G&D Exam 3

A nurse caring for a woman with preeclampsia should monitor for which complications associated with preeclampsia? SELECT ALL THAT APPLY. A. Abruption B. Hyperbilirubinemia C. Nonreassuring fetal status D. Eclampsia E. Gestational diabetes

ANSWER: A B C D Abruption, hyperbilirubinemia, nonreassuring fetal status, and eclampsia can all occur as a complication of preeclampsia. Gestational diabetes is not associated with preeclampsia.

A pregnant client (G7P5) presents after being advised she has a missed abortion. She tells a nurse that she wants to wait and let the pregnancy pass "naturally." Which length of time should the nurse tell the client is the longest she can wait before having a dilatation and curettage (D&C) after being diagnosed with a missed abortion? A. 24 hours B. 72 hours C. 4-6 weeks D. 6-8 weeks

ANSWER C: In missed abortions, a D&C, or suction evacuation, should be performed by 4 to 6 weeks if expulsion of the fetal products has not occurred. Pregnancies that progress beyond 6 weeks put the mother at risk for developing disseminated intravascular coagulation disorder (DIC).

A nurse's client has requested an epidural for pain management during delivery. Which factor is associated with epidural anesthesia? A. Need for medications to stimulate contractions B. Decrease in incidence of vaginal operative deliveries 3. Decrease in second stage of labor D. Increase in cesarean births

ANSWER: A Epidural anesthesia is associated with less pain during the intrapartum period. Women who receive epidural anesthesia are more likely to require stimulation of uterine contractions. There is an increase, not decrease, in incidence of a vaginal operative delivery, such as forceps or vacuum extraction. There is no association between cesarean births and epidural anesthesia.

A pregnant woman, who has a previous surgical history of bariatric surgery, should be counseled by a nurse to supplement her diet with which of the following? SELECT ALL THAT APPLY. A. Vitamin B12 B. Folate C. Iron D. Vitamin A E. Calcium

ANSWER: A B C E Women who have had any type of bariatric surgery should supplement their diets with vitamin B12, folate, iron, and calcium because the surgery decreases the absorption of these vitamins and minerals. Vitamin A excess can lead to fetal defects and should not be supplemented unless specifically indicated.

A nurse should recommend which suggested weight gain for a woman who is in the ideal weight range before becoming pregnant? A. Less than 15 lb B. 15-25 lb C. 25-35 lb D. 35-45 lb

ANSWER: C A woman, who is in the ideal weight range prior to pregnancy, is typically advised to gain 25 to 35 lb during pregnancy. The increased uterine size and its contents, breasts, intravascular fluid, excess fat, water, and protein make up the maternal reserves.

A nurse is reviewing laboratory values for a client who is in the early stage of labor. Based on these findings, which condition should the nurse conclude that the client is experiencing? RBC - 4/2x606/uL WBC - 10,420 cells/uL MCHC 28.2% MCV - 78 fL Hgb - 11/1 g/dL Hct - 30.4% Fe (TOTAL) - 7 umol/L TIBC - 85 umol/L PLT - 182,000/uL A. Megaloblastic anemia B. Thalassemia minor C. Folate anemia D. Iron-deficiency anemia

ANSWER: D Iron-deficiency anemia is marked by decreased hemoglobin and hematocrit levels. In iron-deficiency anemia, the mean corpuscular volume (MCV), or average red blood cell size, is typically less than 80 fL, the mean corpuscular hemoglobin concentration (MCHC, or hemoglobin concentration per red blood cell), is less than 30%, the serum iron is decreased, and the total iron-binding capacity (TIBC) is increased. Normal values are MCV 82-88 fL, MCHC 32%-36%, serum Fe 9-26 µmol/L, and TIBC 45-73 µmol/L. Megaloblastic anemia is a vitamin B12 deficiency. Persons with thalassemia minor have a defective production of hemoglobin and (at most) mild anemia with slight lowering of the hemoglobin level. This can very closely resemble mild iron deficiency anemia, except the person will have a normal serum iron level. Folate-deficiency anemia is a decrease in red blood cells (RBCs) caused by folate deficiency. Normal RBCs for adult females is 4.2 to 5.0 million, with normal values being slightly lower in pregnancy.

A nurse is in the room during a physician's exam of a client who thinks she may be pregnant. Which findings during the exam support a possibility of pregnancy? A. Increased hyperplasia & hypertrophy in the breasts. B. Vaginal atrophy C. Decrease in respiratory tidal volume D. Increase in hemoglobin

ANSWER A The breasts increase in size and weight because of hyperplasia and hypertrophy of the breast tissue in preparation for lactation. Vaginal hypertrophy occurs from the increase in estrogen levels. Tidal volume increases throughout pregnancy because of a small degree of hyperventilation that occurs during pregnancy. Hemoglobin typically decreases as the pregnancy progresses, with some women developing pregnancy induced anemia.

Which laboratory test results, performed during the 15th to 18th week of pregnancy, should a nurse plan to review for a pregnant woman? A. Quadruple screen B. Nuchal translucency testing C. 1-hour glucose screen D. Indirect Coomb's testing

ANSWER A The quadruple screen is performed between 15 to 18 weeks and assesses for trisomies 13, 18, and 21 and for neural tube defects. The nuchal translucency testing is performed between 11 and 13 weeks and screens for trisomies 13, 18, and 21. The 1-hour glucose screen is performed between 24 and 28 weeks, and the indirect Coombs' testing is routinely performed at 28 weeks.

A nurse is caring for a 24-year-old client whose pregnancy history is as follows: elective termination in 1998, spontaneous abortion in 2001, term vaginal deLivery in 2003, and currently pregnant again. Which documentation by the nurse of the client's gravity and parity is correct? A. G4P1 B. G4P2 C. G3P1 D. G2P1

ANSWER A The woman has been pregnant four times in all (gravity). Each time a woman is pregnant it counts as a pregnancy, regardless of the outcome. Parity is counted once a woman delivers a fetus over 20 weeks old, regardless of whether the fetus survives. This woman has delivered once and is currently pregnant, so the parity is 1.

Which physiological cervical changes associated with pregnancy should a nurse expect to find during a physical assessment of a pregnant woman? SELECT ALL THAT APPLY. A. Formation of mucous plug B. Chadwick's sign C. Presence of colostrum D. Goodell's sign E. Cullen's sign

ANSWER A B D Cervical changes associated with pregnancy include the formation of the mucous plug, softening of the cervix (Goodell's sign), and a bluish purple discoloration of the cervix (Chadwick's sign). Colostrum does occur with pregnancy but is a physiological change associated with the breasts. Cullen's sign is a bluish discoloration of the periumbilical skin caused by intraperitoneal hemorrhage. It can occur with a ruptured ectopic pregnancy or acute pancreatitis.

A nurse is caring for a 32-week pregnant client. The client asks how the nurse will monitor the baby's growth & determine if the baby is "really ok.: Based on current evidence, during the 3rd trimester, which assessment should the nurse perform to evaluate the fetus for adequate growth & viability? A. Auscultate maternal heart tones B. Measure fundal height C. Measure the woman's abdominal girth D. Complete a 3rd trimester ultrasound

ANSWER B Current evidence suggests that the presence of fetal (not maternal) heart tones and adequate growth evaluated by measuring the fundal height are the standard to assess fetal growth and viability. Measurement of the woman's abdominal circumference does not provide information about the growth of the fetus. The increase in abdominal girth could be due to weight gain or fluid retention, not just growth of the baby Third trimester ultrasound is not routine nor advised for routine prenatal care because of the added cost and potential risk to the fetus.

The client visits the prenatal clinic stating she believes she is pregnant. A pregnancy test is done to detect elevated levels of: A. Prolactin B. Human Chorionic Gonadotropin C. Lecithin-Sphingomyelin D. Estriol

ANSWER B HCG levels elevate rapidly and can be detected as early two days after the missed period. Answer A is incorrect because prolactin is elevated with a prolactinoma, a type of pituitary tumor. Answer C is incorrect because lecithin/sphingomyelin (L/S ratio) is indicative of lung maturity. Answer D is incorrect because estriol levels indicate fetal well-being.

