High-Risk Antepartum Nursing Care
The nurse is grading a woman's reflexes. Which of the following grades would indicate reflexes that are slightly brisker than normal?
+3 Rationale: Normal is 2+
Which findings should the nurse expect when assessing a client with placenta previa?
Painless vaginal bleeding Rationale: PAINLESS vaginal bleeding is usually the ONLY sign of placenta previa
The nurse is evaluation the effectiveness of bed rest for a client with mild Pre E. What signs and symptoms would the nurse determine as a positive finding?
Weight loss is a positive sign Rationale: There is no rationale, just choose weight loss.
A nurse is about to inject RhoGAM into an Rh-negative mother. Which if the following is the preferred site for injection? 1. deltoid 2. dorsogluteal 3. vastus lateralis 4. ventrogluteal
1. deltoid
The laboratory reported the lecithin/sphingomyelin ratio results from an amniocentesis as 1:1. How should the nurse interpret the result? 1. the baby is premature 2. the mother is at high risk for hemorrhage 3. the infant has kernicterus 4. the mother is at high risk for eclampsia
1. the baby is premature
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.
2. Cardiomegaly. - condition that occurs as a result of the severe anemia
A 12 week gravid client presents in the ED with abdominal cramps and scant bright red bleeding. Which sign and symptoms should the nurse assess this client for?
Tachycardia Headache Fetal heart disrrhythmia Hypertension
A 29 week gestation woman diagnosed with severe Pre E is noted to have blood pressure of 170/112, 4+ protienuria, and a weight gain of 10lbs over the past 2 days. What sign and symptom would the nurse also expect to see?
Papilledema Rationale: due to increased ICP, and third spacing. (Optic disk swelling)k
An ultrasound has identified that a client's pregnancy is complicated by oligohydramnios. 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. Dysplastic kidneys
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. Fever and muscle aches.
A nurse who is caring for a pregnant type 1 diabetic should carefully monitor the client for which of the following? Select all that apply. 1. Urinary tract infection 2. multiple gestation 3. metabolic acidosis 4. pathological hypotension 5. hypolipidemia
1. urinary tract infection - because they excrete glucose in their urine - bacteria growth 3. metabolic acidosis
A client has just done a fetal kick count assessment. She noted 6 movements during the past hour. If taught correctly, what should her next action be? 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 half hour. 4. Drink a glass of orange juice and redo the test.
1. Nothing, because further action is not warranted.
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. One fetal heart acceleration in 20 minutes. There should be a minimum of 2 fetal heart accelerations in 20 minutes.
The physician has ordered a nonstress test to be done on a 41 week gestation client. During the half-hour test, the nurse observed three periods of fetal heart rate accelerations that were 15 beats per min 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 medical doctor. 2. Perform a nipple stimulation test to assess the fetal heart in response to contractions. 3. Prepare the client for induction with IV oxytocin. 4. Place the client on her side with oxygen via face mask.
1. Send the client home and report positive results to the medical doctor.
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.
2. Dyspnea on exertion. - likely going into left-sided CHF
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? Select all that apply. 1. Placenta previa. 2. Gestational diabetes. 3. Deep vein thrombosis 4. Pre-eclampsia 5. Chromosomal defects.
2. Gestational diabetes. 3. Deep vein thrombosis 4. Pre-eclampsia
A gravid client, 25 years old is diagnosed with gallstones. She asks the 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 at 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 slows emptying of the gallbladder, making gravid women at high risk for the disease. hormone that relaxes smooth muscle. leads to delayed emptying of the gallbladder during pregnancy can also lead to constipation
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 which 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. fever or chills 2. lack of fetal movement 3. abdominal pain - can precipitate preterm labor 5. vaginal bleeding - any vaginal loss should be reported. The placenta could have been injured or the membranes may rupture during the procedure.
