Prenatal and antepartum management
The pregnant client is experiencing low back pain. After determining that the client is not in labor, the nurse instructs the client to perform which exercises to increase comfort and decrease the incidence of the low back pain? (Select all that apply) A) Kegel exercises B) Pelvic tilt exercises C) Leg raises D) Back stretch E) Stepping
B) Pelvic tilt exercises C) Leg raises D) Back stretch Pelvic tilt exercises strengthen and stretch the abdominal and back muscles to relieve pain Leg raises strengthen and stretch leg and abdominal muscles to relieve pain Back stretch relieves pain from the back muscles caused by lordosis
The nurse's assessment findings of the pregnant client include darkening of areola and nipple, presence of Goodell's sign, leukorrhea, HR 124 bpm, dysuria, and heartburn. Of these findings, how many require further evaluation? ______ findings (record answer as a whole number)
3 There are 3 abnormal findings that require further evaluation. Leukorrhea needs to be distinguished from a vaginal infection, such as Candida albicans or a sexually transmitted infection. Heart rate can increase by 10 to 15 bpm during pregnancy, but an increase to 124bpm is too high. Dysuria may be a sign of UTI.
The nurse is caring for the 24-y/o client whose pregnancy history is as follows: elective termination age 18 years, spontaneous abortion age 21 years, term vaginal delivery at 22 years old, and currently pregnant again. Which documentation by the nurse of the client's gravidity and parity is correct? A) G4P1 B) G4P2 C) G3P1 D)G2P1
A) G4P1 The client has been pregnant four times in all (gravidity). This client has delivered once (parity) and is currently pregnant, so the parity is 1.
The pregnant client tells the nurse that she smokes two packs per day (PPD) of cigarettes, has smoked in other pregnancies, and has never had any problems. What is the nurse's best response? A) "I'm glad that your other pregnancies went well. Smoking can cause both maternal and fetal problems, and it is best if you could quit smoking." B) "You need to stop smoking for the baby's sake. You could have a spontaneous abortion with this pregnancy if you continue to smoke." C) "Smoking can lead to having a large baby, which can make delivery difficult. You may even need a cesarean section." D) "Smoking less would eliminate the risk for your baby, and you would feel healthier during your pregnancy."
A) "I'm glad that your other pregnancies went well. Smoking can cause both maternal and fetal problems, and it is best if you could quit smoking." The nurse is acknowledging that the client did not experience problems with her other pregnancies but is also informing the client that smoking can cause maternal and fetal problems during pregnancy
The 22-year-old client tells the clinic nurse that her last menstrual period was 3 months ago, which began on November 21. She has a positive urine pregnancy test. Using Naegele's rule, which date should the nurse calculate to be the client's estimated date of confinement (EDC)? A) August 28 B) January 28 C) August 15 D) January 15
A) August 28 Naegele's rule is a common method to determine the EDC. To calculate the EDC, subtract 3 months and add 7 days. This makes the EDC August 28
The pregnant client presents to the ED with a large amount of painless, bright red bleeding. She looks to be about 30 to 34 weeks pregnant based on her uterine size. She speaks limited English and is unable to communicate with the staff. What actions should be taken by the nurse? (Select all that apply) A) Call for an interpreter for this client B) Establish an intravenous access C) Auscultate for FHT D) Place the client into a lithotomy position E) Perform a digital pelvic examination
A) Call for an interpreter for this client B) Establish an intravenous access C) Auscultate for FHT The nurse should call for an interpreter so that the client is able to communicate An IV access should be performed by the nurse to administer any needed medications Auscultating FHT will provide information about fetal well-being
The nurse is taking the health history of the 40-year-old pregnant client. Which identified medical conditions increase the client's risk for complications during her pregnancy? (Select all that apply) A) Diabetes mellitus type 2 B) Previous full-term pregnancy C) Controlled chronic hypertension D) New onset of iron-deficiency anemia E) Hemorrhage with a previous pregnancy
A) Diabetes mellitus type 2 C) Controlled chronic hypertension D) New onset of iron-deficiency anemia E) Hemorrhage with a previous pregnancy DM is a risk factor for complications such as preeclampsia, eclampsia, dystocia, fetal macrosomia, recurrent monilial vaginitis and UTIs, ketoacidosis, congenital abnormalities, and others Controlled chronic hypertension may become uncontrolled during pregnancy due to water retention and other factors related to pregnancy. It is a risk factor for complications such as preeclampsia, placental abruption, and fetal hypoxia Iron-deficiency anemia is associated with an increased incidence of preterm birth, low-birth-weight infants, and maternal and infant mortality Previous pregnancy complications are a risk factor for complications
