CH 7 SUCCESS questions

A nurse remarks to a client who has come to the clinic at 38 weeks' gestation, "It looks like your face and hands are swollen." The client responds, "Yes, you're right. Why do you ask?" The nurse's response is based on the fact that the changes may be caused by which of the following? 1. Altered glomerular filtration 2. Cardiac failure 3. Hepatic insufficiency 4. Altered splenic circulation

1. Altered glomerular filtration Altered glomerular filtration leads to protein loss and, subsequently, to fluid retention, which can lead to swelling in the face and hands.

The blood work of a client hospitalized on the antepartum unit of the hospital is as follows: hematocrit 30% and hemoglobin 10 gm/dL. In light of the laboratory data, which of the following meal choices should the nurse recommend to this client? 1. Chicken livers, sliced tomatoes, and dried apricots 2. Cheese sandwich, tossed salad, and rice pudding 3. Veggie burger, cucumber salad, and wedge of cantaloupe 4. Bagel with cream cheese, pear, and hearts of lettuce

1. Chicken livers, sliced tomatoes, and dried apricots This meal choice is high in iron and ascorbic acid. It would be an excellent lunch choice for this client who has a below-normal hematocrit and hemoglobin

The nurse is evaluating the effectiveness of bedrest for a client with pre-eclampsia without severe features. Which of the following signs/symptoms would the nurse determine is a finding that suggests pre-eclampsia with severe features? 1. Platelet count 95,000/mcL 2. 2+ proteinuria 3. Increase in plasma protein 4. Serum creatinine greater than 1.3 mg/dL

1. Platelet count 95,000/mcL 2. 2+ proteinuria 4. Serum creatinine greater than 1.3 mg/dL 1. A platelet count of less than 100,000 per microliter is a sign of pre-eclampsia with severe features. A normal platelet level in pregancy is 150,000 per microliter. 2. This client is losing protein. A reading of greater than 1+ indicates worsening kidney insufficiency 4. Serum creatinine greater than 1.1 mg/dL indicates worsening renal insufficiency

Which of the following pregnant clients is most high risk for preterm premature rupture of the membranes (PPROM)? Select all that apply 1. 31 weeks gestation with prolapsed mitral valve (PMV) 2. 32 weeks gestation with urinary tract infection (UTI) 3. 33 weeks gestation with twins post in vitro fertilization (IVF) 4. 34 weeks gestation with gestational diabetes (GDM) 5. 35 weeks gestation with deep vein thrombosis (DVT)

2. 32 weeks gestation with urinary tract infection (UTI) 3. 33 weeks gestation with twins post in vitro fertilization (IVF) 2. Clients with UTIs are at high risk for PPROM 3. Clients carrying twins, whether spontaneous or post-IVF, are at high risk for PPROM HINT: Although the exact mechanism is not well understood, clients who have UTI are at high risk for PPROM. This is particularly important because pregnant clients often have UTI that present either with no symptoms at all or only with urinary frequency, a complaint of many pregnant clients. Also, clients carrying twins are at high risk for PPROM

In analyzing the need for health teaching in a client with obstetrical history of G5 P4004 who has been diagnosed with gestational diabetes, the nurse should ask which of the following questions? 1. How old were you at your first pregnancy? 2. Do you exercise regularly? 3. Is your partner diabetic? 4. Do you work outside of the home?

2. Do you exercise regularly? The likelihood of developing either gestational or type 2 diabetes mellitus is reduced when clients exercise regularly

A woman with a diagnosis of ectopic pregnancy is to receive medical intervention rather than a surgical interruption. Which of the following intramuscular medications would the nurse expect to administer? 1. Dexamethasone 2. Methotrexate 3. Menotropin 4. Progesterone

2. Methotrexate methotrexate is the likely medication HINT: Conceptus is a ball of rapidly multiplying cells. Methotrexate interferes with that multiplication, killing the conceptus and, therefore, precluding the need for the client to undergo surgery. Even if the test taker were unfamiliar with its use in ectopic pregnancy but was aware of the action methotrexate, he or she could deduce its efficacy here.

