Maternity scenarios

What are the indicators of nutritional risk in pregnancy in a client who is of normal weight? Select all that apply. 1 Smoker 2 Twin gestation 3 Hemoglobin of 12 g/dL 4 Term delivery 2 years ago 5 Caffeine intake of 180 mg/day 6 Fasting blood sugar of 80 mg/dL

What are the indicators of nutritional risk in pregnancy in a client who is of normal weight? Select all that apply. Smoker Twin gestation hemoglobin of 12 g/dL Term delivery 2 years ago Caffeine intake of 180 mg/day Fasting blood sugar of 80 mg/dL Rationale: Smokers generally have a nutrient-poor diet and are at risk for continuing the same diet through pregnancy. Multifetal pregnancies require nutrition above the normal requirements for pregnancy. A hemoglobin reading of 12 g/dL and fasting blood sugar of 80 mg/dL are normal values. Caffeine intake of 180 mg/day is less than the daily recommended intake.

A client with severe preeclampsia is receiving magnesium sulfate therapy. What is the priority nursing assessment as the nurse monitors this client's response to therapy? 1 Urine output 2 Respiratory rate 3 Deep tendon reflexes 4 Level of consciousness

A client with severe preeclampsia is receiving magnesium sulfate therapy. What is the priority nursing assessment as the nurse monitors this client's response to therapy? 1 Urine output Correct2 Respiratory rate Incorrect3 Deep tendon reflexes 4 Level of consciousness Respiratory depression occurs with toxic levels of magnesium sulfate; calcium gluconate should be readily available to counteract toxicity. Although the other assessments (urine output, deep tendon reflexes, and level of consciousness) are important, none is the priority.

A client admitted with preeclampsia is receiving magnesium sulfate. Which assessment finding indicates that a therapeutic level of the medication has been reached? 1 Increased fetal activity 2 Decreased urine output 3 Deep tendon reflexes of +2 4 Respiratory rate of 12 breaths/min

A client admitted with preeclampsia is receiving magnesium sulfate. Which assessment finding indicates that a therapeutic level of the medication has been reached? 1 Increased fetal activity 2 Decreased urine output Correct3 Deep tendon reflexes of +2 Incorrect4 Respiratory rate of 12 breaths/min Hyperreflexia of severe preeclampsia is 3+ to 4+; therefore a deep tendon reflex of 2+, which is an active, expected reflex, indicates that a therapeutic level of the drug has been reached. A diminished reflex or absence of the reflex indicates that the serum magnesium level is too high. Because magnesium sulfate is a central nervous system depressant, a respiratory rate of 12 indicates that the serum magnesium level is too high. Alterations in fetal activity are not indicators of a therapeutic magnesium sulfate level. Oliguria is a sign of severe preeclampsia; diuresis is a therapeutic effect of magnesium sulfate administration.

A client at 36 weeks' gestation arrives at the prenatal clinic for a routine examination. The nurse determines that the client's blood pressure has increased from 102/60 to 134/88 mm Hg and becomes concerned she may be experiencing mild preeclampsia. What other sign of mild preeclampsia does the nurse anticipate? 1 Proteinuria of 1+ 2 Mild ankle edema 3 Episodes of dizziness on arising 4 Weight gain of 2 lb in 2 weeks

A client at 36 weeks' gestation arrives at the prenatal clinic for a routine examination. The nurse determines that the client's blood pressure has increased from 102/60 to 134/88 mm Hg and becomes concerned she may be experiencing mild preeclampsia. What other sign of mild preeclampsia does the nurse anticipate? Correct1 Proteinuria of 1+ Incorrect2 Mild ankle edema 3 Episodes of dizziness on arising 4 Weight gain of 2 lb in 2 weeks Preeclampsia is characterized by increased blood pressure and proteinuria. Mild ankle edema, known as physiological edema, is commonly seen in the third trimester. Although no longer a diagnostic criterion for preeclampsia, edema, evidenced by excessive weight gain or edema of the hands and face, may support the diagnosis. Episodes of dizziness on arising may occur in the third trimester because the enlarged uterus impedes venous return, causing supine hypotension. Weight gain of 2 lb in 2 weeks is expected during the third trimester.

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? 1 At 8 weeks but no later than 10 weeks 2 At 10 weeks but no later than 12 weeks 3 At 12 weeks but no later than 14 weeks 4 At 14 weeks but no later than 16 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? 1 At 8 weeks but no later than 10 weeks Correct2 At 10 weeks but no later than 12 weeks Incorrect3 At 12 weeks but no later than 14 weeks 4 At 14 weeks but no later than 16 weeks At 8 weeks but no later than 12 weeks is the ideal time for CVS; this gives the client time to consider other options if a problem is discovered. CVS is no longer performed before 10 weeks because it has been associated with digit reduction. At 12 weeks but no later than 14 weeks is too late for CVS. At 14 weeks but no later than 16 weeks is when genetic amniocentesis is performed.

A client with preeclampsia has 2+ protein in her urine and edema of the hands and face. For which signs or symptoms should the nurse assess the client to determine whether HELLP syndrome is developing? Select all that apply. 1 Headache 2 Constipation 3 Abdominal pain 4 Vaginal bleeding 5 Flulike symptoms

A client with preeclampsia has 2+ protein in her urine and edema of the hands and face. For which signs or symptoms should the nurse assess the client to determine whether HELLP syndrome is developing? Select all that apply. Correct1 Headache 2 Constipation Correct3 Abdominal pain Incorrect4 Vaginal bleeding Correct5 Flulike symptoms Headache, abdominal pain, and flulike symptoms are all indications of increasing severity of preeclampsia and HELLP syndrome. Constipation is not related to preeclampsia; neither is vaginal bleeding.

A client with mild preeclampsia is admitted to the high-risk prenatal unit because her blood pressure is progressively increasing. The nurse reviews the practitioner's prescriptions. What prescriptions does the nurse expect? Select all that apply. 1 Daily weight 2 Side-lying bed rest 3 2-gram-sodium diet 4 Deep tendon reflexes 5 Glucose tolerance test

A client with mild preeclampsia is admitted to the high-risk prenatal unit because her blood pressure is progressively increasing. The nurse reviews the practitioner's prescriptions. What prescriptions does the nurse expect? Select all that apply. Correct1 Daily weight Correct2 Side-lying bed rest 3 2-gram-sodium diet Correct4 Deep tendon reflexes Incorrect5 Glucose tolerance test Rapid weight gain is a sign of increasing edema. One liter of fluid is equal to 2.2 lb. Maintaining bedrest promotes fluid shift from the interstitial spaces to the intravascular space, which enhances blood flow to the kidneys and uterus; the side-lying position promotes placental perfusion. A 2 g/day sodium diet will deplete the circulating blood volume, limiting blood flow to the placenta. A moderate sodium intake (≤6 g) is permitted as long as the client is alert and has no nausea or indication of an impending seizure. Deep tendon reflexes should be monitored. Reflexes of +2 are indicative of mild preeclampsia; +4 indicates severe preeclampsia. There is no data indicating that a glucose tolerance test is needed.

A client with severe preeclampsia is receiving 2 g/hr of IV magnesium sulfate. For what sign confirming the effectiveness of this therapy should the nurse assess the client? 1 Increased blood pressure 2 Excessive urinary output 3 Decreased respiratory rate 4 Diminished knee-jerk reflex

A client with severe preeclampsia is receiving 2 g/hr of IV magnesium sulfate. For what sign confirming the effectiveness of this therapy should the nurse assess the client? 1 Increased blood pressure 2 Excessive urinary output Incorrect3 Decreased respiratory rate Correct4 Diminished knee-jerk reflex Magnesium sulfate is used to depress central nervous system (CNS) irritability; diminished reflexes indicate the medication's effectiveness. Magnesium sulfate is a CNS depressant; a decrease in blood pressure, an increase in urinary output, and diminished reflexes all indicate that the magnesium sulfate has been effective. Magnesium sulfate is not a diuretic; it acts as an anticonvulsant. A slowed respiratory rate is a sign of toxicity.

A client with worsening preeclampsia is admitted to the high-risk unit, and the nurse manager places her in a private room. A nonstimulating environment is important for a client with increased cerebral irritability because it: 1 Limits intracellular fluid reabsorption 2 Reduces the severity of frontal headaches 3 Decreases the probability of generalized seizures 4 Prolongs the duration of action of hypotensive medications

A client with worsening preeclampsia is admitted to the high-risk unit, and the nurse manager places her in a private room. A nonstimulating environment is important for a client with increased cerebral irritability because it: 1 Limits intracellular fluid reabsorption Incorrect2 Reduces the severity of frontal headaches Correct3 Decreases the probability of generalized seizures 4 Prolongs the duration of action of hypotensive medications Even minimal sensory stimuli can trigger exaggerated cerebral responses such as seizures; therefore a nonstimulating environment is therapeutic. Intracellular volume should be increased during pregnancy, so limiting the intracellular reabsorption would not be desirable. A nonstimulating environment does not reduce the severity of headaches resulting from hypertension. A nonstimulating environment has no relation to the duration of action of antihypertensive drugs.

