Preterm labor

The nurse is assessing a multi pt at 12 wks who has been admitted to the ER with sharp right-sided abd pain and vaginal spotting. Which of the following should the nurse obtain about the pt's hx? SA A. hx of STI B. number of sexual partner C. last menstrual period D. Cesarean section E. Contraceptive use

A. hx of STI B. number of sexual partner C. last menstrual period E. Contraceptive use

A 36 yo multi client is admitted to the hospital with possible ruptured ectopic pregnancy. When obtaining the client's hx, which of the following would be most important to identify as a predisposing factor? A. UTI B. Marijuna use during preg C. Episodes of PID D. Use of estrogen-progestin contraceptives

C. Episodes of PID ; causes narrowing constriction of fallopian tube

A multigravid pt diagnosed with a probabable ruptured ectopic pregnancy is scheduled for emergency surgery. In addition to monitoring the client's BP before surgery, which of the following would the nurse assess? A. Uterine contx B. Abdominal distention C. H & H D. Pulse rate

D. Pulse rate: BP & PULSE = signs of shock

A primigravid client at 30 wks has been admitted to the hospital with PROM w/o contx. Her cervix is 2 cm dilated and 50 % effaced. The nurse should next assess the client's: a. RBC count b. Degree of discomfort c. Urinary output d. Temperature

d. Temperature

The primary HCP prescribes betamethasone for a 34-yo multigravid client at 32 wks of gestation who is experiencing preterm labor. Previously, the pt has experienced one infant death due to preterm birth at 28 wks. The nurse explains that this drug is given for which of the following reasons? A. To enhance fetal lung maturity B. To counter the effects of tocolytic therapy C. To treat chorioamnionitis D. To decrease neonatal production of surfactant

A. To enhance fetal lung maturity

When teaching a primi Pt with diabetes about common cause of hyperglycemia during pregnancy, which of the following would the nurse include? A. Fetal macrosomia B. Obesity before conception C. Maternal infection D. Pregnancy induced hypertension

C. Maternal infection

The nurse is planning care for a multigravid Pt hospitalized for ROM and no evidence of labor. Which of the following would the nurse expect the primary HCP to prescribe? A. Frequent assessment of cervical dilation B. IV oxytocin admin C. Vaginal culture for Neisseria gonorrhoeae D. Sonogram for amniotic fluid volume index

C. Vaginal culture for Neisseria gonorrhoeae

While caring for a primi with class II at 28 wks the nurse would instruct the pt to contact her primary HCP immediately if the pt experiences which of the following? A. Mild ankle edema B. Emotional stress on the job C. Weight gain of 1lb in a week D. Increased dyspnea at rest

D. Increased dyspnea at rest

After teaching a primi about symptoms of hyperglycemia and hypoglycemia, the nurse determines that the client understands the instruction when she says that hyperglycemia may be manifested by which of the following? A. Dehydration B. Pallor C. Sweating D. Nervousness

A. Dehydration

A 30 yo multigravid pt at 8 weeks has a hx of insulin-dependent diabetes since age 20. When explaining about the importance of blood glucose control during pregnancy, the nurse should tell the client that which of the following will occur regarding the client's insulin needs during the first trimester? A. They will increase B. They will decrease C. They will remain constant D. They will be unpredictable

B. They will decrease

In which of the following maternal locations would the nurse place the US transducer of the external electronic FHR monitor if a fetus at 34 wks gestation is in the left occipitoanterior (LOA) position? A. Near the symphysis pubis B. Two inches (5.1cm) above the umbilicus C. Below the umbilicus on the left side D. At the level of the umbilicus

C. Below the umbilicus on the left side Rationale: with the fetus in the lOA position, the transducer should be placed below the umbilicus on the side where the fetal back is located and uterine displacement during contx is greatest. If the fetus back in near the symphysis pubis, the fetus is presenting as a transverse lie. If the fetus is in a breech position, the fetal back may be at or above umbilicus

A primigravid at 34 wks is experiencing contx every 3-4 mins lasting 35 seconds. Her cervix is dilated and 50% effaced. While the nurse is assessing the pt's VS, the pt says, " I think my bag of water just broke." Which of the following would nurse do first? A. Check the status of FHR B. Turn the Pt to her right side C. Test the leaking fluid with nitrazine paper D. Perform a sterile vaginal examination

A. Check the status of FHR A

On arrival to at the emergency department, a pt tells the nurse that she suspects that she may be pregnant but has been having a small amount of bleeding and has severe pain in the lower abdomen. The pt's bp:70/50 ; P: 120. The nurse notifies the HCP immediately bc of the possiblity of: A. Ectopic pregnancy B. Abruptio placentae C. Gestational trophoblastic disease D. Complete abortion

A. Ectopic pregnancy

Which of the following anticoagulants would the nurse expect to amdin when caring for a primi at 12 wk who has class II cardiac dx due to mitral valve stenosis? A. Heparin B. Warfarin C. Enoxprain D. Ardeparin