Which of the following obstetric clients should the nurse see first? A. The client who is 40 weeks gestation having contractions every 5 mins lasting 50 seconds. B. The client who is 32 weeks with terbutaline (brethine) IV. C. The 1-day postpartum client who has changed 2 peri-pads in the last 6 hours. D. The diabetic obstetric client with a blood glucose of 90.

ANSWER B The client who is 32 weeks gestation receiving Brethrine is unstable and requires further nursing assessment. Answer A is incorrect because the client who is 40 weeks gestation having contractions every five minutes lasting 50 seconds is normal. Answer C is incorrect because changing two peri-pads in the last six hours is normal; therefore, it is not highest priority. Answer D is incorrect because a blood glucose of 90 mg/dL is within normal limit.

The client being treated for preeclampsia has an infusion of magnesium sulfate. The Mg level is checked & found to be 6.3 mEq/L. Which action by the nurse is the most appropriate? A. stop the magnesium sulfate & administer calcium gluconate. B. Continue the magnesium sulfate as ordered. C. Contact the doctor STAT. D. Prep for an emergency delivery.

ANSWER B The therapeutic range for magnesium sulfate is 4.0-9.6 meq/L; therefore, with a magnesium level of 6.3meq/L, the nurse should continue the infusion. Answers A, C, and D indicate that the nurse believes the level to be toxic. This is an incorrect conclusion, making these answers incorrect.

When assessing pregnant clients, during which time frames should a nurse expect clients to report frequent urination throughout the night? SELECT ALL THAT APPLY. A. Before the first missed menstrual period B. During the first trimester C. During the second trimester D. During the third trimester E. One week following delivery

ANSWER B D Urinary frequency is most likely to occur in the first and third trimesters. First-trimester urinary frequency occurs as the uterus enlarges in the pelvis and begins to put pressure on the bladder. In the third trimester, urinary frequency returns due to the increased size of the fetus and uterus placing pressure on the bladder. During the second trimester, the uterus moves into the abdominal cavity, putting less pressure on the bladder. Urinary frequency is not a sign of impending labor. Women do not typically experience urinary changes before the first missed menstrual period. Nocturnal frequency a week after delivery may be a sign of a urinary tract infection.

A nurse is reviewing the laboratory report from the first prenatal visit of a newly admitted client. Which laboratory result should the nurse most likely question? A. Hematocrit: 36.5% B. White blood cells (WBCs): 7,000/mm3 C. Pap smear: Negative; human papillomavirus (HPV) changes noted D. Urine pH: 7.4

ANSWER C A pap smear with HPV changes reflects an abnormal result. HPV changes are a risk factor for cervical cancer and require ongoing assessment and follow-up. A hematocrit of 36.5% is within normal limits for a pregnant woman (normal hematocrit value 38% to 44%; this decreases by 4% to 7% in pregnancy). A WBC count of 7,000/mm3 is normal (normal 5,000 to 15,000/mm3). A urine pH of 7.4 is normal (normal 4.6 to 8.0).

If a pregnant woman is at 20 weeks gestation, at what level should a clinic nurse expect to palpate the woman's uterine height? A. Two finger-breadths above the symphysis pubis B. Halfway between the symphysis pubis and the umbilicus C. At the umbilicus D. Two finger-breadths above the umbilicus

ANSWER C At 20 gestational weeks, the uterus should be at the umbilicus. The uterus should be approximately two finger-breadths above the symphysis pubis at 13 weeks and halfway between the umbilicus and symphysis pubis at 16 weeks. At 22 weeks, the uterus would be two finger-breadths above the umbilicus.

A pregnant woman asks a nurse, who is teaching a prepared childbirth class, when she should expect to feel fetal movement. The nurse responds that fetal movement usually can be first felt between which time frame? A. 8 and 12 weeks of pregnancy B. 12 and 16 weeks of pregnancy C. 18 and 20 weeks of pregnancy D. 22 and 26 weeks of pregnancy

ANSWER C Subtle fetal movement (quickening) can be felt as early as 18 to 20 weeks of gestation, and it gradually increases in intensity. Options 1 and 2 are too early to expect the first fetal movement to be felt and option 4 is later than expected.

The client with premature labor is being treated with terbutaline (Brethine). Which assessment should be done prior to starting Brethine? A. Creatinine B. Cortisol Levels C. Blood glucose D. Liver profile

ANSWER C Terbutaline (Brethine) is a bronchodilator that can also relax smooth muscles. Brethine can cause elevations in blood glucose levels so the client should have blood glucose levels checked prior to beginning treatment with Brethine. Answers A, B, and D are not laboratory studies that are required prior to beginning Brethine.

Which instruction should be given to the client being discharged after evacuation of a hydatidiform mole? A. Return to the clinic in 6 weeks for a urinalysis B. Avoid exercise for at least 6 weeks C. Do not become pregnant for at least 12 months. D. Return to the clinic in 6 months for liver enzyme studies

ANSWER C The client that has experienced a hydatidiform mole should avoid becoming pregnant again for one year because chorionic carcinoma is associated with a hydatidiform mole. If the client does become pregnant and there are cells for chorionic carcinoma, the hormonal stimulation can cause rapid cell proliferation and growth of the cancer. Answer A is incorrect because a urinalysis in six weeks is not necessary. Answer B is incorrect because exercise is not contraindicated after a hydatidiform mole. Answer D is incorrect because checking liver enzymes in six months is not necessary after a hydatidiform mole.

The pregnant client is admitted to the ER with a prolapsed umbilical cord. Which action is the most appropriate? A. Cover the cord with dry, sterile gauze. B. Place the client in high Fowler's. C. Push up on the presenting part with an examining finger. D. Begin an IV of normal saline at keep-open rate.

ANSWER C The nurse should push on the presenting part to relieve pressure on the cord and facilitate blood flow through the cord. Answer A is incorrect because the sterile gauze should be moist, not dry. Answer B is incorrect because the client should be placed in Trendelenburg position, not high Fowler's position. Answer D is incorrect because the IV fluid should be rapid, not keep-open rate, to increase hydration and blood flow to the fetus.

Which finding would require intervention in the client receiving oxytocin (Pitocin) for augmentation of labor? A. Contraction every 5-6 mins lasting 60 seconds. B. Variability of 6-8 BPM. C. Drops in fetal heart tones after contractions lasting 90 seconds with hesitant return to baseline. D. Drops in fetal heart tones prior to the contractions during pushing.

ANSWER C This describes a late deceleration. These decelerations are caused by uteroplacental insufficiency and require intervention by the nurse. The treatment is STOP (Stop Pitocin if infusing; Turn the client to her side; begin Oxygen therapy; Prepare for delivery). Increasing IV fluids helps to increase blood to the uterus. Answer A is within normal limits. Answer B is also within normal limits. Answer D is incorrect because a drop in fetal heart tones prior to the contraction describes an early deceleration caused by head compression. This is expected during pushing.

A nurse is assessing the fundal height for multiple pregnant clients. For which client should the nurse conclude that a fundal height measurement is most accurate? A. A pregnant client with uterine fibroids B. A pregnant client who is obese C. A pregnant client with polyhydramnios D. A pregnant client experiencing fetal movement

ANSWER D Excessive fetal movement may make it difficult to measure a woman's fundal height; however, it should not cause an inaccuracy in the measurement. Fibroids, obesity, and polyhydramnios can all increase fundal height and give a false measurement.

Which test is most diagnostic for syphilis? A. culture B. VDRL C. RPR D. FTA-ABS

ANSWER D The fluorescent treponemal antibody test (FTA-ABS) is most diagnostic for syphilis. Answer A is incorrect because a culture of the discharge is used to diagnose gonorrhea, not syphilis. Answers B and C are incorrect because they are screening tests and are not as diagnostic as the FTA-ABS is.

