High Risk Antepartum Maternity

2. Dyspnea on exertion.

105. 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.

X

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

1. Headache and decreased output. These are signs of preeclampsia.

15. 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.

4. "Did your mother say whether she had a seizure or not?" This is the appropriate question. The nurse is asking whether or not the client's mother developed eclampsia.

1. 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?"

2. Pad the side rails and head of the bed. This is appropriate. The side rails and the head board should be padded.

120. 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.

2. Papilledema.

13. 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.

3. "Reclining will increase the amount of oxygen that your baby gets."

14. 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."

3. Client's weight. Weight is the most important sign for the nurse to assess.

119. 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.

3. Dorsiflex the woman's foot.

10. 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.

3. "On weekends we go out and drink a few beers." The nurse must respond to this com- ment. This young woman is repeat- edly exposing her fetus to alcohol.

100. 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."

3. Continue her education. 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.

101. A 14-year-old woman is seeking obstetric care. Which of the following is an appro- priate 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. Preterm birth. Adolescents are at high risk for preterm labor.

102. 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.

2. "It is a difficult decision. What have you thought about so far?" This is an excellent response. The question opens the door for the teenager to discuss her feelings and thoughts.

103. 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 main- tain 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."

2. Calcium and iron. Pregnant adolescents' diets are often deficient in calcium and iron.

104. 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.

4. "Have you ever been forced to have sex without your permission?" This is an essential question for the nurse to ask.

106. 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?"

4. Epigastric pain. Epigastric pain is associated with the liver involvement of HELLP syndrome.

12. 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.

3. Continue the interview of the woman in private. This is the priority action. The nurse should escort the client to a location where the partner cannot follow.

107. 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 part- ner 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.

4. Fetal intrauterine growth restriction. Smoking in pregnancy does cause fe- tal intrauterine growth restriction.

108. 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.

2. Sanding the paint from an antique crib. Antique cribs are often painted with lead-based paint. This is a dangerous activity.

109. 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. Progesterone slows emptying of the gallbladder making gravid women high risk for the disease. Progesterone is a hormone that re- laxes smooth muscle. This action leads to the delayed emptying of the gallbladder during pregnancy.

110. 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 ad- vised 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.

2. No fetal heart beat. There will be no fetal heart beat when a client has pseudocyesis.

111. 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.

3. The client with multiple miscarriages. Women who have had a number of miscarriages are at high risk for pseudocyesis.

112. 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.

2. Blood type and cross match. 3. Bed rest with passive range of motion exercises. 5. Weekly biophysical profiles. 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. 5. The nurse would expect that weekly biophysical profiles would be done to assess fetal well-being.

113. The nurse is caring for a 32-week G8P7007 with placenta previa. Which of the fol- lowing 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.

4. pO2 90, pCO2 45, HCO3 30 mEq/L, pH 7.50. This client is in metabolic alkalosis. This is consistent with a diagnosis of hyperemesis gravidarum.

114. 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.

2. Start intravenous with multivitamins. Starting an intravenous with multivit- amins takes priority.

115. 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. Dysplastic kidneys. The nurse would expect that the baby has dysplastic kidneys.

116. 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.

2. Tracheoesophageal fistula. The nurse would expect to find that the baby has tracheoesophageal fistula.

117. 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.

3. Cramping. A bicornuate uterus will predispose a client to cramping and preterm labor.

118. 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. G1P0000, age 44 with history of diabetes mellitus.

16. Which of the following clients is at highest risk for developing a hypertensive ill- ness 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.

3. 32 weeks' gestation, complains of epigastric pain and facial edema.

17. 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.

2. Weight 155 lb; urine protein 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.

18. 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.

4. "I'm here to talk if you would like."

19. 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."

2. Gestational diabetes.

74. 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. Fern test. A fern test is performed to assess for the presence of amniotic fluid.

89. 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 mem- branes had ruptured? 1. Fern test. 2. Biophysical profile. 3. Amniocentesis. 4. Kernig sign.

1. Grand mal seizure.

9. 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. Chicken livers, sliced tomatoes, and dried apricots. 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.

20. 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.

2. "When was the first day of your last menstrual period?" Helps the nurse determine how many weeks pregnant the client is.

30. 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?"

4. Serum progesterone level.

32. 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.

2. Amethopterin (methotrexate).

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

2. That she owns a cat and a dog. Cat feces are a potential source of toxoplasmosis.

90. 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.