A client's severe preeclampsia develops into eclampsia. After the seizure, the client has a temperature of 102° F (39° C). What does the nurse suspect as the cause of the temperature? 1 Excessive muscular activity 2 Development of a systemic infection 3 Dehydration caused by rapid fluid loss 4 Irregularity in the cerebral thermal center

A client's severe preeclampsia develops into eclampsia. After the seizure, the client has a temperature of 102° F (39° C). What does the nurse suspect as the cause of the temperature? 1 Excessive muscular activity Incorrect2 Development of a systemic infection 3 Dehydration caused by rapid fluid loss Correct4 Irregularity in the cerebral thermal center Increased electrical charges in the brain during a seizure may disturb the cerebral thermoregulation center in the hypothalamus. Excessive muscular activity usually causes perspiration, leading to a drop in body temperature. One increased reading is not a conclusive sign of infection. Rapid fluid loss does not occur during a seizure; clients with preeclampsia have fluid retention.

A nurse determines that dietary teaching for a client with mild preeclampsia has been effective when the client says: 1 "I should follow a diet that includes high sodium and calories and low protein." 2 "I should follow a diet that includes low sodium and calories and high protein." 3 "I should follow a diet that includes unrestricted sodium and lots of calories and protein." 4 "I should follow a diet that includes moderate sodium and low calories with ample protein."

A nurse determines that dietary teaching for a client with mild preeclampsia has been effective when the client says: 1 "I should follow a diet that includes high sodium and calories and low protein." 2 "I should follow a diet that includes low sodium and calories and high protein." Correct3 "I should follow a diet that includes unrestricted sodium and lots of calories and protein." Incorrect4 "I should follow a diet that includes moderate sodium and low calories with ample protein." Low protein is contraindicated because protein is necessary for fetal growth; there is no reason to increase sodium. Lowering the intake of calories and sodium is detrimental to both fetus and mother. One of the many factors believed to contribute to the development of preeclampsia is inadequate nutrition. Therefore recommendations call for a nutritious diet that includes unrestricted sodium, high protein, and a sufficient number of calories. Additional intake of 300 calories/day is required during pregnancy.

A nurse in the prenatal clinic determines the fundal height of a healthy multipara at 16 weeks' gestation to be one fingerbreadth above the umbilicus. What should the nurse do next? 1 Check for two distinct fetal heart rates. 2 Ascertain the birth weights of the client's other children. 3 Inform the client that she may be mistaken about her due date. 4 Instruct the client about appropriate weight gain during pregnancy.

A nurse in the prenatal clinic determines the fundal height of a healthy multipara at 16 weeks' gestation to be one fingerbreadth above the umbilicus. What should the nurse do next? Correct1 Check for two distinct fetal heart rates. 2 Ascertain the birth weights of the client's other children. Incorrect3 Inform the client that she may be mistaken about her due date. 4 Instruct the client about appropriate weight gain during pregnancy. Twins should be suspected with a faster-than-expected increase in fundal height; the nurse should assess the client for two distinct heartbeats. Fundal height, not the size of the fetus, should prompt the nurse to suspect a multiple pregnancy. The due date cannot be determined until ultrasonography has been performed. Weight gain does not influence the height of the fundus.

A nurse is assessing a pregnant client at the end of her second trimester. What clinical finding causes the nurse to suspect that the client has preeclampsia? 1 Progressive weight gain 2 Two samples showing proteinuria 3 Dependent ankle edema during the late afternoon 4 Blood pressure fluctuations on three successive measurements

A nurse is assessing a pregnant client at the end of her second trimester. What clinical finding causes the nurse to suspect that the client has preeclampsia? 1 Progressive weight gain Correct2 Two samples showing proteinuria Incorrect3 Dependent ankle edema during the late afternoon 4 Blood pressure fluctuations on three successive measurements The presence of proteinuria in a 24-hour sample or two successive random specimens together with hypertension is indicative of preeclampsia. A gradual weight gain is expected as the uterus and fetus enlarge; abrupt weight gain totaling more than 2 kg (4.4 lb) in a week may be reflective of preeclampsia. Dependent ankle edema during late afternoon is a common occurrence during the second half of pregnancy and is not a reliable sign of preeclampsia, but when dependent edema does not resolve with 12 hours of bedrest, preeclampsia may be present. Continued increase of blood pressure, not fluctuation in readings, is related to preeclampsia.

A pregnant client is found to have gestational hypertension. She tells the nurse that she has been following the recommended pregnancy diet. What should the nurse teach her about her diet at this time? 1 Limit proteins. 2 Change nothing. 3 Restrict sodium. 4 Increase carbohydrates.

A pregnant client is found to have gestational hypertension. She tells the nurse that she has been following the recommended pregnancy diet. What should the nurse teach her about her diet at this time? 1 Limit proteins. Correct2 Change nothing. 3 Restrict sodium. Incorrect4 Increase carbohydrates. The recommended diet for a client with gestational hypertension is the same as that recommended for a normotensive pregnant client. Protein intake should be increased during pregnancy. Pregnant clients with gestational hypertension should not restrict their sodium intake or increase their carbohydrate intake over the recommended amount.

A pregnant client with type 1 diabetes is visiting the prenatal clinic for the first time. What is the primary long-term goal for this client? 1 Insulin dosages will decrease. 2 Dietary fluctuations will be minimized. 3 The blood glucose level will remain stable. 4 Pregnancy will end with the birth of a healthy infant.

A pregnant client with type 1 diabetes is visiting the prenatal clinic for the first time. What is the primary long-term goal for this client? 1 Insulin dosages will decrease. 2 Dietary fluctuations will be minimized. Incorrect3 The blood glucose level will remain stable. Correct4 Pregnancy will end with the birth of a healthy infant. In any prenatal situation, the goal is an optimally healthy mother and newborn, no matter what other factors are involved. Insulin is given as necessary to maintain an acceptable glucose level. Minimizing dietary fluctuations is important, but it is not the priority. Stabilizing the blood glucose level is an ongoing goal, not a long-term goal.

A woman has just received the news that she is pregnant. She is ambivalent about the pregnancy because she had planned to go back to work when her youngest child started school next year. What developmental task of pregnancy must the woman accomplish in the first trimester of pregnancy? 1 Recognize her ambivalence. 2 Accept that she is pregnant. 3 Prepare for the birth of the baby. 4 Recognize the fetus as an individual separate from the mother.

A woman has just received the news that she is pregnant. She is ambivalent about the pregnancy because she had planned to go back to work when her youngest child started school next year. What developmental task of pregnancy must the woman accomplish in the first trimester of pregnancy? Incorrect1 Recognize her ambivalence. Correct2 Accept that she is pregnant. 3 Prepare for the birth of the baby. 4 Recognize the fetus as an individual separate from the mother. The developmental task of the first trimester is accepting the reality of the pregnancy. Ambivalence is a normal emotion associated with early pregnancy. It is not a developmental task. Preparing for the birth is a developmental task of the third trimester. Recognizing the fetus as a separate individual from the mother is a developmental task of the second trimester.

A primigravida at 8 weeks' gestation is visiting the prenatal clinic for the first time. What should an assessment reveal at this time? 1 Lightening 2 Quickening 3 Goodell's sign 4 Braxton Hicks sign

A primigravida at 8 weeks' gestation is visiting the prenatal clinic for the first time. What should an assessment reveal at this time? Incorrect1 Lightening 2 Quickening Correct3 Goodell's sign 4 Braxton Hicks sign Goodell's sign, or softening of the cervix, occurs at 8 to 9 weeks' gestation. Lightening or settling of the fetal presenting part into the pelvis usually occurs about 2 weeks before the onset of labor in nulliparas. Quickening refers to fetal movement, usually perceived by the mother between the 16th and 20th weeks of gestation. Braxton Hicks (preparatory) contractions consist of intermittent cramplike contractions that start at the 16th week and grow stronger and more frequent as pregnancy progresses.

A client tells a nurse in the prenatal clinic that she has vaginal staining but no pain. Her history reveals amenorrhea for the last 2 months and pregnancy confirmation after her first missed period. What type of abortion is suspected? 1 Missed 2 Inevitable 3 Threatened 4 Incomplete

A client tells a nurse in the prenatal clinic that she has vaginal staining but no pain. Her history reveals amenorrhea for the last 2 months and pregnancy confirmation after her first missed period. What type of abortion is suspected? Incorrect1 Missed 2 Inevitable Correct3 Threatened 4 Incomplete Spotting in the first trimester may indicate that the client is having a threatened abortion; any client with the possibility of hemorrhage should not be left alone, so her admission to the hospital helps ensure her safety. A missed abortion may not cause any outward signs or symptoms, except that the signs of pregnancy disappear. An inevitable abortion can be confirmed only if vaginal examination reveals cervical dilation. With an incomplete abortion some, but not all, of the products of conception have been expelled.

A client with mild preeclampsia is being treated on an outpatient basis. Three days of bedrest is prescribed. What position should the nurse encourage the client to maintain while in bed? 1 Supine 2 Side-lying 3 Semi-Fowler 4 Slight Trendelenburg

A client with mild preeclampsia is being treated on an outpatient basis. Three days of bedrest is prescribed. What position should the nurse encourage the client to maintain while in bed? 1 Supine Correct2 Side-lying Incorrect3 Semi-Fowler 4 Slight Trendelenburg The side-lying position improves venous return to the heart and increases stroke volume and cardiac output. The supine position impedes venous return and may cause supine hypotension syndrome. The semi-Fowler position does not promote optimal venous return to the heart. A slight Trendelenburg position will cause dyspnea because of increased pressure on the diaphragm from the abdominal organs and fetus.

