Exam 4 Evolve and more

The nurse has evaluated a client with preeclampsia by assessing DTRs. The result is a grade of 3+. Which DTR response most accurately describes this score?

More brisk than expected, slightly hyperactive

For clinical purposes, the most accurate definition of preterm and postterm infants is defined as what?

Preterm: Before 37 weeks of gestation and postterm beyond 42 weeks of gestation; no matter the size for gestational age at birth

A nurse is evaluating several obstetric patients for their risk for cervical insufficiency. Which patient would be considered to be most at risk?

Primip who undergoes a cervical cone biopsy for cervical dysplasia prior to the pregnancy

Which statement regarding hemolytic diseases of the newborn is most accurate?

The indirect Coombs test is performed on the mother before birth; the direct Coombs test is performed on the cord blood after birth.

With regard to hemolytic diseases of the newborn, nurses should be aware that:

The indirect Coombs test is performed on the mother before birth; the direct Coombs test is performed on the cord blood after birth.

Which pregnant client does the nurse suspect is most likely to have placenta previa?

The individual who had the most pregnancies (gravida)

When providing an infant with a gavage feeding, what should the nurse document each time?

The infant's response to the feeding

A woman at 22 weeks' gestation is admitted with heavy bleeding and severe abdominal cramping. When told that no fetal heart sounds can be detected, the client says to the nurse, "We wanted this baby so badly." How should the nurse respond?

"It must be difficult to lose this baby that was important to you both."

S/s of dysfunctional labor

- Contractions too far apart or too close apart - hypertonic uterine contractions - hypotonic uterine contractions

what intervention should be included for SGA newborn

- check FSBS

While working with the pregnant client in her first trimester, what information does the nurse provide regarding when CVS can be performed (in weeks of gestation)?

10 weeks (10-13)

At what weeks should Chorionic villi sampling be done?

10-12 wks

how early can an an amniocentesis be performed

14th week

MSAFP test is performed at what weeks?

15-20 wks

The American College of Obstetricians and Gynecologists (ACOG) has developed a comprehensive list of risk factors associated with the development of preeclampsia. Which client exhibits the greatest number of these risk factors

19-year-old African American who is pregnant with twins

Diabetes refers to a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin action, insulin secretion, or both. Over time, diabetes causes significant changes in the microvascular and macrovascular circulations. What do these complications include? (SATA) a. Atherosclerosis b. Retinopathy c. Intrauterine fetal death (IUFD) d. Nephropathy e. Neuropathy f. Autonomic neuropathy

ABDE a. Atherosclerosis b. Retinopathy d. Nephropathy e. Neuropathy

A client who has undergone a D&C for early pregnancy loss is likely to be discharged the same day. The nurse must ensure that her vital signs are stable, that bleeding has been controlled, and that the woman has adequately recovered from the administration of anesthesia. To promote an optimal recovery, what information should discharge teaching include? (SATA) a. Iron supplementation b. Resumption of intercourse at 6 weeks postprocedure c. Referral to a support group, if necessary d. Expectation of heavy bleeding for at least 2 weeks e. Emphasizing the need for rest

ACE a. Iron supplementation c. Referral to a support group, if necessary e. Emphasizing the need for rest

Which adverse prenatal outcomes are associated with the HELLP syndrome? (SATA) a. Placental abruption b. Placenta previa c. Renal failure d. Cirrhosis e. Maternal and fetal death

ACE a. Placental abruption c. Renal failure e. Maternal and fetal death

Which is the initial treatment for the client with vWD who experiences a PPH?

Desmopressin

Which finding on a prenatal visit at 10 weeks of gestation might suggest a hydatidiform mole?

Fundal height measurement of 18 cm

What is the most common medical complication of pregnancy?

Hypertension

Which of the following antihypertensive medications would cause a pregnant woman to have a positive Coombs test result?

Methyldopa (Aldomet)

When the cervix is soft, anterior, 50% effaced, and dilated 2 cm or more, what does this indicate on the Bishop score?

That the score is 8 or more and that induction of labor will usually be successful.

T/F: The abdominal ultrasound examination requires a full bladder. and it is more useful after the first trimester.

True

Vasa previa can be caused by?

Velamentous insertion of the umbilical cord

In planning for an expected cesarean birth for a woman who has given birth by cesarean section previously and who has a fetus in the transverse presentation, the nurse includes which information?

"Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures."

After giving birth to a stillborn infant, the woman turns to the nurse and says, "I just finished painting the baby's room. Do you think that caused my baby to die?" The nurse's best response to this woman is:

"I can understand your need to find an answer to what caused this. What else are you thinking about?"

The most appropriate statement that the nurse can make to bereaved parents is:

"I'm sorry."

Contraindications of induced labor

-Acute, severe fetal distress - shoulder presentation (transverse lie) - Floating fetal presenting part - uncontrolled hemorrhage - placenta previa - previous uterine incision that prohibits a trial of labor

What types of miscarriage include moderate to heavy amount of bleeding with cervical dilation?

-Inevitable -Incomplete

When is a prophylactic cerclage for an incompetent cervix usually placed (in weeks of gestation)?

12-14 weeks

Normal baby blood sugar

40-60

An infant at 36 weeks of gestation has increasing respirations (80 to 100 breaths per minute with significant substernal retractions). The infant is given oxygen by continuous nasal positive airway pressure (CPAP). What level of partial pressure of arterial oxygen (PaO2) indicates hypoxia?

45mmHg

A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. The client shows the nurse her readings for the past few days. Which reading signals the nurse that the client may require an adjustment of insulin or carbohydrates?

50 mg/dl just after waking up from a nap. This is too low; maybe eat a snack before going to sleep

A nurse is caring for a client whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of:

A fetal heart rate (FHR) of 180 with absence of variability.

Concerning congenital abnormalities involving the central nervous system, nurses should be aware that:

A major preoperative nursing intervention for a neonate with myelomeningocele is to protect the protruding sac from injury.

Which statement is accurate regarding the ABO blood typing system in the body?

A person with type O blood has antibodies to type A and type B.

Women who are obese are at risk for several complications during pregnancy and birth. Which of these would the nurse anticipate with an obese client? (SATA) a. Thromboembolism b. Cesarean birth c. Wound infection d. Breech presentation e. Hypertension

ABCE a. Thromboembolism b. Cesarean birth c. Wound infection e. Hypertension

Which medications are used to manage PPH? (SATA) a. Oxytocin b. Methergine c. Terbutaline d. Hemabate e. Magnesium sulfate

ABD a. Oxytocin b. Methergine d. Hemabate

Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. What are generalized signs and symptoms of this condition?

Abdominal distention, temperature instability, and grossly bloody stools

Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. Some generalized signs are:

Abdominal distention, temperature instability, and grossly bloody stools.

A 16-year-old primigravida who appears to be at or close to term arrives at the emergency department stating that she is in labor and complaining of pain continuing between contractions. The nurse palpates the abdomen, which is firm and shows no sign of relaxation. What problem does the nurse conclude that the client is experiencing?

Abruptio placentae

A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes, dark red vaginal bleeding, and a tense, painful abdomen. Which clinical change does the nurse anticipate?

Abruptio placentae

Which of the following is the most common kind of placental adherence seen in pregnant women?

Accreta

A client is diagnosed with having a stillborn infant. At first, she appears stunned by the news, cries a little, and then asks the nurse to call her mother. What is the proper term for the phase of bereavement that this client is experiencing?

Acute distress

A woman is diagnosed with having a stillborn. At first she appears stunned by the news, cries a little, and then asks you to call her mother. The phase of bereavement the woman is experiencing is called:

Acute distress.

An Rh-negative woman has a miscarriage during the 8th week of pregnancy and a D&C is required. Which priority intervention would be required in the recovery period following the surgical procedure?

Administer RhoGAM.

A pregnant woman arrives at the birth unit in labor at term, having had no prenatal care. After birth, her infant is noted to be small for gestational age with small eyes and a thin upper lip. The infant also is microcephalic. Based on her infants physical findings, this woman should be questioned about her use of which substance during pregnancy?

Alcohol

Which substance, when abused during pregnancy, is the most significant cause of cognitive impairment and dysfunction in the infant?

Alcohol

In caring for a mother who has abused (or is abusing) alcohol and for her infant, nurses should be aware that:

Alcohol-related neurodevelopmental disorders (ARNDs) not sufficient to meet FAS criteria (learning disabilities, speech and language problems) are often not detected until the child goes to school.

A multiparous client with a history of gestational hypertension and previous history of abruption is in the transition phase of labor. The electronic fetal monitor shows fetal bradycardia, and a change is seen in the contour of the client's abdomen. What is the nurse's priority intervention?

Alerting others regarding the need for immediate cesarean delivery

Which priority action would be most beneficial in helping a couple deal with fetal loss following the delivery of a stillborn?

Allow the parents to hold and view the baby following delivery if they so request.

The obstetric provider has informed the nurse that she will be performing an amniotomy on the client to induce labor. What is the nurses highest priority intervention after the amniotomy is performed?

Assessing the fetal heart rate (FHR)

Which nursing intervention should be immediately performed after the forceps- assisted birth of an infant?

Assessing the infant for signs of trauma

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

Assisting the client into the Trendelenburg position

What is the stimulation of uterine contractions after labor has started spontaneously but is not progressing satisfactorily?

Augmentation of labor

Indications for a primary cesarean birth are often nonrecurring. Therefore, a woman who has had a cesarean birth with a low transverse scar may be a candidate for vaginal birth after cesarean (VBAC). Which clients would beless likely to have a successful VBAC? (SATA) a. Lengthy interpregnancy interval b. African-American race c. Delivery at a rural hospital d. Estimated fetal weight <4000 g e. Maternal obesity (BMI >30)

BCE b. African-American race c. Delivery at a rural hospital e. Maternal obesity (BMI >30)

Which information is the highest priority for the nurse to comprehend regarding the BPP?

BPP is an accurate indicator of impending fetal well-being.

Which order should the nurse expect for a client admitted with a threatened abortion?

Bed rest

When would the best timeframe be to establish gestational age based on ultrasound?

Between 14 and 22 weeks

Which statement related to cephalopelvic disproportion (CPD) is the least accurate?

CPD can be accurately predicted.

Which statement regarding congenital anomalies of the cardiovascular and respiratory systems is correct?

Cardiac disease may demonstrate signs and symptoms of respiratory illness.

When attempting to screen and educate parents regarding the treatment of developmental dysplasia of the hip (DDH), which intervention should the nurse perform?

Carefully monitor infants for DDH at follow-up visits.

The nurse in the birthing unit assesses a primigravida who is at 42 weeks' gestation. Fluid is leaking from her vagina, and she is complaining of back pain. Which conclusion is supported by the data that the nurse has collected?

Cesarean birth is anticipated

The nurse applies fetal and uterine monitors to the abdomen of a client in active labor. When the client has contractions, the nurse notes a 15 beats/min deceleration of the fetal heart rate below the baseline lasting 15 seconds. What is the next nursing action?

Changing the maternal position

Which statement most accurately describes the HELLP syndrome?

Characterized by hemolysis, elevated liver enzymes, and low platelets

The nurse at a prenatal clinic determines the fundal height of a healthy multipara at 16 weeks' gestation to be one fingerbreadth above the umbilicus. What might the nurse's next action be?