3. Eat a well-balanced diet.

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

83.5 mg

34. A woman who has been diagnosed with an ectopic pregnancy is to receive methotrexate 50 mg/m2 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

73 mg

35. 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/m2. 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

1. Nausea and vomiting. 2. Abdominal pain. 3. Fatigue. 4. Lightheadedness.

36. 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 tenderness.

4. Report complaints of dizziness or weakness.

37. The nurse is caring for a client who was just admitted to the hospital to rule out ec- topic 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.

2. Pulse.

38. 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.

3. The client will be symptom-free until at least 37 weeks' gestation.

39. 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. Weight loss.

4. 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.

3. Uterine contractions. Preterm labor is a complication in the immediate postprocedure period.

49. A woman, G5P0401, is in the postanesthesia care unit (PACU) after a cervical cer- clage 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.

4. "Please remember to tell me if you become constipated." Straining at stool can result in enough pressure to result in placental bleeding.

40. 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."

4. Listeria monocytogenes. The client is likely suffering from listeriosis, an infection caused by Listeria monocytogenes bacteria.

91. 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. Fever and muscle aches The symptoms of listeriosis are simi- lar to symptoms of the flu and include fever and muscle aches.

92. 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.

3. Penicillin therapy will reduce the risk to the fetus. Usually a single shot of penicillin, ad- ministered to the mother, will cure her and protect the baby.

93. 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.

2. Wear gloves when gardening. The client should be advised to wear gloves when gardening

94. 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.

3. +3. +3 reflexes are defined as slightly brisker than normal or slightly hyper- reflexic.

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

1. Excessive fetal urination.

53. 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. Assess deep tendon reflexes. 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. 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.

3. The woman's uterus contracts 3 times in 10 minutes.

78. 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.

3. Placental abruption.

21. 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 care- fully monitors the woman for which of the following complications of pregnancy? 1. Placenta previa. 2. Transverse fetal lie. 3. Placental abruption. 4. Severe preeclampsia.

4. Dilation and curettage. These will be performed on a client with an incomplete abortion.

22. 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.

2. Anxiety related to unidentified diagnosis.

23. 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 appropri- ate 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. Client will be cancer-free 1 year from diagnosis.

24. Which of the following long-term goals is appropriate for a client, 10 weeks' gesta- tion, 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.

3. Dark brown vaginal bleeding. The condition is usually diagnosed af- ter a client complains of brown vaginal discharge early in the "pregnancy."

25. 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.

2. Grape-like clusters passed from the vagina.

26. 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.

4. Painless vaginal bleeding.

27. 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.

2. Smoker carrying fraternal triplets.

28. 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.

3. Sharp unilateral pain.

29. A woman has been diagnosed with a ruptured ectopic pregnancy. Which of the fol- lowing 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. "Please lie down and drink about four full glasses of water or juice." The first intervention for preterm la- bor is hydration. Clients who are de- hydrated are at high risk for preterm labor.

51. 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. Uterine contractions. Client should be taught to observe for signs of preterm labor.

52. 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

4. Fetal heart dysrhythmias. This client is showing signs of sponta- neous abortion. The nurse should check the fetal heart rate.

41. 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. Perform passive range of motion exercises. 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.

42. A client, 32 weeks' gestation with placenta previa, is on total bed rest. The physi- cian 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.

4. Twin-to-twin transfusion.

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

1. Rapid fundal growth.

44. On ultrasound, it is noted that the pregnancy of a hospitalized woman who is carry- ing 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 failure.

3. The client whose fundal height measurement is 26 cm.

45. 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.

2. 32-week gestation with urinary tract infection (UTI).

46. 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).

2. Signs and symptoms of labor.

47. 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 veins.

2. The client will deliver after 37 weeks' gestation. Client is at high risk for pregnancy loss. This is an appropriate goal.

48. 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. Weight change from 128 pounds to 138 pounds. A weight gain of 10 pounds in a 4-week period is worrisome. The rec- ommended weight gain during the second and third trimesters is approx- imately 1 pound per week.

5. A 32-week-gestation client was last seen in the prenatal client at 28 weeks' gesta- tion. 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. "For the past day I have felt burning when I urinate."

50. 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 11⁄2 miles this morning." 4. "My miscarriage happened a year ago today."

1. Need for less insulin than she normally injects.

54. 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. Send the woman for a glucose tolerance test. The 1-hour GCT results are above normal. She needs a 3-hour glucose tolerance test (GTT).

55. 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.

2. "Because your test results are higher than normal, you will have to have another more specific test."

