maternity test 2

signs of hyperthyroidism

-decreased weight -decreased appetite

if mom is having a seizure,

fetus becomes hypoxic; evidenced by late decelerations on FHR

The nurse is caring for a client after experiencing a placental abruption. Which finding is the priority to report to the health care provider? hematocrit of 36% 45 ml urine output in 2 hours platelet count of 150,000 mm3 hemoglobin of 13 g/dl

45 ml urine output in 2 hours

A pregnant client mentions to the nurse that a friend has given her a variety of herbs to use during her upcoming labor to help manage pain. Specifically, she gave her chamomile tea, raspberry leaf tea, skullcap, catnip, jasmine, lavender, and black cohosh. Which of these should the nurse encourage the client not to take because of the risk of acute toxic effects such as cerebrovascular accident? Skullcap Catnip Black cohosh Jasmine

Black cohosh

The nurse is assessing vital signs on the client and notes a normal blood pressure along with an elevated pulse when the patient moves from a lying to a standing or sitting position. What would this indicate? Delayed labor Overhydration Low fluid volume Arrested labor

Low fluid volume

After teaching a review class to a group of perinatal nurses about various methods for cervical ripening, the nurse determines that the teaching was successful when the group identifies which method as surgical? laminaria breast stimulation amniotomy prostaglandin

amniotomy

A woman who is 8 months' pregnant comes to the clinic with urinary frequency and pain on urination. The client is diagnosed with a urinary tract infection (UTI). Which medication would the nurse anticipate the physician will prescribe? tetracycline bactrim amoxicillin septra

amoxicillin

A pregnant woman with a history of mitral valve stenosis is to be prescribed medication as treatment. Which medication class would the nurse expect the client to be prescribed? inotropic angiotensin receptor blockers vasodilator anticoagulant

anticoagulant

A client is experiencing shoulder dystocia during birth. The nurse would place priority on performing which assessment postbirth? monitor for a cardiac anomaly extensive lacerations brachial plexus assessment assess for cleft palate

brachial plexus assessment

A woman is admitted to the labor suite with contractions every 5 minutes lasting 1 minute. She is postterm and has oligohydramnios. What does this increase the risk of during birth? shoulder dystocia macrosomia fetal hydrocephalus cord compression

cord compression

A woman is being closely monitored and treated for severe preeclampsia with magnesium sulfate. Which finding would alert the nurse to the development of magnesium toxicity in this client? diminished reflexes elevated liver enzymes serum magnesium level of 6.5 mEq/L seizures

diminished reflexes

A woman is in the hospital only 15 minutes when she begins to give birth precipitously. The fetal head begins to emerge as the nurse walks into the labor room. The nurse's best action would be to: attach a fetal monitor to determine fetal status. ask her to push with the next contraction so birth is rapid. place a hand gently on the fetal head to guide birth. assess blood pressure and pulse to detect placental bleeding.

place a hand gently on the fetal head to guide birth.

A patient with diabetes is in the first trimester of pregnancy and is currently having difficulty keeping blood glucose levels within normal limits. The patient explains that she has been "eating for two" so the baby is healthy. How should the nurse respond to the patient? "Elevated blood glucose levels in the first trimester have been linked to congenital anomalies." "Elevated blood glucose levels hasten the development of the fetus in utero." "Elevated blood glucose levels ensure the baby has mature lungs at birth." "Elevated blood glucose levels cause low birth weights in infants."

"Elevated blood glucose levels in the first trimester have been linked to congenital anomalies."

pre-gestational diabetes - 1st trimester assessments

-hemoglobin A-1C (average blood glucose) -evaluation of baseline kidney function with a 24-hour urine collection -screening or thyroid, heart, and eyes

anti-seizure medications

-increased risk for congenital anomalies, ****but continue to take meds and avoid seizure triggers -if on ________________, should take 4mg of folic acid daily beginning 3 months before conception -can cause increased risk for bleeding

A client with a high-risk pregnancy has been prescribed inpatient bed rest. When assessing the client each morning, which risk factor of is common with this treatment plan? Diarrhea Muscle rigidity Depression Weight loss

Depression

The nurse is assessing a mother who just delivered a 7 lb (3136 g) baby via cesarean delivery. Which assessment finding should the nurse prioritize if the mother has a history of controlled atrial fibrillation? Urinary retention Jugular distention Abdominal cramps Nausea and vomiting

Jugular distention

warning signs of eating disorder

-low BMI -history -lack of weight gain over 2 prenatal visits -electrolyte abnormalities -tooth enamel problems (from vomiting) -hyperemesis gravidarum -anxiety/mood disorder

The nurse is explaining the discharge instructions to a client who has developed postpartum cystitis. The client indicates she is not drinking a glass of fluid every hour because it hurts too much when she urinates. What is the best response from the nurse? Instruct to use a sitz bath while voiding. Advise her to take acetaminophen to ease symptoms. Teach that adequate hydration helps clear the infection quicker. Ask primary care provider to prescribe an analgesic.

Teach that adequate hydration helps clear the infection quicker.

signs and symptoms of hypothryroidism

-tiredness -dry skin -weight gain -cold sensitivity

When evaluating fetal well-being, what is the maximum score on a biophysical profile?

10

A patient is confirmed to be in labor. Upon examination she is 3 cm dilated and the fetus has started to descend. Three hours after admission, however, she appears not to be progressing. She remains only 3 cm dilated, and the fetus is in the same position. The physician correctly terms this as which of the following? disorder of protraction precipitous delivery disorder of arrest precipitous labor

disorder of arrest

A nurse is conducting a refresher program for a group of perinatal nurses. Part of the program involves a discussion of HELLP. The nurse determines that the group needs additional teaching when they identify which aspect as a part of HELLP? elevated lipoproteins liver enzyme elevation low platelet count hemolysis

elevated lipoproteins

A nurse is conducting an assessment of a woman who has experienced PROM. Which amniotic fluid finding would lead the nurse to suspect infection as the cause of a client's PROM? blue color on nitrazine paper foul odor ferning yellow-green fluid

foul odor

Which assessment finding will alert the nurse to be on the lookout for possible placental abruption (abruptio placentae) during labor? gestational diabetes gestational hypertension macrosomia low parity

gestational hypertension

chronic hypertension

high blood pressure -diagnosis prior to pregnancy or prior to 20 weeks -associated with higher rate of poor pregnancy outcomes: intrauterine growth restriction, stillbirth, preeclampsia, and stroke -BP > 140/90

A client at 36 weeks' gestation who is 2 years post bariatric surgery would be expected to have a weight gain that is: the same as other pregnant clients at that gestational age determined by the client's BMI and gestational age. less than other pregnant clients at the same gestational age. more than other pregnant clients at the same gestational age.

less than other pregnant clients at the same gestational age

A client in her seventh week of the postpartum period is experiencing bouts of sadness and insomnia. The nurse suspects that the client may have developed postpartum depression. What signs or symptoms are indicative of postpartum depression? Select all that apply. manifestations of mania loss of confidence bizarre behavior decreased interest in life inability to concentrate

loss of confidence decreased interest in life inability to concentrate

A nurse is conducting a review course on tocolytic therapy for perinatal nurses. After teaching the group, the nurse determines that the teaching was successful when they identify which drugs as being used for tocolysis? Select all that apply. magnesium sulfate misoprostol indomethacin dinoprostone nifedipine

magnesium sulfate indomethacin nifedipine

Which factor puts a multiparous client on her first postpartum day at risk for developing hemorrhage? moderate amount of lochia rubra uterine atony hemoglobin level of 12 g/dl (120 g/L) thrombophlebitis

uterine atony

A nursing instructor is teaching students about preexisting illnesses and how they can complicate a pregnancy. The instructor recognizes a need for further education when one of the students makes which statement? "A pregnant woman needs to be careful of and cautious about accidents and illnesses during her pregnancy." "A pregnant woman with a chronic condition can put herself at risk." "A pregnant woman with a chronic illness can put the fetus at risk." "A pregnant woman does not have to worry about contracting new illnesses during pregnancy."

A pregnant woman does not have to worry about contracting new illnesses during pregnancy."

A postpartum woman is prescribed oxytocin to stimulate the uterus to contract. Which action would be most important for the nurse to do? Administer the drug as an IV bolus injection. Withhold the drug if the woman is hypertensive. Piggyback the IV infusion into a primary line. Give as a vaginal or rectal suppository.

Piggyback the IV infusion into a primary line.

The nurse is assessing a postpartum client at a 6-week well-care check and notes questionable behavior on assessment. Which behaviors should the nurse prioritize and report to the RN or health care provider? Restless and agitated, concerned with self and not the infant States being tired and happy at same time Tearful during appointment Talkative and asking questions

Restless and agitated, concerned with self and not the infant

The nurse is assisting with a G2P1, 24-year-old client who has experienced an uneventful pregnancy and is now progressing well through labor. Which action should be prioritized after noting the fetal head has retracted into the vagina after emerging? Use McRoberts maneuver. Use Zavanelli maneuver. Apply pressure to the fundus. Attempt to push in one of the fetus's shoulders.

Use McRoberts maneuver.