A. Heparin; although there is no completely safe anticoagulant therapy during pregnacy; heparin is typically the drug of choice

A multigravid client at 34 wks with PROM tests positive for group B strep. The client is having contx q 4-6 mins. Her VS: bp = 120/80; temp=100; p=100; RR= 18/min A. IV penicillin B. IV gentamicin sulfate C. IM betamethasone D. IM cefaclor

A. IV penicillin

A multigravid client at 34 wks gestation is being treated with indomethacin to halt preterm labor. If the client gives birth to a preterm infant, the nurse should notify the nursery personnel about this therapy because of the possibility for which of the following? A. Pulmonary HTN B. Respiratory distress syndrome C. Hyperbilirubinemia D. Cardiomyopathy

A. Pulmonary HTN Rationale: indomethacin has been successfully used to halt preterm labor; but if the pt should give birth to a preterm infant; the nurse would notify nursery about the tocolytic therapy bc this drug can lead to premature closure of the fetal ductus arteriosus = pulmonary HTN

With plans to breast-feed her neoante, a pregnant client w insulin-dependent diabetes asks the nurse about insulin needs during the postpartum period. Which of the following statements about postpartal insulin requirements for breastfeeding mothers should the nurse include in the explanation? A. They fall significantly in the immediate postpartum period B. They remain the dame as during the labor process C. They usually increase in the immediate postpartum period D. They need constant adjustment during the first 24 hours

A. They fall significantly in the immediate postpartum period usually bc pt at NPO status during laborA

Which statement by the pt indicates an understanding of the teaching regarding the use of magnesium sulfate and corticosteroids for preterm labor? A. " I will be on mag sulfate and corticosteroids until my baby's due date, so he has the best chance of doing well." B. "The magnesium sulfate is to stop contractions while the corticosteroids increase the lung surfactant in my baby so he can breathe better if he is born early." C. "The goal of the mag sul. and the corticosteroids is to stop contx and help me get to my due date." D. "If I take this mag sul. and the corticosteroids, my baby won't have to spend any time in the NICU unit if he is born."

B. "The magnesium sulfate is to stop contractions while the corticosteroids increase the lung surfactant in my baby so he can breathe better if he is born early."

When developing a teaching plan for a primi pt with insulin-dependent diabetes about monitoring blood glucose control and insulin dosage at home, which of the following would the nurse expect to include as a desired target range for blood glucose levels? A. 40-60 b/w 2 & 4 pm B. 70-100 before meals and bedtime snacks C. 110-140 before meals and bedtime snacks D. 140-160 1 hour after meals

B. 70-100 before meals and bedtime snacks

Before surgery to remove an ectopic pregnancy and the fallopian tube, which of the following would alert the nurse to the possibility of tubal rupture? A. Amount of vaginal bleeding and discharge B. Falling hct and hgb C. Slow, bounding pulse rate of 80 bpm D. Marked abdominal edema

B. Falling hct and hgb = shock; occurs with tube ruptures other common symptom of tubal rupture= knife like lower quadrant abd pain, referred shoulder pain - amt of bleeding is a poor est; spotting is common symptom; rapid pulse is sign; abd edema is late sign

Which of the following statements about a BPP would incorporated into the teaching plan for a primigravid client with insulin-dependent diabetes? A. It determines fetal lung maturity B. It is noninvasive using real-time US C. It will correlate with the newborn's apgar score D. It requires the pt to have an empty bladder

B. It is noninvasive using real-time US

The nurse explains the complications of pregnancy that occur with diabetes to a primi Pt at 10 wks who has a 5-year hix of insulin-dependent diabetes. Which of the following complications indicates the need for additional teaching? A. Candida albicans infection B. Twin-to-twin transfer C. Polyhydramnios D. Preeclampsia

B. Twin-to-twin transfer Rationale: Pts who are diabetic are at greater risk for multifetal pregnancy and subsequent twin-to-twin transfer unless they have undergone fertility treatments. Higher risk for complications such as infection, Polyhydramnios, ketoacidosis, and preeclampsia compared with pregnant nondiabetic pt

When developing the collab plan of care with the HCP for a multi clint at 10 wks gestation w a hx of cardiac disease who was being treated with digitalis therapy before this pregnacy, the nurse should instruct the pt about which of the following regarding the pt's drug therapy? A. need for addiitonal dosage B. continuation of the same dose C. switching to a different med D. addition of diuretic to the regiemen

B. continuation of the same dose - only be switched if digitalis toxicity

A pt with GBM who is entering her third trimester is learning how to monitor her fetus's movements. After teaching the client about the kick count, the nurse should provide further instruction if the pt makes which of the following statements? A. "The baby may be more active at different times of the day" B. "How I feel my baby move is different than my friend." C. "The baby should be moving less than 10 times in 2 hours." D. "The baby may not move at times because it is asleep"