The client expresses concerns related to nausea in the first trimester of pregnancy. Which recommendation should the nurse make? A) Eat crackers while still in bed in the morning B) Lie down and rest whenever nausea occurs C) Eat more frequently throughout the day D) Avoid food items containing ginger
A) Eat crackers while still in bed in the morning The nurse should instruct the client to eat dry crackers before rising from bed. This typically relieves some of the nausea
The pregnant client tells the nurse that she thinks she is carrying twins. In reviewing the client's history and medical records, the nurse should determine that which factors are associated with a multiple gestations? (Select all that apply) A) Elevated serum alpha-fetoprotein B) Use of reproductive technology C) Maternal age greater than 40 D) History of twins in the family E) Elevated hemoglobin levels
A) Elevated serum alpha-fetoprotein B) Use of reproductive technology D) History of twins in the family An elevated serum alpha-fetoprotein level (an oncofetal protein normally produced by the fetal liver and yolk sac) is associated with a multiple gestation The use of reproductive technology such as artificial insemination or fertility drugs is associated with a multiple gestation History of twins in the family is associated with a multiple gestation
The nurse is conducting a physical assessment of the pregnant client. Which physiological cervical changes associated with pregnancy should the nurse expect to find? (Select all that apply) A) Formation of mucus plug B) Chadwick's sign C) Presence of colostrum D) Goodell's sign E) Cullen's sign
A) Formation of mucus plug B) Chadwick's sign D) Goodell's sign Cervical changes associated with pregnancy include the formation of the mucus plug. Endocervical glands secrete a thick, tenacious mucus, which accumulates and thickens to form the mucus plug that seals the endocervical canal and prevents the ascent of bacteria or other substances into the uterus. This plug is expelled when cervical dilation begins Cervical changes associated with pregnancy include a bluish-purple discoloration of the cervix (Chadwick's sign) from increased vascularization Cervical changes associated with pregnancy include the softening of the cervix (Goodell's sign) from increased vascularization and hypertrophy and engorgement of the vessels below the growing uterus
The client is diagnosed with pregnancy-related diabetes at 28 weeks' gestation. In teaching the client, the nurse should include what information for managing her blood glucose? (Select all that apply) A) Having glycosylated hemoglobin A1C lab tests B) Performing home blood glucose monitoring C) Developing a weight management plan D) Engaging in appropriate daily exercise E) Taking oral diabetic agents in the a.m.
A) Having glycosylated hemoglobin A1C lab tests B) Performing home blood glucose monitoring C) Developing a weight management plan D) Engaging in appropriate daily exercise Hgb A1C will be drawn and monitored throughout the pregnancy, with a goal of reaching a level of less than 7% Home blood glucose monitoring will help the client identify when her blood glucose is outside normal parameters Excessive weight gain worsens control of glucose levels Exercise adapted for the pregnant body is important to glucose control
The nurse is reviewing the laboratory test results of the pregnant client. Which laboratory test findings would require further follow-up from the nurse? A) Hemoglobin B) 50-g, 1-hour glucose test C) Glucosuria D) Proteinuria
A) Hemoglobin The normal Hgb level should be 12 to 16 g/dL in the pregnant client. The nurse should encourage iron-rich foods
The client is providing nutrition counseling to the client during her first prenatal clinical visit. Which statement, if made by the client, indicates that the client has an understanding of some of the nutritional requirements for pregnancy? A) I can eat cheese as an alternative to milk, as I don't care for milk B) I should be eating more at each meal because I'm eating for two C) I will need to limit my calories because I am already overweight D) I should limit myself to only eating three healthy meals a day
A) I can eat cheese as an alternative to milk, as I don't care for milk Cheese is a milk product and is an alternative to milk. This statement indicates understanding of nutritional requirements regarding milk and milk products
The pregnant client and her significant other are attending childbirth classes. The client asks for guidance on preparing her school-aged child for the new baby's birth. Which strategies might the nurse suggest that the client use with her child? ( Select all that apply) A) Read books about bringing home a new baby B) Think of unique names for the new baby C) Help pack a bag for bringing the new baby home D) Explain how pregnancy occurred, if asked E) Help the child buy presents for the new baby