A woman who is Rh negative asks the nurse how many children she will be able to have before Rh incompatibility causes them to die in utero. The nurse's best response would be that: no more than three children is recommended. she will have to ask her primary care provider. as long as she receives Rho(D) immune globulin, there is no limit. only her next child will be affected.

as long as she receives Rho(D) immune globulin, there is no limit.

A nurse is teaching a 30-year-old gravida 1 who has sickle cell anemia. Providing education on which topic is the highest nursing priority? administration of immunoglobulins consumption of a low-fat diet avoidance of infection constipation prevention

avoidance of infection

A nurse working with a woman in preterm labor receives a telephone report for the fetal fibronectin test done 10 hours ago. The report indicates an absence of the protein, which the nurse knows indicates: birth is likely within the next 2 weeks. birth is unlikely within the 2 next weeks. infection is present. no infection is present.

birth is unlikely within the 2 next weeks.

It is necessary for the mother to have a forceps delivery. To reduce complications from this procedure, the nurse should: empty the mother's bladder. have anesthesia provider present. call the neonatologist. provide pain medication.

empty the mother's bladder.

A client has been admitted with placental abruption. She has lost 1,200 mL of blood, is normotensive, and ultrasound indicates approximately 30% separation. The nurse documents this as which classification of abruptio placentae? grade 2 grade 3 grade 1 grade 4

grade 2

A client appears to be resting comfortably 12 hours after giving birth to her first child. In contrast, she labored for more than 24 hours, the primary care provider had to use forceps to deliver the baby, and she had multiple vaginal examinations during labor. Based on this information what postpartum complication is the client at risk for developing? hemorrhage infection pulmonary emboli depression

infection

antihypertensives - labetalol, methyldopa, and nifedipine

preferred medications to treat severe hypertension in pregnancy

A woman having contractions comes to the emergency department. She tells the nurse that she is at 34 weeks' gestation. The nurse examines her and finds that she is already effaced and dilated 2 cm. What is this woman demonstrating? preterm labor macrosomia normal labor dystocia

preterm labor

supplemental iron

treatment for iron deficiency anemia -can cause pruritus, rash, GI symptoms -take on empty stomach (an hour before eating) ***but may cause GI distress. if you can not handle the distress, take 2 hours after eating with citrus

A pregnant client undergoing labor induction is receiving an oxytocin infusion. Which finding would require immediate intervention? urine output of 20 mL/hour uterine resting tone of 14 mm Hg contractions every 2 minutes, lasting 45 seconds fetal heart rate of 150 beats/minute

urine output of 20 mL/hour

TORCH is an acronym for maternal infections associated with congenital malformations and disorders. Which of the following disorders does the H represent? Herpes simplex virus Hepatitis B virus Human immunodeficiency virus Hemophilia

Herpes simplex virus

The nurse is preparing to teach a pregnant client with iron deficiency anemia about the various iron-rich foods to include in her diet. Which food should the nurse point out will help increase the absorption of her iron supplement? Dried apples Orange juice Fortified grains Dried beans

Orange juice

A nursing instructor is teaching students about fetal presentations during birth. The mostcommon cause for increased incidence of shoulder dystocia is: increased number of overall pregnancies. poor quality of prenatal care. longer length of labor. increasing birth weight.

increasing birth weight.

A client presents to the emergency department reporting regular uterine contractions. Examination reveals that her cervix is beginning to efface. The client is in her 36th week of gestation. The nurse interprets the findings as suggesting which condition is occurring? precipitate labor preterm labor normal labor dystocia

preterm labor

A nursing student correctly identifies the causes of labor dysfunction to include which factors? Select all that apply. problems with the mother's diet problems with the uterus problems with access to health care problems with finances problems with the fetus

problems with the uterus problems with the fetus

mild to moderate chronic hypertension

-140-159 / 90-109 (either one or both) -no clear benefit to treating during pregnancy; no meds

A nurse is assessing a postpartum client who is at home. Which statement by the client would lead the nurse to suspect that the client may be developing postpartum depression? "I keep hearing voices telling me to take my baby to the river." "I just feel so overwhelmed and tired." "It's strange, one minute I'm happy, the next I'm sad." "I'm feeling so guilty and worthless lately."

"I'm feeling so guilty and worthless lately."

The nurse is teaching a client with gestational diabetes about complications that can occur either following birth or at delivery for her baby. Which statement by the mother indicates that further teaching is needed by the nurse? "I may need an amniocentesis during the third trimester to see if my baby's lungs are ready to be born." "If my blood sugars are elevated, my baby's lungs will mature faster, which is good." "My baby may be very large and I may need a cesarean section to have him." "Beginning at 28 weeks' gestation, I will start counting with my baby's movements every day."

"If my blood sugars are elevated, my baby's lungs will mature faster, which is good."

A nurse is teaching a pregnant woman with preterm prelabor rupture of membranes about caring for herself after she is discharged home (which is to occur later this day). Which statement by the woman indicates a need for additional teaching? "It's okay for my husband and me to have sexual intercourse." "I can shower, but I shouldn't take a tub bath." "I need to keep a close eye on how active my baby is each day." "I need to call my doctor if my temperature increases."

"It's okay for my husband and me to have sexual intercourse."

The nurse is teaching a prenatal class on potential problems during pregnancy to a group of expectant parents. The risk factors for placental abruption (abruptio placentae) are discussed. Which comment validates accurate learning by the parents? "If I develop this complication, I will have bright red vaginal bleeding," "Since I am over 30, I run a much higher risk of developing this problem." "I need a cesarean section if I develop this problem." "Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain."

"Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain."

The nurse is preparing discharge instructions for a client at 32 weeks' gestation who was admitted for PROM. What is the best response from the nurse when the client asks when she can have intercourse with her husband again? "Intercourse has nothing to do with preterm labor; you can have sex with your husband." "That is a question to ask your health care provider; at this point you are on pelvic rest to try and stop any further labor." "You will not be able to have intercourse again until 6 weeks after you give birth." "The need to keep the infant safe should be of more concern than when to have sex."

"That is a question to ask your health care provider; at this point you are on pelvic rest to try and stop any further labor."

A multipara woman is fully dilated and effaced and has been pushing for over 2 hours. The student nurse observing asks the nurse, "What is causing this to last so long?" Which response by the nurse would be the most accurate? "The fetal head and shoulders are too large to get through the canal." "The woman's bladder is too full, so the fetus cannot descend." "The fetus probably turned to a breech position at the last minute." "The fetal head is in an abnormal position."

"The fetal head is in an abnormal position."

obesity

-35% of women between 20-39 -fat has endocrine function and can have detrimental effect on inflammatory pathways, vasculature, and metabolism -complications: higher risk of gestational diabetes, preeclampsia, labor induction and induction failure, slower first stage of labor, macrosomic infants, postpartum thromboembolism -pre-pregnancy weight loss can improve outcomes -encourage healthy behaviors -challenges - difficult to monitor/find FHR - can result in inability to monitor FHR during medication administration (oxytocin) and a greater chance of surgical deliveries

severe chronic hypertension

->160 / >110 (either one or both) -goal is to maintain 140-150 / 90-100, unless there is evidence of organ damage, goal may be even lower -treated with meds -carefully monitored for preeclampsia and HELLP syndrome

A laboring woman is receiving oxytocin IV to augment her labor and 2 hours later begins having contractions every 2 minutes lasting 60 to 90 seconds each with little, if any, rest time in between the contractions. At this time, which interventions would be the priority for the nurse caring for this client? Select all that apply. Administer an IV bolus of fluids. Discontinue the oxytocin infusion. Apply oxygen to the woman via mask at 8 to 10 L/min. Administer betamethasone to mature the fetal lungs. Ask the woman to drink 32 ounces (1 L) of water.

Administer an IV bolus of fluids. Discontinue the oxytocin infusion. Apply oxygen to the woman via mask at 8 to 10 L/min.

Which postoperative intervention should a nurse perform when caring for a client who has undergone a cesarean birth? Delay breastfeeding the newborn for a day. Ensure that the client does not cough or breathe deeply. Assess uterine tone to determine fundal firmness. Avoid early ambulation to prevent respiratory problems.

Assess uterine tone to determine fundal firmness.

Which assessment would lead the nurse to believe a postpartum woman is developing a urinary complication? She has voided a total of 1000 mL in two voidings, each spaced 1 hour apart. Her perineum is obviously edematous on inspection. At 8 hours postdelivery she has voided a total of 100 mL in four small voidings. She says she is extremely thirsty.

At 8 hours postdelivery she has voided a total of 100 mL in four small voidings.

The nurse is performing a postpartum check on a 40-year-old client. Which nursing measure is appropriate? Wear sterile gloves when assessing the pad and perineum. Perform the examination as quickly as possible. Instruct the client to empty her bladder before the examination. Place the client in a supine position with her arms overhead for the examination of her breasts and fundus.

