Conditions Occurring During Pregnancy

Normal amniotic fluid index

5 cm to 25 cm using the standard assessment method

cervical cerclage

A ring or loop used to hold the cervix closed, strengthens the cervix

Salpingitis

inflammation of a fallopian tube

Approximately half of women affected by gestational hypertension will develop ________________.

preeclampsia

A woman with an incomplete abortion is to receive misoprostol. The woman asks the nurse, "Why am I getting this drug?" The nurse responds to the client, integrating understanding that this drug achieves which effect? 1 ensures passage of all the products of conception 2 alleviates strong uterine cramping 3 suppresses the immune response to prevent 4 isoimmunization 4 halts the progression of the abortion

1 Misoprostol is used to stimulate uterine contractions and evacuate the uterus after an abortion to ensure passage of all the products of conception. NOT 3 Rho(D) immune globulin is used to suppress the immune response and prevent isoimmunization.

Tocolytics

Act on uterine muscle to cease contractions. Used to stop preterm labor. Terbutaline sulfate (Brethine), ritodrine HCl (Yutopar), nifedipine (Procardia), magnesium sulfate

Disseminated intravascular coagulation (DIC)

Disseminated intravascular coagulation (DIC) begins with excessive/widespread clotting and obstruction of blood flow to the tissues. The excessive clotting is usually stimulated by a substance that enters the blood as part of a disease (such as an infection or certain cancers) or as a complication of childbirth, retention of a dead fetus, or surgery

_______________ is the development of seizure activity in a woman affected by preeclampsia.

Eclampsia

What abnormal laboratory values would a nurse expect to find in a woman with hyperemesis gravidarum? 1 decreased hematocrit 2 ketonuria 3 an increase in sodium, potassium, or chloride 4 hyperkalemia

NOT 1 Women with hyperemesis gravidarum may have an increased hematocrit owing to hemoconcentration from being severely dehydrated. 34. Severe vomiting may lead to hypokalemic (low potassium in the blood) acidosis, which can produce a decrease in sodium, potassium, or chloride. A low level of sodium, potassium, or chloride may also result from decreased oral intake

An amniotic fluid index value of greater than 20 to 25 cm is considered to be ________________

Polyhydramnios May cause women to experience premature contractions, longer labor, difficulties breathing, and other problems during delivery. The condition can also cause complications for the fetus, including anatomical problems, malposition

TORCH acronym

Refers to infectious diseases that my be teratogenic. These include include: Toxoplasmosis Other Rubella Cytomegalovirus Herpes simplex

A pregnant woman with diabetes at 10 weeks' gestation has a glycosylated hemoglobin (HbA1c) level of 13%. At this time the nurse should be most concerned about which possible fetal outcome? 1 congenital anomalies 2 incompetent cervix 3 placenta previa 4 placental abruption (abruptio placentae)

1 A HbA1c level of 13% indicates poor glucose control. This, in conjunction with the woman being in the first trimester, increases the risk for congenital anomalies in the fetus. NOT 2.3.4. Elevated glucose levels are not associated with incompetent cervix, placenta previa, or placental abruption (abruptio placentae).

A client is admitted with a diagnosis of ectopic pregnancy. For what should the nurse anticipate preparing the client? 1 immediate surgery 2 internal uterine monitoring 3 bed rest for the next 4 weeks 4 intravenous administration of a tocolytic

1 An ectopic pregnancy is one in which implantation occurred outside the uterine cavity, usually within the fallopian tube. As the embryo grows, the fallopian tube can rupture. The therapy for ruptured ectopic pregnancy is laparoscopy to ligate the bleeding vessels and to remove or repair the damaged fallopian tube. NOT 2 There is no reason to begin uterine monitoring. 3 The client does not need to be on bed rest for 4 weeks. 4 A tocolytic is not needed because the client is not in labor

A nurse is interviewing a pregnant woman who has come to the clinic for her first prenatal visit. During the interview, the client tells the nurse that she works in a day care center with 2- and 3-year olds. Based on the client's history, the nurse would be alert for the development of which condition? 1 cytomegalovirus 2 chlamydia 3 gonorrhea 4 toxoplasmosis

