High Risk Antepartum- Davis Practice Q's

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

1, 2, 3, and 4 are correct. 1. Nausea and vomiting is a common side effect. 2. Abdominal pain is a common side ef- fect. The pain associated with the medication needs to be carefully mon- itored to differentiate it from the pain caused by the ectopic pregnancy itself. 3. Fatigue is a common side effect. 4. Lightheadedness is a common side effect. 5. Breast tenderness is not seen with this medication. TEST-TAKING TIP: Because methotrexate is an antineoplastic agent, the nurse would expect to see the same types of complaints that he or she would see in a patient receiving chemotherapy for cancer. It is very important that the abdominal pain seen with the medication not be dismissed because the most common complaint of women with ectopic pregnancies is pain. The source of the pain, therefore, must be clearly identified.

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

1. A luteinizing hormone level will not pro- vide information on the viability of a pregnancy. 2. Endometrial biopsy will not provide in- formation on the viability of a pregnancy. 3. Hysterosalpingogram is not indicated in this situation. 4. Serum progesterone will provide infor- mation on the viability of a pregnancy. TEST-TAKING TIP: When a previously gravid client is seen by her health care practi- tioner with a complaint of vaginal bleed- ing, it is very important to determine the viability of the pregnancy as soon as possible. Situational crises are often exac- erbated when clients face the unknown. One relatively easy way to determine the viability of the conceptus is by performing a serum progesterone test; high levels indicate a viable baby whereas low levels indicate a pregnancy loss. Ultrasonogra- phy to assess for a beating heart may also be performed.

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

1. A weight gain of 10 pounds in a 4-week period is worrisome. The recommended weight gain during the second and third trimesters is approximately 1 pound per week. 2. The pulse rate normally increases slightly during pregnancy. 3. A slight drop in BP is normal during pregnancy. 4. The respiratory rate normally increases during pregnancy. TEST-TAKING TIP: A weight gain above that which is recommended can be related to a few things, including preeclampsia, exces- sive food intake, or multiple gestations. The midwife should be advised of the weight gain to identify the reason for the increase and to intervene accordingly.

A nurse works in a clinic with a high adolescent pregnancy population. The nurse provides teaching to the young women in order to prevent which of the following high risk complications of pregnancy? 1. Preterm birth. 2. Gestational diabetes. 3. Macrosomic babies. 4. Polycythemia.

1. Adolescents are at high risk for preterm labor. 2. Life style issues and ethnicity are more important high risk predictors of GDM than is age. 3. Pregnant teens are high risk for deliver- ing babies that are small-for-gestational age rather than macrosomic babies. 4. Pregnant teens are high risk for anemia rather than for polycythemia. TEST-TAKING TIP: It is very important that pregnant teens learn the telltale signs of preterm labor, such as intermittent back- ache, cramping, discomfort low in the pelvic area, and the like. Because of their lifestyle choices, pregnant teens are at high risk for low-birth-weight, preterm births.

A nurse is about to inject RhoGAM into an Rh-negative mother. Which of the following is the preferred site for the injection? 1. Deltoid. 2. Dorsogluteal. 3. Vastus lateralis. 4. Ventrogluteal.

1. Although the dosage can be adminis- tered in the gluteal muscles, the del- toid is the preferred site of the RhoGAM injection. 2. Although the dosage can be administered in the gluteal muscles, the deltoid is the preferred site of the RhoGAM injection. 3. Although the dosage can be administered in the gluteal muscles, the deltoid is the preferred site of the RhoGAM injection. 4. Although the dosage can be administered in the gluteal muscles, the deltoid is the preferred site of the RhoGAM injection. TEST-TAKING TIP: Whenever possible, it is preferable to inject the antibodies into the recommended injection site. The antibodies are absorbed optimally from that site and, therefore, are more apt to suppress the mother's immune response.

A 29-week-gestation woman diagnosed with severe preeclampsia is noted to have blood pressure of 170/112, 4 proteinuria, and a weight gain of 10 pounds over the last 2 days. Which of the following signs/symptoms would the nurse also expect to see? 1. Fundal height of 32 cm. 2. Papilledema. 3. Patellar reflexes of 2. 4. Nystagmus.

1. At 29-weeks' gestation, the normal fun- dal height should be 29 cm. With severe preeclampsia, the nurse may see poor growth—that is, a fundal height below 29 cm. 2. The nurse would expect to see papilledema. 3. The nurse would expect to see hyperreflexia—that is, patellar reflexes higher than 2 4. The nurse would not expect to see nys- tagmus. TEST-TAKING TIP: Intracranial pressure (ICP) is present in a client with severe preeclampsia because she is third spacing large quantities of fluid. As a result of the ICP, the optic disk swells and papilledema is seen when the disk is viewed through an ophthalmoscope.

Prenatal teaching for a pregnant woman should include instructions to do which of the following? 1. Refrain from touching her pet bird. 2. Wear gloves when gardening. 3. Cook pork until medium well. 4. Avoid sleeping with the dog.

1. Domestic birds rarely carry serious disease. 2. The client should be advised to wear gloves when gardening. 3. All meat should be cooked until well done to prevent contracting toxoplasmosis. 4. Dogs rarely carry serious disease. TEST-TAKING TIP: Clients should be advised to wear gloves when gardening because cat feces can carry the toxoplasmosis protozoa. Feral and outdoor domestic cats are nondiscriminating about where they urinate and defecate. They easily could be using the vegetable garden for a cat box. As such, it is also very important for everyone, and especially pregnant women, to wash fresh fruits and vegetables before eating them.

A client has been diagnosed with pseudocyesis. Which of the following signs/symptoms would the nurse expect to see? 1. 4 pedal edema. 2. No fetal heart beat. 3. Hematocrit above 40%. 4. Denial of quickening.

1. Pedal edema is not related to pseudocyesis. 2. There will be no fetal heart beat when a client has pseudocyesis. 3. Polycythemia (hematocrit above 40%) is not related to pseudocyesis. 4. Clients who have pseudocyesis state that they do feel their babies move. TEST-TAKING TIP: Although rare, there are some women who develop pregnancy symptoms and believe themselves preg- nant but who are not actually pregnant. This is a psychiatric illness. The women may develop many of the presumptive signs of pregnancy but there will be few, if any, probable signs and no positive signs of pregnancy.

A nurse who is caring for a pregnant diabetic should carefully monitor the client for which of the following? 1. Urinary tract infection. 2. Multiple gestation. 3. Metabolic alkalosis. 4. Pathological hypotension.

1. Pregnant diabetic clients are particu- larly at high risk for urinary tract in- fections. 2. Pregnant diabetic clients are not at high risk for twinning. 3. Pregnant diabetic clients are at high risk for acidosis, not alkalosis. 4. Pregnant diabetic clients are at high risk for hypertension, not hypotension. TEST-TAKING TIP: It is very important for the test taker to read each response care- fully. If the test taker were to read the responses to the preceding question very quickly, he or she might choose incorrect answers. For example, the test taker might pick pathological hypotension, assuming that it says "hypertension." Pregnant diabetics are high risk for UTIs because they often excrete glucose in their urine. The glucose is an excellent medium for bacterial growth. They also should be assessed carefully for acidosis because an acidotic environment can be life threatening to a fetus.

When counseling a preeclamptic client about her diet, what should the nurse encourage the woman to do? 1. Restrict sodium intake. 2. Increase intake of fluids. 3. Eat a well-balanced diet. 4. Avoid simple sugars

1. Sodium restriction is not recommended. 2. There is no need to increase fluid intake. 3. It is important for the client to eat a well-balanced diet. 4. Although not the most nutritious of foods, there is no need to restrict the intake of simple sugars. TEST-TAKING TIP: Clients with preeclampsia are losing albumin through their urine. They should eat a well-balanced diet with sufficient protein to replace the lost pro- tein. Even though preeclamptic clients are hypertensive, it is not recommended that they restrict salt—they should have a nor- mal salt intake—because during pregnancy the kidney is salt sparing. When salt is restricted, the kidneys become stressed.

A woman with a history of congestive heart disease is 36 weeks pregnant. Which of the following findings should the nurse report to the primary health care practitioner? 1. Presence of striae gravidarum. 2. Dyspnea on exertion. 3. 4-pound weight gain in a month. 4. Patellar reflexes 2.

1. Striae gravidarum, stretch marks, are a normal pregnancy finding. 2. A client who is complaining of dys- pnea on exertion is likely going into left-sided congestive heart failure. 3. It is expected for a client in the third trimester to gain approximately 1 pound per week, or 4 pounds per month. 4. Patellar reflexes of 2 is a normal finding. TEST-TAKING TIP: It is important for the test taker to know that pregnancy is a significant stressor on the cardiac sys- tem. Women who enter the pregnancy with a history of cardiac problems must be monitored very carefully not only by the obstetric practitioner but also by an internist or cardiologist. The nurse must be vigilant in observing for signs of car- diac failure, including respiratory and systemic congestion.

A gravid client is admitted with a diagnosis of third-trimester bleeding. The nurse must carefully monitor for a change in which of the following vital signs? 1. Temperature. 2. Pulse. 3. Respirations. 4. Blood pressure.

1. Temperature is not the highest priority in this situation. 2. The pulse is the highest priority in this situation. 3. The respiratory rate is not the highest priority in this situation. 4. The blood pressure is not the highest priority in this situation. TEST-TAKING TIP: The key to answering this question is the fact that the nursing care plan is for a client with third- trimester bleeding. By the end of the second trimester, pregnant women have almost doubled their blood volume. Because of this, if they bleed, they are able to maintain their blood pressure for a relatively long period of time. Their pulse rate, however, does rise. Nurses, there- fore, must carefully attend to the pulse rate of pregnant women who have been injured or who are being observed for third-trimester bleeding. A drop in blood pressure is a very late and ominous sign.

A client has been admitted with a diagnosis of hyperemesis gravidarum. Which of the following orders written by the primary health care provider is highest priority for the nurse to complete? 1. Obtain complete blood count. 2. Start intravenous with multivitamins. 3. Check admission weight. 4. Obtain urine for urinalysis.

1. The blood count is important but it is not highest priority. 2. Starting an intravenous with multivit- amins takes priority. 3. An admission weight is important but is not highest priority. 4. The urinalysis is important but is not highest priority. TEST-TAKING TIP: Clients who are vomit- ing repeatedly are energy depleted, vita- min depleted, electrolyte depleted, and often dehydrated. It is essential that the client receive her IV therapy as quickly as possible. The other orders should be completed soon after the IV is started.

A 14-year-old woman is seeking obstetric care. Which of the following vital signs must be monitored very carefully during this woman's pregnancy? 1. Heart rate. 2. Respiratory rate. 3. Blood pressure. 4. Temperature.

1. The client's heart rate is important but it is not the most important vital sign. 2. The client's respiratory rate is important but it is not the most important vital sign. 3. The client's blood pressure is the most important vital sign. 4. The client's temperature is important but it is not the most important vital sign. TEST-TAKING TIP: Adolescents who are 16 years old or younger are particularly high risk for hypertensive illnesses of pregnancy. It is especially important for the nurse and the client's primary health care practitioner to determine the client's baseline blood pressure to iden- tify any elevations as early as possible.

An ultrasound has identified that a client's pregnancy is complicated by oligohy- dramnios. The nurse would expect that an ultrasound may show that the baby has which of the following structural defects? 1. Dysplastic kidneys. 2. Coarctation of the aorta. 3. Hydrocephalus. 4. Hepatic cirrhosis.

1. The nurse would expect that the baby has dysplastic kidneys. 2. The nurse would not expect to find that the baby has coarctation of the aorta. 3. The nurse would not expect to find that the baby has hydrocephalus. 4. The nurse would not expect to find that the baby has hepatic cirrhosis. TEST-TAKING TIP: The majority of amni- otic fluid is produced by the fetal kidneys. When a pregnancy is complicated by oligohydramnios, ultrasounds may be performed to check for defects in the fetal renal system.

A gravid woman has been diagnosed with listeriosis. She eats rare meat and raw smoked seafood. Which of the following signs/symptoms would this woman exhibit? 1. Fever and muscle aches. 2. Rash and thrombocytopenia. 3. Petechiae and anemia. 4. Amnionitis and epistaxis.

1. The symptoms of listeriosis are simi- lar to symptoms of the flu and include fever and muscle aches. 2. Neither rash nor thrombocytopenia is related to listeriosis. 3. Neither petechiae nor anemia is related to listeriosis. 4. Neither amnionitis nor epistaxis is re- lated to listeriosis. TEST-TAKING TIP: Even though the adult disease is relatively mild, if listeriosis is contracted during pregnancy, it can lead to serious fetal and neonatal complications. It is important for the nurse to provide the client with needed dietary education to prevent antepartal disease.

A client has been admitted with a diagnosis of hyperemesis gravidarum. Which of the following lab values would be consistent with this diagnosis? 1. pO2 90, pCO2 35, HCO3 19 mEq/L, pH 7.30. 2. pO2 100, pCO2 30, HCO3 21 mEq/L, pH 7.50. 3. pO2 60, pCO2 50, HCO3 28 mEq/L, pH 7.30. 4. pO2 90, pCO2 45, HCO3 30 mEq/L, pH 7.50.

1. This client is in metabolic acidosis. This is consistent with a diagnosis of diarrhea. 2. This client is in respiratory alkalosis. This is consistent with a diagnosis of hyperventilation. 3. This client is in respiratory acidosis. This is consistent with a diagnosis of respira- tory distress. 4. This client is in metabolic alkalosis. This is consistent with a diagnosis of hyperemesis gravidarum. TEST-TAKING TIP: The test taker must not panic when confronted with blood gas data. If assessed methodically, the test taker should have little trouble determin- ing the correct answer. The first action is to determine what the results should show. If a woman is vomiting repeatedly, one would expect her to have lost acid from the stomach. She would, therefore, be in metabolic alkalosis. The test taker should then look at the pH levels—they should be elevated—and the O2 levels— they should be normal—to begin to determine which response is correct.