Check for two distinct fetal heart rates

Patient has BP of 60/50 what is the first intervention the nurse should do?

Check fundus

A client who is at 26 weeks' gestation tells the nurse at the prenatal clinic that she has pain during urination, back tenderness, and pink-tinged urine. A diagnosis of pyelonephritis is made. What is the most important nursing intervention at this time?

Checking for signs of preterm labor

The nurse admits a client with preeclampsia to the high-risk prenatal unit. What is the next nursing action after the vital signs have been obtained?

Checking the client's reflexes

Which of the following would be considered to be an intrapartum risk factor for neonatal sepsis?

Chorioamnionitis

Which statement best describes chronic hypertension?

Chronic hypertension can occur independently of or simultaneously with preeclampsia.

Which finding supports the diagnosis of pathologic jaundice?

Clinical jaundice evident within 24 hours of birth

Despite popular belief, there is a rare type of hemophilia that affects women of childbearing age. Von Willebrand disease is the most common of the hereditary bleeding disorders and can affect males and females alike. It results from a factor VIII deficiency and platelet dysfunction. Although factor VIII levels rise naturally during pregnancy, there is an increased risk for postpartum hemorrhage from birth until 4 weeks postpartum as levels of von Willebrand factor (vWf) and factor VIII fall. The treatment that should be considered first for the client with von Willebrand disease who experiences a postpartum hemorrhage is:

Desmopressin

The nurse is caring for a client in preterm labor who reports that she fell down the stairs. Bruises are apparent on the left part of the client's lower abdomen, the back of each shoulder, and on both wrists. After instituting electronic fetal monitoring, starting tocolytic therapy, and examining the monitor strips, what action should the nurse take next?

Determining whether the client feels safe at home

Which statement concerning the complication of maternal diabetes is the most accurate?

Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy.

During a prenatal visit, the nurse is explaining dietary management to a woman with pregestational diabetes. Which statement by the client reassures the nurse that teaching has been effective?

Diet and insulin needs change during pregnancy

A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes. The nurse caring for this client understands that:

Dietary management involves distributing nutrient requirements over three meals and two or three snacks.

If nonsurgical treatment for late PPH is ineffective, which surgical procedure would be appropriate to correct the cause of this condition?

Dilation and curettage (D&C)

What is the nurse's most important concern when caring for a client with a ruptured tubal pregnancy?

Diminished cardiac output

A primigravida is being monitored at the prenatal clinic for preeclampsia. Which finding is of greatest concern to the nurse?

Dipstick value of 3+ for protein in her urine

The nurse is teaching a client with preterm premature rupture of membranes (PPROM) regarding self-care activities. Which activities should the nurse include in her teaching?

Do not engage in sexual activity

The nurse sees a woman for the first time when she is 30 weeks pregnant. The client has smoked throughout the pregnancy, and fundal height measurements now are suggestive of intrauterine growth restriction (IUGR) in the fetus. In addition to ultrasound to measure fetal size, what is another tool useful in confirming the diagnosis?

Doppler blood flow analysis

The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what would be another tool useful in confirming the diagnosis?

Doppler blood flow analysis

Which factor increases the risk of complications for infants of diabetic mothers?

Duration of maternal disease

A number of metabolic changes occur throughout pregnancy. Which physiologic adaptation of pregnancy will influence the nurses plan of care?

During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus.

To manage her diabetes appropriately and to ensure a good fetal outcome, how would the pregnant woman with diabetes alter her diet?

Eat her meals and snacks on a fixed schedule.

A nurse is examining a patient who has been admitted for possible ectopic pregnancy who is approximately 8 weeks pregnant. Which finding would be a priority concern?

Ecchymosis noted around umbilicus

A pregnant patient presents unilateral abdomial pain. What would the nurse suspect of the patient?

Ectopic Pregnancy

When should the nurse expect the patients insulin dosage to be increased during pregnancy?

End of second trimester to the beginning of the 3rd trimester so 24th to 28th week of gestation

What is the most common postpartum infection that usually occurs after a cesarean section?

Endometritis

A nurse is assessing the effectiveness of a teaching plan regarding self-care and conservative management of gestational hypertension. The nurse confirms that the teaching has been understood when the client notes the importance of what?

Ensuring adequate sodium intake

T/F: The NST has a low rate of false-positive results.

False

T/F: Amniocentesis is done to find the cause of vaginal bleeding

False NEVER do an amniocentesis, contraction stress test, or internal fetal monitor if there is vaginal bleeding.

Which infection shows septicemia, meningitis, conjunctivitis, and scalp abscesses

Gonorrhea

Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother?

Hypoglycemia

What is a maternal indication for the use of vacuum-assisted birth?

Maternal exhaustion

Which factor would contribute to depletion of weight and metabolic stores in the high risk newborn?

Phototherapy

Which preexisting factor is known to increase the risk of GDM?

Previous birth of large infant

A pregnant client has class II cardiac disease. To best plan the client's care, what does the nurse anticipate for the client?

Should be hospitalized if there is evidence of cardiac decompensation

A woman with worsening preeclampsia is admitted to the hospitals labor and birth unit. The physician explains the plan of care for severe preeclampsia, including the induction of labor, to the woman and her husband. Which statement by the husband leads the nurse to believe that the couple needs further information?

Since we will be here for a while, I will call my mother so she can bring the two boys, 2 years and 4 years of age, to visit their mother.

What is the most common reason for late postpartum hemorrhage (PPH)?

Subinvolution of the uterus

Signs of abruptio placenta

Sudden onset of DARK RED VAGINAL BLEEDING, sharp abdominal pain, and tender rigid uterus (board like), history of preeclampsia, uterine tenderness, increasing tone.

Which information should nurses provide to expectant mothers when teaching them how to evaluate daily fetal movement counts (DFMCs)?

The fetal alarm signal should go off when fetal movements stop entirely for 12 hours.

A client's membranes rupture spontaneously during the latent phase of the first stage of labor, and the fluid is greenish brown. What does the nurse conclude?

The fetus may be compromised in utero

A client with maternal phenylketonuria (PKU) has come to the obstetrical clinic to begin prenatal care. Why would this preexisting condition result in the need for closer monitoring during pregnancy?

The fetus may develop neurologic problems.

An MSAFP screening indicates an elevated level of alpha-fetoprotein. The test is repeated, and again the level is reported as higher than normal. What is the next step in the assessment sequence to determine the well-being of the fetus?

Ultrasound for fetal anomalies

What duration of pregnancy is the first trimester?

Week 1-13

Interventions a nurse would include in the plan of care for a small for gestational age (SGA) newborn include

blood sugar

McRoberts maneuver for shoulder dystocia

head of bed flat, exaggerated flexion of maternal legs (Knees to chest)

The laboratory blood tests of a client at 10 weeks' gestation reveal that she has anemia. The client refuses iron supplements. The nurse teaches her that the best source of iron is liver. What other foods does the nurse encourage the client to eat? (SATa)

liver, meats, whole grain or enriched breads, dark green leafy vegetables, legumes, and dried fruits.

What drug is given to a mother with ectopic pregnancy?

methotrexate

What is a missed miscarraige

- pregnancy in which the fetus has died but the products of conception are retained in utero for up to several weeks. There may be no bleeding or cramping, and cervix remains closed

Planning care of newborn with PKU which of the following actions should nurse include in care

- initiate a low protein diet by eliminating phenallynine

Trisomy 21 common characteristics:

- low ears - slanted eyes - transverse palmar creases - protruding tongue

Preparing oxygen via hood therapy for baby born at 30 weeks gest which is appropriate action

- maintain o2 93-95%

early pregnancy bleeding signs

- miscarriage - ectopic pregnancy

During the second postpartum hour after a long labor and difficult birth, a nurse identifies that the client has heavy vaginal bleeding that does not diminish after fundal massage. The client reports, "I'm so thirsty. May I have some ginger ale?" How should the nurse reply?

"I know this is difficult; however, it's best for you to wait until the bleeding has subsided. I can give you a moisturizer for your lips to relieve the dryness."

The nurse determines that dietary teaching for a client with mild preeclampsia has been effective when the client makes which statement?

"I should follow a diet that includes unrestricted sodium and lots of calories and protein."

8 weeks gest has dx hyperemsis gravidum which is not a risk factor

- oligohydraminos

During a follow-up appointment, a client at 21 weeks' gestation is diagnosed with hyperemesis gravidarum. The client says, "Why is this happening to me? I don't know whether I can go on like this." What is the ideal response by the nurse?

"This must be physically and emotionally challenging for you."

A woman who is at 36 weeks of gestation is having a nonstress test. Which statement indicates her correct understanding of the test?

"This test observes for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby."

Which statements would not be advisable to use as a basis for therapeutic discussion following a perinatal loss?

- "This must be hard for you" - "I'm sorry" - "I am sad for you" ^^ these are acceptable statements following perinatal loss.

A pregnant patient experiences thyroid storm following delivery of her infant. What interventions would the nurse anticipate to be ordered by the physician? (SATA)

- Administer O2 - Antipyretics - PTU

Which factors predispose an infant to birth injuries? (SATA)

- Application of an internal fetal scalp electrode - Vacuum-assisted birth

What may be a sign that a patient is experiencing molar pregnancy?

- Brown colored vaginal bleeding.

Which of the following presentations is associated with early pregnancy loss, occurring in less than 12 weeks gestation? (SATA)

- Chromosomal abnormalities - Antiphospholipid syndrome - Hypothyroidism

Interventions to take note of during placenta abruption

- Dark red blood - Painful - Board like

Fetal indications to induce labor

- Diabetes - Postterm pregnancy especially with oligohydraminos - HTN complications - IUGR - Chorioamnionitis - premature ruputure of membranes - Isoimmunization

Maternal indications to induce labor

- Fetal Death - Chorioamnionitis - Hypertensive complications (gestational HTN, preeclampsia, eclampsia)

A pt at 7 weeks gestation has been admitted to the unit with severe hypertension. what are you going to implement?

- Give magnesium sulfate - have calcium gluconate in hand - have a quiet room

Term macrosomic nb with mom uncontrolled DM, baby has respiratory distress syndrome, most likely why?

- Hyperinsulinemia/hypoglycemia

What miscarriage involves the expulsion of the fetus with retention of the placenta?

- Incomplete

Gestational Diabetes Quick Facts:

- Increased hormones - Human placental lactogen stops insulin to do work - Baby fetus blood sugar is also high causing polyhydraminos causing high insulin level on baby - GDM mom = hypoglycemic baby

What miscarriage is often accompanied by rupture of membranes and cervical dilation?

- Inevitable

Signs from the patient that indicate Cardiac Decompensation:

- Irregular, weak, rapid pulse (>100 BPM) - Rapid Respiration Rate (>25) - Progressive, generalized edema - Crackles at base of lungs after two inhale and exhale that do not clear after coughing - Orthopnea; increasing dyspnea - Moist, frequent cough - Cyanosis of lips and nailbeds

Magnesium Sulfate symptoms to look for:

- Low RR - Low urine output - Low deep tendon reflex

What is an appropriate indicator for performing a contraction stress test?

