Maternal-Newborn ch 20 Conditions Occurring During Pregnancy

The nurse is caring for a pregnant woman is determined to be at high risk for gestational diabetes. The nurse prepares to rescreen this client at which time frame? 16 to 20 weeks 20 to 24 weeks 24 to 28 weeks 28 to 32 weeks

24 to 28 weeks

A pregnant woman with type 2 diabetes is scheduled for a laboratory test of glycosylated hemoglobin (HbA1C). What does the nurse tell the client is a normal level for this test? 8% 14% 6% 12%

6%

A nurse in the maternity triage unit is caring for a client with a suspected ectopic pregnancy. Which nursing intervention should the nurse perform first? Assess the client's vital signs. Administer oxygen to the client. Obtain a surgical consent from the client. Provide emotional support to the client and significant other.

Assess the client's vital signs

A woman of 16 weeks' gestation telephones the nurse because she has passed some "berry-like" blood clots and now has continued dark brown vaginal bleeding. Which action would the nurse instruct the woman to do? "Maintain bed rest, and count the number of perineal pads used." "Come to the health care facility if uterine contractions begin." "Continue normal activity, but take the pulse every hour." "Come to the health facility with any vaginal material passed."

"Come to the health facility with any vaginal material passed."

A pregnant women calls the clinic to report a small amount of painless vaginal bleeding. What response by the nurse is best? "Please come in now for an evaluation by your health care provider." "Lie on your left side and drink lots of water and monitor the bleeding." "If the bleeding lasts more than 24 hours, call us for an appointment." "Bleeding during pregnancy happens for many reasons, some serious and some harmless."

"Please come in now for an evaluation by your health care provider."

A woman is to undergo an amnioinfusion. Which statement would be most appropriate to include when teaching the woman about this procedure? "You'll need to stay in bed while you're having this procedure." "We'll give you an analgesic to help reduce the pain." "After the infusion, you'll be scheduled for a cesarean birth." "A suction cup is placed on your baby's head to help bring it out."

"You'll need to stay in bed while you're having this procedure."

A woman is receiving magnesium sulfate as part of her treatment for severe preeclampsia. The nurse is monitoring the woman's serum magnesium levels. Which level would the nurse identify as therapeutic? 3.3 mEq/L 6.1 mEq/L 8.4 mEq/L 10.8 mEq/L

6.1 mEq/L

A primipara at 36 weeks' gestation is being monitored in the prenatal clinic for risk of preeclampsia. Which sign or symptom should the nurse prioritize? A systolic blood pressure increase of 10 mm Hg Weight gain of 1.2 lb (0.54 kg) during the past 1 week A dipstick value of 2+ for protein Pedal edema

A dipstick value of 2+ for protein

A patient in her third trimester comes in for a routine prenatal visit. The nurse places her in a comfortable position and attaches the tocodynamometer and ultrasound monitor to the patient's abdomen. What is the purpose of this test? Assesses readiness for dilation Assesses fetal position Assesses fetal well-being Assesses readiness for delivery

Assesses fetal well-being

A pregnant patient with intermittent preterm contractions at 30 weeks has been on weekly home care assessments for 1 month without health care visits to the doctor or any activities outside the home. The nurse has established adequate fetal growth and is aware that contractions have been occurring roughly two times a day. The patient makes little effort to look at the nurse or discuss her plans for the upcoming delivery. The nurse makes which diagnosis of the current needs of this patient? Threatened preterm delivery related to contractions, as evidenced by reports by the patient of contractions before 38 weeks' gestation Inadequate dietary intake related to activity restriction At risk for venous thromboembolism because of restricted activity At risk for depression because of extended activity restriction, as evidenced by effect

At risk for depression because of extended activity restriction, as evidenced by affect

The nurse is caring for a pregnant client with fallopian tube rupture. Which intervention is the priority for this client? Monitor the client's beta-hCG level. Monitor the mass with transvaginal ultrasound. Monitor the client's vital signs and bleeding. Monitor the fetal heart rate (FHR).

Monitor the client's vital signs and bleeding

A 32-year-old gravida 3 para 2 at 36 weeks' gestation comes to the obstetric department reporting abdominal pain. Her blood pressure is 164/90 mm/Hg, her pulse is 100 beats per minute, and her respirations are 24 per minute. She is restless and slightly diaphoretic with a small amount of dark red vaginal bleeding. What assessment should the nurse make next? Check deep tendon reflexes. Measure fundal height. Palpate the fundus, and check fetal heart rate. Obtain a voided urine specimen, and determine blood type.