A client with mild preeclampsia is instructed to rest at home. She asks the nurse, "What do you mean by rest?" What is the most appropriate response? 1 "What do you consider rest?" 2 "Take three or four naps a day." 3 "Stay off your feet as much as possible." 4 "Would you like to know what I think it means?"

A client with mild preeclampsia is instructed to rest at home. She asks the nurse, "What do you mean by rest?" What is the most appropriate response? Correct1 "What do you consider rest?" Incorrect2 "Take three or four naps a day." 3 "Stay off your feet as much as possible." 4 "Would you like to know what I think it means?" Responding by asking what the client considers rest reflects the client's statement and permits clarification, which will yield information that can be used in planning. Recommending three or four naps each day is too specific an interpretation of a rest requirement; there is more to maintaining rest than naps. There is also more to maintaining rest than staying off one's feet; this response is a vague interpretation of a rest requirement. What the nurse thinks rest means does not provide a clear picture of what the client interprets as rest.

A woman in labor with no known complications rings the call bell to say she has had a "gush" from her vagina. The nurse identifies a large amount of bright-red blood. In what order should the nurse perform these interventions? 1. Call for help. 2. Increase the maintenance IV infusion rate. 3. Start oxygen at 8 L/mask. 4. Check fetal heart tones. 5. Call the health care provider.

A woman in labor with no known complications rings the call bell to say she has had a "gush" from her vagina. The nurse identifies a large amount of bright-red blood. In what order should the nurse perform these interventions? Correct 1. Call for help. Incorrect 2. Increase the maintenance IV infusion rate. Incorrect 3. Start oxygen at 8 L/mask. Incorrect 4. Check fetal heart tones. Correct 5. Call the health care provider. Calling for help will allow all other actions to be completed more quickly. This is especially critical during an emergency situation. Next the nurse should assess the fetal heart tones to identify the effect of the bleeding on the fetus, because the fetus often shows signs of distress before the mother does. After checking the fetal heart tone the nurse should increase the IV infusion rate, which should take only seconds and can have a significant effect on circulation. Oxygen can be instituted after the IV infusion rate has been increased; this will be of benefit to both mother and fetus. Calling the primary health care provider is important, but instituting lifesaving measures takes precedence.

A woman visits the prenatal clinic because an over-the-counter pregnancy test has rendered a positive result. After the initial examination verifies the pregnancy, the nurse explains some of the metabolic changes that occur during the first trimester of pregnancy. Select all that apply. 1 Sleep needs increase. 2 Fluid retention increases. 3 Body temperature decreases. 4 Calcium requirements increase. 5 The need for carbohydrates decreases.

A woman visits the prenatal clinic because an over-the-counter pregnancy test has rendered a positive result. After the initial examination verifies the pregnancy, the nurse explains some of the metabolic changes that occur during the first trimester of pregnancy. Select all that apply. Correct1 Sleep needs increase. Correct2 Fluid retention increases. 3 Body temperature decreases. Correct4 Calcium requirements increase. 5 The need for carbohydrates decreases. Estrogen increases the secretion of corticosteroids, which decrease the basal metabolic rate, resulting in fatigue. Sodium is retained, and fluid retention increases to meet total needs. During the first trimester approximately 1.2 g of calcium is needed each day; this need continues throughout pregnancy as the fetal skeleton is being formed. Body temperature increases because of the increased metabolism related to the growth of the fetus. Carbohydrate needs increase because the secretion of insulin by the pancreas is increased; however, insulin is destroyed rapidly by the placenta. The stress of pregnancy may precipitate gestational diabetes.

What is the priority nursing intervention for a client with severe preeclampsia? 1 Isolating her in a dark room 2 Maintaining her in a supine position 3 Encouraging her to drink clear fluids 4 Protecting her against extraneous stimuli

What is the priority nursing intervention for a client with severe preeclampsia? Incorrect1 Isolating her in a dark room 2 Maintaining her in a supine position 3 Encouraging her to drink clear fluids Correct4 Protecting her against extraneous stimuli Bedrest, a quiet room, and minimal stimulation are essential in reducing the risk of seizures. The client will need constant observation and should not be isolated. Maintaining her in a supine position may cause temporary supine hypotension and resultant fetal bradycardia; it also may result in aspiration if a seizure occurs. Fluid intake depends on the client's condition and the health care provider's prescriptions.

A 16-year-old primigravida at 36 weeks' gestation visits the prenatal clinic for a routine examination. Her blood pressure is significantly increased, and there is 1+ proteinuria. The client's blood pressure had been averaging 92/70 mm Hg during her previous prenatal visits. What is the lowest blood pressure that should cause the nurse to become concerned? 1 100/76 mm Hg 2 108/80 mm Hg 3 110/84 mm Hg 4 122/86 mm Hg

A 16-year-old primigravida at 36 weeks' gestation visits the prenatal clinic for a routine examination. Her blood pressure is significantly increased, and there is 1+ proteinuria. The client's blood pressure had been averaging 92/70 mm Hg during her previous prenatal visits. What is the lowest blood pressure that should cause the nurse to become concerned? 1 100/76 mm Hg Incorrect2 108/80 mm Hg 3 110/84 mm Hg Correct4 122/86 mm Hg An increase of 30 mm Hg systolic and/or 15 mm Hg diastolic has been removed from the official definition of preeclampsia. The new definition encourages practitioners to consider the total situation in determining a diagnosis of preeclampsia. The proteinuria is a sign of mild preeclampsia; the increase in blood pressure should cause concern and warrant close monitoring. A mild increase is within the acceptable increase of blood pressure during pregnancy.

A nurse is monitoring a client with severe preeclampsia for the onset of eclampsia. What clinical finding indicates an impending seizure? 1 Persistent headache with blurred vision 2 Epigastric pain with nausea and vomiting 3 Spots and flashes of light before the eyes 4 Rolling of the eyes to one side with a fixed stare

A nurse is monitoring a client with severe preeclampsia for the onset of eclampsia. What clinical finding indicates an impending seizure? Incorrect1 Persistent headache with blurred vision 2 Epigastric pain with nausea and vomiting 3 Spots and flashes of light before the eyes Correct4 Rolling of the eyes to one side with a fixed stare Rolling of the eyes to one side with a fixed stare is a sign of central nervous system involvement that the nurse can see without obtaining subjective data from the client. It is a sign of an impending seizure. Persistent headache with blurred vision, epigastric pain with nausea and vomiting, and spots and flashes of light before the eyes are all clinical manifestations of severe preeclampsia, not eclampsia.

During a client's first visit to the prenatal clinic, a nurse discusses a pregnancy diet. The client states that her mother told her that she should restrict her salt intake. What is the nurse's best response? 1 "Your mother is always correct. You should use less salt to prevent swelling during pregnancy." 2 "Because you need salt to maintain body water balance, it is not restricted. Just eat a well-balanced diet." 3 "Salt is an essential nutrient that is naturally reduced by the body's estrogen. There's no reason to restrict salt in your diet." 4 "We no longer recommend that salt intake be as restricted as much as in the past, but you still shouldn't add salt to your food."

During a client's first visit to the prenatal clinic, a nurse discusses a pregnancy diet. The client states that her mother told her that she should restrict her salt intake. What is the nurse's best response? 1 "Your mother is always correct. You should use less salt to prevent swelling during pregnancy." Correct2 "Because you need salt to maintain body water balance, it is not restricted. Just eat a well-balanced diet." Incorrect3 "Salt is an essential nutrient that is naturally reduced by the body's estrogen. There's no reason to restrict salt in your diet." 4 "We no longer recommend that salt intake be as restricted as much as in the past, but you still shouldn't add salt to your food." Sodium is needed to maintain body water balance; sodium requirements increase slightly during pregnancy to accommodate the increased blood volume. A healthy pregnant woman should not limit her sodium intake. Using less salt could be detrimental to the client's health. Sodium, although essential, is not a nutrient but a mineral. There are no restrictions on salt intake during a healthy pregnancy without compelling indications.

During a routine examination at the prenatal clinic the nurse notes significant increases in the client's blood pressure and edema of the face and hands. The diagnostic criterion for preeclampsia is a blood pressure of 140/90 mm Hg, but what is the lowest blood pressure that should prompt the nurse to monitor the client for other signs and symptoms of preeclampsia? 1 130/85 mm Hg 2 125/80 mm Hg 3 115/75 mm Hg 4 110/70 mm Hg

During a routine examination at the prenatal clinic the nurse notes significant increases in the client's blood pressure and edema of the face and hands. The diagnostic criterion for preeclampsia is a blood pressure of 140/90 mm Hg, but what is the lowest blood pressure that should prompt the nurse to monitor the client for other signs and symptoms of preeclampsia? Correct1 130/85 mm Hg 2 125/80 mm Hg 3 115/75 mm Hg Incorrect4 110/70 mm Hg A blood pressure of 130/85 mm Hg is a concern even though it does not meet the diagnostic criterion of 140/90 mm Hg, especially when there are other signs of preeclampsia, such as edema; further assessment and possible treatment are warranted. Although 130/85 mm Hg is insufficient to meet the diagnostic criterion of preeclampsia, it is not the lowest one to warrant further investigation. A reading of 115/75 mm Hg is insufficient to indicate a hypertensive disorder of pregnancy, as is a reading of 110/70 mm Hg. The most significant finding is the increase in the client's blood pressure from previous visits.

