OB Chapter 21
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? Chromosomal abnormality The age of the mother Lack of prenatal care Maternal smoking
Chromosomal abnormality The most common cause for the loss of a fetus in the first trimester is associated with a genetic defect or chromosomal abnormality. There is nothing that can be done and the mother should feel no fault. The nurse needs to encourage the parents to speak with a health care provider for further information and questions related to genetic testing. Early pregnancy loss is not associated with maternal smoking, lack of prenatal care, or the age of the mother.
A client at 25 weeks' gestation presents with a blood pressure of 152/99 mm Hg, pulse 78 beats/min, no edema, and urine negative for protein. What would the nurse do next? Assess the client for ketonuria Provide health education Notify the health care provider Document the client's blood pressure
Notify the health care provider The client is exhibiting a sign of gestational hypertension, elevated blood pressure greater than or equal to 140/90 mm Hg that develops for the first time during pregnancy. The health care provider should be notified to assess the client. Without the presence of edema or protein in the urine, the client does not have preeclampsia.
A pregnant woman at 38 weeks' gestation is receiving care for preeclampsia and suddenly complains of sharp abdominal pain. Which action should the nurse prioritize if the nurse notes a firm, distended, and painful abdomen and dark red vaginal bleeding? Dipstick the urine for protein. Implement a tocodynamometer. Obtain a full set of vital signs. Place on the fetal heart monitor.
Obtain a full set of vital signs. The initial assessment is to determine if the client is going into shock from hemorrhaging. The abdominal pain and dark red bleeding indicate a possible abruption of the placenta related to the preeclampsia. The health care provider must be notified ASAP. Assessing the status of the fetus would be next. Assessing for contractions and the urine for protein are not priority assessments for the nurse.
A client with severe preeclampsia is receiving magnesium sulfate as part of the treatment plan. To ensure the client's safety, which compound would the nurse have readily available? calcium gluconate ferrous sulfate calcium carbonate potassium chloride
calcium gluconate The woman is at risk for magnesium toxicity. The antidote for magnesium sulfate is calcium gluconate, and this should be readily available in case the woman has signs and symptoms of magnesium toxicity.
A woman at 35 weeks' gestation with severe polyhydramnios is admitted to the hospital. The nurse recognizes that which concern is greatest regarding this client? hemorrhaging development of eclampsia development of gestational trophoblastic disease preterm rupture of membranes followed by preterm birth
preterm rupture of membranes followed by preterm birth Even with precautions, in most instances of polyhydramnios, there will be preterm rupture of the membranes because of excessive pressure, followed by preterm birth. The other answers are less concerning than preterm birth in this pregnancy.
The nurse is teaching a client who is diagnosed with preeclampsia how to monitor her condition. The nurse determines the client needs more instruction after making which statement? "I will count my baby's movements after each meal." "If I have changes in my vision, I will lie down and rest." "I will weigh myself every morning after voiding before breakfast." "If I have a severe headache, I'll call the clinic."
"If I have changes in my vision, I will lie down and rest." Changes in the visual field may indicate the client has moved from preeclampsia to severe preeclampsia and is at risk for developing a seizure due to changes in cerebral blood flow. The client would require immediate assessment and intervention. Gaining weight is not necessarily a sign of worsening preeclampsia. The other choices are instructions which the client may be given to follow.
A pregnant women calls the clinic to report a small amount of painless vaginal bleeding. What response by the nurse is best? "Bleeding during pregnancy happens for many reasons, some serious and some harmless." "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." "Lie on your left side and drink lots of water and monitor the bleeding."
"Please come in now for an evaluation by your health care provider." Bleeding during pregnancy is always a deviation from normal and should be evaluated carefully. It may be life-threatening or it may be something that is not a threat to the mother and/or fetus. Regardless, it needs to be evaluated quickly and carefully. Telling the client it may be harmless is a reassuring statement, but does not suggest the need for urgent evaluation. Having the mother lay on her left side and drink water is indicated for cramping.