Instruct the client to empty her bladder before the examination

A laboring client has been pushing without delivering the fetal shoulders. The primary care provider determines the fetus is experiencing shoulder dystocia. What intervention can the nurse assist with to help with the birth? Lamaze position McRoberts maneuver fundal pressure positioning the woman prone

McRoberts maneuver

The nurse is caring for a pregnant client with fallopian tube rupture. Which intervention is the priority for this client? Monitor the fetal heart rate (FHR). Monitor the client's vital signs and bleeding. Monitor the client's beta-hCG level. Monitor the mass with transvaginal ultrasound.

Monitor the client's vital signs and bleeding.

The nurse is caring for a woman at 32 weeks' gestation who expresses deep concern because her previous pregnancy ended in a stillbirth. The nurse would encourage the mother to have what screening test? Nonstress test (NST) Contraction stress test Doppler ultrasound Vaginal ultrasound

Nonstress test (NST)

A nurse is assessing a client in her seventh month of pregnancy who has an artificial valve prosthesis. The client is taking an oral anticoagulant to prevent the formation of clots at the valve site. Which of the following nursing interventions is most appropriate in this situation? Urge the client to discontinue the anticoagulant to prevent pregnancy complications Put the client on bed rest Observe the client for signs of petechiae and premature separation of the placenta Instruct the client to avoid wearing constrictive knee-high stockings

Observe the client for signs of petechiae and premature separation of the placenta

The nurse is admitting a client in labor. The nurse determines that the fetus is in a transverse lie by performing Leopold maneuvers. What intervention should the nurse provide for the client? Administer an analgesic to the client. Prepare for a precipitous vaginal birth. Prepare to assist the care provider with an amniotomy. Prepare the client for a cesarean birth.

Prepare the client for a cesarean birth.

A client at 27 weeks' gestation is admitted to the obstetric unit after reporting headaches and edema of her hands. Review of the prenatal notes reveals blood pressure consistently above 136/90 mm Hg. The nurse anticipates the health care provider will prescribe magnesium sulfate to accomplish which primary goal? Decrease blood pressure Reverse edema Prevent maternal seizures Decrease protein in urine

Prevent maternal seizures

When preparing a mother for a trial of labor after cesarean (TOLAC), what information should the nurse include in the teaching plan? There may be a shorter active phase of first stage of labor. There may be a shorter latent phase of labor. There may be a longer active phase of first stage of labor. There may be a longer latent phase of labor.

There may be a longer active phase of first stage of labor.

The nurse is evaluating the fetal heart rate rhythm strip and determines that the amplitude varies with a rate 15 to 20 beats/min. What does this assessment finding indicate to the nurse about variability? Variability is normal. Variability is absent. Variability is minimal. Variability is marked.

Variability is normal.

A nurse is caring for a pregnant client with heart disease in a labor unit. Which intervention is most important in the first 48 hours postpartum? ensuring that the client consumes a high fiber diet inspecting the extremities for edema limiting sodium intake assessing for cardiac decompensation

assessing for cardiac decompensation

multiple sclerosis

chronic immune-modulated demyelinating disease of the CNS that includes relapses and remissions -pregnancy is often remission, while postpartum is relapse -may increase need for Cesarean birth, and decreased neonatal birth weight -medications are often teratogenic and contraindicated, may have to go off meds and hope for no relapse -breastfeeding is not contraindicated but the medications may not be safe for the infant (don't take meds or don't breastfeed)

A pregnant woman is admitted with premature rupture of the membranes. The nurse is assessing the woman closely for possible infection. Which findings would lead the nurse to suspect that the woman is developing an infection? Select all that apply. cloudy malodorous fluid fetal bradycardia decreased C-reactive protein levels abdominal tenderness elevated maternal pulse rate

cloudy malodorous fluid abdominal tenderness elevated maternal pulse rate

hyperthyroidism

excessive activity of the thyroid gland -0.1-0.4% of pregnancies; can cause pregnancy loss, low birth weight baby, maternal heart failure -goal is to control, and avoid the opposite disorder

Which intervention would be most important when caring for the client with breech presentation confirmed by ultrasound? noting the space at the maternal umbilicus auscultating the fetal heart rate at the level of the umbilicus applying suprapubic pressure against the fetal back continuing to monitor maternal and fetal status

continuing to monitor maternal and fetal status

A client at 32 weeks' gestation has been admitted to the labor and birth unit with preterm labor. Which medication would the nurse be likely to administer to reduce the risk of complications in the preterm newborn? nifedipine magnesium sulfate corticosteroids indomethacin

corticosteroids

The nurse recognizes that the postpartum period is a time of rapid changes for each client. What is believed to be the cause of postpartum affective disorders? medications used during labor and birth preexisting conditions in the client drop in estrogen and progesterone levels after birth lack of social support from family or friends

drop in estrogen and progesterone levels after birth

The nurse is assessing a pregnant client with a known history of congestive heart failure who is in her third trimester. Which assessment findings should the nurse prioritize? dyspnea, crackles, and irregular weak pulse increased urinary output, tachycardia, and dry cough shortness of breath, bradycardia, and hypertension regular heart rate and hypertension

dyspnea, crackles, and irregular weak pulse

A woman with type 2 diabetes is considering becoming pregnant and asks the nurse whether she will be able to continue taking her current oral hypoglycemics. The nurse's response will point out which factor? are usually suggested primarily for women who develop gestational diabetes. have been shown to be effective and safe in recent short term studies. can be used as long as they control serum glucose levels. can be taken until the degeneration of the placenta occurs.

have been shown to be effective and safe in recent short term studies.

Assessment of a postpartum client reveals a firm uterus with bright-red bleeding and a localized bluish bulging area just under the skin at the perineum. The woman also reports significant pelvic pain and is experiencing problems with voiding. The nurse suspects which condition? hematoma uterine atony laceration bladder distention

hematoma

After spontaneous rupture of membranes, the nurse notices a prolapsed cord. The nurse immediately places the woman in which position? knee-chest sitting side-lying supine

knee-chest

A nurse is explaining to a group of nurses new to the labor and birth unit about methods used for cervical ripening. The group demonstrates understanding of the information when they identify which method as a mechanical one? membrane stripping laminaria amniotomy herbal agents

laminaria

While providing care to a pregnant woman at the clinic, the nurse suspects that the client may be a victim of intimate partner violence. Which findings would lead the nurse to suspect this? Select all that apply. relaxed appearance during pelvic examinations not keeping up with scheduled treatments up and down weight gain frequent questions about how she and the baby are doing irregular adherence to scheduled prenatal visits

not keeping up with scheduled treatments up and down weight gain irregular adherence to scheduled prenatal visits

signs and symptoms of cardiac decompensation

objective -generalized progressive edema -frequent moist cough -cyanosis of nail beds and lips -tachypnea (25 or more respirations per minute) -crackles in lungs that do not clear with coughing -rapid, weak, irregular pulse subjective -feeling of being smothered -palpitations -generalized edema -difficulty catching breath -cough

A client with full-term pregnancy who is not in active labor has been prescribed oxytocin intravenously. The nurse would notify the health care provider if which finding is noted? postterm status dysfunctional labor pattern overdistended uterus prolonged ruptured membranes

overdistended uterus

A woman with gestational hypertension develops eclampsia and experiences a seizure. Which intervention would the nurse identify as the priority? fluid replacement birth of the fetus oxygenation control of hypertension

oxygenation

A patient who experiences premature rupture of membranes can expect to be put on pelvic rest. The nurse should explain to the patient that pelvic rest involves which of the following? staying off of the feet the majority of the day staying in bed at all times staying in bed with bathroom privileges placing nothing in the vagina

placing nothing in the vagina

The nurse is assessing a client at a postpartum visit and notes the client is emotionally sensitive, complains about being a failure, and appears extremely sad. The nurse concludes the client is presenting with which potential condition? postpartum psychosis anxiety disorders postpartum depression postpartum blues

postpartum depression

A nursing instructor identifies which factor as increasing the chances of infection when coupled with prolonged labor? maternal age premature rupture of membranes multiple births number of previous pregnancies

premature rupture of membranes

A patient who is at 7 months' gestation presents to the emergency department with reports of a large gush and continuous leaking of fluid from her vagina. She does have some slight pelvic pressure but denies any contractions. This patient is showing clinical signs of which of the following? precipitous labor premature rupture of membranes dystocia all of the above

premature rupture of membranes

Methylergonovine is prescribed for a woman experiencing postpartum hemorrhage. The nurse monitors the woman closely for which adverse effects? flushing seizures headache uterine hyperstimulation

seizures

A couple who is in for fertility testing ask the nurse what tests are commonly performed to assess fertility. The nurse replies that there are only three primary tests that are used. What are these tests? pelvic sonogram, ovulation monitoring, and semen analysis serologic test for syphilis, semen analysis, and tubal patency assessment semen analysis, ovulation monitoring, and tubal patency assessment semen analysis, urinalysis, and ovulation monitoring

semen analysis, ovulation monitoring, and tubal patency assessment

The nurse is appraising the medical record of a pregnant client who is resting in a darkened room and receiving betamethasone and magnesium sulfate. The nurse recognizes the client is being treated for which condition? postterm pregnancy gestational diabetes severe preeclampsia gestational hypertension

severe preeclampsia

alcohol

-9.4% of pregnant women drink alcohol -teratogen that can cause fetal alcohol syndrome; no known safe amount of alcohol during pregnancy -FAS signs and symptoms -Distinctive facial features, including small eyes, an exceptionally thin upper lip, a short, upturned nose, and a smooth skin surface between the nose and upper lip -Deformities of joints, limbs and fingers -Slow physical growth before and after birth -Vision difficulties or hearing problems

asthma

-complicates 3-5% of pregnancies -some experience worsening or symptoms and some experience improvement -complications: antepartum & postpartum hemorrhage, pulmonary embolism (life threatening - high mortality), miscarriage, increased bleeding risk -treatment - control and limit exacerbations -nurses encourage to TAKE asthma medications and avoid smoking/2nd hand smoke -asthma exacerbation can be recognized by dyspnea with wheezing or cough

