OB exam 4

A 40-year-old client has just received the news that her triple screen test came back positive for Down syndrome. Which nursing response is appropriate at this time?

"Let's talk about an amniocentesis to confirm these results." The most important instruction is making sure that the client understands the implication of the screening. The triple screen and a quad screen test are screening tests for Down syndrome. It is not a diagnostic test. An amniocentesis, not a sonogram, is a diagnostic test for Down syndrome. A woman who screens positive on a triple screen or a quad screen does not necessarily have a baby with Down syndrome. Maternal age has been related to chromosomal defects.

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?

"Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain." Placental abruption (abruptio placentae) occurs when there is a spontaneous separation of the placenta from the uterine wall. It can occur anywhere on the placenta and will cause painful, dark red vaginal bleeding. If the abruption is small, the ob/gyn will try to deliver the fetus vaginally. But if severe bleeding occurs or there is fetal distress, a cesarean birth will be performed. Women older than 35 are also at higher risk for developing placental abruption.

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 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 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?

"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.

The nurse is caring for a pregnant woman determined to be at high risk for gestational diabetes. The nurse prepares to re-screen this client at which time frame?

24-28 weeks A woman identified as high risk for gestational diabetes would undergo re-screening between 24 and 28 weeks; however, some health care providers can choose to conduct this screening earlier.

The nurse is assessing a pregnant client who has a history of heart disease. The nurse will prioritize assessments focusing on the heart during which time frame?

28 to 32 weeks' gestation A pregnant woman with heart disease is most vulnerable for cardiac decompensation from 28 to 32 weeks' gestation, just after the blood volume peaks. It would be important to assess the client's heart at each visit; however, the client's heart would be more stressed at this time due to the increased blood volume and identifying a serious situation early provides the best opportunity for treatment and preventing complications.

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 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.

Place in proper order the following steps to do chest thrust on a choking pregnant woman.

Ask the woman if she is choking. Point to someone and tell him to go call for help. Ask the woman if she is pregnant. Stand behind the woman, and place your fist with the thumb against the lower part of the sternum. Wrap your other arm underneath her armpits, and cover your fist with your other hand. Apply chest thrusts to the middle of the sternum. The steps in performing a chest thrust on a pregnant woman are performed as follows: (1) Ask the woman if she is choking; (2) have someone go get help; (3) ask the woman if she is pregnant if you don't already know; (4 and 5) stand behind the woman, and place your fist on the lower part of the sternum, wrapping your second arm around the woman's armpits and covering your first fist with your second hand; and (6) apply chest thrusts until the item is dislodged or the woman is unconscious.

A 28-year-old client and her current partner present for the first prenatal appointment with the ob/gyn. The client has no children but does question a possible miscarriage 2 years ago; however, she never sought medical attention because she felt fine. Labs reveal both client and partner are Rh negative. Which action should the nurse prioritize?

Assess client for anti-D antibodies. The client should be checked for sensitization to Rh-positive blood. It is unknown if the client did have a miscarriage earlier, and if so, what the blood type was of the fetus. The risk is high for the current fetus to be affected with hemolytic disease, and this can be easily ruled out by assessing the mother for sensitization. If this screening is negative, then no further testing is required. If the father were Rh positive, then the mother be given Rho(D) immune globulin to prevent the woman from developing antibodies to the Rho(D) factor. However, if it is positive, the health care provider may order an amniocentesis to evaluate the fetus for hemolytic disease so proper treatment and monitoring may be given. It is too early to perform a direct Coombs test. It would be improper to ignore the potential of serious complications and simply continue with routine tasks and procedures at this time.

The nurse is preparing a woman for discharge after a birth and notes the mother's record indicates Rh negative and rubella titer is positive. Which nursing intervention will the nurse prioritize?

Assess the Rh of the baby. The cord blood should be assessed to determine the infant's Rh type. If it is negative, there is no need for any further treatment or concern. However, if it is Rh positive the mother needs to be assessed for possible administration of Rho(D) immune globulin. The criteria for giving Rho(D) immune globulin are as follows: The woman must be Rho(D) negative The woman must not have anti-D antibodies (must not be sensitized) The infant must be Rho(D) positive (fetus cord blood is checked after birth) A direct Coombs test (a test for antibodies performed on cord blood at delivery) must be weakly reactive or negative This all needs to be completed within the first 72 hours of birth, so the mother can receive Rho(D) immune globulin within the proper time frame.

At a prenatal visit, an adolescent client expresses that recently she has had a strange craving for chalk. When considering this statement, which diagnostic test would the nurse anticipate the primary health care provider prescribing?

At a prenatal visit, an adolescent client expresses that recently she has had a strange craving for chalk. When considering this statement, which diagnostic test would the nurse anticipate the primary health care provider prescribing? The nurse is correct to anticipate the client be tested for anemia by completing a complete blood count. The craving to eat ice chips or chalk is called pica and is a sign of iron deficiency anemia. There is no relation to specific cravings and calcium levels or a urinalysis. The client is pregnant so would have a positive hCG.

The nurse is conducting discharge teaching with a postpartum woman. What would be an important instruction for this client?

Call her caregiver if lochia moves from serosa to rubra. Most cases of late postpartum hemorrhage occur after the woman leaves the health care or birthing facility. Therefore, client education before discharge about expected changes and danger signs and symptoms is crucial. Instruct the woman to call her primary care provider if she experiences any signs of infection, such as fever greater than 100.4°F (38°C), chills, or foul-smelling lochia. She should also report lochia that increases (versus decreasing) in amount, or reversal of the pattern of lochia (i.e., moves from serosa back to rubra).

A 40-year-old primipara has been in labor for 12 hours and is still only 6 centimeters dilated. What does the nurse understand may be the cause for this prolonged labor?

Cervical dilation (dilatation) may not occur as spontaneously as in a younger woman. Labor in an older primipara may be prolonged because cervical dilation (dilatation) may not occur as spontaneously as in a younger woman.

A pregnant client with a history of heart disease has been admitted to a health care center reporting breathlessness. The client also reports shortness of breath and easy fatigue when doing ordinary activity. The client's condition is markedly compromised. The nurse would document the client's condition using the New York Heart Association (NYHA) classification system as which class?

Class III The nurse should classify the client's condition as belonging to class III of NYHA. In class III of NYHA classification, the client will be symptomatic with ordinary activity, and her condition is markedly compromised. The client is asymptomatic with all kinds of activity and is in uncompromised state in class I. The client is symptomatic with increased activity and is in slight compromised state in class II. The client is symptomatic when resting and is incapacitated in class IV.

