OB Pregnancy Ch 20

The nurse is caring for a pregnant woman determined to be at high risk for gestational diabetes. The nurse prepares to rescreen this client at which time frame? 16 to 20 weeks 20 to 24 weeks 24 to 28 weeks 28 to 32 weeks

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

A pregnant woman asks the nurse how the uterine arteries will be able to supply blood to the uterus after the uterus increases to four times its prepregnant size. The nurse would explain that this will happen easily because of which of the following? More arteries form during pregnancy. The muscle of the uterus decreases during pregnancy. Venous congestion causes stasis of arterial blood. The normally twisted and coiled uterine vessels uncoil and elongate.

The normally twisted and coiled uterine vessels uncoil and elongate. Explanation: No new arteries form during pregnancy; those already present uncoil and elongate.

Which STI could be transmitted perinatally? herpes simplex chlamydia gonorrhea trichomoniasis

herpes simplex Herpes simplex and syphilis can be transmitted perinatally and sexually. Chlamydia, gonorrhea, and trichomoniasis are transmitted sexually.

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 1+ ankle edema mild hand edema proteinuria of 200 mg/24 hours

urine output of less than 15 ml/hr

During pregnancy a woman's blood volume increases to accommodate the growing fetus to the point that vital signs may remain within normal range without showing signs of shock until the woman has lost what percentage of her blood volume? 40% 30% 50% 20%

40% Explanation: Vital signs can be within normal range, even with significant blood loss, because a pregnant woman can lose up to 40% of her total blood volume without showing signs of shock.

After conducting a refresher class on possible congenital infections with a group of perinatal nurses, the nurse recognizes the class was successful when the group identifies which congenital viral infection as the most common? CMV HIV HPV RSV

CMV Explanation: Cytomegalovirus (CMV) is the most common congenital and perinatal viral infection in the world. Human immunodeficiency virus (HIV), human papillomavirus (HPV), and herpes simplex virus (HSV) are other potential viruses.

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 a low-dose antihypertensive prophylactically. Have her blood pressure checked at every prenatal visit. Monitor the client for headaches or swelling on the body. Take one aspirin every day.

Have her blood pressure checked at every prenatal visit. Explanation: 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 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. An ultrasound will be done to reassess the correctness of gestational dates. 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.

Lab work will be drawn to rule out acid-base imbalances

The nurse is caring for an intrapartum mother whose fetus has asymmetrical intrauterine growth restriction (IUGR) after the 24th week of gestation. Which nursing action is best? Provide emotional support to the mother and support person as the neonate has anomalies. Regular assessment of the fetal monitor tracings and preparation for a cesarean birth, if needed. Anticipate a precipitous delivery since the neonate is small-for-gestational-age. Use regular assessment techniques as an uncomplicated delivery is anticipated.

Regular assessment of the fetal monitor tracings and preparation for a cesarean birth, if needed.

A nurse is describing the use of Rho(D) immune globulin as the therapy of choice for isoimmunization in Rh-negative women and for other conditions to a group of nurses working at the women's health clinic. The nurse determines that additional teaching is needed when the group identifies which situation as an indication for Rho(D) immune globulin? STIs amniocentesis molar pregnancy maternal trauma

STIs Explanation: Indications for Rho(D) immune globulin include isoimmunization, ectopic pregnancy, chorionic villus sampling, amniocentesis, prenatal hemorrhage, molar pregnancy, maternal trauma, percutaneous umbilical sampling, therapeutic or spontaneous abortion, fetal death, or fetal surgery.

A nurse is teaching a prenatal class and is asked the purpose of amniotic fluid. Which statements are correct? Select all that apply. Amniotic fluid promotes fetal movement enhancing musculoskeletal development. The amount of amniotic fluid does not fluctuate throughout pregnancy. Sufficient amounts of amniotic fluid cushion the fetus from trauma. Amniotic fluid allows the fetal umbilical cord to be relatively free from compression. Sufficient amounts of amniotic fluid help the fetus maintain a constant body temperature.

Sufficient amounts of amniotic fluid cushion the fetus from trauma. Amniotic fluid allows the fetal umbilical cord to be relatively free from compression. Sufficient amounts of amniotic fluid help the fetus maintain a constant body temperature. Amniotic fluid promotes fetal movement enhancing musculoskeletal development.

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? Gastrointestinal bleeding Halos around lights Tachycardia Sweating

Tachycardia Explanation: 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.

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. 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. 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. Explanation: 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.

The nurse is caring for a postpartum client with uterine atony. Bladder drainage and massage have been ineffective. Oxytocin IV has been given but has been ineffective in maintaining uterine tone. Which medication does the nurse anticipate being prescribed as the next choice? carboprost tromethamine misoprostol tranexamic acid heparin

carboprost tromethamine Explanation: If oxytocin is not effective at maintaining tone, carboprost tromethamine, a prostaglandin F2-alpha derivative, or methylergonovine maleate, an ergot compound, both given intramuscularly, are the next possible options. Additional options include misoprostol, a prostaglandin E1 analogue, administered rectally to decrease postpartum hemorrhage or ranexamic acid to decrease bleeding. Heparin would increase bleeding and would not be used.