A) Read books about bringing home a new baby B) Think of unique names for the new baby C) Help pack a bag for bringing the new baby home E) Help the child buy presents for the new baby Engaging the child in activities such as reading books about bringing the new baby home helps the child to feel a part of the experience Engaging the child in activities such as naming the new baby helps the child to feel a part of the experience Engaging the child in activities such as packing a bag for the new baby's coming home helps the child to feel a part of the experience Engaging the child in activities such as buying presents for the new baby helps the child to feel a part of the experience
The client presents with vaginal bleeding at 7 weeks. Which action should be taken by the nurse first? A) Take the client's vital signs B) Prepare examination equipment C) Give 2 liters oxygen per nasal cannula D) Assess the client's response to the situation
A) Take the client's vital signs Assessing the client's VS should be completed first. Bleeding can cause hypotension
The client diagnosed with velamentous cord insertion asks, "What symptoms will I experience first if one of the vessels tears?" Which symptom should the nurse address? A) Vaginal bleeding B) Abdominal cramping C) Uterine contractions D) Placental abruption
A) Vaginal bleeding In a velamentous cord insertion, vessels of the cord divide some distance from the placenta in the placental membrane. Thus the most likely first symptom would be vaginal bleeding
The nurse is counseling the client who has SLE. The client tells the nurse that she plans to become pregnant in the next year. Which response by the nurse is correct? A) it is best to plan pregnancy when you have been in remission for 6 months B) having systemic lupus erythematosus will not impact your pregnancy in any way C) your chances of having an infat with congenital malformations are increased with SLE D) you will need to be scheduled for a C-section delivery to prevent disease transmission
A) it is best to plan pregnancy when you have been in remission for 6 months Pregnancy planned during periods of inactive or stable disease often results in giving birth to a healthy full-term baby without increased risk of pregnancy complications
The nurse informs the pregnant client that her test results indicate that she has iron-deficiency anemia. Based on this diagnosis, the nurse should monitor the client for which problems? select all that apply A) susceptibility to infection B) easily fatigued C) increased risk for preeclampsia D) increased risk for diabetes E) congenital defects
A) susceptibility to infection B) easily fatigued C) increased risk for preeclampsia A) iron def anemia is associated with susceptibility to infection because oxygen is not transported effectively B) iron-deficiency anemia is associated with fatigue because oxygen us not transported effectively. C) iron def anemia is associated with risk of preeclampsia because oxygen is not transported effectively
The nurse is caring for the pregnant client at the initial prenatal visit. Which universal screenings should the nurse complete? select all that apply A) taking the client's BP B) Doing a urine dipstick test for protein C) doing a urine dipstick test for glucose D) asking questions about domestic violence E) asking questions about use of tobacco
A) taking the clients BP D) asking questions about domestic violence E) asking questions about the use of tobacco BP screening should be performed at the initial prenatal visit to establish a baseline and to evaluate for actual or potential problems. Domestic violence screening should be performed at the initial prenatal visit to determine fetal and maternal risk for harm Screening for tobacco use should be performed at the initial prenatal visit to determine fetal and maternal risk. Smoking is associated with an increased risk for spontaneous abortion, preterm labor, and low birth weight
Multiple women are being seen in the clinic for various conditions. From which clients should the nurse prepare to obtain a group beta streptococcus (GBS) culture? select all that apply A) the client who is having symptoms of preterm labor B) The woman who had a neonatal death 1 year ago C) all pregnant women coming to the clinic for care D) the women who had a spontaneous abortion 1 week ago E) The women who had an abortion for an unwanted pregnancy
A) the client who is having symptoms of preterm labor C) all pregnant women coming to the clinic for care The client in preterm labor should be screened for GBS infection. between 10% and 30% of all women are colonized for GBS. All pregnant women, regardless of risk status, should be screened for GBS infection.