On her first visit to the prenatal clinic a client with rheumatic heart disease asks the nurse whether she has special nutritional needs. What supplements in addition to the regular pregnancy diet and prenatal vitamin and minerals will she need? Select all that apply. 1 Iron 2 Calcium 3 Folic acid 4 Vitamin C 5 Vitamin B12

On her first visit to the prenatal clinic a client with rheumatic heart disease asks the nurse whether she has special nutritional needs. What supplements in addition to the regular pregnancy diet and prenatal vitamin and minerals will she need? Select all that apply. Correct1 Iron 2 Calcium Correct3 Folic acid 4 Vitamin C Incorrect5 Vitamin B12 Because pregnant women with heart disease are more likely to have anemia, there may be an additional need for iron and also for folic acid. If the pregnant client with heart disease is eating the recommended pregnancy diet and taking prenatal vitamin and mineral supplements, there is no additional need for calcium, vitamin C, and vitamin B12.

What are the primary nursing interventions when a client is receiving an infusion of magnesium sulfate for severe preeclampsia? Select all that apply. 1 Restricting visitors 2 Limiting fluid intake 3 Preparing for a precipitate birth 4 Maintaining a quiet environment 5 Keeping magnesium gluconate at the bedside

What are the primary nursing interventions when a client is receiving an infusion of magnesium sulfate for severe preeclampsia? Select all that apply. Correct1 Restricting visitors 2 Limiting fluid intake Incorrect3 Preparing for a precipitate birth Correct4 Maintaining a quiet environment 5 Keeping magnesium gluconate at the bedside Visitors should be limited to significant others to reduce excessive stimuli that could precipitate a seizure. A quiet room helps reduce stimuli and therefore the risk of seizures. Fluid intake should not be restricted. A precipitous birth is not a usual side effect of magnesium sulfate therapy. Calcium gluconate, not magnesium gluconate, is the antagonist for magnesium sulfate and should be readily available if signs of toxicity appear.

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)? 1 July 8 2 January 7 3 December 7 4 December 24

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)? 1 July 8 Correct2 January 7 Incorrect3 December 7 4 December 24 The date is January 7 of the following year. To use Nägele's rule, subtract 3 months from the first day of the last menstrual period and add 7 days and one year. Three months were added rather than subtracted, to yield a date of July 8. December 7 is too early, and 7 days were subtracted, rather than added, for the December 24 date.

A client at 7 weeks' gestation tells the nurse in the prenatal clinic that she has been bothered by episodes of nausea, but no vomiting, throughout the day. What should the nurse recommend? Select all that apply. 1 Focus on and repeat a rhythmic chant. 2 Sit upright for 30 minutes after meals. 3 Take low-sodium antacids after meals. 4 Drink carbonated beverages with meals. 5 Eat small, frequent meals and eat dry crackers in between.

A client at 7 weeks' gestation tells the nurse in the prenatal clinic that she has been bothered by episodes of nausea, but no vomiting, throughout the day. What should the nurse recommend? Select all that apply. Focus on and repeat a rhythmic chant. 2 Sit upright for 30 minutes after meals. Incorrect3 Take low-sodium antacids after meals. 4 Drink carbonated beverages with meals. 5 Eat small, frequent meals and eat dry crackers in between.

A 37-year-old client with type 1 diabetes and good glycemic control is pregnant for the third time. Her first child is 4 years old, and her second pregnancy resulted in a stillbirth. She is seen in the antepartum testing unit for a nonstress test (NST) at 33 weeks' gestation. What are the primary risk factors in the client's history that indicate a need for the NST? Select all that apply. 1 Age greater than 35 years 2 The risk for placenta previa 3 The risk for placental insufficiency 4 A history of stillbirth from her last pregnancy 5 Maternal history of hypertension

A 37-year-old client with type 1 diabetes and good glycemic control is pregnant for the third time. Her first child is 4 years old, and her second pregnancy resulted in a stillbirth. She is seen in the antepartum testing unit for a nonstress test (NST) at 33 weeks' gestation. What are the primary risk factors in the client's history that indicate a need for the NST? Select all that apply. Incorrect1 Age greater than 35 years 2 The risk for placenta previa Correct3 The risk for placental insufficiency Correct4 A history of stillbirth from her last pregnancy Correct5 Maternal history of hypertension Pregnant women with diabetes are prone to placental insufficiency, which can threaten fetal well-being. In addition, history of stillbirth is also an indication for NST. In addition, maternal conditions that can affect placental perfusion such as hypertension is an indication for a NST. Advanced maternal age alone is not an indicator for an NST; although advanced maternal age increases the risk of placenta previa, it is not the primary reason for having an NST.

A client at 16 weeks' gestation calls the nurse at the prenatal clinic and states that her partner just told her that he has genital herpes. What should the nurse include when teaching the client about sexual activity? 1 Condoms must be used when the couple is having intercourse. 2 Sexual abstinence should be practiced during the last 6 weeks. 3 It will be necessary to refrain from sexual contact during pregnancy. 4 Meticulous cleaning of the vaginal area after intercourse is essential.

A client at 16 weeks' gestation calls the nurse at the prenatal clinic and states that her partner just told her that he has genital herpes. What should the nurse include when teaching the client about sexual activity? Incorrect1 Condoms must be used when the couple is having intercourse. Correct2 Sexual abstinence should be practiced during the last 6 weeks. 3 It will be necessary to refrain from sexual contact during pregnancy. 4 Meticulous cleaning of the vaginal area after intercourse is essential. Abstinence during the 4 to 6 weeks before term is the best way to avoid contracting the virus and having an outbreak before the birth. Because the herpes virus is smaller than the pores of a condom, this type of protection has limited effectiveness. Abstinence is necessary only when disease symptoms are present in the partner and during the last 4 to 6 weeks of pregnancy. Washing is not sufficient to prevent contraction of this virus; contact already has been made.

A client at 36 weeks' gestation is admitted to the high-risk unit with the diagnosis of severe preeclampsia, and antiseizure therapy is instituted. A fetal monitor and an electronic blood pressure machine are applied. What complication of severe preeclampsia requires diligent monitoring of the blood pressure? 1 Stroke 2 Hemorrhage 3 Precipitous labor 4 Disseminated intravascular coagulation

A client at 36 weeks' gestation is admitted to the high-risk unit with the diagnosis of severe preeclampsia, and antiseizure therapy is instituted. A fetal monitor and an electronic blood pressure machine are applied. What complication of severe preeclampsia requires diligent monitoring of the blood pressure? Correct1 Stroke Incorrect2 Hemorrhage 3 Precipitous labor 4 Disseminated intravascular coagulation The likelihood of a stroke or brain attack increases with a rising blood pressure reading. The degree of hypertension is not associated with hemorrhage. The course of labor is not affected by blood pressure changes except in the presence of abruptio placentae. Fluctuations in blood pressure do not affect the status of clotting factors.

A client at 6 weeks' gestation who has type 1 diabetes is attending the prenatal clinic for the first time. The nurse explains that during the first trimester insulin requirements may decrease because: 1 Body metabolism is sluggish in the first trimester. 2 Morning sickness may lead to decreased food intake. 3 Fetal requirements of glucose in this period are minimal. 4 Hormones of pregnancy increase the body's need for insulin.

A client at 6 weeks' gestation who has type 1 diabetes is attending the prenatal clinic for the first time. The nurse explains that during the first trimester insulin requirements may decrease because: 1 Body metabolism is sluggish in the first trimester. Correct2 Morning sickness may lead to decreased food intake. 3 Fetal requirements of glucose in this period are minimal. Incorrect4 Hormones of pregnancy increase the body's need for insulin. Morning sickness, a common occurrence during pregnancy, contributes to decreased food intake; the insulin dosage must be reduced to prevent hypoglycemia. The body's metabolism increases during pregnancy because the needs of the fetus, as well as those of the mother, must be met. Rapid organogenesis requires large amounts of glucose. During the first trimester the blood glucose level is reduced and glycemic control is enhanced; glycemic control is more difficult to maintain later in the pregnancy.

A client calls the nurse-midwife in the prenatal clinic, complaining of sharp shooting pains in the lower abdomen and vaginal spotting. She is met at the emergency department of the hospital, where a diagnosis of ruptured tubal pregnancy is made. At what stage of the pregnancy does the nurse suspect the initial symptoms began? 1 At 16 weeks' gestation 2 Immediately after implantation 3 About 6 weeks into the pregnancy 4 Toward the end of the second trimester

A client calls the nurse-midwife in the prenatal clinic, complaining of sharp shooting pains in the lower abdomen and vaginal spotting. She is met at the emergency department of the hospital, where a diagnosis of ruptured tubal pregnancy is made. At what stage of the pregnancy does the nurse suspect the initial symptoms began? 1 At 16 weeks' gestation Incorrect2 Immediately after implantation Correct3 About 6 weeks into the pregnancy 4 Toward the end of the second trimester At this time the fallopian tube is unable to expand to the size of the growing products of conception. Tubal pregnancies are unable to advance to this stage because of the tube's inability to expand with the growing products of conception. The size of the fertilized egg at this time is minuscule and will cause no problem. Tubal pregnancies are unable to advance to this stage because of the tube's inability to expand with the growing products of conception.