The nurse is caring for a pregnant client with diabetes mellitus. Which potential fetal complications should the nurse monitor the client for as the client presents for her scheduled visits? Select all that apply.

Congenital malformations Macrosomia Respiratory disorder Potential problems during pregnancy involving maternal diabetes mellitus include fetal death, macrosomia (oversized fetus), a fetus with a respiratory disorder, difficult labor, preeclampsia or eclampsia, polyhydramnios, and congenital malformations.

A nurse is caring for a young woman who is in her 10th week of gestation. She comes into the clinic reporting vaginal bleeding. Which assessment finding best correlates with a diagnosis of hydatidiform mole?

Dark red, "clumpy" vaginal discharge Women with hydatidiform mole ("molar pregnancy") often pass blood clots or watery brown/dark red discharge from the vagina in the first trimester. If a complete molar pregnancy continues into the second trimester undetected, other signs and symptoms appear. The woman often presents with complaints of dark to bright red vaginal bleeding and pelvic pain. Infrequently, she will report passage of grapelike vesicles.

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?

Decrease activity and rest more often. If the client is developing symptoms associated with her heart condition, the first intervention is to monitor activity levels, decrease activity, and treat the symptoms. At 32 weeks' gestation, the suggestion to induce labor is not appropriate, and without knowledge of the type of heart condition one would not recommend an increase of fluids or vitamins. Total bed rest may be required if the symptoms do not resolve with decreased activity.

The nurse is assessing a new client who is being admitted with gestational hypertension. Which nursing diagnosis should the nurse prioritize for this client?

Deficient fluid volume related to vasospasm of arteries Gestational hypertension is caused by vasospasms of the arteries. This leads to increased blood pressure and edema. Extensive edema leads to a deficiency of fluid volume. Decreased reflexes is related to the use of magnesium, which is given if the client has developed severe preeclampsia. It would not be appropriate for a client with gestational hypertension. The primary care provider may prescribe a antihypertensive if the benefits outweigh the risks for the mother and fetus.

During a prenatal visit, the health care provider determines that the fetal heart beat is too fast. What drug would the nurse expect to be prescribed to the mother to treat the concern?

Digoxin Digoxin is sometimes administered to a woman during pregnancy to slow the fetal heart rate if fetal tachycardia is present.

The nurse is caring for a client who has been diagnosed with a deep vein thrombosis. Which assessment finding should the nurse prioritize and report immediately?

Dyspnea A DVT is often suspected when an individual with an increased risk develops calf pain, pyrexia, and edema in one lower extremity. After the individual has been positively diagnosed with a DVT, any signs of dyspnea should be suspect of possible pulmonary embolism and should be handled as an emergency. The RN and/or primary care provider should be notified immediately so emergent care can be started, as this is often fatal.

A 40-year old client is pregnant for a third time and has varicose veins in the lower legs. The client works in a job that requires long periods of standing. What strategy(ies) will the nurse teach this client to care for the varicose veins and to reduce the risk of worsening during pregnancy? Select all that apply. Elevate feet during work breaks. Wear knee-high support stockings. Take walk breaks when possible. Take daily iron supplement. Rest in left lateral position.

Elevate feet during work breaks. Take walk breaks when possible. Rest in left lateral position Varicose veins are common in older pregnant clients and can worsen with pregnancy due to the increased pressure on the pelvic veins and decreased venous return. When possible, the client should elevate the feet and take walk breaks to promote venous return. Resting in the left lateral position can also help to relieve pressure on the pelvic veins and promote venous return. Support stockings, if worn, should not be knee-high, because this can increase pressure at the knee and increase the risk of varicose veins. Iron supplements will not influence varicose vein formation.

The maternal health nurse is caring for a pregnant woman with a physical disability. Which action is the nurse's priority when caring for the client?

Establish the impact of the disability on the woman's lifestyle. The priority of care for a pregnant client with a disability is to determine the impact of the disability on the woman's lifestyle. The remaining answer choices are not individualized for the client and it is important for the nurse to understand that disabilities vary with every person who has the disability.

The nurse is assessing a 37-year-old woman who has presented in active labor and notes the client has an increased risk for placental abruption (abruptio placentae). Which assessment finding should the nurse prioritize?

Sharp fundal pain and discomfort between contractions A placental abruption (abruptio placentae) refers to premature separation of the placenta from the uterus. As the placenta loosens, it causes sharp pain. Labor begins with a continuing nagging sensation. Painless vaginal bleeding and a fall in blood pressure are indicative of placenta previa. Pain in a lower quadrant and increased pulse rate are indicative of an ectopic pregnancy. Hypertension and oliguria are indicative of preeclampsia.

A young woman presents at the emergency department reporting lower abdominal cramping and spotting at 12 weeks' gestation. The primary care provider performs a pelvic examination and finds that the cervix is closed. What does the care provider suspect is the cause of the cramps and spotting?

Threatened abortion Spontaneous abortion (miscarriage) occurs along a continuum: threatened, inevitable, incomplete, complete, missed. The definition of each category is related to whether or not the uterus is emptied, or for how long the products of conception are retained.

The nurse obtained a blood pressure of 160/96 on a pregnant adolescent at 32 weeks' gestation. A baseline blood pressure of 130/60 was obtained on her first visit. What intervention does the nurse anticipate advising the adolescent to begin?

She should begin bed rest, preferably in a side-lying position. The best intervention for reducing an increasing blood pressure during pregnancy is bed rest, preferably in a side-lying position.

A laboring pregnant woman cannot assume a lithotomy position because of hip contractures. What other position can the nurse assist the client to maintain in order to facilitate a vaginal birth?

Sims' position If a woman cannot assume a lithotomy position because of hip contracture, vaginal delivery from a Sims' or dorsal recumbent position is best.

The nurse is orientating in the Labor and Delivery unit and asks her preceptor how to differentiate a client with preeclampsia from one with eclampsia. Which symptoms would the preceptor describe to the new nurse as indicative of severe preeclampsia? Select all that apply. Blood pressure above 160/110 mm Hg Nondependent edema Glycosuria Seizure Hyperactive deep tendon reflexes

Hyperactive deep tendon reflexes Nondependent edema Blood pressure above 160/110 mm Hg Preeclampsia occurs when a pregnant woman develops hypertension occurring after 20 weeks' gestation and only resolves after the fetus is delivered. Preeclampsia is exhibited by 2+ or more proteinuria, nondependent edema, blood pressure greater than 140 mm Hg systolic and above 90 mm Hg diastolic, and CNS irritability demonstrated by hyperactive deep tendon reflexes. If the client has a seizure, she has moved to eclampsia. Glycosuria is not associated with preeclampsia.

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?

