Exam 1: Evolve Quiz

Which exercise would the nurse instruct the women in a childbirth preparation class to use for toning the muscles of the pelvic floor? Pelvic tilt Half sit-ups Pelvic rocking Kegel exercises

Kegel exercises Kegel exercises tone the pelvic floor muscles and prepare the area for the second stage of labor. Pelvic tilt, half sit-ups, and pelvic rocking exercises all alleviate backache and strengthen the abdominal muscles.

which vaccines are safe to administer?

TDAP and Hepatitis B

melanocyte-stimulating hormone (MSH)

affects skin pigmentation

vitamin B9

folic acid

The primigravida would be taught by the nurse to anticipate quickening in which week of pregnancy? 24th week 20th week 16th week 12th week

20th week Most primigravidas feel movement by the 20th week of gestation. The 24th week is very late for the pregnant woman to feel initial movement; lack of movement by the 24th week should be investigated. Multiparas may feel movement by the 16th week; however, most primigravidas feel movement between 18 and 20 weeks. Twelve weeks is too early for movement to be felt.

Which diagnosis would the nurse expect in a client at 10 weeks' gestation with vaginal bleeding, abdominal cramping, and a cervical dilation of 2 cm? eptic abortion Inevitable abortion Threatened abortion Incomplete abortion

incomplete Once cervical dilation has begun, the abortion is classified as inevitable. In septic abortion, the cervix is dilated and there is bleeding, but malodorous discharge is also present. Bleeding and cramping may be present in a threatened abortion; however, the cervix is still closed. The products of conception have been partially expelled in an incomplete abortion.

Inevitable abortion

increased bleeding, cramping; cervix dilates

Which description explains striae gravidarum encountered in a client in her 26th week of gestation? Brownish blotches on the face Purplish discoloration of the cervix Reddish streaks on the abdomen and breasts A black line running between the umbilicus and mons veneris

Reddish streaks on the abdomen and breasts Reddish streaks on the abdomen and breasts are striae gravidarum; they occur as a result of stretching of the breast and abdominal skin. These are known as "stretch marks." Chloasma refers to the condition in which brownish blotches develop on the face. Purplish discoloration of the cervix is the Chadwick sign. A black line running between the umbilicus and mons veneris is the linea nigra.

Which information would the nurse give a pregnant client about having a chorionic villus sampling (CVS) before the 10th and 12th weeks? The test can cause fetal anomalies. The results are not as accurate. The information it provides is inadequate. It must be done with the use of laparoscopic surgery.

The test can cause fetal anomalies The American Congress of Obstetricians and Gynecologists recommends that CVS not be performed before 9 weeks' gestation and should be performed between 10 to 12 weeks. If performed before 9 weeks' gestation, it has the potential of interfering with organogenesis. The test, if successfully performed, is 100% accurate, and it provides enough information for a diagnosis. A laparoscopic procedure is not necessary, because CVS is performed either by means of transcervical catheter aspiration or transabdominal needle aspiration.

Threatened abortion

vaginal bleeding, abdominal cramping, cervix closed

Which laboratory finding of a pregnant client would alert the nurse to the need for further assessment? Hemoglobin of 10 g/dL (100 mmol/L) Urine specific gravity of 1.020 Glucose level of 1+ in the urine White blood cell count of 9000/mm 3 (9 × 10 9/L)

Hemoglobin of 10 g/dL (100 mmol/L) This hemoglobin reading suggests a true anemia. The lowest hemoglobin resulting from physiological anemia of pregnancy is 12 g/dL (120 mmol/L). This type of anemia occurs because the plasma volume increases to a greater extent than the red blood cells during pregnancy. A urine specific gravity of 1.020 is within the expected range of 1.010 to 1.030. A 1+ urine glucose level is not unusual during pregnancy because of the lowered renal threshold for glucose during pregnancy; if it increases to 2+, further investigation for diabetes should be undertaken. A white blood cell count of 9000/mm 3 (9 × 10 9/L) is within the expected range of 5000 to 10,000/mm 3 (5 to 10 × 10 9 mmol/L). It may increase to 15,000/mm 3 during the second half of pregnancy.

The nurse gently performs Leopold maneuvers on a client with a suspected placenta previa. Which would the nurse expect to find during this assessment? Firm engagement of the fetal head Difficulty palpating small fetal parts A high, floating fetal presenting part A hard and tetanically contracted uterus

A high, floating fetal presenting part With a low-implanted placenta (placenta previa) the presenting part may have difficulty entering the pelvis. Engagement of the fetal head is difficult with a low-lying placenta. Placenta previa does not make it difficult to palpate small fetal parts. A uterus that is hard and tetanically contracted is found in abruptio placentae.