Palpate the fundus, and check fetal heart rate.

The nurse is caring for a woman at 32 weeks gestation with severe preeclampsia. Which assessment finding should the nurse prioritize after the administration of hydralazine to this client? Gastrointestinal bleeding Halos around lights Tachycardia Sweating

Tachycardia

A nurse is monitoring a client with spontaneous abortion who has been prescribed misoprostol. Which symptoms are common adverse effects associated with misoprostol? Select all that apply. constipation dyspepsia headache hypotension tachycardia

dyspepsia hypotension tachycardia

A woman with an incomplete abortion is to receive misoprostol. The woman asks the nurse, "Why am I getting this drug?" The nurse responds to the client, integrating understanding that this drug achieves which effect? ensures passage of all the products of conception alleviates strong uterine cramping suppresses the immune response to prevent isoimmunization halts the progression of the abortion

ensures passage of all the products of conception

A nurse is taking a history of a client at 5 weeks' gestation in the prenatal clinic; however, the client is reporting dark brown vaginal discharge, nausea, and vomiting. Which diagnosis should the nurse suspect? placenta previa hyperemesis gravidarum gestational trophoblastic disease pregnancy-induced depression

gestational trophoblastic disease

A pregnant client has been admitted with reports of brownish vaginal bleeding. On examination there is an elevated hCG level, absent fetal heart sounds, and a discrepancy between the uterine size and the gestational age. The nurse interprets these findings to suggest which condition? ectopic pregnancy placenta previa gestational trophoblastic disease abruption of placenta

gestational trophoblastic disease

A pregnant client arrives at the community clinic reporting fever blisters and cold sores on the lips, eyes, and face. The health care provider has diagnosed it as the primary episode of genital herpes simplex virus (HSV), for which antiviral therapy is recommended. Which information should the nurse offer the client when educating her about managing the infection? Antiviral drug therapy cures the infection completely. Kissing during the primary episode does not transmit the virus. Safety of antiviral therapy during pregnancy has not been established. Recurrent HSV infection episodes are longer and more severe.

Safety of antiviral therapy during pregnancy has not been established.

A client has come to the office for a prenatal visit during her 22nd week of gestation. On examination, it is noted that her blood pressure has increased to 138/90 mm Hg. Her urine is negative for proteinuria. The nurse recognizes which factor as the potential cause? gestational hypertension chronic hypertension HELLP preeclampsia

gestational hypertension

A client who is HIV-positive is in her second trimester and remains asymptomatic. She voices concern about her newborn's risk for the infection. Which statement by the nurse would be most appropriate? "You'll probably have a cesarean birth to prevent exposing your newborn." "Antibodies cross the placenta and provide immunity to the newborn." "Wait until after the infant is born, and then something can be done." "Antiretroviral medications are available to help reduce the risk of transmission."

"Antiretroviral medications are available to help reduce the risk of transmission."

A woman with placenta previa is being treated with expectant management. The woman and fetus are stable. The nurse is assessing the woman for possible discharge home. Which statement by the woman would suggest to the nurse that home care might be inappropriate? "My mother lives next door and can drive me here if necessary." "I have a toddler and preschooler at home who need my attention." "I know to call my health care provider right away if I start to bleed again." "I realize the importance of following the instructions for my care."

"I have a toddler and preschooler at home who need my attention."

A nurse is teaching a woman diagnosed with gestational diabetes about meal planning and nutrition. The nurse determines that additional teaching is needed based on which client statement? "I need to avoid any fat with my meals." "I should get most of my calories from good complex carbs." "Having a bedtime snack is good for me." "It's okay to eat small meals or snacks throughout the day."

"I need to avoid any fat with my meals."

The nurse is teaching a client who is diagnosed with preeclampsia how to monitor her condition. The nurse determines the client needs more instruction after making which statement? "If I have changes in my vision, I will lie down and rest." "I will weigh myself every morning after voiding before breakfast." "I will count my baby's movements after each meal." "If I have a severe headache, I'll call the clinic."

"If I have changes in my vision, I will lie down and rest."