A nurse's laboring client presents with ruptured membranes, frequent contractions, and bloody show. She reports a greenish discharge for 2 days. Which actions should be taken by the nurse when caring for this client? Prioritize the nurse's actions by placing each step in the correct order. _____ Perform a sterile vaginal exam _____ Assess the woman thoroughly _____ Obtain fetal heart tones _____ Notify the health-care provider (HCP)

ANSWER: 2, 3, 1, 4 The nurse should first obtain the heart tones to determine the status of the fetus. Because the woman has ruptured membranes with greenish fluid, the fetus could be experiencing non-reassuring fetal status. Once the heart tones have been obtained, a vaginal examination should be performed. The woman should be fully assessed before notifying the HCP. The woman should then be moved into an inpatient room.

A nurse is assessing a prenatal client. Which findings should be most concerning to the nurse? Prioritize the nurse's assessment findings at the first prenatal visit from the most significant finding to the least significant finding. _____ Current bleeding and cramping _____ Previous varicella infection _____ Current smoking _____ Intense pelvic pain

ANSWER: 2, 4, 3, 1 Intense pelvic pain is always the most concerning symptom, because it can represent a variety of serious medical conditions (abortion, ectopic pregnancy, appendicitis). This symptom represents a possible pathology that could warrant immediate surgical intervention, which is what makes it the most concerning. Bleeding and cramping in any pregnant woman are also extremely concerning. Smoking in the pregnancy can put the woman at risk for multiple adverse outcomes and should be addressed, although it is not an immediately concerning factor. A previous history of varicella is important to document but poses no risk to the woman or the fetus, so it is the least important factor within this scenario.

A nurse is caring for a pregnant client whose fetal heart rate tracing reveals a reduction in variability over the last 40 minutes. The client has been having occasional decelerations that are now appearing to occur after the onset of the contraction and not re solve until after the contraction is over. Suddenly, the client has a prolonged deceleration that does not re solve. Which steps should the nurse take to provide immediate care to this client? Prioritize the nurse's actions by placing each step in the correct order. ______ Administer oxygen via facemask. ______ Call for assistance and page the health-care provider. ______ Place an indwelling Foley catheter in anticipation for emergency cesarean birth. ______ Increase intravenous fluids. ______ Assist the woman into a different position. ______ Prepare for a vaginal exam and scalp stimulation.

ANSWER: 2, 4, 6, 3, 1, 5

A nurse is caring for a woman who is 9 weeks pregnant and has a past medical history of anemia during pregnancy and postpartum hemorrhage after her last delivery. In which order should interventions be implemented by the nurse? Prioritize the nurse's actions by placing each intervention in the correct sequence. ______ Obtaining serum hemoglobin and hematocrit levels ______ Starting an iron supplement of 27 mg of iron daily ______ Increasing iron supplementation to 120 mg daily ______ Providing dietary counseling for prevention ______ Notifying client of iron deficiency ______ Obtaining serum iron studies (ferritin, serum, iron, total iron binding capacity) if no improvement

ANSWER: 3 2 5 1 4 6 The initial step is to provide dietary counseling at the first prenatal visit. A supplement of 27 mg of iron is recommended for all pregnant women. Obtaining serum hemoglobin and hematocrit levels are next. The woman should then be notified of the results and increase her iron supplement to 120 mg per day. If her level does not increase, serum iron studies may be warranted.

A nurse is caring for a 34-week pregnant client (G2P1) with the following symptoms. Which manifestations should be most concerning to the nurse? Prioritize the abnormal findings for a pregnant woman in the third trimester from the most significant (1) to the least significant (4). ____ +3 pedal edema ____ BP 144/94 ____ GBS postive vaginal culture ____ Fundal height increase 4.5cm in 1 week

ANSWER: 3, 1, 4, 2 Preeclampsia is a condition that can progress to serious complications. A woman suspected of having preeclampsia needs immediate in patient evaluation. A blood pressure (BP) of 144/94 warrants immediate evaluation. A fundal height increase of 1 to 2 cm per week is considered normal fundal growth. An increase in fundal size can be related to gestational diabetes, large for gestational age fetus, fetal anomalies, or polyhydramnios. Further assessment is warranted. Excessive pedal edema can be a normal physiological process if it is an isolated finding. Pedal edema warrants further assessment because it can be a symptom of preeclampsia. A positive group beta streptococcus culture warrants antibiotic treatment in labor but does not warrant intervention during the pregnancy.

A nurse is caring for a woman with decreased fetal movement at 35 weeks gestation. Interventions have been ordered by the physician. Prioritize the prescribed interventions in the order in which they should be performed. ____ Prepare for nonstress test ____ Prepare for biophysical profile ____ Palpate for fetal movement ____ Apply and explain the external fetal monitor

ANSWER: 3, 4, 1, 2 Women who present with a decrease in fetal movement should be evaluated by first palpating for fetal movement externally. Next, the fetal monitor should be placed and the fetus should be monitored for heart rate changes. A nonstress test should be conducted to determine fetal well-being. A biophysical profile, which may or may not be performed in addition to the nonstress test, is the final test performed to determine fetal well-being.

A nurse is providing emotional support for a woman who experienced a recent miscarriage during her second trimester. The nurse's care of the woman should be based on knowing which cause of spontaneous abortions is most common in the second trimester? A. Maternal factors B. Chromosomal abnormalities C. Fetal death D. Alcoholism

ANSWER: A The most common causes of second-trimester losses are maternal factors, such as incompetent cervix. Often, the fetal death may not precede the onset of the abortion.

A nurse is caring for a pregnant woman who states she smokes two packs per day (PPD) of cigarettes. She states she has smoked in other pregnancies and has never had any problems. What is the nurse's best response? A. "I am glad to hear your other pregnancies went well. Smoking can cause a variety of problems in pregnancies and it would be best if you could quit smoking with this pregnancy." B. "You need to stop smoking for the baby's sake." C. "Smoking can lead to having a large baby which can make it difficult for delivery. You may even need a cesarean section." D. "Smoking less would eliminate the risk for your baby."

ANSWER: A The mother should be advised that there are adverse effects associated with smoking. including small for gestational age size, smaller fetal head, spontaneous abortion, placental abruption, neural tube defects, and increase risk of sudden infant death syndrome (SIDS). Secondhand smoke is also associated with adverse health effects for the fetus, including a risk for neural tube defects. Telling the woman to stop smoking for the baby's sake is confrontational, making the woman less likely to listen to the nurse's teaching. Decreasing her smoking intake should be suggested; however, it does not eliminate the risk to the baby completely.

A nurse is reviewing the laboratory test results of a pregnant client. Which lab value is outside the normal range for a pregnant woman? Hemoglobin - 10.6g/dL Indirect Coombs' Test - Negative 50g 1hr Glucose Test - 137 Glycosuria - Negative Proteinuria - Trace Group Beta Streptococcus - Negative A. Hemoglobin B. 50-gram, 1-hour glucose test C. Glycosuria D. Proteinuria

ANSWER: A The normal hemoglobin level should be 12-16 g/dL in a pregnant woman. The indirect Coombs' test should be negative; a positive result is an indication of maternal sensitization. The 50-gram 1-hour glucose test should be less than 140. Values over 140 warrant a 3-hour glucose screen to determine if the woman has gestational diabetes. Proteinuria in trace amounts is common in pregnant women although higher protein concentrations should be evaluated. Group beta streptococcus cultures should be negative. A positive culture indicates maternal infection and possible transmission to the infant during the birth process.

A nurse is about to obtain a fetal heart rate (FHR) on a client in triage for evaluation of possible labor. When preparing to auscultate the FHR, what information is needed to determine where to find the correct placement? A. Fetal position B. Position of the placenta C. Presence of contractions D. Whether ultrasonic gel should be used

ANSWER: A The nurse should first perform Leopold's maneuvers to determine the fetal position, which will enable proper placement of the Doppler device over the location of the FHR. The position of the placenta can pro vide important information. However, if the Doppler device is placed over the placenta, the nurse will hear a swishing sound and not the FHR. The FHR is still assessed regardless of the presence of contractions. The nurse who has difficulty obtaining a FHR because of a contraction can listen again once the contraction has concluded. Ultrasonic gel is used with any ultrasound device and allows for the conduction of sound and continuous contact of the device with the maternal abdomen.