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. hypoxia
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 oral penicillin every 6 hours for 10 days 3. observe the child for signs of respiratory distress 4. administer diphenhydramine every 4 hours as needed
1. notify any exposed pregnant friends
A nurse works in a clinic with a high adolescent pregnancy population. The nurse provides teaching to the young women to prevent which of the following high risk complications of pregnancy? 1. preterm birth 2. gestational diabetes 3. macrosomic babies 4. polycythemia
1. preterm birth
A woman, G1 P000, who is 40 5/7 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. sexual intercourse 3. breast stimulation 4. ingestion of castor oil
The fetus of a 38 week gestation client has been diagnosed with IUGR. The nurse would expect that which of the following diagnostic assessments would be appropriate for the primary healthcare practitioner to order at this time? Select all that apply. 1. biophysical profile 2. nonstress test 3. umbilical arterial Doppler assessment 4. chorionic villus sampling 5. human chorionic gonadotropin test
1. biophysical profile 2. nonstress test 3. umbilical arterial Doppler assessment - assesses blood flow
A 32-week gestation client states that she "thinks" she is leaking amniotic fluid. Which of the following tests could be performed to determine whether the membranes have ruptured? 1. fern test 2. biophysical profile 3. amniocentesis 4. Kernig assessment
1. fern test
A biophysical profile has been performed on a full term client with severe pre-eclampsia. Which of the following interpretations should the nurse make regarding the BPP result of 4? 1. fetal well being is compromised 2. clients BP is returning to normal 3. client is at high risk for seizure 4. fetus's amniotic sac is about to rupture
1. fetal well being is compromised
In analyzing the need for health teaching in a client, G5 P4004 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?"
2. "Do you exercise regularly?" exercise reduces the likelihood of developing either gestational or type 2 diabetes
Which of the following would be the best approach to take with an unmarried 14-year-old 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 though 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 out with adoption later."
2. "It is a difficult decision. What have you though about so far."
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 juice then call her back. 3. Instruct the client to inject herself with regular insulin. 4. Tell the client immediately to telephone her regular doctor.
2. Advise the client to drink a glass of juice then call her back. - it will help stabilize the glucose in the woman's body.
The nurse is caring for a 32 week G8 P7007 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. Bedrest with PROM exercises 4. Daily serum electrolyte assessments 5. Weekly biophysical profiles
2. Blood type and cross match - need in blood bank in case the woman begins to bleed 3. Bedrest with PROM exercises - help to prevent muscle atrophy of woman's muscles 5. Weekly biophysical profiles
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. Diet control with exercise. About 95% of gestational diabetic clients are managed with diet and exercise alone.
A client has been diagnosed with pseudocyesis. Which of the following signs and symptoms would the nurse expect to see? 1. 4+ pedal edema 2. No fetal heartbeat 3. Hematocrit above 40% 4. Denial of quickening
2. No fetal heartbeat psuedocyesis - some women develop pregnancy symptoms and believe themselves pregnant but are not actually pregnant. This is a psychiatric illness.
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
2. The mother produces no Rh antibodies
A client 32 weeks gestation is on total bed rest. The physician expects her to be hospitalized until her c-sections which is scheduled for 38 weeks. To prevent complications while in the hospital the nurse should
Perform Passive ROM exercises Decorate the room with pictures of family Encourage a high fiber diet Teach the client deep breathing exercises
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.
2. Tracheoesophageal fistula.
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.
2. Wear gloves when gardening. - cat feces can carry the toxoplasmosis protozoa
A client is seen at 8 weeks' gestation for her first prenatal visit. During her last gynecological visit, the clients BP was 100/60. Her BP is now 150/90. For which of the follwoing pregnancy related illnesses should this client be assessed? 1. hyperemesis gravidarum 2. hydatidiform mole 3. pre-eclampsia 4. gestational diabetes
2. hydatidiform mole
A lecithin/sphinomyelin 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 fetal lungs 3. potential for fetal development of erythroblastosis fetalis 4. potential for maternal development of gestational diabetes
2. maturation of fetal lungs lecithin and sphinomyelin are two components of surfactant, the slippery substance that lines the alveoli
A Latina client, BMI 31.2 is seen for her first prenatal visit at 7 weeks' gestation. The nurse requests an order from the primary healthcare practitioner for which of the following tests? 1. electroencephalogram 2. oral glucose tolerance test 3. biophysical profile 4. lecithin/sphingomelin ratio
2. oral glucose tolerance test ethnic groups such as Hispanics, Native Americans and Asian Americans are at high risk for type 2 diabetes.