1 The nurse would be alert for the development of cytomegalovirus infection. Pregnant women acquire active disease primarily from sexual contact, blood transfusions, kissing, and contact with children in day care centers. It can also be spread through vertical transmission from mother to child in utero (causing congenital CMV), during birth, or through breastfeeding. Chlamydia, gonorrhea, and toxoplasmosis are not spread through contact with children in day care centers

A 25-year-old client at 22 weeks' gestation is noted to have proteinuria and dependent edema on her routine prenatal visit. Which additional assessment should the nurse prioritize and convey to the RN or health care provider? 1 initial BP 120/80mm Hg; current BP 130/88 mm Hg 2 initial BP 100/70 mm Hg; current BP 140/90 mm Hg 3 initial BP 140/85 mm Hg; current BP 130/80 mm Hg 4 initial BP 110/60 mm Hg; current BP 112/86 mm Hg

2 A proteinuria of trace to 1+ and a rise in blood pressure to above 140/90 mm Hg is a concern the client may be developing preeclampsia. NOT 1.3.4. The blood pressures noted in the other options are not indicative of developing preeclampsia. The edema would not necessarily be indicative of preeclampsia; however, edema of the face and hands would be a concerning sign for severe preeclampsia

A woman at 9 weeks' gestation was unable to control the nausea and vomiting of hyperemesis gravidarum through conservative measures at home. With nausea and vomiting becoming severe, the woman was omitted to the obstetrical unit. Which action should the nurse prioritize? 1 bed rest with bathroom privileges 2 instruct on NPO status 3 establish IV for rehydration 4 administration of antiemetics

3 With severe nausea and vomiting the client may be dehydrated upon coming to hospital for assistance, so establishing an IV line is the priority intervention. NOT 4 This will also allow for hydration, and if needed, the administration of an antiemetic to bypass the gastrointestinal tract. 2.1. Although the nurse will explain the NPO status to the client (so that vomiting may be brought under control) and the likelihood of being placed on bed rest with bathroom privileges, these teaching are not the priority.

A client who is HIV-positive is in her second trimester and remains asymptomatic. She voices concern about her newborn's risk for the infection. Which statement by the nurse would be most appropriate? 1 "You'll probably have a cesarean birth to prevent exposing your newborn." 2 "Antibodies cross the placenta and provide immunity to the newborn." 3 "Wait until after the infant is born, and then something can be done." 4 "Antiretroviral medications are available to help reduce the risk of transmission."

4 Drug therapy is the mainstay of treatment for pregnant women infected with HIV. The goal of therapy is to reduce the viral load as much as possible; this reduces the risk of transmission to the fetus. NOT 1 Decisions about the method of birth should be based on the woman's viral load, duration of ruptured membranes, progress of labor, and other pertinent clinical factors. 2 The newborn is at risk for HIV because of potential perinatal transmission. 3 Waiting until after the infant is born may be too late.

The nurse is identifying nursing diagnoses for a client with gestational hypertension. Which diagnosis would be the most appropriate for this client? 1 risk for injury related to fetal distress 2 imbalanced nutrition related to decreased sodium levels 3 ineffective tissue perfusion related to poor heart 4 contraction 4 ineffective tissue perfusion related to vasoconstriction of blood vessels

4 In gestational hypertension, vasospasm occurs in both small and large arteries during pregnancy. This can lead to ineffective tissue perfusion. NOT 1 There is no evidence to suggest that the fetus is in distress. 2 There is no enough information to support imbalanced nutrition. 3 Gestational hypertension does not affect heart contractions

A woman of 16 weeks' gestation telephones the nurse because she has passed some "berry-like" blood clots and now has continued dark brown vaginal bleeding. Which action would the nurse instruct the woman to do? 1 "Maintain bed rest, and count the number of perineal pads used." 2 "Come to the health care facility if uterine contractions begin." 3 "Continue normal activity, but take the pulse every hour." 4 "Come to the health facility with any vaginal material passed."