C. "The baby should be moving less than 10 times in 2 hours."

A multigravid client at 32 wks visits the hospital because she suspects that her water has broken. After testing the leaking fluid with nitrazine paper, the nurse confirms that the client's membranes have ruptured when the paper turns which of the following colors? A. Yellow B. Green C. Blue D. Red

C. Blue

A primigravid pt with insulin-dependent diabetes tells the nurse that the contx stress test performed earlier in the day was suspicious. The nurse interprets this test result as indicating that the FHR pattern showed which of the following? A. Frequent late decel B. Decreased fetal movement C. Inconsistent late decel D. Lack of fetal movement

C. Inconsistent late decel

A primi pt with diabetes at 39 wks is seen in the high-risk clinic. The HCP estimates that the fetus weighs at least 10 lb. The pt asks, "What causes the baby to be so large?" The nurse's response is based on the understanding that fetal macrosomia is usally r/o which of the following? A. Fam hx of large infants B. Fetal anomalies C. Maternal hyperglycemia D. Maternal hypertension

C. Maternal hyperglycemia

A multi client is admitting to the hospital with a diagnosis of ectopic pregnancy. The nurse anticipates that, bc the pt's fallopian tube has not yet ruptured, which of the following may be prescribed? A. Progestin contraceptives B. Medroxyprogesterone C. Methotrexate D. Dyphyline

C. Methotrexate

The HCP has determined that a preterm labor client at 34 wks of gestation has no fetal fibronectin present. Based on this finding, the nurse would anticipate that within next week: A. The pt will develop preeclampsia B. The fetus will develop mature lungs C. The Pt will not develop preterm labor D. The fetus will not develop gestational diabetes

C. The Pt will not develop preterm labor Rationale: The absence of FFN in a vaginal swab b/w 22 &37 wks indicates there is less than 1% risk of developing preterm labor in the next week. FFN is an extra cellular protein normally found in fetal membranes and decidus

A nurse is discussing preterm labor in a prenatal class. After class, a clint and her partner ask the nurse to identify again the nursing strategies to prevent preterm labor. The clients need further instructions when they state which of the following? A. "I need to stay hydrated all the time." B. "I need to avoid any infections." C. "I should include frequent rest breaks if we travel." D. "Changing to filter cigarettes is helpful."

D. "Changing to filter cigarettes is helpful." - smoking is major risk factor for preterm labor and decreased fetal weight

A primigravid at 36 wks with PROM is to be dc home on bed rest with follow-up by the home health nurse. After instruction about care while at home, which of the following client statements indicates effective teaching? A. "It is permissible to douche if the fluid irritates my vaginal area." B." I can take either a tub bath or a shower when I feel like it" C. "I should limit my fluid intake to less than 1 quart daily." D. "I should contact the doctor if my temp is 100.4 or higher."

D. "I should contact the doctor if my temp is 100.4 or higher."

A primi with class II heart disease who is visiting the clinic at 8 wks tells the nurse that she has been maintiang a lowsodium, 1,800 cal diet. Which of the following instructions should the nurse give the client? A. Avoid folic acid supplements to prevent megaloblastic anemia B. Severely restrict sodium intake throughout the pregnancy C. Take iron supplemtns w milk to enhance absorption D. Increase caloric intake to 2, 200 cal daily to promote fetal growth

D. Increase caloric intake to 2, 200 cal daily to promote fetal growth

When preparing a multigravid client at 34 wks experiencing preterm labor for the shake test performed on amniotic fluid, the nurse would instruct the client that this test is done to evaluate the maturity of which of the following fetal systems? A. Urinary B. GI C. Cardiovascular D. Pulmonary

D. Pulmonary; test is based on the fact that surfactant foams when mixed with ethanol; the more stable the foam = more mature fetal pulmonary system; L-S ratio is used more than this bc its more reliable

At 38 weeks gestation, a primi pt with poorly controlled diabetes and severe preeclampsia is admitted to for a cesarean birth. The nurse explains to the client that childbirth helps to prevent which of the following? A. Neonatal hyperbilirubinemia B. Congenital anomalies C. Perinatal asphyxia D. Stillbirth

D. Stillbirth Rationale: stillbirth caused by placental insufficeny occur increased w frequency in women with diabetes & severe preeclampsia

A 27yo primigravid pt with insulin-dependent diabetes at 34 wks gestation undergoes a NST, the results which are documented as reactive. The nurse should tell the pt that test results indicate which of the following? A. A CST is necessary B. The NST should be repeated C. Chronic villus sampling is necessary D. There is evidence of fetal well-being

D. There is evidence of fetal well-being

After instruction of a primigravid client at 8 wks diagnosed with class I heart disease about self-care during pregnancy, which of the following client statemnets would indiate the need for addtional teaching? a. "I should avoid being near peoplw who have a cold." b. "I may be given antibiotics during my pregnancy" c. "I should reduce my intake of protien in my diet." d. " I should limit my salt intake at meals."

c. "I should reduce my intake of protein in my diet."