A multipara client develops thrombophlebitis after birth. Which assessment findings would lead the nurse to intervene immediately? dyspnea, diaphoresis, hypotension, and chest pain dyspnea, bradycardia, hypertension, and confusion weakness, anorexia, change in level of consciousness, and coma pallor, tachycardia, seizures, and jaundice

dyspnea, diaphoresis, hypotension, and chest pain

A nurse is developing a plan of care for a woman who is at risk for thromboembolism. Which measure would the nurse include as the most cost-effective method for prevention? prophylactic heparin administration warm compresses early ambulation compression stockings

early ambulation

A woman with an incomplete abortion is to receive misoprostol. The woman asks the nurse, "Why am I getting this drug?" The nurse responds to the client, integrating understanding that this drug achieves which effect? halts the progression of the abortion alleviates strong uterine cramping ensures passage of all the products of conception suppresses the immune response to prevent isoimmunization

ensures passage of all the products of conception

The nurse is monitoring the uterine contractions of a woman in labor. The nurse determines the woman is experiencing hypertonic uterine dysfunction based on which contraction finding? brief. well coordinated. poor in quality. erratic.

erratic

HELLP Syndrome

hemolysis elevated, liver enzymes low, platelets

A client who is HIV-positive is in her second trimester and remains asymptomatic. She voices concern about her newborn's risk for the infection. Which statement by the nurse would be most appropriate? "Wait until after the infant is born, and then something can be done." "Antibodies cross the placenta and provide immunity to the newborn." "Antiretroviral medications are available to help reduce the risk of transmission." "You'll probably have a cesarean birth to prevent exposing your newborn."

"Antiretroviral medications are available to help reduce the risk of transmission."

questions to ask about eating disorder

-are you trying to restrict what you eat? -feel out of control of your eating? -eat secretly? -concerned about gaining weight in pregnancy? -how do you feel about your weight? -guilt about how you eat? -do you vomit after you eat or take medications such as laxatives or water pills? -do you exercise? how often, how long, what intensity?

asthma interventions

-auscultate lungs -document cough (productive vs. nonproductive) -pulse ox -supplemental Oxygen -review exacerbation history -avoid all triggers

depression

-majorly not treated in pregnancy in up to half of woman because of: not diagnosed, cost, stigma, fear of harming the fetus -untreated can lead to: substance abuse, poor adherence to care, less prenatal care, suicide risk -treated with SSRIs, which do not have any teratogenic effects but may have low Apgar scores -SSRIs not contraindicated in breastfeeding -stigma is common and women may feel shame and unwillingness to discuss the problem

pre-gestational diabetes - 2nd&3rd trimester assessments

-vasculopathy may be evidenced by fetal growth restriction -antepartum testing for fetal well-being begins between 32-34 weeks and may include Non-stress Test, Biophysical Profiles, Contraction Stress Test (least likely)

A biophysical profile has been completed on a pregnant woman. The nurse interprets which score as normal? 3 7 5 9

9

The nurse assesses that a fetus is in an occiput posterior position. The nurse predicts the client will experience which situation related to this assessment? Need to have the baby manually rotated Shorter dilation (dilatation) stage of labor Experience of additional back pain Necessity for vacuum extraction for birth

Experience of additional back pain

A postpartum client calls the nurse to her room and states that she knows something awful is going to happen to her. What should the nurse do? Call a code. Ask if she would like to see the social worker. Tell her she is being silly; nothing is going to happen to her. Report this immediately to the health care provider.

Report this immediately to the health care provider.

A woman who had preterm labor and preterm PROM successfully halted has reached week 36 of pregnancy and is doing well on home care. Which of the following nursing diagnoses should the nurse prioritize for this client? Hopelessness related to potential loss of pregnancy Risk for fetal infection related to early rupture of membranes Powerlessness related to inability to sustain pregnancy Anticipatory grieving related to high probability for fetal death from placental dysfunction

Risk for fetal infection related to early rupture of membranes

A pregnant woman at the emergency department informs staff that she is at least 2 weeks past her due date. The physician begins to perform several tests to determine fetal age. The nurse anticipates that the woman's amniotic fluid volume will be decreased. How would the nurse measure the amniotic fluid in this situation? aspiration x-ray palpation ultrasound

ultrasound

What would the nurse use to monitor the effectiveness of intravenous anticoagulant therapy for a postpartum woman with deep vein thrombosis? Platelet level Fibrinogen level Prothrombin time Activated partial thromboplastin time

Activated partial thromboplastin time

A patient with asthma who is 32 weeks' pregnant is concerned that the health care provider has reduced the doses of asthma maintenance medications. How should the nurse respond to this patient's concern? Asthma medication may reduce labor contractions and should be reduced. Asthma improves during pregnancy so higher doses are not needed. Asthma medication is ineffective during pregnancy and should be stopped. Asthma medication is teratogenic and should not be taken.

Asthma medication may reduce labor contractions and should be reduced.

A patient with type 2 diabetes mellitus is planning to become pregnant within the next several months. What should the nurse instruct the patient to support the 2020 National Health Goals of reducing the complications of pregnancy from diabetes? Reduce the use of insulin for blood glucose coverage. Avoid episodes of hyperglycemia. Limit the intake of carbohydrates and fats in the diet. Reduce the current exercise regimen by half.

Avoid episodes of hyperglycemia.

A client is admitted to the health care facility. The fetus has a gestational age of 42 weeks and is suspected to have cephalopelvic disproportion. Which should the nurse do next? Administer oxytocin intravenously at 4 mU/minute. Prepare the client for a cesarean birth. Place the client in lithotomy position for birth. Perform artificial rupture of membranes.

Prepare the client for a cesarean birth.

A pregnant client arrives at the clinic for a regular antenatal check-up. Examinations and weight recording reveal a slow fetal weight gain. About which of the following pregnancy-related risks should the nurse alert the client? Preterm labor Uterine infections Prolonged labor Pre-eclampsia

Preterm labor

The nurse is caring for a multigravid who experienced a placental abruption 4 hours ago. For which potential situation will the nurse prioritize assessment? Blood incompatibilities Maternal blood loss Uterine atony Hypertensive crisis

Uterine atony

A nurse is assigned to care for a client with a uterine prolapse. Which of the following would be most important for the nurse to assess when determining the severity of the prolapse? Pain in the lower abdomen Uterine protrusion into the vagina Foul smelling lochia Uterine bleeding present

Uterine protrusion into the vagina

The obstetric nurse is caring for a pregnant client who has been diagnosed with hydatidiform mole. What assessment should the nurse prioritize? Blood pressure Pain Vaginal bleeding Severe nausea and vomiting

Vaginal bleeding

A pregnant woman with diabetes at 10 weeks' gestation has a glycosylated hemoglobin (HbA1c) level of 13%. At this time the nurse should be most concerned about which possible fetal outcome? congenital anomalies incompetent cervix placental abruption (abruptio placentae) placenta previa

congenital anomalies

A nurse is interviewing a pregnant woman who has come to the clinic for her first prenatal visit. During the interview, the client tells the nurse that she works in a day care center with 2- and 3-year olds. Based on the client's history, the nurse would be alert for the development of which condition? gonorrhea cytomegalovirus chlamydia toxoplasmosis

cytomegalovirus

pre-gestational diabetes

diabetes identified before conception -receive preconception care; achieve excellent glycemic control prior to attempting pregnancy -at risk for: preeclampsia, perinatal death, macrocosmic fetus (more than 4000 g), congenital anomalies, polyhydramnios, fetal loss, and preterm birth -vaginal deliveries are not contraindicated, but some providers suggest cesarean section due to macrosomia diagnosed by ultrasound -labor induced often around 39-40 weeks -diet, exercise, and medications closely monitored

A nurse is providing care to a client who has been diagnosed with a common benign form of gestational trophoblastic disease. The nurse identifies this as: ectopic pregnancy. hydatidiform mole. hydramnios. placenta accrete.

hydatidiform mole.

