Antepartum NCLEX 3000

"Which of the following nutritional instructions should the nurse provide to a 32-year-old primigravida?

" 1. Caloric intake should be increased 300 cal/day. 2. Protein intake should be increased by more than 30 g/day. 5. Intake of all minerals, especially iron, should be increased. "

"The nurse is caring for a 16-year-old pregnant client who is taking an iron supplement. Which instruction should the nurse include when teaching the adolescent about ferrous sulfate?

" 3. Avoid taking the supplement with milk. 4. Avoid taking the supplement with antacids. 5. Avoid chewing the extended-release form of the drug"

"A client admitted with preterm labor is prescribed magnesium sulfate to halt contractions. The nurse should monitor the client for which adverse reactions to the drug?

" 3. Respiratory rate less than 12 breaths/minute 4. Extreme muscle weakness 5. Palpitations 6. Hot flashes"

At 15 weeks' gestation, a client is scheduled for a serum alpha-fetoprotein (AFP) test. Which maternal history finding would indicate a need for this test?

"1. Family history of spina bifida in a sister

"The nurse is teaching a pregnant client about exercises that may be helpful during pregnancy. Which points should the nurse include in her instruction?

"1. Pelvic rocking may help relieve lower back pain. 2. Abdominal breathing lifts the abdominal wall off of the uterus. 3. Kegel exercises help improve vaginal contractility and bladder control.

"A client who is 14 weeks pregnant mentions that she has been having difficulty moving her bowels since she became pregnant. Which hormones are responsible for this common discomfort during pregnancy?

"1. Progesterone

A client is in the last trimester of pregnancy. The nurse should instruct her to notify her obstetrician immediately if she notices:

"1. blurred vision.

A low-risk client who's 6 weeks pregnant comes to the clinic for her first prenatal visit. At this time, the nurse should assign highest priority to:

"1. establishing a schedule of prenatal visits.

A pregnant client asks questions about labor and delivery. During the nurse's explanations, the client states, "Is it true that a lot of other people are going to be in the room while I'm giving birth? I was expecting privacy." Which response would be appropriate for the nurse to make to this client?

"2. ""What did the physician tell you about the delivery room?""

After developing severe hydramnios, a primigravid client exhibits dyspnea, along with edema of the legs and vulva. Which procedure should the nurse expect her to undergo and why?

"2. Amniocentesis to temporarily relieve discomfort

A client is in the 8th month of pregnancy. To enhance cardiac output and renal function, the nurse should advise her to use which body position?

"2. Left lateral

A client makes a routine visit to the prenatal clinic. Although she believes that she is 14 weeks pregnant, the size of her uterus approximates that in an 18- to 20-week pregnancy. The physician diagnoses gestational trophoblastic disease and orders ultrasonography. The nurse expects ultrasonography to reveal:

"2. grapelike clusters.

A newly pregnant woman tells the nurse that she hasn't been taking her prenatal vitamins because they make her nauseous. In addition to telling the client how important taking the vitamins are, the nurse should advise her to:

"2. take the vitamin on a full stomach.

A client is receiving terbutaline (Brethine) to stop preterm labor. The physician plans to discharge the client in the morning with a terbutaline infusion pump. Which instruction should the nurse include when teaching the client about the drug?

"3. ""Assess the insertion site for signs of infection.""

During a routine prenatal visit, a pregnant client reports constipation, and the nurse teaches her how to relieve it. Which client statement indicates an accurate understanding of the nurse's instructions?

"3. ""I'll increase my intake of unrefined grains.""

Which findings would be considered positive signs of pregnancy?

"3. Fetal heartbeat and fetal movement on palpation

During her first prenatal visit, a pregnant client admits to the nurse that she uses cocaine at least once per day. Which nursing diagnosis is most appropriate for this client?

"3. Imbalanced nutrition: Less than body requirements related to limited food intake

A client with hyperemesis gravidarum is on a clear liquid diet. Which foods would be appropriate for the nurse to serve?