A client is admitted with a diagnosis of third trimester bleeding. It is a priority for the nurse to assess for a change in which of the following vital signs? 1. Temperature 2. Pulse 3. Respirations 4. Blood pressure

2. Pulse The pulse is the highest priority in this situation HINT: The key to answering this question is the fact that the nursing care plan is for a client with third trimester bleeding. By the end of the second trimester, pregnant women have almost doubled their blood volume. Because of this, if they bleed, they are able to maintain their blood pressure for a relatively long period of time. Their pulse rate, however, does rise. Nurses, therefore, must carefully attend to the pulse rate of pregnant women who have been injured or who are being observed for third trimester bleeding. A drop in blood pressure is very late and ominous sign

The nurse is grading a woman's reflexes. Which of the following grades would indicate reflexes that are slightly brisker than normal 1. +1 2. +2 3. +3 4. +4

3. +3 +3 reflexes are defined as slightly brisker than normal, or slightly hyper-reflexic

A nurse is counseling a pre-eclamptic client about her diet. Which should the nurse encourage the woman to do? 1. Restrict sodium intake 2. Increase intake of fluids 3. Eat a well-balanced diet 4. Avoid simple sugars

3. Eat a well-balanced diet It is important for the client to eat a well balanced diet

A gravid woman has just been admitted to the emergency department subsequent to a head-on automobile accident. Her body appears to be uninjured. The nurse carefully monitors the woman for which of the following possible complications of pregnancy? Select all that apply 1 Placenta previa 2. Transverse fetal lie 3. Placental abruption 4. Pre-eclampsia with severe features 5. Preterm labor

3. Placental abruption 5. Preterm labor 3. Placental abruption may develop as a result of the auto accident 5. The woman may go into preterm labor after an auto accident

A client diagnosed with pre-eclampsia without severe features has been advised to stop working and be on light activities and bedrest at home. She asks why this is necessary. Which of the following is the best response for the nurse to give the client? 1. Bedrest will help you to conserve energy for your labor 2. Bedrest will help to relieve your nausea and anorexia 3. Reclining will increase the amount of oxygen that your baby gets 4. The position change will prevent the placenta from separating

3. Reclining will increase the amount of oxygen that your baby gets Bedrest, especially side-lying, helps to improve perfusion to the placenta

A 25 year old client is admitted with the following history: 12 weeks pregnant, vaginal bleeding, no fetal heartbeat seen on ultrasound. The nurse would expect the doctor to write an order to prepare the client for which of the following? 1. Cervical cerclage 2. Amniocentesis 3. Nonstress testing 4. Dilation and curettage

4. Dilation and curettage Dilate and curettage (D&C) is performed on a client with an incomplete abortion

A woman at 26 weeks' gestation is diagnosed with pre-eclampsia with severe features and HELLP syndrome. The nurse will assess for which of the following signs/symptoms? 1. Low serum creatinine. 2. High serum protein 3. Bloody stools 4. Epigastric pain

4. Epigastric pain Epigastric pain is associated with the liver involvement of HELLP syndrome

Prioritize hypotheses. Where do I start? Note: This is a two-part question. The nurse is planning care for this client. The nurse should first address the client's: 1. Blood glucose findings 2. Fetal heart rate pattern 3. Contraction pattern 4. Dehydration Followed by the client's: a. Blood glucose findings b. Fetal heart rate pattern c. Contraction pattern d. Dehydration

4.) Dehydration and a.) Blood glucose findings. 4. The client's dehydration should be addressed first. a.)The client's hyperglycemia is addressed after the client is hydrated. After rehydration, insulin will be administered per a pump for precise regulation in order to bring glucose into the cells and reduce the body's production of ketone bodies, which will reduce the level of acidemia. None of these changes happens quickly, and both the client and the fetus will remain at high risk until homeostasis is achieved.

Which of the following long-term goals is appropriate for a client at 10 weeks gestation who is diagnosed with gestational trophoblastic disease (hydatidiform mole)? 1. Client will be cancer free 1 year from diagnosis 2. Client will deliver her baby at full term without complications 3. Client will be pain free 3 months after diagnosis 4. Client will have normal hemoglobin and hematocrit at delivery

1. Client will be cancer free 1 year from diagnosis This long term goal is appropriate

Evaluate outcomes. Did it help? The client has been hydrated with an IV infusion of normal saline. She has also received an insulin IV bolus per piggyback pump, and the nurse is setting the pump for a continuous insulin infusion. what outcomes are reasonable to anticipate over the next few hours as a result of these nursing interventions? Select all that apply. 1. FHR in normal range with moderate variability 2. FHR with tachycardia and minimal variability 3. Oxytocin induction 4. Cesarean section 5. Normoglycemia

1. FHR in normal range with moderate variability 5. Normoglycemia 1. It is reasonable to anticipate an FHR in the normal range with moderate variability within 4 to 8 hours after correction of maternal DKA 5. It is reasonable to anticipate normoglycemia within 8 hours of treatment with insulin

Analyze cues. What could it mean? The client's provider does not use standing orders for diabetic clients. The nurse prepares to call the physician. Which of the following orders can the nurse anticipate receiving? Select all that apply. 1. Intravenous fluid hydration 2. Serum blood glucose 3. Insulin IV bolus 4. Continuous insulin drip per pump 5. Orange juice, 1/4 cup 6. Arterial blood gas analysis