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.

The nurse will place priority on which nursing intervention when caring for a pregnant adolescent client in her first trimester?

Make sure the client receives nutritional counseling and reinforce the teaching. Nutritional counseling must be emphasized as part of prenatal care for adolescent clients. Adolescents are not at increased risk for developing gestational diabetes or placenta previa. Adolescent clients are at risk for preterm labor, but not in the first trimester. Due to the adolescent's smaller-sized uterus and continued uterine development, preterm labor may occur in the second and third trimesters.

A pregnant adolescent has reluctantly arrived at the prenatal clinic. The client exhibits signs of jitteriness, uneasiness, and distrust. Which intervention will the nurse use to help the client be comfortable and return for another prenatal appointment?

Minimize the number of health care providers that the client is exposed to. Adolescents often do not seek prenatal care until late in their pregnancy. Adolescents may feel awkward and may miss appointments. Developing a trusting relationship and minimizing the number of health care providers is the most effective way to provide care in the prenatal period. Support groups and a support person with the client are helpful in accepting the pregnancy but do not change the environment where prenatal care is given. Providing incentives typically is not a motivating factor to obtaining prenatal care.

The nurse is completing the first prenatal visit assessment for a pregnant adolescent in her second trimester of pregnancy. The adolescent is homeless and is currently staying with a friend. Which nursing consideration is important based on the client's situation? Select all that apply. Nutritional assessment Screening for gestational hypertension Screening for a large-for-gestational-age infant Laboratory tests for iron-deficiency anemia Measurement for cephalopelvic disproportion Safety and long-term planning

Nutritional assessment Screening for gestational hypertension Laboratory tests for iron-deficiency anemia Measurement for cephalopelvic disproportion Safety and long-term planning The nurse is correct to identify numerous areas of concern when caring for an adolescent with health and social struggles. Due to the pregnant client's age and growth and development, the nurse is concerned about iron-deficiency anemia and cephalopelvic disproportion. Because the client is homeless, safety and food insecurity is a concern. Adolescent clients are also at a risk for gestational hypertension, which can be a concern with the adolescent's current situation. Adolescents are at increased risk for low-birth-weight babies as opposed to large-for-gestational-age infants.

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?

Observe the client for signs of petechiae and premature separation of the placenta Subclinical bleeding from continuous anticoagulant therapy in the woman has the potential to cause placental dislodgement. Observe a woman who is taking an anticoagulant for signs of petechiae and signs of premature separation of the placenta during both pregnancy and labor. The nurse should not urge the client to discontinue the anticoagulant, as this is not within the nurse's scope of practice and, in any case, the client still needs the anticoagulant to prevent clots. Bed rest is prescribed for clients with a thrombus to prevent it from moving and becoming a pulmonary embolus. Avoiding the use of constrictive knee-high stockings is to prevent thrombus formation.

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)?

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.

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?

Orange juice Anemia is a condition in which the blood is deficient in red blood cells, from an underlying cause. The woman needs to take iron to manufacture enough red blood cells. Taking an iron supplement will help improve her iron levels, and taking iron with foods containing ascorbic acid, such as orange juice, improves the absorption of iron. Dried fruit (such as apples), fortified grains, and dried beans are additional food choices that are rich in iron and should be included in her daily diet.

A nurse in the hospital is performing a focused assessment on a 40-year-old client who has been trying to conceive and is now experiencing moderate, painful vaginal bleeding since this morning. The client has a past medical history of longer, heavier menstrual cycles. For each client finding below, click to specify if the finding is consistent with the disease process of ovarian cancer, uterine fibroids, or spontaneous abortion (miscarriage). Each finding may support more than one disease process.

Ovarian Cancer: involves individual being 40 years of age, and moderate to severe bleeding Uterine Fibroids: 40 years of age, painful red bleeding, moderate severe bleeding, longer heavier menstrual cycles Spontaneous Abortion(Miscarriage): 40 years of age, painful red bleeding, moderate to sever bleeding The risks of developing ovarian cancer increase with age. These cancers are usually diagnosed between the age of the early 30s and the 40s. Signs and symptoms of ovarian cancer include moderate to severe bleeding. Uterine fibroids increase with age, commonly diagnosed between early 30s and the 40s. Signs and symptoms include painful moderate to severe red bleeding and longer and heavier menstrual cycles. Spontaneous abortions (miscarriages) increase with age commonly in pregnant clients in their mid-30s (around age 35) or their 40s. Signs and symptoms include painful, moderate to severe, red bleeding. Signs and symptoms of ovarian cancer include painless red bleeding, not painful red bleeding. Longer, heavier menstrual cycles are not associated with ovarian cancer. Signs and symptoms of spontaneous abortion (miscarriage) do not include longer, heavier menstrual cycles.

The nurse is giving an educational presentation to the local Le Leche league chapter. One woman asks about risk factors for mastitis. Which condition would the nurse most likely include in the response?

Pierced nipple Certain risk factors contribute to the development of mastitis. These include inadequate or incomplete breast emptying during feeding or lack of frequent feeding leading to milk stasis; engorgement; clogged milk ducts; cracked or bleeding nipples; nipple piercing; and use of plastic-backed breast pads.

A client at 36 weeks' gestation experiences vaginal bleeding. Which conditions might be the cause of the client's bleeding? Select all that apply. Placenta Previa Placental Abruption ( Abruptio Placentae Bloody Show Ectopic pregnancy Spontaneous abortion (miscarriage)

Placenta Previa Placental Abruption ( Abruptio Placentae Bloody Show In the third trimester, placenta previa, placental abruption, and bloody show are potential causes of vaginal bleeding. Spontaneous abortion (miscarriage) and ectopic pregnancy are causes of vaginal bleeding in the first trimester and would not be seen in the third trimester.

The nurse understands the need to be aware of the potential of bleeding disorders in pregnant clients. Which disorder should she be aware of that occurs in the second trimester?

Placenta previa Second trimester bleeding usually results from placenta previa, where the placenta lies either partially or completely over the cervical os. The pregnant client begins to experience vaginal bleeding of bright, red blood. Spontaneous abortion (miscarriage), hydatidiform mole, and ectopic pregnancy occur in the first trimester and cervical insufficiency is not a bleeding disorder.

A client in their third trimester comes to the clinic reporting vaginal bleeding that started this morning. The nurse performs an assessment to determine the underlying cause of the bleeding. Assessment reveals fundal height appropriate for expected gestational age, uterine pain 10 out of 10 on scale 0 to 10, and bright red vaginal bleeding. Vital signs include a heart rate of 110 beats/min and a blood pressure reading of 90/50 mm Hg. For each finding, click to specify if the finding indicates placenta previa or placental abruption. Each finding may support more than one classification.

