Maternity and Women's Health Nursing

January 7

A 23-year-old woman arrives at the prenatal clinic because she thinks that she is pregnant. Her last menstrual period began on March 31, and her pregnancy test reveals a positive result. According to Nägele's rule, what is this client's expected date of birth (EDB)?

Discussing weight loss, exercise, and a balanced low-fat diet

A 28-year-old woman comes into the clinic and tells the nurse that she fears that she is infertile because she has been trying to become pregnant for 2 years. While collecting the health history the nurse learns that the client experiences irregular and infrequent menstrual periods. The client is overweight and has severe acne and alopecia. The health care provider diagnoses polycystic ovarian syndrome (PCOS). Which of the following interventions is the most important?

Notifying the primary health care provider about the epigastric pain, headache, and blurred vision

A 36-year-old primagravida is receiving treatment for preeclampsia at 29 weeks' gestation. In light of the latest information on the client's record, what does the nurse identify as the priority of care?

Neural tube defect

A 42-year-old client undergoes amniocentesis during the 16th week of gestation because of concern about Down syndrome. What additional information about the fetus will examination of the amniotic fluid reveal at this time?

Start feedings on the unaffected breast until the affected breast heals

A breastfeeding mother asks the nurse what she can do to ease the discomfort caused by a cracked nipple. What should the nurse instruct the client to do?

Obtaining her blood pressure

A client at 24 weeks' gestation arrives at the clinic for a routine examination. She tells the nurse, "I feel puffy all over." In light of this statement, what is most important?

Contacting the health care provider about the need for a cesarean birth

A client at 35 weeks' gestation who has had no prenatal care arrives in labor and delivery and is found to be 20 percent effaced and 2 cm dilated, with her membranes intact and contractions 3 minutes apart. The nurse notices some ruptured blisterlike vesicles in the genital area. What should the nurse's next action be?

Providing a dark, quiet room with minimal stimuli

A client at 36 weeks' gestation is admitted to the high-risk unit because she gained 5 lb in the previous week and there is a pronounced increase in blood pressure. What is the initial intervention in the client's plan of care?

At 10 weeks but no later than 12 weeks

A client at 9 weeks' gestation asks the nurse in the prenatal clinic whether she may have chorionic villi sampling (CVS) performed during this visit. What should the nurse keep in mind as the optimal time for CVS while formulating a response?

"Tell me what you know about Down syndrome."

A client has just given birth to an infant with Down syndrome. The mother is crying and asks the nurse what she is supposed to do now. What is the nurse's best response?

Cesarean birth probably will be necessary

A client in labor is admitted to the birthing unit. Assessment reveals that the fetus is in a footling breech presentation. What should the nurse consider about breech presentations when caring for this client?

Water intoxication

A client in labor is receiving an oxytocin (Pitocin) infusion. For which adverse reaction resulting from prolonged administration should the nurse monitor the client?

Discontinue the oxytocin infusion

A client in labor is receiving an oxytocin (Pitocin) infusion. What should the nurse do first when repetitive late decelerations of the fetal heart rate are observed?

"All of this must leave you very confused and frightened."

A client in preterm labor does not respond to therapy, and birth seems imminent. The client begins to cry and says, "I'm so worried about my baby." What is the nurse's best response?

Test the fluid with nitrazine paper

A client is admitted to the birthing unit because fluid is leaking from her vagina. She is unsure whether her "bag of water" has broken. What should the nurse do to help determine whether the fluid is amniotic fluid?

Two units of typed and screened blood

A client is admitted with a marginal placenta previa. What should the nurse have available?

Fetal growth

A client is concerned about gaining weight during pregnancy. What should the nurse tell the client is the cause of the greatest weight gain during pregnancy?

"With an uncomplicated pregnancy, there are no limitations on sexual activity."

A client visiting the prenatal clinic for the first time tells the nurse that she has heard conflicting stories about sex during pregnancy and asks about continuing sexual activity. How should the nurse respond?

Observing the irradiated site daily for redness or irritation

A client who has breast cancer had postlumpectomy chemotherapy and is now scheduled for radiation on an outpatient basis. What is an important nursing intervention while the client is receiving radiation?

Observing the client's breastfeeding technique

A client who has had a cesarean birth seems upset. She has been having difficulty breastfeeding for 2 days and now asks the nurse to bring her a bottle of formula. What is the nurse's initial action?

Encouraging the client to see and hold the baby while still possible

A client who is 21 weeks pregnant loses the baby because of an incompetent cervix. Once the client's physical needs have been assessed and met, what is the best way for the nurse to meet the client's psychological needs?

High level of chorionic gonadotropin

A client who is at 12 weeks' gestation tells a nurse at the prenatal clinic that she is experiencing severe nausea and frequent vomiting. The nurse suspects that the client has hyperemesis gravidarum. What factor is frequently associated with this disorder?

