LVN LEVEL III OB EXAM 3 ANTEPARTUM
Proteinuria, headaches, and double vision
A client with PIH complains of headache, double vision, and sudden weight gain. A urine specimen reveals proteinuria. Vaginal bleeding and uterine contractions aren't associated with PIH.
presumptive signs of pregnancy
Amenorrhea and quickening
Insulin is a required hormone for any client with diabetes mellitus, including the pregnant client.
Aspirin, magnesium hydroxide, and oral antidiabetic agents aren't recommended for use during pregnancy because these agents may cause fetal harm.
Chadwick's sign
Bluish discoloration of the cervix, vagina and labia during pregnancy as a result of increased vascular congestion.
Positive signs of pregnancy
Fetal heartbeat and fetal movement on palpation
dizygotic
Fraternal twins
When collecting data on a pregnant client with diabetes mellitus, the nurse stays alert for signs and symptoms of a vaginal or urinary tract infection (UTI). Which condition makes this client more susceptible to such infections?
Glycosuria
positive signs of pregnancy.
Hegar's, quickening, ballottement, positive pregnancy test, Chadwick's sign, uterine soufflé
During the first 3 months, which hormone is responsible for maintaining pregnancy?
Human chorionic gonadotropin (hCG) Explanation: The hormone hCG is responsible for maintaining pregnancy until the placenta is in place and functioning. Serial hCG levels are used to determine the status of the pregnancy in clients with complications. Progesterone and estrogen are important hormones responsible for many of the body's changes during pregnancy. Relaxin is an ovarian hormone that causes the mother to feel tired, thus promoting her to seek rest.
Multiply the number of milliliters to be infused (125) by the drop factor (10)
Multiply the number of milliliters to be infused (125) by the drop factor (10); 125 ? 10 = 1,250. Then divide the answer by the number of minutes to run the infusion (60). Use the following equation: 1,250 ¸ 60 = 20.83 (or 20 to 21 gtt/minute).
Potter's syndrome
Primary problem is kidney failure Characterized by a group of findings associated with oligohydramnios and renal failure or bilateral renal agenesis, pulmonary hypoplasia; findings include abnormally positioned extremities, wide-set eyes, and broad nasal bridge
As a client progresses through pregnancy, she develops constipation. What is the primary cause of this problem during pregnancy?
Reduced intestinal motility
Hegar's sign
Softening of the lower uterine segment, present by the 8th week of pregnancy
telangiectasis
Spider-like or linear, bluish or red in color, does not blanch, associated with increased venous pressure states.
positive signs/symptoms are
The changes in the cervix and the sounds of blood flowing at the placenta
uterine souffle'
The rushing or blowing sound in the abdomen that occurs at the same rate as the maternal pulse.
Both estrogen and progesterone levels are rising
Until the seventh month of pregnancy, both estrogen and progesterone are secreted in progressively greater amounts. Between the seventh and ninth months, estrogen secretion continues to increase while progesterone secretion drops slightly. This increasing estrogen-progesterone ratio promotes the onset of uterine contractions.
pulmonary edema
When administered concomitantly with prednisone or another corticosteroid, terbutaline may cause pulmonary edema. Concomitant administration of a corticosteroid and terbutaline doesn't cause increased uterine contractions, asthma exacerbation, or hypertensive crisis.
colostrum
an antibody-rich yellow secretion triggered by onset of labor
Braxton Hicks contractions
are irregular, generally painless contractions of the uterus, that can occur during pregnancy usually beginning around the 23rd week or fourth month p. 184
pregnant women
are susceptible to yeast infections
Placental transport of substances to and from the fetus
begins in the fifth week.
After receiving large doses of an ovulatory stimulant such as menotropins (Pergonal), a client comes in for her office visit. Data collection reveals the following findings: Weight gain of 6 lb (3 kg), ascites, and pedal edema. These findings indicate that the client is
demonstrating signs of hyperstimulation syndrome Characterized by abdominal swelling from ascites, weight gain, and peripheral edema, hyperstimulation syndrome from ovulatory stimulants is an unusual occurrence. This client must be admitted to the hospital for management of the disorder. Nursing care includes emotional support to reduce anxiety and management of symptoms. These signs aren't indicative of pregnancy and aren't normal reactions to ovulatory stimulants.