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. "On weekends we go out and drink a few beers."
A 14-year old woman is seeking obstetric care. Which of the following vital signs must be monitored carefully during this woman's pregnancy. 1. HR 2. RR 3. BP 4. Temp
3. BP - adolescents are at high risk for hypertensive illnesses of pregnancy
A 14-year-old woman is seeking obstetric care. Which of the following is an appropriate care goal for this young woman? The young woman will: 1. Bring her partner to all prenatal visits 2. Terminate the pregnancy 3. Continue her education 4. Undergo prenatal single gene analysis
3. Continue her education
Which of the following findings would the nurse expect to see when assessing a first trimester gravida suspected of having trophoblastic disease (hydatidiform mole) that the nurse would not expect to see when assessing a first trimester gravida with a normal pregnancy?
Grape like clusters passed from the vagina Remarkably higher blood pressure Rationale: women with this disease have the grape clusters with dark brown vaginal bleeding and pre E
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?
Head ache and decreased output Rationale: signs of pre E
A nurse is caring for a 25 year old client that just had a spontaneous first trimester abortion. What response is BEST from the nurse?
I am here to talk if you would like
A client has severe Pre E. The nurse would expect that the primary health care provider to order test to assess the fetus for what?
IUGR Rationale: hypertension reduces maternal placental blood flow.
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.
3. Verify the identity of the woman.
A woman is recovering at the gynecologist's office follwoing a late first-treimester spontaneous abortion. At this time, it is essential for the nurse to check which of the following? 1. maternal varicella titer 2. past obstetric history 3. maternal blood type 4. cervical patency
3. maternal blood type
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 at 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
3. penicillin therapy will reduce the risk to the fetus
The nurse should be aware that which of the following clients is at highest risk for psuedocyesis? 1. the client with lymphatic cancer 2. the client with celiac disease 3. the client with multiple miscarriages 4. the client with grand multiparity
3. the client with multiple miscarriages
A gravid woman who is 42 weeks gestation has just had a 20 minute nonstress test. 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.
3. two fetal heart accelerations of 15 bpm lasting at least 15 seconds.
A 36 week gestation client is having cultures taken to determine whether she is colonized with group B strep. Which of the following sites is being cultured? Select all that apply. 1. throat 2. nipple 3. vagina 4. rectum 5. nostrils
3. vagina 4. rectum
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. BP 2. appearance 3. weight 4. pulse rate
3. weight
A client has just been diagnosed with gestational 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 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."
4. "If you follow your diet and exercise you will probably need no insulin."
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.
4. High number of late prenatal care registrants.
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. Human placental lactogen - is an insulin antagonist
A client has been admitted with a diagnosis of hyperemesis gravidarum. Which of the following orders written by the primary healthcare provider is highest priority for the nurse to complete? 1. PO2 90, PCO2 35, HCO3 19 mEq/L, pH 7.3 2. PO2 100, POC2 30, HCO3 21 mEq/L, pH 7.5 3. PO2 60, POC2 50, HCO3 28 mEq/L, pH 7.3 4. PO2 90, POC2 45, HCO3 30 mEq/L, pH 7.5
4. PO2 90, POC2 45, HCO3 30 mEq/L, pH 7.5 - client is metabolic alkalosis. This is consistent with a diagnosis of hyperemesis gravidarum
Which of the following statements is appropriate for the nurse to say to the patient with a complete placental previa?
It is important to inform me of constipation. Rationale: The straining of pooping can cause more bleeding than already occurring with placenta previa.
A woman with a diagnosis of ectopic pregnancy is to receive medical intervention rather than a surgical interruption. Which of the following IM medications would the nurse expect to administer.
Methotrexate Rationale: Anti neoplastic agent
The nurse is providing health teaching to a group of women of childbearing age. One woman who states that she is a smoker asked about smoking's 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 CNS damage 3. addiction to the nicotine inhaled from the cigarette 4. fetal IUGR
4. fetal IUGR - vasoconstriction effect on the placental site, baby receives less oxygen and nutrients via the placenta.