A woman presents with vaginal bleeding at 7 weeks. What is the primary nursing intervention for a woman who is bleeding during the first trimester? A. Monitor vital signs B. Prepare equipment for examination C. Have oxygen available D. Assess family's response to the situATION

ANSWER: A Assessing the woman's vital signs is the most important nursing intervention. Preparing equipment, having oxygen available, and assessing the family's responses are also important nursing interventions.

A nurse is caring for a Hispanic woman who is in the active stage of labor. What is the most crucial assessment parameter that should be assessed related to the client's ethnicity and stage of labor? A. Choice of pain-control measures B. Desire for hot or cold fluids C. Selection of support persons in the room during the labor and birth D. Desire for circumcision if a male infant is born

ANSWER: A Because cultural variations exist in pain-control measures used and pain tolerance, the most crucial assessment in the active stage of labor is the client's choice of pain-control measures. A desire for hot or cold fluids and selection of support persons are both important aspects that should be determined during the early stage of labor. The desire for circumcision is also an important consideration; however, it is not the primary need during the active stage of labor. All of the factors have cultural implications that require the nurse to have an understanding of cultural diversity and needs.

A nurse is admitting a client who has been in labor for 32 hours at home. Which factor is associated with delayed admission to a labor and delivery unit? A. A reduction in use of pain medications B. A sense of loss of control C. Higher rates of maternal infection D. Higher rates of unplanned out-of-hospital births

ANSWER: A Delayed admission to labor and delivery units have been associated with less use of pain medication. A greater sense of control (rather than loss of control) and shorter overall hospital stays are also associated with delayed admission. There is no increase in out-of-hospital births or maternal and neonatal complications.

A client presents with regular contractions that she describes as strong in intensity. Her cervical exam indicates that she is dilated to 3 cm. This information should suggest to a nurse that the client is experiencing: A. early labor. B. false labor. C. cervical ripening. D. lightening.

ANSWER: A Early labor is a pattern of labor that occurs when contractions be come regular and the cervix dilates to 3 cm. False labor occurs when Braxton-Hicks contractions are strong enough for the woman to believe she is in actual labor. The contractions are infrequent or do not have a definite pattern. The lack of cervical change is also consistent with false labor. The latent phase is characterized by regular contractions, although fetal descent may not occur. Lightening is settling or lowering of the fetus into

A nurse should recommend which preconceptual supplement as a preventative measure to decrease the incidence of neural tube defects? A. Folic acid supplementation B. Iron supplements C. Vitamin C supplementation D. Vitamin B6 supplementation

ANSWER: A Folic acid supplementation when taken at the time of conception has been found to decrease the incidence of neural tube defects. Iron supplements are used to treat anemia that is associated with pregnancy.

An office nurse is evaluating a 32-weeks-pregnant client. The client presents for her routine visit with an elevated blood pressure of 142/89 mm Hg. Her urine is negative for protein and her weight gain is 2 pounds since her last routine visit at 30 weeks. She has trace pedal edema. Based on this information, the nurse should conclude that the client is most likely experiencing: A. gestational hypertension. B. chronic hypertension. C. preeclampsia. D. eclampsia.

ANSWER: A Gestational hypertension is defined as an elevation of maternal blood pressure with normal urine findings. Chronic hypertension occurs before 20 weeks and is a preexisting condition. Preeclampsia is marked by an elevated blood pressure with proteinuria. Eclampsia is characterized by the addition of nonepileptic seizures that coexist with preeclampsia.

The nurse is caring for an antepartal client with a velamentous cord insertion. The client asks what symptom she would most likely experience first if one of the vessels should tear. The nurse responds that the most likely symptom to occur is: A. vaginal bleeding. B. cramping. C. uterine contractions. D. placenta abruption

ANSWER: A In a velamentous cord insertion, vessels of the cord divide some distance from the placenta in the placental membrane. Thus, the most likely symptom would be vaginal bleeding. Cramping and contractions are unlikely to occur because it is not related to uterine activity. An abruption, when the placenta comes off the uterine wall, results in severe abdominal pain.

A nurse is caring for a client who has been in the second stage of labor for the last 12 hours. The nurse should monitor for which cardiovascular change that occurs during labor? A. An increase in maternal heart rate B. A decrease in cardiac output C. An increase in peripheral vascular resistance D. A decrease in the uterine artery blood flow during contractions

ANSWER: A Maternal heart rate is normally increased due to pain resulting from increased catecholamine secretion, fear, anxiety, and increased blood volume. During the second stage of labor, the maternal intravascular volume is increased by 300 to 500 mL of blood from the contracting uterus. Following delivery, this autotransfusion compensates for blood losses during delivery, resulting in increased cardiac output, increased stroke volume, and a decreased heart rate. A 30% increase in cardiac output occurs during labor.

A 35-year-old client, who is now 1 week past her due date, presents to a labor and birth unit. She had an ultrasound at 6 weeks for vaginal bleeding and another scan at 20 weeks. She believes that, according to her last menstrual period (LMP), she should be 3 days before her due date; however, she has a history of irregular periods. The estimated date of confinement (EDC) is off by 11 days on the second sonogram. Her fundal height is 43 centimeters. Based on this information, the nurse determines that which method would be the most accurate for dating this pregnancy? A. The crown-rump length on the 6-week sonogram B. Her last menstrual period C. Head circumference on a second-trimester sonogram D. Her fundal height measurement obtained today

ANSWER: A The 6-week ultrasound offers the most accurate dating. Because she has irregular periods, the client's LMP is not a good measure of gestational age. Second-trimester ultrasound is less accurate than first-trimester ultra sound. Fundal height can be varied by multiple factors, including amount of amniotic fluid, maternal weight, fetal size, and fetal position.

A nurse determines that a gestationally diabetic client in preterm labor has a reactive nonstress test (NST) when which findings are noted? A. Two fetal heart rate (FHR) accelerations of 15 beats per minute (bpm) above baseline for at least 15 seconds in a 20-minute period B. A FHR acceleration of 15 bpm above baseline for at least 15 seconds in a 20-minute period C. Two FHR accelerations of 20 bpm above baseline for at least 20 seconds in a 20-minute period D. The absence of decelerations in a 20-minute period

ANSWER: A The criterion for a reactive NST is the presence of 2 accelerations of 15 bpm above baseline lasting 15 seconds or longer in a 20-minute period.

A laboring client is experiencing dyspnea, diaphoresis, tachycardia, and hypotension. A nurse suspects aortocaval compression. Which intervention should the nurse implement immediately? A. Turning the client onto her left side B. Turning the client onto her right side C. Positioning the bed in reverse Trendelenburg's position D. Positioning the client in a supine position

ANSWER: A When a laboring woman lies flat on her back, the gravid uterus completely occludes the inferior vena cava and laterally displaces the sub-renal aorta. This aortocaval compression reduces maternal cardiac output, producing dyspnea, diaphoresis, tachycardia, and hypotension. Other symptoms include air hunger, nausea, and weakness. Lying on the right side, reverse Trendelenburg's position, and the supine positions all increase aortocaval compression.

A pregnant woman presents to the emergency department with a large amount of bright red bleeding and intense abdominal pain. She looks to be about 30 to 34 weeks pregnant based on her uterine size. She speaks limited English and is unable to communicate with the staff. Which interventions are appropriate for this client? SELECT ALL THAT APPLY. A. Calling for an interpreter for this client B. Establishing intravenous access C. Obtaining fetal heart tones D. Positioning the client into a lithotomy position with her legs in stirrups E. Performing a vaginal examination to determine the cause of the bleeding

ANSWER: A B C Calling for an interpreter, establishing intravenous access, and obtaining fetal heart tones should all be performed by the nurse. Positioning the client in a lithotomy position can increase the abdominal pain; there is no indication that birth is imminent for delivery in the emergency department. A pregnant woman who presents in later pregnancy should never have a digital pelvic exam because this could cause additional bleeding in a woman with placenta previa.