A client with a history of cervical insufficiency is seen for reports of pink-tinged discharge and pelvic pressure. The primary care provider decides to perform a cervical cerclage. The nurse teaches the client about the procedure. Which client response indicates that the teaching has been effective? "Purse-string sutures are placed in the cervix to prevent it from dilating." "The cervix is glued shut so no amniotic fluid can escape." "Staples are put in the cervix to prevent it from dilating." "A cervical cap is placed so no amniotic fluid can escape."
"Purse-string sutures are placed in the cervix to prevent it from dilating." The cerclage, or purse string suture, is inserted into the cervix to prevent preterm cervical dilation (dilatation) and pregnancy loss. Staples, glue, or a cervical cap will not prevent the cervix from dilating.
A 28-year-old client with a history of endometriosis presents to the emergency department with severe abdominal pain and nausea and vomiting. The client also reports her periods are irregular with the last one being 2 months ago. The nurse prepares to assess for which possible cause for this client's complaints? Ectopic pregnancy Placenta previa Healthy pregnancy Molar pregnancy
Ectopic pregnancy The most commonly reported symptoms of ectopic pregnancy are pelvic pain and/or vaginal spotting. Other symptoms of early pregnancy, such as breast tenderness, nausea, and vomiting, may also be present. The diagnosis is not always immediately apparent because many women present with complaints of diffuse abdominal pain and minimal to no vaginal bleeding. Steps are taken to diagnose the disorder and rule out other causes of abdominal pain. Given the history of the client and the amount of pain, the possibility of ectopic pregnancy needs to be considered. A healthy pregnancy would not present with severe abdominal pain unless the client were term and she was in labor. With a molar pregnancy the woman typically presents between 8 to 16 weeks' gestation reporting painless (usually) brown to bright red vaginal bleeding. Placenta previa typically presents with painless, bright red bleeding that begins with no warning.
Which medication will the nurse anticipate the health care provider will prescribe as treatment for an unruptured ectopic pregnancy? promethazine ondansetron methotrexate oxytocin
methotrexate Methotrexate, a folic acid antagonist that inhibits cell division in the developing embryo, is most commonly used to treat ectopic pregnancy. Oxytocin is used to stimulate uterine contractions and would be inappropriate for use with an ectopic pregnancy. Promethazine and ondansetron are antiemetics that may be used to treat hyperemesis gravidarum.
A client experiencing a threatened abortion is concerned about losing the pregnancy and asks what she can do to help save her baby. What is the most appropriate response from the nurse? "Carry on with the activity you engaged in before this happened." "Strict bed rest is necessary so as not to jeopardize this pregnancy." "Restrict your physical activity to moderate bed rest." "There is no research evidence that I can recommend to you."
"Restrict your physical activity to moderate bed rest." With a threatened abortion, moderate bedrest, light activities, and supportive care are recommended. Regular physical activity may increase the chances of miscarriage. Strict bedrest is not necessary and may hide additional bleeding as it pools in the vagina, only to begin again as the woman ambulates. Activity restrictions are part of standard medical management.
A 16-year-old client was at 12 weeks' gestation when she gave birth to a fetus last week. The client has come to the office for follow-up and, while waiting in an examination room, notices that on the schedule is written her name and "follow-up of spontaneous abortion." The client is upset about what is written on the schedule. How can the nurse best explain this terminology? "Abortion is a medical term for any interruption of pregnancy before a fetus is viable." "Oh, that just means it was a miscarriage." "Spontaneous abortion is a more specific term used to describe a spontaneous miscarriage, which is a loss of pregnancy before 20 weeks. This term does not imply that you did anything to affect the pregnancy." "Spontaneous abortion is the medical name for a miscarriage."