- Maternal diabetes mellitus and postmaturity

Interventions to take note of during placenta previa

- No cervical exam - No sex - Bedrest - No vaginal birth

A patient has undergone an amniocentesis for evaluation of fetal well-being. Which intervention would be included in the nurse's plan of care after the procedure? (SATA)

- Observe the patient for possible uterine contractions. - Administer RhoGAM to the patient if she is Rh negative.

In which situations would the use of Methergine or prostaglandin be contraindicated even if the patient was experiencing a postpartum significant bleed? (SATA)

- Patient's blood pressure postpartum is 180/90. - Patient has a history of asthma. - Patient has a mitral valve prolapse.

s/s of endometritis:

- Pelvic pain - fever - foul smelling, profuse lochia - increased pulse - chills - anorexia - nausea - fatigue - lethargy - uterine tendernes

What causes Disseminated Intravascular Coagulation (DIC)?

- Placental Abruption - Miscarriage (dead fetus syndrome and amniotic fluid embolis or anaphylactoid syndrome) - Severe preeclampsia - HELLP - gram-negative sepsis

Which laboratory values would be found in a patient diagnosed with preeclampsia? (SATA)

- Platelet count of 75,000 - LDH 100 units/L - BUN 25 mg/dL

Pt is in labor, she is at 40 wks gestation and has saturated 2 perineal pad in 30 minutes suspecting placenta previa. What intervention should do the nurse do?

- Prepare for cesarean section

Which of the following processes or findings increase the risk of preterm infants in which hematologic problems are developing? (SATA)

- Prolonged PT time - Decreased RBC survival time - Decrease in erythropoiesis

In terms of Rh incompatibility, which situations would cause a potential problem? (SATA)

- Rh-negative mom having an Rh-positive baby - The infant of an Rh-negative mom with Rh-positive father who is homozygous for the trait

Which factors would lead to an increased likelihood of uterine rupture? (SATA)

- Short interval between pregnancies - Patient receiving a trial of labor (TOL) following a VBAC delivery - Patient who had a primary caesarean section with a classic incision

S/S of Postterm Newborn

- Skull looks bigger than body - Dry, cracked (desquamating), parchment-like (leathery) skin at birth - Firm nails extending beyond the fingertips - profuse scalp hair - depleted subcutaneous fat layers, making skin look loose - long and thin body - absent vernix - meconium staining - can have alert, wide-eyed appearance symptomatic of chronic intrauterine hypoxia

A nurse is providing instruction for an obstetrical patient to perform a daily fetal movement count (DFMC). Which instructions could be included in the plan of care? (SATA)

- The patient can monitor fetal activity once daily for a 60-minute period and note activity. The fetal alarm signal is reached when no fetal movements are noted for a period of 12 hours. - Monitor fetal activity two times a day either after meals or before bed for a period of 2 hours or until 10 fetal movements are noted. The fetal alarm signal is reached when no fetal movements are noted for a period of 12 hours. - Count all fetal movements in a 12-hour period daily until 10 fetal movements are noted. The fetal alarm signal is reached when no fetal movements are noted for a period of 12 hours.

What types of miscarriage presents not cervical dilation?

- Threatened - Missed - Complete

Signs of compete miscarriage?

- cervix has already clsoed after all fetal tissue was expelled - Slight bleeding may occur - Mild uterine cramping may be present

In addition to hyperglycemia, other causes of stillbirth include:

- congenital abnormalities - placental insufficiency or fetal growth restriction - macrosomia or polyhydraminos - obstructed labor (intrapartum stillbirth)

Major causes of perinatal mortality related to maternal diabetes mellitus are:

- congenital malformations - respiratory distress syndrome - extreme prematurity - miscarriage

test results that indicate DIC disseminated intravascular coagulation

- decreased platelets, fibrinogen, factor 5 (proaccelerin), and factor 8 (antihemolytic factor) -prolonged PT and aPTT - increased Fibrin degradation products and D-dimer test - red blood smear- fragmented rbc

A woman is being seen in the prenatal clinic at 36 weeks' gestation. The nurse is reviewing signs and symptoms that should be reported to the primary healthcare provider with the mother. Which signs and symptoms require further evaluation by the primary healthcare provider? (SATA)

- decreased urine output - blurred vision with spots - contractions that are regular and 5 minutes apart

A nurse is working with a diabetic patient who recently found out she is pregnant. In coordinating an interdisciplinary team to help manage the patient throughout the pregnancy, the nurse would include: (SATA)

- dietician - perinatologist - Nephrologist

38 wk gestation reports vaginal bleeding what will you do?

- do ultrasound and check location of placenta

pt is 7 days postpartum and reports to clinic of pain and redness in calf, what should the triage nurse suggest to the pt?

- elevate leg to encourage venous return

Woman has preeclampsia which s/sx would you report to MD

- epigastric pain, unresolved headache

S/S of septic miscarriage

- fever - abdominal tenderness - Slight to heavy vaginal bleeding, usually malodorous

physical s/s of DIC disseminated intravascular coagulation

- tachycardia - diaphoresis - Hematuria - GI Bleeding - Brusing - petechiae - spontaneous bleeding of gun and nose - oozing, excessive bleeding from venipuncture site, IV access, or site of insertion of urinary catheter

An amniotomy is performed to stimulate labor in a client at 42-weeks' gestation. Place the nursing care actions in their order of priority.

1. Inspect the perineum for umbilical cord prolapse 2. Check the FHR tracings 3. Assess characteristics of the amniotic fluid 4. Evaluate the client for signs of infection

The indirect Coombs test is a screening tool for Rh incompatibility. If the titer is greater than ______, amniocentesis may be a necessary next step.

1:8

the earliest and elective induction of labor can be?

39 weeks

Which ratio would be used to restore effective circulating volume in a postpartum patient who is experiencing hypovolemic shock?

3:1

A nurse is working in the nursery and observes a nursing student repeatedly performing an Ortolani test. What priority action should the nurse take?

Have the student stop performing the test immediately.

What kinds of miscarriage presents no uterine cramping and almost no bleeding (spotting)

Missed

A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits:

A respiratory rate of 10 breaths/min.

What is velamentous insertion of the umbilical cord?

A variation of vasa previa, it occurs when the cord vessels begin to branch at the membranes and then course onto the placenta.

Cell-free deoxyribonucleic acid (DNA) screening is a new method of noninvasive prenatal testing (NIPT) that has recently become available in the clinical setting. This technology can provide a definitive diagnosis of which findings? (SATA) a. Fetal Rh status b. Fetal gender c. Maternally transmitted gene disorder d. Paternally transmitted gene disorder e. Trisomy 21

ABDE a. Fetal Rh status b. Fetal gender d. Paternally transmitted gene disorder e. Trisomy 21

The nurse is caring for an infant with DDH (hip dysplasia). Which clinical manifestations should the nurse expect to observe? (SATA) a. Positive Ortolani click b. Unequal gluteal folds c. Negative Babinski sign d. Trendelenburg sign e. Telescoping of the affected limb

AB a. Positive Ortolani click b. Unequal gluteal folds

The most widespread use of postnatal testing for genetic disease is the routine screening of newborns for inborn errors of metabolism (IEM). Which conditions are considered metabolic disorders? (SATA) a. Phenylketonuria (PKU) b. Galactosemia c. Hemoglobinopathy d. Cytomegalovirus (CMV) e. Rubella

ABC a. Phenylketonuria (PKU) b. Galactosemia c. Hemoglobinopathy

Which risk factors are associated with NEC? (SATA) a. Polycythemia b. Anemia c. Congenital heart disease d. Bronchopulmonary dysphasia e. Retinopathy

ABC a. Polycythemia b. Anemia c. Congenital heart disease

A number of common drugs of abuse may cross into the breast milk of a mother who is currently using these substances, which may result in behavioral effects in the newborn. Which substances are contraindicated if the mother elects to breastfeed her infant? (SATA) a. Cocaine b. Marijuana c. Nicotine d. Methadone e. Morphine

ABC a. Cocaine b. Marijuana c. Nicotine

Which assessments are included in the fetal BPP? (SATA) a. Fetal movement b. Fetal tone c. Fetal heart rate d. AFI e. Placental grade

ABCD a. Fetal movement b. Fetal tone c. Fetal heart rate d. AFI

What are the complications and risks associated with cesarean births? (SATA) a. Pulmonary edema b. Wound dehiscence c. Hemorrhage d. Urinary tract infections e. Fetal injuries

ABCDE a. Pulmonary edema b. Wound dehiscence c. Hemorrhage d. Urinary tract infections e. Fetal injuries

Transvaginal ultrasonography is often performed during the first trimester. While preparing a 6-week gestational client for this procedure, she expresses concerns over the necessity for this test. The nurse should explain that this diagnostic test may be indicated for which situations? (SATA) a. Multifetal gestation b. Obesity c. Fetal abnormalities d. Amniotic fluid volume e. Ectopic pregnancy

ABCE a. Multifetal gestation b. Obesity c. Fetal abnormalities e. Ectopic pregnancy

IUGR is associated with which pregnancy-related risk factors? SATA a. Poor nutrition b. Maternal collagen disease c. Gestational hypertension d. Premature rupture of membranes e. Smoking

ABCE a. Poor nutrition b. Maternal collagen disease c. Gestational hypertension e. Smoking

What is the correct terminology for an abortion in which the fetus dies but is retained within the uterus?

Missed abortion

The reported incidence of ectopic pregnancy has steadily risen over the past 2 decades. Causes include the increase in sexually transmitted infections (STIs) accompanied by tubal infection and damage. The popularity of contraceptive devices such as the IUD has also increased the risk for ectopic pregnancy. The nurse suspects that a client has early signs of ectopic pregnancy. The nurse should be observing the client for which signs or symptoms? (SATA) a. Pelvic pain b. Abdominal pain c. Unanticipated heavy bleeding d. Vaginal spotting or light bleeding e. Missed period

ABDE a. Pelvic pain b. Abdominal pain d. Vaginal spotting or light bleeding e. Missed period

One of the most important components of the physical assessment of the pregnant client is the determination of BP. Consistency in measurement techniques must be maintained to ensure that the nuances in the variations of the BP readings are not the result of provider error. Which techniques are important in obtaining accurate BP readings? (SATA) a. The client should be seated. b. The clients arm should be placed at the level of the heart. c. An electronic BP device should be used. d. The cuff should cover a minimum of 60% of the upper arm. e. The same arm should be used for every reading.

ABE a. The client should be seated. b. The clients arm should be placed at the level of the heart. e. The same arm should be used for every reading.