4 This is a typical time in pregnancy for gestational trophoblastic disease to present. Asking the woman to bring any material passed vaginally would be important so the material can be assessed for this

A woman is receiving magnesium sulfate as part of her treatment for severe preeclampsia. The nurse is monitoring the woman's serum magnesium levels. The nurse determines that the drug is at a therapeutic level based on which result? A 3.3 mEq/L B 6.1 mEq/L C 8.4 mEq/L D 10.8 mEq/L

B. Although exact levels may vary among agencies, serum magnesium levels ranging from 4 to 7 mEq/L are considered therapeutic NOT C.D. whereas levels more than 8 mEq/dL are generally considered toxic.

Cytomegalovirus (CMV)

CMV Infection is a viral infection that may occur during pregnancy, after birth, or at any age. In severely affected newborns, associated symptoms and findings may include growth retardation, an abnormally small head (microcephaly), enlargement of the liver and spleen (hepatosplenomegaly), inflammation of the liver (hepatitis), low levels of the oxygen-carrying pigment in the blood due to premature destruction of red blood cells (hemolytic anemia), calcium deposits in the brain, and/or other abnormalities.

Gestational trophoblastic disease (GTD)

Gestational trophoblastic disease (GTD) is a group of rare diseases in which abnormal trophoblast cells grow inside the uterus after conception. Hydatidiform mole (HM) is the most common type of GTD

HSV

Neonatal Herpes is a rare disorder affecting newborns infected with the Herpes simplex virus (HSV). This disorder may vary from mild to severe. In most cases, the disorder is transmitted to an infant from an infected mother with active genital lesions at the time of delivery.

Toxoplasmosis

Toxoplasmosis is an infectious disease caused by the microscopic parasitic organism called Toxoplasma gondii. (commonly transmitted from pets to humans by contact with contaminated animal feces) Toxoplasmosis may be associated with abnormal smallness of the head (microcephaly), inflammation of the middle and innermost layers of the eyes (chorioretinitis), calcium deposits in the brain (intracranial calcifications), and/or other abnormalities.

HELLP syndrome

A variant of gestational hypertension where hematologic conditions coexist with severe preeclampsia and hepatic dysfunction.

A woman has presented to the emergency department with symptoms that suggest an ectopic pregnancy. Which finding would lead the nurse to suspect that the fallopian tube has ruptured? 1 referred shoulder pain 2 vaginal spotting 3 nausea 4 breast tenderness

1 Referred pain to the shoulder area indicates bleeding into the abdomen caused by phrenic nerve irritation when a tubal pregnancy ruptures. NOT 2.3.4. Vaginal spotting, nausea, and breast tenderness are typical findings of early pregnancy and an unruptured ectopic pregnancy.

A woman at 8 weeks' gestation is admitted for ectopic pregnancy. She is asking why this has occurred. The nurse knows that which factor is a known risk factor for ectopic pregnancy? 1 high number of pregnancies 2 multiple gestation pregnancy 3 use of oral contraceptives 4 history of endometriosis

4 The nurse needs to complete a full history of the client to determine if she had any other risk factors for an ectopic pregnancy. Adhesions, scarring, and narrowing of the tubal lumen may block the zygote's progress to the uterus. Any condition or surgical procedure that can injure a fallopian tube increases the risk. Examples include salpingitis, infection of the fallopian tube, endometriosis, history of prior ectopic pregnancy, any type of tubal surgery, congenital malformation of the tube, and multiple abortions (elective terminations of pregnancy). Conditions that inhibit peristalsis of the tube can result in tubal pregnancy. NOT 1.2.3. A high number of pregnancies, multiple gestation pregnancy, and the use of oral contraceptives are not known risk factors for ectopic pregnancy

A client at 37 weeks' gestation presents to the emergency department with a BP 150/108 mm Hg, 1+ pedal edema, 1+ proteinuria, and normal deep tendon reflexes. Which assessment should the nurse prioritize as the client is administered magnesium sulfate IV? 1 urine protein 2 ability to sleep 3 hemoglobin 4 respiratory rate

A4 therapeutic level of magnesium is 4 to 8 mg/dl (1.65 to 3.29 mmol/L). If magnesium toxicity occurs, one sign in the client will be a decrease in the respiratory rate and a potential respiratory arrest. Respiratory rate will be monitored when on this medication. NOT 3.2. The client's hemoglobin and ability to sleep are not factors for ongoing assessments for the client on magnesium sulfate. 1 Urinary output is measured hourly on the preeclamptic client receiving magnesium sulfate, but urine protein is not an ongoing assessment.