The nurse is caring for the client with mild preeclampsia. The nurse should monitor for which complications associated with mild preeclampsia? select all that apply. A) placental abruption B) hyperbilirubinemia C) non reassuring fetal status D) severe preeclampsia E) gestational diabetes
A, B, C, D A) placental abruption can occur as a complication of preeclampsia due to hypoperfusion of the placenta and endothelial injury B) hyperbilirubinemia can occur as a complication of preeclampsia due to hypoperfusion to the liver C) non-reassuring fetal status can occur as complication of preeclampsia due tp hypoperfusion to the placenta D) severe preeclampsia can occur as a complication of preeclampsia if the BP remains uncontrolled.
The nurse is caring for the client who is Rh negative at 13 weeks' gestation. The client is having cramping and has moderate vaginal bleeding. Which HCP order should the nurse question? A) Administer Rho(D) immune globulin (RhoGAM) B) Obtain a beta human chorionic gonadotropin level (BHCG) C) Schedule for an immediate ultrasound D) Place on continuous external fetal monitoring
B) Obtain a beta human chorionic gonadotropin level (BHCG) Obtaining BHCG level is not indicated at 13 weeks' gestation. BHCG levels are followed in early pregnancy before a fetal heartbeat can be confirmed
The client who is 32 weeks pregnant asks how the nurse will monitor the baby's growth and determine if the baby is "really okay." which assessments should the nurse identify for evaluating the fetus for adequate growth and viability? Select all that apply A) auscultate maternal heart tones B) Measure the height of the fundus C) measure the clients abdominal girth D) complete a third-trimester ultrasound E) auscultate the fetal heart tones
B measure the height of the fundus E) auscultate the fetal heart tones Adequate fetal growth is evaluated by measuring the fundal height. Auscultating the FHT assesses fetal viability
The client at 31 weeks' gestation is diagnosed with mild preeclampsia and placed on home management. What information should the nurse include when educating the client? (Select all that apply) A) "Plan for hospitalization when nearing 36 weeks' gestation." B) "Weigh daily and inform the HCP of a sudden increase in weight." C) "Home care will be consulted to take your BP daily." D) "Perform stretching and range-of-motion exercises twice daily." E) "Rest as much as possible, especially in the lateral recumbent position."
B) "Weigh daily and inform the HCP of a sudden increase in weight." D) "Perform stretching and range-of-motion exercises twice daily." E) "Rest as much as possible, especially in the lateral recumbent position." A sudden weight gain could indicate that the mild preeclampsia is uncontrolled and the client is retaining fluid. The HCP should be consulted Stretching and ROM exercises can help prevent thrombophlebitis and venous stasis The lateral recumbent position improves uteroplacental blood flow, reduces maternal BP, and promotes diuresis
The nurse is caring for the client admitted to the antepartum unit at 32 weeks' gestation with possible preterm labor. The nurse is performing a fetal fibronectin (fFN) test. Which event, if it occurred, would require the nurse to recollect the specimen? A) The specimen is collected before a vaginal examination B) A lubricant was used to facilitate insertion of the swab C) The client reports that she has not had intercourse for 3 days D) The specimen is collected before other specimens are collected
B) A lubricant was used to facilitate insertion of the swab When collecting a fetal fibronectin test swab, the nurse must not use lubricant, as it will interfere with the collection of the specimen and contaminate the specimen. If this occurs, the test will need to be repeated
The nurse assesses the 34-week pregnant client (G2P1). Place the assessment findings in the sequence that they should be adressed by the nurse from the most significant to the least significant. A) pedal edema at 3+ B) BP 144/94 mm HG C) positive GBS vaginal culture D) fundal height increase from 4.5 cm in 1 week
B) BP 144/94 D) fundal height increase from 4.5 cm in 1 week A) pedal edema at 3+ C) positive GBS vaginal culture BP 144/94 warrants immediate evaluation. It could cause preeclampsia, a condition that can progress to serious complications Fundal height increase of 4.5 cm in 1 week is abnormal and requires further follow-up. Normal fundal height increase is 1 to 2 cm per week. An increase in fundal size can be related to gestational Diabetes, large-for-gestational-age fetus, fetal anomalies, or polyhydramnios. Pedal edema at 3+ may be a normal physiological process if it is an isolated finding. Pedal edema warrants further assessment because it can be a symptom of preeclampsia Positive GBS vaginal culture warrants antibiotic treatment in labor but does not warrant intervention during pregnancy.