A serious but uncommon complication of undiagnosed or partially treated hyperthyroidism is a thyroid storm, which may occur in response to stress such as infection, birth, or surgery. What are the signs and symptoms of this emergency disorder? (SATA) a. Fever b. Hypothermia c. Restlessness d. Bradycardia e. Hypertension

AC a. Fever c. Restlessness

Infants born between 34 0/7 and 36 6/7 weeks of gestation are called late-preterm infants because they have many needs similar to those of preterm infants. Because they are more stable than early-preterm infants, they may receive care that is similar to that of a full-term baby. These infants are at increased risk for which conditions? (SATA) a. Problems with thermoregulation b. Cardiac distress c. Hyperbilirubinemia d. Sepsis e. Hyperglycemia

ACD a. Problems with thermoregulation c. Hyperbilirubinemia d. Sepsis

Cleft lip or palate is a common congenital midline fissure, or opening, in the lip or palate resulting from the failure of the primary palate to fuse. Multiple genetic and, to a lesser extent, environmental factors may lead to the development of a cleft lip or palate. Which factors are included? (SATA) a. Alcohol consumption b. Female gender c. Use of some anticonvulsant medications d. Maternal cigarette smoking e. Antibiotic use in pregnancy

ACD a. Alcohol consumption c. Use of some anticonvulsant medications d. Maternal cigarette smoking

Approximately 10% to 15% of all clinically recognized pregnancies end in miscarriage. What are possible causes of early miscarriage? (SATA) a. Chromosomal abnormalities b. Infections c. Endocrine imbalance d. Systemic disorders e. Varicella

ACDE a. Chromosomal abnormalities b. Infections c. Endocrine imbalance d. Systemic disorders e. Varicella

Lacerations of the cervix, vagina, or perineum are also causes of PPH. Which factors influence the causes and incidence of obstetric lacerations of the lower genital tract? (SATA) a. Operative and precipitate births b. Adherent retained placenta c. Abnormal presentation of the fetus d. Congenital abnormalities of the maternal soft tissue e. Previous scarring from infection

ACDE a. Operative and precipitate births c. Abnormal presentation of the fetus d. Congenital abnormalities of the maternal soft tissue e. Previous scarring from infection

The induction of labor is considered an acceptable obstetric procedure if it is in the best interest to deliver the fetus. The charge nurse on the labor and delivery unit is often asked to schedule clients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction. What are appropriate indications for induction? (SATA) a. Rupture of membranes at or near term b. Convenience of the woman or her physician c. Chorioamnionitis (inflammation of the amniotic sac) d. Postterm pregnancy e. Fetal death

ACDE a. Rupture of membranes at or near term c. Chorioamnionitis (inflammation of the amniotic sac) d. Postterm pregnancy e. Fetal death

A client in the third trimester has just undergone an amniocentesis to determine fetal lung maturity. Which statement regarding this testing is important for the nurse in formulating a care plan?

Administration of Rho(D) immunoglobulin may be necessary.

In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate?

Administration of blood

In caring for the woman with disseminated intravascular coagulation DIC, which order should the nurse anticipate?

Administration of blood

Which interventions should be included in the plan of care for a client with class I cardiac disease during the last weeks of pregnancy?

Advising the client to limit stress, promoting rest after meals, and educating the client about the analgesia and anesthesia used during labor

At 35 weeks of pregnancy, a woman experiences preterm labor. Although tocolytic medications are administered and she is placed on bed rest, she continues to experience regular uterine contractions and her cervix is beginning to dilate and efface. What is an important test for fetal well-being at this time?

Amniocentesis for fetal lung maturity

A thrombosis results from the formation of a blood clot or clots inside a blood vessel and is caused by inflammation or partial obstruction of the vessel. Three thromboembolic conditions are of concern during the postpartum period; which of the following is not?

Amniotic fluid embolism (AFE)

The majority of ectopic pregnancies are located in the:

Ampulla.

With regard to hemorrhagic complications that may occur during pregnancy, what information is most accurate?

An incompetent cervix is usually not diagnosed until the woman has lost one or two pregnancies.

A 3.8-kg infant was vaginally delivered at 39 weeks after a 30-minute second stage. A nuchal cord was found at delivery. After birth, the infant is noted to have petechiae over the face and upper back. Which information regarding petechiae is most accurate and should be provided to the parents?

Are benign if they disappear within 48 hours of birth

Which nursing intervention is paramount when providing care to a client with preterm labor who has received terbutaline?

Assess for dyspnea and crackles.

What is the highest priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy?

Assessing FHR and maternal vital signs

A client at 40 weeks' gestation is admitted to the birthing unit in early active labor. During her intake assessment, she tells the nurse that her membranes ruptured 26 hours ago. Initial assessments of the fetal heart rate range between 168 and 174 beats/min. What is the priority nursing action?

Assessing maternal vital signs

T/F If shoulder dystocia is present apply fundal pressure

False DO NOT APPLY FUNDAL PRESSURE, suprapubic is ok.

The nurse recognizes that uterine hyperstimulation with oxytocin requires emergency interventions. What clinical cues alert the nurse that the woman is experiencing uterine hyperstimulation? (SATA) a. Uterine contractions lasting <90 seconds and occurring >2 minutes in frequency b. Uterine contractions lasting >90 seconds and occurring <2 minutes in frequency c. Uterine tone <20 mm Hg d. Uterine tone >20 mm Hg e. Increased uterine activity accompanied by a nonreassuring FHR and pattern

BDE b. Uterine contractions lasting >90 seconds and occurring <2 minutes in frequency d. Uterine tone >20 mm Hg e. Increased uterine activity accompanied by a nonreassuring FHR and pattern

General indicator of miscarriage

Before the sixth week, the only evidence might be a heavy menstrual flow. After the 12th week, more severe pain, similar to that of labor, is likely.

A 41-week pregnant multigravida arrives at the labor and delivery unit after a NST indicated that her fetus could be experiencing some difficulties in utero. Which diagnostic tool yields more detailed information about the condition of the fetus?

Biophysical profile (BPP)

The client has been on magnesium sulfate for 20 hours for the treatment of preeclampsia. She just delivered a viable infant girl 30 minutes ago. What uterine findings does the nurse expect to observe or assess in this client?

Boggy uterus with heavy lochia flow

A client with a history of endometriosis gives birth to a healthy infant. She expresses concern that the problems associated with endometriosis will return now that her pregnancy is over. What is the best response by the nurse?

Breast-feeding will delay the return of the endometriosis.

NEC is an acute inflammatory disease of the gastrointestinal mucosa that can progress to perforation of the bowel. Approximately 2% to 5% of premature infants succumb to this fatal disease. Care is supportive; however, known interventions may decrease the risk of NEC. Which intervention has the greatesteffect on lowering the risk of NEC?

Breastfeeding

Which condition might premature infants who exhibit 5 to 10 seconds of respiratory pauses, followed by 10 to 15 seconds of compensatory rapid respiration, be experiencing?

Breathing in a respiratory pattern common to premature infants

Premature infants who exhibit 5 to 10 seconds of respiratory pauses followed by 10 to 15 seconds of compensatory rapid respiration are:

Breathing in a respiratory pattern common to premature infants.

A premature infant never seems to sleep longer than an hour at a time. Each time a light is turned on, an incubator closes, or people talk near her crib, she wakes up and inconsolably cries until held. What is the correct nursing diagnosis beginning with ineffective coping, related to?

Environmental stress

What is the name of the condition in which the fetus compensates for anemia by producing large numbers of immature erythrocytes to replace those hemolyzed.

Erythroblastosis Fetalis

A primigravida has just delivered a healthy infant girl. The nurse is about to administer erythromycin ointment in the infants eyes when the mother asks, What is that medicine for? How should the nurse respond?

Erythromycin is prophylactically given to prevent a gonorrheal infection.

Hypothyroidism occurs in 2 to 3 pregnancies per 1000. Because severe hypothyroidism is associated with infertility and miscarriage, it is not often seen in pregnancy. Regardless of this fact, the nurse should be aware of the characteristic symptoms of hypothyroidism. Which do they include? (SATA) a. Hot flashes b. Weight loss c. Lethargy d. Decrease in exercise capacity e. Cold intolerance

CDE c. Lethargy d. Decrease in exercise capacity e. Cold intolerance

Maternal age older than 35 years and balanced translocation (maternal and paternal) are risk factors for:

Chromosomal abnormalities

Which maternal condition always necessitates delivery by cesarean birth?

Complete placenta previa

Preconception counseling is critical in the safe management of diabetic pregnancies. Which complication is commonly associated with poor glycemic control before and during early pregnancy?

Congenital anomalies in the fetus

A nurse is performing a pulse oximetry reading on a newborn to test for:

Congenital heart disease.

Near the end of the first week of life, an infant who has not been treated for any infection develops a copper-colored maculopapular rash on the palms and around the mouth and anus. The newborn is displaying signs and symptoms of which condition?

Congenital syphilis

In appraising the growth and development potential of a preterm infant, the nurse should be cognizant of the information that is best described in which statement?

Correct for milestones, such as motor competencies and vocalizations, until the child is approximately 2 years of age.

The nurse is caring for a postpartum client with preeclampsia being managed with a magnesium sulfate infusion. What is the priority nursing assessment?

Counting respiratory rate

Which clinical findings would alert the nurse that the neonate is expressing pain?

Cry face; eyes squeezed; increase in blood pressure

A woman arrives for evaluation of signs and symptoms that include a missed period, adnexal fullness, tenderness, and dark red vaginal bleeding. On examination, the nurse notices an ecchymotic blueness around the womans umbilicus. What does this finding indicate?

Cullen sign associated with a ruptured ectopic pregnancy

T/F: Mothers with chronic DM have an increased risk of giving birth to a baby with genital disorders.

False; chronic DM is not associated with genital disorders

In caring for an immediate postpartum client, the nurse notes petechiae and oozing from her intravenous (IV) site. The client would be closely monitored for which clotting disorder?

DIC disseminated intravascular coagulation

An 18-year-old client who has reached 16 weeks of gestation was recently diagnosed with pregestational diabetes. She attends her centering appointment accompanied by one of her girlfriends. This young woman appears more concerned about how her pregnancy will affect her social life than her recent diagnosis of diabetes. A number of nursing diagnoses are applicable to assist in planning adequate care. What is the most appropriate diagnosis at this time?

Deficient knowledge, related to diabetic pregnancy management

In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes that the most important factor affecting pregnancy outcome is the:

Degree of glycemic control during pregnancy.

A nurse in the clinic is conducting a routine assessment of a primigravida client. The nurse notes bruises on the client's upper arms. When questioned, the client responds that her boyfriend was upset and hit her. What is the priority nursing action?

Developing a safety plan with the client

The nurse is performing an assessment on a client who thinks she may be experiencing preterm labor. Which information is the most important for the nurse to understand and share with the client?

Diagnosis of preterm labor is based on gestational age, uterine d. activity, and progressive cervical change.

When is fetal fibronectin present

During labor

When assisting the mother, father, and other family members to actualize the loss of an infant, which action is most helpful?

Ensuring the baby is clothed or wrapped if the parents choose to visit with the baby

Of these psychosocial factors, which has the least negative effect on the health of the mother and/or fetus?

Moderate coffee consumption

A woman arrives at the clinic seeking confirmation that she is pregnant. The following information is obtained: She is 24 years old with a body mass index (BMI) of 17.5. She admits to having used cocaine several times during the past year and occasionally drinks alcohol. Her blood pressure is 108/70 mm Hg. The family history is positive for diabetes mellitus and cancer. Her sister recently gave birth to an infant with a neural tube defect (NTD). Which characteristics places this client in a high-risk category?

Family history, BMI, drug and alcohol abuse

During a childbirth preparation class, the nurse teacher discusses the importance of the "spurt" of energy that occurs before labor. Why is it important to conserve this energy?