A gravida 2 para 1 client with a history of gestational hypertension chooses to not add any salt to her current diet, even though her blood pressure has been within normal limits. The nurse supports the client's decision but instructs the client to consume what foods? cranberries and seafood yogurt and almonds dark green vegetables and eggs organ meat and dried fruit

cranberries and seafood Explanation: Iodine is added to table salt and is needed for thyroid function. Cranberries and seafood contain iodine. Yogurt, almonds, vegetables, eggs, organ meat, and dried fruit do not have adequate iodine to support thyroid function.

A nurse is assessing a pregnant client for the possibility of preexisting conditions that could lead to complications during pregnancy. The nurse suspects that the woman is at risk for hydramnios based on which preexisting condition? diabetes hypertension late maternal age isoimmunization

diabetes Approximately 18% of all women with diabetes will develop hydramnios during their pregnancy. Hydramnios occurs in approximately 2% of all pregnancies and is associated with fetal anomalies of development.

A woman at 10 weeks' gestation comes to the clinic for an evaluation. Which assessment finding should the nurse prioritize? report of frequent mild nausea blood pressure of 120/84 mm Hg history of bright red spotting 6 weeks ago fundal height measurement of 18 cm

fundal height measurement of 18 cm Explanation: 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 novice nurse asks to be assigned to the least complex antepartum client. Which condition would necessitate the least complex care requirements? preeclampsia placental abruption (abruptio placentae) placenta previa gestational hypertension

gestational hypertension Explanation: Hypertensive disorders represent the most common complication of pregnancy. Gestational hypertension is elevated blood pressure without proteinuria, other signs of preeclampsia, or preexisting hypertension. Placental abruption (abruptio placentae), a separation of the placenta from the uterine wall; placenta previa (placenta covering the cervical os); and preeclampsia are high-risk, potentially life-threatening conditions for the fetus and mother during labor and birth.

The nurse is preparing the client for the routine laboratory tests that will be obtained at the first prenatal visit. Which test will the nurse prioritize at this visit? prolactin levels hepatitis screen magnesium level rubeola titer

hepatitis screen The woman will undergo tests for hepatitis B, HIV, syphilis, gonorrhea, and chlamydia. Each of these infections can cause serious fetal problems unless they are treated. Rubella is more concerning than rubeola and a titer may be completed to assess the woman's immunity to rubella. Other blood tests will include a complete blood count to evaluate anemia, blood type and antibody screen, and possibly thyroid screen to evaluate for hypothyroidism.

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 Explanation: 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.

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 gestational hypertension preeclampsia with severe features eclampsia

preeclampsia without severe features 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.

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 development of eclampsia hemorrhaging development of gestational trophoblastic disease

preterm rupture of membranes followed by preterm birth

The nurse is concerned that a pregnant client is experiencing abruptio placentae. What did the nurse assess in this client? increased blood pressure and oliguria pain in a lower quadrant and increased pulse rate painless vaginal bleeding and a fall in blood pressure sharp fundal pain and discomfort between contractions

sharp fundal pain and discomfort between contractions Explanation: Abruptio placentae is characterized by a sharp, stabbing pain high in the uterine fundus as the initial separation occurs. Manifestations of abruptio placentae do not include increased blood pressure, oliguria, pain in the lower quadrant, increased pule rate, painless vaginal bleeding, or a fall in blood pressure.

The nurse is evaluating care provided to a client in the third trimester of pregnancy who has been diagnosed with gestational hypertension. Which finding indicates that treatment has been successful for this client? urine protein 0 increased perspiration weight gain of 1 lb/week diastolic blood pressure 20 mmHg over normal level

urine protein 0 Manifestations of gestational hypertension include elevated blood pressure, edema, and proteinuria. Absence of protein in the urine indicates that treatment has been successful. Increased perspiration is not a manifestation of gestational hypertension. A weight gain of 1 lb/week in the client who is in the third trimester of pregnancy is an indication of ongoing edema. A diastolic blood pressure that is 20 mmHg over normal level is an indication of ongoing hypertension.

A nurse is caring for a client who is scheduled to undergo an amnioinfusion. The nurse would question this prescription if which finding is noted upon client assessment? uterine hypertonicity active genital herpes infection blood pressure of 130/88 mm Hg decreased urine output

uterine hypertonicity Explanation: The nurse should ensure that the client does not have uterine hypertonicity to confirm that amnioinfusion is not contraindicated. Other factors that enforce contraindication of amnioinfusion include vaginal bleeding of unknown origin, umbilical cord prolapse, amnionitis, and severe fetal distress. Active genital herpes infection is a condition that enforces contraindication of labor induction rather than amnioinfusion. Urine output and blood pressure do not determine a client's ability to receive an amnioinfusion.