The nurse is providing instruction to a woman who is 18 weeks pregnant. Which findings are expected at this time?
fundal ht of 18" and quickening Between 18 and 30 weeks' gestation, fundal height in centimeters is approximately the same as the number of weeks' gestation. In this case, the client is 18 weeks pregnant, so fundal height should measure approximately 18 cm. Quickening, which is typically described as light fluttering and is usually felt between 16 and 22 weeks' gestation, is caused by fetal movement. Insomnia, Braxton Hicks contractions, and leg cramps are common during the third trimester.
respiratory
increased requirements of oxygen leads to increased volume of air of 30- 40%; nasal stuffiness and epistaxis (nosebleeds) may occur due to estrogen-induced edema and hyper-secretion of mucus
cardiovascular
increases to 40-50% above non-pregnant levels enlarging uterus puts pressure on pelvic and femoral vessels- this condition leads to dependent edema, varicosity of the veins in the legs, vulva, and rectum (hemorrhoids) in late pregnancy and prone to postural hypotension
A marginal placenta previa
is characterized by implantation of the placenta in the margin of the cervical os, not covering it
effleurage
is the light stroking of the abdomen with the fingertips
When the largest diameter of the presenting part (typically the biparietal diameter of the fetal head) is
level with the ischial spines, the fetus is at station 0. A station of -1 indicates that the fetal head is 1 cm above the ischial spines. At +1, it's 1 cm below the ischial spines. At +2, it's 2 cm below the ischial spines.
A client who is 14 weeks pregnant mentions that she has been having difficulty moving her bowels since she became pregnant. Which hormones are responsible for this common discomfort during pregnancy?
progesterone
Which of the following nutritional instructions should the nurse provide to a 32-year-old primigravida?
A pregnant woman should increase her caloric intake by 300 cal/day. The protein requirements (76 g/day) of a pregnant woman exceed those of a nonpregnant woman by 30 g/day. All mineral requirements, especially iron, are increased in a pregnant woman. The woman should increase her intake of all vitamins and a prenatal vitamin is usually recommended. Folic acid intake is particularly important to help prevent fetal anomalies such as neural tube defects. Intake should be increased to 800 mg/day.
Ballottement
A technique of palpation to detect or examine a floating object in the body. In obstetrics, the fetus, when pushed, floats away and then returns to touch the examiner's fingers.
A pregnant client concerned about gaining weight during pregnancy questions the nurse about dietary intake. Which response by the nurse is best?
"I'll ask the dietitian to speak with you about normal weight gain during pregnancy." The nurse should respond by telling the client that she'll ask a dietitian to speak to her about normal weight gain during pregnancy. Option 1 is inappropriate and encourages excessive weight gain. Option 2 is confrontational. Asking the client to choose a diet is inappropriate; the client may choose a diet that isn't nutritionally sound during pregnancy.
Evaluating the client for edema at each prenatal visit
During each prenatal checkup, the nurse should evaluate the client for edema, a possible sign of pregnancy-induced hypertension (PIH). The client's Hb is measured during the first prenatal visit, at 24 to 28 weeks' gestation, and at 36 weeks' gestation. The pelvis is measured and the Rh factor determined during the first prenatal visit.
At 15 weeks' gestation, a client is scheduled for a serum alpha-fetoprotein (AFP) test. Which maternal history finding would indicate a need for this test?
Family history of spina bifida in a sister
Quickening
Maternal perception of fetal movement (feeling of life) usually occurs between weeks 16 and 20 of gestation, but may be felt earlier by multiparous woman.
A partial placenta previa
is the partial occlusion of the cervical os by the placenta
Amniotomy increases
the risk of umbilical cord prolapse, which would impair the fetal blood supply and tissue perfusion. Because the fetus's life depends on the oxygen carried by that blood, maintaining fetal tissue perfusion takes priority over goals related to increased knowledge, infection prevention, and pain relief.
oligohydramnios
< 0.5 L of amniotic fluid; associated with placental insufficency, bilateral renal agenesis, or posterior urethral valves (in males) and resultant inability to excrete urine. Can give rise to Potter's syndrome Abnormally small amount of amniotic fluid, less than about 500 mL at term.
"Assess the insertion site for signs of infection."
A client is receiving terbutaline (Brethine) to stop preterm labor. The physician plans to discharge the client in the morning with a terbutaline infusion pump. Which instruction should the nurse include when teaching the client about the drug?
Add lactase replacement drops to milk at least 24 hours before drinking it.
A client with lactose intolerance must take lactase replacement drops or tablets whenever milk or a milk product is consumed. The drops must be added to a carton of milk at least 24 hours before the milk is consumed to ensure proper action. Lactase replacement drops and tablets are available without a prescription. Milk need not be warmed to room temperature before adding lactase replacement products.