Fatigue may influence pain medication requirements

A nurse providing care to preterm infants should understand that nasogastric and orogastric tubes are used to:

Feed the infants

Women with mild gestational hypertension and mild preeclampsia can be safely managed at home with frequent maternal and fetal evaluation. Complete or partial bed rest is still frequently ordered by some providers. Which complication is rarely the result of prolonged bed rest?

Fluid retention

A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, how should the nurse respond?

Frequent, serial casting is tried first.

A macrosomic infant is born after a difficult forceps-assisted delivery. After stabilization, the infant is weighed, and the birth weight is 4550 g (9 lb, 6 oz). What is the nurses first priority?

Frequently monitor blood glucose levels, and closely observe the infant for signs of hypoglycemia.

A pregnant client is admitted to the high-risk unit with uterine tenderness and some dark-red vaginal bleeding. Abruptio placentae is diagnosed. Which priority assessment should be included with vital signs, skin color, urine output, and fetal heart rate?

Fundal height

In the past, factors to determine whether a woman was likely to develop a high- risk pregnancy were primarily evaluated from a medical point of view. A broader, more comprehensive approach to high-risk pregnancy has been adopted today. Four categories have now been established, based on the threats to the health of the woman and the outcome of pregnancy. Which category should notbe included in this group?

Geographic

In the past, factors to determine whether a woman was likely to have a high risk pregnancy were evaluated primarily from a medical point of view. A broader, more comprehensive approach to high risk pregnancy has been adopted. There are now four categories based on threats to the health of the woman and the outcome of pregnancy. Which of the options listed here is not included as a category?

Geographic

Pt at 22 weeks of gestation has not been able to control her DM with diet or exercise, what prescription order would the nurse expect from doctor?

Glyburide

A newborn was admitted to the neonatal intensive care unit (NICU) after being delivered at 29 weeks of gestation to a 28-year-old multiparous, married, Caucasian woman whose pregnancy was uncomplicated until the premature rupture of membranes and preterm birth. The newborns parents arrive for their first visit after the birth. The parents walk toward the bedside but remain approximately 5 feet away from the bed. What is the nurses most appropriate action?

Go to the parents, introduce him or herself, and gently encourage them to meet their infant. Explain the equipment first, and then focus on the newborn.

What is the most important nursing action in preventing neonatal infection?

Good handwashing

A nurse caring for a family during a loss might notice that a family member is experiencing survivor guilt. Which family member is most likely to exhibit this guilt?

Grandparents

A nurse is caring for a group of postpartum clients. Which client is at the highest risk for disseminated intravascular coagulation (DIC)?

Gravida I who has had an intrauterine fetal death

When evaluating the preterm infant, the nurse understands that compared with the term infant, what information is important for the nurse to understand?

Greater surface area in proportion to weight

What bacterial infection is definitely decreasing because of effective drug treatment?

Group B streptococci (GBS) infection

Patient is 12 hours postpartum, what assessment should alert the nurse?

HR 160

What condition indicates concealed hemorrhage when the client experiences abruptio placentae?

Hard, boardlike abdomen

A 17-year-old client at 38 weeks' gestation is being prepared for an emergency cesarean birth because of abruptio placentae and severe fetal compromise. The client received 10 mg of nalbuphine intravenously 30 minutes ago. Because the client is too sedated to sign the consent form, what should the nurse do?

Have the surgeon and attending primary healthcare provider sign the consent form.

With regard to the classification of neonatal bacterial infection, nurses should be aware that:

Health care-associated infection can be prevented by effective handwashing; early-onset infection cannot.

During a client's labor the fetal monitor reveals a fetal heart pattern that signifies uteroplacental insufficiency. What is the nurse's priority intervention?

Helping the client turn to the side-lying position

Normal Laboratory Values for pregnant women:

Hemoglobin: 12-16 g/dl, 37%-47% Platelets: 150k-400k/mm^3 Prothrombin time: (PT), Partial thromboplastin time (Ptt): 12-14 sec, 60-70 sec Fibrinogen: 200-400 mg/dl Fibrin split products: (FSPs): Absent Blood urea nitrogen: (BUN): 10-20 mg/dl Creatinine: 0.5-1.1 mg/dl Lactate dehydrogenase (LDH): 45-90 units/I Aspartate aminotransferase (AST): 4-20 units/I Alanine aminotransferase (ALT): 3-21 units/I Creatinine clearance: 80-125 ml/min Burr cells or schistocytes: absent Uric Acid: 2-6.6 mg/dl Bilirubin (total): 0.1-1 mg/dl

The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the oxytocin (Pitocin) infusion, the nurse reviews the womans latest laboratory test findings, which reveal a platelet count of 90,000 mm3, an elevated aspartate aminotransaminase (AST) level, and a falling hematocrit. The laboratory results are indicative of which condition?

Hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome

To explain hemolytic disorders in the newborn to new parents, the nurse who cares for the newborn population must be aware of the physiologic characteristics related to these conditions. What is the most common cause of pathologic hyperbilirubinemia?

Hemolytic disorders

A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Which information assists the nurse in developing the plan of care?

Hemorrhage is the primary concern.

A woman diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At present she is at the greatest risk for:

Hemorrhage.

Infants who display growth restriction, skin lesions, microcephaly, hypertonicity, and seizures are showing signs of what infection?

Herpes simplex virus (HSV)

Which statement is most likely to be associated with a breech presentation?

High rate of neuromuscular disorders

While a multiparous client is in active labor, her membranes rupture spontaneously. The nurse notes a loop of umbilical cord protruding from her vagina. What is the priority nursing action at this time?

Holding the presenting part away from the cord

A woman with severe preeclampsia has been receiving magnesium sulfate by IV infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature 37.1° C, pulse rate 96 beats/min, respiratory rate 24 breaths/min, blood pressure 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for:

Hydralazine

A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the client and documents the following findings: temperature of 37.1 C, pulse rate of 96 beats per minute, respiratory rate of 24 breaths per minute, BP of 155/112 mm Hg, 3+ DTRs, and no ankle clonus. The nurse calls the provider with an update. The nurse should anticipate an order for which medication?

Hydralazine

A nurse caring for pregnant women must be aware that the most common medical complication of pregnancy is:

Hypertension.

Intrauterine growth restriction (IUGR) can be caused by what?

Hypertensive Mom

Hypertonic Vs hypotonic Uterine Dysfunction

Hypertonic: - More common - Happens in latent phase - Contractions are frequent and painful - causes cervical dilation or effacement to progess Hypotonic: - Happens in active phase - Contractions are weak and inefficient or stop altogether - progress for cervical effacement and dilation is insufficient

A client who has experienced a severe abruptio placentae asks the nurse why there was so much bleeding. What should the nurse consider as the cause of the heavy bleeding before responding in language that the client will understand?

Hypofibrinogenemia

An infant was born 2 hours ago at 37 weeks of gestation and weighs 4.1 kg. The infant appears chubby with a flushed complexion and is very tremulous. The tremors are most likely the result of what condition?

Hypoglycemia

An infant weighing 4.1 kg was born 2 hours ago at 37 weeks of gestation. The infant appears chubby with a flushed complexion and is very tremulous. The tremors are most likely the result of:

Hypoglycemia.

The nurse is assigned a home care visit of a 5-day-old infant for the treatment of jaundice. A thorough assessment is completed, and a health history is obtained. Which sign or symptom indicates that the infant may be displaying the initial phase of encephalopathy?

Hypotonia, lethargy, and poor suck

During the assessment of a preterm infant, the nurse notices continued respiratory distress even though oxygen and ventilation have been provided. In this situation, which condition should the nurse suspect?

Hypovolemia and/or shock

After giving birth to a stillborn infant, the woman turns to the nurse and says, I just finished painting the babys room. Do you think that caused my baby to die? What is the nurses most appropriate response?

I can understand your need to find an answer to what caused this. What else are you thinking about?

The nurse who elects to practice in the area of womens health must have a thorough understanding of miscarriage. Which statement regarding this conditionis most accurate?

If a miscarriage occurs before the 12th week of pregnancy, then it may be observed only as moderate discomfort and blood loss.

Which information regarding to injuries to the infants plexus during labor and birth is most accurate?

If the nerves are stretched with no avulsion, then they should completely recover in 3 to 6 months.

With regard to injuries to the infant's plexus during labor and birth, nurses should be aware that:

If the nerves are stretched with no avulsion, they should recover completely in 3 to 6 months.

Preterm infants are more likely to become septic because:

IgG level is directly proportional to gestational age

A 26-year-old primigravida has come to the clinic for her regular prenatal visit at 12 weeks. She appears thin and somewhat nervous. She reports that she eats a well- balanced diet, although her weight is 5 pounds less than it was at her last visit. The results of laboratory studies confirm that she has a hyperthyroid condition. Based on the available data, the nurse formulates a plan of care. Which nursing diagnosisis most appropriate for the client at this time?

Imbalanced nutrition: less than body requirements

What is the clinical finding most likely to be exhibited in an infant diagnosed with erythroblastosis fetalis?

Immature red blood cells

Which nursing diagnosis is most appropriate for a newborn diagnosed with a diaphragmatic hernia?

Impaired gas exchange

The nurse is caring for a pregnant woman with class II cardiac disease. The client has anemia with a hemoglobin level of 8 g/dL (80 mmol/L). What is the nurse's primary concern for this client?

Impending heart failure

The nurse is evaluating a neonate who was delivered 3 hours ago by vacuum- assisted delivery. The infant has developed a cephalhematoma. Which statement is most applicable to the care of this neonate?

In many infants, signs of hemorrhage in a full-term infant are absent and diagnosed only through laboratory tests.

A pregnant patient who is at term has been informed that her fetus has died. This finding was verified at the physician's office by an ultrasound when the patient stated that she had not felt the baby move for a few days. Subsequently, the patient is going to be admitted to the obstetric unit. When developing a plan of care, the nurse would focus on which priority measure?

Incorporating perinatal palliative care into the patient's plan of care.

What is the chemical or mechanical initiation of uterine contractions before their spontaneous onset for the purpose of bringing about birth?

Induction of labor

Which intervention is most important when planning care for a client with severe gestational hypertension?

Induction of labor is likely, as near term as possible.

Which infant is most likely to express Rh incompatibility?

Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh facto

With regard to infants who are SGA and intrauterine growth restriction (IUGR), the nurse should be aware of which information?

Infants with asymmetric IUGR have the potential for normal growth and development.

With regard to small-for-gestational age (SGA) infants and intrauterine growth restriction (IUGR), nurses should be aware that:

Infants with asymmetric IUGR have the potential for normal growth and development.

A 26-year-old primigravida experiencing severe abdominal pain is brought to the emergency department by ambulance with a suspected ruptured tubal pregnancy. What should the nurse's initial action be?

Insert an intravenous (IV) catheter.

At 37 weeks' gestation a client's membranes spontaneously rupture; however, she does not have any labor contractions. What action is most important in the nursing plan of care for this client?

Monitoring for the presence of fever

Which nursing intervention is necessary before a first-trimester transabdominal ultrasound?

Instruct the woman to drink 1 to 2 quarts of water.

In contrast to placenta previa, what is the most prevalent clinical manifestation of abruptio placentae?