"3. Tea and gelatin 4. Ginger ale and apple juice 5. Cranberry juice and chicken broth "

A client who's 7 months pregnant reports severe leg cramps at night. Which nursing action would be most effective in helping her cope with these cramps?

"3. Teaching her to dorsiflex her foot during the cramp

A client with hyperemesis gravidarum is on a clear liquid diet. The nurse should serve this client:

"3. tea and gelatin dessert.

A pregnant client concerned about gaining weight during pregnancy questions the nurse about dietary intake. Which response by the nurse is best?

"4. ""I'll ask the dietitian to speak with you about normal weight gain during pregnancy.""

The nurse is caring for a client with hyperemesis gravidarum who will need close monitoring at home. When should the nurse begin discharge planning?

"4. On admission to the facility

What key psychosocial tasks must a woman accomplish during the third trimester?

"4. Overcoming fears she may have about the unknown, loss of control, and death

Which drug will the physician probably order to treat a pregnant client who is experiencing morning sickness?

"4. Phosphorated carbohydrate solution (Emetrol)

A client, 2 months pregnant, has hyperemesis gravidarum. Which expected outcome is most appropriate for her?

"4. The client will exhibit uterine growth within the expected norms for gestational age.

A client is admitted to the facility in preterm labor. To halt her uterine contractions, the nurse expects the physician to prescribe:

"4. terbutaline (Brethine).

Which statement accurately describes estrogen and progesterone levels during the 16th week of pregnancy?

1. Both estrogen and progesterone levels are rising.

A client who's pregnant with her second child comes to the clinic complaining of a pulling and tightening sensation over her pubic bone every 15 minutes. She reports no vaginal fluid leakage. Because she has just entered her 36th week of pregnancy, she's apprehensive about her symptoms. Vaginal examination discloses a closed, thick, posterior cervix. These findings suggest that the client is experiencing

1. Braxton Hicks contractions

During a routine prenatal visit, a pregnant client reports heartburn. To minimize her discomfort, the nurse should include which suggestion in the plan of care

1. Eat small, frequent meals

During each prenatal checkup, the nurse obtains the client's weight and blood pressure and measures fundal height. What is another essential part of each prenatal checkup?

1. Evaluating the client for edema

During a home-care visit with a pregnant client, the nurse notices extension cords crossing between rooms. How should the nurse intervene?

1. Explain that extension cords can pose a danger to the client when she's walking.

The nurse is providing instruction to a woman who is 18 weeks pregnant. Which findings are expected at this time?

1. Fundal height of approximately 18 cm 2. Quickening "

The nurse is assisting in planning care for a 16-year-old client in the prenatal clinic. Adolescents are prone to which complication during pregnancy?

1. Iron deficiency anemia

A client, 7 months pregnant, is admitted to the unit with abdominal pain and bright red vaginal bleeding. Which action should the nurse take?

1. Place the client on her left side and start supplemental oxygen, as ordered, to maximize fetal oxygenation

An adolescent in her first trimester of pregnancy continues to smoke cigarettes. The client tells the nurse that she'd like to quit but she doesn't want to gain any more weight. What should the nurse do for this client?

1. Review the hazards of smoking with the client and suggest a smoking-cessation class.

"During a prenatal screening of a client with diabetes, the nurse should keep in mind that the client is at increased risk for which complications?

1. Still birth 3. Pregnancy-induced hypertension 5. Spontaneous abortion

The nurse is discussing posture with a client who's 18 weeks pregnant. Why should the nurse caution her to avoid the supine position?

1. This position impedes blood flow to the fetus.

A client who's 5 weeks pregnant reports nausea and vomiting. The nurse reassures the client that these symptoms probably will subside by:

2. 9 to 12 weeks' gestation.

A client comes to her prenatal examination complaining of increasing episodes of leg cramping. Which intervention by the nurse is most appropriate?

2. Instructing the client to gently stretch her legs to relieve the cramping

A pregnant client who's diabetic is at risk for having a large-for-gestational-age infant because of which of the following?