A nurse informs a pregnant woman that her laboratory test indicates she has iron-deficiency anemia. Based on this diagnosis, for which problems should the nurse monitor this client? SELECT ALL THAT APPLY. A. Susceptibility to infection B. Fatigue C. Increased risk of preeclampsia D. Increased risk of diabetes E. Congenital defects

ANSWER: A B C Iron-deficiency anemia is associated with susceptibility to infection, fatigue, and risk of preeclampsia because oxygen is not transported effectively. It is not associated with an increased risk of diabetes or congenital defects.

A nurse is caring for a woman who had a miscarriage 2 months ago. The woman is a heavy drinker (more than four drinks per day), and she has been advised that her recent miscarriage may have been associated with her alcohol use. Which additional problems re lated to prolonged alcohol abuse should the woman be informed about by the nurse? SELECT ALL THAT APPLY. A. Malnutrition B. Bone marrow suppression C. Liver disease D. Hepatitis B infection E. Neurological damage to a developing fetus

ANSWER: A B C E Alcohol use is associated with malnutrition, bone marrow suppression, and liver disease. Fetuses cannot remove the breakdown products of alcohol. The large buildup of these byproducts leads to vitamin B deficiency and accompanying neurologic damage. Alcoholism is not associated with hepatitis B; although hepatitis B can also cause liver disease.

A pregnant client tells a nurse that she thinks she is carrying twins. In reviewing the client's history and medical records, the nurse should determine that which factors are associated with a multiple gestation? SELECT ALL THAT APPLY. A. Elevated serum alpha-fetoprotein B. Use of reproductive technology C. Maternal age greater than 40 D. Family history E. Elevated hemoglobin

ANSWER: A B D An elevated serum alpha-fetoprotein level (an oncofetal protein normally produced by the fetal liver and yolk sac), use of reproductive technology, and family history are all associated with a multiple gestation. Maternal age greater than 40 and an elevated hemoglobin are not associated with multiple gestation.

A 38-year-old pregnant woman has just been told she has hydramnios after undergoing a sonogram for size greater than dates. For which conditions, associated with hydramnios, should the nurse assess? SELECT ALL THAT APPLY. A. Presence of major congenital anomaly B. Gestational diabetes C. Chronic hypertension D. Infections E. Preeclampsia

ANSWER: A B D Infants with congenital anomalies and mothers who are affected by gestational diabetes or infected with toxoplasmosis, rubella, cytomegalovirus, or herpes simplex virus infection (TORCH) are more likely to have hydramnios (excess amniotic fluid). Chronic hypertension and preeclampsia are not associated with excess amniotic fluid.

A nurse receives notification that a client is to be admitted for labor induction for suspected macrosomia. For which risk factors should the nurse assess the client upon admission? SELECT ALL THAT APPLY. A. Maternal obesity B. Post-term pregnancy C. Female sex of the fetus D. Previous macrosomic infant E. Past history of anorexia F. Large for gestational age (LGA) infant delivered at 30 weeks

ANSWER: A B D Maternal obesity, post-term pregnancy, and previous macrosomic infant are all associated with macrosomic infants. Male infants are more likely to be macrosomic than infants who are female. Women with anorexia (and those with a past history) may be at risk to deliver an infant that is small for gestational age (SGA). An infant can be classified as LGA at any gestational age; however, only infants that are greater than 4,500 grams are classified as macrosomic.

Multiple clients are being seen in a clinic. Which clients should a nurse prepare to receive a group beta streptococcus (GBS) culture? SELECT ALL THAT APPLY. A. Women experiencing preterm labor B. Women who had a previous neonatal death C. All pregnant women between 35 to 37 weeks gestation D. Women with a history of spontaneous abortion E. Women with a history of an abortion for an unwanted pregnancy

ANSWER: A C All pregnant women, regardless of risk status, should be screened for GBS infection. Ten to 30% of all women are colonized for GBS. There is no indication that a woman with a previous neonatal death is pregnant. A woman would not be screened for GBS solely because of a history of spontaneous or an elective abortion.

A nurse's laboring client is becoming increasingly uncomfortable during labor and requests to labor in a tub of water. Which factors are true regarding laboring in the water? SELECT ALL THAT APPLY. A. Clients who labor in a tub of water perceive less pain than women who do not use water therapy in early labor. B. Women who labor in a tub have a prolonged first stage of labor because of uterine relaxation. C. Women who labor in water report greater satisfaction during the second stage of labor. D. Neonates who deliver after being submerged in water show no differences in adverse outcomes when compared to neonates whose mothers have not labored in water. E. Clients who labor in water have a reduced incidence of feces being expelled while pushing during the second stage of labor.

ANSWER: A C D Women who labor in water perceive less pain and report greater satisfaction with the pushing stage of labor. Neonates born to mothers who have labored or given birth in a tub bath do not show differences in adverse outcomes. Differences in the length of labor have not been reported in women who use hydrotherapy in labor. Laboring in water has no effect on whether feces are expelled with pushing during the second stage of labor. A concern with laboring in water is that the water can become contaminated with feces expelled with pushing during the second stage of labor, thus increasing the mother's risk of uterine infection and the fetus's risk of aspiration pneumonia.

A nurse is taking the health history of a new, pregnant client. Which medical conditions are most likely to be risk factors for complications during pregnancy? SELECT ALL THAT APPLY. A. Diabetes B. Previous pregnancy C. Controlled chronic hypertension D. Anemia E. Hemorrhage with a previous pregnancy

ANSWER: A C D E Diabetes, hypertension, anemia, and previous pregnancy complications are all risk factors for complications. Having a previous pregnancy is not a risk factor for a current pregnancy.

A laboring client is experiencing problems, and a nurse is concerned about possible side effects from the epidural anesthetic just administered. Which problems should the nurse attribute to the epidural anesthetic? SELECT ALL THAT APPLY. A. Uncontrolled pain B. Postpartum hemorrhage C. Period of inability to move lower extremities D. Inability to urinate E. Maternal fever

ANSWER: A C D E Epidural anesthesia is associated with less pain during the intrapartum period. Women who receive epidural anesthesia are more likely to experience an inability to move the lower extremities, inability to urinate, and maternal fever. Postpartum hemorrhage is not associated with epidural anesthesia.

Which universal screenings should a nurse complete during the initial prenatal visit? SELECT ALL THAT APPLY. A. Taking the blood pressure B. Testing the urine for protein C. Testing the urine for glucose D. Screening for domestic violence E. Screening for smoking

ANSWER: A D E Blood pressure screening, domestic violence screening, and screening for smoking should all be performed at the initial prenatal visit to determine fetal and maternal risk. The use of routine urine dip assessments are unreliable in detecting proteinuria and glycosuria and are not always considered accurate.

Which is the first intervention that should be recommended to a pregnant woman complaining of hemorrhoid pain? A. Steroid-based creams B. Diet modifications C. Surgery D. Oral medications

ANSWER: B A high-fiber diet is the first intervention that should be attempted when counseling a woman on the management of hemorrhoids. Steroid-based creams are frequently used, although evidence does not support their effectiveness. Oral medications, such as flavonoids, are found to aid in symptom relief, although they are not recommended as the first line of treatment. Surgical intervention to remove hemorrhoids is not recommended in pregnancy because they frequently resolve after pregnancy.

A new pregnant client (G1P0) presents at a clinic and states that she is anxious regarding her pregnancy, her prenatal care, and her labor and birth. Which teaching need is priority during the first trimester? A. Sexual relations with her spouse B. Fetal growth and development C. Labor and delivery options D. Completion of preparations for the baby

ANSWER: B Information about fetal growth and development is important to cover during the first trimester. There is no indication that sexual relations is a concern for the woman. Labor and delivery options and completion of preparations for the baby are priorities in the third trimester. Birth control methods are priorities in the postpartum period.