Intense abdominal pain

The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is:

Intense abdominal pain.

After a deep vein thrombosis developed in a postpartum client, an intravenous (IV) infusion of heparin therapy was instituted 2 days ago. The client's activated partial thromboplastin time (aPTT) is now 98 seconds. What should the nurse do next?

Interrupt the infusion and notify the primary healthcare provider of the aPTT result

Which neonatal complications are associated with hypertension in the mother?

Intrauterine growth restriction (IUGR) and prematurity

The nurse who is caring for a woman hospitalized for hyperemesis gravidarum would expect the initial treatment to involve what?

Intravenous (IV) therapy to correct fluid and electrolyte imbalances

Which priority intervention would be needed if the nurse suspected that an infant was septic?

Intravenous access

Which condition is considered a medical emergency that requires immediate treatment?

Inversion of the uterus

Which PPH conditions are considered medical emergencies that require immediate treatment?

Inversion of the uterus and hypovolemic shock

A client with severe preeclampsia develops eclampsia. After the seizure, the client has a temperature of 102° F (38.9° C). What does the nurse suspect as the cause of the elevated temperature?

Irregularity in the cerebral thermal center

Which statement most accurately describes complicated grief?

Is an extremely intense grief reaction that persists for a long time

Complicated bereavement:

Is an extremely intense grief reaction that persists for a long time.

Nurses should be aware that HELLP syndrome:

Is characterized by hemolysis, elevated liver enzymes, and low platelets.

A nurse providing care for the antepartum woman should understand that the contraction stress test (CST):

Is considered to have a negative result if no late decelerations are observed with the contractions.

Which description most accurately describes the augmentation of labor?

Is part of the active management of labor that is instituted when the labor process is unsatisfactory

A nurse providing care to a woman in labor should be aware that cesarean birth:

Is performed primarily for the benefit of the fetus.

Which statement related to the induction of labor is most accurate?

Is rated for viability by a Bishop score

A client who has placenta previa now has started bleeding heavily and is being admitted to the high-risk unit. Why should the nurse place the client in the knee-chest position?

It prevents shock

With regard to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that:

Its most important function is to afford the opportunity to administer antenatal glucocorticoids.

A nurse practicing in the perinatal setting should promote kangaroo care regardless of an infants gestational age. Which statement regarding this interventionis most appropriate?

Kangaroo care helps infants interact directly with their parents and enhances their temperature regulation.

The priority assessment in evaluating a pregnant woman with severe nausea and vomiting is:

Ketonuria.

A number of methods can be used for inducing labor. Which cervical ripening method falls under the category of mechanical or physical?

Labor can sometimes be induced with balloon catheters or laminaria tents.

What would a steady trickle of bright red blood from the vagina in the presence of a firm fundus suggest to the nurse?

Lacerations of the genital tract

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

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

For diagnostic and treatment purposes, nurses should know the birth weight classifications of high risk infants. For example, extremely low birth weight (ELBW) is the designation for an infant whose weight is:

Less than 1000 g.

A male infant at 26 weeks of gestation arrives from the delivery room intubated. The nurse weighs the infant, places him under the radiant warmer, and attaches him to the ventilator at the prescribed settings. A pulse oximeter and cardiorespiratory monitor are placed. The pulse oximeter is recording oxygen saturation values of 80%. The prescribed saturation value is 92%. The nurse's most appropriate action is to:

Listen to breath sounds and ensure the patency of the endotracheal tube, increase oxygen, and notify a physician.

An infant at 26 weeks of gestation arrives intubated from the delivery room. The nurse weighs the infant, places him under the radiant warmer, and attaches him to the ventilator at the prescribed settings. A pulse oximeter and cardiorespiratory monitor are placed. The pulse oximeter is recording oxygen saturations of 80%. The prescribed saturations are 92%. What is the nurses most appropriate action at this time?

Listening to breath sounds, and ensuring the patency of the endotracheal tube, increasing oxygen, and notifying a physician

The nurse is teaching a prenatal class regarding the risks of smoking during pregnancy. What neonatal consequence of maternal smoking should the nurse include in the teaching?

Low birthweight

The primary healthcare provider diagnoses placenta previa in a primiparous client. What does this indicate to the nurse regarding the condition of the placenta?

Low-lying

Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy. Which statement regarding monitoring techniques is the most accurate?

MSAFP is a screening tool only; it identifies candidates for more definitive diagnostic procedures

Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including that:

MSAFP is a screening tool only; it identifies candidates for more definitive procedures.

A 30-year-old gravida 3, para 2-0-0-2 is at 18 weeks of gestation. Which screening test should the nurse recommend be ordered for this client?

MSAFP screening

Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the client mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. This fetus is at the greatest risk for which condition?

Macrosomia

Which of the following findings is not likely to be seen in a pregnant patient who has hypothyroidism?

Macrosomia

Macrosomia quick facts

Macrosomia = Big Baby = low blood sugar = hypoglycemia

What helps stop contractions

Magnesium Sulfate

During rounds, a nurse suspects that a patient who has recently delivered via vaginal route is having excessive postpartum bleeding. Which intervention would be the priority action taken by the nurse at this time?

Massage the uterine fundus.

A breast-feeding mother experiences redness and pain in the left breast, a temperature of 100.8° F (38.2° C), chills, and malaise. Which condition does the nurse suspect?

Mastitis

Which postpartum infection is most often contracted by first-time mothers who are breastfeeding?

Mastitis

Most congenital anomalies of the CNS result from defects in the closure of the neural tube during fetal development. Which factor has the greatest impact on this process?

Maternal folic acid deficiency

Factors associated with the potential development of cleft lip or palate are?

Maternal infections, alcohol consumption, radiation exposure, corticosteroid use, use of some anticonvulsant medications, male gender, Native-American or Asian descent, and maternal smoking during pregnancy

A pregnant woman was admitted for induction of labor at 43 weeks of gestation with sure dates. A nonstress test (NST) in the obstetricians office revealed a nonreactive tracing. On artificial rupture of membranes, thick meconium-stained fluid was noted. What should the nurse caring for the infant after birth anticipate?

Meconium aspiration, hypoglycemia, and dry, cracked skin

The nurse is caring for a client in labor whose fetus is in the breech presentation. Which would be an expected finding for this client?

Meconium in the amniotic fluid

A client who is at 38 weeks' gestation is admitted to the birthing unit because her membranes ruptured 24 hours ago and contractions have started. The fetus is in a breech presentation. The nurse observes that the amniotic fluid is green. What does the nurse conclude from these findings?

Meconium is being expelled with contractions

The condition, hypospadias, encompasses a wide range of penile abnormalities. Which information should the nurse provide to the anxious parents of an affected newborn?

Mild cases involve a single surgical procedure.

The management of the pregnant client who has experienced a pregnancy loss depends on the type of miscarriage and the signs and symptoms. While planning care for a client who desires outpatient management after a first-trimester loss, what would the nurse expect the plan to include?

Misoprostol

A client at 6 weeks' gestation who has type 1 diabetes is attending the prenatal clinic for the first time. The nurse explains that during the first trimester insulin requirements may decrease for what reason?

Morning sickness may result in decreased food intake.

By understanding the four mechanisms of heat transfer (convection, conduction, radiation, and evaporation), the nurse can create an environment for the infant that prevents temperature instability. Which significant symptoms will the infant display when experiencing cold stress?

Mottled skin with acrocyanosis

A patient tells the nurse about the funeral arrangements for her newborn son. The patient is thereby providing the nurse with information about:

Mourning process

Which analysis of maternal serum may predict chromosomal abnormalities in the fetus?

Multiple-marker screening

A woman is undergoing a nipple-stimulated CST. She is having contractions that occur every 3 minutes. The fetal heart rate (FHR) has a baseline heart rate of approximately 120 beats per minute without any decelerations. What is the correct interpretation of this test?

Negative

Providing care for the neonate born to a mother who abuses substances can present a challenge for the health care team. Nursing care for this infant requires a multisystem approach. What is the first step in the provision of care for the infant?

Neonatal abstinence syndrome (NAS) scoring

What information regarding a fractured clavicle is most important for the nurse to take into consideration when planning the infants care?

No special treatment is necessary.

The primary healthcare provider determines that a fetus is in a breech presentation. Which complication should the nurse monitor this client for?

Nonreassuring fetal signs, indicating prolapse of the cord

Two hours after a client gives birth, her physical assessment findings include a blood pressure of 86/40 mm Hg; temperature of 98 °F (36.7 °C); pulse rate of 100 beats/min; respirations of 22 breaths/min; a firm fundus, four fingerbreadths above the umbilicus; small spots of lochia rubra on the perineal pad; and a distended bladder. After a urinary catheterization the client's fundus remains firm and four fingerbreadths above the umbilicus. What should the nurse do next?

Notify the client's primary healthcare provider immediately

During a follow-up home visit, the nurse plans to evaluate whether parents have progressed to the second stage of grieving (phase of intense grief). Which behavior would the nurse not anticipate finding?

Numbness or lack of response

Prolonged rupture of membranes, IUGR, intrauterine fetal death, and renal agenesis (Potter syndrome) place the client at risk for developing:

Oligohydraminos

For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse?

One fetal movement noted in 1 hour of assessment by the mother

Which client is at increased risk for postpartum hemorrhage?

One who gives birth to an infant weighing 9 lb 8 oz (4366 g)

Parents have asked the nurse about organ donation after that infants death. Which information regarding organ donation is important for the nurse to understand?

Organ donation can aid grieving by giving the family an opportunity to see something positive about the experience.

A new mother with a thyroid disorder has come for a lactation follow-up appointment. Which thyroid disorder is a contraindication for breastfeeding?

PKU

The first and most important nursing intervention when a nurse observes profuse postpartum bleeding is to:

Palpate the uterus and massage it if it is boggy

With regard to an eventual discharge of the high-risk newborn or the transfer of the newborn to a different facility, which information is essential to provide to the parents?

Parents of high-risk infants need special support and detailed contact information.

Antidepressant medication is the mainstay treatment for maternal depression, with selective serotonin reuptake inhibitors (SSRIs) being the first line of pharmacotherapy. Reports of cardiac defects have been associated with the use of which SSRI?

Paroxetine

While mopping the kitchen floor, a client at 37 weeks' gestation experiences a sudden sharp pain in her abdomen with a period of fetal hyperactivity. When the client arrives at the prenatal clinic, the nurse examines her and detects fundal tenderness and a small amount of dark-red bleeding. What does the nurse conclude is the probable cause of these clinical manifestations?

Partial abruptio placentae

Which indicator would lead the nurse to suspect that a postpartum patient experiencing hemorrhagic shock is getting worse?

Patient complaint of headache and increased reaction time to questioning

What is the primary nursing responsibility when caring for a client who is experiencing an obstetric hemorrhage associated with uterine atony?

Performing fundal massage

A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. Which intervention is the nurse's top priority?

Place the woman in the knee-chest position.

Which classification of placental separation is not recognized as an abnormal adherence pattern?

Placenta abruptio

A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency to every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of:

Placental abruption.

Which physiologic alteration of pregnancy most significantly affects glucose metabolism?

Placental hormones are antagonistic to insulin, thus resulting in insulin resistance.