A woman is to receive methotrexate IM for an ectopic pregnancy. Which common side effects should the nurse teach the client on
Nausea Vomiting Abdominal Pain Fatigue Light headedness
A nurse remarks to a 30 week gravid client "it looks like your face and hands are swollen." The client responds "yes, you're right. Why do you ask? " The nurses response is based on the fact that the changes may be caused by what?
Altered Glomular Filtration Rationale: Protein loss, fluid retention that can lead to swelling in the hands and face
A client being seen in the ED has a medical diagnosis of third trimester bleeding r/o placental previa. Each time the nurse passes the room the client says "please tell me that the baby is alright?:" Which diagnosis is made by the nurse.
Anxiety related to inconclusive diagnosis Rationale: situational crisis, client is frightened and concerned
The nurse is caring for a client that was just admitted to the hospital to r/o ectopic pregnancy. What order is the MOST important for the nurse to perform
Assess for the complaint of dizziness or weakness Rationale: hypovolemia from internal bleeding
A type I diabetic is being seen for preconception counseling. The nurse should emphasis that during the first trimester the woman may experience which of the following?
Need for less insulin that she normally injects Rationale: nausea and vomiting reduces choleric intake resulting in a reduction of insulin need.
A hospitalized gravidas blood work Hematocrit: 30%, Hemoglobin 10gm/dL. In light of the laboratory data, which of the following meal choices should the nurse recommend to this patient?
Chicken liver, sliced tomatoes and dried apricots Rationale: high in iron and ascorbic acid
A 25 year old client is admitted with the follwoing hx. 12 wks pregnant, vaginal bleeding, no FHR seen on US. The nurse would expect the dr to write an order to prepare the client for which of the following?
D&C (dialition and curettage) Rationale: She is experiencing an incomplete abortion and it must be completed to reduce the risk of infection
Which of the following bindings should the nurse expected when assess a client with gestational trophoblastic disease (hydatidiform mole)?
Dark brown vaginal bleeding Rationale: The most important thing to remember when answering questions about ..... that even though a positive pregnancy test has been reported there is NO pregnancy. This disease produces a trophoblastic layer develops but no fetus develops. Think moles are brown, and the "bleeding" that is reported is also brown
A client is admitted to the hospital with severe Pre E. The nurse is assessing for clonus. What should the nurse perform?
Dorso flex the womans foot (push the foot towards the mothers head and let go) Rationale: observe for signs of involuntary, rhythmic, muscular contractions and relaxations
A nurse is counseling a pre E client about her diet. What should the nurse encouraged the client to do?
Eat a well balanced diet Rationale: The loss of albumin in the urine needs to be replaced.
A 26 week gestation woman is diagnosed with severe pre E with HELLP syndrome. The nurse will assess for what signs and symptoms?
Epigastric pain Rationale: associated with the involvement of the liver.
A patient 32 wks pregnant with severe headache was admitted to the hospital with Pre E. In addition to obtaining VS and placing the patient on bed rest, the physician ordered the following 4 items: Assess DTR, Obtain a CBC, Assess baseline weight, Obtain routine UA. Which should the nurse do first.
First should be DTR Rationale: the nurse can make a preliminary assessment of the severity of the Pre E. +2 is good, however +4 with clonus (involuntary, rhythmic, muscular contractions and relaxations)
A 30 week gestation multigravida G3P1011 is admitted to the L&D suite. She is contracting every 5 mins for 40 seconds. Which statement by the client is most informative of the etiology of the clients current condition.
For the last few days I have felt burning when I urinate Rationale: UTI puts client at risk for PPROM and delivery
A gravid client with 4+ proteinuria and 4+ reflexes is admitted to the hospital. The nurse must closely monitor the woman for what?
Grand Mal Seizure Rationale: This would put the patient into an eeclamptic state.
A 24 week gravid client is being seen in the prenatal clinic. She states " i have had a terrible head ache for the last two days." Which action is most important for the nurse to perform next.