A client presents with moderate vaginal bleeding and intense abdominal pain at 38 weeks gestation. The fetal heart rate is 90 beats per minute with no variability. A sonogram completed at 20 weeks reveals no evidence of a previa and an anterior placenta. The nurse determines that the most likely cause of her bleeding and pain is: A. class 0 placenta abruption. B. class 2 placenta abruption. C. late-onset placenta previa D. spontaneous abortion

ANSWER: B Placenta abruption is characterized by painful vaginal bleeding. A class 2 (not class 0) placenta abruption is characterized by moderate vaginal bleeding with non-reassuring fetal status. Placenta previa does not occur in the third trimester but instead is an ongoing physiological finding once the placenta has implanted. Spontaneous abortions occur in the beginning of pregnancy. The term spontaneous abortion is not used in late pregnancy.

A nurse is teaching a woman who wishes to travel by airplane during the first 36 weeks of her pregnancy. Which is the primary risk of air travel for this woman that the nurse should address? A. Preterm labor B. Deep vein thrombosis C. Spontaneous miscarriage D. Nausea and vomiting

ANSWER: B The most significant medical risk that can occur with air travel during pregnancy is deep vein thrombosis, because pregnancy increases the risk of blood coagulation and prolonged sitting produces venous stasis. Although nausea and vomiting can occur, they are not dangerous. Preterm labor and spontaneous abortion are not associated with air travel.

A pregnant client has an abnormal 1-hour glucose screen and completes a 3-hour, 100-gram oral glucose tolerance test. Which test result should a nurse interpret as being abnormal? A. Fasting blood sugar = 84 mg/dL B. 1 hr = 186 mg/dL C. 2 hr = 146 mg/dL D. 3 hr = 129 mg/dL

ANSWER: B A 1-hour value of 186 is abnormal. All other options are at or less than the normal expected values for a glucose tolerance test: fasting blood sugar = 95 mg/dL; 1 hr = 180 mg/dL; 2 hr = 155 mg/dL; 3 hr = 140 mg/dL.

A nurse is caring for a client who just gave birth vaginally. The nurse indicates that the presenting part was vertex and a hand. What should the proper documentation read in this woman's chart? A. "Client gave birth via vertex presentation with a second-degree perineal laceration." B. "Client gave birth via compound presentation of vertex and hand with a second-degree perineal laceration." C. "Client gave birth via breech presentation." D. "Client gave birth via cesarean section with a hand presentation and breech part

ANSWER: B A compound presentation occurs when there is more than one presenting part and occurs when the presenting part is not completely filling the pelvic inlet. The typical compound part is the occiput and a hand. When a compound presentation is noted, the 2 parts should be identified. By stating it was a vertex presentation, there is no indication that a com pound presentation occurred. The question indicates it was a vertex (head presentation). A breech present

Another nurse is caring for a 29-weeks-pregnant woman who presents with decreased fetal movement. Her initial blood pressure (BP) reading is 140/90 mmHg. She states she "doesn't feel well" and her vision is "blurry" Additional assessment data include +3 re-flexes and hands. What is the most important information that the nurse should obtain from the client's prenatal record? A. BP at 20 weeks B. BP at her first prenatal visit C. Urine dip stick from last visit D. Weight gain pattern

ANSWER: B A pregnant woman with a BP that is greater than 140/90 mmHg with the presence of proteinuria is diagnosed with preeclampsia. The BP at 20 weeks, urine dip from the last visit, and weight gain pattern should all be reviewed, but are not the most important to review.

A nurse caring for multiple clients determines that which woman would be a candidate for intermittent monitoring during labor? A. A woman with a previous cesarean birth B. A 41-weeks primigravida C. A woman with preeclampsia D. A woman with gestational diabetes

ANSWER: B A woman who is overdue by 7 days, but has a reassuring fetal heart rate pattern, is able to have intermittent fetal monitoring. Women with a previous cesarean birth are at an increased risk for uterine rupture. Women with preeclampsia and gestational diabetes are at an increased risk for placental insufficiency and need continuous monitoring during labor.

A nurse's laboring client is being monitored electronically during her labor. The baseline fetal heart rate (FHR) throughout the labor has been in the 130s. In the last 2 hours, the baseline has decreased to the 100s. How should the nurse document this heart rate pattern? A. Tachycardia B. Bradycardia C. Prolonged deceleration D. Acceleration

ANSWER: B An FHR baseline less than 110 is classified as bradycardia. Tachycardia occurs when the baseline is greater than 160 beats per minute. A prolonged deceleration is defined as a change from the baseline FHR that occurs for 2 to 10 minutes before returning to baseline. An "acceleration" is an increase in the FHR.

A nurse is caring for a client who is Rh negative at 13 weeks gestation. The client is having cramping and has moderate vaginal bleeding. Which physician order should the nurse question? A. Administer Rho(D) immune globulin (RhoGAM®). B. Obtain a beta human chorionic gonadotropin level (BHCG). C. Schedule an ultrasound. D. Assess for fetal heart tones.

ANSWER: B Obtaining the BHCG level is not indicated at this late stage in pregnancy. BHCG levels are followed in early pregnancy before a fetal heart can be confirmed. RhoGAM® is indicated for any pregnant woman with bleeding who is Rh negative. An ultrasound can identify the cause of bleeding and confirm viability. A Doppler can be used to confirm a fetal heartbeat.

A nurse admits a woman with a diagnosis of placenta previa. Which symptom is the nurse most likely to assess in a woman with this diagnosis? A. Painful vaginal bleeding B. Painless vaginal bleeding C. Contractions D. Absence of fetal movement

ANSWER: B Placenta previa is characterized by painless vaginal bleeding. Painful vaginal bleeding is often associated with placental abruption. Contractions are associated with preterm labor. An absence of fetal movement is always cause for concern but is not a primary symptom of placenta previa.

A nurse is caring for a client who has a positive quadruple screen for Down's syndrome at 16 weeks. Which diagnostic test can be used to confirm the diagnosis? A. Chorionic villus sampling (CVS) B. Amniocentesis C. Level II ultrasound D. Nuchal translucency testing

ANSWER: B The amniocentesis is the only diagnostic test that can be performed at this time during the pregnancy to confirm diagnosis of Down's syndrome. CVS and nuchal translucency testing are both done during the first trimester and cannot be performed at 16 weeks. An ultrasound can be performed after 16 weeks but is not a diagnostic test. It is also considered a screening test and does not offer a definitive diagnosis.

A pregnant client presents to a clinic with ongoing nausea, vomiting, and anorexia at 29 weeks gestation. Her medical record reveals a hemoglobin level of 5 g/dL. A blood smear reveals that newly formed red blood cells are macrocytic. The nurse determines that the client is most likely experiencing: A. sickle cell anemia. B. folic acid deficiency anemia. C. beta thalassemia minor. D. beta thalassemia major.

ANSWER: B These symptoms and lab findings are indicative of folic acid deficiency. It is usually seen in the third trimester and coexists with iron-deficiency anemia. Sickle cell anemia is an inherited disorder in which the hemoglobin is abnormally formed. The chief complaint among individuals with sickle cell anemia is pain. Thalassemia is another inherited hematological disorder in which there is a defect in the synthesis of the beta chain within the hemoglobin molecule. Beta-thalassemia minor typically results in mild anemia, whereas beta-thalassemia major is much more severe. Pregnancy in individuals with beta-thalassemia major is rare. Symptoms are usually severe anemia that warrants transfusion therapy.

A 39-year-old client presents in active labor. The client is breathing rapidly and having difficulty cop ing with the contractions. Based on this assessment, what would a nurse predict should occur if interventions are not initiated immediately? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

ANSWER: B Women who are hyperventilating have a decrease in the PaCO2 levels, which leads to respiratory alkalosis. Respiratory acidosis occurs because of hypoventilation, which does not routinely occur in labor. Metabolic acidosis occurs when there is an excessive acidity in the blood and most commonly occurs in kidney failure, diabetic ketoacidosis, and cases of shock. Although it could occur in women with severe diabetes or in a client who has had a considerable obstetric hemorrhage and is in shock, it is not a normal occurrence in pregnancy or labor. Metabolic alkalosis is primarily related to kidney and gastrointestinal disorders and is not a normal physiological process that occurs in labor.