A client in her second trimester is at the prenatal clinic for a routine visit. While listening to the fetal heart, the nurse hears a heartbeat at the rate of 136 in the right upper quadrant and also at the midline below the umbilicus. What are the sources of these two sounds? 1 Heart tones of two fetuses 2 Maternal and fetal heart tones 3 Funic souffle and fetal heart rate 4 Maternal heart rate with a uterine souffle

A client in her second trimester is at the prenatal clinic for a routine visit. While listening to the fetal heart, the nurse hears a heartbeat at the rate of 136 in the right upper quadrant and also at the midline below the umbilicus. What are the sources of these two sounds? 1 Heart tones of two fetuses 2 Maternal and fetal heart tones Correct3 Funic souffle and fetal heart rate Incorrect4 Maternal heart rate with a uterine souffle The funic souffle is the sound of blood rushing through the fetal umbilical cord and is therefore the same rate as the fetal heart rate. Twins will have different heart rates. The maternal heart rate should be much slower than the fetal heart rate. The uterine souffle, caused by blood moving through the maternal side of the placenta, is the same as the mother's heart rate, which should be less than 100.

A client is admitted to the labor and delivery unit for labor augmentation with oxytocin (Pitocin). She is postterm at 40 weeks +3 days and is a gestational diabetic. The cervix is dilated 2 cm and 90% effaced. The health care provider performed an amniotomy to permit internal electronic fetal monitoring. The amniotic fluid is pale yellow and moderate in amount. Immediately after the amniotomy the nurse will assess the fetal heart rate for at least 1 full minute for signs of: 1 Infection 2 Uterine atony 3 Uterine cord prolapse 4 Maternal hypertension

A client is admitted to the labor and delivery unit for labor augmentation with oxytocin (Pitocin). She is postterm at 40 weeks +3 days and is a gestational diabetic. The cervix is dilated 2 cm and 90% effaced. The health care provider performed an amniotomy to permit internal electronic fetal monitoring. The amniotic fluid is pale yellow and moderate in amount. Immediately after the amniotomy the nurse will assess the fetal heart rate for at least 1 full minute for signs of: Incorrect1 Infection 2 Uterine atony Correct3 Uterine cord prolapse 4 Maternal hypertension The umbilical cord can slip down during after the amniotomy and be compressed between the fetal presenting part and the woman's pelvis. Cord compression is suspected if deep or prolonged variable decelerations occur during contractions or if persistent bradycardia is present after contractions. Uterine atony and maternal hypertension are not assessed with the use of electronic fetal monitoring. It is important to monitor the client for possible infection, but the risk is low immediately after amniotomy; it increases with the interval between membrane rupture and birth.

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? 1 Fetal growth 2 Fluid retention 3 Metabolic alterations 4 Increased blood volume

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? Correct1 Fetal growth 2 Fluid retention 3 Metabolic alterations Incorrect4 Increased blood volume Weight gain during pregnancy averages 25 to 35 lb (11.3 to 15.8 kg); of this amount, the fetus accounts for 7 to 8 lb (3.2 to 3.6 kg), or approximately 30%. Fluid retention accounts for 20% to 25% of weight gain. Metabolic alterations do not cause weight gain. Increased blood volume accounts for 12% to 16% of weight gain.

A client making her first visit to the prenatal clinic asks which immunization can be administered safely to a pregnant woman. What should the nurse tell her? 1 Rubella (measles) 2 Rubeola (German measles) 3 Inactive influenza 4 Varicella (chicken pox) The inactive influenza and diphtheria, tetanus, pertussis (dTAP) can be safely administered during the first trimester of pregnancy, although dTAP is recommended at 27 to 36 weeks' gestation to provide immunity to the mother and infant. Rubella (measles) and rubeola (German measles) are both live viruses that should never be administered during pregnancy because they can have teratogenic effects. The inactivated influenza vaccine may be given because it is a killed virus vaccine and will not have a teratogenic effect.

A client making her first visit to the prenatal clinic asks which immunization can be administered safely to a pregnant woman. What should the nurse tell her? Incorrect1 Rubella (measles) 2 Rubeola (German measles) Correct3 Inactive influenza 4 Varicella (chicken pox) The inactive influenza and diphtheria, tetanus, pertussis (dTAP) can be safely administered during the first trimester of pregnancy, although dTAP is recommended at 27 to 36 weeks' gestation to provide immunity to the mother and infant. Rubella (measles) and rubeola (German measles) are both live viruses that should never be administered during pregnancy because they can have teratogenic effects. The inactivated influenza vaccine may be given because it is a killed virus vaccine and will not have a teratogenic effect.

A client with chronic hypertension and superimposed preeclampsia gives birth at 39 weeks' gestation to a 4-lb 12-oz infant. What condition does the nurse anticipate when assessing this infant? 1 Prematurity 2 Cardiac anomalies 3 Respiratory infection 4 Intrauterine growth restriction

A client with chronic hypertension and superimposed preeclampsia gives birth at 39 weeks' gestation to a 4-lb 12-oz infant. What condition does the nurse anticipate when assessing this infant? 1 Prematurity Incorrect2 Cardiac anomalies 3 Respiratory infection Correct4 Intrauterine growth restriction The pathological changes of maternal chronic vascular disease cause uteroplacental insufficiency; vasospasms diminish fetal oxygenation and nutrition, which lead to slow fetal growth. Prematurity is defined as gestational age of less than 37 weeks. There is no greater incidence of cardiac anomalies in infants with intrauterine growth restriction. Neither is there a greater incidence of infection in infants with low birthweight; however, they may have a lower resistance to infection.

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? 1 "Let's explore your available current support and opportunities for child care." 2 "Are you worried about how you'll be able to handle this problem?" 3 "You can get a neighbor to help out, and your husband can do the housework in the evening." 4 "You can prepare light meals and the children can go to nursery school a few hours each day."

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? Correct1 "Let's explore your available current support and opportunities for child care." Incorrect2 "Are you worried about how you'll be able to handle this problem?" 3 "You can get a neighbor to help out, and your husband can do the housework in the evening." 4 "You can prepare light meals and the children can go to nursery school a few hours each day." Asking the client how she plans to manage with getting child care help addresses the problem directly while providing an opportunity for the client to examine her options. The therapeutic regimen includes bedrest and peace of mind; these can best be fulfilled if the children are cared for adequately. Asking whether the client is worried about how she will be able to handle this problem explores feelings but does not include a therapeutic regimen. Stating that the client can get a neighbor to help out and have the husband do the housework in the evening is giving a solution rather than exploring the situation with the client. Complete bedrest has been prescribed, and the suggestion of nursery school for the children assumes that the client is able to afford it.

A client with preeclampsia is to receive a magnesium sulfate infusion, and the nurse assesses the client's status to obtain baseline information. Which assessments are necessary? Select all that apply. 1 Patellar reflex 2 Output of urine 3 Respiratory rate 4 Body temperature 5 Urine specific gravity

A client with preeclampsia is to receive a magnesium sulfate infusion, and the nurse assesses the client's status to obtain baseline information. Which assessments are necessary? Select all that apply. Correct1 Patellar reflex Correct2 Output of urine Correct3 Respiratory rate 4 Body temperature Incorrect5 Urine specific gravity A baseline measurement of the patellar reflex should be obtained because magnesium sulfate is a central nervous system depressant; an absence of patellar reflexes indicates magnesium sulfate toxicity. Magnesium sulfate is excreted by way of the kidneys; adequate urine output is necessary to prevent toxicity. Magnesium sulfate is a central nervous system depressant; a slowed respiratory rate is a sign of magnesium sulfate toxicity. Magnesium sulfate does not affect body temperature. The urine specific gravity test is not used before, during, or after magnesium sulfate therapy.

A multipara client with a history of gestational hypertension and previous history of abruption is in the transition phase of labor. Suddenly the electronic fetal monitor shows fetal bradycardia and a change is seen in the contour of client's abdomen. What is the nurse's first priority? 1 Checking the client's vital signs 2 Placing the client on her left side 3 Immediately placing an internal scalp electrode on the fetus 4 Alerting others about the need for immediate cesarean delivery

A multipara client with a history of gestational hypertension and previous history of abruption is in the transition phase of labor. Suddenly the electronic fetal monitor shows fetal bradycardia and a change is seen in the contour of client's abdomen. What is the nurse's first priority? 1 Checking the client's vital signs Incorrect2 Placing the client on her left side 3 Immediately placing an internal scalp electrode on the fetus Correct4 Alerting others about the need for immediate cesarean delivery Another nurse should be asked to get the operating room staff, obstetrician, anesthesiologist, neonatal team ready; the client's nurse should monitor vital signs, watch for signs of hypotension and tachycardia, insert an indwelling catheter, and stay as calm as possible while explaining to client that the staff are working together to bring about a safe outcome. The client is exhibiting signs of uterine rupture. An emergency cesarean birth is the priority. Vital signs may be checked immediately after another nurse has been asked to bring the team together. Placing an internal fetal monitor is a poor use of valuable time and requires a prescription from the health care provider. Client history and fetal bradycardia, and change of abdominal contour indicates uterine rupture.