"Spontaneous abortion is a more specific term used to describe a spontaneous miscarriage, which is a loss of pregnancy before 20 weeks. This term does not imply that you did anything to affect the pregnancy." Abortion is a medical term for any interruption of a pregnancy before a fetus is viable, but it is better to speak of these early pregnancy losses as spontaneous abortions to avoid confusion with intentional terminations of pregnancies. The other responses are correct, but they do not provide the client with the most complete nor reassuring answer.
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 (D&C). The client looks frightened and confused and states that she does not believe in induced abortion (medical abortion). Which statement by the nurse is best? "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." "You have experienced an incomplete abortion (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 induced abortion (medical abortion).
"Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications." The nurse should not inform the client what she must do but supply information about what has happened and teach the client about the treatments that are used to correct the situation. A threatened spontaneous abortion (miscarriage) becomes an imminent (inevitable) miscarriage if uterine contractions and cervical dilation (dilatation) occur. A woman who reports cramping or uterine contractions is asked to seek medical attention. If no fetal heart sounds are detected and an ultrasound reveals an empty uterus or nonviable fetus, her health care provider may perform a dilatation and curettage (D&C) or a dilation and evacuation (D&E) to ensure all products of conception are removed. Be certain the woman has been told the pregnancy was already lost and all procedures, such as suction curettage, are to clear the uterus and prevent further complications such as infection, not to end the pregnancy. This scenario does not involve an abortion (elective termination of pregnancy) or an incomplete miscarriage.
A client reporting she recently had a positive pregnancy test has reported to the emergency department stating one-sided lower abdominal pain. The health care provider has prescribed a series of tests. Which test will provide the most definitive confirmation of an ectopic pregnancy? Abdominal ultrasound Pelvic examination Qualitative human chorionic gonadotropin (hCG) test Quantitative human chorionic gonadotropin (hCG) test
Abdominal ultrasound An ectopic pregnancy refers to the implantation of the fertilized egg in a location other than the uterus. Potential sites include the cervix, uterus, abdomen, and fallopian tubes. The confirmation of the ectopic pregnancy can be made by an ultrasound, which would confirm that there was no uterine pregnancy. A quantitative hCG level may be completed in the diagnostic plan. hCG levels in an ectopic pregnancy are traditionally reduced. While this would be an indication, it would not provide a positive confirmation. The qualitative hCG test would provide evidence of a pregnancy, but not the location of the pregnancy. A pelvic exam would be included in the diagnostic plan of care. It would likely show an enlarged uterus and cause potential discomfort to the client but would not be a definitive finding.
A nurse in the maternity triage unit is caring for a client with a suspected ectopic pregnancy. Which nursing intervention should the nurse perform first? Assess the client's vital signs. Provide emotional support to the client and significant other. Administer oxygen to the client. Obtain a surgical consent from the client.
Assess the client's vital signs. A suspected ectopic pregnancy can put the client at risk for hypovolemic shock. The assessment of vital signs should be performed first, followed by any procedures to maintain the ABCs. Providing emotional support would also occur, as would obtaining a surgical consent, if needed, but these are not first steps.
A woman in her 20s has experienced a spontaneous abortion (miscarriage) at 10 weeks' gestation and asks the nurse at the hospital what went wrong. She is concerned that she did something that caused her to lose her baby. The nurse can reassure the woman by explaining that the most common cause of miscarriage in the first trimester is related to which factor? Advanced maternal age Exposure to chemicals or radiation Faulty implantation Chromosomal defects in the fetus
Chromosomal defects in the fetus Fetal factors are the most common cause of early miscarriages, with chromosomal abnormalities in the fetus being the most common reason. This client fits the criteria for early spontaneous abortion (miscarriage) since she was only 10 weeks' pregnant and early miscarriage occurs before 12 weeks.