A woman enters the prenatal clinic accompanied by her partner. When she is asked by the nurse about her reason for seeking care, the woman looks down as her partner states, "She says she thinks she's pregnant. She constantly complains of feeling tired. And her vomiting is disgusting!" Which of the following is the priority action for the nurse to perform? 1. Ask the woman what times of the day her fatigue seems to be most severe. 2. Recommend to the couple that they have a pregnancy test done as soon as possible. 3. Continue the interview of the woman in private. 4. Offer suggestions on ways to decrease the vomiting.

1. This is not a priority action. 2. This is not a priority action. 3. This is the priority action. The nurse should escort the client to a location where the partner cannot follow. 4. This is not a priority action. TEST-TAKING TIP: This couple is exhibiting classic signs of an abusive relationship. The woman is subjective, looking down and allowing her partner to respond to questions. The partner is dominant and demeaning in his description of his partner. To question the woman regard- ing her relationship, it is important for the nurse to interview the client in private. The women's bathroom is an excellent location for the interview.

A 30-week-gestation multigravida, G3P1011, is admitted to the labor suite. She is contracting every 5 minutes 40 seconds. Which of the comments by the client would be most informative regarding the etiology of the client's present condition? 1. "For the past day I have felt burning when I urinate." 2. "I have a daughter who is 2 years old." 3. "I jogged 1 1⁄2 miles this morning." 4. "My miscarriage happened a year ago today."

1. This is the most important statement made by the client. 2. The age of her first child is not relevant. 3. Her exercise regimen is not relevant. 4. The date of her miscarriage is not relevant. TEST-TAKING TIP: Preterm labor is strongly associated with the presence of a urinary tract infection. Whenever an infection is present in the body, the body produces prostaglandins. Prostaglandins ripen the cervix and the number of oxytocin recep- tor sites on the uterine body increase. Preterm labor can then develop.

In analyzing the need for health teaching in a client, G5P4004 with gestational diabetes, the nurse should ask which of the following questions? 1. "How old were you at your first pregnancy?" 2. "Do you exercise regularly?" 3. "Is your partner diabetic?" 4. "Do you work outside of the home?"

1. This question is not related to the client's need for health teaching. 2. The likelihood of developing either gestational or type 2 diabetes is re- duced when clients exercise regularly. 3. This question is not related to the client's need for health teaching. 4. This question is not related to the client's need for health teaching. TEST-TAKING TIP: There are a number of issues that the nurse should discuss with a client who has been diagnosed with gesta- tional diabetes. The need for exercise is one of those topics. Other topics are diet, blood glucose testing, treatment for hypoglycemic episodes, and the like.

A woman who has been diagnosed with an ectopic pregnancy is to receive methotrexate 50 mg/m 2 IM. The woman weighs 136 lb and is 5 ft 4 inches tall. What is the maximum safe dose, in mg, of methotrexate that this woman can receive? ______ mg

83.5 mg Because the recommended dosage is written per square meters, the nurse must calculate a safe dosage level for this medication using a body surface area formula. The formula for determining the body surface area (BSA) of a client, using the English system, is: _____________________ BSA = √weight (lb) × height (in.) 3,131 The nurse first calculates the BSA. (The test taker must remember that there are 12 inches in 1 foot.) The calculation in this situation is: 136 × 64 3,131 8,704 3,131 √2.779 BSA = √2.78 BSA = 1.67 m2 Second, a ratio and proportion equation must be created and solved: Recommended dosage = Safe dosage 1 m2 Client's BSA 50 = x 1 1.67 x = 83.5 mg The nurse now knows that the maximum dosage of methotrexate that this client can safely receive is 83.5 mg.

Please place an "X" on the picture of the abdominal ectopic pregnancy.

X TEST-TAKING TIP: Ectopic pregnancies rarely develop to full term. It is possible, however, for a placenta to attach to the outside of the uterus and to provide enough nutrition and oxygen to a fetus for the fetus to come to term. In that case, the baby would have to be birthed via an abdominal incision.

Which of the following findings should be reported to the primary health care practitioner when assessing a first-trimester gravida suspected of having gestational trophoblastic disease (hydatiform mole)? 1. Hematocrit 39%. 2. Grape-like clusters passed from the vagina. 3. White blood cell count 8000/mm3. 4. Hypertrophied breast tissue.

1. A hematocrit of 39% is well within nor- mal limits. 2. Women with hydatiform mole often expel grape-like clusters from the vagina. 3. A WBC of 8000/mm 3 is well within normal limits. 4. Hypertrophied breast tissue is expected early in pregnancy. TEST-TAKING TIP: It is very important that the test taker know the normal values of common laboratory values, especially the complete blood count, and that the test taker be familiar with deviations from normal diagnostic signs and symptoms.

Which of the following clients is highest risk for pseudocyesis? 1. The client with lymphatic cancer. 2. The client with celiac disease. 3. The client with multiple miscarriages. 4. The client with grand multiparity.

1. Although women who have had gynecol- ogical cancer and who are unable to con- ceive may be at high risk, those with can- cers in other systems are not at high risk. 2. Women with celiac disease are not at high risk for pseudocyesis. 3. Women who have had a number of miscarriages are at high risk for pseudocyesis. 4. Grand multiparas are not at high risk for pseudocyesis. TEST-TAKING TIP: The prefix "pseudo" means "false" and "cyesis" means "preg- nancy." Women who develop pseudocye- sis are women who have an overwhelming desire to become pregnant. Those who have had multiple miscarriages may be so desperate they develop signs of pregnancy but are not really pregnant.

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

1. It is inappropriate for the nurse to make this statement. 2. It is inappropriate for the nurse to make this statement. 3. It is inappropriate for the nurse to make this statement. 4. This statement is appropriate. The nurse is offering his or her assistance to the client. TEST-TAKING TIP: There is a great deal of information included in this question. The test taker must methodically assess each of the pieces of data. Important things to attend to are the timing of the appointments—2 weeks apart; changes in vital signs—it is normal for pulse and respiratory rates to increase slightly and BP to drop slightly; changes in urinary protein—trace is normal, +2 is not normal; and changes in weight—2-lb increase over 2 weeks is normal, a 10-lb increase is not normal.

A 15-year-old client is being seen for her first prenatal visit. Because of this client's special nutritional needs, the nurse evaluates the client's intake of: 1. Protein and magnesium. 2. Calcium and iron. 3. Carbohydrates and zinc. 4. Pyroxidine and thiamine.

1. Pregnant adolescents usually have an excellent protein intake, although they may or may not have an adequate magnesium intake. 2. Pregnant adolescents' diets are often deficient in calcium and iron. 3. Pregnant adolescents usually have an excellent carbohydrate intake and zinc in- take. 4. Cereals and grains are enriched with the B vitamins, and most adolescents do eat these foods. TEST-TAKING TIP: Adolescents are in need of higher levels of both calcium and iron during their pregnancies than are adult women. These nutrients are needed because many of the teens who become pregnant have not completed their own growth. Calcium is, of course, needed for the teen's own bone growth as well as for the bone growth of the fetus. Similarly, iron is needed for the teen's hematological function as well as the baby's blood supply.

An ultrasound has identified that a client's pregnancy is complicated by hydramnios. The nurse would expect that an ultrasound may show that the baby has which of the following structural defects? 1. Pulmonic stenosis. 2. Tracheoesophageal fistula. 3. Ventriculoseptal defect. 4. Developmental hip dysplasia.

1. The nurse would not expect to find that the baby has pulmonic stenosis. 2. The nurse would expect to find that the baby has tracheoesophageal fistula. 3. The nurse would not expect to find that the baby has ventriculoseptal defect. 4. The nurse would not expect to find that the baby has developmental hip dysplasia. TEST-TAKING TIP: Babies swallow the amniotic fluid while in utero. When there is a surplus of fluid, ultrasounds may be performed to check for defects in the fetal gastrointestinal system.

A client, G8P3406, 14 weeks' gestation, is being seen in the prenatal clinic. During the nurse's prenatal teaching session, the nurse will emphasize that the woman should notify the obstetric office immediately if she notes which of the following? 1. Change in fetal movement. 2. Signs and symptoms of labor. 3. Swelling of feet and ankles. 4. Appearance of spider vein

1. The obstetric history is high risk for preterm delivery, not of fetal death. 2. The nurse should emphasize the need for the client to notify the office of signs of preterm labor. 3. Dependent edema is a normal complica- tion of pregnancy. 4. The appearance of spider veins is a nor- mal complication of pregnancy. TEST-TAKING TIP: The test taker must be able to interpret a client's gravidity and parity. The letter "G" stands for gravid, or the number of pregnancies. The letter "P" stands for para, or the number of deliveries. The delivery information is further distinguished by 4 separate numbers: the first refers to the number of full-term pregnancies the client has had, the second refers to the number of preterm pregnancies the client has had, the third refers to the number of abor- tions the client has had (any pregnancy loss before 20 weeks' gestation), and the fourth refers to the number of living children that the client currently has. The client in the scenario, therefore, has had 8 pregnancies (she is currently pregnant) with 3 full-term deliveries, 4 preterm deliveries, and no abortions, and she currently has 6 living children.

A hospitalized gravida's blood work is hematocrit 30% and hemoglobin 10 gm/dL. In light of the laboratory data, which of the following meal choices should the nurse recommend to this patient? 1. Chicken livers, sliced tomatoes, and dried apricots. 2. Cheese sandwich, tossed salad, and rice pudding. 3. Veggie burger, cucumber salad, and wedge of cantaloupe. 4. Bagel with cream cheese, pear, and hearts of lettuce.

1. This meal choice is high in iron and ascorbic acid. It would be an excellent lunch choice for this client who has a below normal hematocrit level. 2. Although high in calcium, this lunch choice will not help to change the client's lab values. 3. Although nutritious, this lunch choice will not help to change the client's lab values. 4. Cream cheese has little to no nutritional value. This meal choice would provide a large number of calories and is not the most nutritious choice. TEST-TAKING TIP: The client in the scenario is anemic. Although a hematocrit of 32% in pregnancy is acceptable, it is recom- mended that the value not drop below that level. The nurse, having evaluated the lab statement, should choose foods that are high in iron. Liver and dried fruits are good iron sources. Tomatoes are high in vitamin C, which promotes the absorption of iron.

The nurse is caring for a 32-week G8P7007 with placenta previa. Which of the following interventions would the nurse expect to perform? Select all that apply. 1. Daily contraction stress tests. 2. Blood type and cross match. 3. Bed rest with passive range of motion exercises. 4. Daily serum electrolyte assessments. 5. Weekly biophysical profiles.

2, 3, and 5 are correct. 1. It would be inappropriate to perform contraction stress tests. 2. There should be blood available in the blood bank in case the woman be- gins to bleed. 3. The nurse would expect to keep the woman on bed rest with bathroom privileges only. 4. Although important to monitor, it would be unnecessary to assess the elec- trolytes daily. The client is able to eat a normal diet. 5. The nurse would expect that weekly biophysical profiles would be done to assess fetal well-being. TEST-TAKING TIP: Because clients with placenta previa are at high risk for bleeding from the placental site, it is essential that they be limited in their activity and have blood on hand in case of hemorrhage. In addition, their babies must be monitored carefully for signs of fetal well-being. It would be inappro- priate to stimulate contractions because dilation of the cervix would stimulate bleeding.

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

1. Assessing the client's temperature is im- portant, but reporting dizziness and weakness is more important. 2. Documenting the contents and timing of the client's last meal is not the most im- portant action. 3. Obtaining urine for urinalysis and cul- ture is not the most important action. 4. It is most important for the nurse to report complaints of dizziness or weakness. TEST-TAKING TIP: The nurse must priori- tize care. When the question asks the test taker to decide which action is most important, all four possible responses are plausible actions. The test taker must determine which is the one action that cannot be delayed. In this situation, the most important action for the nurse to perform is to assess for complaints of dizziness or weakness. These symptoms are seen when clients develop hypovolemia from internal bleeding.

A type 1 diabetic client has developed polyhydramnios. The client should be taught to report which of the following? 1. Uterine contractions. 2. Reduced urinary output. 3. Marked fatigue. 4. Puerperal rash.

1. The client should be taught to ob- serve for signs of preterm labor. 2. The client is not at high risk for de- creased urinary output. 3. The client is not at high risk for marked fatigue. 4. The client is not at high risk for puer- peral rash. TEST-TAKING TIP: Clients with hydram- nios have excessive quantities of amni- otic fluid in their uterine cavities. The excessive quantities likely result from increased fetal urine production, caused by the mother's having periods of hyperglycemia. When the uterus is overextended from the large quantities of fluid, these women are at high risk for preterm labor.

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

1. The nurse would expect to see high serum creatinine levels associated with severe preeclampsia. 2. The nurse would expect to see low serum protein levels with severe preeclampsia. 3. Bloody stools are never associated with severe preeclampsia 4. Epigastric pain is associated with the liver involvement of HELLP syndrome. TEST-TAKING TIP: When the liver is deprived of sufficient blood supply, as can occur with severe preeclampsia, the organ becomes ischemic. The client experiences pain at the site of the liver as a result of the hypoxia in the liver.

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

1. +1 reflexes are defined as hyporeflexic. 2. +2 reflexes are defined as normal. 3. +3 reflexes are defined as slightly brisker than normal or slightly hyper- reflexic. 4. +4 reflexes are defined as much brisker than normal or markedly hyperreflex TEST-TAKING TIP: Although, as seen above, a clear categorization of reflex assessment exists, the value assigned to a reflex by a clinician does have a subjective component. Therefore, it is recommended that at the change of shift both the new and departing nurses together assess the reflexes of a client who has suspected abnormal reflexes. A common understanding of the reflex assessment can then be determined.