Placental Abruption: has pain, bright red blood, uterine tenderness, decreased hemoglobin, increased heart rate, decreased blood Placenta Previa: has Bright red blood, fundal height greater than expected gestational age, decreased hemoglobin, increased heart rate, and decreased blood pressure Placenta previa presents with painless bright red blood, and a fundal height greater than expected for gestational age. Depending on blood loss, the client's hemoglobin and hematocrit may be decreased; as a result, the blood pressure would also be decreased with an elevated heart rate. Placental abruption presents with painful, bright red bleeding; a boardlike, tender uterus; a fundal height at a height expected for gestational age; decreased hemoglobin, hematocrit, and blood pressure; and an elevated heart rate. Placenta previa does not present with a painful, tender uterus. In placenta previa, the fundal height would be higher than expected for gestational age. In placental abruption, the fundal height would be at a height expected for gestational age.

The nurse is leading a discussion with a group of pregnant women who have diabetes. The nurse should point out which situation can potentially occur during their pregnancy?

Polyhydramnios Polyhydramnios is an increase, or excess, in amniotic fluid and is a pregnancy-related complication associated with diabetes. An infant who is small-for-gestational-age is not associated with a mother who had diabetes prior to pregnancy. Other pregnancy-related complications associated with pregestational diabetes mellitus include hypertensive disorders, preterm birth, and shoulder dystocia.

The nurse is caring for a pregnant client considered at high risk for pregnancy complications. What nursing action(s) included in the plan of care help achieve a positive outcome? Select all that apply. Provide educational pamphlets on topics such as nutrition and exercise. Stress the importance of attending monthly health care provider appointments. Make sure the client maintains bed rest for the duration of the pregnancy. Inform the client of consequences and potential negative outcomes. Provide time for the client and support person to ask questions.

Provide educational pamphlets on topics such as nutrition and exercise. Stress the importance of attending monthly health care provider appointments. Provide time for the client and support person to ask questions. Interventions for the high-risk pregnant client include promoting a healthy pregnancy and preventing pregnancy complications. Care focuses on teaching, maintaining appointments, and encouraging a client with any special needs to determine how best to manage the pregnancy according to the client's situation. Providing educational pamphlets on related topics allows the client to review information at home. Maintaining health care appointments is essential in monitoring the progress of the client and fetus. Allowing the opportunity to ask questions clarifies any misconceptions. Discussing consequences and potential negative outcomes may be considered punitive and deter therapeutic communication. Bed rest during pregnancy is not encouraged unless medically necessary. Exercise throughout pregnancy is more common.

The maternal health nurse is caring for a group of high-risk pregnant clients. Which client condition will the nurse identify as being the highest risk for pregnancy?

Pulmonary hypertension Pulmonary hypertension is considered the greatest risk to a pregnancy because of the hypoxia that is associated with the condition. The remaining conditions represent potential cardiac complications that may increase the client's risk in pregnancy; however, these do not present the greatest risk in pregnancy.

A nurse is caring for a postpartum client whose most recent assessment reveals a large, purple area of edema on the left side of the perineum. What is the nurse's best action?

Report the finding promptly to the primary care provider. This client's presentation is consistent with a hematoma, which indicates a hemorrhage and which must be treated promptly. Reporting this change in status is priority over hot/cold treatments. This is not an expected finding.

A client whose membranes have prematurely ruptured is admitted to the hospital. Which nursing intervention is a priority?

Routine monitoring of vital signs Rupture of the membranes without the onset of labor places the woman at risk for infection. The priority is to monitor temperature routinely by the completion of vital signs. Antibiotic therapy is often initiated as well, depending upon closeness of labor initiation (naturally or induced). The fetus will be monitored on a regular basis and then continuously when the labor process occurs. Urine analysis and strict intake and output are not typically completed.

The nurse is teaching a client about mastitis. Which statement should the nurse include in her teaching?

Symptoms include fever, chills, malaise, and localized breast tenderness. Mastitis is an infection of the breast characterized by flu-like symptoms, along with redness and tenderness in the breast. The most common causative agent is Staphylococcus aureus. Breast abscess is rarely a complication of mastitis if the client continues to empty the affected breast. Mastitis usually occurs in one breast, not bilaterally.

The nurse is caring for a woman at 32 weeks' gestation with severe preeclampsia. Which assessment finding should the nurse prioritize after the administration of hydralazine to this client?

Tachycardia Hydralazine reduces blood pressure but is associated with adverse effects such as palpitation, tachycardia, headache, anorexia, nausea, vomiting, and diarrhea. It does not cause gastrointestinal bleeding, blurred vision (halos around lights), or sweating. Magnesium sulfate may cause sweating.

The nurse is providing care to several postpartum clients who report being able to urinate but feeling like the amount is small. The nurse suspects urinary retention and obtains an order to catheterize each client for residual. The nurse would keep the catheter in place for which client?

The client with 135 ml of residual urine If the amount of urine left in the bladder after voiding (termed residual ) is greater than 100 ml, the client is retaining more than the usual amount of urine. Typically the catheter is left in place if the amount is greater than 100 ml.

A young client gives birth to twin boys who shared the same placenta. What serious complication are they at risk for?

Twin-to-twin transfusion syndrome (TTTS) When twins share a placenta, a serious condition called twin-to-twin transfusion syndrome (TTTS) can occur.

A pregnant woman at 36 weeks' gestation comes to the care center for a follow-up visit. The woman is to be screened for group B streptococcus (GBS) infection. When describing this screening to the woman, the nurse would explain that a specimen will be taken from which area(s)? Select all that apply. Throat Nasal Cavity Vagina Rectum Conjunctiva

Vagina Rectum According to Centers for Disease Control and Prevention guidelines, all pregnant women should be screened for GBS at 35 to 37 weeks' gestation and treated. Vaginal and rectal specimens are cultured for the presence of the bacterium. Specimens from the throat, nasal cavity, or conjunctiva are not used.

The nurse is caring for a client who has remained in stable condition at 37 weeks' gestation. The client's condition suddenly changes. Which assessment change should the nurse prioritize?

Vaginal bleeding and no pain Placenta previa includes bright red and painless vaginal bleeding, which is different from the dark red bleeding of placental abruption (abruptio placenta) accompanied by severe pain. This differentiates the two conditions. Uterine contractions with vaginal mucus may be indications of the start of labor with the mucus plug being discharged. The fetal heart rate, fundal height, and contour of the abdomen are normal components that are assessed during the labor process.