A client is admitted to the emergency department at 34 weeks' gestation with trauma and significant bleeding from the leg. What is the priority intervention after determining fetal well-being?

Placing the client in a left lateral position

A pregnant womans amniotic membranes have ruptured. A prolapsed umbilical cord is suspected. What intervention would be the nurses highest priority?

Placing the woman in the knee-chest position

A nurse is performing an assessment on a newborn and notes 6 digits on each foot. This finding is an example of:

Polydactyly.

The nurse is planning the care for a laboring client with diabetes mellitus. This client is at greater risk for which clinical finding?

Polyhydramnios

A nurse is monitoring a patient's reflexes (DTRs) while receiving magnesium sulfate therapy for treatment of preeclampsia. Which assessment finding indicates a cause for concern?

Positive clonus response elicited unilaterally

Which assessment is least likely to be associated with a breech presentation?

Postterm gestation

Anencephaly, placental insufficiency, and perinatal hypoxia contribute to the risk for:

Postterm pregnancy

What is the medical term of labor happening too fast?

Precipitous labor

With regard to preeclampsia and eclampsia, nurses should be aware that:

Preeclampsia results in decreased function in such organs as the placenta, kidneys, liver, and brain.

A patient who is pregnant already has Type 2 diabetes with a hemoglobin A1c value of 7. The nurse would categorize this patient as having:

Pregestational diabetes mellitus

What is the correct definition of a spontaneous termination of a pregnancy (abortion)

Pregnancy is less than 20 weeks.

A client asks the nurse at the prenatal clinic whether she may continue to have sexual relations while pregnant. What is one indication that the client should refrain from intercourse during pregnancy?

Premature rupture of membranes

Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. What is an appropriate management approach for this type of abortion?

Prepare the woman for an ultrasound and blood work.

Which laboratory marker is indicative of disseminated intravascular coagulation DIC?

Presence of fibrin split products

Which clinical finding is a major use of ultrasonography in the first trimester?

Presence of maternal abnormalities

The nurse who elects to work in the specialty of obstetric care must have the ability to distinguish between preterm birth, preterm labor, and low birth weight. Which statement regarding this terminology is correct?

Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of gestation.

The primary healthcare provider prescribes a contraction stress test (CST) for a client whose nonstress test (NST) was nonreactive. Which maternal complications should prompt the nurse to question the prescription?

Preterm labor, drug addiction, incompetent cervix, premature rupture of membranes

A multipara whose membranes have ruptured is admitted in early labor. Assessment reveals a breech presentation, cervical dilation of 3 cm, and fetal station at -2. For what complication should the nurse assess when caring for this client?

Prolapse of the umbilical cord

In planning for home care of a woman with preterm labor, which concern should the nurse need to address?

Prolonged bed rest may cause negative physiologic effects.

A pregnant woman with a history of heart disease visits the prenatal clinic toward the end of her second trimester. Which intervention does the nurse anticipate will be part of this client's care plan?

Prophylactic antibiotics at the time of birth (to prevent bacterial endocarditis)

What is the highest priority nursing intervention for an infant born with myelomeningocele?

Protect the sac from injury.

A client at 36 weeks' gestation is admitted to the high-risk unit because she has gained 5 lb (2.3 kg) in the previous week and there is a pronounced increase in blood pressure. What is the initial intervention in the client's plan of care?

Providing a dark, quiet room with minimal stimuli

In caring for the preterm infant, what complication is thought to be a result of high arterial blood oxygen level?

ROP

How does the nurse document a NST during which two or more FHR accelerations of 15 beats per minute or more occur with fetal movement in a 20-minute period?

Reactive

What is the term when 3 or more spontaneous pregnancy losses has occurred before 20 wks gestation?

Recurrent (habitual) early miscarriage

A family is visiting two surviving triplets. The third triplet died 2 days ago. What action indicates that the family has begun to grieve for the dead infant?

Refers to the dead infant in the past tense

Which conditions are infants of diabetic mothers (IDMs) at a higher risk for developing?

Respiratory distress syndrome

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

Respiratory rate

The client being cared for has severe preeclampsia and is receiving a magnesium sulfate infusion. Which new finding would give the nurse cause for concern?

Respiratory rate of 10 breaths per minute

When providing an infant with a gavage feeding, which infant assessment should be documented each time?

Response to the feeding

The nurse is instructing a family how to care for their infant in a Pavlik harness to treat (hip dysplasia) DDH. What information should be included in the teaching?

Return to the clinic every 1 to 2 weeks.

A pregnant woman at 14 weeks of gestation is admitted to the hospital with a diagnosis of hyperemesis gravidarum. The primary goal of her treatment at this time is to:

Reverse fluid, electrolyte, and acid-base imbalances.

Because of the premature infants decreased immune functioning, what nursing diagnosis should the nurse include in a plan of care for a premature infant?

Risk for infection

What nursing diagnosis is the most appropriate for a woman experiencing severe preeclampsia?

Risk for injury to mother and fetus, related to central nervous system (CNS) irritability

A nurse is monitoring a client with severe preeclampsia for the onset of eclampsia. What objective clinical finding indicates an impending seizure?

Rolling of the eyes to one side with a fixed stare

When would an internal version be indicated to manipulate the fetus into a vertex position?

Second twin from a transverse lie to a breech presentation during a vaginal birth

A woman is having her first child. She has been in labor for 15 hours. A vaginal examination performed 2 hours earlier revealed the cervix to be dilated to 5 cm and 100% effaced, and the presenting part of the fetus was at station 0; however, another vaginal examination performed 5 minutes ago indicated no changes. What abnormal labor pattern is associated with this description?

Secondary arrest

A woman with severe preeclampsia is being treated with an IV infusion of magnesium sulfate. This treatment is considered successful if:

Seizures do not occur.

A pregnant woman at 37 weeks of gestation has had ruptured membranes for 26 hours. A cesarean section is performed for failure to progress. The fetal heart rate (FHR) before birth is 180 beats per minute with limited variability. At birth the newborn has Apgar scores of 6 and 7 at 1 and 5 minutes and is noted to be pale and tachypneic. Based on the maternal history, what is the most likely cause of this newborns distress?

Sepsis

In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, which finding alerts the nurse to possible side effects?

Serum magnesium level of 10 mg/dl

A primigravida at 40 weeks of gestation is having uterine contractions every to 2 minutes and states that they are very painful. Her cervix is dilated 2 cm and has not changed in 3 hours. The woman is crying and wants an epidural. What isthe likely status of this womans labor?

She is exhibiting hypertonic uterine dysfunction.

A primigravida is admitted to the emergency department with a sharp, shooting pain in the lower abdomen and vaginal spotting. A ruptured tubal pregnancy is diagnosed. During what week of gestation does this condition most commonly occur?

Sixth

An infant is to receive gastrostomy feedings. Which intervention should the nurse institute to prevent bloating, gastrointestinal reflux into the esophagus, vomiting, and respiratory compromise?

Slow, small, warm bolus feedings over 30 minutes

For an infant experiencing symptoms of drug withdrawal, which intervention should be included in the plan of care?

Snugly swaddling the infant and tightly holding the baby

Parents are often asked if they would like to have an autopsy performed on their infant. Nurses who are assisting parents with this decision should be aware of which information?

Some religions prohibit autopsy

A woman who is 30 weeks of gestation arrives at the hospital with bleeding. Which differential diagnosis would not be applicable for this client?

Spontaneous abortion

The most effective and least expensive treatment of puerperal infection is prevention. What is the most important strategy for the nurse to adopt?

Strict aseptic technique, including hand washing, by all health care personnel

A nurse is caring for a client with type 1 diabetes on her first postpartum day. While planning care for this client, what changes in insulin requirements does the nurse anticipate?

Suddenly decrease

A pregnant woman who is at 21 weeks of gestation has an elevated blood pressure of 140/98. Past medical history reveals that the woman has been treated for hypertension. On the basis of this information, the nurse would classify this patient as having:

Superimposed preeclampsia.

A premature infant with respiratory distress syndrome (RDS) receives artificial surfactant. How does the nurse explain surfactant therapy to the parents?

Surfactant improves the ability of your babys lungs to exchange oxygen and carbon dioxide.

Symptoms of hypothyroidism

Symptoms include weight gain, lethargy, decrease in exercise capacity, and intolerance to cold. Other presentations might include constipation, hoarseness, hair loss, and dry skin.

7. What is one of the initial signs and symptoms of puerperal infection in the postpartum client?

Temperature of 38 C (100.4 F) or higher on 2 successive days

Which information is an important consideration when comparing the CST with the NST?

The NST has no known contraindications.

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding indicates that preterm labor is occurring?

The cervix is effacing and dilated to 2 cm.

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. Which finding indicates that preterm labor is occurring?

The cervix is effacing and dilated to 2 cm.

The client is being induced in response to worsening preeclampsia. She is also receiving magnesium sulfate. It appears that her labor has not become active, despite several hours of oxytocin administration. She asks the nurse, Why is this taking so long? What is the nurses most appropriate response?

The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor.

A perinatal nurse is giving discharge instructions to a woman, status postsuction, and curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. What is the bestresponse by the nurse?

The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, then it would make the diagnosis of this cancer more difficult.

Diabetes in pregnancy puts the fetus at risk in several ways. Nurses should be aware that:

The most important cause of perinatal loss in diabetic pregnancy is congenital malformations.

What is the primary purpose for the use of tocolytic therapy (terbutaline) to suppress uterine activity?

The most important function of tocolytic therapy is to provide the opportunity to administer antenatal glucocorticoids.

Which finding would indicate to the nurse that the grieving parents have progressed to the reorganization phase of grieving?

The parents are discussing sex and a future pregnancy, even if they have not yet sorted out their feelings.

A pregnant woman has maternal phenylketonuria (PKU) and is interested in whether or not she will be able to breastfeed her baby. Which reaction by the nurse indicates accurate information?

The patient should be advised to not breastfeed the infant because her breast milk will contain large amounts of phenylalanine.

A pregnant woman is being discharged from the hospital after the placement of a cervical cerclage because of a history of recurrent pregnancy loss, secondary to an incompetent cervix. Which information regarding postprocedural care should the nurse emphasize in the discharge teaching?

The presence of any contractions, rupture of membranes (ROM), or severe perineal pressure should be reported.

Clasic sign of Vasa Previa?

The sudden appearance of bright red blood at the time of ROM and a sudden change in the FHR without other known risk factors

A pregnant womans BPP score is 8. She asks the nurse to explain the results. How should the nurse respond at this time?

The test results are within normal limits.

In comparing the abdominal and transvaginal methods of ultrasound examination, which information should the nurse provide to the client?

The transvaginal examination allows pelvic anatomy to be evaluated in greater detail.

Which statement regarding the laboratory test for glycosylated hemoglobinAlc is correct?

This laboratory test measures the levels of hemoglobin Alc, which should remain at less than 7%

A newborn in the neonatal intensive care unit (NICU) is dying as a result of a massive infection. The parents speak to the neonatologist, who informs them of their sons prognosis. When the father sees his son, he says, He looks just fine to me. I cant understand what all this is about. What is the most appropriate response or reaction by the nurse at this time?

This must be a difficult time for you. Tell me how youre doing.