A 14-year-old woman is seeking obstetric care. Which of the following is an appropriate nursing care goal for this young woman? 1. Bring her partner to all prenatal visits. 2. Terminate the pregnancy. 3. Continue her education. 4. Undergo prenatal chromosomal analysis.

1. Teen's partners may or may not be ac- tively engaged in the pregnancy process. If he is interested in attending prenatal appointments, he should be welcomed. If not, the nurse should help the young woman to identify other important sup- port people. 2. The pregnant teen has the same choices that the pregnant adult has. She can de- cide to terminate the pregnancy, main- tain the pregnancy and give the child up for adoption, or maintain the pregnancy and retain custody of the child. It is not the nurse's choice to make, although the nurse should provide the young woman with all of her options. 3. It is important for the young woman to work toward completing the tasks of adolescence at the same time that she is engaged in maintaining a healthy pregnancy. She should con- tinue her education. 4. It is unnecessary, unless a chromosomal anomaly is in the young woman's medical history, for the client to undergo chro- mosomal analyses. TEST-TAKING TIP: Working with adoles- cents can be exciting as well as challeng- ing. The nurse is likely to be the young woman's most important support system during the early weeks of the pregnancy. Slowly, with the nurse's help, it is hoped that the young woman will make healthy choices, including eating well, refraining from drinking alcohol and using drugs, and staying in school.

A lecithin:sphingomyelin (L/S) ratio has been ordered by a pregnant woman's obstetrician. Which of the following data will the nurse learn from this test? 1. Coagulability of maternal blood. 2. Maturation of the fetal lungs. 3. Potential for fetal development of erythroblastosis fetalis. 4. Potential for maternal development of gestational diabetes.

1. The L/S ratio indicates the maturity of the fetal lungs, not the coagulability of maternal blood. 2. The L/S ratio indicates the maturity of the fetal lungs. 3. The L/S ratio indicates the maturity of the fetal lungs, not the potential for erythroblastosis fetalis. 4. The L/S ratio indicates the maturity of the fetal lungs, not the potential for gestational diabetes. TEST-TAKING TIP: Lecithin and sphin- gomyelin are two components of surfac- tant, the slippery substance that lines the alveoli. The fetal lungs have usually reached maturation when the ratio of the substances is 2:1 or higher. To perform the test, the obstetrician must obtain amniotic fluid during an amniocentesis. A quick test, called a shake or foam test, can also be performed on the amniotic fluid to assess fetal lung maturation. (It is important to note that even with an L/S ratio above 2:1, the lungs of fetuses of diabetic mothers are often immature.)

A 39-year-old, 16-week-gravid woman has had an amniocentesis. Before discharge, the nurse teaches the woman to call her doctor if she experiences any of the following side effects? Select all that apply. 1. Fever or chills. 2. Lack of fetal movement. 3. Abdominal pain. 4. Rash or pruritus. 5. Vaginal bleeding.

1, 2, 3, and 5 are correct. 1. The client should call her practitioner if she experiences fever or chills. 2. Because the fetus can be injured during an amniocentesis, the client should report either a decrease or an increase in fetal movement. 3. The client should report abdominal pain or cramping. An amniocentesis can precipitate preterm labor. 4. Neither rash nor pruritus is associated with amniocentesis. 5. The client should report any vaginal loss—blood or amniotic fluid. The placenta may become injured or the membranes may rupture during an amniocentesis. TEST-TAKING TIP: During an amniocentesis, the amniotic sac is entered with a large needle. As a result of the procedure, a number of complications can develop, including infection, preterm labor, rupture of the membranes, and/or fetal injury. Although the incidence of complications is small, it is very important for the nurse to advise the client of the signs of each of these problems.

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

1, 3, 4, and 5 are correct. 1. Passive range of motion will help to decrease the potential for muscle atrophy. 2. Fluid restriction is inappropriate. To maintain healthy bowel and bladder function the client should drink large quantities of fluids. 3. This client is separated from family. The separation can lead to depres- sion. Decorating the room and enabling family to visit freely is very important. 4. A high-fiber diet will help to maintain normal bowel function. 5. Deep breathing exercises are impor- tant in order to maintain the client's respiratory function. TEST-TAKING TIP: Although bed rest is of- ten used as therapy for antenatal clients, it does not come without its complications— constipation, depression, respiratory compromise, muscle atrophy, to name but a few. The nurse must provide preven- tive care to maintain the health and well- being of the client as much as possible.

A nurse is interviewing a prenatal client. Which of the following factors in the client's history should the nurse highlight for the health care practitioner? 1. That she is eighteen years old. 2. That she owns a cat and a dog. 3. That she eats peanut butter every day. 4. That she works as an airline pilot.

1. It is not unsafe for women 18 years of age to become pregnant. 2. Cat feces are a potential source of toxoplasmosis. 3. Peanut butter is an excellent source of protein. 4. Women working as airline pilots are not especially at high risk. TEST-TAKING TIP: The nurse must be familiar with any possible circumstances that place antepartal clients and their fetuses at high risk. Toxoplasmosis is an illness caused by a protozoan. The organ- ism can be contracted in a number of ways, including eating rare or raw meat, drinking unpasteurized goat milk, and coming in contact with cat feces. When contracted by the mother during preg- nancy, it can cause serious fetal and neonatal disease.

A client has just done a fetal kick count assessment. She noted 6 movements during the last hour. If taught correctly, what should be her next action? 1. Nothing because further action is not warranted. 2. Call the doctor to set up a nonstress test. 3. Redo the test during the next one-half hour. 4. Drink a glass of orange juice and redo the test.

1. She should do nothing because the woman should feel 3 or more counts in 1 hour. 2. A nonstress test is warranted if the woman feels fewer than 3 counts in an hour. 3. There is no need to redo the test. 4. There is no need for the client to redo the test. TEST-TAKING TIP: Fetal kick counting is a valuable, noninvasive means of monitor- ing fetal well-being. Mothers are taught to consciously count the numbers of times they feel their baby kick during one or more 60-minute periods during the day. If the baby kicks 3 or more times, the woman can be reassured that the baby is healthy. If the baby kicks fewer times, the woman should notify her health care practitioner, who will likely perform either a nonstress test or, in some situations, a more sophisticated fetal assessment test.

Which of the following clients is at highest risk for developing a hypertensive illness of pregnancy? 1. G1P0000, age 44 with history of diabetes mellitus. 2. G2P0101, age 27 with history of rheumatic fever. 3. G3P1102, age 25 with history of scoliosis. 4. G3P1011, age 20 with history of celiac disease.

1. This primigravid client—age 44 and with a history of diabetes—is very high risk for preeclampsia. 2. Multigravid clients with a history of rheumatic fever are not significantly at high risk for preeclampsia, unless they have a history of preeclampsia with their preceding pregnancies, or have devel- oped a vascular or hypertensive disease since their last pregnancy. 3. Multigravid clients with scoliosis are not significantly at high risk for preeclampsia, unless they have a history of preeclampsia with their preceding pregnancies, or have developed a vascular or hypertensive dis- ease since their last pregnancy. 4. Multigravid clients with celiac disease are not significantly at high risk for preeclampsia, unless they have a history of preeclampsia with their preceding pregnancies, or have developed a vascular or hypertensive disease since their last pregnancy. TEST-TAKING TIP: Preeclampsia is a vascu- lar disease of pregnancy. Although any woman can develop the syndrome, women who are highest risk for the disease are primigravidas, those with multiple gesta- tions, women who are younger than 17 or older than 34, those who had preeclamp- sia with their first pregnancy, and women who have been diagnosed with a vascular disease like diabetes mellitus or chronic hypertension.

During a prenatal interview, a client tells the nurse, "My mother told me she had toxemia during her pregnancy and almost died!" Which of the following questions should the nurse ask in response to this statement? 1. "Does your mother have a cardiac condition?" 2. "Did your mother tell you what she was toxic from?" 3. "Does your mother have diabetes now?" 4. "Did your mother say whether she had a seizure or not?"

1. Toxemia is not related to a cardiac condition. 2. Toxemia is not related to a toxic substance. 3. Toxemia is not directly related to diabetes mellitus. 4. This is the appropriate question. The nurse is asking whether or not the client's mother developed eclampsia. TEST-TAKING TIP: The hypertensive illnesses of pregnancy used to be called toxemia of pregnancy as well as pregnancy-induced hypertension (PIH). That term is still heard in the community because the mothers and grandmothers of clients were told that they had toxemia of pregnancy. Because daughters of clients who have had preeclampsia are high risk for hypertensive illness, it is important to find out whether or not the client's mother had developed eclampsia.

A woman is to receive methotrexate IM for an ectopic pregnancy. The drug reference states that the recommended safe dose of the medicine is 50 mg/m She weighs 52 kg and is 148 cm tall. What is the maximum safe dose, in mg, of methotrexate that this woman can receive? ______ mg

73 mg This question resembles the preceding ques- tion, except the weight and height are written in the metric system rather than the English system. The formula for BSA using the met- ric system is: BSA = weight (kg) × height (cm) 3,600 The solution in this situation is: BSA = 52 kg × 148 cm 3,600 BSA = 7,696 3,600 BSA = √2.14 BSA = 1.46 m2 Then, a ratio and proportion equation must be created: Recommended dosage = Safe dosage 1 m2 Client's BSA 50 = x 1 1.46 x = 73 mg The maximum dosage of methotrexate that this client can safely receive is 73 mg. Note that no decimal point or zero is seen after the 73, even though the stem stated "if rounding is needed, please round to the near- est tenth." The Joint Commission states that trailing zeroes should never be used.

A woman, G1P0000, is 40 weeks' gestation. Her Bishop score is 4. Which of the following complementary therapies do midwives frequently recommend to clients in similar situations? Select all that apply. 1. Sexual intercourse. 2. Aromatherapy. 3. Breast stimulation. 4. Ingestion of castor oil. 5. Aerobic exercise.

1, 3, and 4 are correct. 1. Sexual intercourse has been recom- mended to women as a means of in- creasing their Bishop score. 2. Aromatherapy is not recommended to women as a means of increasing their Bishop score. 3. Midwives have recommended that women employ breast stimulation as a means of stimulating labor. 4. Midwives have recommended that women ingest castor oil as a means of increasing their Bishop score. 5. Aerobic exercise is not recommended to women as a means of increasing their Bishop score. TEST-TAKING TIP: There are many inter- ventions that have been used to increase women's Bishop scores and/or to stimu- late labor. Because oxytocin is produced during orgasm and when the breasts are stimulated, intercourse and breast stimu- lation both can be used as complementary methods of stimulating labor. Castor oil stimulates the bowels. Prostaglandins, which ripen the cervix, are produced as a result of gastrointestinal stimulation. In addition, when ingested, primrose oil con- verts to prostaglandin in the body. If there is any indication that the baby may be un- able to withstand labor, however, these means should not be employed.

A 32-weeks' gestation client states that she "thinks" she is leaking amniotic fluid. Which of the following tests could be performed to determine whether the membranes had ruptured? 1. Fern test. 2. Biophysical profile. 3. Amniocentesis. 4. Kernig sign.

1. A fern test is performed to assess for the presence of amniotic fluid. 2. A biophysical profile assessment is per- formed to assess fetal well-being, not for the presence of amniotic fluid. 3. During amniocentesis, amniotic fluid is extracted from the uterine body in order to perform genetic analyses or fetal lung maturation assessments as well as other analyses. It is not done to assess for rup- ture of the membranes. 4. The Kernig sign is an assessment per- formed on clients who are suspected of having meningeal irritation. It is unre- lated to pregnancy. TEST-TAKING TIP: The fern test was so named because when amniotic fluid is viewed under a microscope, it appears as a fern-like image. The image is a reflection of the high estrogen levels in the fluid that create a crystalline pattern. When the fern appears, the nurse can be assured that amniotic fluid is leaking from the amniotic sac.

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

1. Cervical cerclage is performed on clients with cervical insufficiency. 2. Amniocentesis is performed to obtain fetal cells in order to assess genetic information. 3. Nonstress testing is performed during the third trimester to monitor the well-being of the fetus. 4. Dilation and curettage will be per- formed on a client with an incomplete abortion. TEST-TAKING TIP: This client is experienc- ing an incomplete abortion. The baby has died—there is no fetal heartbeat—and she has expelled some of the products of conception, as evidenced by frank vaginal bleeding. It is important for the remain- ing products of conception to be removed to prevent hemorrhage and infection. A D&C in which the physician dilates the cervix and scrapes the lining of the uterus with a curette is one means of completing the abortion. Another method of complet- ing the abortion is by administering an abortifacient medication.

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

1. Fundal growth is often accelerated. 2. Vaginal bleeding is not related to twin- to-twin transfusion. 3. Vomiting is not related to twin-to-twin transfusion. 4. Congestive heart failure is not related to twin-to-twin transfusion. TEST-TAKING TIP: Fundal growth is acceler- ated for two reasons: (a) With two babies in utero, uterine growth is increased and (b) the recipient twin—the twin receiving blood from the other twin—often produces large quantities of urine, resulting in polyhydramnios.

A nurse is performing an assessment on four 22-week-pregnant clients. The nurse reports to the obstetrician that which of the clients may be carrying twins? 1. The client who states that she feels huge. 2. The client with a weight gain of 13 pounds. 3. The client whose fundal height measurement is 26 cm. 4. The client whose alpha-fetoprotein level is one-half normal.

