High Risk Antepartum chapter 8 NCLEX book

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. Lightheadedness. 5. Breast tendernes

1. Nausea and vomiting. 2. Abdominal pain. 3. Fatigue. 4. Lightheadedness. 1. Nausea and vomiting is a common side effect. 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. Lightheadedness is a common side effect.

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. Calcium and iron. Pregnant adolescents' diets are often deficient in calcium and iron.

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. Cramping. A bicornuate uterus will predispose a client to cramping and preterm labor.

8. When counseling a preeclamptic client about her diet, what 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.

A woman is to receive Rho(D) immune globulin 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. Verify the identity of the woman. Although this is an important action that must be taken before the administration of any medication, it is especially critical in this situation.

A client at 36 weeks' gestation 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. vagina 4. rectum -the vagina and rectum are cultured for group B strep -the vagina and rectum are cultured for group B strep.

132. the antepartum nurse has just received shift report on four pregnant clients at 0700. Which of the clients should the nurse assess first? a. G5 P2202, 32 weeks, placenta privia, today's hemoglobin 11.6 g/dL b. G5 P0101, 39 weeks, type 2 diabetes mellitus (T2DM), fasting blood glucose 85 mg/dL (4.7 mmol/L). c. G1 P0000, 32 weeks, partial placental abruption, fetal heart rate (FHR) 120 bpm 15 minutes ago d. G2 P1001, 28 weeks, Rh- negative (Rh-), 1 day post cerclage placement

c. G1 P0000, 32 weeks, partial placental abruption, fetal heart rate (FHR) 120 bpm 15 minutes ago a placental abruption is a life-threatening situation for the fetus and possibly for the mother. it has been 15 minutes since the client was assessed. although the FHR was within the normal range 15 minutes ago, this is the nurse's priority because the condition can deteriorate rapidly.

a client at 29 weeks' gestation is admitted to the antepartum unit with vaginal bleeding. to differentiate between placenta previa and abruptio placentae, the nurse should assess which of the following? a. Leopold's maneuver results b. quantity of vaginal bleeding c. presence of abdominal pain d. maternal blood pressure

c. presence of abdominal pain the most common difference between placenta previa and placenta abruption is the absence of abdominal pain

a nurse is caring for four antepartum cleints. which of the clients will the nurse carefully monitor for signs of placental abruption? a. G2 P0010, 27 weeks' gestation, polyhydramnios b. G3 P1101, 36 weeks' gestation, flu c. G4 P2101, 32 weeks' gestation, cancer survivor d. G5 P1211, 24 weeks' gestation, cocaine use

d. G5 P1211, 24 weeks' gestation, cocaine use cocaine is a powerful vasoconstrictive agent. its use at any time during pregnancy places pregnant clients at high risk for placental abruption regardless of gestational age

A client with an obstetrical history of G6P5005, has been admitted to the hospital at 24 weeks' gestation with 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

The client will be symptom-free until at least 37 weeks' gestation. 3. That the client be symptom-free until at least 37 weeks' gestation is a long-term goal. At that time, the baby will be full term.

A pregnant client 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. Fever and muscle aches. The symptoms of listeriosis are similar to symptoms of the flu and include fever and muscle aches.

A 30-week-gestation multigravida, G3 P1011, is admitted to the labor suite. She is contracting every 5 minutes with a contraction duration of 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 1 1⁄2 miles this morning." 4. "My miscarriage happened a year ago today."

1. "For the past day I have felt burning when I urinate." 1. This is the most important statement made by the client.

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. "Please lie down and drink about four full glasses of water or juice. 1. The first intervention for preterm labor is hydration. Clients who are dehydrated are at high risk for preterm labor.

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 filtration. 2. Cardiac failure. 3. Hepatic insufficiency. 4. Altered splenic circulation.