Amniotomy
ARTIFICIAL RUPTURE OF MEMBRANES (AROM). Indicated to induce labor or augment labor if the progress begins to slow. incision into the amnion *every two hours to check TEMP*, incision into the amnion (rupture of the fetal membrane to induce labor Artificial rupture of membranes. Cervix needs to be dilated at least 2cm. PRIORITY IS TO ASSESS FOR UMBILICAL CORD PROLAPSE
A client is admitted for an amniocentesis. Initial data collection findings include the following: 16 weeks pregnant, vital signs within normal limits, hemoglobin 12.2 gm, hematocrit 35%, and type O-negative blood. Which action would be most important to include in the client's plan of care after the amniocentesis has been completed?
Administer RhoGAM. To prevent maternal sensitization, RhoGAM must be given after any invasive procedure on an Rh-negative client. All the other aspects are important but the administration of RhoGAM is the priority.
Pyelonephritis
An infection of the renal pelvis & interstitium that will cause the kidney to shrink, scar, and become irregular shape. Common causes are kidney stones, vesicoureteral reflux (chronic reflux of urine up ureter), pregnancy, neurogenic bladder, instrumentation (organisms brought in by catheters, scopes, etc) and female sexual trauma. (pg 794,795 or 214 n)
What key psychosocial tasks must a woman accomplish during the third trimester?
During the third trimester, a key psychosocial task is to overcome fears the woman may have about the unknown, labor pain, loss of self-esteem, loss of control, and death. During the first trimester, the mother copes with the common discomforts and changes. During the second trimester, psychosocial tasks include mother-image development, coping with body image and sexuality changes, and prenatal bonding.
The nurse is providing care for a pregnant client with gestational diabetes. The client asks the nurse if her gestational diabetes will affect her delivery. The nurse should know that:
Early induction or early cesarean are possibilities if the mother has diabetes and euglycemia that hasn't been maintained during pregnancy. Cesarean delivery isn't always necessary.
During the sixth month of pregnancy, a client reports intermittent earaches and a constant feeling of fullness in the ears. What is the likely cause of these symptoms?
Eustachian tube vascularization During pregnancy, increasing levels of estrogen — not progesterone — cause vascularization of the eustachian tubes, leading to such problems as earaches, impaired hearing, and a constant feeling of fullness in the ears. Nothing in the question implies that the client has a serious neurologic disorder or an ear infection.
A client, now 37 weeks pregnant, calls the clinic because she's concerned about being short of breath and is unable to sleep unless she places three pillows under her head. After listening to her concerns, the nurse should take which action?
Explain that these are expected problems for the latter stages of pregnancy. Explanation: The nurse must distinguish between normal physiologic complaints of the latter stages of pregnancy and those that need referral to the health care provider. In this case, the client indicates normal physiologic changes related to the growing uterus and pressure on the diaphragm. These signs aren't indicative of heart failure. The client doesn't need to be seen or admitted for delivery at this time
Which findings would be considered positive signs of pregnancy?
Fetal heartbeat and fetal movement on palpation Fetal heartbeat and fetal movement on palpation are considered positive signs of pregnancy because they can't be caused by any other condition. Fatigue can be caused by chronic illness or anemia. Skin changes can result from cardiopulmonary disorders, estrogen-progesterone hormonal contraceptives, obesity, or a pelvic tumor. Excessive flatus or increased peristalsis can cause the perception of quickening. Breast changes can be related to hyperprolactinemia induced by tranquilizers, infection, prolactin-secreting pituitary tumor, pseudocyesis, or premenstrual syndrome. Abdominal enlargement can result from ascites, obesity, or a uterine or pelvic tumor, and the perception of Braxton Hicks contractions can result from hematometra or a uterine tumor.
Because uteroplacental circulation is compromised in clients with preeclampsia, a nonstress test (NST) is performed to detect which condition?
Fetal well-being Explanation: An NST is based on the theory that a healthy fetus has transient fetal heart rate accelerations with fetal movement. A fetus with compromised uteroplacental circulation usually won't have these accelerations, which indicate a nonreactive NST. An NST can't detect anemia in a fetus. Serial ultrasounds will detect IUGR and oligohydramnios in a fetus.
A nurse is obtaining a medication history from a client who suspects she's pregnant. At which week of gestation does placental transport of substances to and from the fetus begin?
Fifth week
A client calls to schedule a pregnancy test. The nurse knows that most pregnancy tests measure which hormone?
Human chorionic gonadotropin (hCG) Widely used pregnancy tests detect hCG in the blood and urine through immunologic tests specifically designed to detect the beta subunit of hCG. Human placental lactogen, human chorionic thyrotropin, and estradiol are hormones produced by the placenta; however, they aren't used to detect pregnancy.