An 18-year-old pregnant client is hospitalized as she recovers from hyperemesis gravidarum. The client reveals she wanted to have an abortion (elective termination of pregnancy) but her cultural background forbids it. She is very unhappy about being pregnant and even expresses a wish for a spontaneous abortion (miscarriage). Which action by the nurse is most appropriate? Encourage the client to keep her feelings to herself. Continue to monitor the client's hyperemesis gravidarum. Share the information with the client's family. Contact the health care provider to report the client's feelings.
Contact the health care provider to report the client's feelings. The client may be experiencing a psychological situation that needs intervention by a trained professional in the area of mental health. The hyperemesis gravidarum may worsen her feelings toward the pregnancy and needs to be monitored, so reporting her feelings to the health care provider is the best action at this time. Although the nurse will continue to monitor the client's hyperemesis gravidarum, this is not the only action needed at this time and there is a better action. Encouraging the client to remain silent about her feelings may obstruct therapeutic communication. Sharing the information with the client's family is not appropriate because the scenario described does not indicate that the nurse has the client's permission to share this information with her family.
A client tells that nurse in the doctor's office that her friend developed high blood pressure on her last pregnancy. She is concerned that she will have the same problem. What is the standard of care for preeclampsia? Take one aspirin every day. Have her blood pressure checked at every prenatal visit. Monitor the client for headaches or swelling on the body. Take a low-dose antihypertensive prophylactically.
Have her blood pressure checked at every prenatal visit. Preeclampsia and eclampsia are common problems for pregnant clients and require regular blood pressure monitoring at all prenatal visits. Antihypertensives are not prescribed unless the client is already hypertensive. Monitoring for headaches and swelling is a good predictor of a problem but doesn't address prevention—nor does it predict who will have hypertension. Taking aspirin has shown to reduce the risk in women who have moderate to high risk factors, but has shown no effect on those women with low risk factors.
A 24-year-old woman presents with vague abdominal pains, nausea, and vomiting. An urine hCG is positive after the client mentioned that her last menstrual period was 2 months ago. The nurse should prepare the client for which intervention if the transvaginal ultrasound indicates a gestation sac is found in the right lower quadrant? Bed rest for the next 4 weeks Intravenous administration of a tocolytic Immediate surgery Internal uterine monitoring
Immediate surgery The client presents with the signs and symptoms of an ectopic pregnancy, which is confirmed by the transvaginal ultrasound. Ectopic pregnancy means an embryo has implanted outside the uterus. Surgery is necessary to remove the growing structure before damage can occur to the woman's internal organs. Bed rest, a tocolytic, and internal uterine monitoring will not correct the situation. The growing structure must be removed surgically.
A woman who is 10 weeks' pregnant calls the physician's office reporting "morning sickness" but, when asked about it, tells the nurse that she is nauseated and vomiting all the time and has lost 5 pounds. What interventions would the nurse anticipate for this client? Lab work will be drawn to rule out acid-base imbalances. Since morning sickness is a common problem for pregnant women, the nurse will suggest the woman drink more fluids and eat crackers. The nurse will encourage the woman to lie down and rest whenever she feels ill. An ultrasound will be done to reassess the correctness of gestational dates.
Lab work will be drawn to rule out acid-base imbalances. Morning sickness that lasts all day and is severe is called hyperemesis gravidarum. It is much more serious than "morning sickness" and can lead to significant weight loss and electrolyte imbalance. Lab work needs to be drawn to determine the extent of electrolyte loss and acid-base balance. An ultrasound is performed but it is done to determine if the mother is experiencing a molar pregnancy. Treatment for hyperemesis gravidarum requires much more care than just rest, drinking fluids and eating crackers.
A woman at 34 weeks' gestation presents to labor and delivery with vaginal bleeding. Which finding from the obstetric examination would lead to a diagnosis of placental abruption (abruptio placentae)? Sonogram shows the placenta covering the cervical os Uterus is soft between contractions Fetus is in a breech position Onset of vaginal bleeding was sudden and painful
Onset of vaginal bleeding was sudden and painful Sudden onset of abdominal pain and vaginal bleeding with a rigid uterus that does not relax are signs of a placental abruption (abruptio placentae). The other findings are consistent with a diagnosis of placenta previa.