1. Many pregnant women, whether carrying a single baby or twins, feel big. 2. This is an appropriate weight increase: approximately 3 lb during the entire first trimester and approximately 1 lb per week after that—3 (first trimester) 10 (1 lb per week for 10 weeks) 13 pounds. 3. It is possible that this client is carry- ing twins. 4. Low alpha-fetoprotein levels are associ- ated with Down syndrome pregnancies. TEST-TAKING TIP: After 20 weeks' gestation, the nurse would expect the fundal height to be equal to the number of weeks of the woman's gestation. Because the fundal height is 4 cm above the expected 22 cm, it is likely that the woman is either having twins or has polyhydramnios.

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

1. Pain is not associated with this condition. 2. There is no fetus; therefore, there will be no fetal heart. 3. The condition is usually diagnosed af- ter a client complains of brown vaginal discharge early in the "pregnancy." 4. Suicidal ideations are not associated with this condition. TEST-TAKING TIP: The most important thing to remember when answering questions about hydatidiform mole is the fact that, even though a positive pregnancy test has been reported, there is no "pregnancy." The normal conceptus develops into two portions—a blastocyst, which includes the fetus and amnion, and a trophoblast, which includes the fetal portion of the placenta and the chorion. In gestational trophoblas- tic disease (hydatidiform mole), only the trophoblastic layer develops; no fetus develops. With the proliferation of the chorionic layer, the client is high risk for gynecological cancer.

A woman is to receive RhoGAM at 28 weeks' gestation. What action must the nurse take before giving the injection? 1. Validate that the baby is Rh negative. 2. Assess that the direct Coombs' test is positive. 3. Verify the identity of the woman. 4. Reconstitute the globulin with sterile water.

1. RhoGAM is administered to Rh(-) mothers only. 2. Although in rare instances the Coombs' test may be positive, the direct Coombs' test is usually negative. 3. Although this is an important action that must be taken before the administration of any medication, it is especially critical in this situation. 4. RhoGAM is not reconstituted. TEST-TAKING TIP: When RhoGAM is given, the nurse is administering Rh antibodies to Rh- mothers. If the nurse should make a mistake and administer the dosage to an Rh+ mother, the client would then have been injected with antibodies that would act to destroy her own blood.

A client, 8 weeks pregnant, has been diagnosed with a bicoruate uterus. Which of the following signs should the nurse teach the client to carefully monitor for? 1. Hyperthermia. 2. Palpitations. 3. Cramping. 4. Oliguria.

1. A bicornuate uterus will not predispose a client to infection. 2. A bicornuate uterus will not predispose a client to palpitations. 3. A bicornuate uterus will predispose a client to cramping and preterm labor. 4. A bicornuate uterus will not predispose a client to oliguria. TEST-TAKING TIP: If the test taker is unfamiliar with the term bicornuate, he or she could break down the word into its parts to determine its meaning: "bi" means "2" and "cornuate" means "horn." A bicornuate uterus, therefore, is a uterus that has a septum down the center, creating a 2-horned fundus. Sometimes the uterus is heart-shaped and sometimes the uterus is divided in half. Because of its shape, there is often less room for the fetus to grow. The uterus becomes irritable and predisposes the client to preterm labor.

A nurse is caring for four prenatal clients in the clinic. Which of the clients is high risk for placenta previa? 1. Jogger with low body mass index. 2. Smoker carrying fraternal triplets. 3. Registered professional nurse. 4. Police officer on foot patrol.

1. A jogger with low body mass index (BMI) is not necessarily high risk for pla- centa previa. 2. A smoker carrying fraternal triplets is high risk for placenta previa. 3. Registered professional nurses are not high risk for placenta previa. 4. Police officers are not high risk for pla- centa previa. TEST-TAKING TIP: The placenta usually implants at a vascular site on the posterior portion of the uterine wall. Two of the women are at high risk for placenta previa. There are 3 placentas nourishing fraternal triplets. Because of the amount of space needed for the placentas, it is not unusual for one to implant near or over the cervi- cal os. The uterine lining of women who smoke is often not well perfused, some- times resulting in the placenta implanting on or near the cervical os. Women with vascular disease and grand multigravidas are also high risk for placenta previa..

Which of the following would indicate that a nipple stimulation test is creating the desired effect? 1. The woman's inverted nipples become erect. 2. The woman's nipple and breast tissue hypertrophy. 3. The woman's uterus contracts 3 times in 10 minutes. 4. The woman's cervix dilates 2 centimeters in 3 hours.

1. A nipple stimulation test is performed to assess the baby's response to contractions. 2. A nipple stimulation test is performed to assess the baby's response to contractions. 3. The nipples are stimulated with the goal of achieving a q 3-minute con- traction pattern. 4. The nipple stimulation test is not performed in order to induce labor. TEST-TAKING TIP: If the primary health care practitioner is questioning the well- being of the fetus, he or she may order a nipple stimulation test. One nipple is stimulated for 2 minutes followed by a 5-minute rest period. The process is repeated with the other nipple until the uterus begins to contract approximately every 3 minutes. The fetal heart is then assessed in relation to the contraction pattern. A negative test result—which is a positive finding—occurs when there are no fetal heart decelerations noted. A positive test result—which is a negative finding—is the presence of fetal heart decelerations.

A gravid client, 27 weeks' gestation, has been diagnosed with gestational diabetes. Which of the following therapies will most likely be ordered for this client? 1. Oral hypoglycemic agents. 2. Diet control with exercise. 3. Regular insulin injections. 4. Inhaled insulin.

1. About 95% of gestational diabetic clients are managed with diet and exercise alone. 2. About 95% of gestational diabetic clients are managed with diet and ex- ercise alone. 3. About 95% of gestational diabetic clients are managed with diet and exercise alone. 4. About 95% of gestational diabetic clients are managed with diet and exercise alone. TEST-TAKING TIP: Gestational diabetic clients are first counseled regarding proper diet and exercise as well as blood glucose assessments. The vast majority of women are able to regulate their glucose levels with this intervention. If the glucose levels do not stabilize, the obstetrician will deter- mine whether to order oral hypoglycemics or injectable insulin.

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

1. After the embryo dies, the nurse would expect to see vaginal bleeding. Rectal bleeding would not be expected. 2. Nausea and vomiting are not characteristic of a ruptured ectopic. 3. Sharp unilateral pain is a common symptom of a ruptured ectopic. 4. Hyperthermia is not characteristic of a ruptured ectopic. TEST-TAKING TIP: The most common loca- tion for an ectopic pregnancy to implant is in a fallopian tube. Because the tubes are nonelastic, when the pregnancy becomes too big, the tube ruptures. Unilateral pain can develop because only one tube is being affected by the condi- tion, but some women complain of generalized abdominal pain.

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

1. Altered glomerular filtration leads to protein loss and, subsequently, to fluid retention, which can lead to swelling in the face and hands. 2. Monitoring women for the appearance of swollen hands and puffy face is related to the development of preeclampsia, not of cardiac failure. 3. Monitoring women for the appearance of swollen hands and puffy face is related to the development of preeclampsia, not of hepatic insufficiency. 4. Monitoring women for the appearance of swollen hands and puffy face is related to the development of preeclampsia, not of altered splenic circulation. TEST-TAKING TIP: The hypertension associ- ated with preeclampsia results in poor per- fusion of the kidneys. When the kidneys are poorly perfused, the glomerlular filtration is altered, allowing large molecules, most no- tably the protein albumin, to be lost through the urine. With the loss of protein, the colloidal pressure drops in the vascular tree, allowing fluid to third space. The body gets the message to retain fluids, exacerbating the problem. One of the early signs of the third spacing is the swelling of a client's hands and face.

A 16-year-old woman is being seen for the first time in the obstetric office. Which of the following comments by the young woman is highest priority for the nurse to respond to? 1. "My favorite lunch is a burger with fries." 2. "I've been dating my new boyfriend for 2 weeks." 3. "On weekends we go out and drink a few beers." 4. "I dropped out of school about 3 months ago."

1. Although eating burgers with fries is not the best choice for the young woman to make, it is not the most important comment for the nurse to respond to at this time. 2. This comment is informative because the nurse learns that this client has multiple sex partners. It is not the most important comment, however. 3. The nurse must respond to this com- ment. This young woman is repeat- edly exposing her fetus to alcohol. 4. This comment is important since this young woman is not completing her edu- cation but it is not the most important comment for the nurse to respond to at this time. TEST-TAKING TIP: The nurse must priori- tize her care with teen clients as well as with mature clients. This young woman will eventually need to be counseled regarding diet, infection control, and her education, but the fetus is at highest risk at the present time from repeated alcohol exposure. Indeed, alcohol expo- sure is injurious for the unborn child throughout the entire pregnancy. The nurse must discuss this with the young woman at this time.

A gravid woman with sickle cell anemia is admitted in vaso-occlusive crisis. Which of the following is the priority intervention that the nurse must perform? 1. Administer narcotic analgesics. 2. Apply heat to swollen joints. 3. Place on strict bed rest. 4. Infuse intravenous solution.

1. Although narcotic medications must be administered to relieve the pain of the crisis, this is not the priority action. 2. Although heat to the joints must be ap- plied to dilate the blood vessels, this is not the priority action. 3. Although the client should be kept on bed rest to protect the joints and to pre- vent further sickling, this is not the pri- ority action. 4. Administering intravenous fluids is the priority action. TEST-TAKING TIP: Although this question is not directly related to pregnancy, the nurse must be able to translate informa- tion from another medical discipline into the obstetric area. The priority action is to improve perfusion to the client's organs. By providing intravenous fluids, the blood can flow through the vessels and perfuse the organs, including the placenta. When the client is dehydrated, the sickled red blood cells clump together, inhibiting perfusion.

A woman is recovering at the gynecologist's office following a late first-trimester spontaneous abortion. At this time, it is essential for the nurse to check which of the following? 1. Maternal rubella titer. 2. Past obstetric history. 3. Maternal blood type. 4. Cervical patency.

1. Although the woman's rubella titer is important, it is not essential that it be as- sessed at this time. 2. Although the woman's obstetric history is important, it is not essential that it be assessed at this time. 3. It is essential that the woman's blood type be assessed. 4. It is not appropriate to assess the woman's cervical patency. TEST-TAKING TIP: If the woman is found to be Rh-, even though the fetal blood type is unknown, the woman must receive a dose of RhoGAM within 72 hours of the abortion. If the fetus were Rh+ and the woman were not to receive RhoGAM, the woman's immune system might be stimulated to produce antibodies against Rh+ blood. Any future Rh+ fetus would be in danger of developing erythroblastosis fetalis.

A client with mild preeclampsia, who has been advised to be on bed rest at home, asks why it is necessary. Which of the following is the best response for the nurse to give the client? 1. "Bed rest will help you to conserve energy for your labor." 2. "Bed rest will help to relieve your nausea and anorexia." 3. "Reclining will increase the amount of oxygen that your baby gets." 4. "The position change will prevent the placenta from separating."

1. Bed rest for the preeclamptic client is not ordered in order for her to conserve energy. 2. Preeclamptic clients rarely complain of nausea or anorexia. 3. Bed rest, especially side-lying, helps to improve perfusion to the placenta. 4. Although indirectly this response may be accurate, that is not the primary reason the positioning. TEST-TAKING TIP: This question requires the nurse to have a clear understanding of the pathology of preeclampsia. Only with an understanding of the underlying disease can the test taker be able to remember the rationale for many aspects of client care. The vital organs of preeclamptic clients are being poorly perfused as a result of the abnormally high blood pressure. When a woman lies on her side, blood return to the heart is improved and the cardiac output is also improved. With improved cardiac output, perfusion to the placenta and other organs is improved.

An ultrasound is being done on an Rh-negative woman. Which of the following pregnancy findings would indicate that the baby has developed erythroblastosis fetalis? 1. Caudal agenesis. 2. Cardiomegaly. 3. Oligohydramnios. 4. Hyperemia.

1. Caudal agenesis is a severe birth defect that can result from maternal hyper- glycemia in early pregnancy. 2. Cardiomegaly is one of the common signs of erythroblastosis fetalis. 3. The nurse would expect to see polyhy- dramnios, not oligohydramnios. 4. Hyperemia is not related to erythroblas- tosis fetalis or Rh incompatibility. TEST-TAKING TIP: Erythroblastosis fetalis is the fetal condition that results when an Rh- mother who is sensitized to Rh+ blood is pregnant with an Rh+ baby. Maternal antibodies cross the placenta and destroy the fetal red blood cells. As a result, the baby becomes severely anemic. Car- diomegaly is one of the complications that occurs as a result of the severe anemia.

The nurse suspects that a client is third spacing fluid. Which of the following signs will provide the nurse with the best evidence of this fact? 1. Client's blood pressure. 2. Client's appearance. 3. Client's weight. 4. Client's pulse rate.

1. Clients who are third spacing are often preeclamptic. The blood pressure, there- fore, may be elevated. This is not, how- ever, the most important sign for the nurse to assess. 2. The faces and hands of clients who are third spacing often appear puffy. The ap- pearance, however, is not the most im- portant sign for the nurse to assess. 3. Weight is the most important sign for the nurse to assess. 4. The client's pulse rate may change, but it is not the most important sign for the nurse to assess. TEST-TAKING TIP: When clients third space, they are retaining fluids. Fluid is very heavy. A sudden weight increase is, therefore, the most important assess- ment the nurse can make to determine whether or not a client is third spacing. Clients who are being assessed for preeclampsia, therefore, should be weighed daily.

Which of the following pregnant clients is most high risk for preterm premature rupture of the membranes (PPROM)? 1. 30-week gestation with prolapsed mitral valve (PMV). 2. 32-week gestation with urinary tract infection (UTI). 3. 34-week gestation with gestational diabetes (GDM). 4. 36-week gestation with deep vein thrombosis (DVT).