A 42-year-old woman who had a partial hydatidiform molar pregnancy 3 months ago, asks a nurse whether she and her husband can try conceiving again. Which response by the nurse is incorrect and warrants follow-up action by an observing nurse manager? A. "You will need serial beta human chorionic gonadotropin (BHCG) levels every 1 to 2 weeks until negative, and then every 1 to 2 months for 6 to 12 months." B. "You cannot conceive again because of the risk of choriocarcinoma." C. "You should not become pregnant for 6 to 12 months." D. "Your risk of hydatidiform

ANSWER: B Women who have had a molar pregnancy can conceive again once their BHCG levels are normal and remain normal for a certain time period, usually 6 to 12 months. Women undergo serial serum BHCG testing after a hydatidiform molar pregnancy. These women are at risk for choriocarcinoma and need careful follow-up; however, in the absence of this malignancy, pregnancy is not contraindicated. Couples with a past history of molar pregnancy have the same statistical chance of conceiving again and having a normal pregnancy as those without.

A 28-year-old pregnant client (G3P2) has just been diagnosed with gestational diabetes at 30 weeks. The client asks what types of complications may occur with this diagnosis. Which complications should the nurse identify as being associated with gestational diabetes? SELECT ALL THAT APPLY. A. Seizures B. Large for gestational age infant C. Low birth weight infant D. Congenital anomalies E. Preterm labor

ANSWER: B D Infants of diabetic mothers can be large as a result of excess glucose to the fetus. Congenital anomalies are more common in diabetic pregnancies. Seizures do not occur as a result of diabetes but can be associated with preeclampsia, another pregnancy complication. Preterm labor is not typically associated with maternal diabetes.

A nurse is working in a government nutritional education program. The nurse is counseling a young pregnant woman who is a vegan. Based on the nurse's knowledge of vegetarianism, which definition of vegan is correct? A. An individual who does not eat meat B. An individual who does not eat eggs C. An individual who does not eat animal products D. An individual who prefers vegetables

ANSWER: C A vegan is an individual who does not eat any animal products, including meat, eggs, and milk. A lacto-ovo vegetarian does not eat meat, but does eat eggs and drink milk. A lacto-vegetarian drinks milk, but does not eat eggs.

A nurse working in a prenatal clinic is asked which testing regimen is recommended by the Center for Disease Control and Prevention (CDC) regarding HIV testing. What is the correct 2006 CDC recommendation upon which the nurse should base a response? A. All women should be encouraged to have the HIV test and sign a separate consent form. B. All women with risk factors should be tested after consent for HIV testing has been obtained. C. All pregnant women should have an HIV test included in the prenatal panel after obtaining a general consent form for all screening tests. D. HIV testing may be done on all pregnant women without obtaining consent because the fetus is at risk.

ANSWER: C According to the CDC (2006), all pregnant women should have HIV testing included in the prenatal panel. A separate consent is not needed. The other options are incorrect.

A nurse is caring for a client who wants minimal intervention in terms of pain relief. A physician recommends a procedure of injecting perineal anesthesia into the pudendal plexus for pain relief for the second stage of labor, birth, and episiotomy repair. Which type of anesthesia should the nurse anticipate that the health-care provider will likely request? A. Epidural anesthesia B. Systemic analgesia C. Pudendal bloc D. Local infiltration anesthesia

ANSWER: C Pudendal anesthesia involves injecting perineal anesthesia into the pudendal plexus for pain relief for the second stage of labor, birth, and episiotomy repair. Epidural anesthesia is injected into a space between the vertebrae of the spine. Systemic analgesics are intravenous or intramuscular anesthesia that is given to the mother to provide pain relief. Local infiltration anesthesia is used to repair the perineal and vaginal area after an episiotomy or laceration has occurred.

A 22-year-old client, who is experiencing vaginal bleeding in the first trimester of pregnancy, fears that she has lost her baby at 8 weeks. Which definitive test result should indicate to a nurse that the client's fetus has been lost? A. Falling beta human chorionic gonadotropin (BHCG) measurement B. Low progesterone measurement C. Ultrasound demonstrating lack of fetal cardiac activity D. Ultrasound determining crown-rump length

ANSWER: C Ultrasound is used to determine if the fetus has died. The lack of fetal heart activity in a pregnancy over 6 weeks determines a fetal loss. Crown-rump length determines only the fetal gestational age. Falling BHCG levels and low progesterone levels do not conclusively diagnose fetal demise.

A nurse practitioner informs a new nurse that a client in the last delivery room is having a prolonged deceleration on the monitor. The new nurse interprets this to mean that there is a fetal heart rate (FHR) decrease of: A. 30 beats per minute (bpm) below baseline for greater than 30 seconds. B. 15 bpm or more below baseline that occurs for at least 2 minutes but not more than 5 minutes. C. 15 bpm or more below baseline that occurs for at least 2 minutes but not more than 10 minutes. D. 15 bpm or more below baseline that occurs for 10 minutes and then resolves spontaneously or with interventions.

ANSWER: C A prolonged deceleration occurs when the FHR decreases 15 bpm or more below baseline for at least 2 minutes but not more than 10 minutes. The prolonged deceleration may resolve spontaneously or with the aid of interventions.

A nurse is caring for a woman who is being evaluated for a suspected malpresentation. The fetus's long axis is lying across the maternal abdomen, and the contour of the abdomen is elongated. Which should be the nurse's documentation of the lie of the fetus? A. Vertex B. Breech C. Transverse D. Brow

ANSWER: C A transverse lie occurs in 1 in 300 births and is marked by the fetus's lying in a side-lying position across the abdomen. Both vertex and breech presentations result in the lie being vertical. A brow presentation is also a vertical lie.

A nurse's client has had recurrent variable decelerations for the last 2 hours. For which intervention should the nurse plan? A. Continuous electronic fetal monitoring B. Maternal position changes C. Amnioinfusion D. Cesarean delivery

ANSWER: C Amnioinfusion is sterile fluid instillation into the amniotic cavity through a catheter to supplement the amniotic fluid and prevent further cord compression. It is usually performed transcervically during the intrapartum period. Amnioinfusion has been found to be effective in the treatment of severe variable decelerations and decreases the need for cesarean births. Continuous electronic fetal monitoring is not a treatment for variable decelerations. Position changes may be effective, al though the evidence supports the use of amnioinfusion as an intervention that decreases the need for cesarean section birth.

A 39-year-old client, diagnosed with type 1 diabetes mellitus, presents at 36 weeks gestation with regular contractions. A physician decides to do an amniocentesis. Which statement best supports why a nurse should prepare the client for an amniocentesis now? A. Diabetic women have a higher incidence of birth defects, and the physician wants to determine if a birth defect is present. B. The woman is over 35 and is at risk for chromosomal disorders. C. Infants of diabetic mothers are less likely to have mature lung capacity at this gestational age, and determination of lung maturity can influence whether delivery should proceed. D. The amniocentesis is more accurate than the fetal fibronectin test in determining if delivery is imminent.

ANSWER: C An amniocentesis performed at this stage is most commonly done to determine if the fetal lungs have matured. In midpregnancy, the cells in amniotic fluid can be studied for genetic abnormalities such as Down's syndrome and birth defects. Many women over the age of 35 have amniocentesis done for this reason, but not this late in the pregnancy. Fetal fibronectin testing is used to determine if a preterm birth is likely (not amniocentesis), but it cannot be used to determine lung maturity.

A pregnant client presents with vaginal bleeding and increasing cramping. Her exam reveals that the cervical os is open. Which term should the nurse expect to see in the client's chart notation to most accurately describe the client's condition? A. Ectopic pregnancy B. Complete abortion C. Imminent abortion D. Incomplete abortion

ANSWER: C In imminent abortion, the woman's bleeding and cramping increase and the cervix is open, which indicates that abortion is imminent or inevitable. In ectopic pregnancy, the pregnancy is outside of the uterus and intervention is indicated to resolve the pregnancy. A complete abortion indicates that the contents of the pregnancy have been passed. In an incomplete abortion, a portion of the pregnancy has been expelled and a portion remains in the uterus.

