UWORLD Questions

During a routine second-trimester visit to the prenatal clinic a client expresses concern regarding gaining weight and losing her figure. She says to the nurse, "I'm going on a diet." What is the nurse's best response?

"If you add 340 calories a day to your regular diet, you won't become overweight."

The nurse instructs a pregnant client regarding fetal growth and development. Which statement indicates that the client requires further teaching?

"The fetus gets nutrients from the amniotic fluid."

There has been a major disaster involving a manufacturing plant explosion. The emergency department nurse is sent to triage victims. Which client should the nurse send to the hospital first?

A client with a broken, protruding tibia and a grey pulseless foot

measuring fundal height

After 20 weeks gestation, the fundal height measurement in centimeters should correlate closely with the number of weeks pregnant (eg, 24 cm = 24 weeks).

The nurse is planning education for clients in group prenatal care who are entering the second trimester of pregnancy. Which of the following are appropriate for the nurse to include in second-trimester teaching? Select all that apply. 1. Anticipate light fetal movements around 16-20 weeks gestation 2. Expect to have an abdominal ultrasound for fetal anatomy evaluation 3. Gain about 1 lb (0.5 kg) per week if pre-pregnancy BMI was normal 4. Increase consumption of iron-rich foods like meat and dried fruit 5. Plan for gestational diabetes screening near the end of the second trimester

Anticipate light fetal movements around 16-20 weeks gestation Expect to have an abdominal ultrasound for fetal anatomy evaluation Gain about 1 lb (0.5 kg) per week if pre-pregnancy BMI was normal Increase consumption of iron-rich foods like meat and dried fruit Plan for gestational diabetes screening near the end of the second trimester

A client who is formula feeding her infant complains of discomfort from engorged breasts. What should the nurse recommend that the client do?

Apply cold packs and a snugly fitting bra.

When checking the cervical dilation of a client in labor, the nurse notes that the umbilical cord has prolapsed. What is the priority nursing action?

Assisting the client into the Trendelenburg position

A client who is being evaluated for suspected ectopic pregnancy reports sudden-onset, severe, right lower abdominal pain and dizziness. Which additional assessment findings will the nurse anticipate if the client is experiencing a ruptured ectopic pregnancy? Select all that apply.

Blood pressure of 82/64 Pulse of 120/min Shoulder pain

During an emergency birth the fetal head is crowning on the perineum. How should the nurse support the head as it is being delivered?

By distributing the fingers evenly around the head

The client who is pregnant for the first time asks the nurse about the changes in her body. While describing the changes in each body system, the nurse mentions that the system that undergoes the most profound change of all during pregnancy is the what?

Cardiovascular system

The nurse is reinforcing instructions to a client at 34 weeks gestation who is preparing to travel by airplane. Which of the following instructions are appropriate?

Carry a copy of your most recent prenatal record Increase fluid intake before and during the flight Secure the lap belt below the abdomen and cross hips Wear compression hoes and lose fitting clothing

During the postpartum period a client tells a nurse that she has been having leg cramps. Which foods should the nurse encourage the client to eat?

Cheese and Broccoli (calcium deficiency)

While reviewing laboratory results of clients seen at the maternity clinic, the nurse notes that one client's maternal serum alpha-fetoprotein level is lower than expected. What does the nurse recognizes that this may be associated with?

Down syndrome

The nurse cares for a client with a terminal disease who has an advance directive supporting a do not resuscitate (DNR) code status. The client stops breathing and loses a pulse. The client's adult child states, "I changed my mind. Do whatever you can to save him!" Which intervention is most appropriate at this time? 1. Call for help to initiate cardiopulmonary resuscitation 2. Call the health care provider to confirm the DNR status 3. Explain the client's wishes to the client's child 4. Offer to call the hospital chaplain to provide support

Explain the client's wishes to the client's child

A client suspects she is pregnant and comes for prenatal evaluation. Which assessment findings indicate definitive evidence (positive signs) of pregnancy?

Fetal heart tones detected by doppler Visualization of fetus by ultrasound

The nurse explains the purpose of a nonstress test to a pregnant client who is at 39 weeks' gestation. This test is a way of evaluating the condition of the fetus by comparing the fetal heart rate with what?

Fetal movement

The nurse assesses a client at term gestation who reports having contractions for the last 2 hours. The client states, "I'm not sure, but I think my water broke." The nurse performs a nitrazine pH test, which turns blue. When documenting the results of the test, which client statement is most concerning to the nurse?

I had sex with my partner 1 hour before coming in today

The nurse is teaching a client, gravida 1 para 0, at 8 weeks gestation about expected weight gain during pregnancy. The client's prepregnancy BMI is 21 kg/m2. Which statement by the client indicates an appropriate understanding about weight gain?

I should gain a total of about 30 lbs during pregnancy

A pregnant client is scheduled for ultrasonography at the end of her first trimester. What should the nurse instruct her to do in preparation for the sonogram?