Cytomegalovirus (CMV)

CMV is the most common cause of congenital infections in developed countries and the leading cause of nonhereditary hearing loss. It can also result in other neurodevelopmental disabilities, including vision impairment and cerebral palsy. Most women who contract the virus experience no or flu-like symptoms. Fetal infection may be detected by amniocentesis or cord blood sampling, and some fetal anomalies resulting from CMV may be detected by ultrasound or magnetic resonance imaging.

Signs of magnesium toxicity (4)

Diminished deep tendon reflexes (1+) suggest magnesium toxicity, which requires immediate intervention. Additional signs of magnesium toxicity include a respiratory rate less than 12 breaths/minute, urine output less than 30 ml/hour, and a decreased level of consciousness. Urinary retention, not frequency of micturition, is seen with magnesium sulfate toxicity Magnesium sulfate is given to treat seizures associated with hypertension and proteinuria in pregnancy, and therefore decreases the blood pressure

Cytomegalovirus

Herpes-type virus that usually causes disease when the immune system is compromised

Para

Is the number of completed pregnancies beyond 20 weeks gestation (whether viable or nonviable).

Gravida

Is the number of pregnancies a woman has had. A multiple gestation counts as a single pregnancy.

premature ovarian failure

Menopause before age 40

Amniotic fluid index less than 5 cm is considered to be ________________

Oligohydramnios If there are very low levels of amniotic fluid for your baby to float around in, there is a slight risk of intrauterine growth restriction and umbilical cord constriction during birth. More likely to have a C-section

A pregnant client with a history of premature cervical dilatation undergoes cervical cerclage. Which outcome indicates that this procedure has been successful? 1 The client delivers a full-term fetus at 39 weeks' gestation. 2 The client's membranes spontaneously rupture at week 30 of gestation. 3 The client experiences minimal vaginal bleeding throughout the pregnancy. 4 The client has reduced shortness of breath and abdominal pain during the pregnancy.

Premature cervical dilatation is when the cervix dilates prematurely and cannot retain a fetus until term. After the loss of one child because of premature cervical dilatation, a surgical operation termed cervical cerclage can be performed to prevent this from happening in a second pregnancy. This procedure is the use of purse-string sutures placed in the cervix to strengthen the cervix and prevent it from dilating until the end of pregnancy. 1 Evidence that this procedure is effective would be the client delivering a full-term fetus at 39 weeks' gestation. NOT 2 Spontaneous rupture of the membranes could indicate that the procedure was not successful. 3 Vaginal bleeding could indicate another health problem or that the procedure was not successful. 4 This procedure does not impact the client's respirations or amount of abdominal pain while pregnant; could indicate another health problem r/t pregnancy.

Rubella

Rubella is a viral infection characterized by fever, upper respiratory infection, swelling of the lymph nodes, skin rash, and joint pain. Severely affected newborns and infants may have visual and/or hearing impairment, heart defects, calcium deposits in the brain, and/or other abnormalities.

Precautions & non-pharmaceutical interventions for woman with preeclampsia with severe features:

The woman with preeclampsia with severe features should be maintained on complete bed rest in a dark and quiet room to avoid stimulation. The client is at risk for seizures; therefore, institution and maintenance of seizure precautions should be in place.

A nurse in the maternity triage unit is caring for a client with a suspected ectopic pregnancy. Which nursing intervention should the nurse perform first? 1 Assess the client's vital signs. 2 Administer oxygen to the client. 3 Obtain a surgical consent from the client. 4 Provide emotional support to the client and significant other.