The 29- weeks pregnant client presents to triage with decreased fetal movement. Her initial BP is 140/90 mm HG. She states she "doesn't feel well" and her vision is "blurry." Additional assessment findings include normal reflexes, +2 proteinuria trace pedal edema, and puffy face and hands. What is the most important information that the nurse should obtain from the client's prenatal record? A) Depressed liver enzymes B) BP at her first prenatal visit C) urine dipstick from last visit D) the pattern of weight gain
B) BP at her first prenatal visit The pregnant client with a BP that is greater than 140/90 mm HG with the presence of proteinuria may have preeclampsia. New-onset hypertension is associated with preeclampsia.
The pregnant client (G1P0) in the first trimester tells the nurse that she is anxious about losing her baby, prenatal care, and her labor and birth. Which teaching should the nurse identify as priority? A) Sexual relations with her spouse B) Fetal growth and development C) Options for labor and delivery D) Preparing needed items for the baby
B) Fetal growth and development Information about fetal growth and development is priority and important to address during the first trimester, especially when the client expresses concerns about losing her baby
The experienced nurse is observing the new nurse determine the fetal position of the pregnant client using Leopold maneuver. The experienced nurse determines that the new nurse correctly identifies the first Leopold maneuver when placing the hands in which position illustrated first? A) hands placed at the top and bottom of the abdomen B) both hands placed at the top of the abdomen C) both hands placed at the bottom of the abdomen D) both hands placed on the sides of the abdomen
B) both hands placed at the top of the abdomen The nurse palpates the fundus to determine which fetal body part (e.g., head or buttocks) occupies the uterine fundus
The nurse is teaching the client who is wishing to travel by airplane during the first 36 weeks of her pregnancy. Which is the primary risk of air travel for this client that the nurse should address? A) risk of preterm labor B) deep vein thrombosis C) spontaneous abortion D) nausea and vomiting
B) deep vein thrombosis The primary risk with air travel during pregnancy is DVT. pregnancy increases the risk of blood coagulation, and prolonged sitting produces venous stasis.
The nurse is assessing pregnant clients. During which time frames should the nurse expect clients to report frequent urination throughout the night? Select all that apply A) before the first missed menstrual period B) during the first trimester C) during the second trimester D) during the third trimester E) one week following delivery
B) during the first trimester D) during the third trimester Urinary frequency is most likely to occur in the first and third trimesters. First trimester urinary frequency occurs as the uterus enlarges in the pelvis and begins to put pressure on the bladder In the third trimester, urinary frequency returns due to the increased size of the fetus and uterus placing pressure on the bladder.
The nurse is teaching the pregnant client during her first trimester. The nurse identifies that which decision is most important for her to make first? A) bottle vs breastfeeding B) Labor and delivery location C) pain management during labor D) method for delivery of the baby
B) labor and delivery location A decision regarding labor and delivery location has priority for the client to properly plan for a home birth vs a hospital birth, HCP availability at the location, and type of labor and delivery settings available at the location
The 28 y/o pregnant client (G3P2) has just been diagnosed with gestational diabetes at 30 weeks. The client asks what types of complications may occur with the diagnosis. Which complications should the nurse identify as being associated with gestational diabetes? select all that apply. A) seizures B) large-for-gestational-age infant C) low-birth-weight infant D) congenital anomalies E) preterm labor
B) large-for-gestational-age infant D) congenital anomalies B) Infants of diabetic mother can be large as a result of excess glucose to the fetus D) Congenital anomalies are more common in diabetic pregnancies
The nurse is counseling the pregnant client who has painful hemorrhoids. Which initial recommendation should be made by the nurse? A) apply steroid-based creams B) modify the diet to include more fiber C) treat those surgically before delivery D) increase intake of foods and flavonoids
B) modify the diet to include more fiber an initial recommendation should be a high-fiber diet because high-fiber foods increase intestinal bulk and make passage of stool easier