The nurse is caring for clients in the second or third trimester of pregnancy who have used drugs or had alcohol within the past week. Which woman does the nurse evaluate as having the highest risk of placental abruption?

a woman who used cocaine yesterday The nurse is correct to identify the substance and when the client was last exposed. When considering that a substance could lead to fetal demise, the action of the substance is considered. Because cocaine is a potent vasoconstrictor, it can cause the placenta to prematurely separate from the wall of the uterus, causing placental abruption. Heroin use passes through to the fetus and may cause preterm labor. Marijuana use is associated with preterm labor and low-birth-weight neonates. Alcohol is a central nervous system depressant and may cause fetal alcohol syndrome.

A nurse is caring for a client who just experienced a spontaneous abortion (miscarriage) in the first trimester. When asked by the client why this happened, which is the best response from the nurse?

abnormal fetal development The most frequent cause of spontaneous abortion (miscarriage) in the first trimester of pregnancy is abnormal fetal development, due either to a teratogenic factor or to a chromosomal aberration. In other miscarriages, immunologic factors may be present or rejection of the embryo through an immune response may occur. Another common cause of early miscarriage involves implantation abnormalities. Miscarriage may also occur if the corpus luteum on the ovary fails to produce enough progesterone to maintain the decidua basalis.

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?

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 client 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 To prevent isoimmunization, the woman should receive Rho(D) immune globulin at 28 weeks and again within 72 hours after birth.

At the beginning of the second trimester of pregnancy, a client has an elevated maternal serum α-fetoprotein (MS-AFP). Based on this result, the nurse explains that a follow-up sonogram will be performed to look for which conditions in the fetus? Select all that apply. omphalocele gastroschisis spina bifida umbilical hernia tracheoesophageal fistula

omphalocele gastroschisis spina bifida At the 15th week of pregnancy, the level of MS-AFP will be abnormally increased if there is an open spinal or abdominal lesion such as omphalocele, gastroschisis, or spina bifida. An umbilical hernia and tracheoesophageal fistula are not open lesions.

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 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 nurse is assigned to care for a client experiencing early postpartum hemorrhage. The nurse is required to administer the prescribed methylergonovine maleate intramuscularly to the client. Which condition would the nurse identify as necessitating the cautious administration of this drug?

cardiovascular disease Nurses must administer methylergonovine maleate with caution in women who have elevated blood pressure or cardiovascular disease because it causes a sudden increase in blood pressure and could initiate a cerebrovascular accident (stroke) in women at risk with preexisting conditions. Low blood pressure, respiratory problems, or mild fever are not known to enforce cautious use of methylergonovine maleate in clients with early postpartum hemorrhage.

A pregnant woman tests positive for tuberculosis (TB). The nurse explains to the woman that additional tests are needed to confirm the diagnosis. When describing these tests, which one(s) would the nurse likely include? Select all that apply. Chest xray sputum culture whole body ct scan spirometry

chest xray sputum culture If a TB screening test is positive, the woman will need a follow-up chest x-ray with lead shielding over the abdomen, as well as sputum cultures to confirm the diagnosis. A whole-body CT scan, spirometry, or abdominal ultrasound are not used to confirm the diagnosis.

A 41-year-old client at 11 weeks' gestation has arrived for a prenatal visit. When reviewing the client's past office visit report, which assessment would the nurse anticipate specifically related to the client's age?

chromosomal assessment The nurse is correct to review relevant lab work associated with the client's pregnancy. Because the risk for Down syndrome is higher in older clients than in younger ones, a quad-screen or an integrated screen (sometimes referred to as a sequential screen) is anticipated in order to detect if an open spinal-cord defect or chromosomal defect could be present in the fetus. Nutrition and mental health assessments are normal assessments that are made for any pregnant client, not specifically for those over age 40. A biophysical profile evaluates the current status of the fetus and consists of the fetal heartbeat via nonstress test with fetal ultrasound.

The nurse is assessing a group of infants and notes one of the infants has chronic constipation and an enlarged abdomen. The nurse would determine this infant is showing indications of which condition?

congenital hypothyroidism Two common features seen in the infant with congenital hypothyroidism are chronic constipation and abdomen enlargement caused by poor muscle tone. Infants with galactosemia will present with vomiting and diarrhea resulting in dehydration, weight loss, and jaundice. Infants with phenylketonuria show progressive mental deficiency, frequent vomiting, aggressive and hyperactive traits, as well as a musty urine smell. Infants with Turner syndrome present with short stature, low set ears, broad-based neck, broad chest, increased angle of the arms, and edema of the hands and feet.

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 The nurse should be alert for signs of cardiac de-compensation due to congestive heart failure, which include crackles in the lungs from fluid, difficulty breathing, and weak pulse from heart exhaustion. The heart rate would not be regular, and a cough would not be dry. The heart rate would increase rather than decrease.

A woman in week 36 of her pregnancy has been involved in a car accident and suffered significant trauma. Which of the following is the most reliable indicator of the presence or absence of a specific complication caused by the accident?

elevation of serum liver enzyme levels, indicating liver trauma Serum liver enzyme levels such as serum glutamic-oxaloacetic transaminase, serum glutamate pyruvate transaminase, and lactate dehydrogenase remain the same during pregnancy. This means, if these are elevated after an injury, liver trauma can still be detected. To move the increased blood volume that is normal in pregnancy adequately through the body, a woman's heart rate increases 15 to 20 beats above normal, so a pulse rate of 80 to 95 beats/min is not unusual. Based on this, following an unintentional injury during pregnancy, do not assume a rapid pulse rate indicates hemorrhage. Peripheral blood flow, in general, is increased during pregnancy because of decreased peripheral vascular resistance. As a result, the pregnant woman can be in severe shock, yet her extremities will still not feel cold and clammy. During pregnancy, the leukocyte count rises (to 20,000 mm3 at term), so using this measure as a sign of infection after an open wound is yet another way assessment can be problematic.

A first time breast-feeding mother asks how she can prevent mastitis. Which intervention should the nurse recommend?

exposing the nipples to air for at least part of every day To prevent mastitis, it's important to prevent nipples from cracking through measures such as exposing the nipples to air for at least part of every day, among other things. Taking an antibiotic and applying an ice compress to the breast are measures taken to manage mastitis once it has occurred, not to prevent it. The nurse should not instruct the new mother to switch to bottle feeding, as this is not necessary.

A pregnant client with deep vein thrombosis has been diagnosed as having systemic lupus erythematosus (SLE). The nurse would monitor the client closely for the development of which complication?

fetal malnutrition SLE is an autoimmune disorder in which there is a deposition of immune complexes in the capillaries and visceral structures. Clients with SLE who become pregnant are at an increased risk of fetal malnutrition due to decreased placental circulation. Pregnancy-related problems in SLE include prematurity, stillbirth, decreased placental weight, and thinner placental villi. In clients with SLE, there is preterm birth and decreased placental weight. Fetal macrosomia is seen in clients having gestational diabetes, not SLE.