1 A suspected ectopic pregnancy can put the client at risk for hypovolemic shock. NOT 2 The assessment of vital signs should be performed first, followed by any procedures to maintain the ABCs. 3.4. Providing emotional support would also occur, as would obtaining a surgical consent, if needed, but these are not first steps

A primigravida 21-year-old client at 24 weeks' gestation has a 2-year history of HIV. As the nurse explains the various options for delivery, which factor should the nurse point out will influence the decision for a vaginal birth? 1 the viral load 2 amniocentesis results at 34 weeks' gestation 3 the mother's age 4 prophylactic antiretroviral therapy (ART) to the infant at birth

1 A woman who has HIV during pregnancy is at risk for transmitting the infection to the fetus during pregnancy or childbirth and to the newborn while breastfeeding. The type of birth, vaginal or cesarean, depends on several factors, including the woman's viral load, use of ART during pregnancy (not waiting until the birth), length of time membranes have been ruptured, and gestational age (not mother's age). NOT 4 With prenatal ART (antiretroviral therapy) and prophylactic treatment of the newborn, there is a reduced risk of perinatal HIV transmission. 2 The amniocentesis results would not be a factor in preventing the spread of HIV to the infant and may actually lead to the fetus being infected through the puncture site and bleeding into the amniotic sac.

A 40-year-old female client with a chronic pelvic infection expresses her desire to conceive post-treatment. When discussing this with the client the nurse keeps in mind that the client is at increased risk for which of the following? 1 ectopic pregnancy 2 symptoms of menopause 3 decreased menses 4 gestational diabetes

1 Chronic pelvic infection increases the risk for narrowed or blocked fallopian tubes. It decreases the possibility of fertility or increases the risk of ectopic pregnancy. NOT 2 Only in case of a premature ovarian failure will the client experience symptoms of menopause earlier than expected. 2 A client with hyperthyroidism will experience decreased or absent menses. 4 The client with chronic pelvic infection is not susceptible to gestational diabetes. Clients with multiple gestations are more susceptible to gestational diabetes.

The nurse recognizes that documenting accurate blood pressures is vital in the diagnosing of preeclampsia, severe preeclampsia and eclampsia. The nurse suspects preeclampsia based on which finding? 1 BP of 140/90 mm Hg last week and at current visit after 20 weeks' gestation 2 BP of 130/90 mm Hg on three occasions 3 hours apart 3 BP of 160/110 mm Hg on two occasions after 28 weeks' gestation 4 BP of 120/90 mm Hg on three occasions after 20 weeks' gestation

1 Gestational hypertension is diagnosed when systolic blood pressure is over 140 mm Hg and/or diastolic pressure is over 90 mm Hg on at least two occasions at least 4 to 6 hours apart after the 20th week of gestation in women known to be normotensive prior to this time and prior to pregnancy. NOT 3 Severe preeclampsia (i.e., preeclampsia with severe features) may develop suddenly or within days and bring with it high blood pressure of more than 160/110 mm Hg, cerebral and visual symptoms, and pulmonary edema

A nurse is assessing the following antenatal clients. Which client is at highest risk for having a multiple gestation? 1 the 41-year-old client who conceived by in vitro fertilization 2 the 38-year-old client whose spouse is a triplet 3 the 19-year-old client diagnosed with polycystic ovary syndrome 4 the 27-year-old client who gave birth to twins 2 years ago

1 The nurse should assess infertility treatment as a contributor to the increased probability of multiple gestations. Multiple gestations do not occur with an adolescent birth; instead, chances of multiple gestations are known to increase due to the increasing number of women giving birth at older ages.

A woman with gestational hypertension develops eclampsia and experiences a seizure. Which intervention would the nurse identify as the priority? 1 fluid replacement 2 oxygenation 3 control of hypertension 4 birth of the fetus

2 As with any seizure, the priority is to clear the airway and maintain adequate oxygenation both to the mother and the fetus. NOT 1.3. Fluids and control of hypertension are addressed once the airway and oxygenation are maintained. 4 Delivery of fetus is determined once the seizures are controlled and the woman is stable.