The nurse assesses the client in her third trimester with suspected placenta previa. Which finding should the nurse associate with placenta previa. A) cerfix is 100% effaced B) painless vaginal bleeding C) the fetal lie is transverse D) absence of fetal movement
B) painless vaginal bleeding In placenta previa, the abnormal location of the placenta causes painless, bright red vaginal bleeding as the lower uterine segment stretches and thins
The client is pregnant and recieving diet counseling. Which response by the nurse is most helpful when the client states she does not consume any dairy products due to her cultural heritage? A) tell me how you perceive dairy products in your culture B) try having a glass of soy milk at each meal and at bedtime C) tell me about your intake of fortified tofu and leafy green vegs D) rice milk fortified with calcium and nettle tea are good calcium choices
C) tell me about your intake of fortified tofu and leafy green vegetables Assessing the client's intake of calcium rich foods is the best response
The client tells the nurse, "Most days, I am so happy I am pregnant, but other days, I am not sure that I am ready to have a baby." Which is the most accurate response from the nurse? A) "This is such a happy time in your life. You need to be optimistic to feel happy." B) "How does your spouse feel about the pregnancy? I hope he is happy about the baby." C) "Feeling differently from day to day is normal. How do you feel today?" D) "Why do you feel this way? Is there something I can do to make it better for you?"
C) "Feeling differently from day to day is normal. How do you feel today?" It is most therapeutic to acknowledge the client's feelings and probe for more information on her thoughts and feelings about the pregnancy
The pregnant client asks the nurse, who is teaching a prepared childbirth class, when she should expect to feel fetal movement. The nurse responds that fetal movement usually can first be felt during which time frame? A) 8 to 12 weeks of pregnancy B) 12 to 16 weeks of pregnancy C) 18 to 20 weeks of pregnancy D) 22 to 26 weeks of pregnancy
C) 18 to 20 weeks of pregnancy Subtle fetal movement (quickening) can be felt as early as 18 to 20 weeks of gestation, and it gradually increases in intensity
The nurse is caring for the pregnant client at 20 weeks' gestation. At what level should the clinic nurse expect to palpate the client's uterine height? A) Two finger-breadths above the symphysis pubis B) Halfway between the symphysis pubis and the umbilicus C) At the level of the umbilicus D) Two finger-breadths above the umbilicus
C) At the level of the umbilicus At 20 gestational weeks, the uterus should be at the level of the umbilicus
The pregnant client presents with vaginal bleeding and increasing cramping. Her exam reveals that the cervical os is open. Which term should the nurse expect to see in the client's chart notation is most accurately describe the client's condition? A) Ectopic pregnancy B) Complete abortion C) Imminent abortion D) Incomplete abortion
C) Imminent abortion In imminent abortion, the client's bleeding and cramping increase and the cervix is open, which indicates that abortion is imminent or inevitable
The nurse is providing nutrition counseling to a primigravida who is 10 weeks pregnant. Which meal choice stated by the client indicates she needs additional information? A) Black beans, wild rice, collard greens B) Dry cereal, milk, dried cranberries C) Tuna, broccoli, baked potato D) Beef strips, lentils, red peppers
C) Tuna, broccoli, baked potato Tuna contains mercury and should be limited in pregnancy due to risk of mercury poisoning. The nurse should provide this additional information
The nurse evaluates the pregnant client with sickle cell disease during her second trimester. The nurse should identify which manifestation as being related to sickle cell disease and not pregnancy? A) hand and lower extremities edema B) elevated serum blood glucose level C) decreased oxygen saturation D) elevated BP
C) decreased oxygen saturation Decreased oxygen saturation level is a clinical manifestation of sickle cell disease. Dehydration and anemia during pregnancy can result in vaso-occlusive crisis, which causes damage to RBCs and decreased oxygenation. The decrease in oxygenation manifests in decreased oxygen saturation levels.
The nurse is counseling the client who is trying to become pregnant. To promote fetal health when the client is unaware of a pregnancy, which nutrient should the nurse stress to include in daily food intake? A) potassium B) calcium C) Folic acid D) sodium
C) folic acid The nurse should educate the client about the need for adequate folic acid intake. Folic acid is important in preventing neural tube defects, esp during the first 4 weeks of fetal development.