A client has been in labor for 10 hours, with contractions occurring consistently about 5 minutes apart. The resting tone of the uterus remains at about 9 mm Hg, and the strength of the contractions averages 21 mm Hg. The nurse recognizes which condition in this client? hypotonic contractions uncoordinated contractions hypertonic contractions Braxton Hicks contractions

hypotonic contractions

A client in her sixth week postpartum reports general weakness. The client has stopped taking iron supplements that were prescribed to her during pregnancy. The nurse would assess the client for which condition? hyperglycemia hypovolemia hypertension hypothyroidism

hypovolemia

A nurse is reviewing a client's history and physical examination findings. Which information would the nurse identify as contributing to the client's risk for an ectopic pregnancy? heavy, irregular menses ovarian cyst 2 years ago use of oral contraceptives for 5 years recurrent pelvic infections

recurrent pelvic infections

levothyroxine (T4 replacement)

treatment for hypothyroidism -adjusted based on TSH levels every 4 weeks to 3 months -required more frequently in early pregnancy -take first thing in the morning on an empty stomach with no further oral intake for 1 hour

The nurse is reviewing the physical examination findings for a client who is to undergo labor induction. Which finding would indicate to the nurse that a woman's cervix is ripe in preparation for labor induction? firm closed posterior position shortened

shortened

A postpartum client who had a cesarean birth reports right calf pain to the nurse. The nurse observes that the client has nonpitting edema from her right knee to her foot. The nurse knows to prepare the client for which test first? transthoracic echocardiogram venous duplex ultrasound of the right leg noninvasive arterial studies of the right leg venogram of the right leg

venous duplex ultrasound of the right leg

A nurse is interviewing a couple at a preconception counseling session. The couple is of Greek heritage and are concerned about the possibility of their children being born with a genetic disorder. Based on the nurse's understanding of genetic disorders, the nurse would identify this couple as being at risk for which condition? Tay-Sachs disease sickle cell anemia α-thalassemia β-thalassemia

β-thalassemia

After teaching a woman with a postpartum infection about care after discharge, which client statement indicates the need for additional teaching? "I need to call my doctor if my temperature goes above 100.4° F (38° C)." "When I put on a new pad, I'll start at the back and go forward." "I'll point the spray of the peri-bottle so the water flows front to back." "If I have chills or my discharge has a strange odor, I'll call my doctor."

"When I put on a new pad, I'll start at the back and go forward."

A client with asthma is confused by her primary care provider continuing her medication while she is pregnant, since she read online the medications can cause birth defects. What is the nurse's best response? "Your primary care provider will order safe doses of your medication." "They won't cause any major defects." "It's OK to not use them if you would feel more comfortable." "I'll let your primary care provider know how you feel about it."

"Your primary care provider will order safe doses of your medication."

A client has had a cesarean birth. Which amount of blood loss would the nurse document as a postpartum hemorrhage in this client? 750 mL 1000 mL 250 mL 500 mL

1000 mL

A client is admitted to the unit in preterm labor. In preparing the client for tocolytic drug therapy, the nurse anticipates that the client's pregnancy may be prolonged for how long when this therapy is used? 2 to 7 days 4 to 8 days 6 to 10 days 1 to 5 days

2 to 7 days

The nurse determines that a woman is experiencing postpartum hemorrhage after a vaginal birth when the blood loss is greater than which amount? 750 mL 500 mL 300 mL 1000 mL

500 mL

hypothyroidism

A disorder caused by a thyroid gland that is slower and less productive than normal -sometimes diagnosed in pregnancy (lack of doctor visits) -0.3-0.5% pregnancies; can cause preeclampsia, postpartum hemorrhage, and early pregnancy loss

cardiovascular disease

A general term for all diseases of the heart and blood vessels -only complicates a small number of pregnancies -significant cause of maternal morbidity and mortality in pregnancy -cardiac output increases 50% during pregnancy and may exacerbate any underlying cardiac conditions -fetal well-being around 32-34 weeks, monitor mothers more frequent -management depends on disease type, severity, complications and involves collaboration between obstetrics, cardiology, and neonatology

The nurse is caring for a client in the transition stage of labor. In which scenario would the nurse predict the use of forceps may be used to assist with the birth? Reduce risk of complications The fetus is descending too slowly Abnormal position of the fetal head To lessen the mother's pain

Abnormal position of the fetal head

During a prenatal ultrasound, the client is discovered to have a placenta succenturiata. Following delivery of the fetus and placenta, which nursing assessment is most important? Assessment for hemorrhage Assessment for pain Assessment for shortness of breath Assessment for a thrombus

Assessment for hemorrhage

The nurse notes uterine atony in the postpartum client. Which assessment is completed next? Assessment of bowel function Assessment of the lung fields Assessment of laboratory data Assessment of the perineal pad

Assessment of the perineal pad

A nurse is caring for a postpartum client diagnosed with von Willebrand disease. What should be the nurse's priority for this client? Assess the temperature. Assess the fundal height. Monitor the pain level. Check the lochia.

Check the lochia.

A client at 35 weeks' gestation is now in stable condition after being admitted for vaginal bleeding. Which assessment should the nurse prioritize? Fetal heart tones Signs of shock Infection Uterine stabilization

Fetal heart tones

The nurse is caring for a client with a high-risk pregnancy. Which circumstance(s) may have caused the pregnancy to be labeled as high-risk? Select all that apply. multiple gestation pregnancy three-vessel umbilical cord daily exercises by mother maternal high blood pressure genetic defect of fetus HIV-positive mother

HIV-positive mother multiple gestation pregnancy genetic defect of fetus maternal high blood pressure

A postpartum patient is prescribed methylergonovine 0.2 mg for uterine subinvolution. Which action should the nurse take before administering the medication to the patient? Measure urine output. Measure blood pressure. Assess ambulation. Evaluate current hematocrit level.

Measure blood pressure.

What medication would the nurse administer to a client experiencing uterine atony and bleeding leading to postpartum hemorrhage? Calcium gluconate Magnesium sulfate Oxytocin Domperidone

Oxytocin

After a regular prenatal visit, a pregnant client asks the nurse to describe the differences between placental abruption (abruptio placentae) and placenta previa. Which statement will the nurse include in the teaching? Placental abruption requires "watchful waiting" during labor and birth. Placenta previa is an abnormally implanted placenta that is too close to the cervix. Placenta previa causes painful, dark red vaginal bleeding during pregnancy. Placental abruption results in painless, bright red vaginal bleeding during labor.

Placenta previa is an abnormally implanted placenta that is too close to the cervix.

When assessing a pregnant client for possible gestational hypertension, which factors would lead the nurse to suspect that the client is at increased risk? Select all that apply. High socioeconomic status Preexisting hypertension History of antiphospholipid syndrome Primiparas, particularly obese clients Age group within 18-35 years

Preexisting hypertension History of antiphospholipid syndrome Primiparas, particularly obese clients

A woman in labor suddenly reports sharp fundal pain accompanied by slight dark red vaginal bleeding. The nurse should prepare to assist with which situation? Preterm labor that was undiagnosed Premature separation of the placenta Possible fetal death or injury Placenta previa obstructing the cervix

Premature separation of the placenta

The following hourly assessments are obtained by the nurse on a client with preeclampsia receiving magnesium sulfate: 97.3oF (36.2oC), HR 88, RR 12 breaths/min, BP 148/110 mm Hg. What other priority physical assessments by the nurse should be implemented to assess for potential toxicity? Magnesium sulfate level Reflexes Lung sounds Oxygen saturation

Reflexes

A client at 37 weeks' gestation presents to the emergency department with a BP 150/108 mm Hg, 1+ pedal edema, 1+ proteinuria, and normal deep tendon reflexes. Which assessment should the nurse prioritize as the client is administered magnesium sulfate IV? Ability to sleep Urine protein Respiratory rate Hemoglobin

Respiratory rate

The nurse is caring for a postpartum woman who is diagnosed with endometritis. Which position should the nurse encourage the client to maintain? On her left side Trendelenburg Flat in bed Semi-Fowler

Semi-Fowler

The client is 32 weeks pregnant and has been referred for biophysical profile (BPP) after a nonreassuring nonstress test (NST). Which statement made by the client indicates that the nurse's explanation of the procedure was effective? The BPP is a blood test to detect placental problems. The BPP is a screening for neural tube defects. The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume. The BPP is a diagnostic procedure whereby a needle is inserted into the amniotic sac to obtain fluid.

The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume.

A pregnant patient with a history of premature cervical dilatation undergoes cervical cerclage. Which outcome indicates that this procedure has been successful? The client has reduced shortness of breath and abdominal pain during the pregnancy. The client's membranes spontaneously rupture at week 30 of gestation. The client delivers a full-term fetus at 39 weeks' gestation. The client experiences minimal vaginal bleeding throughout the pregnancy.

The client delivers a full-term fetus at 39 weeks' gestation.

The nurse is caring for a client who underwent a cesarean birth 24 hours ago. Which assessment finding indicates the need for further action? The client is having a moderate amount of rubra lochia. The client is afebrile. Bowel sounds are active. The client requires assistance to ambulate in the hallway. The fundus is located 2 fingerbreadths above the umbilicus.

The fundus is located 2 fingerbreadths above the umbilicus.