Human papillomavirus (HPV) can cause condylomata acuminata that can develop in clusters on the vulva, within the vagina, on the cervix, or around the anus. What is their risk? 1 neonatal auricular papillomas 2 block a vaginal birth 3 heavy bleeding during vaginal birth 4 neonatal hemorrhage

2 Genital warts have a tendency to increase in size during pregnancy. These warts may grow large enough to block a vaginal birth. The pregnant woman can pass HPV to her fetus during the birth process. In rare instances, neonatal HPV infection can result in life-threatening laryngeal papillomas. HPV infection transmitted to the infant may not appear for as long as 10 years after birth.

The nurse is giving discharge instructions to a client who experienced a complete spontaneous abortion (miscarriage). Which question should the nurse prioritize at this time? 1 "Are you going to wait a while before you try to get pregnant again?" 2 "Do you have someone to talk to, or may I give you the names and numbers for some possible grief counselors?" 3 "Did you know that 75% of women who are trying to get pregnant experience this same thing?" 4 "May I give you some resources that you can use to try to prevent this from happening again?"

2 When a woman has a spontaneous abortion (miscarriage) one important consideration is the emotional needs of the woman once she is home. She may not want to talk about the loss for a period of time, but the nurse needs to determine her support system for the future. NOT 1 Asking the woman if she is "going to try again" is an inappropriate question for the nurse to ask and diminishes the experience of having a spontaneous abortion (miscarriage). 3.4. It would be inappropriate to point out the woman is not the only one to have this experience or to offer ways to prevent it from happening in the future. The woman needs to deal with this situation first before moving on to a possible "next" time.

A nurse is monitoring a client with PROM who is in labor and observes meconium in the amniotic fluid. What does the observation of meconium indicate? 1 cord compression 2 fetal distress related to hypoxia 3 infection 4 CNS involvement

2 When meconium is present in the amniotic fluid, it typically indicates fetal distress related to hypoxia. Meconium stains the fluid yellow to greenish brown, depending on the amount present. NOT 1 A decreased amount of amniotic fluid reduces the cushioning effect, thereby making cord compression a possibility. 3 A foul odor of amniotic fluid indicates infection. 4 Meconium in the amniotic fluid does not indicate CNS involvement

The nurse is comforting and listening to a young couple who just suffered a spontaneous abortion (miscarriage). When asked why this happened, which reason should the nurse share as a common cause? 1 Maternal smoking 2 Lack of prenatal care 3 Chromosomal abnormality 4 The age of the mother

3 The most common cause for the loss of a fetus in the first trimester is associated with a genetic defect or chromosomal abnormality. There is nothing that can be done and the mother should feel no fault. The nurse needs to encourage the parents to speak with a health care provider for further information and questions related to genetic testing. NOT 1.2.4. Early pregnancy loss is not associated with maternal smoking, lack of prenatal care, or the age of the mother

A client in her third trimester comes in for a routine prenatal visit. The nurse places her in a comfortable position and attaches the tocodynamometer and ultrasound monitor to the client's abdomen. What is the purpose of this test? 1 to assess readiness for dilation (dilatation) 2 to assess fetal position 3 to assess fetal well-being 4 to assess readiness for delivery

3 During the third trimester, the client may be scheduled for a nonstress test (NST) in conjunction with her prenatal visit. The purpose of the NST is to assess fetal well-being. If the client is scheduled for an NST, the nurse will put the client on the electronic fetal monitor after her usual data are gathered. The nurse puts the client in a comfortable position, places the tocodynamometer on the fundus to measure uterine contractions, and places the ultrasound monitor where the fetal heart can be heard and measure its rate (FHR). The nurse checks periodically to make sure that the sensors are tracing accurately and that the mother is still comfortable. If the monitoring strip is not becoming reactive, the nurse may offer the mother a position change or a drink of juice in hopes of stimulating the fetus to react to these changes. The nurse reports any sign of fetal distress to the provider immediately