1. Clients who have a history of prolapsed mitral valve are not at high risk for PPROM. 2. Clients with UTIs are high risk for PPROM. Clients with gestational diabetes are not high risk for PPROM. 4. Clients with deep vein thrombosis are not high risk for PPROM. TEST-TAKING TIP: Although the exact mechanism is not well understood, clients who have urinary tract infections are high risk for PPROM. This is particularly important as pregnant clients often have urinary tract infections that present either with no symptoms at all or only with urinary frequency, a complaint of many pregnant clients. Also, clients carrying twins are at high risk for PPROM.

A woman, G5P0401, is in the postanesthesia care unit (PACU) after a cervical cerclage procedure. During the immediate postprocedure period, what should the nurse carefully monitor this client for? 1. Hyperthermia. 2. Hypotension. 3. Uterine contractions. 4. Fetal heart dysrhythmias.

1. Clients who have cerclages placed are not high risk for hyperthermia in the im- mediate postprocedure period. 2. Hypotension is not a major complication of clients who have had a cerclage placed. 3. Preterm labor is a complication in the immediate postprocedure period. 4. A fetal heart dysrhythmia is not a com- plication related to the placement of the cerclage. TEST-TAKING TIP: Cerclages are inserted when clients have a history of recurring pregnancy loss related to a cervical insuf- ficiency. This client has had 5 pregnancies but only one living child. Unfortunately, with the manipulation of the cervix at the time of the cerclage, the clients may develop preterm labor. The clients should be monitored carefully with a tocometer to assess for labor contractions.

A client with 4 protein and 4 reflexes is admitted to the hospital with severe preeclampsia. The nurse must closely monitor the woman for which of the following? 1. Grand mal seizure. 2. High platelet count. 3. Explosive diarrhea. 4. Fractured pelvis.

1. Clients with severe preeclampsia are high risk for seizure. 2. Clients with severe preeclampsia should be monitored for a drop in platelets. 3. Clients with severe preeclampsia are not at risk for explosive diarrhea. 4. Clients with severe preeclampsia are not at risk for fractured pelvis. TEST-TAKING TIP: A client who is diag- nosed with 4+ proteinuria and 4+reflexes is severely preeclampsia and, therefore, at high risk for becoming eclamptic. Preeclamptic clients are diagnosed with eclampsia once they have had a seizure.

A woman with a diagnosis of ectopic pregnancy is to receive medical intervention rather than a surgical interruption. Which of the following intramuscular medications would the nurse expect to administer? 1. Decadron (desamethasone). 2. Amethopterin (methotrexate). 3. Pergonal (menotropins). 4. Prometrium (progesterone).

1. Decadron is a steroid. It is not an appropriate therapy for this situation. 2. Methotrexate is the likely medication. 3. Pergonal is an infertility medication. It is not an appropriate therapy for this situation. 4. Progesterone injections are administered to clients who have a history of preterm labor. It is not an appropriate therapy for this situation. TEST-TAKING TIP: Methotrexate is an anti- neoplastic agent. Even if the test taker were unfamiliar with its use in ectopic pregnancy but was aware of the action of methotrexate, he or she could deduce its efficacy here. Methotrexate is a folic acid antagonist that interferes with DNA synthesis and cell multiplication. The conceptus is a ball of rapidly multiplying cells. Methotrexate interferes with that multiplication, killing the conceptus and, therefore, precluding the need for the client to undergo surgery.

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

1. Discovering whether or not the client has allergies is important for the nurse to learn if medications are to be ordered, but that is not the most important infor- mation the nurse needs to learn. 2. The nurse should assess the client's blood pressure. 3. Fundal height assessment is important, but not the most important information the nurse needs to learn at this time. 4. Discovering whether or not the client has stressors at work is important, but it is not the most important information the nurse needs to learn about. TEST-TAKING TIP: Headache is a symptom of preeclampsia. Preeclampsia, a serious complication, is a hypertensive disease of pregnancy. To determine whether or not the client is preeclamptic, the next action by the nurse would be to assess the woman's blood pressure.

A gravid woman, who is 42 weeks' gestation, has just had a 20-minute nonstress test (NST). Which of the following results would the nurse interpret as a reactive test? 1. Moderate fetal heart baseline variability. 2. Maternal heart rate accelerations to 140 bpm lasting at least 20 seconds. 3. Two fetal heart accelerations of 15 bpm lasting at least 15 seconds. 4. Absence of maternal premature ventricular contractions.

1. During a reactive nonstress test, the practitioner would expect to see moder- ate baseline variability in the FH but, the definition of a reactive NST, the nurse should see two fetal heart accelerations of 15 bpm lasting 15 or more seconds during a 20-minute period. 2. The maternal heart rate is not evaluated during an NST. 3. This is the definition of a reactive nonstress test—there are two fetal heart accelerations of 15 bpm lasting 15 or more seconds during a 20-minute period. 4. The maternal heart rate is not evaluated during an NST. TEST-TAKING TIP: When a practitioner notes a reactive nonstress test, he or she can be fairly confident that the fetus is well and will probably remain well for at least 3 to 4 days. NSTs, therefore, are usually performed twice weekly. A nonre- active nonstress test, when the fetal heart fails to show 2 accelerations of 15 bpm lasting 15 or more seconds during a 20-minute period, is very hard to inter- pret. Usually practitioners order more extensive testing to determine the well- being of the baby after a nonreactive NST.

The nurse notes that the results of a gravid woman's contraction stress test are equivocal. How should the nurse interpret the finding? 1. Baby is acidotic and should be delivered. 2. Fetal heart rate accelerated once during the test. 3. Baby is preterm but the heart rate is normal. 4. Additional data is needed to make a diagnosis.

1. Equivocal results are difficult to interpret. Additional information is needed. 2. Fetal heart accelerations are not evaluated during contraction stress tests. 3. Contraction stress tests are not performed on preterm clients. 4. Equivocal results are difficult to interpret. Additional information is needed. TEST-TAKING TIP: When a test is equivocal, the results can be interpreted both posi- tively and negatively. When contraction stress test results are equivocal, one of two things has usually happened: (a) either there are late decelerations noted, but they are not consistent or (b) the client has developed a hyperstimulated contraction pattern. In either case, the results of the test are uninterpretable and, therefore, additional testing is usually ordered.

An insulin-dependent diabetic woman will require higher doses of insulin as which of the following pregnancy hormones increases in her body? 1. Estrogen. 2. Progesterone. 3. Human chorionic gonadotropin. 4. Human placental lactogen.

1. Estrogen does not compete with insulin. 2. Progesterone does not compete with in- sulin. 3. Human chorionic gonadotropin does not compete with insulin. 4. Human placental lactogen is an in- sulin antagonist so the client will re- quire higher doses of insulin as the level of placental lactogen increases. TEST-TAKING TIP: During the first trimester, the insulin needs of a woman with type 1 diabetes are usually low. Once the diabetic client enters the second trimester, however, insulin demands increase. One of the most important reasons that insulin demands increase is the increasingly higher levels of human placental lactogen that are found in the mother's bloodstream.

The nurse has assessed four primigravid clients in the prenatal clinic. Which of the women would the nurse refer to the nurse midwife for further assessment? 1. 10 weeks' gestation, complains of fatigue with nausea and vomiting. 2. 26 weeks' gestation, complains of ankle edema and chloasma. 3. 32 weeks' gestation, complains of epigastric pain and facial edema. 4. 37 weeks' gestation, complains of bleeding gums and urinary frequency

1. Fatigue and nausea and vomiting are normal in clients at 10 weeks' gestation. 2. Ankle edema and chloasma are normal in clients at 26 weeks' gestation. 3. Epigastric pain and facial edema are not normal. This client should be re- ferred to the nurse midwife. 4. Bleeding gums and urinary frequency are normal in clients at 37 weeks' gestation. TEST-TAKING TIP: The nurse must be pre- pared to identify clients with symptoms that are unexpected. This question requires the test taker to differentiate between normal signs and symptoms of pregnancy at a variety of gestational ages and those that could indicate a serious complication of pregnancy.

The nurse is providing health teaching to a group of women of childbearing age. One woman, who states that she is a smoker, asks about its impact on the pregnancy. The nurse responds that which of the following fetal complications can develop if the mother smokes? 1. Genetic changes in the fetal reproductive system. 2. Extensive central nervous system damage. 3. Addiction to the nicotine inhaled from the cigarette. 4. Fetal intrauterine growth restriction.

1. Genetic changes in the fetal reproductive system have not been associated with smoking during pregnancy. 2. Extensive central nervous system damage has not been associated with smoking during pregnancy. 3. There is no direct evidence that prenatal smoking causes fetal nicotine addiction. 4. Smoking in pregnancy does cause fe- tal intrauterine growth restriction. TEST-TAKING TIP: When someone smokes, there is a vasoconstrictive effect that occurs in the body. This vasoconstrictive effect is also seen at the placental site. Placentas of women who smoke are much smaller than those of nonsmoking women; because of this, babies receive less oxygen and nutrients via the placenta. As a result, their growth is restricted.

In anticipation of a complication that may develop in the second half of pregnancy, the nurse teaches an 18-week gravid client to call the office if she experiences which of the following? 1. Headache and decreased output. 2. Puffy feet. 3. Hemorrhoids and vaginal discharge. 4. Backache.

1. Headache and decreased output are signs of preeclampsia. 2. Dependent edema is seen in most preg- nant women. It is related to the weight of the uterine body on the femoral vessels. 3. Hemorrhoids and vaginal discharge are experienced by many pregnant women. Hemorrhoids are varicose veins of the rectum. They develop as a result of chronic constipation and the weight of the uterine body on the hemorrhoidal veins. An increase in vaginal discharge results from elevated estrogen levels in the body. 4. Backache is seen in most pregnant women. It develops as a result of the weight of the uterine body and the re- sultant physiological lordosis. TEST-TAKING TIP: It is important for the test taker to realize that although some symptoms like puffy feet may seem signifi- cant, they are normal in pregnancy, while other symptoms like headache, which in a nonpregnant woman would be considered benign, may be potentially very important in a pregnant woman.

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

1. Headaches are not associated with the diagnosis of placenta previa. 2. A history of renal disease is rarely associated with a diagnosis of placenta previa. 3. Previous preterm deliveries are not associated with a diagnosis of placenta previa. 4. Painless vaginal bleeding is often the only symptom of placenta previa. TEST-TAKING TIP: There are three different forms of placenta previa: low-lying placenta—one that lies adjacent to, but not over, the internal cervical os; partial— one that partially covers the internal cervical os; and complete—a placenta that completely covers the internal cervical os. There is no way to deliver a live baby vaginally when a client has a complete previa, although there are cases when live babies have been delivered when the clients had low-lying or partial previas.

The laboratory reported the L/S ratio results from an amniocentesis as 1:1. How should the nurse interpret the result? 1. The baby is premature. 2. The mother is high risk for hemorrhage. 3. The infant has kernicterus. 4. The mother is high risk for eclampsia.

1. The baby is preterm. 2. The L/S ratio is not related to blood loss. 3. The L/S ratio is not related to hyper- bilirubinemia. 4. The L/S ratio is not related to preeclampsia. TEST-TAKING TIP: The amount of lecithin must be 2 times the amount of sphin- gomyelin before the practitioner can be assured that the fetal lungs are mature. The ratio in the scenario—1:1—indicates that the surfactant is insufficient for extrauterine respirations.

An insulin-dependent diabetic, G3P0200, 38 weeks' gestation, is being seen in the labor and delivery suite in metabolic dysequillibrium. The nurse knows that which of the following maternal blood values is most high risk to her unborn baby? 1. Glucose 150 mg/dL. 2. pH 7.25. 3. pCO2 34 mm Hg. 4. Hemoglobin A 1c 10%.

1. Hyperglycemia is most damaging to the fetus during the first trimester of pregnancy. Although it is abnormal at 38 weeks' gestation, it is not the most important finding. 2. Acidosis is fatal to the fetus. This is the most important finding. 3. Hypocapnia is abnormal, but it is not the most important finding. 4. A high glycohemoglobin is abnormal, but it is not the most important finding. TEST-TAKING TIP: Acidosis is life threaten- ing to the fetus. It is essential that the nurse monitor clients for situations that would put the fetus in jeopardy of being in an acidotic environment, including mater- nal hypoxia and diabetic ketoacidosis.

A patient who is 24 weeks pregnant has been diagnosed with syphilis. She asks the nurse how the infection will affect the baby. The nurse's response should be based on which of the following? 1. She is high risk for premature rupture of the membranes. 2. The baby will be born with congenital syphilis. 3. Penicillin therapy will reduce the risk to the fetus. 4. The fetus will likely be born with a cardiac defect.

1. If treated early, there likely will be no pregnancy or fetal damage noted. 2. If treated, the baby will not be born with congenital syphilis. 3. Usually a single shot of penicillin, ad- ministered to the mother, will cure her and protect the baby. 4. The woman is past the first trimester when the major organ systems are developed. TEST-TAKING TIP: Clients are assessed for sexually transmitted infections during the pregnancy—usually at the first prenatal visit and shortly before the expected date of delivery. It is important to test all women, even those who have an apparently low probability of diseases like married women and women from the upper socioeconomic strata. Infections, includ- ing those that are sexually transmitted, can be contracted by anyone.

A 12-week-gravid client presents in the emergency department with abdominal cramps and scant dark red bleeding. What should the nurse assess this client for? 1. Shortness of breath. 2. Enlarging abdominal girth. 3. Hyperreflexia and clonus. 4. Fetal heart dysrhythmias.