Obtain a BP Rationale: rule out Pre E
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 30 degrees 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. the woman should lie on her side with her head elevated about 30 degrees
A 30-year-old gravida, G3 P1201, who is planning to become pregnant again, 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
2. nutrition counseling - folic acid intake 600 micrograms per day no NTD history - 400 micrograms NTD history - 4 mg per day
An insulin-dependent diabetic, G3P0200, 38 weeks' gestation, is being seen in the labor and delivery suite in metabolic disequilibrium. 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 mmHg. 4. Hemoglobin A, 10%.
2. pH 7.25.
A client is being admitted to the labor suite with a diagnosis of eclampsia. The FHR tracing shows moderate variability with early deceleration's. 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 simulation 4. provide the client with grief counseling
2. pad the side rails and head of the bed
A pregnant woman mentions to the clinic nurse that she and her husband enjoy working together on projects around the house and says, "I always wear protective gloves when I work." The nurse should advise the woman that even when she wears 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
2. sanding the paint from an antique crib - lead based paint
A client has been admitted with a diagnosis of hyperemesis gravidarum. Which of the following orders written by the primary healthcare provider is highest priority for the nurse to complete? 1. obtain CBC 2. start IV with multivitamins 3. check admission weight 4. obtain urine for urinalysis
2. start IV with multivitamins
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."
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."
A client who has been taking Zoloft (sertraline) for depression for 2 years is seen for a prenatal appointment. She states, "I just read that my baby is going to be really sick if I keep taking Zoloft so I stopped taking my medications." The nurse's response is based on which of the following information? 1. There is evidence that other antidepressant medications can cause birth defects but SSRI medications are safe to take during pregnancy. 2. Although some evidence shows that SSRI medications can cause birth defects, the defects are easily repaired immediately following delivery. 3. Although some evidence shows that SSRI medications can cause birth defects, the health and well being of the mother may outweigh the potential injury to the baby. 4. There is no evidence that SSRI medications are injurious prenatlly, but the woman should be advised not to breastfeed her baby while taking the medication.
3. Although some evidence shows that SSRI medications can cause birth defects, the health and well being of the mother may outweigh the potential injury to the baby.
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 vomit 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.
3. Continue the interview of the woman in private.
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 vaginal or clitoral surgery?" 2. "Have you work 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?"
4. "Have you ever been forced to have sex?"
The nurse is educating a client who has been diagnosed with gestational diabetes how to perform home blood glucose testing. Which of the following information should be included in the teaching session? 1. When pricking the fingertip, always prick the center of the fingertip. 2. One-hour postprandial glucose values should be 146 mg/dL or lower. 3. Blood glucose testing should be performed 2 times per day -- before breakfast and before bedtime. 4. All blood glucose results should be kept in a log for evaluation by the nurse and primary healthcare provider.
4. All blood glucose results should be kept in a log for evaluation by the nurse and primary healthcare provider.
A gravid woman has just been admitted to the ED after a head on motor vehicle crash. She appears uninjured the nurse assess the woman for what complication?
Placental abruption and preterm labor Rationale: impact could have dislodged the placenta from the uterine wall, and preterm labor could occur due to stress. Monitor FHR
A client who works as a waitress and is 35 weeks gestation calls the L&D suite and states "I am feeling tightening in my groin every 5-6 mins." What comment by the nurse is appropriate at this time.
Please lay down and drink about 4 full glasses of water or juice Rationale: The first intervention for preterm labor is hydration.
A gravid client is admitted with a diagnosis with third trimester bleeding. It is priority for the nurse to assess for a change in which VS
Pulse Rationale: increased blood volume from pregnancy will allow for compensation in the BP reading for a long period of time. The pulse will rise first.
On US 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?
Rapid fundal growth Rationale: The twin getting all the goods is making a bunch of urine creating polyhydramnios.
A client with mild Pre E who has been advised to be on bed rest at home asked why doing so is necessary. What is the best response the nurse can give the client?
Reclining will increase the amount of oxygen that the baby gets. Rationale: improves perfusion to placenta
A woman 8 weeks pregnant is admitted to the OB unit. With a diagnosis of threatened abortion. Which test helps determine if the woman is carrying a viable pregnancy.
Serum progesterone levels.
A woman has been diagnosed with a ruptured ectopic pregnancy. Which signs and symptoms are characteristic?