A woman in her 20s has experienced a spontaneous abortion (miscarriage) at 10 weeks' gestation and asks the nurse at the hospital what went wrong. She is concerned that she did something that caused her to lose her baby. The nurse can reassure the woman by explaining that the most common cause of miscarriage in the first trimester is related to which factor? 1 Exposure to chemicals or radiation 2 Advanced maternal age 3 Chromosomal defects in the fetus 4 Faulty implantation

3 Fetal factors are the most common cause of early miscarriages, with chromosomal abnormalities in the fetus being the most common reason. This client fits the criteria for early spontaneous abortion (miscarriage) since she was only 10 weeks' pregnant and early miscarriage occurs before 12 weeks

The following hourly assessments are obtained by the nurse on a client with preeclampsia receiving magnesium sulfate: 97.3oF (36.2oC), HR 88, RR 12 breaths/min, BP 148/110 mm Hg. What other priority physical assessments by the nurse should be implemented to assess for potential toxicity? 1 Lung sounds 2 Oxygen saturation 3 Reflexes 4 Magnesium sulfate level

3 Reflex assessment is part of the standard assessment for clients on magnesium sulfate. The first change when developing magnesium toxicity may be a decrease in reflex activity. The health care provider needs to be notified immediately. NOT 1.2. A change in lung sounds and oxygen saturation are not indicative of magnesium sulfate toxicity. 4 Hourly blood draws to gain information on the magnesium sulfate level are not indicated

A client at 11 weeks' gestation experiences pregnancy loss. The client asks the nurse if the bleeding and cramping that occurred during the miscarriage were caused by working long hours in a stressful environment. What is the most appropriate response from the nurse? 1 "Your spontaneous bleeding is not work-related." 2 "It is hard to know why a woman bleeds during early pregnancy." 3 "I can understand your need to find an answer to what caused this. Let's talk about this further." 4 "Something was wrong with the fetus."

3 Talking with the client may assist her to explore her feelings. She and her family may search for a cause for a spontaneous early bleeding so they can plan for future pregnancies. Even with modern technology and medical advances, however, a direct cause cannot usually be determined

A nurse is conducting an in-service program for a group of nurses working at the women's health facility about the causes of spontaneous abortion (miscarriage). The nurse determines that the teaching was successful when the group identifies which condition as the most common cause of first-trimester miscarriage? 1 maternal disease 2 cervical insufficiency 3 fetal genetic abnormalities 4 uterine fibroids (uterine myomas)

3 The causes of spontaneous abortion (miscarriage) are varied and often unknown. The most common cause for first-trimester miscarriage is fetal genetic abnormalities, usually unrelated to the mother. Chromosomal abnormalities are more likely causes in first trimester, and maternal disease is more likely in the second trimester. NOT 1.2.4. Those occurring during the second trimester are more likely related to maternal conditions, such as cervical insufficiency, congenital or acquired anomaly of the uterine cavity (uterine septum or fibroids), hypothyroidism, diabetes, chronic nephritis, use of crack cocaine, inherited and acquired thrombophilias, lupus, polycystic ovary syndrome, severe hypertension, and acute infection such as rubella virus, cytomegalovirus, herpes simplex virus, bacterial vaginosis, and toxoplasmosis

A client with a history of cervical insufficiency is seen for reports of pink-tinged discharge and pelvic pressure. The primary care provider decides to perform a cervical cerclage. The nurse teaches the client about the procedure. Which client response indicates that the teaching has been effective? 1 "Staples are put in the cervix to prevent it from dilating." 2 "The cervix is glued shut so no amniotic fluid can escape." 3 "Purse-string sutures are placed in the cervix to prevent it from dilating." 4 "A cervical cap is placed so no amniotic fluid can escape."

3 The cerclage, or purse string suture, is inserted into the cervix to prevent preterm cervical dilation (dilatation) and pregnancy loss. NOT 1.2.4. Staples, glue, or a cervical cap will not prevent the cervix from dilating.