Chapter 19

conditions existing before conception

The nursing student doing a rotation in obstetrics is talking to her preceptor about dystocia. She asks what is meant by the term "expulsive forces," better known as the "powers." The preceptor correctly tells her that the "powers" include which factors? Select all that apply. analgesia mother's age presentation fetal development position

presentation fetal development position

A 44-year-old client has lost several pregnancies over the last 10 years. For the past 3 months, she has had fatigue, nausea, and vomiting. She visits the clinic and takes a pregnancy test; the results are positive. Physical examination confirms a uterus enlarged to 13 weeks' gestation; fetal heart tones are heard. Ultrasound reveals that the client is experiencing some bleeding. Considering the client's prenatal history and age, what does the nurse recognize as the greatest risk for the client at this time? premature birth spontaneous abortion (miscarriage) preterm labor hypertension

spontaneous abortion (miscarriage)

thioamides

treatment for hyperthyroidism (class of medications) -cross the placenta, suppress fetal thyroid hormone synthesis -associated with fetal anomalies, *take anyway

Which factor would contribute to a high-risk pregnancy? type 1 diabetes history of allergy to honey bee pollen first pregnancy at age 33 blood type O positive

type 1 diabetes

After teaching a class of pregnant women on ways to decrease the postpartum complication of thrombotic conditions, the nurse recognizes more teaching is needed when one of the participants states: "He has to do the deep breathing exercises with me." "Using passive range-of-motion exercises in bed sounds easy enough." "At least I don't have to give up smoking for this one." "I should drink more so I don't get dehydrated."

"At least I don't have to give up smoking for this one."

The nurse provides education to a postterm pregnant client. information will the nurse include to assist in early identification of potential problems? "Increase your fluid intake to prevent dehydration." "Continue to monitor fetal movements daily." "Monitor your bowel movements for constipation." "Be sure to measure 24-hour urine output daily."

"Continue to monitor fetal movements daily."

A nursing instructor is teaching about causes of infertility and identifies a need for further instruction when a student states which of the following? "Diet does not play a role in infertility." "Exercise can influence infertility." "A genetic abnormality may cause infertility." "An absence of ovulation may cause infertility."

"Diet does not play a role in infertility."

A woman with hyperemesis gravidarum asks the nurse about suggestions to minimize nausea and vomiting. Which suggestion would be most appropriate for the nurse to make? "Make sure that anything around your waist is quite snug." "Drink fluids in between meals rather than with meals." "Lie down for about an hour after you eat." "Try to eat three large meals a day with less snacking."

"Drink fluids in between meals rather than with meals."

A nurse is conducting a class for pregnant women who are in their third trimester. The nurse is reviewing information about the emotional changes that occur in the postpartum period, including postpartum blues and postpartum depression. After reviewing information about postpartum blues, the group demonstrates understanding when they make which statement about this condition? "Postpartum blues is a long-term emotional disturbance." "Extended psychotherapy is needed for treatment." "Getting some outside help for housework can lessen feelings of being overwhelmed." "The mother loses contact with reality."

"Getting some outside help for housework can lessen feelings of being overwhelmed."

Which statement by the nurse would be considered inappropriate when comforting a family who has experienced a stillborn infant? "I know you are hurting, but you can have another baby in the future." "Many mothers who have lost an infant want pictures of the baby. Can I make some for you?" "I will make handprints and footprints of the baby for you to keep." "Have you named your baby yet? I would like to know your baby's name."

"I know you are hurting, but you can have another baby in the future."

A mother is talking to the nurse and is concerned about managing her asthma while she is pregnant. Which response to the nurse's teaching indicates that the woman needs further instruction? "I will monitor my peak expiratory flow rate regularly to help me predict when an asthma attack is coming on." "I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring." "I need to be aware of my triggers and avoid them as much as possible." "It is fine for me to use my albuterol inhaler if I begin to feel tight."

"I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring."

A pregnant woman is diagnosed with iron-deficiency anemia and is prescribed an iron supplement. After teaching her about the prescribed iron supplement, which statement indicates successful teaching? "I need to drink plenty of fluids to prevent constipation." "I will call the health care provider if my stool is black and tarry." "I should take my iron with milk." "I should avoid drinking orange juice."

"I need to drink plenty of fluids to prevent constipation."

A postpartum woman who developed deep vein thrombosis is being discharged on anticoagulant therapy. After teaching the woman about this treatment, the nurse determines that additional teaching is needed when the woman makes which statement? "I will call my health care provider if my stools are black and tarry." "I will use a soft toothbrush to brush my teeth." "I can take ibuprofen if I have any pain." "I need to avoid drinking any alcohol."

"I will use a soft toothbrush to brush my teeth."

A 32-year-old woman with epilepsy mentions to the nurse during a routine well-visit that she would like to have children and asks the nurse for advice. Which response is most appropriate from the nurse? "Do you want to talk to a counselor who can help you weigh the pros and cons of having your own child rather than adopting?" "You should talk to the doctor about that; the medications you're on can damage the fetus." "I'll let the doctor know so you can discuss your medications. In the meantime, I'll give you a list of folate-rich foods you can add to your diet." "That's great. I've got a 4-year-old and a 2-year-old myself."

"I'll let the doctor know so you can discuss your medications. In the meantime, I'll give you a list of folate-rich foods you can add to your diet."

A woman has been in labor for the past 8 hours, and she has progressed to the second stage of labor. However, after 2 hours with no further descent, the provider diagnoses an "arrested descent." The woman asks, "Why is this happening?" Which response is the best answer to this question? "Maybe your baby has developed hydrocephaly and the head is too swollen." "Maybe your uterus is just tired and needs a rest." "More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal." "It is likely that your body has not secreted enough hormones to soften the ligaments so your pelvic bones can shift to allow birth of the baby."

"More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal."

A pregnant women calls the clinic to report a small amount of painless vaginal bleeding. What response by the nurse is best? "Please come in now for an evaluation by your health care provider." "Bleeding during pregnancy happens for many reasons, some serious and some harmless." "Lie on your left side and drink lots of water and monitor the bleeding." "If the bleeding lasts more than 24 hours, call us for an appointment."

"Please come in now for an evaluation by your health care provider."

The nurse is teaching a pregnant woman with type 1 diabetes about her diet during pregnancy. Which client statement indicates that the nurse's teaching was successful? "Pregnancy affects insulin production, so I'll need to make adjustments in my diet." "I'll basically follow the same diet that I was following before I became pregnant." "I'll adjust my diet and insulin based on the results of my urine tests for glucose." "Because I need extra protein, I'll have to increase my intake of milk and meat."

"Pregnancy affects insulin production, so I'll need to make adjustments in my diet."

The nurse is teaching a prenatal class about preparing for their expanding families. What is helpful advice from the nurse? "The hormones of pregnancy may cause anxiety or depression postpartum." "Expect your other children to react positively to their new brother/sister." "Caring for your new infant is instinctual and will come naturally to you." "Your old coping methods will adequately get you through this period of adjustment."

"The hormones of pregnancy may cause anxiety or depression postpartum."

The nurse is caring for several women in the postpartum clinic setting. Which statement(s), when made by one of the clients, would alert the nurse to further assess that client for postpartum psychosis? Select all that apply. "The newborn is not really mine emotionally, since I was never pregnant and do not have children." "When the newborn is sleeping, I can see his thoughts projected on my phone and I do not like the thoughts." "I am sad because I am not spending as much time with my toddler now that my newborn is here." "Sometimes I get tired of being with only the newborn, so I call my mom and sister to come visit." "I believe my newborn is losing weight because I will not feed him because my milk was poisoned by the health care provider."

"The newborn is not really mine emotionally, since I was never pregnant and do not have children." "When the newborn is sleeping, I can see his thoughts projected on my phone and I do not like the thoughts." "I believe my newborn is losing weight because I will not feed him because my milk was poisoned by the health care provider."

A client in her first trimester arrives at the emergency room with reports of severe cramping and vaginal spotting. On examination, the health care provider informs her that no fetal heart sounds are evident and orders a dilatation and curettage. The client looks frightened and confused and states that she does not believe in abortion. Which statement by the nurse is best? "Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications." "You have experienced an incomplete miscarriage and must have the placenta and any other tissues cleaned out." "The choice is up to you but the health care provider is recommending an abortion." "I know that it is sad but the pregnancy must be terminated to save your life."

"Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications."

anxiety: Generalized anxiety disorder (GAD)

-12% of people in the US -report fatigue, tension, irritability, pervasive sense of apprehension -assessed with seven-item scale (GAD-7) -main treatment with SSRIs because then are safe, and counseling -some treatment with benzodiazepines but they may cause withdrawal in neonate and a higher risk of fetal loss and preterm birth -nurses can empower patients with realistic education about therapies and self-care measures; mindfulness, exercise, good nutrition

smoking

-15.4% of pregnant women smoke -can cause preterm birth, intrauterine growth restriction, and stillbirth

iron deficiency anemia

-16-29% will become during pregnancy -severe, is associated with non-reassuring FHR, prematurity, fetal loss, maternal death (rare in developed countries) -physiologic - expected finding with normal hemoglobin level 11-14 g/dL -below 10.5 g/dL for diagnosis

opioids and opioid replacements

-5.4% pregnant women use illegal drugs high risk for neonatal abstinence syndrome (NAS) - withdrawal syndrome signs and symptoms -Body shakes (tremors) -seizures (convulsions) -overactive reflexes (twitching), tight muscle tone -Fussiness, excessive crying/high-pitched cry -Poor feeding/sucking or slow weight gain -Breathing problems, breathing really fast -Fever, sweating or blotchy skin

intimate partner violence - IPV

-7-20% of pregnancies are complicated by physical abuse -psychologic and sexual abuse, goes underreported -5% women report partners tried to get them pregnant and they did not want to be -screen for this during prenatal visits, hospitalization, and postpartum appointments -use standardized screening tool bc can be intimidating -screen when alone -make appropriate referrals

substance abuse

-may not seek prenatal care bc they feel ashamed or are worried about the involvement of social services -ALL women should be screened -stopping consumption at any point can improve outcomes -some have comorbid conditions and psychosocial challenges ex. homelessness; treat underlying cause to reduce use -don't threaten that baby will be taken -focus on positives (smoking 1 less cigarette per day)

eating disorders

-poor health and psychologic outcomes -pregnancy may be challenging due to normal body changes because of body image -women may not menstruate, but they may ovulate -pregnancy should be planned for a time of remission, need to get nutrients to fetus -anorexia nervosa, bulimia nervosa, binge eating disorder

The experienced labor and birth nurse knows to evaluate progress in active labor by using which simple rule? 2 cm/hour for cervical dilation 1/2 cm/hour for cervical dilation 1 cm/hour for cervical dilation 1/4 cm/hour for cervical dilation

1 cm/hour for cervical dilation

A client is 33 weeks pregnant and has had diabetes since age 21. When checking her fasting blood glucose level, which value would indicate the client's disease is controlled? 120 mg/dL 85 mg/dL 136 mg/dL 45 mg/dL

85 mg/dL

While the placenta is being delivered after labor, a patient experiences an amniotic fluid embolism. What should the nurse do first to help this patient? Administer oxygen by mask. Increase intravenous fluid infusion rate. Put firm pressure on the fundus of the uterus. Tell the patient to take short, shallow breaths.

Administer oxygen by mask.

A woman is going to have labor induced with oxytocin. Which statement reflects the induction technique the nurse anticipates the primary care provider will prescribe? Administer oxytocin diluted in the main intravenous fluid. Administer oxytocin in two divided intramuscular sites. Administer oxytocin in a 20 cc bolus of saline. Administer oxytocin diluted as a "piggyback" infusion.

Administer oxytocin diluted as a "piggyback" infusion.

The nurse is reviewing orders written for a postpartum patient with a fourth-degree perineal laceration. Which order should the nurse question before implementing? Administering an enema Providing a sitz bath Urging to drink all the milk provided during meals Administering acetaminophen and codeine for pain

Administering an enema

Which of the following statements regarding weight and pregnancy is correct? An underweight woman should increase her caloric intake by 500 to 1000 calories a day. Women who are underweight coming into pregnancy should gain the same amount of weight as women with a normal BMI. Dieting during pregnancy to reduce weight is recommended only for morbidly obese women. Obesity usually occurs from hypothyroidism.

An underweight woman should increase her caloric intake by 500 to 1000 calories a day.

A pregnant patient with intermittent preterm contractions at 30 weeks has been on weekly home care assessments for 1 month without health care visits to the doctor or any activities outside the home. The nurse has established adequate fetal growth and is aware that contractions have been occurring roughly two times a day. The patient makes little effort to look at the nurse or discuss her plans for the upcoming delivery. The nurse makes which diagnosis of the current needs of this patient? Inadequate dietary intake related to activity restriction At risk for venous thromboembolism because of restricted activity At risk for depression because of extended activity restriction, as evidenced by affect Threatened preterm delivery related to contractions, as evidenced by reports by the patient of contractions before 38 weeks' gestation

At risk for depression because of extended activity restriction, as evidenced by affect

A client develops mastitis 3 weeks after giving birth. What part of client self-care is emphasized as most important? Administer antibiotic medication for the full 10 days even if she begins to feel better Increase her fluid intake to ensure that she will continue to produce adequate milk Breastfeed or otherwise empty her breasts every 1 to 2 hours Use NSAIDs, warm showers, and warm compresses to relieve her discomfort

Breastfeed or otherwise empty her breasts every 1 to 2 hours

The nurse is caring for a mother laboring with her second baby. Her last vaginal exam revealed 5 cm dilated at a -2 station. The nurse notes on the monitor that the fetus is now experiencing severe bradycardia and variable decelerations. What should the nurse do first? Call for help Apply oxygen to the mother Lift the head off the cord Notify the obstetric provider

Call for help

Before calling the health care provider to report a slow progression or an arrest of labor, several assessments need to be made. What other maternal assessment does the nurse need to make prior to calling the health care provider? Make sure the client is lying on her left side. Assess vital signs every 30 minutes. Check for a full bladder. Make sure the epidural medication is turned down.

Check for a full bladder.

The nurse is comforting and listening to a young couple who just suffered a spontaneous abortion (miscarriage). When asked why this happened, which reason should the nurse share as a common cause? Maternal smoking Chromosomal abnormality Lack of prenatal care The age of the mother

Chromosomal abnormality

A mother in labor with ruptured membranes comes to the labor and delivery unit. It is determined that the fetus is in a single footling breech presentation. The nurse assesses the mother for which complication associated with this fetal position? Brachial plexus injury Uterine atony Cord prolapse Placental abruption

Cord prolapse

A woman with cardiac disease at 32 weeks' gestation reports she has been having spells of light-headedness and dizziness every few days. Which instruction should the nurse prioritize? Bed rest and bathroom privileges only until birth. Increase fluids and take more vitamins. Discuss induction of labor with the health care provider. Decrease activity and rest more often.

Decrease activity and rest more often.

The nurse is assessing a new client who is being admitted with gestational hypertension. Which nursing diagnosis should the nurse prioritize for this client? Imbalanced nutrition related to decreased sodium levels Deficient fluid volume related to vasospasm of arteries Risk for injury related to fetal distress Decreased reflexes due to medication administration

Deficient fluid volume related to vasospasm of arteries

A client in preterm labor is receiving magnesium sulfate IV and appears to be responding well. Which finding on assessment should the nurse prioritize? Depressed deep tendon reflexes Elevated blood glucose Bradycardia Tachypnea

Depressed deep tendon reflexes

Which response is most appropriate for a client with diabetes who wants to breast-feed but is concerned about the effects of breastfeeding on her health? Diabetic clients who breast-feed have a hard time controlling their insulin needs Diabetic clients may breast-feed; insulin requirements may decrease from breast-feeding Diabetic clients shouldn't breast-feed because of potential complications Diabetic clients shouldn't breast-feed; insulin requirements are doubled

Diabetic clients may breast-feed; insulin requirements may decrease from breast-feeding

A pregnant patient receiving intravenous oxytocin for 1 hour has contractions lasting 80 seconds. What should the nurse do first for this patient? Increase the flow rate of the main line infusion. Slow the infusion to below 10 gtt/minute. Continue to monitor contraction duration every 2 hours. Discontinue the oxytocin infusion.

Discontinue the oxytocin infusion.

A patient in her late twenties visits the clinic to begin the process of in vitro fertilization (IVF). Her husband in his late fifties asks if there are any tests to check for any irregularities. What tests should the nurse discuss with this couple? CVS PPD Examination of egg and sperm amniocentesis

Examination of egg and sperm

A pregnant client in her 35th week of gestation arrives at the clinic with bright red vaginal spotting. An ultrasound indicates that the placenta is partially covering the cervical os. The nurse interprets this as which? Grade I- Low lying placenta Grade II- Marginal previa Grade III- Partial previa Grade IV- Complete previa

Grade III- Partial previa

A pregnant patient reports feeling pain similar to menstrual cramps. What should the nurse explain about this patient's symptoms? Exercise helps reduce the frequency of them. Lying down for a few hours will help them stop. They are false labor and do not need to be reported. If rhythmical, they could indicate preterm labor.

If rhythmical, they could indicate preterm labor.

The nurse is identifying nursing diagnoses for a client with gestational hypertension. Which diagnosis would be the most appropriate for this client? Risk for injury related to fetal distress Ineffective tissue perfusion related to vasoconstriction of blood vessels Ineffective tissue perfusion related to poor heart contraction Imbalanced nutrition related to decreased sodium levels

Ineffective tissue perfusion related to vasoconstriction of blood vessels

Preterm premature rupture of membranes (PROM) can be a serious complication of labor. What is the most common cause of preterm PROM? Cephalopelvic disproportion Infection Incompetent cervix Macrosomia

Infection

A pregnant woman has been admitted to the hospital due to preeclampsia with severe features. Which measure will be important for the nurse to include in the care plan? Plan for immediate induction of labor. Institute and maintain seizure precautions. Admit the client to the middle of ICU where she can be constantly monitored. Institute NPO status.

Institute and maintain seizure precautions.

A pregnant patient asks why an α-fetoprotein serum level has been ordered. What should the nurse explain to the patient about this test? It screens for placenta function. It may reveal chromosomal abnormalities. It tests the ability of the patient's heart to accommodate the pregnancy. It measures the fetal liver function.