1. Altered glomerular filtration. Altered glomerular filtration leads to protein loss and, subsequently, to fluid retention, which can lead to swelling in the face and hands.

the fetus of a client at 38 weeks' gestation 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 provider to order at this time? select all that apply 1. Biophysical profile (BPP) 2. Nonstress test (NST) 3. Umbilical artery (UA) Doppler assessment 4. Chorionic villus sampling (CVS) 5. Human chorionic gonadotropin test (HCG)

1. Biophysical profile (BPP) 2. Nonstress test (NST) 3. Umbilical artery (UA) Doppler assessment - it would be appropriate to perform a biophysical profile (BPP) -it would be appropriate to perform a nonstress test (NST) - It would be appropriate to perform an umbilical artery (UA) Doppler assessment

The blood work of a client hospitalized on the antepartum unit of the hospital is as follows: 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. Chicken livers, sliced tomatoes, and dried apricots. 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 level.

Which of the following long-term goals is appropriate for a client, 10 weeks' gestation, who is diagnosed with gestational trophoblastic disease (hydatiform 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. Client will be cancer-free 1 year from diagnosis. This long-term goal is appropriate.

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

1. Deltoid. Although the dosage can be administered in the gluteal muscles, the deltoid is the preferred site of the Rho(D) immune globulin injection.

A pregnant diabetic has been diagnosed with polyhydramnios. 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. Excessive fetal urination. 1. The hydramnios is likely a result of excessive fetal urination.

A client at 32-weeks' 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. Fern test. A fern test is performed to assess for the presence of amniotic fluid.

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 any 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. Fever or chills. 2. Lack of fetal movement. 3. Abdominal pain. 5. Vaginal bleeding. -The client should call her practitioner if she experiences fever or chills. - Albeit rare, Because the fetus can be injured during an amniocentesis, the client should report either a decrease or an increase in fetal movement. - The client should report abdominal pain or cramping. An amniocentesis can precipitate preterm labor. -The client should report any vaginal loss—blood or amniotic fluid. The placenta may become injured or the membranes may rupture during an amniocentesis.

Which of the following clients is at highest risk for developing a hypertensive illness of pregnancy? 1. G1P0000, age 44 with history of diabetes mellitus. 2. G2P0101, age 27 with history of rheumatic fever. 3. G3P1102, age 25 with history of scoliosis. 4. G3P1011, age 20 with history of celiac disease.

1. G1P0000, age 44 with history of diabetes mellitus. 1. This primigravid client—age 44 and with a history of diabetes—is very high risk for preeclampsia.

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

1. Grand mal seizure 1. Clients with severe preeclampsia are high risk for 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. 1. Headache and decreased output are signs of preeclampsia.

A client, 32 weeks' gestation with placenta previa, is on total bed rest. The physician expects her to be hospitalized on bed rest 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. Perform passive range of motion exercises. 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 in order to maintain the client's respiratory function.

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. Rapid fundal growth. 1. Fundal growth is often accelerated.

The nurse caring for a client with type 1 diabetes (T1DM) who wishes to become pregnant notes that the client's glycohemoglobin, or glycosylated hemoglobin (HgbA 1c), 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 last 3 months and is within target today. 2. The client has been normoglycemic for the last 3 months and is within targe today. 3. The client has been hyperglycemic for the last 3 months and normoglycemic today. 4. The client has been normoglycemic for the last 3 months and hyperglycemic today.

1. The client has been hyperglycemic for the last 3 months and is within target today. The client has been hyperglycemic for 3 months but is normoglycemic today.

A type 1 diabetic client has developed polyhydramnios. She is 34 weeks pregnant. 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. Uterine contractions. 1. The client should be taught to observe for signs of preterm labor.

In analyzing the need for health teaching in a client with an obstetrical history of G5P4004 who has been diagnosed 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. "Do you exercise regularly" 2. The likelihood of developing either gestational or type 2 diabetes is reduced when clients exercise regularly.

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

3. Uterine contractions. 3. Preterm labor is a complication in the immediate post-procedure period.

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. "It is a difficult decision. What have you thought about so far?" This is an excellent response. The question opens the door for the teenager to discuss her feelings and thoughts.