1. It is unlikely that these symptoms are related to a respiratory problem. 2. The client is only 12 weeks' gestation. The nurse would not expect the abdomi- nal girth measurements to increase. 3. This client is only 12 weeks' gestation. Preeclampsia and its complications, such as hyperreflexia and clonus, are virtually never seen before 20 weeks' gestation. 4. This client is showing signs of sponta- neous abortion. The nurse should check the fetal heart rate. TEST-TAKING TIP: It is essential that the test taker carefully read the weeks of ges- tation when answering pregnancy-related questions. If the client had been earlier in the first trimester of her pregnancy, the signs and symptoms would also have been consistent with an ectopic pregnancy. It would then have been appropriate to assess for referred shoulder pain as well.

A client has just been diagnosed with gestation diabetes. She cries, "Oh no! I will never be able to give myself shots!!" Which of the following responses by the nurse is appropriate at this time? 1. "I am sure you can learn for your baby." 2. "I will work with you until you feel comfortable giving yourself the insulin." 3. "We will be giving you pills for the diabetes." 4. "If you follow your diet and exercise you will probably need no insulin."

1. It is unlikely that this client will need any medication. 2. It is unlikely that this client will need any medication. 3. It is unlikely that this client will need any medication. 4. It is unlikely that this client will need any medication. Diet and exercise will probably control the diabetes. TEST-TAKING TIP: The client should be reminded that if she follows her diet and exercises regularly that she will likely be able to manage her diabetes without medication. She should also be encouraged to continue the diet and exercise after delivery to prevent the development of type 2 diabetes later in life.

It is discovered that a 28-week-gestation gravid is leaking amniotic fluid. Before the client is sent home on bed rest, the nurse teaches her which of the following? 1. Perform a nitrazine test every morning upon awakening. 2. Immediately report any breast tenderness to the primary health care practitioner. 3. Abstain from engaging in vaginal intercourse for the rest of the pregnancy. 4. Carefully weigh all of her saturated peripads.

1. It is unnecessary to perform a daily nitrazine assessment 2. Breast tenderness is unrelated to PPROM. 3. This client must abstain from vaginal intercourse for the remainder of the pregnancy. 4. It is unnecessary for the client to weigh her saturated pads. TEST-TAKING TIP: Once the membranes are ruptured, the barrier between the vagina and the uterus is broken. As a result, the pathogens in the vagina and the external environment are potentially able to ascend into the sterile uterine body. In addition, once the membranes are ruptured, the client is at high risk for preterm labor. Intercourse must be curtailed for both of these reasons.

A client is being taught fetal kick counting. Which of the following should be included in the patient teaching? 1. The woman should choose a time when her baby is least active. 2. The woman should lie on her side with her head elevated about 30º. 3. The woman should report fetal kick counts of greater than 10 in an hour. 4. The woman should refrain from eating immediately before counting.

1. It would be best to choose a time when the fetus is most active. 2. This is the best position for perfusing the placenta. 3. Fewer than 3 counts in 1 hour should be reported. 4. It is unnecessary to refrain from eating prior to the test. TEST-TAKING TIP: Because the goal of fetal kick counting is to monitor fetal well- being, it is best to do the test when the baby is most active and is most likely to be well nourished and well oxygenated. Many women find that the best time for the assessment is immediately after a meal.

An obese gravid woman is being seen in the prenatal clinic. The nurse will monitor this client carefully throughout her pregnancy because she is high risk for which of the following complications of pregnancy? 1. Placenta previa. 2. Gestational diabetes. 3. Abruptio placentae. 4. Chromosomal defects.

1. Obese clients are not especially at high risk for placenta previa. 2. Obese clients are at high risk for gestational diabetes. 3. Obese clients are not especially at high risk for placental abruption. 4. Obese clients are not especially at high risk for chromosomal defects. TEST-TAKING TIP: Because clients who enter pregnancy obese are at such high risk for gestational diabetes, many obste- tricians skip the glucose challenge test and automatically schedule a glucose tolerance test at approximately 24 weeks' gestation. As a result, the complication is discovered much earlier and intervention can begin much earlier. The patients are also carefully monitored for signs and symptoms of preeclampsia.

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

1. Patellar reflexes are assessed by striking the patellar tendon. 2. Clonus is not assessed by palpating the woman's ankle. 3. To assess clonus, the nurse should dorsiflex the woman's foot. 4. Clonus is not assessed by positioning the woman's feet flat on the floor. TEST-TAKING TIP: When clients have severe preeclampsia, they are often hyperreflexic and develop clonus. To assess for clonus, the nurse should dorsiflex the foot and then let the foot go. The nurse should observe for and count any pulsations of the foot. The number of pulsations is documented. The higher the number of pulsations there are, the more irritable the woman's central nervous system is.

A woman has just been admitted to the emergency department subsequent to a head-on automobile accident. Her body appears to be uninjured. The nurse carefully monitors the woman for which of the following complications of pregnancy? 1. Placenta previa. 2. Transverse fetal lie. 3. Placental abruption. 4. Severe preeclampsia.

1. Placenta previa is not an acute problem. It is related to the site of placental implantation. 2. Transverse fetal lie is a malpresentation. It would not be related to the auto accident. 3. Placental abruption may develop as a result of the auto accident. 4. Preeclampsia does not occur as a result of an auto accident. 5. The woman may go into preterm labor after an auto accident. TEST-TAKING TIP: The fetus is well pro- tected within the uterine body. The muscu- lature of the uterus and the amniotic fluid provide the baby with enough cushioning to withstand minor bumps and falls. A major automobile accident, however, can cause anything from preterm premature rupture of the membranes, to preterm labor, to a ruptured uterus, to placental abruption. The nurse should especially monitor the fetal heartbeat for any variations.

Which of the following nursing diagnoses would be most appropriate for a 15-year-old woman who is in her first trimester of pregnancy? 1. Sleep pattern disturbance related to discomforts of pregnancy. 2. Knowledge deficit related to care of infants. 3. Anxiety related to fear of labor and delivery. 4. Ineffective individual coping related to developmental level.

1. Pregnant women are often fatigued and it is not uncommon for adolescents to sleep long hours. This is not the best nursing diagnosis. 2. The teen is likely to need teaching re- garding the care of infants, but it is too early in the pregnancy for this diagnosis to take precedence. 3. The teen is likely to be anxious regarding labor and delivery, but it is too early in the pregnancy for this diagnosis to take precedence. 4. The developmental tasks of adoles- cence are often in conflict with the tasks of pregnancy. This nursing diag- nosis is the most appropriate. TEST-TAKING TIP: The major developmen- tal tasks of adolescence—completing her education, developing abstract thinking, and developing skills that foster inde- pendence—can be in conflict with those of pregnancy. Adolescents often test rules, use drugs, and drink alcohol, all of which are detrimental to the developing fetus. At the very least, teens socialize with friends, often eating at fast-food restau- rants where a well-balanced high-calcium, high-iron diet is hard to obtain.

A gravid client, 25 years old, is diagnosed with gallstones. She asks her nurse, "Aren't I too young to get gallstones?" The nurse bases her response on which of the following? 1. Progesterone slows emptying of the gallbladder making gravid women high risk for the disease. 2. Gallbladder disease has a strong genetic component so the woman should be advised to see a genetic counselor. 3. Older women are no more prone to gallstones than are younger women. 4. Gallbladder disease is related to a high dietary intake of carbohydrates.

1. Progesterone is a hormone that re- laxes smooth muscle. This action leads to the delayed emptying of the gallbladder during pregnancy. 2. Although there is a genetic tendency for people of some ethnic groups to excrete large quantities of cholesterol, a con- tributing factor in gallbladder disease, there is not a direct genetic link to the problem. 3. Women are more likely to have gallblad- der disease than are men and older women are more prone to the disease than are younger women. 4. Gallbladder disease is related to high levels of cholesterol in the diet and in the blood stream. TEST-TAKING TIP: The hormones of preg- nancy not only maintain the pregnancy but also affect all parts of the body. High estrogen levels can lead to nosebleeds and gingivitis and high progesterone lev- els can lead to constipation and gallblad- der disease.

A child has been diagnosed with rubella. What must the pediatric nurse teach the child's parents to do? 1. Notify any exposed pregnant friends. 2. Give penicillin po every 6 hours for 10 full days. 3. Observe the child for signs of respiratory distress. 4. Administer diphenhydramine every 4 hours as needed.

1. Rubella is a teratogenic disease. The parents should notify any pregnant friends. 2. Rubella is a virus. Penicillin will not treat it. 3. Rubella is a relatively benign illness when contracted in childhood. 4. Rubella is not a pruritic illness. Diphen- hydramine is not needed. TEST-TAKING TIP: Of all of the communi- cable illnesses, rubella is the most poten- tially teratogenic. If mothers contract the disease during the first trimester, up to 50% of the fetuses will develop congenital defects. The incidence of disease does drop with each successive week, but babies are still at high risk for injury. The most common defects from rubella are deafness, cataracts, and cardiovascular disease.

A woman's glucose challenge test (GCT) results are 155 mg/dL at 1 hour post-glucose ingestion. Which of the following actions, as ordered by the physician, is appropriate? 1. Send the woman for a glucose tolerance test. 2. Teach the woman how to inject herself with insulin. 3. Notify the woman of the normal results. 4. Provide the woman with oral hypoglycemic agents.

1. The 1-hour GCT results are above normal. She needs a 3-hour glucose tolerance test (GTT). 2. The 1-hour GCT results are above normal. She needs a 3-hour GTT. 3. The 1-hour GCT results are above normal. She needs a 3-hour GTT. 4. The 1-hout GCT results are above normal. She needs a 3-hour GTT. TEST-TAKING TIP: The glucose challenge test (GCT) is a nonfasting test performed on the vast majority of pregnant clients at or about 24 weeks' gestation. The test is performed to assess for gestational diabetes. Clients with test results of 130 mg/dL or higher (Some physicians use 140 mg/dL as the cutoff.) are referred for a 3-hour glucose tolerance test to make a definitive diagnosis.

At 28 weeks' gestation, an Rh-negative woman receives RhoGAM. Which of the following would indicate that the medication is effective? 1. The baby's Rh status changes to Rh negative. 2. The mother produces no Rh antibodies. 3. The baby produces no Rh antibodies. 4. The mother's Rh status changes to Rh positive.

1. The baby's Rh status cannot change. 2. That the mother produces no Rh antibodies is the goal of RhoGAM administration. 3. The baby will not produce antibodies. 4. The mother's Rh status cannot change. TEST-TAKING TIP: The test taker should review the immune response to an anti- gen. In this situation, the antigen is the baby's Rh+ blood. It can leak into the maternal bloodstream from the fetal bloodstream at various times during the pregnancy. Most commonly it happens at the time of placental delivery. Because the mother is antigen negative—that is, Rh-, when exposed to Rh+ blood, her immune system develops antibodies. RhoGAM is composed of Rh+ antibodies. It acts as passive immunity. Because antibodies are already present in the mother's blood- stream, her immune system is suppressed and fails to develop antibodies via the active immune response.

The nurse caring for a type 1 diabetic client who wishes to become pregnant notes that the client's glycohemoglobin, or glycosylated hemoglobin (HgbA 1c), result was 15% today and the fasting blood glucose result was 100 mg/dL. Which of the following interpretations by the nurse is correct in relation to these data? 1. The client has been hyperglycemic for the last 3 months and is hyperglycemic today. 2. The client has been normoglycemic for the last 3 months and normoglycemic today. 3. The client has been hyperglycemic for the last 3 months and normoglycemic today. 4. The client has been normoglycemic for the last 3 months and hyperglycemic today.

1. The client has been hyperglycemic for 3 months but is normoglycemic today. 2. The client has been hyperglycemic for 3 months but is normoglycemic today. 3. The client has been hyperglycemic for 3 months but is normoglycemic today. 4. The client has been hyperglycemic for 3 months but is normoglycemic today. TEST-TAKING TIP: It is very important for a glycohemoglobin test to be performed at the same time that a fasting glucose is done to have an idea of a diabetic client's glucose control over the past 3 months in comparison to the results of the fasting test. When in a hyperglycemic environ- ment, the red blood cell (RBC) becomes a compound molecule with a glucose group attached to it. Because the RBC lives for approximately 120 days, the health care practitioner can estimate the glucose control of the client over the preceding 3 months time by analyzing the glycohe- moglobin. Up to 5% glycohemoglobin is considered normal. An HgbA1c level of 15%, therefore, indicates that the client has been hyperglycemic for the past 3 months. Because her fasting blood glucose level of 100 mg/dL is normal, however, she is normoglycemic today.

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

1. The client is not at high risk for oligohy- dramnios but rather for polyhydramnios. 2. Because there are two placentas, placenta previa is more common in dizygotic twins. There is only one placenta in a monozygotic twin pregnancy, however. 3. Twins are usually smaller than singletons. Although malpresentation may occur, it is unlikely that cephalopelvic dispropor- tion will occur. 4. Twin-to-twin transfusion is a rela- tively common complication of monozygotic twin pregnancies. TEST-TAKING TIP: The key to answering this question is the fact that the twins orig- inate from the same egg—that is, they are monozygotic twins. They share a placenta and a chorion. Because their blood supply is originating from the same source, the twins' circulations are connected. As a result, one twin may become the donor twin while the second twin may become the recipient. The donor grows poorly and develops severe anemia. The recipient becomes polycythemic and large.

A gestational diabetic, who requires insulin therapy to control her blood glucose levels, telephones the triage nurse complaining of dizziness and headache. Which of the following actions should the nurse take at this time? 1. Have the client proceed to the office to see her physician. 2. Advise the client to drink a glass of milk and then call back. 3. Instruct the client to inject herself with regular insulin. 4. Tell the client immediately to telephone her medical doctor.