The nurse is counseling the client who is pregnant. The nurse should teach that which assessment finding requires follow-up with the HCP. A) dependent edema B) Edema in the hands C) generalized edema D) edema occurring every evening
C) generalized edema The nurse needs to teach the client that generalized edema is a sign of preeclampsia and requires follow-up by an HCP for further evaluation
The nurse is reviewing the laboratory report from the first prenatal visit of the pregnant client. Which laboratory result should the nurse most definitely discuss with the HCP? A) hemoglobin 11 g/dL; hematocrit 33% B) WBC count: 7000/mm3 C) pap smear: Human papilloma virus changes D) urine PH: 7.4; specific gravity 1.015
C) pap smear: HPV changes a pap smear with HPV changes reflects an abnormal result. HPV changes are a risk factor for cervical cancer. The nurse should discuss the result with the HCP because it requires further assessment and follow-up.
The nurse is reviewing the medication history of the client during preconception counseling. The client reports taking isotretinoin for acne. Which is the nurse's best response? A) stop taking isotretinoin now! it can cause serious birth defects if you become pregnant. B) you need to be on some type of birth control right now. Getting pregnant is not an option. C) talk with your HCP about changing isotretinoin before you consider becoming pregnant D) once you are off isotretinoin for treating acne, you can safely become pregnant
C) talk with you HCP about changing isotretinoin before you consider becoming pregnant The best response is to have the client consult her HCP so another medication can be prescribed. This response indicates that isotretinoin is not safe but that alternative medications can be prescribed.
The 22 y/o client, who is experiencing vaginal bleeding in the first trimester of pregnancy, fears that she has lost her baby at 8 weeks. Which definitive test result should indicate to the nurse that the client's fetus has been lost? A) falling beta human chorionic gonadotropin measurement B) low progesterone measurement C) ultrasound showing lack of fetal cardiac activity D) ultrasound determining crown-rump length
C) ultrasound showing lack of fetal cardiac activity Ultrasound is used to determine if the fetus has died. The lack of fetal heart activity in a pregnancy over 6 weeks determines a fetal loss
The HCP prescribes interventions for the client with decreased fetal movement at 35 weeks' gestation. Place the prescribed interventions in the sequence that they should be performed by the nurse. A) prepare for a nonstress test B) prepare for a biophysical profile C) palpate for fetal movement D) apply and explain the external fetal monitor
C, D, A, B C) Palpate for fetal movement should be performed first. Assessment should be first to verify fetal movement D) apply and explain the external fetal monitor should be next. The fetus should be monitored for heart rate changes A) prepare for an NST. The NST is performed to determine fetal well-being B) prepare for a biophysical profile (BPP). The BPP ables: FHR acceleration, fetal breathing, fetal movements, fetal tone, and amniotic fluid volume. The first criterion is assessed with the NST. The other variables are assessed by ultrasound scanning.
The nurse is caring for the client with a grade 3 placental abruption. Prioritize how the nurse should implement the prescribed interventions. A) obtain serum blood draw for clotting disorders B) Administer 1 unit whole blood C) start oxygen at 2 to 4 liters per nasal cannula D) administer lactated ringers at 200 mL/hr E) prepare for C-section delivery if fetal distress F) do continuous external fetal monitoring
C, D, F, A, B, E. C) start oxygen at 2 to 4 liters per nasal cannula is priority to maximize fetal oxygenation D) administer lactated ringers at 200 mL/hr to treat hypovolemia, increase blood flow, and maximize oxygenation F) continuous external fetal monitoring should be performed to identify fetal distress early A) obtain serum blood draw for clotting disorders, specifically DIC B) administer 1 unit whole blood is next and will depend on the amount of blood loss E) prepare for C section delivery if fetal distress would be last because it would depend on the client and fetal status
The client tells the nurse that she is using cocoa butter on her abdomen to prevent stretch marks. Which is the most accurate response from the nurse? A) "That is wonderful. If you continue to use cocoa butter daily, you should have no stretch marks after delivery." B) "The cocoa butter will not prevent stretch marks completely, but it will help to reduce their number." C) "The cocoa butter will not prevent stretch marks, but will decrease the appearance of the linea nigra." D) "Cocoa butter does not prevent stretch marks, but it soothes itching that occurs as your abdomen enlarges."