The health care provider has diagnosed a pregnant client with megaloblastic anemia and has prescribed treatment. When questioned by the client as to what this means, which is the best response from the nurse?

folic acid deficiency anemia Folic acid anemia is a deficiency in folic acid. It is also called megaloblastic anemia, which means enlarged red blood cells. The mean corpuscular volume will be elevated. This deficiency takes several weeks to develop, so it may not be apparent until the second trimester of pregnancy

A woman at 10 weeks' gestation comes to the clinic for an evaluation. Which assessment finding should the nurse prioritize?

fundal height measurement of 18 cm A fundal height of 18 cm is larger than expected and should be further investigated for gestational trophoblastic disease (hydatidiform mole). One of the presenting signs is the uterus being larger than expected for date. Mild nausea would be a normal finding at 10 weeks' gestation. Blood pressure of 120/84 mm Hg would not be associated with hydatidiform mole and depending on the woman's baseline blood pressure may be within acceptable parameters for her. Bright red spotting might suggest a spontaneous abortion (miscarriage).

A pregnant client has been admitted with reports of brownish vaginal bleeding. On examination, there is an elevated human chorionic gonadotropin (hCG) level, absent fetal heart sounds, and a discrepancy between the uterine size and the gestational age. The nurse interprets these findings to suggest which condition?

gestational trophoblastic disease The client is most likely experiencing gestational trophoblastic disease, or a molar pregnancy. In gestational trophoblastic disease, there is an abnormal proliferation and eventual degeneration of the trophoblastic villi. The signs and symptoms of molar pregnancy include brownish vaginal bleeding, elevated hCG levels, discrepancy between the uterine size and the gestational age, and absent fetal heart sounds. Placental abruption is characterized by premature separation of the placenta. Ectopic pregnancy is a condition where there is implantation of the blastocyst outside the uterus. In placenta previa, the placental attachment is at the lower uterine segment

A nurse is taking a history of a client at 5 weeks' gestation in the prenatal clinic; however, the client is reporting dark brown vaginal discharge, nausea, and vomiting. Which diagnosis should the nurse suspect?

gestational trophoblastic disease This client has risk factors of a "molar" pregnancy: nausea and vomiting at an early gestational week and dark brown vaginal discharge. The early nausea/vomiting can be due to a high hCG level, which is a sign of gestational trophoblastic disease. There is only one sign/symptom of hyperemesis gravidarum. Placenta previa is marked by bright red bleeding and tends to happen later in gestation. There are no data to support any psychosis at this stage.

A pregnant client at 8 weeks' gestation comes to the facility for vaginal bleeding. Assessment reveals that the client has experienced an incomplete spontaneous abortion (miscarriage) for which suction curettage is planned. While preparing the client for the procedure, the nurse would closely monitor for which possible complication?

hemorrhage With an incomplete miscarriage, there is a danger of maternal hemorrhage as long as part of the conceptus is retained in the uterus because the uterus cannot contract effectively under this condition. Gestational hypertension or HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelets) are not associated with an incomplete miscarriage. It would be important to determine the client's Rh type because the blood type of the conceptus is unknown. Therefore, all clients with Rh-negative blood should receive Rh (D antigen) immune globulin (RhIG) to prevent the buildup of antibodies in the event the conceptus was Rh-positive to prevent isoimmunization in future pregnancies.

The nurse receives a report on a client with type 1 diabetes whose delivery was complicated by polyhydramnios and macrosomia. The nurse is aware of these complications and knows to monitor the client closely for which of the following?

postpartum hemorrhage The client is at risk for a postpartum hemorrhage from the overdistention of the uterus because of the extra amniotic fluid and the large neonate. The uterus may not be able to contract as well as it would normally. The client with diabetes usually has decreased insulin needs for the first few days postpartum. Neither polyhydramnios nor macrosomia would increase the client's risk of gestational hypertension or mastitis

Which two conditions of the fetus/newborn is the infant of a heroin-addicted mother least likely to have?

hyperbilirubinemia and respiratory distress Constant exposure to heroin in utero causes the fetal liver to mature faster than normal. Therefore, hyperbilirubinemia usually is not a problem for these infants. In addition, the fetal lungs are more mature, and they experience less respiratory distress.

A client visits a health care facility reporting amenorrhea for 10 weeks, fatigue, and breast tenderness. Which assessment finding(s) will the nurse prioritize for immediate intervention? Select all that apply. elevated human chorionic gonadotropin (hCG) levels whitish discharge from the vagina absence of fetal heart sounds dyspareunia hyperemesis gravidarum

hyperemesis gravidarum absence of fetal heart sounds elevated human chorionic gonadotropin (hCG) levels This client presents with signs and symptoms suspicious for hydatidiform mole. The signs and symptoms of molar pregnancy include an elevated hCG level, absence of fetal heart sounds, bright red bleeding, pelvic pain, and hyperemesis gravidarum. Whitish discharge from the vagina and dyspareunia (painful sexual intercourse) are seen in cases of infection. In molar pregnancy, a brownish vaginal bleeding is often seen.

A client is 10 days postpartum. Which of the following would the nurse expect to assess if the client develops a genital tract infection?

hypotension and chills Manifestations of a genital tract infection include hypotension, chills, prolonged fever with fluctuations, decreased bowel sounds, nausea, subinvolution, vomiting, lateral extension of abdominal pain, and pain and tenderness in both iliac fossae. Rubra-colored lochia and excessive clots are indications of late postpartum hemorrhage and not a genital tract infection. Hypovolemic shock also occurs in case of hemorrhage or uterine atony. Hypovolemic shock is not known to be a manifestation of a genital tract infection. Cyanosis and oliguria are signs and symptoms of hypovolemic shock. These are not known to occur in the case of a genital tract infection.

A pregnant woman diagnosed with cardiac disease 4 years ago is told that her pregnancy is a high-risk pregnancy. The nurse then explains that the danger occurs primarily because of the increase in circulatory volume. The nurse informs the client that the most dangerous time for her is when?

in weeks 28 to 32 The danger of pregnancy in a woman with cardiac disease occurs primarily because of the increase in circulatory volume. The most dangerous time for a woman is in weeks 28 to 32, just after the blood volume peaks.