1. Intravenous fluid hydration 2. Serum blood glucose 3. Insulin IV bolus 4. Continuous insulin drip per pump 6. Arterial blood gas analysis 1. Correcting dehydration is the most important treatment this client needs initially. Aggressive hydration is done before administering an insulin bolus or insulin drip. IV fluids decrease stress hormones, which contribute to acidemia. In addition, IV fluids decrease stress hormones, which contribute to acidemia. In addition, IV fluids perfuse the cells, and dilute the blood, which effectively reduces the hyperglycemia and increases the response to insulin therapy when it is started. 2. An initial capillary blood glucose may be obtained on admission and may be sued for titrating insulin during care, but a serum blood glucose is more accurate for a client in this type of emergency situation and should be drawn to establish a baseline 3. The nurse can anticipate orders to administer an insulin bolus after hemodilution has been achieved 4. Following the insulin bolus, a low dose, continuous insulin drop is started per pump for maintenance until the client's blood sugars are stable enough to return to subcutaneous insulin injections 6. A person with type 1 diabetes mellitus (T1DM) is at risk for diabetic ketoacidosis if insulin is not administered regularly. An arterial blood gas analysis will confirm the level of metabolic acidosis and can guide further decisions for treatment.

Generate solutions. What can I do? select words from the choices below to fill in each blank found in the following sentences: The best outcomes for the client would be to (1) ___ and (2) ____. To achieve optimal outcomes, the nurse should (3) ___ and (4) ____. a. Rehydrate b. Accelerate fetal lung maturity c. Insert urinary catheter d. Achieve normoglycemia e. Administer IV fluids f. Achieve term delivery. g. Administer insulin

1.) a. Rehydrate 2.) d. Achieve normoglycemia 3.) e. Administer IV fluids 4.) g. Administer insulin The best outcomes for the client would be to 1 (a) rehydrate and 2(d) achieve normoglycemia. To achieve optimal outcomes, the nurse should 3(e) administer IV fluids and 4(g) administer insulin

The nurse has assessed four primigravid clients in the prenatal clinic. Which of the women would the nurse refer to the nurse midwife for further assessment? 1. 10 weeks gestation, complains of fatigue with nausea and vomiting 2. 26 weeks gestation, complains of ankle edema and chloasma 3. 32 weeks gestation, complains of epigastric pain and facial edema 4. 38 weeks gestation, complains of bleeding gums and urinary frequency

3. 32 weeks gestation, complains of epigastric pain and facial edema Epigastric pain and facial edema are not normal. This client should be referred to the nurse midwife.

A client is pregnant with monochorionic twins. For which of the following complications should this pregnancy be monitored? 1. Oligohydramnios 2. Placenta previa 3. Cephalopelvic disproportion 4. Twin to twin transfusion

4. Twin to twin transfusion Twin to twin transfusion is a relatively common complication of monozygotic twin pregnancies

The results of a 75 gram oral glucose tolerance test (OGTT) for a client at 25 weeks gestation are: -Fasting --100mg/dL (5.5 mmol/L) -One hour--200 mg/dL (11.1 mmol/L) -Two hour--160 mg/dL (8.9 mmol/L) Which of the following information is appropriate for the nurse to give the client at this time? 1. Inform the client that the glucose results are normal 2. Inform the client that an additional 3 hour 100 gram oral glucose test is necessary for follow up 3. Inform the client that the primary healthcare provider will likely order an oral hypoglycemic agent 4. Inform the client that the primary healthcare provider will likely order a referral to a registered dietician.

4. Inform the client that the primary healthcare provider will likely order a referral to a registered dietician. This statement is correct. The client should be referred to a registerd dietician for diet counseling. HINT: The american dieabetes association recommends taht all pregnant women not previously diagnosed with diabetes undergo a 75 gram OGTT between 24 and 28 weeks gestation. Those whose values exceed the following cutoff values are diagnosed with gestational diabetes -Fasting: 92 mg/dL (5.1 mmol/L, and either -1 hour: 180 mg/dL (10 mmol/L) or -2 hour: 153 mg/dL (8.5 mmol/L)

A client's previous clinic assessment at 32 weeks was: BP 90/60; TPR 98ºF (37ºC), P 92, R 20, weight 145 lb; and urine negative for protein. Which of the following findings at 34 week appointment should the nurse highlight for the certified nurse midwife? 1. BP 110/70; TPR 99ºF (37ºC), P 88, R 20 2. weight 155 lb, urine protein +2 3. Urine protein trace, BP 88/56 4. Weight 147 lb; TPR 99ºF (37ºC), P 76, R 18

2. weight 155 lb, urine protein +2 There has been a 10 lb weight gain in 2 weeks and a significant amount of protein is being spilled in the urine. This client should be brought to the attention of the midwife