Which of the following findings should be reported to the primary health care practitioner when assessing a first-trimester gravida suspected of having gestational trophoblastic disease (hydatiform 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 8000/mcL. 5. Hypertrophied breast tissue.

2. Grape-like clusters passed from the vagina. 3. markedly elevated blood pressure 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

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 heart beat. 3. Hematocrit above 40%. 4. Denial of quickening.

2. No fetal heart beat. There will be no fetal heartbeat when a client has pseudocyesis.

A 30-year-old client with an obstetrical history of G3P1101, states that she is planning to become pregnant again. She reports that 8 years ago she gave birth to a premature baby boy who 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. Nutrition counseling. This client is in need of nutrition counseling.

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

2. Oliguria 2. the nurse would expect to see oliguria

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

2. Pulse. 2. The pulse is the highest priority in this situation.

A pregnant client mentions to the clinic nurse that she and her husband enjoy working together on projects around the house and, "I always wear protective gloves when I work." The nurse should advise the woman that, even when wearing 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. Sanding the paint from an antique crib. Sanding the paint from an antique crib is a dangerous activity because antique cribs are often painted with lead-based paint.

A grand multipara with an obstetrical history of G8P3406 is being seen at 14 weeks' gestation 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. Signs and symptoms of labor. 2. The nurse should emphasize the need for the client to notify the office of signs of preterm labor.

the doctor writes the following order for a client at 31 weeks' gestation with symptomatic placenta previa: weigh all vaginal pads and estimate blood loss. the nurse weighs one of the client's saturated pads at 24 grams and a dry pad at 4 grams. how many milliliters (mL) of blood can the nurse estimate the client has bled? calculate to the nearest whole number. ____________ mL

20 mL of blood

A 16-year-old client 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. "On weekends we go out and drink a few beers." The nurse must respond to this comment. This young woman is repeatedly exposing her fetus to alcohol.

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 +3 reflexes are defined as slightly brisker than normal or slightly hyper-reflexic.

A woman who has been diagnosed with an ectopic pregnancy is to receive methotrexate 50 mg/m2 IM. The woman weighs 136 lb and is 5 ft 4 inches tall. What is the maximum safe dose, in mg, of methotrexate that this woman can receive? ______ mg

83.5 mg

It is discovered that a client 24 weeks' gestation is leaking amniotic fluid. Before the client is sent home on bed rest, 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 health care provider. 3. Abstain from engaging in vaginal intercourse for the rest of the pregnancy. 4. Carefully weigh all of her saturated peripads.

3. Abstain from engaging in vaginal intercourse for the rest of the pregnancy. This client must abstain from intercourse for the remainder of the pregnancy.

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. Blood pressure. The client's blood pressure is the most important vital sign.

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. Client's weight. Weight is the most important sign for the nurse to assess.

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 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. Penicillin therapy will reduce the risk to the fetus. Usually a single shot of penicillin, administered to the mother will cure her and protect the baby.

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? 1. Placenta previa. 2. Transverse fetal lie. 3. Placental abruption. 4. Pre-eclampsia with severe features 5. Preterm labor

3. Placental abruption. 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

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. 3. Sharp unilateral pain is a common symptom of a ruptured ectopic pregnancy

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. The client whose fundal height measurement is 26 cm. 3. It is possible that this client is carrying twins.

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 its 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. fetal dependence on nicotine 4. Fetal intrauterine growth restriction.

3. fetal dependence on nicotine 4. Fetal intrauterine growth restriction. -The word "addiction" does not apply to a fetus, since the fetus does not purposefully seek nicotine after birth. however, a fetus may be born dependent on nicotine and suffer withdrawal when the level of nicotine is reduced after birth. -Smoking in pregnancy does cause fetal intrauterine growth restriction.

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. "Have you ever been forced to have sex?" asking about forced sexual activity is an essential question for the nurse to ask.

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 complaints of dizziness or weakness.

4. Assess for complaints of dizziness or weakness. 4. It is most important for the nurse to report complaints of dizziness or weakness.