Chorioamnionitis

A client who is in labor is admitted 30 hours after her membranes ruptured. For what condition does the nurse anticipate that the client is most at risk?

"We'll be encouraging you to walk early after surgery."

A client who is pregnant for the first time and is carrying twins is scheduled for a cesarean birth. What should the nurse tell the client to expect?

"I have to wash my hands with soap and water before handling the baby."

A client with active genital herpes has a cesarean birth. The nurse teaches the mother how to limit transmission of the virus to her newborn. The nurse concludes that the instructions have been understood when the mother states:

"Let's explore your available current support and opportunities for child care."

A client with mild preeclampsia is told that she must remain on bedrest at home. The client starts to cry and tells the nurse that she has two small children at home who need her. How should the nurse respond?

"Please go on to see your daughter. I'll bring the baby to her room."

A couple arrives at the newborn nursery asking to take their newborn grandson to his mother's room. What is the best response by the nurse?

Instructing them in the frequency and timing of intercourse to promote conception

A couple, married for 5 years, want to start a family. When talking with the nurse the husband says, "Well, I guess we're going to have to jump into bed three or four times a day, every day, until it works." What is the nurse's best response?

The eggs in the ovaries can be removed and frozen for future use.

A female client with Hodgkin disease is to start total nodal irradiation. She and her partner, who are planning a family, become concerned when they learn that the radiation therapy includes the pelvic area. Before responding what must the nurse consider?

The response is a common one in a new mother who is finding it difficult to accept that her newborn is less than perfect.

A mother is seeing her newborn, who has visible birth defects, for the first time. When she sees her baby, she becomes disturbed, pushes away, and tells a nurse, "Oh, take the baby away; I never want to see it again." What does the nurse conclude from this behavior?

"Babies can be bathed in a tub after the cord has fallen off."

A new mother asks the nurse whether she may wash her baby in a tub after they go home. What is the nurse's best response?

It is used to measure protein metabolism.

A newborn who has remained in the hospital because the mother had a cesarean birth is to be tested for phenylketonuria (PKU) on the morning of discharge. What should the nurse explain to the mother about the purpose of PKU testing?

7.5

A nitrazine test strip that turns deep blue indicates that the fluid being tested has a pH of:

Respiratory depression

A nurse administers the prescribed intravenous dose of magnesium sulfate to a client with severe preeclampsia. What adverse effect should the nurse address when evaluating the client's response to the medication?

9

A nurse assesses a newborn 1 minute after birth. The body is pink with blue extremities; the heart rate is 122 beats/min; the legs are withdrawn when the soles are flicked, respiration is easy, with no evidence of distress; and the arms and legs are flexed and moving vigorously. What Apgar score should the nurse document in the newborn's medical record?

Slow-chest Slow-chest breathing pattern is used during the early phase of labor, when mild contractions dilate the cervix to 3 cm. The pant-blow breathing pattern is used during the transition phase of labor. The shallow-chest breathing pattern is used in combination with other breathing patterns; it is a part of the accelerated-decelerated pattern. The accelerated-decelerated breathing pattern is used during the active phase of the first stage of labor.

A nurse determines that the husband of a client in the early phase of labor understands the teaching from childbirth classes when he helps his wife use the breathing pattern of:

Immaturity of the central nervous system (CNS)

A nurse elicits the Babinski reflex on a newborn. The nurse concludes that this finding indicates:

"I would prefer another assignment that is not contrary to my beliefs."

A nurse from the pediatric clinic who is strongly opposed to any chemical or mechanical method of birth control is asked to work in the family planning clinic. What is the most professional response that this nurse could give to the requesting supervisor?

Increased blood volume

A nurse in the prenatal clinic reviews second-trimester physiological changes in the hematological system before explaining them to a client. What change should the nurse identify?

Hemorrhage

A nurse is caring for a client who has had a spontaneous abortion. For what complication should the nurse monitor this client?

Calcium gluconate

A nurse is caring for a client with preeclampsia who is receiving intravenous magnesium sulfate therapy. What antidote should the nurse have readily available?

Applying sterile, moist nonadherent dressings to the sac

A nurse is caring for a newborn with a myelomeningocele. What should immediate nursing care for this infant include?

30 years old, gravida 6, para 5

A nurse is caring for several pregnant clients in the prenatal clinic. Which client causes the most concern because of her predisposition to placenta previa?

Breast size Genital development

A nurse is estimating a newborn's gestational age. What parameters should the nurse evaluate? (Select all that apply.)

Rh-negative woman who has had an amniocentesis

A nurse is planning to administer Rhogam (Rh immune globulin). Which situation requires the administration of this medication?