A nurse is caring f or a 25 year old client who has had a spontaneous first trimester abortion. Which of the following comments by the nurse is appropriate? 1. You can try again very soon 2. It is probably better this way 3. At least you weren't very far along 4 I'm here to talk if you would like

4 I'm here to talk if you would like This statement is appropriate. The nurse is offering their assistance to the client

Recognize cues. What matters most? What additional information requires immediate follow-up? Select all that apply 1. Fundal height 2. Fetal heart rate 3. Capillary blood glucose (CBG) 4. Urinalysis 5. Height and weight

2. Fetal heart rate 3. Capillary blood glucose (CBG) 4. Urinalysis 2. A maternal blood sugar of 320 mg/dL (17.8 mmol/L) and the maternal vital signs put the fetus at risk of hypoxia. As such, fetal status must be assessed urgently by continuous external fetal monitoring (EFM) 3. Although the client's husband reports a recent CBG monitor to establish a baseline and to get a current reading. 4. Low abdominal pain suggests both preterm labor and a urinary tract infection (UTI) HINT: Of the assessments listed, the test taker is asked to identify assessments that require immediate follow-up. This is not intended to complete list, just an assessment of the test taker's ability to prioritize items within the list. Blood glucose is a priority in diabetic conditions. In pregnant women, both the fetus and abdominal pain are also priorities. A urinalysis will help to define a possible cause of the abdominal pain. The mother has been vomiting. Maternal dehydration leads to decreased uteroplacental blood flow, causing impaired oxygen delivery to the fetus. This complicates the fetal demand for oxygen, which is increased by fetal hyperglycemia and hyperinsulinemia and an increased metabolism.

The nurse is educating a client who has been diagnosed with gestational diabetes how to perform home blood glucose testing. Which of the following information should be included in the teaching session? 1. When pricking the fingertip, always prick the center of the fingertip 2. One hour postprandial glucose values should be 146 mg/dL (8 mmol/L) or lower 3. Blood glucose testing should be performed 2 times per day--before breakfast and before bedtime 4. All blood glucose results should be kept in a log for evaluation by the nurse and primary healthcare provider.

4. All blood glucose results should be kept in a log for evaluation by the nurse and primary healthcare provider. This statement is correct. All blood glucose results should be kept in a log for evaluation by the nurse and primary healthcare provider. If the results are above cutoff values, the primary healthcare provider may order dietary changes or the addition of oral hypoglycemic medications to the client's therapeutic regimen.

A pregnant client with diabetes has been diagnosed with polyhydramnios. Which of the following would explain this finding? 1. Excessive fetal urination 2. Recurring hypoglycemic episodes 3. Fetal sacral agenesis 4. Placental vascular damage

1. Excessive fetal urination Hydramnios is likely a result of excessive fetal urination HINT: For the first 16 weeks of the pregnancy, most of the amniotic fluid consists of maternal plasma which passes through the placenta into the gestational sac. Once the fetal kidney begins working at around 16 weeks gestation, fetal urine becomes the primary source, although the fetal lungs also contribute a small amount of fluid. Fetuses of mothers with diabetes often experience polyuria as a result o hyperglycemia. If the mother's diabetes is not controlled, excess glucose diffuses across the placental membrane and the fetus becomes hyperglycemic. As a result, the fetus exhibits the classic sign of diabetes==polyuria. If the mother's serum glucose levels are very high during the first trimester, it is likely that the fetus will develop structural congenital defects, including heart defects and sacral agensis.

A multigravida at 30 weeks gestation with an obstetrical history of G3 P1011 is admitted to the labor suite. She is contracting every 5 minutes, with a contraction duration of 40 seconds. Which of the comments by the client would be most informative regarding the etiology of the client's present condition? 1. For the past day I have felt burning when I urinate 2. I have a daughter who is 2 years old 3. I jogged 1&1/2 miles this morning 4. My miscarriage happened a year ago today

1. For the past day I have felt burning when I urinate This is the most important statement made by the client HINT: Preterm labor is strongly associated with the presence of a UTI. Whenever an infection is present in the body, the body produces prostaglandins, an inflammatory hormone. Prostaglandins ripen the cervix and the number of oxytocin receptor sites on the uterine body increase in response. Preterm labor can then develop.