2. Insulin acting as a growth hormone on the fetus

A client, 8 weeks pregnant, has a history of lactose intolerance. To prevent a nutritional deficiency as a result of lactose intolerance, the nurse teaches her about lactase replacement. Which teaching point is appropriate?

3. Add lactase replacement drops to milk at least 24 hours before drinking it.

The nurse is caring for a client in the first 4 weeks of pregnancy. The nurse should expect to collect which findings?

3. Breast sensitivity

A pregnant client is prescribed an iron supplement. Which point should the nurse include when teaching the client about taking the supplement?

3. Eat a diet rich in vitamin C to promote iron absorption.

A nurse is obtaining a medication history from a client who suspects she's pregnant. At which week of gestation does placental transport of substances to and from the fetus begin?

3. Fifth week

A client with pregnancy-induced hypertension (PIH) probably exhibits which of the following symptoms?

3. Proteinuria, headaches, and double vision

A client in the first trimester of pregnancy joins a childbirth education class. During this trimester, the class is most likely to cover which physiologic aspect of pregnancy?

3. Warning signs of complications

A client, 11 weeks pregnant, is admitted to the facility with hyperemesis gravidarum. She tells the nurse she has never known anyone who had such severe morning sickness. The nurse understands that hyperemesis gravidarum results from:

3. an unknown cause.

A client who's 12 weeks pregnant attends a class on fetal development as part of a childbirth education program. The nurse says that at 16 weeks' gestation, the client's fetus will likely:

3. have audible heart sounds.

Infertility in a 25-year-old couple is defined as:

3. the couple's inability to conceive after 1 year of unprotected attempts

Which of the following functions would the nurse expect to be unrelated to the placenta?

4. Production of maternal antibodies

A client who's 4 weeks pregnant comes to the clinic for her first prenatal visit. When obtaining her health history, the nurse explores her use of drugs, alcohol, and cigarettes. Which client behavior identifies a safe level of alcohol intake for this client?

4. The client consumes no alcohol.

The nurse is reviewing a pregnant client's nutritional status. To determine whether she has an adequate intake of vitamin A, the nurse should check her diet for consumption of:

4. dairy products"

When teaching a group of pregnant adolescents about reproduction and conception, the nurse is correct when stating that fertilization occurs:

4. in the first third of the fallopian tube.

A client at 28 weeks' gestation is complaining of contractions. Following admission and hydration, the physician writes an order for the nurse to give 12 mg of betamethasone I.M. This medication is given to:

4. promote fetal lung maturity.

The nurse is providing dietary teaching to a pregnant client. To help meet the client's iron needs, the nurse should advise her to eat:

4. spinach and beef.

The nurse is caring for a client after evacuation of a hydatidiform mole. The nurse should tell the client to:

4. use birth control for at least 1 year.

"A client is scheduled for amniocentesis. What should the nurse do to prepare the client for the procedure?

" 1. Ask the client to void. 4. Assess fetal heart rate. 6. Monitor maternal vital signs. "

The nurse uses nitrazine paper to determine whether a pregnant client's membranes have ruptured. If the membranes have ruptured, the paper will turn which color?

2. Blue

A client is 8 weeks pregnant. Which teaching topic is most appropriate at this time?

2. Common discomforts of pregnancy

The nurse is caring for a client who's on ritodrine (Yutopar) therapy to halt premature labor. What condition indicates an adverse reaction to ritodrine therapy?

2. Crackles

During a physical examination, a client who's 32 weeks pregnant becomes pale, dizzy, and light-headed while supine. Which action should the nurse immediately take?

1. Turn the client on her left side

During the sixth month of pregnancy, a client reports intermittent earaches and a constant feeling of fullness in the ears. What is the likely cause of these symptoms?

2. Eustachian tube vascularization

When determining maternal and fetal well-being, which of the following data collection findings is most important?

2. Fetal heart rate and activity

A client who's 30 weeks pregnant has a corrected atrial septal defect and minor functional limitations. Which pregnancy-related physiologic change places her at greatest risk for more severe cardiac problems?

2. Increased plasma volume

A pregnant client in her second trimester reveals that she feels very anxious because of a lack of knowledge about giving birth. Which intervention by the nurse is most appropriate for this client?