A 25-year-old client is admitted with the following history: 12 weeks pregnant, vaginal bleeding, no fetal heart beat 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. 4. Dilation and curettage (D&C) will be performed on a client with an incomplete abortion.

A 26-week-gestation woman is diagnosed with severe preeclampsia 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. 4. Epigastric pain is associated with the liver involvement of HELLP syndrome.

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

4. High incidence of late prenatal care teens are likely to delay entry into the healthcare system

A client with insulin-dependent diabetes 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. Human placental lactogen is an insulin antagonist so the client will require higher doses of insulin as the level of placental lactogen increases.

A pregnant 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 bed rest. 4. Infuse intravenous solution.

4. Infuse intravenous solution. administering intravenous fluids is the priority action

A client has severe preeclampsia. The nurse would expect the primary health care 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. Intrauterine growth restriction. The fetus should be assessed for intrauterine growth restriction.

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. Hysterosalpinogram. 4. Serum progesterone level

4. Serum progesterone level Serum progesterone will provide information on the viability of a pregnancy.

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.' Twin-to-twin transfusion is a relatively common complication of monozygotic twin pregnancies.

A client has been admitted with a diagnosis of hyperemesis gravidarum. Which of the following lab values would be consistent with this diagnosis? 1. pO2 90, pCO2 35, HCO3 19 mEq/L, pH 7.30. 2. pO2 100, pCO2 30, HCO3 21 mEq/L, pH 7.50. 3. pO2 60, pCO2 50, HCO3 28 mEq/L, pH 7.30. 4. pO2 90, pCO2 45, HCO3 30 mEq/L, pH 7.50.

4. pO2 90, pCO2 45, HCO3 30 mEq/L, pH 7.50. This client is in metabolic alkalosis. This is consistent with a diagnosis of hyperemesis gravidarum.

which of the following signs or symptoms would the nurse expect to see in a client with a placental abruption? a. sinusoidal fetal heart rate b. pain-free vaginal bleeding c. fetal heart accelerations d. hyperthermia with leukocytosis

a. sinusoidal fetal heart rate as a result of placental bleeding, the fetus can suffer significant blood loss that results in anemia, demonstrated by a sinusoidal fetal heart-rate pattern

An antepartum nurse is caring for a client at 38 weeks' gestation, who has been diagnosed with symptomatic placenta previa. which of the following orders by the primary healthcare provider should the nurse question? a. begin oxytocin drip rate at 0.5 milliunits/min b. assess fetal heart rate every 10 minutes c. weigh all vaginal pads d. assess hematocrit and hemoglobin

a. begin oxytocin drip rate at 0.5 milliunits/min -an order for oxytocin administration should be questioned

a client with a complete placenta previa is on the antepartum clinical unit in preparation for delivery. which of the following should the nurse include in a teaching session for this client? a. coughing and deep breathing b. phases of the first stage of labor c. lamaze labor techniques d. Leboyrer hydro-birthing

a. coughing and deep breathing because the client will have a cesarean section with anesthesia, the client should be taught coughing and deep-breathing exercises for the postoperative period

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 (8 mmol/L) 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. all blood glucose results should be kept in a log for evaluation by the nurse and primary healthcare provider 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 cutoff values, the primary healthcare provider may order dietary changes or the addition of oral hypoglycemic medications to the client's therapeutic regimen.

The results of a 75-gram oral glucose tolerance test (OGTT) for a client at 25 weeks' gestation are: Fasting -100 mg/dL (5.5 mmol/L) One hour- 200 mg/dL (11.1 mmol/L) Two-hour -160 mg/dL (8.9 mmol/L) which of the following information is appropriate for the nurse to give the client at this time? 1. inform the client that the glucose results are normal 2. Inform the client that an additional 3-hour 100-gram oral glucose test is necessary for follow up. 3. inform the client that the primary healthcare provider will likely order an oral hypoglycemic agent 4. inform the client that the primary healthcare provider will likely order a referral to a registered dietician.

4. inform the client that the primary healthcare provider will likely order a referral to a registered dietician. this statement is correct. the client should be referred to a registered dietician for diet counseling

31. 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 4. Painless vaginal bleeding is often the only symptom of placenta previa.