"You seem a little tense. Tell me how you feel about breastfeeding."

A postpartum client tells the nurse that she wishes to breastfeed. When the nurse brings her newborn to be breastfed, the client asks whether she may drink a small glass of wine to help her relax. How should the nurse respond?

"The oxytocin causes contraction of the uterine musculature."

A postpartum client who was receiving an intravenous infusion of oxytocin (Pitocin) to stimulate labor asks the nurse why it is not being discontinued now that the baby is born. The nurse responds:

Facilitating the birth with vacuum extraction

A pregnant client with cardiac disease asks a nurse to clarify what she was told about making the birth easier for her. What should the nurse remind her is an option to facilitate birth?

Arranging transportation to the hospital

A pregnant woman at 34 weeks' gestation is being seen at the clinic. The client's blood pressure is 166/100 mm Hg and her urine is +3 for protein. She states that she has a severe headache and occasional blurred vision. Her baseline blood pressure was 100/62 mm Hg. What is the priority nursing action?

Quickening

A pregnant woman tells a nurse, "I think I can feel the baby move now. It feels like butterflies in my stomach. My friend calls it feeling life." What term should the nurse include when discussing fetal movement with the woman?

Abruptio placentae

A pregnant woman who is in the third trimester arrives in the emergency department with vaginal bleeding. She states that she snorted cocaine approximately 2 hours ago. Which complication does the nurse suspect as the cause of the bleeding?

Progesterone

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

Explaining that the client may still be capable of becoming pregnant

A primigravida is admitted with a ruptured fallopian tube resulting from a tubal pregnancy and surgery is performed to remove the fallopian tube. What should postoperative nursing care include?

The anal sphincter muscle has been injured.

A primipara gives birth to an infant weighing 9 lb 15 oz (4508 g). During labor a midline episiotomy is performed and the client sustains a third-degree laceration. The client tells the nurse that her perineal area is very painful. What should the nurse consider before explaining the reason for the pain?

"It must be difficult to lose this baby that was important to you both."

A woman at 22 weeks' gestation is admitted with heavy bleeding and severe abdominal cramping. When told that no fetal heart sounds can be detected, the client says to the nurse, "We wanted this baby so badly." How should the nurse respond?

Imbalance between nutrient intake and fluid loss

A woman who had a home birth brings the infant to the well-baby clinic on the third day after the birth, and the infant weighs 5% less than at birth. What does the nurse suspect as the cause of this weight loss?

Blood pressure

After a client gives birth she has the following vital signs: temperature 99.4° F (37.4° C); pulse rate 80 beats/min and regular; respiratory rate of 16 breaths/min, with even respirations; and blood pressure of 148/92 mm Hg. Which vital sign should the nurse continue to monitor?

"It's expected, and it's called vernix caseosa."

After the birth of a neonate, a parent asks, "What is that white substance over the baby's body?" The nurse initially responds:

Increase daily fluid consumption.

After treatment for a bladder Infection; a client asks whether there is anything she can do to prevent cystitis in the future. What is the best response by the nurse?

Appropriate for gestational age (AGA) and term

An infant born at 40 weeks' gestation weighs 6 lb 13 oz (3090 g). What category describes this neonate?

Painless vaginal bleeding

At 32 weeks' gestation a client undergoes ultrasound, which reveals a low-lying placenta. What complication should the nurse anticipate as the client's pregnancy approaches term?

ROA, 0 station

Examination of a client in active labor reveals fetal heart sounds in the right lower quadrant. The head is in the anterior position, is well flexed, and is at the level of the ischial spines. What fetal position should the nurse document?

Uterine atony

For what complication should the nurse specifically monitor a grand multipara who has just given birth?

Helping the client maintain control

How should a nurse direct care for a client in the transition phase of the first stage of labor?

Having the client empty her bladder

In the second hour after the client gives birth her uterus is firm, above the level of the umbilicus, and to the right of midline. What is the most appropriate nursing action?

Breakdown of fetal red blood cells

On the third postpartum day a mother visits the clinic and asks why her newborn's skin has begun to appear yellow. The nurse explains that the change in her infant's skin tone is the result of:

Chlamydia and gonorrhea

Shortly after birth the nurse instills erythromycin ophthalmic ointment in the newborn's eyes. The father asks why an antibiotic is needed because the mother does not have an infection. The nurse explains that it protects the newborn from:

Gynecoid A gynecoid pelvis is considered most favorable for a vaginal birth because the inlet allows the fetus room to pass. The gynecoid pelvis is considered the typical female pelvis. An android pelvis, which has a heart shape, is considered a male pelvis. The fetus often gets stuck. The anthropoid pelvis is elongated, with a roomy anterior posterior dimension and a narrower transverse diameter than the gynecoid pelvis. Although delivery is possible with this type of pelvis, it is less likely to be successful. The platypelloid pelvis is flat, with a compressed oval shape as the middle opening, instead of an open circle like the gynecoid pelvis. This is a rare type of pelvis.