1. The client may need to be seen, but this is not the appropriate response by the nurse at this time. 2. The client should drink a full glass of milk. 3. It is contraindicated to have the client inject herself with insulin. 4. The client may need to speak with her medical doctor, but that is not the appro- priate response by the nurse at this time. TEST-TAKING TIP: Because the signs and symptoms of hyperglycemia and hypo- glycemia are very similar, it is important for the nurse to err on the side of caution. If the client should be hypoglycemic, this is a medical emergency. Drinking a glass of orange juice will stabilize the glucose in the woman's body. If she is hyper- glycemic, the juice may increase the glu- cose levels, but not significantly. A blood glucose assessment can be done and insulin can be administered, if needed, shortly after consuming the juice.

A client has severe preeclampsia. The nurse would expect the primary health care practitioner to order tests to assess the fetus for which of the following? 1. Severe anemia. 2. Hypoprothrombinemia. 3. Craniosynostosis. 4. Intrauterine growth restriction.

1. The fetus will not be assessed for signs of severe anemia. 2. The fetus will not be assessed for signs of hypoprothrombinemia. 3. The fetus will not be assessed for signs of craniosynostosis. 4. The fetus should be assessed for in- trauterine growth restriction. TEST-TAKING TIP: Perfusion to the placenta drops when clients are preeclamptic because the client's hypertension impairs adequate blood flow. When the placenta is poorly perfused, the baby is poorly nourished. Without the nourishment provided by the mother through the umbilical

A pregnant Latina is being seen in the prenatal clinic with diarrhea, fever, stiff neck, and headache. Upon inquiry, the nurse learns that the woman drinks unpasteurized milk and eats soft cheese daily. For which of the following bacterial infections should this woman be assessed? 1. Staphylococcus aureus. 2. Streptococcus albicans. 3. Pseudomonas aeruginosa. 4. Listeria monocytogenes.

1. The symptoms are not likely caused by Staphylococcus aureus. 2. The symptoms are not likely caused by Streptococcus albicans. 3. The symptoms are not likely caused by Pseudomonas aeruginosa. 4. The client is likely suffering from listeriosis, an infection caused by Listeria monocytogenes bacteria. TEST-TAKING TIP: Latin women are espe- cially at high risk for listeriosis because of their dietary patterns. They often eat soft cheeses and are unlikely to fear drinking unpasteurized milk. It is important that the nurse communicate to all pregnant women the need to refrain from consum- ing those substances with a clear rationale for the warning.

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

1. The first intervention for preterm la- bor is hydration. Clients who are de- hydrated are at high risk for preterm labor. 2. This statement is inappropriate. The client may actually be in true labor. 3. After being hydrated it is possible that the client's cramping will stop. 4. It is not normal for a client to have rhythmic cramping even if she works on her feet. TEST-TAKING TIP: Preterm cramping should never be ignored. To assess whether or not a client is in true labor, clients are encouraged to improve their hydration. The client is encouraged to drink about 1 quart of fluid and to lie on her side. If the contractions do not stop, she should proceed to the hospital to have her cervix assessed. If the cervix begins to dilate or efface, a diagnosis of preterm labor would be made. If the contractions stop, clients are usually allowed to begin light exercise. But if the contractions restart, the woman should proceed to the hospital to be assessed.

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

1. The hydramnios is likely a result of excessive fetal urination. 2. The hydramnios is unlikely related to hypoglycemic episodes. 3. Fetal sacral agenesis can result from maternal hyperglycemic episodes during the fetal organogenic period. 4. The hydramnios is unlikely related to impaired placental function. TEST-TAKING TIP: The majority of amni- otic fluid is created as urine by the fetal kidneys. Fetuses of diabetic mothers often experience polyuria as a result of hyper- glycemia. If the mother's diabetes is out of control, excess glucose diffuses across the placental membrane, resulting in the fetus becoming hyperglycemic. As a result, the fetus exhibits the classic sign of diabetes—polyuria. If the mother's serum glucose levels are very high during the first trimester, it is likely that the fetus will develop structural congenital defects. Sacral agenesis is one of the most severe of these defects.

A patient, 32 weeks pregnant with severe headache, is admitted to the hospital with preeclampsia. In addition to obtaining baseline vital signs and placing the client on bed rest, the physician ordered the following four items. Which of the orders should the nurse perform first? 1. Assess deep tendon reflexes. 2. Obtain complete blood count. 3. Assess baseline weight. 4. Obtain routine urinalysis.

1. The nurse should check the client's patellar reflexes. The most common way to assess the deep tendon reflexes is to assess the patellar reflexes. 2. The blood count is important, but the nurse should first assess patellar reflexes. 3. The baseline weight is important, but the nurse should first assess patellar reflexes. 4. The urinalysis should be obtained, but the nurse should first assess patellar reflexes. TEST-TAKING TIP: Preeclampsia is a very serious complication of pregnancy. The nurse must assess for changes in the blood count, for evidence of marked weight gain, and for changes in the urinalysis. By assessing the patellar reflexes first, however, the nurse can make a preliminary assessment of the severity of the preeclampsia. For example, if the reflexes are E2, the client would be much less likely to become eclamptic than a client who has E4 reflexes with clonus.

The physician has ordered a nonstress test (NST) to be done on a 41-week- gestation client. During the 1/2 hour test, the nurse observed three periods of fetal heart accelerations that were 15 beats per minute above the baseline and that lasted 15 seconds each. No contractions were observed. Based on these results, what should the nurse do next? 1. Send the client home and report positive results to the MD. 2. Perform a nipple stimulation test to assess the fetal heart in response to contractions. 3. Prepare the client for induction with IV oxytocin or endocervical prostaglandins. 4. Place the client on her side with oxygen via face mask.

1. The nurse should report the positive results to the doctor. 2. There is no need to perform the nipple stimulation test. 3. There is no need to induce the client. 4. There is no need to administer oxygen to the client. TEST-TAKING TIP: This client is postdates. The NST is being performed to assess the well-being of the fetus. The results of the test—reactive NST results—are evidence that the fetus is well and will likely be well for another few days. There is no need to provide emergent care.

A diabetic client is to receive 5 units regular and 15 units NPH insulin at 0800. In order to administer the medication appropriately, what should the nurse do? 1. Draw 5 units regular in one syringe and 15 units NPH in a second syringe and inject in different locations. 2. Draw 5 units regular first and 15 units NPH second into the same syringe and inject. 3. Draw 15 units NPH first and 5 units regular second into the same syringe and inject. 4. Mix 5 units regular and 15 units NPH in a vial before drawing the full 20 units into a syringe and inject.

1. The regular and NPH can be adminis- tered in one syringe. 2. This is the appropriate method. The regular insulin should be drawn up first and then the NPH insulin in the same syringe. 3. Regular insulin should be drawn up first. 4. The insulins should not be mixed to- gether in a vial. TEST-TAKING TIP: The nurse must be familiar with the appropriate method for administering medications. Insulin must be drawn up in the correct sequence: regular insulin first and NPH insulin second.

A pregnant woman, 24 weeks' gestation, who has been diagnosed with gallstones is scheduled for surgery. In order to provide high-quality care, what should the nurse be aware of? 1. That preterm delivery of the baby must precede the cholescystectomy surgery. 2. That decreased gastric motility of pregnancy increases her risk of postoperative vomiting. 3. That physiological anemia of pregnancy increases her risk of perioperative hemorrhage. 4. That antiembolic stockings are contraindicated for the pregnant woman after surgery.

1. The surgery, if indicated, can be per- formed while the client is pregnant. 2. This response is correct. Proges- terone slows gastric motility, increas- ing the client's potential for postoper- ative vomiting and for postoperative gas pains. 3. The presence of anemia does not influ- ence a client's potential for hemorrhaging. 4. Antiembolic stockings are not con- traindicated during pregnancy. Rather they should be placed on the client while she is immobile. TEST-TAKING TIP: Surgery is performed on a pregnant woman only when absolutely necessary. When it is performed, however, the client's pregnancy hormone levels, the cardiovascular changes of pregnancy, and the size of the gravid uterus all place the client at risk of complications. In addition, of course, the maintenance of the pregnancy itself is at risk because of the surgery.

A client, G2P1001, telephones the gynecology office complaining of left-sided pain. Which of the following questions by the triage nurse would help to determine whether the one-sided pain is due to an ectopic pregnancy? 1. "When did you have your pregnancy test done?" 2. "When was the first day of your last menstrual period?" 3. "Did you have any complications with your first pregnancy?" 4. "How old were you when you first got your period?"

1. The timing of the pregnancy test is irrelevant. 2. The date of the last menstrual period will assist the nurse in determining how many weeks pregnant the client is. 3. The woman's previous complications are irrelevant at this time. 4. The age of the woman's menarche is irrelevant. TEST-TAKING TIP: The date of the last menstrual period is important for the nurse to know. Ectopic pregnancies are usually diagnosed between the 8th and the 9th week of gestation because, at that gestational age, the conceptus has reached a size that is too large for the fallopian tube to hold.

A client's 32-week clinic assessment was: BP 90/60; TPR 98.6ºF, P 92, R 20; weight 145 lb; and urine negative for protein. Which of the following findings at the 34-week appointment should the nurse highlight for the certified nurse midwife? 1. BP 110/70; TPR 99.2ºF, 88, 20. 2. Weight 155 lb; urine protein 2. 3. Urine protein trace; BP 88/56. 4. Weight 147 lb; TPR 99.0ºF, 76, 18.

1. The vital signs are within normal limits. 2. There has been a 10-lb weight gain in 2 weeks and a significant amount of protein is being spilled in the urine. This client should be brought to the attention of the primary caregiver. 3. Trace urine protein is considered normal in pregnancy. The blood pressure is within normal limits. 4. The client has had a normal 2-lb weight gain in the past 2 weeks and her vital signs are within normal limits. TEST-TAKING TIP: There is a great deal of information included in this question. The test taker must methodically assess each of the pieces of data. Important things to attend to are the timing of the appointments—2 weeks apart; changes in vital signs—it is normal for pulse and respiratory rates to increase slightly and BP to drop slightly; changes in urinary protein—trace is normal, +2 is not normal; and changes in weight—2-lb increase over 2 weeks is normal, a 10-lb increase is not normal.

Nurses working in obstetric clinics know that, in general, teen pregnancies are high risk because of which of the following? 1. High probability of chromosomal anomalies. 2. High oral intake of manganese and zinc. 3. High numbers of postterm deliveries. 4. High number of late prenatal care registrants.

1. There is not a high incidence of chromo- somal defects in babies born to teen mothers. 2. Teens do not have an inordinately high intake of manganese and zinc. 3. Teens are prone to having preterm deliveries rather than postterm deliveries. 4. Teens are likely to delay entry into the health care system. TEST-TAKING TIP: Late entry into prenatal care is particularly problematic for teen pregnancies. Because organogenesis occurs during the first trimester, by the time many teens acknowledge that they are pregnant and seek care they are already past this critical period. They are likely to have consumed damaging substances or, at the very least, con- sumed inadequate quantities of essential nutrients, like folic acid.

A woman, G4P0210 and 12 weeks' gestation, has been admitted to the labor and delivery suite for a cerclage procedure. Which of the following long-term outcomes is appropriate for this client? 1. The client will gain less than 25 pounds during the pregnancy. 2. The client will deliver after 37 weeks' gestation. 3. The client will have a normal blood glucose throughout the pregnancy. 4. The client will deliver a baby that is appropriate for gestational age.

1. There is nothing in this scenario that implies that this client is overweight or has gained too much weight during the pregnancy. 2. This client is at high risk for preg- nancy loss. This is an appropriate long-term goal. 3. There is nothing in this scenario that im- plies that this client is at high risk for gestational diabetes. 4. There is nothing in this scenario that implies that this client is at high risk for delivering babies that are either small-for-gestational or large-for- gestational age. TEST-TAKING TIP: This question requires the test taker to know why a client may have cervical cerclage placed—namely, because of multiple pregnancy losses from cervical insufficiency (incompetent cervix). The gravidity and parity information pro- vides an important clue to the question. The client has had four pregnancies— with two preterm births and one abortion, but she has no living children. The goal for the therapy, therefore, is that the pregnancy will go to term.

A gravid woman, 36 weeks' gestation with type 1 diabetes, has just had a biophysical profile (BPP). Which of the following results should be reported to the obstetrician? 1. One fetal heart acceleration in 20 minutes. 2. Three episodes of fetal rhythmic breathing in 30 minutes. 3. Two episodes of fetal extension and flexion of 1 arm. 4. One amniotic fluid pocket measuring 3 cm.

1. There should be a minimum of 2 fetal heart accelerations in 20 minutes (approximately 1 every 10 minutes). 2. This result is acceptable. There should be a minimum of 1 episode of fetal rhythmic breathing in 30 minutes. 3. This result is acceptable. There should be a minimum of 1 fetal limb extension and flexion. 4. This result is acceptable. There should be a minimum of 1 amniotic fluid pocket measuring 2 cm. TEST-TAKING TIP: The BPP is a compre- hensive assessment geared to evaluate fetal health. In addition to the four items mentioned above, the fetus should exhibit 3 or more discrete body or limb movements in 30 minutes.

A client, 37 weeks' gestation, has been advised that she is positive for group B streptococci. Which of the following comments by the nurse is appropriate at this time? 1. "The doctor will prescribe intravenous antibiotics for you. A visiting nurse will administer them to you in your home." 2. "You are very high risk for an intrauterine infection. It is very important for you to check your temperature every day." 3. "The bacteria are living in your vagina. They will not hurt you but we will give you medicine in labor to protect your baby from getting sick." 4. "This bacteria causes scarlet fever. If you notice that your tongue becomes very red and that you feel feverish you should call the doctor immediately."