A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. The nurse determines that the medication is at a therapeutic level based on which finding? urinary output of 20 mL per hour deep tendons reflexes 2+ respiratory rate of 10 breaths/minute difficulty in arousing
deep tendons reflexes 2+ With magnesium sulfate, deep tendon reflexes of 2+ would be considered normal and therefore a therapeutic level of the drug. Urinary output of less than 30 mL, a respiratory rate of less than 12 breaths/minute, and a diminished level of consciousness would indicate magnesium toxicity.
A nurse suspects that a client is developing HELLP syndrome. The nurse notifies the health care provider based on which finding? elevated platelet count disseminated intravascular coagulation (DIC) hyperglycemia elevated liver enzymes
elevated liver enzymes HELLP is an acronym for hemolysis, elevated liver enzymes, and low platelets. Hyperglycemia is not a part of this syndrome. HELLP may increase the woman's risk for DIC but it is not an assessment finding.
A pregnant woman at 12 weeks' gestation comes to the office reporting she has begun minimal fresh vaginal spotting. She is distressed because her primary care provider indicates after examining her that they will "wait and see." Which response would be most appropriate from the nurse in answering this client's concerns? Advise her to ask for a second care provider opinion. Suggest she take an over-the-counter tocolytic just to feel secure. Tell her that medication to prolong a 12-week pregnancy usually is not advised. Explain that "wait and see" means that her care provider wants her to maintain strict bed rest.
Tell her that medication to prolong a 12-week pregnancy usually is not advised. Because many early pregnancy losses occur as the result of chromosome abnormalities, an aggressive approach to prolong these is not usually recommended. It would not be appropriate for the nurse to suggest an over-the-counter tocolytic, nor to tell the client that the care provider meant something else such as maintaining strict bed rest. Advising the client to seek a second opinion would not change the end results.
A client is 20' weeks pregnant. At a prenatal visit, the nurse begins the prenatal assessment. Which finding would necessitate calling the primary care provider to assess the client? The client vomited. The client has a white vaginal discharge. The client has rhinitis and epistaxis. The client has pink vaginal discharge and pelvic pressure.
The client has pink vaginal discharge and pelvic pressure. Cervical dilation (dilatation) usually occurs painlessly, and often the first symptom is pink vaginal discharge or increased pelvic pressure, which then is followed by rupture of membranes and discharge of the amniotic fluid. The other answers are nonthreatening signs and symptoms.
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 Hypertensive crisis Uterine atony Decrease in maternal blood loss
Uterine atony A placental abruption (abruptio placentae) may occur any time before and during the labor process. After delivery, the woman who has had an abruption requires close monitoring for postpartum hemorrhage because of the risk for uterine atony. This does not cause increased blood pressure or blood incompatibilities.
A client at 34 weeks gestation has reported to the hospital in labor. The following is documented on history and physical assessment: No rupture of membranes, mild cramping, no bleeding, reassuring pattern on fetal heart monitor, cervix dilated 3 cm, effacement 30%. The nurse anticipates which treatment plan? discharge instructions including rest and increased fluids admission to the hospital and immediate cesarean birth admission to the hospital for continued labor and vaginal birth admission to the hospital, bed rest, and a tocolytic agent
admission to the hospital, bed rest, and a tocolytic agent Preterm labor is labor that occurs before the end of week 37 of gestation. It is always potentially serious because if it results in the infant's birth, the infant will be immature. Medical attempts can be made to stop labor if the fetal membranes have not ruptured, fetal distress is absent, there is no evidence that bleeding is occurring, the cervix is not dilated more than 4 to 5 cm, and effacement is not more than 50%. A woman who is in preterm labor is usually first admitted to the hospital and placed on bed rest to relieve the pressure of the fetus on the cervix. Tocolytic agents are drugs used to halt labor.