A 32-year-old gravida 3 para 2 at 36 weeks' gestation comes to the obstetric department reporting abdominal pain. Her blood pressure is 164/90 mm Hg, her pulse is 100 beats per minute, and her respirations are 24 per minute. She is restless and slightly diaphoretic with a small amount of dark red vaginal bleeding. What assessment should the nurse make next? 1 Check deep tendon reflexes. 2 Measure fundal height. 3 Palpate the fundus and check fetal heart rate. 4 Obtain a voided urine specimen and determine blood type.

3 The classic signs of placental abruption (abruptio placentae) are pain, dark red vaginal bleeding, a rigid, board-like abdomen, hypertonic labor, and fetal distress

A 44-year-old client has lost several pregnancies over the last 10 years. For the past 3 months, she has had fatigue, nausea, and vomiting. She visits the clinic and takes a pregnancy test; the results are positive. Physical examination confirms a uterus enlarged to 13 weeks' gestation; fetal heart tones are heard. Ultrasound reveals that the client is experiencing some bleeding. Considering the client's prenatal history and age, what does the nurse recognize as the greatest risk for the client at this time? 1 premature birth 2 hypertension 3 spontaneous abortion (miscarriage) 4 preterm labor

3 The client's advanced maternal age (pregnancy in a woman 35 years or older) increases her risk for spontaneous abortion (miscarriage). NOT 1.2.4. Hypertension, preterm labor, and prematurity are risks as this pregnancy continues. Her greatest risk at 13 weeks' gestation is losing this pregnancy

The nurse is monitoring a pregnant client who is receiving intravenous magnesium sulfate for eclampsia. During the last assessment, the nurse was unable to elicit a patellar reflex. What should the nurse do? 1 Check the fetal heart rate. 2 Measure blood pressure. 3 Stop the current infusion. 4 Increase the infusion rate.

3 When infusing magnesium sulfate, the nurse should stop the infusion if deep tendon reflexes are absent. NOT 1.2. Checking the fetal heart rate and measuring blood pressure could waste time and provide the client with more magnesium sulfate. 4 The infusion rate should not be increased because this could lead to cardiac dysrhythmias and respiratory depression

A novice nurse asks to be assigned to the least complex antepartum client. Which condition would necessitate the least complex care requirements? 1 preeclampsia 2 placental abruption (abruptio placentae) 3 placenta previa 4 gestational hypertension

4 Hypertensive disorders represent the most common complication of pregnancy. Gestational hypertension is elevated blood pressure without proteinuria, other signs of preeclampsia, or preexisting hypertension. NOT 2 Placental abruption (abruptio placentae), a separation of the placenta from the uterine wall; 3 placenta previa (placenta covering the cervical os); and 1 preeclampsia are high-risk, potentially life-threatening conditions for the fetus and mother during labor and birth

The nurse is transcribing messages from the answering service. Which phone message should the nurse return first? 1 an 18-year-old, 38-week G2P1 client with intermittent cramping; the client's last blood pressure was 98/50 mm Hg, and proteinuria was 1+ 2 a 25-year-old, 31-week G1P0 client with blood pressure of 100/80 mm Hg and left flank pain; the client's last blood pressure was 100/77 mm Hg and she had no proteinuria 3 a 20-year-old, 31-week G1P0 client with malaise and rhinitis; the client's last blood pressure was 120/80 mm Hg, and she had no proteinuria 4 a 35-year-old, 21-week G3P2 client with blood pressure of 160/110 mm Hg, blurred vision, and whose last blood pressure was 143/99 mm Hg and urine dipstick showed a +2 proteinuria

4 The nurse should call the at-risk 35-year-old client first. She is 21 weeks and has symptoms (blurred vision) of preeclampsia. She also had an increase of protein in her urine (2+) and a 15% increase in her BP. NOT 1.2. The nurse will need more information to determine if the 38-week client may be in the early stages of labor, and if the 31-week client with flank pain has a kidney infection. 3 The client with malaise and rhinitis will need to talk to the nurse last to find out what over-the-counter medication she is able to take.