1. This answer is incorrect. Antibiotics, if given prenatally, are administered orally. 2. This answer is incorrect. Group B strep bacteria are normal flora for this client. She need not take her temperature. 3. This answer is correct. Exposure to group B strep is very dangerous for neonates. 4. Group B strep does not cause scarlet fever. Group A strep causes scarlet fever and strep pharyngitis. TEST-TAKING TIP: Group B strep can cause serious neonatal disease. Babies are at high risk for meningitis, sepsis, pneumo- nia, and even death. IV antibiotics are administered to the laboring mother every 4 hours to decrease the colonization in the mother's vagina and rectum. In addi- tion, the antibiotics cross the placenta and act as a prophylaxis for the baby.

A 30-year-old gravida, G3P1101, 6 weeks' gestation, states that her premature baby boy, born 8 years ago, died shortly after delivery from an infection secondary to spina bifida. Which of the following interventions is most important for this client? 1. Grief counseling. 2. Nutrition counseling. 3. Infection control counseling. 4. Genetic counseling.

1. This client is many years past her baby's death. Grief counseling is probably not needed at this time. 2. This client is in need of nutrition counseling. 3. The woman is not in need of infection control counseling at this time. 4. Although there may be some genetic ba- sis to spina bifida, about 95% of affected babies are born to parents with no family history of the disease. TEST-TAKING TIP: There is a strong associ- ation between low folic acid intake during the first trimester of pregnancy and spina bifida, a neural tube defect. It is very important that all clients, and especially clients with a family or personal history of a neural tube defect, consume adequate amounts of folic acid during their preg- nancies. It is recommended that all women consume at least 600 micrograms of the vitamin per day. To that end, to prevent neural tube defects, it is recom- mended that pregnant women with no family history take a supplement of 400 micrograms per day, while pregnant women with a family history take a supplement that is 10 times the standard dose, or 4 mg per day.

A client's admitting medical diagnosis is third-trimester bleeding: rule out placenta previa. Each time the nurse enters the client's room, the woman asks: "Please tell me, do you think the baby will be all right?" Which of the following is an appropriate nursing diagnosis for this client? 1. Hopelessness related to possible fetal loss. 2. Anxiety related to unidentified diagnosis. 3. Situational low self-esteem related to blood loss. 4. Potential for altered parenting related to inexperience.

1. This client is not exhibiting signs of hopelessness. 2. This client is very anxious. 3. This client is not exhibiting signs of low self-esteem. 4. This client is not showing signs that she will be a poor parent. TEST-TAKING TIP: Situational crises arise when problems occur unexpectedly. And crises are often intensified when informa- tion is lacking. In this situation, the exact diagnosis is unknown. The client is exhibiting her fright and concern by repeatedly asking the nurse his or her opinion of the baby's health.

A 25-week-pregnant client, who had eaten a small breakfast, has been notified that her glucose challenge test results were 132 mg/dL 1 hour after ingesting the glucose. Which of the following is appropriate for the nurse to say at this time? 1. "Because you ate before the test, the results are invalid and will need to be repeated." 2. "Because your test results are higher than normal, you will have to have another more specific test." 3. "Because of the results you will have to have weekly glycohemoglobin testing done." 4. "Because your results are within normal limits you need not worry about gestational diabetes."

1. This comment is inappropriate. The GCT is a nonfasting test. 2. This comment is appropriate. The client will be referred for a 3-hour glucose tolerance test. 3. This comment is inappropriate. Glycohemoglobin levels are assessed about once a month, not once a week. 4. The results are not normal. This client will be referred for a GTT. TEST-TAKING TIP: The GCT is merely a screening test. The vast majority of women are sent for the test at about 24 weeks' ges- tation when their human placental lactogen (a placental hormone that is an insulin antagonist) levels reach a specific point. If the GCT results are 130 mg/dL or higher (or 140 mg/dL or higher), the client is re- ferred for a 3-hour glucose tolerance test.

During a prenatal examination, the nurse notes scarring on and around the woman's genitalia. Which of the following questions is most important for the nurse to ask in relation to this observation? 1. "Have you ever had a severe infection of your sex organs?" 2. "Have you worn any piercings in your genital area?" 3. "Have you had a tattoo removed from your genital area?" 4. "Have you ever been forced to have sex without your permission?"

1. This is an important question but it is unrelated to scarring around the genitalia. 2. This is an important question but it is not the most important question that the nurse should ask. 3. This is an important question but it is not the most important question that the nurse should ask. 4. This is an essential question for the nurse to ask. TEST-TAKING TIP: The nurse should question all obstetric clients about a possible history of physical abuse and/or sexual abuse. Women are especially high risk for abusive injuries during the preg- nancy period. Any gravida who exhibits trauma to the genital area, therefore, must be viewed as a possible victim of sexual abuse.

Which of the following would be the best approach to take with an unmarried 14-year-old girl who tells the nurse that she is undecided whether or not to maintain an unplanned pregnancy? 1. "You should consider an abortion since you are so young." 2. "It is a difficult decision. What have you thought about so far?" 3. "Studies show that babies living with teen mothers often become teen parents." 4. "Why don't you keep the pregnancy? You could always opt for adoption later."

1. This is an inappropriate statement. The nurse should act as a counselor, not as a decision maker. 2. This is an excellent response. The question opens the door for the teenager to discuss her feelings and thoughts. 3. This is a true statement, but it is inap- propriate to say to a young woman who is ambivalent about her pregnancy. 4. This is an inappropriate statement. The nurse should act as a counselor, not as a decision maker. TEST-TAKING TIP: It is very important that nurses working in the obstetric area come to terms with their role and with their own beliefs and biases. One's per- sonal belief system should not influence the nurse's teaching and counseling roles. The nurse must be truthful and unbiased when counseling any prenatal client, including the pregnant teen.

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

1. This is inappropriate. The client will have to have a cesarean section. 2. Clients with complete placenta previa are discouraged from ambulating extensively. Usually they are placed on bed rest only, although they may have bathroom privileges. 3. This is inappropriate. A 25-week- gestation baby is very preterm. The pregnancy will be maintained as long as possible; hopefully until at least 37 weeks. 4. Straining at stool can result in enough pressure to result in placental bleeding. TEST-TAKING TIP: Clients diagnosed with complete placenta previa are usually maintained on bed rest. Because one of the many complications of bed rest is con- stipation, these clients must be monitored carefully. Many physicians order Colace (docusate sodium), a stool softener, to prevent this complication.

A client is being admitted to the labor suite with a diagnosis of eclampsia. Which of the following actions by the nurse is appropriate at this time? 1. Tape a tongue blade to the head of the bed. 2. Pad the side rails and head of the bed. 3. Provide the client with needed stimulation. 4. Provide the client with grief counseling.

1. This is not appropriate. Because it is dangerous for tongue blades to be in- serted into the mouths of seizing clients, the nurse should not place a tongue blade in the client's room. 2. This is appropriate. The side rails and the head board should be padded. 3. The room of an eclamptic client should be quiet. Excess stimulation can precipi- tate a seizure. 4. There is no reason to provide grief coun- seling to this client. TEST-TAKING TIP: When a client has been diagnosed with eclampsia, she has already had at least one seizure. The nurse, therefore, must be prepared to care for the client during another seizure. The most important action during the seizure is to protect the client from injury. Padding the side rails and headboard will provide that protection. This client's fetus is exhibiting a normal heart rate pattern.

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

1. This long-term goal is appropriate. 2. This client is not pregnant. She will not deliver a baby. 3. This client is not in intense pain. This long-term goal is not appropriate. 4. This client is not pregnant. She will not deliver a baby. TEST-TAKING TIP: When nurses plan care, they have in mind short-term and long- term goals that their clients will achieve. Short-term goals usually have a time frame of a week or two and often are specific to the client's current hospitalization. Long-term goals are expectations of client achievement over extended periods of time. It is important for nurses to develop goals to implement appropriate nursing interventions.

A pregnant woman mentions to the clinic nurse that she and her husband enjoy working together on projects around the house and, "I always wear protective gloves when I work." The nurse should advise the woman that, even when wearing gloves, which of the following projects could be high risk to the baby's health? 1. Replacing a light fixture in the nursery. 2. Sanding the paint from an antique crib. 3. Planting tulip bulbs in the side garden. 4. Shoveling snow from the driveway.

1. This project should not adversely affect the pregnancy. 2. Antique cribs are often painted with lead-based paint. This is a dangerous activity. 3. As long as she wears gloves, this activity should be safe. 4. As long as she does not become dyspneic, this activity should be safe. TEST-TAKING TIP: It is very important that clients stay away from aerosolized lead that can develop when lead paint is being sanded. Lead can enter the body through the respiratory tract as well as through the gastrointestinal tract. Once it is ingested, the lead enters the vascu- lar tree and is transported across the placenta to the unborn baby. The baby, especially the baby's central nervous sys- tem, can be severely adversely affected by the lead.

An obese client is being seen by the nurse during her prenatal visit. Which of the following comments by the nurse is appropriate at this time? 1. "We will want you to gain the same amount of weight we would encourage any pregnant woman to gain." 2. "To have a healthy baby we suggest that you go on a weight reduction diet right away." 3. "To prevent birth defects we suggest that you gain weight during the first trimester and then maintain your weight for the rest of the pregnancy." 4. "We suggest that you gain weight throughout your pregnancy but not quite as much as other women."

1. This statement is not true. Obese clients are encouraged to gain about 15 to 25 lb during their pregnancies. 2. This statement is not true. Although obese clients are encouraged to eat fewer calories than nonobese clients, they are still encouraged to gain weight during their pregnancies. 3. This statement is not true. Obese clients are expected to gain weight - 15 to 25 pounds total - throughout their pregnancies. 4. This statement is true. Normal weight clients are encouraged to gain between 25 and 35 pounds. TEST-TAKING TIP: It is not appropriate for an obese client to lose weight or to refrain from gaining weight during her pregnancy. When clients lose weight, they begin to break down fats and ketones develop. An acidic environment is unsafe for the unborn baby

A type 1 diabetic is being seen for preconception counseling. The nurse should emphasize that during the first trimester the woman may experience which of the following? 1. Need for less insulin than she normally injects. 2. An increased risk for hyperglycemic episodes. 3. Signs and symptoms of hydramnios. 4. A need to be hospitalized for fetal testing.

1. Type 1 diabetics often need less in- sulin during the first trimester than they did preconception. 2. The client will be at high risk for hypo- glycemic episodes. 3. Hydramnios does not develop until the 2nd or 3rd trimester. 4. The client will likely be hospitalized during the 2nd and/or 3rd trimesters for fetal testing. TEST-TAKING TIP: Nausea and vomiting are common complaints of gravid clients dur- ing the first trimester. As a result, women, including diabetic women, consume fewer calories than they did before becoming pregnant. Their need for insulin drops commensurately. Therefore, it is very important that the women monitor their blood glucose regularly upon awakening and throughout the day.

A gravid woman has sickle cell anemia. Which of the following situations could precipitate a vaso-occlusive crisis in this woman? 1. Hypoxia. 2. Alkalosis. 3. Fluid overload. 4. Hyperglycemia.

1. Vaso-occlusive crises are precipitated by hypoxia in pregnant as well as non- pregnant sickle cell clients. 2. Acidosis, not alkalosis, precipitates vaso- occlusive crises. 3. Dehydration, not fluid overload, precipi- tates vaso-occlusive crises. 4. A hyperglycemic state does not precipi- tate vaso-occlusive crises. TEST-TAKING TIP: Sickle cell anemia is an autosomal recessive disease. The hemo- globin in the red blood cells of sickle cell clients becomes misshapen when the clients are hypoxic, acidotic, and/or dehydrated. This is a very serious state for the preg- nant woman and her fetus. These clients must be cared for immediately with intra- venous fluids and methods to reverse the hypoxia and acidosis.

The nurse is evaluating the effectiveness of bed rest for a client with mild preeclampsia. Which of the following signs/symptoms would the nurse determine is a positive finding? 1. Weight loss. 2. 2 proteinuria. 3. Decrease in plasma protein. 4. 3 patellar reflexes.

1. Weight loss is a positive sign. 2. This client is losing protein. The nurse would evaluate a 0-to-trace amount of protein as a positive sign. 3. A decrease in serum protein is a sign of pathology. An increase in serum protein would be a positive sign. 4. 3 reflexes are pathological. Normal reflexes are 2 TEST-TAKING TIP: The key to answering this question is the test taker's ability to inter- pret the meaning of mild preeclampsia and to realize that this is an evaluation question. There are two levels of preeclampsia. Mild preeclampsia is characterized by the follow- ing signs/symptoms: blood pressure 140/90, urine protein +2, patellar reflexes +3, and weight gain. As can be seen, the values included in answers 2 and 4 are the same as those in the diagnosis. They, therefore, are not signs that the preeclampsia is resolving. Similarly, loss of protein is not a sign of resolution of the disease..

A gravid client, G6P5005, 24 weeks' gestation, has been admitted to the hospital for placenta previa. Which of the following is an appropriate long term goal for this client? 1. The client will state an understanding of need for complete bedrest. 2. The client will have a reactive nonstress test on day 2 of hospitalization. 3. The client will be symptom-free until at least 37 weeks' gestation. 4. The client will call her children shortly after admission.

1. Women with placenta previa are often on bed rest. This is, however, a short- term goal. 2. Another short-term goal is that the baby would have a reactive NST on day 2 of hospitalization. 3. That the client be symptom-free until at least 37 weeks' gestation is a long- term goal. At that time, the baby will be full term. 4. Another short-term goal is that the woman would call her children shortly after admission. TEST-TAKING TIP: Each and every one of the goals is appropriate for a client with placenta previa. Only the statement that projects the client's response into the future is, however, a long-term goal.