Sharp unilateral pain Rationale: Ectopic means not in the right place. The fallopian tubes are not elastic and rupture occurs. The pain is visceral and often reported on ONE side.
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.
The patient with epigastric pain and facial edema Rationale: These are abnormal findings of pregnancy
A gravid woman is carrying monochorionic twins (twins originate from same egg and share placenta). Which complication should this pregnancy be monitored?
Twin to Twin transfusion Rationale: The placenta is shared between the twins. One receives the blood and nutrients first, so the second doesnt get as much.
A type I diabetic gravida has developed polyhydramnios. the client should be taught to report which of the following.
Uterine contractions Rationale: signs of preterm labor
A client's 32-week clinic assessment was: BP 90/60; TPR 98.6°F, 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 99.2°F, 88, 20. 2. Weight 155 lb; urine protein +2. 3. Urine protein trace; BP 88/56. 4. Weight 147 lb; TPR 99.0°F, 76,
Weight 155lb; urine protein +2 Rationale: a 10lb weight gain and increased protein.
A nurse is caring for four prenatal clients in the clinic. Which patient is at high risk for placenta previa?
a primigravida who smokes a pack a day a infertility client who is carrying invitro triplets Rationale: This is a select all that apply. Smoking reduces oxygen perfusion resulting placental implantation near the cervix. Multiples will have multiple placentas and the amount of space may lead to implantation near or over the cervix.
A pregnant diabetic has been diagnosed with hydramnios. Which of the following would explain this finding.
excessive fetal urination Rationale: The majority of amniotic fluid is created as urine from the fetal kidneys. Fetuses of diabetic mothers often experience polyuria as a result of hyperglycemia.
A gravid client G6P5005, 24 weeks gestation, has been admitted to the hospital for placenta previa. What is a long term goal for the client?
symptom free until at least 37 weeks gestation Rationale: knowing the difference between long term and short term goals. Other option 2 day hospital stay.
A woman G5P0311 is in the PACU after a cervical cerclage procedure. During the immediate post procedure procedure, what should the nurse monitor the client for.
uterine contractions A cerclage is used for cervical insufficiency
A diabetic client is to receive 5 units of regular and 15 units of NPH insulin at 0800. 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 insulin 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.
2. Draw 5 units regular first and 15 units NPH second into the same syringe and inject.
A nurse is interviewing a prenatal client. Which of the following factors in the client's history should the nurse highlight for the healthcare practitioner? 1. that she is 18 years old 2. that she owns a cat and a dog 3. that she eats peanut butter daily 4. that she works as a surgeon
2. that she owns a cat and a dog - cat feces are a potential source of toxoplasmosis
Which of the following pregnant clients is most high risk for Preterm, Premature, Rupture of Membranes PPROM
32 weeks gestation with UTI 33 week gestation with twins post invitro Rationale: UTI puts the client at a higher risk for PPTROM
A pregnant Latina is being seen in the prenatal clinic for 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. staph aureus 2. streptococcus albicans 3. pseudomonas aeruginosa 4. listeria monocytogenes
4. listeria monocytogenes - client is likely suffering from listeriosis
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.
Signs and symptoms of labor Rationale: Think of your ballons people
Which of the following long term goals is appropriate for a client that is 10 weeks gestation that is diagnoses with gestational trophoblastic disease (hydatidiform mole)?
That the client is cancer free 1 year from diagnosis Rationale: Choose the answer that has the longest duration, the question may ask about goals that are resolved in 1-2 weeks or even months.
Which of the following clients is highest risk for developing a hypertensive illness of pregnancy: 1. G1P0000 age 41 with hx of Diabetes 2. G2P0101 age 34 with hx of Rheumatic fever 3. G3P1102 age 27 with hx of scoliosis 4. G3P1011 age 20 with hx of ciliac disease
The 41 year old with existing diabetes
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.
The client will deliver after 37 weeks gestation Rationale: Long term A cerclage is used for cervical insufficiency
A nurse is performing an assessment on four 22 week pregnant clients. The nurse reports to the OB Dr that which client is carrying twins?