A woman is to receive methotrexate IM for an ectopic pregnancy. The drug reference states that the recommended safe dose of the medicine is 50 mg/m2. She weighs 52 kg and is 148 cm tall. What is the maximum safe dose, in mg, of methotrexate that this woman can receive? ______ mg

73 mg

A biophysical profile (BPP) has been performed on a full-term client who has pre-eclampsia with severe features. 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. Fetal well-being is compromised a BPP of 4 indicates that fetal well-being is compromised

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. Hypoxia. Vaso-occlusive crises are precipitated by hypoxia in both pregnant and nonpregnant clients with sickle cell disease.

An ultrasound has identified 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. Multicystic Dysplastic kidneys. 2. Coarctation of the aorta. 3. Hydrocephalus. 4. Hepatic cirrhosis.

1. Multicystic Dysplastic kidneys. The nurse would expect that the baby has dysplastic kidneys.

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. Need for less insulin than she normally injects. 1. Type 1 diabetics often need less insulin during the first trimester than they did preconception.

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 penicillin po 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. Notify any exposed pregnant friends. Rubella is a teratogenic disease. The parents should notify any pregnant friends who may have been exposed.

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

2. 32-week gestation with urinary tract infection (UTI). 3. 33 weeks'' gestation with twins post-in vitro fertilization (IVF) 2. Clients with UTIs are high risk for PPROM. 3. Clients with gestational diabetes are not high risk for PPROM.

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. Dexamethasone 2. Amethopterin (methotrexate). 3. Pergonal (menotropins). 4. Prometrium (progesterone).

2. Amethopterin (methotrexate). 2. Methotrexate is the likely medication.

A client, 37 weeks' gestation, has been advised that she is positive for group B streptococci (GBS). 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 very high risk for an intrauterine infection. It is very 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. "This bacteria causes scarlet fever. If you notice that your tongue becomes very red and that you feel feverish you should call the doctor immediately."

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." This answer is correct. Exposure to group B strep is very dangerous for neonates.

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. 32 weeks' gestation, complains of epigastric pain and facial edema. 3. Epigastric pain and facial edema are not normal. This client should be referred to the nurse midwife.

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

3. Continue her education. 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.

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

3. Dark brown vaginal bleeding. 3. The condition is usually diagnosed after a client complains of brown vaginal discharge early in the "pregnancy."

A client is admitted to the hospital with severe preeclampsia. 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 flat on the floor.

3. Dorsiflex the woman's foot. To assess clonus, the nurse should dorsiflex the woman's foot.

Which of the following clients is 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. The client with multiple miscarriages. Women who have had a number of miscarriages are at high risk for pseudocyesis.

A client 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. Maternal blood type. It is essential that the woman's blood type be assessed.

A client at 36 weeks' gestation with type 1 diabetes mellitus (T1DM) 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. One fetal heart acceleration in 20 minutes. 1. There should be a minimum of 2 fetal heart accelerations in 20 minutes (approximately 1 every 10 minutes).

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

1. Preterm birth. Adolescents are at high risk for preterm labor.

A gravid (pregnant) 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 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 slows emptying of the gallbladder making gravid women high risk for the disease. Progesterone is a hormone that relaxes smooth muscle. This action leads to the delayed emptying of the gallbladder during pregnancy.

The physician has ordered a nonstress test (NST) to be done on a 41-week- gestation client. During the 1/2 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 MD. 2. Perform a nipple stimulation test to assess the fetal heart in response to contractions. 3. Prepare the client for induction with IV oxytocin 4. Place the client on her side with oxygen via face mask.

1. Send the client home and report positive results to the MD. The nurse should report the positive results to the doctor.

A client with an obstetrical history of G1 P0000, is at 40 5/7 weeks' gestation. Her Bishop score is 4. Which of the following complementary therapies might be recommended? Select all that apply. 1. Sexual intercourse. 2. Aromatherapy. 3. Breast stimulation. 4. Ingestion of castor oil. 5. Aerobic exercise.