A client who's 30 weeks pregnant has a corrected atrial septal defect and minor functional limitations. Which pregnancy-related physiologic change places her at greatest risk for more severe cardiac problems?
Pregnancy increases plasma volume and expands the uterine vascular bed, possibly increasing the heart rate and boosting cardiac output. These changes may cause cardiac stress, especially during the second trimester. Blood pressure during early pregnancy may decrease 5 to 10 mm Hg, reaching its lowest point during the second half of the second trimester. During the third trimester, it gradually returns to first-trimester levels.
Which of the following functions would the nurse expect to be unrelated to the placenta?
Production of maternal antibodies Fetal immunities are transferred through the placenta, but the maternal immune system is actually suppressed during pregnancy to prevent maternal rejection of the fetus, which the mother's body considers a foreign protein. Thus, the placenta isn't responsible for the production of maternal antibodies. The placenta produces estrogen and progesterone, detoxifies some drugs and chemicals, and exchanges nutrients and electrolytes.
A client with diabetes who is in the late third trimester has a nonstress test twice weekly. The 20-minute test showed three fetal heart rate accelerations that exceeded the baseline by 15 beats/minute and lasted longer than 15 seconds. The nurse knows these results are consistent with which interpretation of a nonstress test?
Reactive test Explanation: The nonstress test is the preferred antepartum heart rate screening test for pregnant clients with diabetes. A reactive nonstress test is two or more fetal heart rate accelerations that exceed baseline by at least 15 beats/minute and last longer than 15 seconds within a 20-minute period. A nonreactive nonstress test lacks accelerations in the fetal heart rate with fetal movement. The terms positive and negative aren't used to describe the interpretation of nonstress tests.
A client admitted with preterm labor is prescribed magnesium sulfate to halt contractions. The nurse should monitor the client for which adverse reactions to the drug?
Respiratory rate less than 12 breaths/minute Extreme muscle weakness Palpitations Hot flashes The nurse should monitor the client receiving magnesium sulfate for severe hypotension (not hypertension), absent (not hyperactive) deep tendon reflexes, respiratory rate less than 12 breaths/minute, extreme muscle weakness, palpitations, hot flashes, nausea, vomiting, dizziness, and blurred vision.
A client who's 7 months pregnant reports severe leg cramps at night. Which nursing action would be most effective in helping her cope with these cramps?
Teaching her to dorsiflex her foot during the cramp Explanation: Common during late pregnancy, leg cramps cause shortening of the gastrocnemius muscle in the calf. Dorsiflexing or standing on the affected leg extends that muscle and relieves the cramp. Although moderate exercise promotes circulation, walking 2 hours daily during the third trimester is excessive. Excessive calcium intake may cause hypercalcemia, promoting leg cramps; the physician must evaluate the client's need for calcium supplements. If the client eats a well-balanced diet, calcium supplements and additional servings of high-calcium foods may be unnecessary.
A client, 11 weeks pregnant, is admitted to the facility with hyperemesis gravidarum. She tells the nurse she has never known anyone who had such severe morning sickness. The nurse understands that hyperemesis gravidarum results from:
The cause of hyperemesis gravidarum isn't known. However, etiologic theories implicate hormonal alterations and allergic or psychosomatic conditions. No evidence suggests that hyperemesis gravidarum results from a neurologic disorder, inadequate nutrition, or hemolysis of fetal RBCs.
be taught about diet.
The client's blood glucose level should be controlled initially by diet and exercise, rather than insulin. The client will need to watch her overall diet to control her blood glucose level. Oral antidiabetic drugs aren't prescribed for pregnant clients. Urine sugars aren't an accurate indication of blood glucose levels.
A 30-year-old primiparous client at 34 weeks' gestation comes to the prenatal facility concerned about the reddish streaks she has increasingly developed on her breasts and abdomen. She asks what these skin changes are and whether they're permanent. What should the nurse tell her?
The client's weight gain and enlarging uterus, combined with the action of adrenocorticosteroids, lead to stretching of the underlying connective tissue of the skin, creating striae gravidarum in the second and third trimesters. Better known as stretch marks, these streaks commonly develop in skin covering the breasts, abdomen, buttocks, and thighs. After delivery, they typically grow lighter. Linea nigra is a dark line that extends from the umbilicus or above to the mons pubis. In the primigravid client, this line develops at approximately the third month of pregnancy. In the multigravid client, linea nigra typically appears before the third month. Tiny bright hemangiomas may occur during pregnancy as a result of estrogen release. They're called vascular spiders because of the branching pattern that extends from each spot. They typically appear on the neck, thorax, face, and arms. Nevi are circumscribed, benign proliferations of pigment-producing cells in the skin.