56. 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 glu- cose. 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."

2. "Do you exercise regularly?" The likelihood of developing either gestational or type 2 diabetes is re- duced when clients exercise regularly.

57. In analyzing the need for health teaching in a client, G5P4004 with gestational dia- betes, 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. One fetal heart acceleration in 20 minutes.

58. 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.

2. Diet control with exercise. About 95% of gestational diabetic clients are managed with diet and ex- ercise alone.

59. 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.

2. Take the woman's blood pressure.

6. 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 appro- priate 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. Nothing because further action is not warranted. She should do nothing because the woman should feel 3 or more counts in 1 hour.

60. 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. Urinary tract infection. Pregnant diabetic clients are particu- larly at high risk for urinary tract in- fections.

61. 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.

2. Advise the client to drink a glass of milk and then call back. The client should drink a full glass of milk.

62. 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.

2. Draw 5 units regular first and 15 units NPH second into the same syringe and inject. This is the appropriate method. The regular insulin should be drawn up first and then the NPH insulin in the same syringe.

63. 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.

3. The client has been hyperglycemic for the last 3 months and normoglycemic today.

64. The nurse caring for a type 1 diabetic client who wishes to become pregnant notes that the client's glycohemoglobin, or glycosylated hemoglobin (HgbA1c), result was 15% today and the fasting blood glucose result was 100 mg/dL. Which of the fol- lowing 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.

4. Human placental lactogen. 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.

65. 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.

4. "If you follow your diet and exercise you will probably need no insulin."

66. 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."

2. pH 7.25. Acidosis is fatal.

67. 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 A1c 10%.

2. Nutrition counseling.

68. 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.

3. Two fetal heart accelerations of 15 bpm lasting at least 15 seconds. 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.

69. 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. Altered glomerular filtration. Altered glomerular filtration leads to protein loss and, subsequently, to fluid retention, which can lead to swelling in the face and hands

7. 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 re- sponse 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. Sexual intercourse. 3. Breast stimulation. 4. Ingestion of castor oil. 1. Sexual intercourse has been recom- mended to women as a means of in- creasing 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.

70. 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

2. That decreased gastric motility of pregnancy increases her risk of postoperative vomiting. This response is correct. Proges- terone slows gastric motility, increas- ing the client's potential for postoper- ative vomiting and for postoperative gas pains.

71. 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. Hypoxia. Vaso-occlusive crises are precipitated by hypoxia in pregnant as well as non- pregnant sickle cell clients.

72. 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.

4. Infuse intravenous solution.

73. 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.

4. "We suggest that you gain weight throughout your pregnancy but not quite as much as other women."

75. 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. Send the client home and report positive results to the MD.

76. 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. Fever or chills. 2. Lack of fetal movement. 3. Abdominal pain. 5. Vaginal bleeding. 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. 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.

77. 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 follow- ing 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.

4. Additional data is needed to make a diagnosis.

79. 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.

4. Intrauterine growth restriction.

8. 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.

2. Maturation of the fetal lungs.

80. A lecithin:sphingomyelin (L/S) ratio has been ordered by a pregnant woman's ob- stetrician. 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 baby is premature.

81. 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.

2. The woman should lie on her side with her head elevated about 30o. This is the best position for perfusing the placenta.

82. A client is being taught fetal kick counting. Which of the following should be in- cluded 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.

2. Cardiomegaly.

83. 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.

3. Verify the identity of the woman.

84. 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. Deltoid. Although the dosage can be adminis- tered in the gluteal muscles, the del- toid is the preferred site of the RhoGAM injection.

85. 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.

3. Maternal blood type.

86. 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.

2. The mother produces no Rh antibodies.

87. 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.

3. Abstain from engaging in vaginal intercourse for the rest of the pregnancy.

88. 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. Notify any exposed pregnant friends. Rubella is a teratogenic disease. The parents should notify any pregnant friends.

95. 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.

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." This answer is correct. Exposure to group B strep is very dangerous for neonates.

96. A client, 37 weeks' gestation, has been advised that she is positive for group B strep- tococci. 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."

4. Ineffective individual coping related to developmental level. The developmental tasks of adoles- cence are often in conflict with the tasks of pregnancy. This nursing diag- nosis is the most appropriate.

97. 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.

4. High number of late prenatal care registrants. Teens are likely to delay entry into the health care system.

98. 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.

3. Blood pressure. The client's blood pressure is the most important vital sign.

99. 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.