1. provide her with the information and teach her the skills she'll need to understand and cope during

A woman who's 10 weeks pregnant tells the nurse that she's worried about her fatigue and frequent urination. The nurse should:

1. recognize these as normal early pregnancy signs and symptoms.

A famous pregnant client comes to the physician's office for a routine prenatal examination. While the client is in the office, the media arrives asking for information about the client. What should the nurse do?

2. Inform the media that you can't comment about whether the person is being seen in the office

A client is expecting her second child in 6 months. During the psychosocial assessment, she says, "I've been through this before. Why are you asking me these questions?" What is an appropriate response by the nurse?

1. "Each pregnancy has a unique psychosocial meaning."

An adolescent who's 14 weeks pregnant comes to the clinic for a prenatal examination. During the examination, the client says to the nurse, "I'm still not sure whether I want to keep my baby." Which response by the nurse is best?

1. "Have you and your physician discussed your options?"

A pregnant client asks the nurse about the percentage of congenital anomalies caused by drug exposure. How should the nurse respond?

1. 1%

The caloric requirements for a client of normal weight increase by how much during pregnancy?

1. 300 kcal

A client is admitted for an amniocentesis. Initial data collection findings include the following: 16 weeks pregnant, vital signs within normal limits, hemoglobin 12.2 gm, hematocrit 35%, and type O-negative blood. Which action would be most important to include in the client's plan of care after the amniocentesis has been completed?

1. Administer RhoGAM.

Which of the following would the nurse expect to find as presumptive signs of pregnancy?

1. Amenorrhea and quickening

A client is scheduled for amniocentesis. When preparing her for the procedure, the nurse should complete which of the following tasks?

1. Ask her to void.

During her first prenatal visit, a client expresses concern about gaining weight. Which of the following actions should be the nurse's next step?

1. Ask the client how she feels about gaining weight and provide instructions about expected weight gain and diet.

During her fourth clinic visit, a client who's 5 months pregnant tells the nurse she was exposed to rubella during the past week and asks whether she can be immunized now. How should the nurse respond?

2. "No, because the live viral vaccine is contraindicated during pregnancy."

A client has just expelled a hydatidiform mole. She's visibly upset over the loss and wants to know when she can try to become pregnant again. Which of the following would be the nurse's best response?

2. ""I can see that you're upset; however, you must wait at least 1 year before becoming pregnant again.""

The nurse is teaching a client who's 28 weeks pregnant and has gestational diabetes how to control her blood glucose levels. Diet therapy alone has been unsuccessful in controlling this client's blood glucose levels, so she has started insulin therapy. The nurse should consider the teaching effective when the client says:

2. ""I need to use insulin each day.""

When collecting data on a client during her first prenatal visit, the nurse discovers that the client had a reduction mammoplasty. The mother indicates she wants to breast-feed. What information should the nurse give to this mother regarding breast-feeding success?

2. ""I support your commitment; however, you may have to supplement each feeding with formula.

A client in the first trimester of pregnancy comes to the facility for a routine prenatal visit. She tells the nurse she doesn't know whether she's ready to have a baby, even though this was a planned pregnancy. Which response should the nurse offer?

2. ""You're feeling ambivalent, which is normal during the first trimester.""

A pregnant client tells the nurse that she dreads coming for her prenatal examinations. She states, "When I see the physician, he constantly reminds me that so many women keep weight on after having children; it really depresses me." How should the nurse respond?

2. "Have you asked the physician why he feels it's important for him to say that to you?"

When evaluating a client's knowledge of symptoms to report during her pregnancy, which statement would indicate to the nurse that the client understands the information given to her?

2. "If I have blurred or double vision, I should call the clinic immediately."

A client comes to the clinic for a routine prenatal examination. The nurse notices that the client is disheveled and unkempt. The client explains, "I have no energy to take care of myself and I really don't care." How should the nurse intervene?

2. Offer to assist the client with basic care needs while waiting for the physician.

The nurse is teaching a pregnant client how to distinguish prelabor contractions from true labor contractions. Which statement about prelabor contractions is accurate?