Which of the following clients is at highest risk for developing a hypertensive illness of pregnancy? 1. G1 P0000, age 41 with history of diabetes mellitus 2. G2 P0101, age 34 with history of rheumatic fever 3. G3 P1102, age 27 with history of scoliosis 4. G3 P1011, age 20 with history of celiac disease

1. G1 P0000, age 41 with history of diabetes mellitus This primigravid client--age 41 and with a history of diabetes--is at very high risk for pre-eclampsia

A gravid client with 4+ proteinuria and 4+ reflexes is admitted to the hospital. The nurse must closely monitor the woman for which of the following? 1. Grand mal seizure 2. High platelet count 3. Explosive diarrhea 4. Jaundice

1. Grand mal seizure Clients with pre-eclampsia with severe features are at high risk for seizure

In anticipation of a complication that may develop in the second half of pregnancy, the nurse teaches a client at 18 weeks' gestation to call the office if she experiences which of the following? 1. Headache and deceased output 2. Puffy feet 3. Hemorrhoids and vaginal discarge 4. Backache

1. Headache and deceased output Headache and decreased output are signs of pre-eclampsia

A client is at 32 weeks' gestation with a severe headache and ankle swelling is admitted in the hospital with pre-eclampsia. Her vital signs are as follows: T 98.6°F (37°C), pulse rate 100, RR 20, BP 160/112. The blood pressure was repeated in 15 minutes and was 140/70. The nurse is preparing to call the primary healthcare provider. Which of the anticipated provider's orders can the nurse consider to be indicated, nonessential, or contraindicated. 1. Magnesium sulfate 4 gm bolus over 20 minutes, followed by maintenance infusion of 2 gm/hour IV per pump 2. Insert indwelling catheter and send urine specimen to lab 3. Continuous fetal monitoring 4. Corticosteroids 5. Begin oxytocin induction 6. Begin 24 hour urine collection for protein 7. Antihypertensive medication

1. Indicated 2. Nonessential 3. Indicated 4. Indicated 5. Contraindicated 6. Indicated 7. Indicated 1. Magnesium sulfate is indicated for this client to prevent seizures 2. The client doesn't need an indwelling catheter at this point 3. The fetus must be monitored continuously 4. Steroids are indicated to enhance fetal lung maturity in case a premature deliver becomes necessary 5. At his point, there is nothing in the client's presentation to require an oxytocin induction 6. A 24 hour urine collection for protein assessment can guide the patent's plan of care, that may include an indwelling catheter and complete bedrest, steroids, and an oxytocin induction. However, at this point there is nothing to indicate those interventions are necessary. 7. Antihypertensive medication is indicated to prevent a stroke.

Take action. What will I do? The nurse is initiating treatment for this client. Select two interventions that must be completed first. Select two. 1. Insert indwelling catheter 2. Administer intravenous insulin therapy 3. Administer intravenous fluid therapy 4. Administer subcutaneous insulin therapy 5. Administer bicarbonate 6. Assess capillary blood glucose 7. Administer steroids for fetal lung maturity.

1. Insert indwelling catheter 3. Administer intravenous fluid therapy 1. An indwelling catheter is inserted to assess hydration and hourly output 3. Intravenous fluid therapy is the first step in treatment for DKA

A woman is to receive methotrexate IM for an ectopic pregnancy. The nurse should teach the woman about which of the following common side effects of the therapy? Select all that apply. 1. Nausea and vomiting 2. Abdominal pain 3. Fatigue 4. Light-headedness 5. Breast tenderness

1. Nausea and vomiting 2. Abdominal pain 3. Fatigue 4. Light-headedness 1. Nausea and vomiting are common side effects 2. Abdominal pain is common side effect. The pain associated with the medication needs to be carefully monitored to differentiate it from the pain caused by the ectopic pregnancy itself 3. Fatigue is a common side effect 4. Light headedness is a common side effect HINT: Because methotrexate is an antineoplastic agent, the nurse would expect to see the same types of complaints that he or she would see in a client receiving chemotherapy for cancer. It is very important that the abdominal pain seen with the medication not be dismissed because a common complaint of women with ectopic pregnancies is pain. The source of the pain, therefore, must be clearly identified.

A client with type 1 diabetes mellitus (T1DM_ is being seen for preconception counseling. The nurse should emphasize that during the first trimester the woman may experience which of the following? 1. Needing less insulin than normal 2. More frequent hyperglycemic episodes 3. Polyhydramnios 4. A need to be hospitalized for fetal testing

1. Needing less insulin than normal Clients with type 1 diabetes mellitus often need less insulin toward the end of the first trimester than tey did before pregancy

A client is on total bedrest at 32 weeks gestation with placenta previa. The physician expects her to be hospitalized on bedrest until her cesarean section, which is scheduled for 38 weeks gestation. To prevent complications while in the hospital, the nurse should do which of the following? Select all that apply 1. Perform passive range of motion exercises 2. Restrict the fluid intake of the client 3. Decorate the room with pictures of family 4. Encourage the client to eat a high-fiber diet 5. Teach the client deep breathing exercises

1. Perform passive range of motion exercises 3. Decorate the room with pictures of family 4. Encourage the client to eat a high-fiber diet 5. Teach the client deep breathing exercises 1. Passive range of motion will help to decrease the potential for muscle atrophy and thrombus formation 3. This client is separated from family. The separation can lead to depression. Decorating the room and enabling family to visit freely is very important 4. A high fiber diet will help to maintain normal bowel function 5. Deep breathing exercises are important to maintain the client's respiratory function.

