review questions

The nurse is assessing a pregnant client with type 1 diabetes mellitus about her understanding regarding changing insulin needs during pregnancy. The nurse determines that further teaching is needed if the client makes which statement? a. "I will need to increase my insulin dosage during the first 3 months of pregnancy." b. "My insulin dose will likely need to be increased during the second and third trimesters." c. "Episodes of hypoglycemia are more likely to occur during the first 3 months of pregnancy." d. "My insulin needs would return to prepregnant levels within 7 to 10 days after birth if I am bottle-feeding."

a. "I will need to increase my insulin dosage during the first 3 months of pregnancy." Insulin needs decrease in the first trimester of pregnancy because of increased insulin production by the pancreas and increased peripheral sensitivity to insulin. The statements in options 2, 3, and 4 are accurate and signify that the client understands control of her diabetes during pregnancy.

The nurse is teaching a pregnant client with diabetes about nutrition and insulin needs during pregnancy. The nurse would provide the client with which information? a. Glucose crosses the placenta. b. Insulin crosses the placenta. c. Increased caloric intake is needed. d.Decreased caloric intake is required.

a. Glucose crosses the placenta. Glucose crosses the placenta, but insulin does not. High fetal demands for glucose, combined with the insulin resistance caused by hormonal changes in the last half of pregnancy can result in elevation of maternal blood glucose levels. This increases the pregnant client's demand for insulin and is referred to as the diabetogenic effect of pregnancy. Caloric requirements are not affected by diabetes.

The nurse is providing education to a client who is pregnant and has gestational diabetes about the signs and symptoms of hyperglycemia. The nurse determines that the client understands the teaching if the client identifies which clinical manifestations as signs or symptoms of hyperglycemia? a. Nausea b. Diarrhea c. Vomiting d. Abdominal pain e. Excessive thirst f. Fruity breath odor

a. Nausea c. Vomiting d. Abdominal pain e. Excessive thirst f. Fruity breath odor

The nurse is collecting data from a pregnant client in the second trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which findings are associated with abruptio placentae? Select all that apply. a. Uterine tenderness b. Acute abdominal pain c. A hard, "board-like" abdomen d. Painless, bright red vaginal bleeding e. Increased uterine resting tone on fetal monitoring

a. Uterine tenderness b. Acute abdominal pain c. A hard, "board-like" abdomen e. Increased uterine resting tone on fetal monitoring

The senior nursing student is assigned to care for a client with severe preeclampsia who is receiving an intravenous infusion of magnesium sulfate. The co-assigned registered nurse asks the student to describe the actions and effects of this medication. Which statement, if made by the student, indicates the need for further teaching? a. "It decreases the frequency and duration of uterine contractions." b. "It increases acetylcholine, blocking neuromuscular transmission." c. "It decreases the central nervous system activity, acting as an anticonvulsant." d. "It produces flushing and sweating due to decreased peripheral blood pressure."

b. "It increases acetylcholine, blocking neuromuscular transmission."

The nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes mellitus. Which statement made by the client indicates a need for further teaching? a. "I need to stay on the diabetic diet." b. "I need to perform glucose monitoring at home." c. "I would avoid exercise because of the negative effects on insulin production." d. "I need to be aware of any infections and report signs of infection immediately to my primary health care provider (PHCP)."

c. "I would avoid exercise because of the negative effects on insulin production." Exercise is safe for a client with gestational diabetes mellitus and is helpful in lowering the blood glucose level. Dietary modifications are the mainstay of treatment, and the client is placed on a standard diabetic diet. Many clients are taught to perform blood glucose monitoring. If the client is not performing the blood glucose monitoring at home, it is performed at the clinic or PHCP's office. Signs of infection need to be reported to the PHCP.

The nurse in a maternity unit is reviewing the clients' records. Which clients would the nurse identify as being at the most risk for developing disseminated intravascular coagulation (DIC)? Select all that apply. a. A primigravida with mild preeclampsia b. A primigravida who delivered a 10-lb infant 3 hours ago c. A gravida II who has just been diagnosed with dead fetus syndrome d. A gravida IV who delivered 8 hours ago and has lost 500 mL of blood5A primigravida at 29 weeks of gestation who was recently diagnosed with severe preeclampsia

c. A gravida II who has just been diagnosed with dead fetus syndrome d. A gravida IV who delivered 8 hours ago and has lost 500 mL of blood5A primigravida at 29 weeks of gestation who was recently diagnosed with severe preeclampsia

The nurse is caring for a client in labor and notes that minimal variability is present on a fetal heart rate (FHR) monitor strip. Which conditions are most likely associated with minimal variability? Select all that apply. a. Early labor b. Amniotomy c. Tachycardia d. Fetal hypoxia e. Metabolic acidemia f. Congenital anomalies

c. Tachycardia d. Fetal hypoxia e. Metabolic acidemia f. Congenital anomalies The fluctuations in the baseline FHR are the definition of variability. Variability can be classified into four different categories: absent, minimal, moderate, and marked. Minimal variability is defined as fluctuations that are fewer than six beats/minute. Tachycardia, fetal hypoxia, metabolic acidemia, and congenital anomalies are all associated with possible minimal variability. Rupturing membranes and early labor are not correlated to this condition.