2. They're usually felt in the abdomen.

A client with pregnancy-induced hypertension (PIH) receives magnesium sulfate, 4 g in 50% solution I.V. over 20 minutes. What is the purpose of administering magnesium sulfate to this client?

2. To prevent seizures

A client's membranes rupture during the 36th week of pregnancy. Eighteen hours later, the nurse measures the client's temperature at 101.8° F (38.8° C). After initiating prescribed antibiotic therapy, the nurse should prepare the client for:

2. delivery.

After receiving large doses of an ovulatory stimulant such as menotropins (Pergonal), a client comes in for her office visit. Data collection reveals the following findings: Weight gain of 6 lb (3 kg), ascites, and pedal edema. These findings indicate that the client is:

2. demonstrating signs of hyperstimulation syndrome.

The nurse is caring for a client in her 34th week of pregnancy who wears an external monitor. Which statement by the client indicates an understanding of the nurse's teaching?

3. ""I can lie in any comfortable position, but I should stay off my back.""

The nurse observes many cuts and bruises on the back, arms, and legs of a pregnant client. The client tells the nurse, "I was cleaning and a box of supplies fell on me." Which response by the nurse is most appropriate?

3. ""It's our responsibility to maintain client confidentiality and to make sure our clients are safe. I'd be glad to listen if there's anything you want to talk about.""

The nurse is providing care for a pregnant 16-year-old client. The client says that she's concerned she may gain too much weight and wants to start dieting. The nurse should respond by saying:

3. ""Nutrition is important because depriving your baby of nutrients can cause developmental and growth problems.""

A pregnant client is brought to the emergency department after being an unrestrained driver in a motor vehicle accident. When questioned about seatbelt use, the client states that she thought a seatbelt would harm her baby. Which response by the nurse is best?

3. ""The only way to safely secure yourself in a car is to use a seatbelt.""

A 30-year-old primiparous client at 34 weeks' gestation comes to the prenatal facility concerned about the reddish streaks she has increasingly developed on her breasts and abdomen. She asks what these skin changes are and whether they're permanent. What should the nurse tell her?

3. ""These streaks are called striae gravidarum, or stretch marks; they'll grow lighter after delivery.""

A client who's 37 weeks pregnant comes to the clinic for a prenatal checkup. To evaluate the client's preparation for parenting, the nurse might ask which question?

3. "What changes have you made at home to get ready for the baby?"

A client has come to the clinic for her first prenatal visit. The nurse should include which statement about using drugs safely during pregnancy in her teaching?

4. ""Consult with your health care provider before taking any medications.""

A client is at her ideal weight when she conceives. During a prenatal visit 2 months later, she asks the nurse how much weight she should gain during pregnancy. What is the nurse's best response?

4. ""You should gain 24 to 32 lb.""

A client in her second trimester of pregnancy has been diagnosed with gestational diabetes. While instructing the client about home glucose monitoring the client states, "Why should I use this if the diabetes is going to resolve after I have my baby anyway?" Which response by the nurse is best?

4. "The monitor helps you see how your blood sugar is being controlled during your pregnancy to help prevent complications."

The nurse has a client at 30 weeks' gestation who has tested positive for the human immunodeficiency virus (HIV). What should the nurse tell the client when she says that she wants to breast-feed her baby?

4. Discourage breast-feeding because HIV can be transmitted through breast milk.

After undergoing prenatal blood testing, a client learns that she tested positive for human immunodeficiency virus (HIV). What should the nurse do with this information?

4. Follow facility policy for documenting and communicating HIV status

When questioned, a pregnant client admits she sometimes has several glasses of wine with dinner. Her alcohol consumption puts her fetus at risk for which condition?

4. Learning disability

The labor and delivery unit has 10 clients in varying stages of labor. Staffing for the upcoming shift consists of four registered nurses (RNs) and one licensed practical nurse (LPN). Which client care assignment is best?

The stable clients in the early stages of labor should be assigned to the LPN.