It is determined that a client's blood Rh is negative and her partner's is Rh positive. To help prevent Rh isoimmunization, the nurse would expect to administer Rho(D) immune globulin at which time? at 28 weeks' gestation and again within 72 hours after birth in the first trimester and within 2 hours of birth at 32 weeks' gestation and immediately before discharge 24 hours before birth and 24 hours after birth
at 28 weeks' gestation and again within 72 hours after birth To prevent isoimmunization, the woman should receive Rho(D) immune globulin at 28 weeks and again within 72 hours after birth.
Current research indicates that supplementation with what before pregnancy may reduce the risk of placental abruption? folic acid calcium iron vitamin C
folic acid New research indicates that folic acid supplementation before or during pregnancy reduces the risk of placental abruption. Neither supplementation with vitamin C, iron, nor calcium is associated with a decreased risk for placental abruption.
The nurse is assessing a client at 12 weeks' gestation at a routine prenatal visit who reports something doesn't feel right. Which assessment findings should the nurse prioritize? elevated hCG levels, enlarged abdomen, quickening visible fetal skeleton on ultrasound, absence of quickening, enlarged abdomen vaginal bleeding, increased hPL levels gestational hypertension, hyperemesis gravidarum, absence of FHR
gestational hypertension, hyperemesis gravidarum, absence of FHR The early development of gestational hypertension/preeclampsia, hyperemesis gravidarum, and the absence of FHR are suspicious for gestational trophoblastic disease. The elevated levels of hCG lead to the severe morning sickness. There is no fetus, so FHR, quickening, and evidence of a fetal skeleton would not be seen. The abdominal enlargement is greater than expected for pregnancy dates, but hCG, not hPL, levels are increased.
A client comes to the emergency department with moderate vaginal bleeding. She says, "I have had to change my pad about every 2 hours and it looks like I may have passed some tissue and clots." The woman reports that she is 9 weeks' pregnant. Further assessment reveals the following: Cervical dilation Strong abdominal cramping Ultrasound positive for products of conception The nurse suspects that the woman is experiencing which type of spontaneous abortion (miscarriage)? complete inevitable threatened incomplete
incomplete Based on the assessment findings, the woman is likely experiencing an incomplete abortion characterized by vaginal bleeding, cervical dilation, strong abdominal cramping, and presence of products of conception. A threatened abortion is characterized by slight vaginal bleeding, no cervical dilation or change in cervical consistency, mild abdominal cramping, close cervical os, and no passage of fetal tissue. An incomplete abortion is characterized by intense abdominal cramping, heavy vaginal bleeding and cervical dilation with passage of some products of conception. A complete abortion is characterized by a history of vaginal bleeding and abdominal pain along with passage of tissue and subsequent decrease in pain and decrease in bleeding.
Which measure would the nurse include in the plan of care for a woman with prelabor rupture of membranes if her fetus's lungs are mature? reduction in physical activity level observation for signs of infection administration of corticosteroids labor induction
labor induction With prelabor rupture of membranes (PROM) in a woman whose fetus has mature lungs, induction of labor is initiated. Reducing physical activity, observing for signs of infection, and giving corticosteroids may be used for the woman with PROM when the fetal lungs are immature.
A pregnant client diagnosed with hyperemesis gravidarum is prescribed intravenous fluids for rehydration. When preparing to administer this therapy, which solution would the nurse anticipate being prescribed initially? normal saline dextrose 5% and water albumin 0.45% sodium chloride
normal saline For the client with hyperemesis gravidarum, parenteral fluids and drugs are prescribed to rehydrate the client and reduce the symptoms. The first choice for fluid replacement is generally isotonic, such as normal saline, which aids in preventing hyponatremia, with vitamins (pyridoxine, or vitamin B6) and electrolytes added. Dextrose 5% and water and 0.45% sodium chloride are hypotonic solutions that would cause the cells to swell and possibly burst. Albumin could lead to fluid overload.