A newly arrived Russian immigrant attends the prenatal clinic for the first time. Although she states that she has had immunizations, she does not know which ones. Which immunizations should the nurse recommend? Select all that apply. 1 Mumps 2 Measles 3 Diphtheria 4 Hepatitis B 5 Chickenpox

A newly arrived Russian immigrant attends the prenatal clinic for the first time. Although she states that she has had immunizations, she does not know which ones. Which immunizations should the nurse recommend? Select all that apply. 1 Mumps 2 Measles Correct3 Diphtheria Correct4 Hepatitis B Incorrect5 Chickenpox The diphtheria vaccine and hepatitis B vaccine contain dead viruses and can be administered safely. The mumps, measles, and chickenpox vaccines are all contraindicated because they contains live virus, which is teratogenic.

A nurse is assessing a pregnant 16-year-old client. What factors that may affect the outcome of the pregnancy should the nurse consider? Select all that apply. 1 Tendency to abuse drugs 2 Inappropriate dietary choices 3 Immature reproductive system 4 Underdeveloped musculoskeletal system 5 Undeveloped secondary sex characteristics

A nurse is assessing a pregnant 16-year-old client. What factors that may affect the outcome of the pregnancy should the nurse consider? Select all that apply. Incorrect1 Tendency to abuse drugs Correct2 Inappropriate dietary choices Correct3 Immature reproductive system Correct4 Underdeveloped musculoskeletal system 5 Undeveloped secondary sex characteristics Adolescents are peer oriented and tend to eat fast foods with their friends; the diet is generally high in fats and carbohydrates and deficient in protein, calcium, fruits, and vegetables. At 16 years, development of the reproductive organs is incomplete: Full growth of the vagina, uterus, ovaries, and uterine tubes does not occur until 20 years of age. Musculoskeletal growth is generally not complete until early adulthood. Although adolescents may experiment with drugs, it is a judgmental belief that they all abuse drugs. Secondary sex characteristics appear early and are complete by the end of puberty; if the adolescent is pregnant, she has completed puberty.

A nurse is assessing the effectiveness of a teaching plan about self-care and conservative management of gestational hypertension. The nurse confirms that the teaching has been understood when the client notes the importance of: 1 Eating a low-protein diet 2 Ensuring adequate sodium intake 3 Joining a weight-reduction program 4 Following the prescribed diuretic regimen

A nurse is assessing the effectiveness of a teaching plan about self-care and conservative management of gestational hypertension. The nurse confirms that the teaching has been understood when the client notes the importance of: 1 Eating a low-protein diet Correct2 Ensuring adequate sodium intake 3 Joining a weight-reduction program Incorrect4 Following the prescribed diuretic regimen 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.

A nurse is being oriented to a prenatal clinic after graduation. The new nurse takes a course on several tests during pregnancy. Place the tests in the order in which they should be performed during pregnancy. 1. Sickle cell screening 2. Fetal movement test 3. α-Fetoprotein (AFP) testing for neural tube defects 4. Serum glucose for gestational diabetes 5. Group B Streptococcus culture

A nurse is being oriented to a prenatal clinic after graduation. The new nurse takes a course on several tests during pregnancy. Place the tests in the order in which they should be performed during pregnancy. Correct 1. Sickle cell screening Incorrect 2. Fetal movement test Incorrect 3. α-Fetoprotein (AFP) testing for neural tube defects Incorrect 4. Serum glucose for gestational diabetes Correct 5. Group B Streptococcus culture Sickle cell screening, particularly for black women, should be done on the initial visit. AFP testing for neural tube defects should be done between 14 and 16 weeks. Serum glucose testing for gestational diabetes should be done between 26 and 28 weeks. Fetal movement tests may be started at 28 weeks' gestation because the fetus' pattern of movement becomes stabilized at this time. Group B Streptococcus culture should be done between 36 and 38 weeks.

A nurse is discussing immunizations needed to confer active immunity with a pregnant client during her first visit to the prenatal clinic. What information should the nurse consider including that the client will understand with regard to active immunity? 1 Protein antigens are formed in the blood to fight invading antibodies. 2 Protein substances are formed by the body to destroy or neutralize antigens. 3 Blood antigens are aided by phagocytes in defending the body against pathogens. 4 Sensitized lymphocytes from an immune donor act as antibodies against invading pathogens.

A nurse is discussing immunizations needed to confer active immunity with a pregnant client during her first visit to the prenatal clinic. What information should the nurse consider including that the client will understand with regard to active immunity? Incorrect1 Protein antigens are formed in the blood to fight invading antibodies. Correct2 Protein substances are formed by the body to destroy or neutralize antigens. 3 Blood antigens are aided by phagocytes in defending the body against pathogens. 4 Sensitized lymphocytes from an immune donor act as antibodies against invading pathogens. Active immunity occurs when the individual's cells produce antibodies in response to an agent or its products; these antibodies will destroy the foreign agent (antigen) should it enter the body again. Antigens do not fight antibodies; they trigger the formation of antibodies that in turn attacks the antigen. Sensitized lymphocytes do not act as antibodies.

A nurse is obtaining a health history from a primigravida on her first visit to the prenatal clinic. Before discussing the client's health habits with her, what does the nurse consider the most important factor in the survival of the client's newborn? 1 Reproductive history 2 Adequacy of prenatal care 3 Health habits and social class 4 Gestational age and birthweight

A nurse is obtaining a health history from a primigravida on her first visit to the prenatal clinic. Before discussing the client's health habits with her, what does the nurse consider the most important factor in the survival of the client's newborn? 1 Reproductive history 2 Adequacy of prenatal care Incorrect3 Health habits and social class Correct4 Gestational age and birthweight Adaptation to the extrauterine environment is dependent on the functional capacity of vital organ systems, which is established during intrauterine development; this is measurable in terms of the newborn's gestational age and weight. Although reproductive history, adequacy of prenatal care, and health habits and social class may all influence health, none is the most critical to neonatal survival.

A nurse is planning a prenatal class about the changes that occur during pregnancy and the necessity of routine health care throughout pregnancy. Which cardiovascular compensatory mechanisms should the nurse explain will occur? Select all that apply. 1 Systemic vasodilation 2 Increased blood volume 3 Increased blood pressure 4 Increased cardiac output 5 Enlargement of the heart 6 Decreased erythrocyte production

A nurse is planning a prenatal class about the changes that occur during pregnancy and the necessity of routine health care throughout pregnancy. Which cardiovascular compensatory mechanisms should the nurse explain will occur? Select all that apply. Systemic vasodilation Increased blood volume Increased blood pressure Increased cardiac output Enlargement of the heart Decreased erythrocyte production Rationale: Blood volume increases to meet the metabolic demands of pregnancy. Increased cardiac output is necessary to accommodate the increased blood volume needed to meet the demands of the growing fetus. Cardiac hypertrophy is a result of the demands made by the increased blood volume and cardiac output. Systemic vasodilation is not expected. There is little variation in blood pressure but a slight decrease during the second trimester. Erythrocyte production increases; because the plasma volume increases more than the red blood cell count, the hematocrit is lower.

A nurse is teaching a class of expectant parents about nutritional needs during pregnancy. What information should the nurse include? 1 Carbohydrate needs decrease during pregnancy. 2 Protein needs increase to at least 70 g/day during pregnancy. 3 Phosphorus and calcium needs decrease gradually throughout pregnancy. 4 Caloric needs increase gradually up to 100 more kcal/day throughout pregnancy.

A nurse is teaching a class of expectant parents about nutritional needs during pregnancy. What information should the nurse include? 1 Carbohydrate needs decrease during pregnancy. Correct2 Protein needs increase to at least 70 g/day during pregnancy. 3 Phosphorus and calcium needs decrease gradually throughout pregnancy. Incorrect4 Caloric needs increase gradually up to 100 more kcal/day throughout pregnancy. An increase in all nutrients is needed to meet the increased metabolic requirements of pregnancy. Increased amounts of protein are needed for growth and maintenance of maternal and fetal tissues. Calcium and phosphorus needs increase to meet the rapid demand for fetal bone deposits during the last month of pregnancy. Caloric needs increase by a minimum of 300 kcal/day during pregnancy.

A nurse is teaching a prenatal class about the changes that occur during the second trimester of pregnancy. What cardiovascular changes should the nurse include? Select all that apply. 1 Cardiac output increases. 2 Blood pressure decreases. 3 The heart is displaced upward. 4 The blood plasma volume peaks. 5 The hematocrit level is lowered.