The nurse is monitoring a client who is receiving oxytocin to induce labor. Which assessment findings would cause the nurse to immediately discontinue the oxytocin infusion? Select all that apply. a. Fatigue b. Drowsiness c. Uterine hyperstimulation d. Late decelerations of the fetal heart rat e. Early decelerations of the fetal heart rate

c. Uterine hyperstimulation d. Late decelerations of the fetal heart rate Oxytocin stimulates uterine contractions and is a pharmacological method to induce labor. Late decelerations, a nonreassuring fetal heart rate pattern, is an ominous sign indicating fetal distress. Drowsiness and fatigue may be caused by the labor experience. Early decelerations of the fetal heart rate are a reassuring sign and do not indicate fetal distress.

The nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which is noted on the external monitor tracing during a contraction? a. Variability b. Accelerations c. Early decelerations d. Variable decelerations

d. Variable decelerations

Shortly after receiving epidural anesthesia, a laboring client's blood pressure drops to 95/43 mm Hg. Which immediate actions would the nurse take? Select all that apply. a. Prepare for delivery. b. Administer a tocolytic. c. Administer an opioid antagonist. d. Turn the client to a lateral position. e. Increase the rate of the intravenous infusion. f. Administer oxygen by face mask at 10 L/minute.

d. Turn the client to a lateral position. e. Increase the rate of the intravenous infusion. f. Administer oxygen by face mask at 10 L/minute.

The nurse is performing an assessment on a pregnant client in the last trimester with a diagnosis of severe preeclampsia. The nurse reviews the assessment findings and determines that which finding is most closely associated with a complication of this diagnosis? a. Enlargement of the breasts b. Complaints of feeling hot when the room is cool c. Periods of fetal movement followed by quiet periods d. Evidence of bleeding, such as in the gums, petechiae, and purpura

d. Evidence of bleeding, such as in the gums, petechiae, and purpura Severe preeclampsia can trigger disseminated intravascular coagulation (DIC) because of the widespread damage to vascular integrity. Bleeding is an early sign of DIC and needs to be reported to the primary health care provider if noted on assessment. Options 1, 2, and 3 are normal occurrences in the last trimester of pregnancy

The nurse is counseling a pregnant client diagnosed with gestational diabetes at 29 weeks' gestation. Which information would the nurse discuss with the client? Select all that apply a. Plan induction at 35 weeks. b. Plan amniocentesis at this time. c. Schedule a biophysical profile immediately. d. Plan for weekly nonstress tests at 32 weeks. e. Obtain nutritional counseling with a dietitian.

d. Plan for weekly nonstress tests at 32 weeks. e. Obtain nutritional counseling with a dietitian. Gestational diabetes can result in delayed lung maturity and complications, and carrying the baby until full term is the goal. The nurse would discuss nonstress testing procedures, the plan for nutritional counseling, and the plan for delivery. Amniocentesis is not indicated at this time. Biophysical profile is done at 32 to 36 weeks' gestation.

The nurse reviews the assessment history for a client with a suspected ectopic pregnancy. Which assessment findings predispose the client to an ectopic pregnancy? Select all that apply. a. Use of diaphragm b. History of Chlamydia c. Use of fertility medications d. Use of an intrauterine device e. History of pelvic inflammatory disease (PID)

b. History of Chlamydia c. Use of fertility medications d. Use of an intrauterine device e. History of pelvic inflammatory disease (PID)

The nurse in a maternity unit is reviewing the clients' records. Which clients would the nurse identify as being at the most risk for developing disseminated intravascular coagulation (DIC)? Select all that apply. a. A primigravida with abruptio placentae b. A primigravida who delivered a 10-lb infant 3 hours ago c. A gravida 2 who has just been diagnosed with dead fetus syndrome d. A gravida 4 who delivered 8 hours ago and has lost 500 mL of blood e. A primigravida at 29 weeks of gestation who was recently diagnosed with gestational hypertense.

a. A primigravida with abruptio placentae c. A gravida 2 who has just been diagnosed with dead fetus syndrome e. A primigravida at 29 weeks of gestation who was recently diagnosed with gestational hypertension

The nurse is performing an assessment on a client who has just been told that a pregnancy test is positive. Which assessment finding indicates that the client is at risk for preterm labor? a. The client is a 35-year-old primigravida. b. The client has a history of cardiac disease. c. The client's hemoglobin level is 13.5 g/dL (135 mmol/L). d. The client is a 20-year-old primigravida of average weight and height.

b. The client has a history of cardiac disease.