A pregnant client with preeclampsia with severe features has developed HELLP syndrome. In addition to the observations necessary for preeclampsia, what other nursing intervention is critical for this client? observation for bleeding monitoring for infection maintaining a patent airway administration of a tocolytic, if prescribed
observation for bleeding Because of the low platelet count associated with this condition, women with HELLP syndrome need extremely close observation for bleeding, in addition to the observations necessary for preeclampsia. Maintaining a patent airway is a critical intervention needed for a client with eclampsia while she is having a seizure. Administration of a tocolytic would be appropriate for halting labor. Monitoring for infection is not a priority intervention in this situation.
A client with a multiple gestation has come to a health care facility for a regular antenatal check-up. When educating the client on pregnancy, about which complication should the nurse inform the client? frequent diarrhea hypotension fetal macrosomia placental dysfunction
placental dysfunction The nurse should inform the client that placental dysfunction might occur as a complication of multiple pregnancies. Other complications of multiple pregnancies include preterm labor, hypertension, anemia, cord abnormalities, congenital anomalies, intrauterine growth restriction, and low birth weight. Hypertension, and not hypotension, is seen in multiple pregnancies. Fetal macrosomia is not seen in cases of multiple gestation. Constipation, and not diarrhea, is also seen as a complication of multiple pregnancies. This is due to the decreased functioning of the gastrointestinal system in multiple pregnancy.
A antepartum client at 35 weeks' gestation arrives at the clinic stating bright, red vaginal spotting occurred in the morning but has seemed to have stopped. An ultrasound indicates that the placenta is partially covering the cervical os. Which nursing intervention is intiated first? obtaining a urine specimen to assess for ketones vaginal examination to assess for cervical dilation (dilatation) nonstress test to track fetal movement positioning client on bed rest in a side-lying position
positioning client on bed rest in a side-lying position The nurse will identify the condition as placenta previa by the ultrasound results. Immediate care measures include first placing the client on bed rest and in a side-lying position, which increases perfusion. Next, a fetal monitor will be attached to record fetal heart sounds and uterine contractions. Neither a vaginal examination by the nurse nor urine specimen collection is a priority at this time. A health care provider may complete an examination of the vagina and cervix to establish fetal engagement.
A pregnant client at 34 weeks' gestation is diagnosed with amnionitis due to group B streptococcus. The nurse monitors the client closely based on the understanding that the client is at risk for which of the following? fetal macrosomia preterm birth fetal hydrops neural tube defect
preterm birth The complication that may occur due to infection of pregnant clients with GBS is preterm birth. Pregnant clients infected with GBS may be asymptomatic or they may develop urinary tract infection, amnionitis, and endometritis. Fetal hydrops, fetal macrosomia, and fetal neural tube defects are not complications occurring with the infection of a pregnant client with GBS. Infection with parvovirus during pregnancy may result in fetal non-immune hydrops. Fetal macrosomia is seen in gestational diabetes. Fetal neural tube defect is seen due to folic acid deficiency in pregnant clients.
A 24-year-old client presents in labor. The nurse notes there is an order to administer Rho(D) immune globulin after the birth of her infant. When asked by the client the reason for this injection, which reason should the nurse point out? stimulate maternal D immune antigens. prevent maternal D antibody formation. promote maternal D antibody formation. prevent fetal Rh blood formation.
prevent maternal D antibody formation. Because Rho(D) immune globulin contains passive antibodies, the solution will prevent the woman from forming long-lasting antibodies which may harm a future fetus. The administration of Rho(D) immune globulin does not promote the formation of maternal D antibodies; it does not stimulate maternal D immune antigens or prevent fetal Rh blood formation.