1. Sexual intercourse. 3. Breast stimulation. 4. Ingestion of castor oil. 1. Sexual intercourse has been recommended to women as a means of increasing their Bishop score. 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.

A pregnant woman with obesity is being seen in the prenatal clinic. The nurse will monitor this client carefully throughout her pregnancy because she is 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. gestational diabetes 3. deep vein thrombosis 4. Pre-eclampsia 2. Obese clients are at high risk for gestational diabetes. 3. clients with obesity are at high risk for deep vein thrombosis 4.clients with obesity are at high risk for pre-eclampsia

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. hydatidiform mole unless the pregnant client developed chronic hypertension during her pregnancy, hydatidiform mole is the most likely cause of her high blood pressure

A client with a BMI of 31.2, is seen for her first prenatal visit at 7 weeks' gestation. the nurse requests an order from the primary healthcare provider for which of the following tests? 1. electroencephalogram 2. oral glucose tolerance test 3. biophysical profile 4. lecithin/sphingomyelin ratio

2. oral glucose tolerance test the nurse should request an order for an oral glucose tolerance test

A client with insulin-dependent diabetes and an obstetrical history of G3P0200, 38 weeks' gestation, is being seen in the labor and delivery suite. The client states she has ahd nausea and vomiting for the past 24 hours and thinks she has a bladder infection. the nurse knows which of the following maternal blood values presents the highest risk to her unborn baby? 1. Glucose 150 mg/dL (8.3 mmol/L) 2. pH 7.25. 3. pCO2 34 mm Hg. 4. Hemoglobin A 1c 6%.

2. pH 7.25. Acidosis is fatal to the fetus. This is the most important finding.

A client diagnosed with pre-eclampsia without severe features has been advised to stop working and be on light activities and bedrest at home. She asks why this is necessary. Which of the following is the best response for the nurse to give the client? 1. "Bed rest will help you to conserve energy for your labor." 2. "Bed rest 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. "Reclining will increase the amount of oxygen that your baby gets." 3. Bed rest, especially side-lying, helps to improve perfusion to the placenta.

A 12-week-gravid client presents in the emergency department with abdominal cramps and scant dark red bleeding. What should the nurse assess this client for? 1. Tachycardia 2. Referred shoulder pain 3. headache 4. Fetal heart dysrhythmias. 5. hypertension

1. Tachycardia 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-eclampsia, 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 client 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-eclampsia, including headache and hypertension.

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 high risk for hemorrhage. 3. The infant has kernicterus. 4. The mother is high risk for eclampsia.

1. The baby is premature. The baby is preterm.

A nurse who is caring for a pregnant diabetic should carefully monitor the client for which of the following? 1. Urinary tract infection. 2. Multiple gestation. 3. Metabolic alkalosis. 4. Pathological hypotension. 5. hypolipidemia

1. Urinary tract infection. 3. Metabolic alkalosis. 1. Pregnant diabetic clients are particularly at high risk for urinary tract infections. 3. Pregnant clients with type 1 diabetes mellitus (T1DM) are at high risk for acidosis.

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. Weight change from 128 pounds to 138 pounds. 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.

The nurse is evaluating the effectiveness of bed rest for a client with mild preeclampsia without severe features. Which of the following signs/symptoms would the nurse determine is a finding that suggests pre-eclampsia with severe features? 1. platelet count 95,000/mcL 2. 2+ proteinuria 3. increase in plasma protein 4. serum creatinine greater than 1.3 mg/dL

1. platelet count 95,000/mcL 2. 2+ proteinuria 4. serum creatinine greater than 1.3 mg/dL 1. a platelet count of less than 100,000 per microliter is a sign of pre-eclampsia with severe features. a normal platelet level in pregnancy is 150,000 per microliter 2. this client is losing protein. a reading of greater than 1+ indicates worsening kidney insufficiency 4. serum creatinine greater than 1.1 mg/dL indicates worsening renal insufficiency

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. Maturation of the fetal lungs. The L/S ratio indicates the maturity of the fetal lungs.