It may reveal chromosomal abnormalities.

When the nurse is assisting the parents in the grieving process after the death of their neonate, what is the nurse's most important action? Removing the infant quickly. Keeping the communication lines open. Leaving the parents alone. Contacting a grief counselor.

Keeping the communication lines open.

The nurse is caring for a diabetic, postpartum client who has developed an infection.The nurse is aware that infections in diabetic clients tend to be more severe and can quickly lead to complications. Which complication should the nurse assess this client for? Respiratory acidosis Anemia Respiratory alkalosis Ketoacidosis

Ketoacidosis

A pregnant client is admitted to a health care facility with a diagnosis of premature rupture of membranes (PROM). Which of the following tests would the nurse expect to be used to predict fetal lung maturity when the client goes into labor? Lecithin/sphingomyelin ratio Reticulocyte count Nitrazine test Test for antiphospholipids

Lecithin/sphingomyelin ratio

A woman in labor is having very intense contractions with a resting uterine tone >20 mm Hg. The woman is screaming out every time she has a contraction. What is the highest priorityfetal assessment the health care provider should focus on at this time? Monitor heart rate for tachycardia. Monitor fetal movements to ensure they are neurologically intact. Look for late decelerations on monitor, which is associated with fetal anoxia. Monitor fetal blood pressure for signs of shock (low BP, high FHR).

Look for late decelerations on monitor, which is associated with fetal anoxia.

A nursing instructor is teaching students about caring for a pregnant patient with a pre-existing disease. Which of the following does the instructor suggest has added to an increased incidence of pregnant women with a pre-existing disease? More women waiting until after age 30 years to get pregnant Women seeking out earlier prenatal care Better tests to diagnose diseases Better assessment skills by physicians

More women waiting until after age 30 years to get pregnant

A pregnant client with diabetes in the hospital reports waking up with shakiness and diaphoresis. Which action should the nurse prioritize after discovering the client's fasting blood sugar is 60 mg/dl (3.33 mmol/L)? Withhold her insulin, and notify the health care provider. Stay with her, and ask another nurse to bring her insulin. Provide the client some milk to drink. Recheck her blood sugar for accuracy.

Provide the client some milk to drink.

A patient having an examination to check the placement of an intrauterine device (IUD) is diagnosed as being pregnant. For which action should the nurse prepare the patient at this time? Potential for a spontaneous abortion Surgery to abort the fetus Removal of the IUD Nothing since the IUD can remain in place

Removal of the IUD

The nurse is assisting with a vaginal birth. The patient is fully dilated, 100% effaced and is pushing. The nurse observes the "turtle sign" with each push and there is no progress. What does the nurse suspect may be occurring with this fetus? Nuchal cord Shoulder dystocia Umbilical cord prolapse Breech position

Shoulder dystocia

The nurse is caring for a pregnant client admitted for abdominal trauma following an assault. The nurse will monitor the client for which potential complications? Select all that apply. Spontaneous abortion (miscarriage) Placental abruption (abruptio placentae) Preterm labor Uterine rupture Gestational hypertension

Spontaneous abortion (miscarriage) Placental abruption (abruptio placentae) Preterm labor Uterine rupture

Over the past 20 weeks, the following blood pressure readings are documented for a pregnant client with chronic hypertension: week 16 - 130/86 mm Hg; week 20 - 138/88 mm Hg; week 24 - 136/82 mm Hg; and week 28 - 138/88 mm Hg. The nurse interprets these findings as indicating which classification of her blood pressure? Stage 2 Elevated Stage 1 Hypertensive crisis

Stage 1

Which situation should concern the nurse treating a postpartum client within a few days of birth? The client would like to watch the nurse give the baby her first bath. The client is nervous about taking the baby home. The client feels empty since she gave birth to the neonate. The client would like the nurse to take her baby to the nursery so she can sleep.

The client feels empty since she gave birth to the neonate.

A primigravida 21-year-old client at 24 weeks' gestation has a 2-year history of HIV. As the nurse explains the various options for delivery, which factor should the nurse point out will influence the decision for a vaginal birth? The mother's age Prophylactic ART to infant at birth Amniocentesis results at 34 weeks The viral load

The viral load

A nurse is caring for a pregnant client. The initial interview reveals that the client is accustomed to drinking coffee at regular intervals. For which increased risk should the nurse make the client aware? anemia scurvy heart disease rickets

anemia

When preparing a schedule of follow-up visits for a pregnant woman with chronic hypertension, which schedule would be most appropriate? bi-monthly visits until 28 weeks, then weekly visits bi-monthly visits until 36 weeks, then weekly visits monthly visits until 32 weeks, then bi-monthly visits monthly visits until 20 weeks, then bi-monthly visits

bi-monthly visits until 28 weeks, then weekly visits

Which measurement best describes delayed postpartum hemorrhage? blood loss in excess of 1,000 ml, occurring at least 24 hours and up to 12 weeks after birth blood loss in excess of 500 ml, occurring at least 24 hours and up to 12 weeks after birth blood loss in excess of 300 ml, occurring at least 24 hours and up to 12 weeks after birth blood loss in excess of 800 ml, occurring at least 24 hours and up to 12 weeks after birth

blood loss in excess of 500 ml, occurring at least 24 hours and up to 12 weeks after birth

A pregnant client with type I diabetes asks the nurse about how to best control her blood sugar while she is pregnant. The best reply would be for the woman to: exercise for 1 to 2 hours each day to keep the blood glucose down. limit weight gain to 15 pounds during the pregnancy. begin oral hyperglycemic medications along with the insulin she is currently taking. check her blood sugars frequently and adjust insulin accordingly.

check her blood sugars frequently and adjust insulin accordingly.

epilepsy

chronic brain disorder characterized by recurrent seizure activity -1-2% of people have this -increased risk of passing disorder onto fetus -mostly uneventful, complications can include: preeclampsia, preterm labor, fetal death -anti-seizure medications* -monitor CBC (hemoglobin, hematocrit, platelets); and for bruising or Petechiae (to look for bleeding/hemorrhaging)

A nurse suspects that a client is developing HELLP syndrome. The nurse notifies the health care provider based on which finding? disseminated intravascular coagulation (DIC) elevated platelet count hyperglycemia elevated liver enzymes

elevated liver enzymes

A client at 38 weeks' gestation has an ultrasound performed at a routine office visit and learns that her fetus has not moved out of a breech position. Which intervention does the nurse anticipate for this client? trial labor external cephalic version vacuum extraction forceps birth

external cephalic version

A nurse is monitoring a client with PROM who is in labor and observes meconium in the amniotic fluid. What does the observation of meconium indicate? infection central nervous system (CNS) involvement cord compression fetal distress related to hypoxia

fetal distress related to hypoxia

A nurse is conducting an in-service program for a group of nurses working at the women's health facility about the causes of spontaneous abortion. The nurse determines that the teaching was successful when the group identifies which condition as the most common cause of first trimester abortions? uterine fibroids cervical insufficiency fetal genetic abnormalities maternal disease

fetal genetic abnormalities

A pregnant woman is diagnosed with abruptio placentae. When reviewing the woman's physical assessment in her medical record, which finding would the nurse expect? firm, rigid uterus on palpation fetal heart rate within normal range bright red vaginal bleeding absence of pain

firm, rigid uterus on palpation

A nurse is describing the risks associated with post-term pregnancies as part of an inservice presentation. The nurse determines that more teaching is needed when the group identifies which factor as an underlying reason for problems in the fetus? meconium aspiration increased amniotic fluid volume aging of the placenta cord compression

increased amniotic fluid volume

A client experienced prolonged labor with prolonged premature rupture of membranes. The nurse would be alert for which condition in the mother and the newborn? hemorrhage infection hypovolemia trauma

infection

A nurse informs a pregnant woman with cardiac disease that she will need two rest periods each day and a full night's sleep. The nurse further instructs the client that which position for this rest is best? left lateral recumbent right lateral recumbent on her back prone

left lateral recumbent

In women with cardiac failure, the maternal blood pressure becomes insufficient to provide an adequate supply of blood to the placenta. The infant will likely experience some undesired effects, including which of the following? high birth weight hypoglycemia low birth weight hyperglycemia

low birth weight

A primary care provider prescribes intravenous tocolytic therapy for a woman in preterm labor. Which agent would the nurse expect to administer? nifedipine betamethasone magnesium sulfate indomethacin

magnesium sulfate

Which medication will the nurse anticipate the health care provider will prescribe as treatment for an unruptured ectopic pregnancy? oxytocin methotrexate promethazine ondansetron

methotrexate

A woman is experiencing a postpartum hemorrhage due to uterine atony. Which risk factor would the nurse recognize as contributory to this specific problem? fetal demise placenta accreta multiparity preeclampsia

multiparity

A pregnant woman has arrived to the office reporting vaginal bleeding. Which finding during the assessment would lead the nurse to suspect an inevitable abortion? strong abdominal cramping no passage of fetal tissue slight vaginal bleeding closed cervical os

strong abdominal cramping