nurse and primary healthcare provider. If the results are above cut values, the primary healthcare provider may order dietary changes or the addition of hypoglycemic medications to the client's therapeutic regimen. TEST-TAKING TIP: The American Diabetic Association has developed recommended cut values for blood glucose levels for gestational diabetic clients. The values are: fasting—at or below 95 mg/dL, one hour postprandial—140 mg/dL, and two hours postprandial—120 mg/dL

The results of a 25-week-gestation client's 75-gram oral glucose tolerance test (OGTT) are: fasting—100 mg/dL, 1 hour—200 mg/dL, and 2 hour—160 mg/dL. Which of the following actions by the nurse is appropriate at this time? 1. Inform the client and the primary healthcare provider regarding the normal glucose results. 2. Request the primary healthcare provider to order a 3-hour 100-gram oral glucose test for the client. 3. Request the primary healthcare provider to order an oral hypoglycemic agent for the client. 4. Request the primary healthcare provider to order a referral to a registered dietitian for the client.

4. This statement is correct. The client should be referred to a registered dietitian for diet counseling. TEST-TAKING TIP: The American Diabetes Association recommends that all pregnant women not previously diagnosed with diabetes undergo a 75-gram OGTT between 24 and 28 weeks' gestation. Those whose values exceed the following cut values: 92 mg/dL at fasting, 180 mg/ dL one hour after drinking the glucose, and/or 153 mg/dL two hours after drinking the glucose are diagnosed with gestational diabetes

An obese client is being seen by the nurse during her prenatal visit. Which of the following comments by the nurse is appropriate at this time? 1. "We will want you to gain the same amount of weight we would encourage any pregnant woman to gain." 2. "To have a healthy baby we suggest that you go on a weight-reduction diet right away." 3. "To prevent birth defects we suggest that you gain weight during the first trimester and then maintain your weight for the rest of the pregnancy." 4. "We suggest that you gain weight throughout your pregnancy but not quite as much as other women."

4. This statement is true. Normal weight clients are encouraged to gain between 25 and 35 pounds during their pregnancies, while obese clients are encouraged to gain only 11 and 20 pounds. TEST-TAKING TIP: It is not appropriate for an obese client, defined as a client whose BMI is 30 kg/m 2 or more, to lose weight or to refrain from gaining weight during her pregnancy. When clients lose weight, they begin to break down fats and ketones develop. An acidic environment is unsafe for the unborn baby. Overweight women, or those whose BMI is between 25 and 29.9 kg/m 2 are also recommended to gain fewer pounds than the normal weight client, that is, between 15 and 25 pounds during their pregnancies

A gravid woman is carrying monochorionic twins. For which of the following complications should this pregnancy be monitored? 1. Oligohydramnios. 2. Placenta previa. 3. Cephalopelvic disproportion. 4. Twin-to-twin transfusion.

4. Twin-to-twin transfusion is a relatively common complication of monozygotic twin pregnancies. TEST-TAKING TIP: The key to answering this question is the fact that the twins originate from the same egg—that is, they are monozygotic twins. They share a placenta and a chorion. Because their blood supply is originating from the same source, the twins' circulations are connected. As a result, one twin may become the donor twin while the second twin may become the recipient. The donor grows poorly and develops severe anemia. The recipient becomes polycythemic and large.