A client at 24 weeks' gestation has been diagnosed with severe choledocholithiasis and is scheduled for cholecystectomy under general anesthesia. In addition to routine surgical and postsurgical care, the nurses should pay special attention to which of the following? 1. the circulating nurse should place the woman supine and slightly titled to the left during the surgical procedure 2. an obstetrical nurse should assess the fetal heart rate regularly following the surgery 3. the post-anesthesia care nurse should monitor the woman carefully for nausea and vomiting 4. the post-anesthesia care nurse should monitor the woman carefully for nausea and vomiting 5. the circulating nurse should place anti-embolic stockings on the woman's legs preoperatively

1. the circulating nurse should place the woman supine and slightly titled to the left during the surgical procedure 2. an obstetrical nurse should assess the fetal heart rate regularly following the surgery 4. the post-anesthesia care nurse should monitor the woman carefully for nausea and vomiting 5. the circulating nurse should place anti-embolic stockings on the woman's legs preoperatively -the woman should be maintained in the lateral recumbent position during the surgery because, if laid flat, the gravid uterus would compress the great vessels and impede the return of blood to the heart. - the fetal heart rate and contraction pattern should be monitored frequently after surgery by an obstetrical nurse for any signs of fetal stress and/or for preterm labor - the client would be at high risk for postoperative vomiting and for postoperative gas pains for 2 reasons: progesterone during pregnancy slows gastric motility and the stomach and intestines are displaced by the gravid uterus. in addition, nausea and vomiting are complications of general anesthesia. -this response is correct. because pregnancy puts the client at risk of thrombi, antiembolic stockings should be placed on the client before surgery and should remain in place for the entire time that she is immobile.

A client is being stabilized to the labor suite following a diagnosis of eclampsia. The fetal heart rate tracing shows moderate variability with intermittent late decelartions. 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. Pad the side rails and head of the bed. This is appropriate. The side rails and the headboard should be padded incase the client has another seizure.

A pregnant client with an obstetrical history G2P1001, 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. "When was the first day of your last menstrual period?" 2. The date of the last menstrual period will assist the nurse in determining how many weeks pregnant the client is.

A client with gestational diabetes who requires insulin therapy to control her blood glucose levels telephones the hospital's obstetrical unit, complaining of dizziness and a racing pulse. Which of the following actions should the nurse take at this time? 1. Have the client proceed to the office to see her primary healthcare provider 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 to telephone her primary healthcare provider immediately.

2. Advise the client to drink a glass of juice and then call back. The client should drink a full glass of milk.

The nurse is caring for a multigravid client at 32-weeks with an obstetrical history of G8P7007. she has been diagnosed 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. Bed rest with passive range of motion exercises. 4. Daily serum electrolyte assessments. 5. Weekly biophysical profiles.

2. Blood type and cross match. 3. Bed rest with passive range of motion exercises. 5. Weekly biophysical profiles. -There should be blood available in the blood bank in case the woman begins to bleed. -The nurse would expect to keep the woman on bed rest with bathroom privileges only. -The nurse would expect that weekly biophysical profiles would be done to assess fetal well-being.

A client has just done a fetal kick count assessment. She noted 6 movements during the last hour. If taught correctly, what should be her next action? 1. Nothing because further action is not warranted. 2. Call the primary healthcare provider to discuss next steps 3. Redo the test during the next one-half hour. 4. Drink a glass of orange juice and redo the test.

2. Call the primary healthcare provider to discuss next steps A nonstress test is warranted if the woman feels fewer than 3 counts in an hour.

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 Cardiomegaly is one of the common signs of erythroblastosis fetalis.

A client at 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. Diet control with exercise. 2. About 95% of gestational diabetic clients are managed with diet and exercise alone.