A client pregnant with twins comes to the clinic for an evaluation. While assessing the client, the nurse would be especially alert for signs and symptoms for which potential problem?

preeclampsia Women with multiple gestations are at high risk for preeclampsia, preterm labor, polyhydramnios, hyperemesis gravidarum, anemia, and antepartal hemorrhage. There is no association between multiple gestations and the development of chorioamnionitis.

The nurse reviews the medication therapy regimen of a pregnant woman with chronic hypertension. Which medication would the nurse most likely expect to find?

labetalol and nifedipine Although beta-blockers and calcium channel blockers may be prescribed to reduce blood pressure by peripheral dilation to a safe level, it should not be reduced below the threshold that allows for good placenta circulation. Labetalol and nifedipine are typical drugs that may be prescribed.

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?

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 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 The pregnant woman should rest in the left lateral recumbent position to prevent supine hypotension syndrome and increased heart effort.

All of the following are commonly seen in infants born to cocaine-addicted mothers except:

lethargy. Infants born to women who are cocaine and crack dependent are at risk for intracranial hemorrhage and often demonstrate tremors, irritability, and muscle rigidity—not lethargy.

When monitoring a postpartum client 2 hours after birth, the nurse notices heavy bleeding with large clots. Which response is most appropriate initially?

massaging the fundus firmly Initial management of excessive postpartum bleeding is firm massage of the fundus and administration of oxytocin. Bimanual compression is performed by a primary health care provider. Ergonovine maleate should be used only if the bleeding does not respond to massage and oxytocin. The primary health care provider should be notified if the client does not respond to fundal massage, but other measures can be taken in the meantime.

The maternal nurse is caring for a pregnant client who has consumed alcohol during pregnancy. Which long-term impact does the nurse recognize may impact the client's infant?

memory deficits Maternal alcohol use is linked to fetal alcohol syndrome (FAS), which may cause memory deficits. The remaining answer choices are not linked directly to maternal alcohol use.

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

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 woman is experiencing a postpartum hemorrhage due to uterine atony. Which risk factor would the nurse recognize as contributory to this specific problem?

multiparity Risk factors for postpartum hemorrhage due to uterine atony include many factors, including multiparity. Placenta accreta is associated with placental issues, preeclampsia is seen in disruption of maternal clotting factors, and fetal demise can cause a disruption in maternal clotting factors, but not uterine atony.

Which manifestation would alert the nurse to suspect that a postpartum client has septic pelvic thrombophlebitis (SPT)?

pain in lower abdomen Common manifestations of septic pelvic thrombophlebitis include pain in the lower abdomen, spiking fever despite antibiotic therapy, and pain in flank. Increased uterine cramping occurs in clients with late postpartum hemorrhage. Lower back pain and recurrent vaginal infections should be assessed in clients experiencing uterine displacement.

A client at 33 weeks' gestation comes to the emergency department with vaginal bleeding. Assessment reveals the following: Onset of slight vaginal bleeding at 29 weeks with spontaneous cessation Recent onset of bright red vaginal bleeding, more than with previous episode No uterine contractions at present Fetal heart rate within normal range Uterus soft and nontender Based on the assessment findings, which condition would the nurse likely suspect?

placenta previa The assessment findings suggest placenta previa, a bleeding condition that occurs during the last two trimesters of pregnancy. It is characterized by slight, bright red vaginal bleeding that initially stops spontaneously and then recurs later in amounts greater than the initial episode; absence of pain/contractions; soft, relaxed uterine tone; and a fetal heart rate within normal parameters. Placental abruption (abruptio placentae) is characterized by a sudden onset with concealed or visible dark vaginal bleeding, uterine tenderness and pain, a firm or rigid uterus, and fetal distress. The hallmark of ectopic pregnancy is abdominal pain with spotting within 6 to 8 weeks after a missed menstrual period. If ectopic rupture or hemorrhage occurs before treatment begins, symptoms may worsen and include: severe, sharp, and sudden pain in the lower abdomen as the tube tears open and the embryo is expelled into the pelvic cavity feelings of faintness referred pain to the shoulder area, indicating bleeding into the abdomen caused by phrenic nerve irritation hypotension marked abdominal tenderness with distention hypovolemic shock Polyhydramnios is initially suspected when uterine enlargement, maternal abdominal girth, and fundal height are larger than expected for the fetus's gestational age. With polyhydramnios, there is a discrepancy between fundal height and gestational age, or a rapid growth of the uterus is noted. Shortness of breath and uterine contractions from overstretching may occur. Often the fetal parts and heart rate are difficult to obtain because of the excess fluid present.

The nurse caring for a small-for-gestational-age newborn in the special-care nursery. What characteristics are commonly documented? Select all that apply. poor skin turgor tight and moist skin sparse or absent hair narrow skull sutures diminished muscle tissue increased fatty tissue

poor skin turgor sparse or absent hair diminished muscle tissue Characteristics of the small for gestational age newborn include poor skin turgor, loose and dry skin, sparse or absent hair, wide skull sutures caused by inadequate bone growth, and diminished muscle and fatty tissue. Weight, length, and head circumference are below normal expectations as defined on growth charts.

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?

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.

During a routine prenatal visit, a client is found to have 1+ proteinuria and a blood pressure rise to 140/90 mm Hg with mild facial edema. The nurse recognizes that the client has which condition?

preeclampsia without severe features A woman is said to have gestational hypertension when she develops an elevated blood pressure (140/90 mm Hg) but has no proteinuria or edema. If a seizure from gestational hypertension occurs, a woman has eclampsia, but any status above gestational hypertension and below a point of seizures is preeclampsia. A woman is said to have preeclampsia without severe features when she has proteinuria and a blood pressure rise to 140/90 mm Hg, taken on two occasions at least 6 hours apart and mild facial or extremity edema. A woman has progressed to preeclampsia with severe features when her blood pressure rises to 160 mm Hg systolic and 110 mm Hg diastolic or above on at least two occasions 6 hours apart at bed rest (the position in which blood pressure is lowest) or her diastolic pressure is 30 mm Hg above her prepregnancy level. Marked proteinuria, 3+ or 4+ on a random urine sample or more than 5 g in a 24-hour sample, and extensive edema are also present. A woman has passed into eclampsia when cerebral edema is so acute a tonic-clonic seizure or coma has occurred.

The most common serious complications in a pregnant woman with blunt abdominal trauma are:

preterm labor and placental abruption (abruptio placentae). A woman who has had blunt trauma to the abdomen in pregnancy may dislodge the placenta, causing placental abruption, or the trauma may cause contractions and subsequently preterm labor.

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?

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.

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?

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?

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?

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.