A nurse is teaching a prenatal class about the changes that occur during the second trimester of pregnancy. What cardiovascular changes should the nurse include? Select all that apply. Correct1 Cardiac output increases. Correct2 Blood pressure decreases. Correct3 The heart is displaced upward. Incorrect4 The blood plasma volume peaks. 5 The hematocrit level is lowered. Cardiac output increases during the second trimester because of an increasing plasma volume. The blood pressure decreases because of the enlarged intravascular compartment and hormonal effects on peripheral resistance. As the fetus grows and the enlarging uterus outgrows the pelvic cavity, it displaces the heart upward and to the left. The blood volume starts to increase earlier but does not peak until the third trimester. The reduction in hematocrit occurs in the first trimester; the erythrocyte increase may not be in direct proportion to the blood volume, lowering hematocrit and hemoglobin levels, which remain lower throughout pregnancy.

A nurse on the high-risk unit assesses a client admitted with severe preeclampsia. The client has audible crackles in the lower left lobe, slight blurring of vision in the right eye, generalized facial edema, and epigastric discomfort. Which clinical manifestation indicates the potential for a seizure? 1 Audible crackles 2 Blurring of vision 3 Epigastric discomfort 4 Generalized facial edema

A nurse on the high-risk unit assesses a client admitted with severe preeclampsia. The client has audible crackles in the lower left lobe, slight blurring of vision in the right eye, generalized facial edema, and epigastric discomfort. Which clinical manifestation indicates the potential for a seizure? 1 Audible crackles Incorrect2 Blurring of vision Correct3 Epigastric discomfort 4 Generalized facial edema Epigastric discomfort suggests liver edema; it is an ominous symptom that indicates an impending seizure. Audible crackles indicate pulmonary edema, but although they are a sign of severe preeclampsia they are not as definitive as epigastric pain. Blurred vision is a sign of retinal edema; although it is a sign of severe preeclampsia it is not as definitive as epigastric pain. Although generalized facial edema is a sign of severe preeclampsia, it is not as definitive as epigastric pain.

A nurse on the high-risk unit is caring for a client with severe preeclampsia. What intervention is most effective in preventing a seizure? 1 Providing a plastic airway 2 Controlling external stimuli 3 Having emergency equipment available 4 Keeping calcium gluconate at the bedside

A nurse on the high-risk unit is caring for a client with severe preeclampsia. What intervention is most effective in preventing a seizure? 1 Providing a plastic airway Correct2 Controlling external stimuli 3 Having emergency equipment available Incorrect4 Keeping calcium gluconate at the bedside Reducing lights, noise, and stimulation minimizes central nervous system irritability, which can trigger a seizure. A plastic airway will not prevent a seizure. Available emergency equipment will not prevent a seizure, although oxygen and suction equipment may be useful after a seizure. Calcium gluconate is the antidote for magnesium sulfate toxicity; it does not prevent seizures.

A nurse places a newly admitted client with worsening preeclampsia in a private room. Why is it important for this client to be in a nonstimulating environment? 1 The number of respirations is increased. 2 The severity of frontal headaches is decreased. 3 The probability of tonic-clonic seizures is reduced. 4 The duration of action of hypotensive medications is prolonged.

A nurse places a newly admitted client with worsening preeclampsia in a private room. Why is it important for this client to be in a nonstimulating environment? Incorrect1 The number of respirations is increased. 2 The severity of frontal headaches is decreased. Correct3 The probability of tonic-clonic seizures is reduced. 4 The duration of action of hypotensive medications is prolonged. Even minimal sensory stimuli can trigger an exaggerated cerebral response such as seizures; therefore a nonstimulating environment is most therapeutic. Women with preeclampsia do not have respiratory problems. Although respiration may become depressed with magnesium sulfate therapy, a quiet environment will have no effect on respiration. A nonstimulating environments does not reduce the severity of headaches resulting from hypertension and has no relationship to the effects of antihypertensive drugs.

A nurse teaching a prenatal class is asked why infants of diabetic mothers are larger than those born to women who do not have diabetes. On what information about pregnant women with diabetes should the nurse base the response? 1 Taking exogenous insulin stimulates fetal growth. 2 Consuming more calories covers the insulin secreted by the fetus. 3 Extra circulating glucose causes the fetus to acquire fatty deposits. 4 Fetal weight gain increases as a result of the common response of maternal overeating.

A nurse teaching a prenatal class is asked why infants of diabetic mothers are larger than those born to women who do not have diabetes. On what information about pregnant women with diabetes should the nurse base the response? Incorrect1 Taking exogenous insulin stimulates fetal growth. 2 Consuming more calories covers the insulin secreted by the fetus. Correct3 Extra circulating glucose causes the fetus to acquire fatty deposits. 4 Fetal weight gain increases as a result of the common response of maternal overeating. It is difficult to maintain maternal normoglycemia throughout pregnancy; excess glucose passes into the fetus, where it is converted to fat. The problem is excess glucose, which is why exogenous insulin must be administered. Although all pregnant women consume extra calories to meet the increased metabolism associated with pregnancy, fetal insulin does not pass from the fetus to the mother. Stating that fetal weight gain increases because pregnant women commonly overeat is a stereotypical statement; not all clients with diabetes overeat.

A pregnant woman with a history of heart disease visits the prenatal clinic at the end of her second trimester. What does the nurse anticipate about the care she will need? 1 Preparation for a cesarean birth 2 Bedrest during the last trimester 3 Prophylactic antibiotics at the time of birth 4 Increasing dosages of cardiac medications as pregnancy progresses

A pregnant woman with a history of heart disease visits the prenatal clinic at the end of her second trimester. What does the nurse anticipate about the care she will need? 1 Preparation for a cesarean birth 2 Bedrest during the last trimester Correct3 Prophylactic antibiotics at the time of birth Incorrect4 Increasing dosages of cardiac medications as pregnancy progresses Prophylactic antibiotics are given to clients with heart disease to reduce their risk for bacterial endocarditis. A vaginal birth, with a shortened second stage and an assisted birth involving forceps or vacuum extraction, is preferred. The data do not indicate which class of heart disease the client has; if it is class I and there is no cardiac decompensation, activities may be restricted but bedrest is not necessary. Increasing the dosages of the client's cardiac medications may or may not be necessary; dosages are based on each individual's response to the stress imposed by pregnancy.

A primigravida at 38 weeks of gestation presents to the clinic with a blood pressure of 142/94, edema in all extremities, and a weight gain of five pounds since the previous checkup one week ago. During the assessment, symptoms suggestive of preeclampsia were obtained. Select all that apply. 1 Headache 2 Double vision 3 Brisk reflexes 4 Epigastric pain 5 Sluggish reflexes 6 Edema of +1 in lower extremities

A primigravida at 38 weeks of gestation presents to the clinic with a blood pressure of 142/94, edema in all extremities, and a weight gain of five pounds since the previous checkup one week ago. During the assessment, symptoms suggestive of preeclampsia were obtained. Select all that apply. Correct1 Headache Correct2 Double vision Correct3 Brisk reflexes Correct4 Epigastric pain 5 Sluggish reflexes 6 Edema of +1 in lower extremities A severe headache occurs with cerebral edema, double vision occurs because of retinal edema, reflexes are brisk because of central nervous system changes, and epigastric pain accompanies hepatic edema. Sluggish reflexes would not accompany preeclampsia. Edema of +1 is minimal and is present in many pregnant women in the lower extremities. Edema above the waist is considered significant.

A primigravida with type 1 diabetes is having her first prenatal visit. While discussing changes in insulin needs during pregnancy and after birth, the nurse explains that in light of the client's blood glucose readings she should expect to increase her insulin dosage. Between which weeks of gestation is this expected to occur? 1 10th and 12th weeks of gestation 2 18th and 22nd weeks of gestation 3 24th and 28th weeks of gestation 4 36th and 40th weeks of gestation

A primigravida with type 1 diabetes is having her first prenatal visit. While discussing changes in insulin needs during pregnancy and after birth, the nurse explains that in light of the client's blood glucose readings she should expect to increase her insulin dosage. Between which weeks of gestation is this expected to occur? 1 10th and 12th weeks of gestation Incorrect2 18th and 22nd weeks of gestation Correct3 24th and 28th weeks of gestation 4 36th and 40th weeks of gestation At the end of the second trimester and the beginning of the third trimester, insulin needs increase because of an increase in maternal resistance to insulin. During the earlier part of pregnancy, fetal demands for maternal glucose may cause a tendency toward hypoglycemia. During the last weeks of pregnancy, maternal resistance to insulin decreases and insulin needs decrease accordingly.

A teenager at 32 weeks' gestation is hospitalized with preeclampsia. She is anorexic and appears depressed. Which comment indicates to the nurse that further exploration of the client's emotional status is indicated? 1 "I'm tired of feeling so clumsy." 2 "I'll be glad when I can sleep all night." 3 "I dreamed my baby only had one arm." 4 "I was really happy before I got pregnant."

A teenager at 32 weeks' gestation is hospitalized with preeclampsia. She is anorexic and appears depressed. Which comment indicates to the nurse that further exploration of the client's emotional status is indicated? 1 "I'm tired of feeling so clumsy." 2 "I'll be glad when I can sleep all night." Incorrect3 "I dreamed my baby only had one arm." Correct4 "I was really happy before I got pregnant." The client's statement that she was happy before getting pregnant indicates a failure to resolve conflicting feelings about pregnancy that should have been resolved in the first trimester. The statement that she is tired of feeling clumsy is an expected feeling in the third trimester. The statement that she'll be glad when she can sleep all night is expected in the third trimester as the enlarging uterus limits the number of comfortable positions that can be assumed during sleep. Concerns about the expected infant's having physical abnormalities are common in the third trimester.