Increase fluid intake for 1 hour before the procedure.

A pregnant client at 30 weeks gestation comes to the prenatal clinic. Which vaccines may be administered safely at this prenatal visit? Select all that apply.

Influenza vaccine Tetanus diphtheria pertussis

A pregnant client comes in for a routine first prenatal examination. According to the last menstrual period, the estimated gestational age is 12 weeks. Where would the nurse expect to palpate the uterine fundus in this client?

Just above the symphysis pubis

The nurse is caring for a high-risk pregnant client who has had a positive contraction stress test (CST). What would the nurse interpret the result to mean?

Late decelerations of the fetal heart rate are occurring with each contraction

What common problem affects the client in labor when an external fetal monitor has been applied to her abdomen?

Mobility

What type of lochia should the visiting nurse expect to observe on a client's pad on the fourth day after a vaginal delivery?

Moderate serosa

A nurse is caring for a client at 12 weeks gestation who is admitted for hyperemesis gravidarum. Which clinical manifestation should the nurse expect?

Moderate to high urine ketones

The nurse is caring for a client in the first trimester during an initial prenatal clinic visit. Based on the information provided by the client, which factor places the client at an increased risk for preterm labor?

Periodontal diseaseA pregnant client comes in for a routine first prenatal examination.

How does the nurse explain physiologic anemia to a pregnant client?

Plasma volume increases.

On a routine prenatal visit, what is the sign or symptom that a healthy primigravida at 20 weeks' gestation will most likely report for the first time?

Quickening

The nurse is admitting a client in active labor. When the fetal monitor is applied to the client's abdomen, it records late decelerations. What should the nurse do first?

Reposition her on her left side

Late decelerations are present on the monitor strip of a client who received epidural anesthesia 20 minutes ago. What should the nurse do immediately?

Reposition the client from supine to left lateral.

A client at 30 weeks' gestation is being examined in the prenatal clinic. The nurse identifies a respiratory rate of 26 breaths/min, blood pressure of 100/60 mm Hg, and diaphragmatic tenderness. The client also reports increased urinary output. Which of these findings indicates that the client may be experiencing a complication?

Respiratory rate

A client with a history of a congenital heart defect is admitted to the birthing unit in early labor. Which position does the nurse encourage the client to assume?

Semi-Fowler

The nurse is caring for a client in active labor. Which positions should the nurse encourage the client to assume to help promote comfort during back labor? Select all that apply.

Sitting, Lateral, and knee to chest

The nurse is caring for a client in the first stage of labor. Which position is the least desirable for the client if she is experiencing lower back pain?

Supine

The graduate nurse (GN) is caring for a client at 20 weeks gestation with secondary syphilis. The client reports an allergic reaction to penicillin as a child but does not know what kind of reaction occurred. When discussing the client's potential treatment plan with the precepting nurse, which statement by the GN indicates an appropriate understanding?

The client will require penicillin desensitization to receive appropriate treatment.

Which information should the nurse include in the discharge teaching of a postpartum client?

The prenatal Kegel tightening exercises should be continued.

A pregnant client is asking the nurse when she will gain the greatest amount of weight during the pregnancy. At which time during prenatal development should the nurse tell the client to expect the greatest fetal and maternal weight gain?

Third Trimester

A pregnant client at 39 weeks gestation is brought to the emergency department in stable condition following a motor vehicle collision. The client, who is secured supine on a backboard, suddenly becomes pale with a blood pressure of 88/50 mm Hg. Which action should the nurse take first?

Tilt the backboard to one side

A client has a diagnosis of unruptured tubal pregnancy. Which assessment findings correlate with this diagnosis? Select all that apply.

Unilateral abdominal pain History of a sexually transmitted infection (STI)

A client has chronic obstructive pulmonary disease (COPD) exacerbation. The pulse oximeter shows a saturation of 86% on room air. The nurse assesses diminished lung sounds and low-pitched wheezing posteriorly, shallow respirations, respiratory rate of 32/min, and use of accessory muscles. What is the most appropriate oxygen delivery device for this client?

Venturi Mask

Intrahepatic cholestasis of pregnancy

a liver disorder developed during pregnancy that involves intense itching

Pica

abnormal pregnancy cravings due to anemia

Naegele's rule

last menstrual period minus 3 months plus 7 days

acceleration

pAn acceleration is an abrupt increase in FHR above the baseline of 15 beats/min for 15 seconds; if the acceleration persists for more than 10 minutes, it is considered a change in baseline rate. Early decelerations, not increases, occur. An early deceleration starts before the peak of the uterine contraction and returns to baseline when the uterine contraction ends. A sonographic motion is not a term used in fetal monitoring. A tachycardic FHR is one faster than 160 beats per minute.

indirect Coombs test

performed to screen for Rh sensitization any time hemorrhage secondary to placental abruption is suspected (eg, maternal trauma)