A client is diagnosed with peripartum cardiomyopathy (PPCM). Which therapy would the nurse expect to administer to the client?

restricted sodium intake The client with peripartum cardiomyopathy should be prescribed a restricted sodium intake to control the blood pressure. Monoamine oxidase inhibitors are given to treat depression in pregnancy, not peripartum cardiomyopathy. Methadone is a drug given for the treatment of a substance use disorder during pregnancy. Complementary therapies like ginger therapy help in the alleviation of hyperemesis gravidarum, not peripartum cardiomyopathy.

The nurse is performing a focused assessment on a client who is 2 days postpartum. The client reports pelvic pain, chills, profuse dark, foul-smelling lochia with blood clots. The client states, "my bleeding before was light and now it is heavy." Vital signs: temperature, 99.5°F (37.5°C); heart rate, 102 beats/min; blood pressure, 100/66 mm Hg.

retained fragments of placenta pelvic pain profuse dark lochia with blood clots Endometritis is an infection of the uterine lining that may occur on the second to the fifth day postpartum. Signs and symptoms of endometritis include pelvic pain; malodorous dark, profuse lochia; and a low-grade fever. Retained fragments of the placenta can occur when the placenta does not come out whole. The symptoms of retained pieces are delayed and heavy bleeding with clots, foul-smelling vaginal discharge, fever, chills, and feeling sick or flulike. The client would have had severe symptoms 2 days postpartum. Pelvic pain 2 days postpartum may indicate retained fragments of placenta. Foul-smelling lochia 2 days postpartum is a sign of retained fragments of placenta. Signs and symptoms of urinary tract infection (UTI) include dysuria, pelvic pain (cystitis), or costovertebral pain if the infection is in the kidney (pyelonephritis). Signs and symptoms of puerperal infections include flulike symptoms such as high fevers, chills, malaise, and anorexia. A heart rate of 102 beats/min is slightly above average, most likely due to the low-grade fever. Although a temperature of 99.5°F (37.5°C) is a low-grade fever that may occur in endometritis, this is not the best answer. A blood pressure of 100/66 mm Hg has nothing to do with retained placenta fragments. Decreased appetite has nothing to do with retained placenta fragments.

When giving a postpartum client self-care instructions, the nurse instructs her to report heavy or excessive bleeding. How should the nurse describe "heavy bleeding?"

saturating 1 pad in 1 hour Bleeding is considered heavy when a woman saturates 1 sanitary pad in 1 hour. Excessive bleeding occurs when a postpartum client saturates 1 pad in 15 minutes. Moderate bleeding occurs when the bleeding saturates less than 6 in. (15 cm) of 1 pad in 1 hour.

A nurse is providing care to a pregnant client hospitalized with preeclampsia. The nurse immediately notifies the health care provider that the client has developed eclampsia based on which finding?

seizure activity Although a blood pressure greater than 160/110 mm Hg, hyperreflexia and proteinuria are associated with eclampsia. The onset of seizure activity identifies eclampsia.

A client in her first trimester comes to the clinic for an evaluation. Assessment reveals reports of fatigue, anorexia, and frequent upper respiratory infections. The client's skin is pale and the client is slightly tachycardic. The client also reports drinking about 6 cups of coffee on average each day. A diagnosis of iron-deficiency anemia is suspected. The client is scheduled for laboratory testing and the results are as follows: Hemoglobin 11.5 g/dL (115 g/L) Hematocrit 35% (0.35) Serum iron 32 µg/dL (5.73 µmol/L) Serum ferritin 90 ng/dL (90 µg/L) Which laboratory finding would the nurse correlate with the suspected diagnosis?

serum ferritin level Laboratory tests for iron-deficiency anemia usually reveal low hemoglobin (less than 11 g/dL or 110 g/L), low hematocrit (less than 35% or 0.35), low serum iron (less than 30 µg/dL or 5.37 µmol/L), microcytic and hypochromic cells, and low serum ferritin (less than 100 ng/dL or 100 µg/L). The client's hemoglobin, hematocrit, and serum iron levels are borderline low normal, but the client's serum ferritin is below 100 ng/dL (100 µg/L), helping to support the diagnosis.

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 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 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?

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.

Which action should nurses advocate to help the nation achieve the 2020 National Health Goals? Select all that apply. teaching about folic acid supplementation prior to conception obtaining early prenatal care providing support after the diagnosis of a fetal disorder encouraging sonograms at every prenatal visit initiating oral iron supplementation at the time of conception

teaching about folic acid supplementation prior to conception obtaining early prenatal care providing support after the diagnosis of a fetal disorder Nurses can help achieve the 2020 National Health Goals by urging women to enter pregnancy with an adequate folic acid level, ensuring women obtain prenatal care, and receive comprehensive advice and support after diagnosis of a fetal or newborn disorder. Frequent sonograms are not necessary, and initiating oral iron supplementation at conception may worsen the nausea and vomiting of early pregnancy.

A pregnant client at 22 weeks' gestation is cut on the finger by some rusty metal fencing (above). What medication(s) will the nurse anticipate in the primary health care provider's prescriptions for this client? Select all that apply. Rh immunoglobulin tetanus, diphtheria, pertussis (Tdap) vaccine tetanus immunoglobulin hepatitis B vaccine hepatitis B immunoglobulin

tetanus, diphtheria, pertussis (Tdap) vaccine tetanus immunoglobulin The client should receive the Tdap vaccine to reduce the risk of tetanus infection. Because the most recent tetanus vaccine is greater than 10 years ago, tetanus immunoglobulin is also indicated. Rh immunoglobulin is not required, because there is no risk factor indicating its use or risk of mixing of fetal/pregnant client blood. Hepatitis B vaccine and immunoglobulin are not indicated for this client.

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. transvaginal ultrasound beta-human chorionic gonadotropin (hCG) level urine for protein platelet level complete blood count

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.

A nurse is caring for a pregnant client admitted with mild preeclampsia. Which assessment finding should the nurse prioritize?

urine output of less than 15 ml/hr Severe preeclampsia may develop suddenly and bring with it high blood pressure of more than 160/110 mm Hg, proteinuria of more than 500 mg in 24 hours, oliguria of less than 15 ml/hr, cerebral and visual symptoms, and rapid weight gain. Mild facial edema or hand edema occurs with mild preeclampsia. A urinary output of 15 ml/hr would result in an output of 360 ml/24 hours, which would be below the recommended range and should be reported. Ankle edema of 1+ could be related to regular pregnancy and not necessarily just severe preeclampsia. A finding of 3+ to 4+ pitting edema would be more alarming and require intervention.

The obstetric nurse is caring for a pregnant client who has been diagnosed with a hydatidiform mole. What assessment should the nurse prioritize?

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.