HESI EAQ QUIZ High Risk Pregnancy
When does a nurse caring for a client with eclampsia determine that the risk for another seizure has decreased?
48 hours postpartum The danger of a seizure in a woman with eclampsia subsides when postpartum diuresis has occurred, usually 48 hours after birth; however, the risk for seizures may remain for as long as 2 weeks after delivery. After birth occurs, after labor starts, and 24 hours after delivery are all too soon.
A client with a history of phenylketonuria (PKU) who was maintained on a low-phenylalanine diet until 9 years of age is pregnant. What is most important for the nurse to discuss with this client?
Reinstitution of the low-phenylalanine diet will protect her baby from the disorder The fetus is at risk from a build-up of metabolites in the PKU-affected mother if the prescribed diet is not followed. The infant will not be affected if a low-phenylalanine diet is maintained by the mother during pregnancy; also, the infant may inherit PKU by way of an autosomal recessive gene. The client should restart a phenylalanine-restricted diet when planning to become pregnant and continue it throughout pregnancy.
The nurse instructs a pregnant woman in labor that she must avoid lying on her back. The nurse bases this instruction on the information that the supine position is primarily avoided because it can do what?
cause decreased placental perfusion In the supine position the gravid uterus impedes venous return; this causes decreased cardiac output and results in reduced placental circulation. Although a prolonged course of labor may result if the client lies supine, this is not the most significant reason for avoiding the supine position during labor. The supine position may result in hypotension, not hypertension. Interference with free movement of the coccyx is not the most significant reason for avoiding the supine position while in labor, although it may be partially true.
A nurse is assessing the effectiveness of a teaching plan regarding self-care and conservative management of gestational hypertension. The nurse confirms that the teaching has been understood when the client notes the importance of what?
ensuring adequate sodium intake Sodium is not restricted, because restriction decreases blood volume, which in turn reduces placental perfusion. Women at risk for preeclampsia are advised to eat a high-protein diet. Losing weight is contraindicated during pregnancy and does not reduce the risk of preeclampsia. Diuretic therapy is contraindicated because it decreases blood volume, which in turn reduces placental perfusion. Test-Taking Tip: Monitor questions that you answer with an educated guess or changed your answer from the first option you selected. This will help you to analyze your ability to think critically. Usually your first answer is correct and should not be changed without reason.
The nurse is caring for a client who has had a spontaneous abortion. Which complication should the nurse assess this client for?
hemorrhage Hemorrhage may result if placental tissue is retained or uterine atony occurs. There is no indication that the client has been deprived of fluids. Hypotension, not hypertension, may occur with postabortion hemorrhage. Subinvolution is more likely to occur after a full-term birth. STUDY TIP: Enhance your time-management abilities by designing a study program that best suits your needs and current daily routines by considering issues such as the following: (1) Amount of time needed; (2) Amount of time available; (3) "Best" time to study; (4) Time for emergencies and relaxation.
At 32 weeks' gestation a client undergoes an ultrasound examination, which reveals a low-lying placenta. What complication should the nurse anticipate as the client's pregnancy approaches term?
painless vaginal bleeding Because the process of effacement occurs in the latter part of pregnancy, placental separation from the uterus may occur, causing painless bleeding. There is pain with premature separation of a normally implanted placenta (abruptio placentae). Lower back pain is not associated with placenta previa. Rupture of membranes usually does not occur before the placenta starts to separate. STUDY TIP: Do not change your pattern of study. It obviously has contributed to your being here, so it worked. If you have studied alone, continue to study alone. If you have studied in a group, form a study group.
While mopping the kitchen floor, a client at 37 weeks' gestation experiences a sudden sharp pain in her abdomen with a period of fetal hyperactivity. When the client arrives at the prenatal clinic, the nurse examines her and detects fundal tenderness and a small amount of dark-red bleeding. What does the nurse conclude is the probable cause of these clinical manifestations?
partial abrupt placentae Typical manifestations of abruptio placentae are sudden sharp localized pain and small amounts of dark-red bleeding caused by some degree of placental separation. True labor begins with regular contractions, not sharp localized pain. There is no pain with placenta previa, just the presence of bright-red bleeding. There are no data to indicate that the client sustained an injury. STUDY TIP: Enhance your organizational skills by developing a checklist and creating ways to improve your ability to retain information, such as using index cards with essential data, which are easy to carry and review whenever you have a spare moment.
The nurse is assessing a client with worsening preeclampsia. What is the most significant clinical manifestation of severe preeclampsia?
proteinuria of 3+ As preeclampsia worsens, blood pressure and edema increase and degenerative changes of the kidney cause increasing proteinuria (3+). With worsening preeclampsia, oliguria, not polyuria, is expected. Vaginal spotting is not a sign of worsening preeclampsia. A blood pressure of 130/80 mm Hg is within acceptable limits; however, there is insufficient information to determine whether it is increased in this client. STUDY TIP: Remember that intelligence plays a vital role in your ability to learn. However, being smart involves more than just intelligence. Being practical and applying common sense are also part of the learning experience.
A client with a history of a congenital heart defect is admitted to the birthing unit in early labor. Which position does the nurse encourage the client to assume?
semi fowler position The head of the bed should be elevated 45 degrees; this permits maximal chest expansion for ventilation. The laboring woman should not assume the supine position, because this would increase the risk of hypotension as a result of decreased venous return. The Trendelenburg position interferes with optimal cardiac function during labor and is contraindicated. Test-Taking Tip: Study wisely, not hard. Use study strategies to save time and be able to get a good night's sleep the night before your exam. Cramming is not smart, and it is hard work that increases stress while reducing learning. When you cram, your mind is more likely to go blank during a test. When you cram, the information is in your short-term memory so you will need to relearn it before a comprehensive exam. Relearning takes more time. The stress caused by cramming may interfere with your sleep. Your brain needs sleep to function at its best.
A client with poorly controlled type 1 diabetes is now in her thirty-fourth week of pregnancy. The primary healthcare provider tells her that she should have an amniocentesis at 37 weeks to assess fetal lung maturity and that induction of labor will be initiated if the fetus's lungs are mature. The client asks the nurse why an early birth may be necessary. How should the nurse reply?
your glucose level will be hard to control as you reach term Explaining that risk to the fetus increases as the pregnancy reaches term secondary to the mother's poorly controlled diabetes provides accurate information and answers the client's direct question. Labor is never induced for the sole purpose of preventing preeclampsia. This is not the reason for early induction; the longer the pregnancy is allowed to progress, the greater the risk for complications or a stillbirth; if the fetus becomes compromised, an emergency cesarean birth is usually required. Neonates can develop hypoglycemia shortly after birth related to many factors such as gestational diabetes and hypothermia, but this is not related to an early birth. The infant's size is anticipated to be larger than normal, not smaller. STUDY TIP: Establish your study priorities and the goals by which to achieve these priorities. Write them out and review the goals during each of your study periods to ensure focused preparation efforts.