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? ovarian cyst 2 years ago use of oral contraceptives for 5 years heavy, irregular menses recurrent pelvic infections
recurrent pelvic infections In the general population, most cases of ectopic pregnancy are the result of tubal scarring secondary to pelvic inflammatory disease. Oral contraceptives, ovarian cysts, and heavy, irregular menses are not considered risk factors for ectopic pregnancy.
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? lung sounds oxygen saturation magnesium sulfate level reflexes
reflexes Reflex assessment is part of the standard assessment for clients on magnesium sulfate. The first change when developing magnesium toxicity may be a decrease in reflex activity. The health care provider needs to be notified immediately. A change in lung sounds and oxygen saturation are not indicative of magnesium sulfate toxicity. Hourly blood draws to gain information on the magnesium sulfate level are not indicated.
The nurse is caring for a client who has a multifetal pregnancy. What topic should the nurse prioritize during health education? signs of preterm labor risk for blood incompatibilities parenting skills risk for hypertension
signs of preterm labor The client with a multifetal pregnancy must be made aware of the risks posed by preterm labor. There is no corresponding increase in the risk for hypertension or blood incompatibilities. Parenting skills are secondary to physiologic needs at this point.
A woman at 12 weeks' gestation comes to the clinic with vaginal bleeding. When assessing the woman further, the nurse would suspect a threatened abortion based on which finding? cervical dilation high beta human chorionic gonadotropin (hCG) level slight vaginal bleeding passage of fetal tissue
slight vaginal bleeding Slight vaginal bleeding early in pregnancy, no cervical dilation, and a closed cervical os are associated with a threatened abortion. With an inevitable abortion, passage of the products of conception may occur. No fetal tissue is passed with a threatened abortion. Beta hCG is a hormone produced by trophoblast cells of the placenta, and its levels double every 29 to 53 hours during the first 30 days post implantation with a healthy, progressing pregnancy.
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 preterm labor hypertension spontaneous abortion (miscarriage)
spontaneous abortion (miscarriage) The client's advanced maternal age (pregnancy in a woman 35 years or older) increases her risk for spontaneous abortion (miscarriage). Hypertension, preterm labor, and prematurity are risks as this pregnancy continues. Her greatest risk at 13 weeks' gestation is losing this pregnancy.
A client who is 8 weeks' pregnant comes to the emergency department reporting abdominal pain and spotting. The client also reports breast tenderness and fatigue. Additional assessment suggests a possible ectopic pregnancy and diagnostic evaluation is scheduled. The nurse would prepare the client for which test(s) to aid in confirming this diagnosis? Select all that apply. complete blood count platelet level transvaginal ultrasound urine for protein beta-human chorionic gonadotropin (hCG) level
transvaginal ultrasound beta-human chorionic gonadotropin (hCG) level The use of transvaginal ultrasound to visualize the misplaced pregnancy and low levels of serum beta-hCG assist in diagnosing an ectopic pregnancy. The ultrasound determines whether the pregnancy is intrauterine, assesses the size of the uterus, and provides evidence of fetal viability. The visualization of an adnexal mass and the absence of an intrauterine gestational sac are diagnostic of ectopic pregnancy. In a normal intrauterine pregnancy, beta-hCG levels typically double every 2 to 4 days until peak values are reached 60 to 90 days after conception. Concentrations of hCG decrease after 10 to 11 weeks and reach a plateau at low levels by 100 to 130 days. Therefore, low beta-hCG levels are suggestive of an ectopic pregnancy. Urine for protein, platelet level, and complete blood count would provide no information about an ectopic pregnancy.
The obstetric nurse is caring for a pregnant client who has been diagnosed with a hydatidiform mole. What assessment should the nurse prioritize? blood pressure vaginal bleeding pain severe nausea and vomiting
vaginal bleeding Molar pregnancies constitute a major risk factor for vaginal bleeding. The client does not normally have an increased risk for nausea, pain, or hypertension.