A client who works as a waitress and is 35 weeks pregnant telephones the labor suite after getting home from work and states, "I am feeling tightening in my groin about every 5 to 6 minutes." Which of the following comments by the nurse is appropriate at this time? 1. Please lie down and drink about four full glasses of water or juice 2.You are having false labor pains so you need not worry about them 3. It is essential that you get to the hospital immediately 4. That is very normal for someone who is on her feet all day

1. Please lie down and drink about four full glasses of water or juice Clients who are dehydrated may experience contractions that can lead to preterm labor if the dehydration is not alleviated.

On ultrasound, it is noted that the pregnancy of a hospitalized woman who is carrying monochorionic twins is complicated by twin to twin transfusion. The nurse should carefully monitor this client for which of the following? 1. Rapid fundal growth 2. Vaginal bleeding 3. Projectile vomiting 4. Congestive heart failure

1. Rapid fundal growth Fundal growth is often accelerated HINT: Fundal growth is accelerated for two reasons: (a) with two babies in utero, uterine growth is increased and (b) the recipient twin--the twin receiving blood from the other twin--often produces large quantities of urine, resulting in polyhydraminios.

A client at 12 weeks gestation presents in the emergency department with abdominal cramps and scant, dark red bleeding. For which of the following signs/symptoms should the nurse assess this client? Select all that apply. 1. Tachycardia 2. Referred shoulder pain 3. Headache 4. Fetal heart dysrhythmias 5. Hypertension

1. Tachycardia 3. Headache 4. Fetal heart dysrhythmias 5. Hypertension 1. The client should be assessed for tachycardia, which could indicate that the client is bleeding internally 3. This client's signs and symptoms are consistent with both spontaneous abortion and hydatidiform mole. Although this client is only at 12 weeks gestation, if she has a hydatidiform mole, she may be exhibiting signs of pre-eclampsia, including headache and hypertension 4. This client's signs and symptoms are consistent with both spontaneous abortion and hydatidiform mole. To determine whether or not the client is carrying a viable fetus, the nurse should check the fetal heart rate 5. This client's signs and symptoms are consistent with both spontaneous abortion and hydatidiform mole. Although this client is only 12 weeks gestation, if she has a hydatidiform mole, she may be exhibiting signs of pre-eclampsia, including headache and hypertension.

A client at 32 weeks' gestation was last seen in the prenatal clinic 4 weeks ago at 28 weeks' gestation. Which of the following changes should the nurse bring to the attention of the certified nurse midwife? 1. Weight change from 128 pounds to 138 pounds 2. Pulse rate change from 88 bpm to 92 bpm 3. Blood pressure change from 120/80 to 118/78 4. Respiratory rate change from 16 to 20

1. Weight change from 128 pounds to 138 pounds A weight gain of 10 pounds in a 4-week period is worrisome. the recommended weight gain during the second and third trimesters is approximately 1 pound per week

A client with type 1 diabetes mellitus (T1DM) has developed polyhydramnios. She is 34 weeks pregnant. The client should be taught to report which of the following? 1. Uterine contractions 2. Reduced urinary output 3. Marked fatigue 4. Puerperal rash

1. Uterine contractions The client should be taught to observe for signs of preterm labor. HINT: Clients with polyhydramnios have excessive quantities of amniotic fluid in their uterine cavities. The excessive quantities likely result from increased fetal urine production, caused by fetal hyperglycemia. When the uterus is overextended from the large quantities of fluid, these women are at high risk for preterm labor.

Which of the following findings would the nurse expect to see when assessing a first trimester gravida client suspected of having gestational trophoblastic disease (hydatidiform mole) that the nurse would not expect to see when assessing a first trimester gravida with a normal pregnancy? Select all that apply. 1. Hematocrit 29% 2. Grape like clusters passed from the vagina 3. Markedly elevated blood pressure 4. White blood cell count 8,000/ mcL 5. Hypertrophied breast tissue

2. Grape like clusters passed from the vagina 3. Markedly elevated blood pressure 2. Women with hydatidiform mole often expel grape like clusters from the vagina 3. Although signs and symptoms of pre-eclampsia usually appear only after a pregnancy has reached 20 weeks or later, pre-eclampsia is seen in the first trimester of pregnancy in women with hydatidiform mole.