An increase in which factor causes urinary frequency in the first trimester of pregnancy? Estrogen level Extracellular fluid volume Kidney glomerular filtration Bladder pressure from the enlarged uterus

Bladder pressure from the enlarged uterus The anatomical position of the uterus in the pelvis is directly above the urinary bladder; as the uterus enlarges, it exerts pressure on the bladder. After the first trimester, the uterus rises into the abdominal cavity and urinary frequency lessens until late pregnancy, when the descent of the presenting part of the fetus exerts pressure on the bladder and the client would again experience urinary frequency. Estrogen causes fluid retention, not frequency. An increase in extracellular volume does not occur until the second trimester. An increased glomerular filtration rate does not cause urinary frequency.

Which cardiovascular changes would the nurse include in a prenatal class explaining physiological changes in the second trimester of pregnancy? Select all that apply. One, some, or all responses may be correct. Cardiac output increases. Blood pressure decreases. The heart is displaced upward. The blood plasma volume peaks. The hematocrit level is lowered.

Cardiac output increases. Blood pressure decreases. The heart is displaced upward. Cardiac output increases during the second trimester due to an increasing plasma volume. The blood pressure decreases because of the enlarged intravascular compartment and hormonal effects on peripheral resistance. As the fetus grows and the enlarging uterus outgrows the pelvic cavity, it displaces the heart upward and to the left. The blood volume starts to increase earlier, but does not peak until the third trimester. The reduction in hematocrit occurs in the first trimester; the erythrocyte increase may not be in direct proportion to the blood volume, lowering hematocrit and hemoglobin levels, which remain lower throughout pregnancy.

Which vaccines are considered teratogens?

Chickenpox, mumps and measles

Which is a primary focus of teaching for a pregnant adolescent at her first prenatal clinic visit? Instructing her about the care of an infant Informing her of the benefits of breast-feeding Advising her to watch for danger signs of preeclampsia Encouraging her to continue regularly scheduled prenatal care

Encouraging her to continue regularly scheduled prenatal care It is not uncommon for adolescents to avoid prenatal care; many do not recognize the deleterious effect that lack of prenatal care can have on them and their infants. Instruction in the care of an infant can be done in the later part of pregnancy and reinforced during the postpartum period. Informing the client of the benefits of breast-feeding should come later in pregnancy but not before the client's feelings about breast-feeding have been ascertained. Advising the client to watch for danger signs of preeclampsia is necessary, but it is not the priority intervention at this time.

Which nursing intervention is necessary to prepare a client with a suspected placenta previa for a repeat sonogram at 16 weeks' gestation? Inserting an indwelling urinary catheter Cleansing the abdomen with germicidal soap Ensuring that the client drinks two 8-oz (237-mL) glasses of water Administering a cleansing enema of 500 mL of normal saline

Ensuring that the client drinks two 8-oz (237-mL) glasses of water A full bladder helps stabilize the uterus during sonography, allowing better visualization of the fetus. Two full glasses of water, ingested 1 hour before the test, will fill the bladder. Emptying the bladder with an indwelling urinary catheter is inadvisable, because a full bladder supports the uterus and improves visualization. Because the procedure is noninvasive, it is unnecessary to cleanse the skin. An enema is contraindicated when placenta previa is suspected and will not improve visualization of the uterus anyway.

Septic abortion

Fever, abdominal pain and tenderness; foul-smelling vaginal discharge; bleeding from scant to heavy; treated with termination of pregnancy, antibiotic therapy and monitoring for shock

A 26-year-old primigravida experiencing severe abdominal pain is brought to the emergency department by ambulance with a suspected ruptured tubal pregnancy. Which is the priority nursing action? Inserting an intravenous (IV) catheter Asking the client to sign a surgical consent form Determining whether a family member is present Ascertaining the first day of the client's last menstrual period

Inserting an intravenous (IV) catheter The client is at risk for hypovolemic shock resulting from hemorrhage; administration of IV fluids is the priority. Asking the client to sign a surgical consent form, determining whether a family member is present, or ascertaining the first day of the client's last menstrual period is not the priority in an emergency situation.

Which would the nurse do to prepare a client in her third trimester who is scheduled for an amniocentesis? Instruct her to void immediately before the test. Tell her to assume the high Fowler position before the test. Encourage her to drink three glasses of water before the test. Advise her to take nothing by mouth for several hours before the test.

Instruct her to void immediately before the test. The client is instructed to void immediately before the test to help prevent injury to the bladder as the needle is introduced into the amniotic sac. The supine position with a hip roll under the right hip is the preferred position for this procedure. Telling the client to assume the high Fowler position before the test will cause the bladder to fill, making it vulnerable to injury as the needle is inserted into the amniotic sac. Encouraging the client to drink three glasses of water before the test is advised if the amniocentesis is being performed early during pregnancy. There is no reason to withhold food or fluid, because the test does not involve the gastrointestinal tract.