A nurse is screening prenatal clients who may be carriers for potential genetic abnormalities. Which ethnic group should the nurse identify as having the lowest risk for hemoglobinopathies, such as sickle cell disease and thalassemia? A. African descent B. Southeast Asian descent C. Scandinavian descent D. Mediterranean descent

ANSWER: C Individuals of Scandinavian descent are not an identified risk group for hemoglobinopathies. Individuals of African, Southeast Asian, or Mediterranean descent are all at risk for hemoglobinopathies and should be offered carrier screening.

A client who is 39-weeks pregnant presents to the birthing facility with a complaint of uterine contractions. Her contractions are mild, infrequent, and every 9 to 12 minutes; however, she is having variable decelerations. A physician orders a sonogram to determine if her amniotic fluid index (AFI) is adequate. The nurse interprets that which AFI is normal at 39 weeks? A. 4.75 cm B. 5.0 cm C. 10.5 cm D. 26 cm

ANSWER: C The normal AFI for a term pregnancy is greater than 5 and less than 25 cm. The abdomen is divided into four quadrants. The fluid volume is assessed by measuring the largest vertical pocket in each quadrant and adding these four measurements. Fluid levels less than 5 or greater than 25 are outside of normal limits.

A pregnant woman is suspected of having a he moglobinopathy. Which test should a nurse anticipate that the health-care provider would order to appropriately diagnose a hemoglobinopathy? A. Complete blood count (CBC) B. Solubility test C. Hemoglobin electrophoresis D. CBC and hemoglobin electrophoresis

ANSWER: D CBC and hemoglobin electrophoresis are both appropriate tests for diagnosing hemoglobinopathies. Both are necessary to determine a specific diagnosis for hemoglobinopathies. Solubility testing is not recommended because it fails to identify the transmissible hemoglobin gene abnormalities.

A first-trimester pregnant woman asks a nurse if the activities in which she participates are safe in the first trimester. Which activity should the nurse verify as a safe activity during the client's first trimester? A. Hair coloring B. Hot tub use C. Sauna use D. Sexual activity

ANSWER: D Sexual activity is not contraindicated in pregnancy unless a specific risk factor is identified. Hair coloring and hot tub and sauna use should be avoided in the first trimester of pregnancy because of the dangers to the developing fetus and pregnant woman.

A nurse is assessing a laboring client who is morbidly obese. The nurse is unable to determine the fetal position. Which is the most accurate method of determining fetal position in this client? A. Inspection of the fetal abdomen B. Palpation of the abdomen C. Vaginal examination D. Ultrasound

ANSWER: D The most accurate assessment measure is ultrasound. Inspection of the abdomen, palpation of the abdomen, and vaginal examination are all assessment techniques that can be used to determine fetal position. It is not uncommon to have difficulty assessing the fetal presentation in obese women or when the fetal part is not engaged.

A nurse is monitoring a laboring client, who has ruptured membranes and is 4 cm dilated. The client has been having intermittent decelerations for the last hour. There is a decrease in variability, although the fetal heart rate (FHR) remains in the 140s. The decelerations are now becoming more regular. What is the most accurate means to monitor the FHR in this client? A. Fetal electrocardiography B. Continuous external fetal monitoring C. Cardiotocography D. Fetal electrocardiography & cardioocography

ANSWER: D Evidenced-based research indicates that the combination of fetal electrocardiography and cardiotocography provides the most accurate assessment, results in less surgical intervention, and ensures better oxygen levels. Although all of these methods can provide a means of assessing the FHR, options 1, 2, and 3 are not the most accurate of the options.

A nurse is caring for a young woman who presents to a hospital with a severe headache at 32 weeks gestation. The client has not been seen by her obstetrician in 3 weeks. Her admission blood pressure is 184/104 mmHg. She is requesting pain medications. The physician orders a nonstress test and laboratory studies. Based on the findings of the serum laboratory report, the nurse suspects that the woman is experiencing: Serum Bilirubin - 2.1 mg/dL LDH - 782 IU/L AST - 84 IU/L ALT - 51 IU/L PLT - 99,000 mm3 Hgb - 12.1 g/dL Hct 42.8% A. renal failure. B. liver failure. C. preeclampsia. D. HELLP syndrome.

ANSWER: D The clinical laboratory values support the diagnosis of HELLP syndrome, a variation of pregnancy-induced hypertension characterized by hemolysis, elevated liver enzymes, and low platelets. The laboratory results involved both renal and liver alterations, making either liver or renal failure unlikely. The diagnosis of preeclampsia commonly coexists with HELLP; however, these laboratory findings show worsening symptoms that are associated with HELLP syndrome.

A nurse's client, who is in labor, is waiting for laboratory results to come back so epidural anesthesia can be administered. Which result is abnormal and should be reported to a physician? A. White blood cells (WBCs): 24,000/mm3 B. Glucose: 78 gm/dL C. Hemoglobin: 13.2 g/dL D. Platelets: 112,000/mm3

ANSWER: D The normal platelet count is 150,000 to 450,000/mm3. Counts less than 150,000 should be evaluated because they can contribute to bleeding. Counts less than 100,000 may interfere with the woman's choice to receive epidural anesthesia. The normal WBC count in labor is increased and can be as high as 25,000/mm3 to 30,000/mm3. The normal glucose level falls during labor because of an expenditure in labor. Anemia or a reduction in the hemoglobin and hematocrit are common in pregnancy. Hemoglobin levels less than 10 g/dL are considered abnormal in pregnancy.

A primigravida client has been pushing for 2 hours when the head emerges. The fetus fails to deliver, and the physician notes that the turtle sign has occurred. Which should be a nurse's interpretation of this information? A. Cephalopelvic disproportion B. Shoulder dystocia D. Persistent occiput posterior position E. Cord prolapse

Shoulder dystocia is a significant complication when the head is born but the fetal shoulders are unable to deliver. Cephalopelvic disproportion occurs when the head is too large to fit through the pelvis. In that case, fetal descent ceases. Persistent occiput posterior results in prolonged pushing; however, once the head is born, the remainder of the birth occurs without difficulty. A cord prolapse occurs when the umbilical cord enters the cervix before the fetal presenting part and is considered a medical emergency.

A 22-year-old women tells a clinic nurse that her last period was 3 months ago, which began on 11/21. She has a positive urine pregnancy test. Using Nagele's rule, which date would the nurse calculate the woman's EDC? A. 8/28 B. 1/28 C. 8/15 D. 1/15

ANSWER A To calculate the EDC using Nagele's rule, subtract 3 months, and add 7 days. This makes the EDC 8/28.

The client is diagnosed with genital herpes. Which med is used to treat? A. Acyclovir (Zovirax) B. Podophyllin C. AZT (Retrovir) D. Isoniazid (Lanzid)

ANSWER A Acyclovir is used to treat genital herpes. Answer B is incorrect because Podophyllin is used to treat condyloma acuminata (venereal warts). Answer C is incorrect because AZT (Retrovir) is used prevent HIV transmission from mother to baby. Answer D is incorrect because isoniazid is used to treat tuberculosis, not herpes.

The pregnant client with AIDS is diagnosed with cytomegalovirus. The nurse is aware that the client probably contracted cytomegalovirus from... A. Blood or body fluid exposure to the virus B. emptying her cat's liter box C. Contaminated food or water D. Pigeon feces

ANSWER A Cytomegalovirus virus is transmitted predominantly by blood or body fluid exposure to the virus. Answer B is incorrect, toxoplasmosis is transmitted through contaminated cat feces. Answer C is incorrect because contaminated food or water can cause many illnesses; for example, E. coli, listeria, Clostridium difficile, and many others. Answer D is incorrect because histoplasmosis is transmitted by bird feces.

A woman who is actively bleeding due to a spontaneous abortion asks a nurse why this is happening. The nurse advises the woman that the majority of first-trimester losses are related to which of the following? A. Cervical incompetence B. Chronic maternal disease C. Poor implantation D. Chromosomal abnormalities

ANSWER: D Chromosomal abnormalities account for the majority of first-trimester spontaneous abortions. The other options also can result in spontaneous abortion, but do not account for the majority.