A woman at 29 weeks' gestation with a diagnosis of pre-eclampsia with severe features is noted to have a blood pressure of 170/112, 4+ proteinuria and a weight gain of 10 pounds over the past 2 days. Which of the following signs/symptoms would the nurse expect to see? 1. Fundal height of 32 cm 2. Oliguria 3. Patellar reflexes of +2 4. Nystagmus

2. Oliguria The nurse would expect to see oliguria

A nurse is caring for four prenatal clients in the clinic. Which of the clients is at high risk for placenta previa? Select all that apply. 1. Jogger with low body mass index 2. Primigravida who smokes 1 pack of cigarettes per day 3. Infertility client who is carrying in-vitro triplets 4. Registered nurse who works 12 hour shifts 5. Police officer on foot patrol

2. Primigravida who smokes 1 pack of cigarettes per day 3. Infertility client who is carrying in-vitro triplets 2. A smoker is at high risk for placenta previa 3. A woman carrying triplets is at high risk for placenta previa

A grand multipara with an obstetrical history of G8 P3406 is being seen at 14 weeks gestation in prenatal clinic. During the nurse's prenatal teaching session, the nurse will emphasize that the woman should notify the obstetric office immediately if she notes which of the following? 1. Change in fetal movement 2. Signs and symptoms of labor 3. Swelling of feet and ankles 4. Appearance of spider veins.

2. Signs and symptoms of labor The nurse should emphasize the need for the client to notify the office of sings of preterm labor

A client at 24 weeks' gestation is being seen in the prenatal clinic. She states, "I have had a terrible headache for the past 2 days." Which of the following is the most appropriate action for the nurse to perform next? 1. Inquire whether or not the client has allergies 2. Take the woman's blood pressure 3. Assess the woman's fundal height 4. Ask the woman about stressors at work

2. Take the woman's blood pressure The nurse should assess the client's blood pressure

A woman at 12 weeks gestation with an obstetrical history of G4 P0210 has been admitted to the labor and delivery suite for a cerclage procedure. Which of the following long-term outcomes is average for this client? 1. The client will gain less than 25 pounds during the pregnancy 2. The client will deliver after 38 weeks gestation 3. The client will have a normal blood glucose throughout the pregnancy 4. The client will deliver a baby who is average for gestational age

2. The client will deliver after 38 weeks gestation This client is at high risk for pregnancy loss. This is an appropriate long-term goal HINT: This question requires the test taker to know why. a client may have a cervical cerclage placed, namely because of multiple pregnancy losses from cervical insufficiency (sometimes called " incompetent cervix). The gravidity and parity information provides an important clue to the question. The client has had four pregnancies-- with two preterm births and one abortion, but she has no living children. The goal for the therapy, therefore, is that the pregnancy will go to term

A pregnant client with an obstetrical history of G2 P1001, telephones the gynecology office complaining of left-sided pain. Which of the following questions by the triage nurse would help to determine whether the one-sided pain is due to an ectopic pregnancy? 1. When did you have your pregnancy test done? 2. When was the first day of your last menstrual period? 3. Did you have any complications with your first pregnancy? 4. How old were you when you first got your period?

2. When was the first day of your last menstrual period? The date of the last menstrual period will assist the nurse in determining how many weeks pregnant the client is. HINT: Date of the last menstrual period is important for the nurse to know ectopic pregnancies are usually diagnosed between the 8th and 9th week of gestation because, at that gestational age, the conceptus has reached a size that is too large for the fallopian tube to contain it.

Which of the following findings should the nurse expect when assessing a client at 8 weeks gestation with gestational trophoblastic disease (hydatidiform mole)? 1. Protracted pain 2. Variable fetal heart decelerations 3. Dark brown vaginal bleeding 4. Suicidal ideations

3. Dark brown vaginal bleeding The condition is usually diagnosed after a client complains of brown vaginal discharge early in the pregnancy

A client is admitted to the hospital with a diagnosis of pre-eclampsia with severe features. The nurse is assessing for clonus. Which of the following actions should the nurse perform? 1. Strike the woman's patellar tendon 2. Palpate the woman's ankle 3. Dorsiflex the woman's foot 4. Position the woman's feet flat on the floor

3. Dorsiflex the woman's foot To assess clonus, the nurse should dorsiflex the woman's foot

A woman is to receive methotrexate IM for an ectopic pregnancy. The drug reference states that the recommended safe dose of the medicine is 50 mg/m2. She weighs 52 kg and is 148 cm tall. What is the maximum safe dose in mg of methotrexate that this woman can receive? (If rounding is needed, please round to the nearest tenth) ______mg

73 mg

A woman has been diagnosed with ruptured ectopic pregnancy. Which of the following sings/symptoms is characteristic of this diagnosis? 1. Dark brown rectal bleeding 2. Severe nausea and vomiting 3. Sharp unilateral pain 4. Marked hyperthermia