A woman arrives at the emergency department with complaints of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary care provider finds that the cervix is closed. The anticipated plan of care for this woman would be based on a probable diagnosis of which type of spontaneous abortion?

Threatened

A woman presents to the emergency department complaining of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary health care provider finds that the cervix is closed. The anticipated plan of care for this woman is based on a probable diagnosis of which type of spontaneous abortion?

Threatened

What kind of miscarriage include spotting, closed cervix, and mild uterine contractions

Threatened

A client at 12 weeks' gestation arrives in the prenatal clinic complaining of cramping and vaginal spotting. A pelvic examination reveals that the cervix is closed. Which probable diagnosis should the nurse expect?

Threatened abortion

What kind of abortion indicates that the woman has cramping and bleeding but no cervical dilation

Threatened abortion

A woman who has recently given birth complains of pain and tenderness in her leg. On physical examination, the nurse notices warmth and redness over an enlarged, hardened area. Which condition should the nurse suspect, and how will it be confirmed?

Thrombophlebitis; using real-time and color Doppler ultrasound

Human immunodeficiency virus (HIV) may be transmitted perinatally or during the postpartum period. Which statement regarding the method of transmissionis most accurate?

Through the ingestion of breast milk from an infected mother

Fever, restlessness, tachycardia, vomiting, hypotension, and stupor indicate symptoms of what?

Thyroid Storm

Which statement is accurate with regard to the emotional state of grief?

Time limit for grief experiences is variable among individuals.

A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment, the nurse finds the following vital signs: temperature 37.3 C, pulse rate 88 beats per minute, respiratory rate 10 breaths per minute, BP 148/90 mm Hg, absent deep tendon reflexes (DTRs), and no ankle clonus. The client complains, Im so thirsty and warm. What is thenurses immediate action?

To discontinue the magnesium sulfate infusion

During the initial acute distress phase of grieving, parents still must make unexpected and unwanted decisions about funeral arrangements and even naming the baby. What is the nurses role at this time?

To ensure that the parents, themselves, approve the final decisions

What is the primary purpose for magnesium sulfate administration for clients with preeclampsia and eclampsia?

To prevent convulsions

A client at 36 weeks' gestation is admitted to the high-risk unit with heavy bleeding because of complete placenta previa. Why does the nurse place the client in a lateral Trendelenburg position?

To prevent shock

Prostaglandin gel has been ordered for a pregnant woman at 43 weeks of gestation. What is the primary purpose of prostaglandin administration?

To ripen the cervix in preparation for labor induction

A woman with preeclampsia has a seizure. What is the nurses highest priority during a seizure?

To stay with the client and call for help

A woman in preterm labor at 30 weeks of gestation receives two 12-mg intramuscular (IM) doses of betamethasone. What is the purpose of this pharmacologic intervention?

To stimulate fetal surfactant production

A client at 39 weeks of gestation has been admitted for an external version. Which intervention would the nurse anticipate the provider to order?

Tocolytic drug

Which TORCH infection could be contracted by the infant because the mother owned a cat?

Toxoplasmosis

Nurses need to understand the basic definitions and incidence data regarding PPH. Which statement regarding this condition is most accurate?

Traditionally, PPH has been classified as early PPH or late PPH with respect to birth.

A 40-year-old woman with a high body mass index (BMI) is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time?

Transvaginal ultrasound

A 26-year-old pregnant woman, gravida 2, para 1-0-0-1, is 28 weeks pregnant when she experiences bright red, painless vaginal bleeding. On her arrival at the hospital, which diagnostic procedure will the client most likely have performed?

Transvaginal ultrasound for placental location

T/F: A vacuum-assisted delivery occurs during childbirth if the mother is too exhausted to push

True

T/F: An incomplete abortion means that not all of the products of conception were expelled.

True

T/F: An inevitable abortion means that the cervix is dilating with the contractions.

True

T/F: the transvaginal ultrasound examination requires an empty bladder and it is more useful during the first trimester. It is beneficial for obese women and it is performed with the woman in a lithotomy position.

True

A primigravida client with type 1 diabetes is attending her first prenatal visit. While discussing changes in insulin needs during pregnancy and after birth, the nurse explains that in light of the client's blood glucose readings she should expect to increase her insulin dosage. Between which weeks of gestation is this expected to occur?

Twenty-fourth and twenty-eighth weeks of gestation

The nurse in the birthing unit is caring for several postpartum clients. Which factor will increase the risk for hypotonic uterine dystocia?

Twin gestation

In terms of the incidence and classification of diabetes, which information should the nurse keep in mind when evaluating clients during their ongoing prenatal appointments?

Type 2 diabetes often goes undiagnosed.

Laboratory studies reveal that a pregnant client's blood type is O and she is Rh-positive. Problems related to incompatibility may develop in her infant if the infant is what?

Type A or B

A Gravida III, Para 0 is concerned about the potential outcome for this pregnancy because all of her prior pregnancies have resulted in stillborn deliveries. Which diagnostic test would help assess for fetal well-being now that her pregnancy is at 32 weeks gestation?

Ultrasound

A nurse suspects cephalopelvic disproportion in a client who is having a difficult labor. For which test should the nurse prepare the client?

Ultrasound

A 39-year-old primigravida woman believes that she is approximately 8 weeks pregnant, although she has had irregular menstrual periods all her life. She has a history of smoking approximately one pack of cigarettes a day; however, she tells the nurse that she is trying to cut down. Her laboratory data are within normal limits. What diagnostic technique would be useful at this time?

Ultrasound examination

Within minutes of giving birth to a healthy infant, the client displays symptoms of respiratory distress. An amniotic fluid embolism is suspected. In addition to respiratory distress, for what other complication should the nurse assess the client?

Uncontrolled bleeding

The nurse should be cognizant of which condition related to skeletal injuries sustained by a neonate during labor or childbirth?

Unless a blood vessel is involved, linear skull fractures heal without special treatment.

The nurse is preparing to administer methotrexate to the client. This hazardous drug is most often used for which obstetric complication?

Unruptured ectopic pregnancy

The nurse suspects that her postpartum client is experiencing hemorrhagic shock. Which observation indicates or would confirm this diagnosis?

Urinary output of at least 30 ml/hr

What is Betamethasone used for?

Used to enhance lung maturity in the fetus if preterm delivery is likely

What physical manifestations can a nurse expect on a mother who delivered a macrosomic baby

Uterine Atony

A perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the client is experiencing profuse bleeding. What is the most likely cause for this bleeding?

Uterine atony

While caring for a woman who has had a positive contraction stress test (CST), what complication does the nurse suspect?

Uteroplacental insufficiency

A client gives birth vaginally to an infant who weighs 8 lb, 13 oz (3997 g). An ice pack is applied to the perineum to ease the swelling and pain. The client complains, "This pain in my vagina and rectum is excruciating, and my vagina feels so full and heavy." What does the nurse suspect as the cause of the pain?

Vaginal hematoma

A laboring woman with no known risk factors suddenly experiences spontaneous ROM. The fluid consists of bright red blood. Her contractions are consistent with her current stage of labor. No change in uterine resting tone has occurred. The fetal heart rate (FHR) begins to decline rapidly after the ROM. The nurse should suspect the possibility of what condition?

Vasa previa

Congenital heart defects (CHDs) are anatomic abnormalities in the heart that are present at birth, although they may not be diagnosed immediately. The most common type of CHD is:

Ventricular septal defect (VSD)

The exact cause of preterm labor is unknown but believed to be multifactorial. Infection is thought to be a major factor in many preterm labors. Which type of infection has not been linked to preterm birth?

Viral

What duration of pregnancy is the second trimester?

Week 14-26

What duration of pregnancy is the third trimester?

Week 27-40

Which statement is the most appropriate for the nurse to make when caring for bereaved parents?

What can I do for you?

A pregnant woman at 29 weeks of gestation has been diagnosed with preterm labor. Her labor is being controlled with tocolytic medications. She asks when she might be able to go home. Which response by the nurse is mostaccurate?

When we can stabilize your preterm labor and arrange home health visits.

Which options for saying good-bye would the nurse want to discuss with a woman who is diagnosed with having a stillborn girl?

When your baby is born, would you like to see and hold her?

Which client is at greatest risk for early PPH?

Woman with severe preeclampsia on magnesium sulfate whose labor is being induced

With regard to dysfunctional labor, nurses should be aware that:

Women experiencing precipitous labor are about the only women experiencing dysfunctional labor who are not exhausted.

On day 3 of life, a newborn continues to require 100% oxygen by nasal cannula. The parents ask if they may hold their infant during his next gavage feeding. Considering that this newborn is physiologically stable, what response should the nurse provide?

You may hold your baby during the feeding.

An infant is being discharged from the NICU after 70 days of hospitalization. The infant was born at 30 weeks of gestation with several conditions associated with prematurity, including RDS, mild bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP), requiring surgical treatment. During discharge teaching, the infants mother asks the nurse if her baby will meet developmental milestones on time, as did her son who was born at term. What is thenurses most appropriate response?

Your baby will need to be corrected for prematurity.

During a prenatal examination, a woman reports having two cats at home. The nurse informs her that she should not be cleaning the litter box while she is pregnant. The client questions the nurse as to why. What is the nursesmost appropriate response?

Your cats could be carrying toxoplasmosis. This is a zoonotic parasite that can infect you and have severe effects on your unborn child.

A client asks her nurse, My doctor told me that he is concerned with the grade of my placenta because I am overdue. What does that mean? What is thenurses best response?

Your placenta changes as your pregnancy progresses, and it is given a score that indicates how well it is functioning.

What Causes PKU (Phenylketonuria)

an inborn error of metabolism caused by an autosomal recessive trait that creates a deficiency in the enzyme phenylalanine hyrdolase. Absence of this enzyme impairs the body ability to metabolize phenylalanine found in protein foods.

Newborn who has jittering and diaphoresis what you finna do?

check FSBS of baby

How is kernicterus caused?

chronic and permanent results of bilirubin toxicity

What are signs of Nectrotizing enterocolitis (NEC)?

decreased activity, hypotonia, pallor, recurrent apnea and bradycardia, decreased oxygen saturation values, respiratory distress, metabolic acidosis, oliguria, hypotension, decreased perfusion, temperature instability, cyanosis, abdominal distention, residual gastric aspirates, vomiting,grossly bloody stools, abdominal tenderness, and erythema of the abdominal wall.

What is an indication for placenta previa

painless vaginal bleeding

Reduced HTN reports continuous pain and vaginal bleeding

placenta abruption

Polyhydraminos puts the client at risk for:

premature rupture of membranes, premature labor, and postpartum hemorrhage.

Indications fro the use of PUBS include:

prenatal diagnosis of inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of fetuses with IUGR, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus

what to look for when patient takes terbutaline aka tocolytic:

pulmonary edema and/or difficulty breathing (dyspnea)

What can be done to determine placental age

ultrasonography

A patient is presented with heavy vaginal bleeding at 30 weeks gestation. What test can the nurse anticipate from the doctor?

ultrasound

When would a nurse suspect Dysfunctional labor?

when there is an alteration in the characteristics of uterine contractions, a lack of progress in the rate of cervical dilation, or a lack of progress in fetal descent and expulsion