The nurse in a maternity unit is reviewing the clients' records. Which clients would the nurse identify as being at the most risk for developing disseminated intravascular coagulation (DIC)? Select all that apply. a. A primigravida with abruptio placentae b. A primigravida who delivered a 10-lb infant 3 hours ago c. A gravida 2 who has just been diagnosed with dead fetus syndrome d. A gravida 4 who delivered 8 hours ago and has lost 500 mL of blood e. A primigravida at 29 weeks of gestation who was recently diagnosed with gestational hypertension

a. A primigravida with abruptio placentae c. A gravida 2 who has just been diagnosed with dead fetus syndrome e. A primigravida at 29 weeks of gestation who was recently diagnosed with gestational hypertension

The nurse is providing education to a client with pregestational diabetes who is at 8 weeks' gestation and the client's partner. The nurse describes measures to take during a hypoglycemic episode. The client's partner asks the nurse how to respond if the client is hypoglycemic and becomes unconscious. The nurse would tell the client and partner that which is the most appropriate action? a. Administer intramuscular glucagon. b. Place peanut butter under the client's tongue. c. Place two to four glucose tablets in the client's mouth. d. Slowly pour water with dissolved sugar into the client's mouth.

a. Administer intramuscular glucagon. Hypoglycemia is defined as a blood glucose level of less than 70 mg/dL (3.9 mmol/L). The signs and symptoms of hypoglycemia include irritability, nervousness, hunger, sweating, dizziness, headache, or blurred vision. If the client is unconscious, it is inappropriate to orally administer medications or food in an attempt to increase blood glucose as this places the client at risk for aspiration. Glucagon needs to be given intramuscularly to the hypoglycemic unconscious client. Therefore, option 1 is correct as options 2, 3, and 4 all involve giving the client food or medication by mouth.

The nurse is monitoring a client who is in the active stage of labor. The nurse documents that the client is experiencing labor dystocia. The nurse determines that which risk factors in the client's history placed the client at risk for this complication? Select all that apply a. Age 54 b. Body mass index of 28 c. Previous difficulty with fertility d. Administration of oxytocin for induction e. Potassium level of 3.6 mEq/L (3.6 mmol/L)

a. Age 54 b. Body mass index of 28 c. Previous difficulty with fertility

The nurse is reviewing the medical record of a client scheduled for a weekly prenatal appointment. The nurse notes that the client has been diagnosed with mild preeclampsia. Which interventions would the nurse include in planning nursing care for this client? Select all that apply. a. Assess blood pressure. b. Check the urine for protein. c. Assess deep tendon reflexes. d. Discuss the need for hospitalization. e. Teach the importance of keeping track of a daily weight.

a. Assess blood pressure. b. Check the urine for protein. c. Assess deep tendon reflexes. e. Teach the importance of keeping track of a daily weight. With mild cases of preeclampsia, the condition is monitored with self-care and bed rest at home. Before the need for hospitalization is discussed, the client would need to be assessed for progression of the disease process. The nurse must assess blood pressure, weight, and the presence of protein in the urine because an increase in these areas would indicate a worsening condition.

The nurse is assisting a client undergoing induction of labor at 41 weeks of gestation. The client's contractions are moderate and occurring every 2 to 3 minutes, with a duration of 60 seconds. An internal fetal heart rate monitor is in place. The baseline fetal heart rate has been 120 to 122 beats per minute for the past hour. What is the priority nursing action? a. Discontinue the infusion of oxytocin. b. Notify the primary health care provider. c. Place oxygen on at 8 to 10 L/minute via face mask. d. Contact the client's primary support person(s) if not currently present.

a. Discontinue the infusion of oxytocin.

The maternity nurse is caring for a client with abruptio placentae and is monitoring the client for disseminated intravascular coagulation (DIC). Which assessment findings are most likely associated with disseminated intravascular coagulation? Select all that apply. a. Petechiae b. Hematuria c. Increased platelet count d. Prolonged clotting times e. Oozing from injection sites f. Swelling of the calf of one leg Submit

a. Petechiae b. Hematuria d. Prolonged clotting times e. Oozing from injection sites

The nurse is preparing to care for a client with hypertonic labor. The nurse is told that the client is experiencing uncoordinated contractions that are erratic in their frequency, duration, and intensity. Which is the priority nursing intervention? a. Provide pain relief measures. b. Prepare the client for an amniotomy. c. Monitor the oxytocin infusion closely. d. Promote ambulation every 30 minutes.

a. Provide pain relief measures.