A diabetic client is to receive 5 units regular and 15 units NPH insulin at 0800. To administer the medication appropriately, what is the best approach? 1. Draw 5 units regular in one syringe and 15 units NPH in a second syringe and inject in different locations. 2. Draw 5 units regular first and 15 units NPH second into the same syringe and inject. 3. Draw 15 units NPH first and 5 units regular second into the same syringe and inject. 4. Mix 5 units regular and 15 units NPH in a vial before drawing the full 20 units into a syringe and inject.

2. Draw 5 units regular first and 15 units NPH second into the same syringe and inject. 2. This is the appropriate method. The regular insulin should be drawn up first and then the NPH insulin in the same syringe.

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

2. Dyspnea on exertion. A client who is complaining of dyspnea on exertion is likely going into left-sided congestive heart failure.

A nurse is caring for four prenatal clients in the clinic. Which of the clients is 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 nurse who works 12 hour shifts 5. Police officer on foot patrol.

2. Primigravida who smokes 1 pack of cigarettes per day 3. Infertility client who is carrying in-vitro triplets 2. A smoker is at high risk for placenta previa. 3. A woman carrying triplets is at high risk for placenta previa

A client has been admitted with a diagnosis of hyperemesis gravidarum. Which of the following orders written by the primary health care 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. Start intravenous with multivitamins. Starting an intravenous with multivitamins takes priority.

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. Take the woman's blood pressure. The nurse should assess the client's blood pressure.

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

2. That she owns a cat and a dog. Cat feces are a potential source of toxoplasmosis.

A woman at 12 weeks' gestation with an obstetrical history of G4P0210 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 that is appropriate for gestational age.

2. The client will deliver after 38 weeks' gestation. 2. This client is at high risk for pregnancy loss. This is an appropriate long-term goal.

At 28 weeks' gestation, an Rh-negative woman receives Rho(D) immune globulin. What is the expected outcome of administering the medication? 1. The baby's Rh status changes to Rh negative (Rh-) 2. The mother produces no Rh antibodies. 3. The baby produces no Rh antibodies. 4. The mother's Rh status changes to Rh positive (Rh+).

2. The mother produces no Rh antibodies. That the mother produces no Rh antibodies is the expected outcome of Rho(D) immune globulin administration.

A client is being taught fetal kick counting. Which of the following should be included in the patient teaching? 1. The client should choose a time when her baby is least active. 2. The woman should lie on her side. 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. The woman should lie on her side. This is the best position for perfusing the placenta.

An ultrasound has identified that a client's pregnancy is complicated by polyhydramnios. 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. Tracheoesophageal fistula. The nurse would expect to find that the baby has tracheoesophageal fistula.

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. 4. Avoid sleeping with the dog.

2. Wear gloves when gardening. The client should be advised to wear gloves when gardening.

A client's 32-week clinic assessment was: BP 90/60; TPR 98.6ºF, 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 99.2ºF, 88, 20. 2. Weight 155 lb; urine protein 2. 3. Urine protein trace; BP 88/56. 4. Weight 147 lb; TPR 99.0ºF, 76, 18.

2. Weight 155 lb; urine protein 2. 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.

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. Continue the interview of the woman in private. continuing the interview of the woman in private is the priority action. The nurse should escort the client to a location where the partner cannot follow.

A client at 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. Two fetal heart accelerations of 15 bpm lasting at least 15 seconds. This is the definition of a reactive nonstress test—there are two fetal heart accelerations of 15 bpm lasting 15 or more seconds during a 20-minute period.

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. "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.

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. "If you follow your diet and exercise you will probably need no insulin." It is unlikely that this client will need any medication. Diet and exercise will probably control the diabetes.

Which of the following statements is appropriate for the nurse to say to a client 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. "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.

A client with obesity 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 the guidelines are lower for women in your weight category

4. "We suggest that you gain weight throughout your pregnancy but the guidelines are lower for women in your weight category This statement is true. clients without obesity are encouraged to gain between 25 and 35 pounds during their pregnancies, while clients with obesity are encouraged to gain only 11 to 20 pounds.

A pregnant client 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. Listeria monocytogenes. The client is likely suffering from listeriosis, an infection caused by Listeria monocytogenes bacteria.