D) "Cocoa butter does not prevent stretch marks, but it soothes itching that occurs as your abdomen enlarges." Cocoa butter is an emollient and provides moisture to the skin, thereby decreasing the itching associated with stretching of the skin as the abdomen enlarges
The client at 32 weeks' gestation presents to the ED with a severe headache. Her BP is 184/104 mm Hg. Based on the assessment and the serum laboratory report results, which most severe complication warrants the nurse's further assessment? A) Renal failure B) Liver failure C) Preeclampsia D) HELLP syndrome
D) HELLP syndrome It is most important for the nurse to further assess for HELLP syndrome, a variation of pregnancy-induced hypertension characterized by hemolysis (elevated bilirubin), elevated liver enzymes, and low platelets
While assessing the prenatal client, the nurse found a number of concerning problems. Place the concerning problems in the sequence that they should be addressed by the nurse. A) Currently bleeding and cramping B) Previous varicella infection C) Currently using tobacco D) Has intense pelvic pain
D) Has intense pelvic pain A) Currently bleeding and cramping C) Currently using tobacco B) Previous varicella infection Has intense pelvic pain is most concerning and should be addressed first by the nurse. It could be a symptom of a serious medical condition, such as a miscarriage, ectopic pregnancy, or appendicitis. This symptom represents a possible pathology that could warrant immediate surgical intervention Currently bleeding and cramping should be addressed next. It could be associated with the pelvic pain and could be a symptom of a serious medical condition, such as a miscarriage or ectopic pregnancy Currently using tobacco can put the client at risk for multiple adverse outcomes and should be addressed, although it is not an immediately concerning factor Previous varicella infection is important to document but poses no risk to the client or the fetus, so it is the least important to address
The first-trimester pregnant client asks the nurse if the activities in which she participates are safe in the first trimester. Which activities should the nurse verify as a safe activity during the client's first trimester? A) Hair coloring B) Hot tub use C) Pesticide use D) Sexual activity
D) Sexual activity Sexual activity is not contraindicated in pregnancy unless a specific risk factor is identified
The client who is actively bleeding after a spontaneous abortion asks the nurse why she lost the baby. The nurse responds that the majority of first-trimester losses are related to which problem? A) cervical incompetence B) chronic maternal disease C) poor implantation D) chromosomal abnormalities
D) chromosomal abnormalities chromosomal abnormalities account for the majority of first-trimester spontaneous abortions
The nurse assess the fundal height for multiple pregnant clients. For which client should the nurse conclude that a fundal height measurement is most accurate? A) the pregnant client with uterine fibroids B) The pregnant client who is obese C) the pregnant client with polyhydramnios D) the pregnant client having fetal movement
D) the pregnant client having fetal movement Excessive fetal movement may make it difficult to measure the client's fundal height; however, it should not cause an inaccuracy in the measurement
The client admitted in preterm labor is told that an amniocentesis needs to be performed. The client asks the nurse why this is necessary when the HCP has been performing ultrasounds throughout the pregnancy. Which is an appropriate response by the nurse? A) your baby is older now, and an amniocentesis provides us with more information on how your baby is doing B) an amniocentesis could not be preformed before 32 weeks, so you will be having this test form now until delivery C) your doctor wants to make sure that there are no problems with your baby that an ultrasound might not be able to identify D) with your preterm labor your doctor needs to know your baby's lung maturity; this is best identified by amniocentesis.
D) with your preterm labor your doctor needs to know your baby's lung maturity. The amniocentesis is being performed to determine fetal lung maturity. Once fetal lung maturity is determined, appropriate care can be planned, including administration of betamethasone, administration of tocolytics, or delivery of the baby.
The nurse is assessing the client who is 34 weeks gestation. Place an X where the nurse should place the Doppler first to assess the FHR when the fetus is thought to be left occiput anterior (LOA)
FHT are best heard in the lower left quadrant of the client's abdomen when the fetus is LOA The FHT varies according to the fetal position. The FHR is heard most clearly directly over the fetal upper back. Think about where the fetal back is located when positioned LOA