Where on the maternal abdomen would the nurse place the fetal heart transducer when the fetus is in the left sacrum anterior position? Left lower quadrant Left upper quadrant Right upper quadrant Midline lower quadrant

Left upper quadrant The left sacrum anterior position indicates that the fetus is in a breech presentation and the head is in the fundus; fetal heart sounds are best heard in the left upper quadrant. Fetal heart sounds will be in the left lower quadrant if the fetus is in the left occiput anterior position. Fetal heart sounds will be in the right upper quadrant if the fetus is in the right sacrum anterior position. The fetal heart sounds will not be heard in the midline part of a lower quadrant in a single-fetus pregnancy.

Which finding would be a concern when assessing a client at 35 weeks' gestation? Frequent painless urination Painful intermittent contractions Increased fetal movement after eating Lower back pain that results in insomnia

Painful intermittent contractions Painful contractions at this time may indicate preterm labor or the presence of preparatory contractions (also known as Braxton-Hicks contractions). The client's painful intermittent contractions must be assessed further to distinguish between the two types. Frequent urination is common during the last trimester because of the pressure of the enlarging fetus; painful urination may indicate a urinary tract infection. Fetal movement usually increases after the mother eats. Difficulty sleeping and lower back pain are both common adaptations during the third trimester.

The nurse explains to the client that infertility caused by a defect in the tube is most often related to which condition? A tubal injury Past infection A fibroid tumor A congenital anomaly

Past infection Past pelvic infections may result in tubal occlusions, most of which are caused by postinfection adhesions. Although tubal injury is possible, tubal infections are more common. Fibroid tumor is a benign tumor of the uterus and does not affect the tube unless it was so large as to compress the tube. Tubal congenital anomalies are rare; uterine anomalies are more common.

Women who become pregnant for the first time at a later reproductive age (35 years or older) are at risk for which complications? Select all that apply. One, some, or all responses may be correct. Seizures Preterm labor Multiple gestation Chromosomal anomalies Bleeding in the first trimester

Preterm labor Multiple gestation Chromosomal anomalies Bleeding in the first trimester Increased risk for preterm labor is linked to age; it occurs more commonly in older primigravidas and adolescents. Mature women have an increased incidence of multiple gestations as a result of fertility medication use and in vitro fertilization. After 35 years of age, mature women have an increased risk of having children with chromosomal abnormalities. Bleeding in the first trimester as a result of spontaneous abortion is more common in mature gravidas. Seizures are not more common in mature gravidas.

A client at 28 weeks' gestation visits the clinic for a routine examination. Which finding is of greatest concern to the nurse? Puffy fingers Glycosuria 1+ Proteinuria 1+ Dependent edema

Puffy fingers One sign of mild preeclampsia is puffiness of the fingers, eyes, and face. Glycosuria is a common finding in pregnancy; an increased glomerular filtration rate in conjunction with decreased capacity of the tubules to reabsorb glucose may cause spillage of glucose into urine. Minimal proteinuria may occur in a healthy pregnancy; the amount of protein that must be filtered exceeds the ability of the tubules to absorb it, causing small amounts to be lost in the urine. Venous obstruction from the gravid uterus decreases blood flow to the heart; as a result, fluid pools in the lower extremities; dependent edema is expected.

A client being prepared for surgery because of a ruptured tubal pregnancy reports that she feels light-headed. Her pulse is rapid, and her color is pale. Which common complication of a ruptured tubal pregnancy is suggested by these findings? Shock Anxiety Infection Hyperoxygenation

Shock Hemorrhage can result from a ruptured tubal pregnancy, and shock may ensue. Although the client may be very anxious, the signs and symptoms are those of hemorrhagic shock. There are no data, such as fever or a rising white blood cell count, to support the conclusion that the client has an infection. The data do not support a hyperoxygenated state.

Which complication of pregnancy is of most concern when there is a positive contraction stress test (CST)? Preeclampsia Placenta previa Imminent preterm birth Uteroplacental insufficiency

Uteroplacental insufficiency A positive CST indicates a compromised fetus during contractions, which is associated with uteroplacental insufficiency. Preeclampsia does not cause a positive CST. The CST is contraindicated in women with suspected placenta previa, because the contractions can cause bleeding and may stimulate the onset of true labor. A CST is contraindicated in a woman with the potential for preterm birth or a pregnancy of less than 33 weeks' gestation because contractions may stimulate true labor.

Incomplete abortion

products of conception partially expelled

Past pelvic infections may result in what?

tubal blockage, which can lead to tubal infections