The nurse is teaching a pregnant client about exercises that may be helpful during pregnancy. Which points should the nurse include in her instruction?
The nurse should explain that pelvic rocking exercises may help relieve lower back pain. Abdominal breathing exercises help relaxation and lift the abdominal wall off of the uterus. Kegel exercises help improve vaginal contractility and bladder control. The client may exercise regularly at least three times per week, but the duration of exercise should be limited to 35 minutes, especially in hot, humid, weather. The client should perform non-weight-bearing exercises such as swimming.
A client admitted with preterm labor is prescribed magnesium sulfate to halt contractions. The nurse should monitor the client for which adverse reactions to the drug?
The nurse should monitor the client receiving magnesium sulfate for severe hypotension (not hypertension), absent (not hyperactive) deep tendon reflexes, respiratory rate less than 12 breaths/minute, extreme muscle weakness, palpitations, hot flashes, nausea, vomiting, dizziness, and blurred vision.
Amniotomy nursing management
There is risk of infection, umbilical cord prolapse and fetal injury. Once MEMBRANE is ruptured, monitor temp every 1-2 hours. When this is done, immediately monitor FHR. note the time of rupture, amount, color and odor of amniotic fluid. Infection of the amniotic fluid is chorioamnioitis.
The nurse is caring for a client after evacuation of a hydatidiform mole. The nurse should tell the client to:
USE BIRTH CONTROL FOR AT LEAST 1 YEAR Explanation: After experiencing a hydatidiform molar pregnancy, the client should be counseled to use a reliable method of birth control for at least 1 year. Because of the risk of choriocarcinoma, her hCG levels need to be monitored monthly for 1 to 2 years. Sterilization isn't necessary after developing a hydatidiform mole. If hCG levels remain low, a woman may try to become pregnant after 1 year. The risk of recurrence of a hydatidiform mole is low.
A client, 7 months pregnant, is receiving the tocolytic agent terbutaline (Bricanyl), 17.5 mcg/minute I.V., to halt uterine contractions. She also takes prednisone (Orasone), 5 mg by mouth twice per day, to control asthma. To detect an adverse interaction between these drugs, the nurse should monitor the client for:
When administered concomitantly with prednisone or another corticosteroid, terbutaline may cause pulmonary edema. Concomitant administration of a corticosteroid and terbutaline doesn't cause increased uterine contractions, asthma exacerbation, or hypertensive crisis.
A low-lying placenta previa
is implanted in the lower uterine segment but does not reach the cervical os
The client will maintain adequate fetal tissue perfusion.
is the highest priority goal for after an amniotomy,
A reactive non-stress test
is two or more fetal heart rate accelerations that exceed baseline by at least 15 beats/minute and last longer than 15 seconds within a 20-minute period.
A nonreactive nonstress test
lacks accelerations in the fetal heart rate with fetal movement.
The nurse is caring for a client whose membranes ruptured prematurely 12 hours ago. When collecting data on this client, the nurse's highest priority is to evaluate:
maternal vital signs and fetal heart rate (FHR). After premature rupture of the membranes (PROM), monitoring maternal vital signs and FHR takes priority. Maternal vital signs, especially temperature and pulse, may suggest maternal infection caused by PROM. FHR is the most accurate indicator of fetal status after PROM and may suggest sepsis caused by ascending pathogens. Assessing cervical effacement and dilation should be avoided in this client because it requires a pelvic examination, which may introduce pathogens into the birth canal. Evaluating the frequency and duration of contractions doesn't provide insight into fetal status. The WBC count may suggest maternal infection; however, it can't be measured as often as maternal vital signs and FHR can and therefore provides less current information.
pregnancy tests- urine
needs to be the first urine in the morning 10-14 days after the first missed period
Nausea, vomiting, urinary frequency, and urinary urgency
normally subside between 9 and 12 weeks' gestation.
The nurse is caring for a 16-year-old pregnant client who is taking an iron supplement. Which instruction should the nurse include when teaching the adolescent about ferrous sulfate?
not with food, or milk with OJ do take with antacids Because food delays absorption, the nurse should instruct the client to take the supplement between meals to increase absorption. The client should take the supplement with juice (preferably orange juice) or water, but not with milk or antacids. The nurse should also tell the client not to crush or chew extended-release forms of the drug.
cervix
softening - Goodell's sign bluish discoloration - Chadwick's sign
Doula
someone who assists an expectant mother through the birthing process