3. Sharp unilateral pain Sharp unilateral pain is a common symptom of a ruptured ectopic pregnancy

A nurse is performing assessments on four clients at 22 weeks gestation. The nurse reports to the obstetrician that which of the clients may be carrying twins? 1. The client whose progesterone levels are elevated 2. The client with a weight gain of 13 pounds 3. The client whose fundal height measurement is 26 cm 4. The client whose alpha-fetoprotein level is one half normal

3. The client whose fundal height measurement is 26 cm It is possible that this client is carrying twins. HINT: After 20 weeks gestation, the nurse would expect the fundal height to be equal to the number of weeks of the woman's gestation. Because the fundal height is 4 cm above the expected 22 cm, it is likely that the woman is either having twins or has polyhydramnios

A client with an obstetrical history of G6 P5005, has been admitted to the hospital at 24 weeks' gestation with placenta previa. Which of the following is an appropriate long-term goal for this client? 1. The client will state an understanding of need for complete bedrest 2. The client will have a reactive nonstress test (NST) on day 2 of hospitalization 3. The client will be symptom free until at least 37 weeks gestation 4. The client will have normal vital signs on admission

3. The client will be symptom free until at least 37 weeks gestation That the client be symptom-free until at least 37 weeks gestation is a long term goal. HINT: Each of the goals is appropriate for a client with placenta previa. Only the statement that projects the client's response into the future, however, is a long-term goal.

A woman who has been diagnosed with an ectopic pregnancy is to receive methotrexate 50 mg/m2 IM. The woman weighs 136 lb and is 5 ft 4 in. tall. What is the maximum safe dose in mg of methotrexate that this woman can receive? (If rounding is needed, please round to the nearest tenth) ____________mg

83.5 mg

A woman with an obstetrical history of G5 P0311 is in the post-anesthesia care unit (PACU) after a cervical cerclage procedure. During the immediate post procedure period, what should the nurse carefully monitor this client for? 1. Hyperthermia 2. Hypotension 3. Uterine contractions 4. Fetal heart dysrhythmias

3. Uterine contractions Preterm labor is a complication in the immediate post procedure period

The nurse is caring for a client who was just admitted to the hospital to rule out ectopic pregnancy. Which of the following orders is the most important for the nurse to perform? 1. Take the client's temperature 2. Document the time of the client's last meal 3. Obtain urine for urinalysis and culture 4. Assess for complaint of dizziness or weakness

4. Assess for complaint of dizziness or weakness Assessing for complaints of dizziness or weakness is most important HINT: The nurse must prioritize care according to the highest risk of morbidity or mortality, or of a time-dependent nature. When the question asks the test taker to decide which action is most important, all four possible responses are plausible actions. The test taker must determine which is the one action that cannot be delayed and that may indicate a serious threat to the client's well being. In this situation the most important action for the nurse to perform is to assess for complains of dizziness or weakness. These symptoms are seen when clients develop hypovolemia from internal bleeding. Internal bleeding will be present if the client's fallopian tube has ruptured.

A client has pre-eclampsia with severe features. The nurse would expect the primary healthcare provider to order tests to assess the fetus for which of the following? 1. Severe anemia 2. Hypoprothrombinemia 3. Craniosynostosis 4. Intrauterine growth restriction

4. Intrauterine growth restriction The fetus should be assessed for intrauterine growth restriction

Which of the following statements is appropriate for the nurse to say to a client with a complete placenta previa? 1. During the first phase of labor you will do slow chest breathing 2. You should ambulate in the halls at least two times each day 3. The doctor will deliver you once you reach 25 weeks gestation 4. It is important that you inform me if you become constipated

4. It is important that you inform me if you become constipated Straining at stool can result in enough pressure to result in placental bleeding.

Which finding should the nurse expect when assessing a client with placenta previa? 1. Severe occipital headache 2. History of thyroid cancer 3. Previous premature delivery 4. Painless vaginal bleeding

4. Painless vaginal bleeding Painless vaginal bleeding is often the only symptom of placenta previa

A woman, 8 weeks pregnant, is admitted to the obstetrical unit with a diagnosis of threatened abortion. Which of the following tests would help to determine whether the woman is carrying a viable or a nonviable pregnancy? 1. Luteinizing hormone level 2. Endometrial biopsy 3. Hysterosalpingogram 4. Serum progesterone level

4. Serum progesterone level Serum progesterone will provide information on the viability of a pregnancy HINT: When a pregnant client is seen by her healthcare provider with a complaint of vaginal bleeding, it is very important to determine the viability of the pregnancy as soon as possible. One relatively easy way to determine the viability of the conceptus is performing a serum progesterone test. Progesterone is "pro" gestation and supports pregnancy. High levels indicate a viable embryo, whereas low levels indicate a pregnancy loss. Ultrasonography to assess for a beating heart and serum human chorionic gonadotropin levels may also be performed and provide more certain information about the location of the implantation, and size of the embryo. In addition, the location of the placenta is of importance.