The nurse is reviewing the record of a pregnant client seen in the health care clinic for the first prenatal visit. Which data if noted on the client's record would alert the nurse that the client is at risk for developing gestational diabetes during this pregnancy? a. The client's last baby weighed 10 pounds at birth b. The client's previous deliveries were by cesarean section c. The client has a family history of cardiovascular disease. d. The client is 5 feet, 3 inches tall and weighs 165 pounds.

a. The client's last baby weighed 10 pounds at birth Known risk factors that increase the risk of developing gestational diabetes include obesity (more than approximately 198 pounds, depending on height), chronic hypertension, family history of diabetes mellitus, previous birth of a large infant (greater than 4000 g), and gestational diabetes in a previous pregnancy. Options 2, 3, and 4 are not risk factors associated with the development of gestational diabetes.

The nurse is collecting data from a pregnant client in the second trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which findings are associated with abruptio placentae? Select all that apply. a. Uterine tenderness b. Acute abdominal pain c. A hard, "board-like" abdomen d. Painless, bright red vaginal bleeding. e. Increased uterine resting tone on fetal monitoring

a. Uterine tenderness b. Acute abdominal pain c. A hard, "board-like" abdomen e. Increased uterine resting tone on fetal monitoring

the nurse is caring for a client who is experiencing a precipitous labor and is waiting for the primary health care provider to arrive. When the infant's head crowns, what instruction would the nurse give the client? a. Bear down. b. Breathe rapidly. c. Hold your breath. d. Push with each contraction.

b. Breathe rapidly. During a precipitous labor, when the infant's head crowns, the nurse instructs the client to breathe rapidly to decrease the urge to push. The client is not instructed to push or bear down. Holding the breath decreases the amount of oxygen to the birthing parent and the fetus.

A pregnant client is receiving magnesium sulfate for the management of preeclampsia. The nurse determines that the client is experiencing toxicity from the medication if which findings are noted on assessment? Select all that apply. a. Proteinuria of 3+ b. Urine output of 20 mL in an hour c. Presence of deep tendon reflexes d. Respirations of 10 breaths/minute e. Serum magnesium level of 4 mEq/L (2 mmol/L)

b. Urine output of 20 mL in an hour d. Respirations of 10 breaths/minute Magnesium toxicity can occur from magnesium sulfate therapy. Signs of magnesium sulfate toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression, loss of deep tendon reflexes, and a sudden decline in fetal heart rate and maternal heart rate and blood pressure. Respiratory rate below 12 breaths per minute is a sign of toxicity. Urine output needs to be at least 25 to 30 mL per hour. Proteinuria of 3+ is an expected finding in a client with preeclampsia. Presence of deep tendon reflexes is a normal and expected finding. Therapeutic serum levels of magnesium are 4 to 7.5 mEq/L (2 to 3.75 mmol/L).

A client in the third trimester of pregnancy with a diagnosis of mild preeclampsia is being monitored at home. The home care nurse teaches the client about the signs that need to be reported to the primary health care provider (PHCP). The nurse would tell the client to call the PHCP if which occurs? a. Urine test is negative for protein. b. Fetal movements are more than four per hour. c. Weight increases by more than 1 pound in a week. d. The blood pressure reading ranges between 122/80 mm Hg and 130/82 mm Hg. Submit

c. Weight increases by more than 1 pound in a week. The nurse would instruct the client to report any increase in blood pressure, protein in the urine, weight gain greater than 1 pound per week, or edema. The client also is taught how to count fetal movements and is instructed that decreased fetal activity (three or fewer movements per hour) may indicate fetal compromise and would be reported.

A client at 39 weeks of gestation calls the maternity unit, stating, "My baby has not moved very much in the past few days. Should I be concerned?" Which is the best response made by the nurse? a. "Six to eight fetal movements in a 24-hour period are adequate to determine that the fetus is healthy." b. "Fetal movement is a sign of fetal health. Even if the amount has decreased, the fetus is still healthy." c. "Continue to count fetal movements for the next 24 hours, and call your primary health care provider if the number of movements continues to decrease." d. "Fetal movements do not decrease as a person nears term; therefore, you need to be seen by your primary health care provider for further evaluation."

d. "Fetal movements do not decrease as a person nears term; therefore, you need to be seen by your primary health care provider for further evaluation." Fetal movements may decrease during fetal sleep cycles and while a person is taking depressant medication, drinking alcohol, or smoking cigarettes. A decrease in fetal movement over a period of one or more days or as the person approaches term is abnormal and requires further evaluation for fetal well-being.

The nurse is caring for a client who is at 38 weeks' gestation with poorly controlled pregestational diabetes mellitus. The client is worried about birth complications and asks the nurse to explain macrosomia. How would the nurse define this condition? a. Birth weight more than the 75th percentile b. Birth weight more than the 80th percentile c. Birth weight more than the 85th percentile d.Birth weight more than the 90th percentile

d.Birth weight more than the 90th percentile