A woman is being seen in the prenatal clinic at 36 weeks' gestation. The nurse is reviewing signs and symptoms that should be reported to health care provider with the mother. Which signs and symptoms require further evaluation by the health care provider? Select all that apply. 1 Decreased urine output 2 Blurred vision with spots 3 Urinary frequency without dysuria 4 Heartburn after eating a fatty meal 5 Contractions that are regular and 5 minutes apart 6 Shortness of breath after climbing a flight of stairs

A woman is being seen in the prenatal clinic at 36 weeks' gestation. The nurse is reviewing signs and symptoms that should be reported to health care provider with the mother. Which signs and symptoms require further evaluation by the health care provider? Select all that apply. Correct1 Decreased urine output Correct2 Blurred vision with spots 3 Urinary frequency without dysuria 4 Heartburn after eating a fatty meal Correct5 Contractions that are regular and 5 minutes apart 6 Shortness of breath after climbing a flight of stairs Decreased urine output, blurred vision, and severe headache may occur with pregnancy-associated hypertension. Contractions that become regular are associated with the onset of labor. Preparatory (Braxton Hicks) contractions ease when the client walks. Swelling of the face and hands is a warning sign. Urinary frequency occurs in the first trimester and again in the third trimester as the uterus settles back into the pelvis. The weight of the uterus may delay emptying of the stomach and make heartburn a more frequent problem. Shortness of breath would be expected after the client climbs a flight of stairs.

All women of childbearing age are advised to include at least 400 micrograms of folic acid in the daily diet to lessen the risk of neural tube defects in pregnancy. What should the nurse recommend to meet the recommendation? Select all that apply. 1 Vitamin A 2 Vitamin B6 3 Vitamin B9 4 Vitamin B12 5 Legumes, dark-green leafy vegetables, and citrus fruits 6 Eggs, meat, and poultry

All women of childbearing age are advised to include at least 400 micrograms of folic acid in the daily diet to lessen the risk of neural tube defects in pregnancy. What should the nurse recommend to meet the recommendation? Select all that apply. 1 Vitamin A Incorrect2 Vitamin B6 Correct3 Vitamin B9 Incorrect4 Vitamin B12 Correct5 Legumes, dark-green leafy vegetables, and citrus fruits 6 Eggs, meat, and poultry Vitamin B9 is folic acid, and legumes, dark-green leafy vegetables, and citrus fruits are natural sources of folic acid. Most women receive adequate vitamin A in their diets, and too much may cause birth defects. Vitamin B6 aids in metabolism conversion and the formation of red blood cells. Vitamin B12 is associated with nerve cells and red blood cells. Eggs, meat, and poultry are sources of vitamin B12.

During a routine prenatal visit, a client tells a nurse that she gets leg cramps. What condition does the nurse suspect, and what suggestion is made to correct the problem? 1 Hypercalcemia; avoid eating hard cheeses. 2 Hypocalcemia; increase her intake of milk. 3 Hyperkalemia; consult her health care provider. 4 Hypokalemia; increase intake of green leafy vegetables.

During a routine prenatal visit, a client tells a nurse that she gets leg cramps. What condition does the nurse suspect, and what suggestion is made to correct the problem? Incorrect1 Hypercalcemia; avoid eating hard cheeses. Correct2 Hypocalcemia; increase her intake of milk. 3 Hyperkalemia; consult her health care provider. 4 Hypokalemia; increase intake of green leafy vegetables. The most likely cause is a disturbance in the ratio of calcium to phosphorus, with the amount of serum calcium reduced and the serum phosphorus increased; milk and other dairy products are excellent sources of calcium. Leg cramps are related to hypocalcemia, not to hypercalcemia. An increased potassium level manifests as muscle weakness. A low potassium level is evidenced by fatigue and muscle weakness.

During her first visit to the prenatal clinic a client tells the nurse that she has a cat and is responsible for changing the cat's litterbox. The client asks whether doing this will be harmful to her or the fetus. How should the nurse reply? 1 "Cat litter is not harmful during pregnancy." 2 "Exposure to cat litter for short periods of time is not harmful." 3 "There are several factors that determine a person's response to the toxins in cat litter." 4 "Fetal abnormalities are associated with exposure to cat litter, even after minimal contact."

During her first visit to the prenatal clinic a client tells the nurse that she has a cat and is responsible for changing the cat's litterbox. The client asks whether doing this will be harmful to her or the fetus. How should the nurse reply? 1 "Cat litter is not harmful during pregnancy." 2 "Exposure to cat litter for short periods of time is not harmful." Correct3 "There are several factors that determine a person's response to the toxins in cat litter." Incorrect4 "Fetal abnormalities are associated with exposure to cat litter, even after minimal contact." Among the factors that can precipitate a teratogenic fetal response are exposure to the teratogen, intensity of the exposure, and maternal/fetal genetic predisposition. Exposure to cat feces containing the oocysts of Toxoplasma gondii can result in maternal toxoplasmosis, which may be transmitted to the fetus. The duration of maternal exposure is but one variable in determining if the fetus will be affected.

The nurse is providing care to a client with preeclampsia who is receiving magnesium sulfate 2 g/hr. The nurse receives a call from the laboratory technician indicating that the client has a magnesium level of 6.4 mEq/L. What is the next nursing action? 1 Stopping the infusion 2 Assessing the client's deep tendon reflexes 3 Assessing the client's level of consciousness 4 Documenting the level in the client's electronic medical record

The nurse is providing care to a client with preeclampsia who is receiving magnesium sulfate 2 g/hr. The nurse receives a call from the laboratory technician indicating that the client has a magnesium level of 6.4 mEq/L. What is the next nursing action? Incorrect1 Stopping the infusion 2 Assessing the client's deep tendon reflexes 3 Assessing the client's level of consciousness Correct4 Documenting the level in the client's electronic medical record Documentation of the magnesium level on the fetal monitoring strip can serve as a point of correlation between the blood level and a decrease in fetal activity or fetal heart rate reactivity, which is common in a client receiving magnesium sulfate. There is no indication that the infusion of magnesium sulfate needs to be stopped. Although the magnesium level is well above the normal range of 1.7 to 2.2 mg/dL, the therapeutic range for magnesium for the preeclamptic client is 4 to 7.5 mEq/L, or 5 to 8 mg/dL. The nurse must constantly assess the client for a toxic level of magnesium, which can depress the central nervous system and slow the respiratory rate, alter the level of consciousness, and cause deep tendon reflexes to diminish or disappear. These manifestations generally appear after the magnesium level is above 8 mg/dL; respiratory arrest is associated with a level above 10 mg/dL.

The nurse is teaching a prenatal breathing and relaxation class. What does the nurse suggest to best ease back discomfort during labor? 1 Alternating lying on the back and side 2 Having support persons use back massage techniques 3 Using distraction techniques such as abdominal effleurage 4 Maintaining the knee-chest position before and after assessments of the fetal heart rate

The nurse is teaching a prenatal breathing and relaxation class. What does the nurse suggest to best ease back discomfort during labor? Incorrect1 Alternating lying on the back and side Correct2 Having support persons use back massage techniques 3 Using distraction techniques such as abdominal effleurage 4 Maintaining the knee-chest position before and after assessments of the fetal heart rate The fetus exerts pressure against the spine during labor; back massage provides counterpressure, which eases the discomfort. The back-lying position is contraindicated because the weight of the fetus compresses the vena cava, decreasing the flow of blood to the placenta. Although abdominal effleurage can serve as a distraction during labor, it will not relieve back discomfort. The knee-chest position will not relieve back pain during labor.

Which interventions are included in the nursing care for a client receiving magnesium sulfate for severe preeclampsia? Select all that apply. 1 Monitoring deep tendon reflexes 2 Assessing urine output every 8 hours 3 Maintaining a dark, quiet environment 4 Using a pump to regulate the medication 5 Having calcium gluconate available at the bedside 6 Notifying the care provider if the respiratory rate is slower than 20 breaths/min

Which interventions are included in the nursing care for a client receiving magnesium sulfate for severe preeclampsia? Select all that apply. Correct1 Monitoring deep tendon reflexes 2 Assessing urine output every 8 hours Correct3 Maintaining a dark, quiet environment Correct4 Using a pump to regulate the medication Correct5 Having calcium gluconate available at the bedside Incorrect6 Notifying the care provider if the respiratory rate is slower than 20 breaths/min Maintaining a dark, quiet environment lessens stimulation and reduces the risk of seizures. Magnesium sulfate must be administered with the use of an infusion pump because it can be toxic and cause respiratory distress. The medication level is monitored closely because toxicity may occur with levels over 8 mg/dL. Magnesium works by relaxing skeletal muscle; therefore deep tendon reflexes should be assessed hourly. Calcium gluconate is the antidote to magnesium sulfate and should be immediately available for the treatment of overdose. Assessing urine output every 8 hours is not sufficient. Urine output of less than 30 mL/hr must be reported to the health care provider. A respiratory rate slower than 10 breaths/min, not 20, must be reported to the health care provider.