The client with a fundal height of 26cm Rationale: The fundal height should match gestation week in a single baby pregnancy.
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 Mg 2. Ca and Iron 3. carbohydrates and zinc 4. pyroxidine and thiamine
2. Ca and Iron - adolescents needs higher levels of calcium and iron than adult women who are pregnant.
A pregnant woman, 24 weeks' gestation, who has been diagnosed with severe choledocholithiasis is scheduled for a cholecystectomy under general anesthesia. In addition to routine surgical and postsurgical care, the nurse should pay special attention to which of the following? Select all that apply. 1. The circulating nurse should place the woman supine and slightly tilted to the left during the surgical procedure. 2. The circulating nurse and post-anesthesia care nurses should assess the fetal heart rate regularly following the surgery. 3. The post-anesthesia care nurse should monitor the client's lochia and the firmness of her fundus. 4. The post-anesthesia care nurse should monitor the woman carefully for nausea and vomiting. 5. The post -anesthesia care nurse should place antiembolic stockings on the woman's legs.
1. The circulating nurse should place the woman supine and slightly tilted to the left during the surgical procedure. 2. The circulating nurse and post-anesthesia care nurses should assess the fetal heart rate regularly following the surgery. 4. The post-anesthesia care nurse should monitor the woman carefully for nausea and vomiting. 5. The post -anesthesia care nurse should place antiembolic stockings on the woman's legs.
The nurse is caring for a type 1 diabetic client who wishes to become pregnant notes that the client's glycohemoglobin, or glycosylated hemoglobin (HgbA1c) result was 7% today and the fasting blood glucose result was 100 mg/dL. Which of the following interpretations by the nurse is correct in relation to the data? 1. The client has been hyperglycemic for the past 3 months and is hyperglycemic today. 2. the client has been normoglycemic for the past 3 months and is normoglycemic today. 3. The client has been hyperglycemic for the past 3 months and is normoglycemic today. 4. The client has been normoglycemic for the past 3 months and is hyperglycemic today.
1. The client has been hyperglycemic for the past 3 months and is hyperglycemic today. up to 5% glycohemoglobin is normal cut level of fasting blood glucose is 95 mg/dL
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.
3. Abstain from engaging in vaginal intercourse for the rest of the pregnancy.
A client, 8 weeks pregnant, has been diagnosed with a bicornuate uterus. Which of the following signs should the nurse teach the client to carefully monitor for? 1. Hyperthermia. 2. Palpitations. 3. Cramping. 4. Oliguria.
3. Cramping. - a bicornuate uterus will predispose a client to cramping and preterm labor
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 could 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 can weight throughout your pregnancy but not quite as much as other women."
4. "We suggest that you can weight throughout your pregnancy but not quite as much as other women." normal weight clients encouraged to gain between 25-35 lbs obese clients are encourage to gain only 11-20 lbs
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. ineffective individual coping related to developmental level
A 32 week gestation client was last seen in the prenatal clinic at 28 weeks gestation. Which of the following changes should the nurse bring to the attention to the certified nurse midwife
Report a weight gain of 10lbs in 4 weeks. Rationale: recommended weight gain between 2nd and 3rd trimester is 1 lb per week.
Results of a 25 week gestation client 75 gram oral glucose test are: fasting: 100 mg/dL, 1 hour: 200 mg/dL, 2 hour: 160 mg/dL. Which action is appropriate from the nurse.
Request a consult with a registered dietition Rationale: She is slightly over the expected fasting result of 92, the 1 hr of 180 and the 2 hr of 153. So this can be managed with diet.
During a prenatal interview a client tells a nurse, "my mother told me she had toxemia during her pregnancy and almost died." Which questions should the nurse ask in response to this statement.
She should ask "Did you mother say whether she had a seizure or not?" Rationale: Preeclampsia was referred to as toxemia. A family history is a predisposing factor.
A client G2P1001 telephones the GYN office complaining of left sided pain. Which question should the triage nurse ask to r/o ectopic pregnancy.
When was the first day of your last menstrual period. Rationale: Determining the gestation of the baby will be indicative of the size. They are usually diagnosed in the 8th and 9th week of pregnancy.