The four essential components of labor are powers, passageway, passenger, and psyche. Passageway refers to the bony pelvis. What type of pelvis is considered the most favorable for a vaginal delivery?

Taking-in

The gravida 1 now para 1 woman delivered a 7-lb 6 oz female infant at 11 pm yesterday after a labor of 14 hours. After breakfast the nursery staff brings the baby to the new mother. The mother smiles at the baby, then asks that the nurse take the baby back to the nursery because she has not had a shower yet. One hour later the nurse returns with the infant. Again the mother smiles at the baby; then she holds her, kisses her, and feeds her a bottle. Immediately after feeding the baby, the mother calls the nursery and asks that the baby be picked up so she can take a nap. What behavior is the new mother demonstrating?

Dry and provide skin-to-skin contact with the mother

The health care provider hands a neonate to a nurse immediately after birth. What should the nurse do next for the newborn?

3

The health care provider has prescribed 500 mg of cephalexin (Keflex) by mouth every 6 hours for 10 days for a client with mastitis. The health care provider has given the client 24 sample tablets of 250 mg apiece. How many days should this supply last? Record your answer using a whole number. _____ days

"The health care provider will tell you how your baby's pain will be controlled."

The mother of a newborn son tells the nurse that she is concerned about circumcision because of the pain involved. What is the nurse's best response?

Fetal movement

The nurse explains to a pregnant client undergoing a nonstress test that the test is a way of evaluating the condition of the fetus by comparing the fetal heart rate with:

"I'm glad I'll be able to get back into my jogging routine next week."

The nurse is conducting teaching for a client being discharged after an abdominal hysterectomy. Which statement by the client indicates a need for further teaching?

The mouth covers most of the areolar surface.

The nurse is helping a mother breastfeed her newborn. What is the best indication that the newborn has achieved an effective attachment to the breast?

These areas usually are normal and will fade within the first year.

The parents of a newborn ask the nurse about several areas of deep-blue coloring on their baby's lower back and buttocks. The nurse's response is based on the information that:

Parent-child attachment

The practice of separating parents from their newborn immediately after birth and limiting their time with the infant during the first few days after delivery contradicts studies of:

Staphylococcus aureus

The transmission of which microorganism that causes maternal mastitis is minimized by frequent handwashing by nursing staff members?

Enlarged head

Two days after birth a neonate's head circumference is 16 inches (40 cm) and the chest circumference is 13 inches (32.5 cm). What does the nurse infer from these measurements?

Increased white blood cell (WBC) count

Two days after delivery, a client has a temperature of 101° F (38.3), general malaise, anorexia, and chills. What does the nurse expect to identify on the client's laboratory report?

Bradycardia with no change in respirations

What does a nurse expect to find when checking the vital signs of a client in the early postpartum period?

The nurse will educate the client to wear a bra that provides firm support, keeps the breasts lifted and supported at all times. The nurse will explain that this will help decrease breast tenderness and soreness

What education will the registered nurse provide to the 15 week gestation woman complaining of breast tenderness and soreness?

Intrusion on movement

What is a common problem that affects the client in labor when an external fetal monitor has been applied to her abdomen?

Advising the client to limit stress, promoting rest after meals, and educating the client about the analgesia and anesthesia used during labor

What should be included in the plan of care for a client with class I cardiac disease during the last weeks of pregnancy?

Administer oxygen by face mask

When entering the room of a client in active labor to answer the call light, the nurse sees that she ashen gray, dyspneic, and clutching her chest. What should the nurse do after pressing the emergency light in the client's room?

Allow the clients to express their grief

When working with a client who has spontaneously aborted a pregnancy, it is important for the nurse to first deal with his or her own feelings about abortion, death, and loss so that he or she may :

-wear gloves when working in the flowerbeds around the house -ask partner to take over the cleaning of the litter box -wash all fruits and veg in diluted vinegar before eating raw

Which action can the 4 week gestation nullipara woman implement to protect herself and the fetus from toxoplasmosis? Select all that apply -have the family house cat relocated to an outdoor living space during the pregnancy -be sure when eating sushi, cooked or uncooked, that it is soaked in rice vinegar -wear gloves when working in the flowerbeds around the house -ask partner to take over the cleaning of the litter box -wash all fruits and veg in diluted vinegar before eating raw

A woman who required catheterization after voiding less than 75 mL

Which client is at risk for a postpartum infection?

Partial abruptio placentae

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?

Barrel-shaped chest

While observing a newborn with a diaphragmatic hernia, what does the nurse expect to identify?