A client with a history of cervical insufficiency is seen for reports of pink-tinged discharge and pelvic pressure. The primary care provider decides to perform a cervical cerclage. The nurse teaches the client about the procedure. Which client response indicates that the teaching has been effective? "Staples are put in the cervix to prevent it from dilating." "The cervix is glued shut so no amniotic fluid can escape." "Purse-string sutures are placed in the cervix to prevent it from dilating." "A cervical cap is placed so no amniotic fluid can escape."

"Purse-string sutures are placed in the cervix to prevent it from dilating."

A client in her first trimester arrives at the emergency room with reports of severe cramping and vaginal spotting. On examination, the health care provider informs her that no fetal heart sounds are evident and orders a dilatation and curettage. The client looks frightened and confused and states that she does not believe in abortion. Which statement by the nurse is best? "Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications." "I know that it is sad but the pregnancy must be terminated to save your life." "The choice is up to you but the healthcare provider is recommending an abortion." "You have experienced an incomplete miscarriage and must have the placenta and any other tissues cleaned out."

"Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications."

The nurse is orientating in the Labor and Delivery unit and asks her preceptor how to differentiate a client with preeclampsia from one with eclampsia. Which symptoms would the preceptor describe to the new nurse as indicative of severe preeclampsia? Select all that apply. Blood pressure above 160/110 mm Hg Nondependent edema Glycosuria Seizure Hyperactive deep tendon reflexes

Blood pressure above 160/110 mm Hg Nondependent edema Hyperactive deep tendon reflexes

A woman in her 20s has experienced a miscarriage at 10 weeks' gestation and asks the nurse at the hospital what went wrong. She is concerned that she did something that caused her to lose her baby. The nurse can reassure the woman by explaining that the most common cause of spontaneous miscarriage in the first trimester is related to which factor? Exposure to chemicals or radiation Advanced maternal age Chromosomal defects in the fetus Faulty implantation

Chromosomal defects in the fetus

What special interventions would the nurse implement in a client who is carrying twin fetuses? Schedule non-stress tests (NST) starting at 16 weeks. Demonstrate to the client how to perform fetal movement counts after 32 weeks. Assist the physician on doing uterine ultrasounds every 2 weeks to monitor fetal size and placental information. Remind the client to monitor her intake since she does not need any more food for a multiple pregnancy than she would ingest for a singleton pregnancy.

Demonstrate to the client how to perform fetal movement counts after 32 weeks.

A patient with heart disease who is 28 weeks pregnant asks the nurse why office appointments have been scheduled every week for the next 4 weeks. What should the nurse respond to the patient? This is the routine schedule for all pregnant patients. This is when most patients have a risk of going into early labor. During weeks 28 and 32, blood volume peaks, and heart function can be affected. Extra care is needed to make sure the fetus is developing normally during this time period.

During weeks 28 and 32, blood volume peaks, and heart function can be affected.

A patient in her late twenties visits the clinic to begin the process of in vitro fertilization (IVF). Her husband in his late fifties asks if there are any tests to check for any irregularities. What tests should the nurse discuss with this couple? Examination of egg and sperm amniocentesis CVS PPD

Examination of egg and sperm

The nurse is preparing a postpartum nursing care plan for a single HIV-positive primigravida client. The nurse should prioritize in the plan how to acquire which resource? Breast pump Diapers Car seat Formula

Formula

A 24-year-old woman presents with vague abdominal pains, nausea, and vomiting. A urine hCG is positive after the client mentioned that her last menstrual period was 2 months ago. The nurse should prepare the client for which intervention if the transvaginal ultrasound indicates a gestation sac is found in the right lower quadrant? Bed rest for the next 4 weeks Intravenous administration of a tocolytic Immediate surgery Internal uterine monitoring

Immediate surgery

The nurse is identifying nursing diagnoses for a client with gestational hypertension. Which diagnosis would be the most appropriate for this client? Risk for injury related to fetal distress Imbalanced nutrition related to decreased sodium levels Ineffective tissue perfusion related to poor heart contraction Ineffective tissue perfusion related to vasoconstriction of blood vessels

Ineffective tissue perfusion related to vasoconstriction of blood vessels

The nurse is caring for a pregnant client with severe preeclampsia. Which nursing intervention should a nurse perform to institute and maintain seizure precautions in this client? Provide a well-lit room. Keep head of bed slightly elevated. Place the client in a supine position. Keep the suction equipment readily available.

Keep the suction equipment readily available.

A 25-week-gestation client presents with a blood pressure of 152/99, pulse 78, no edema, and urine negative for protein. What would the nurse do next? Notify the health care provider Provide health education Assess the client for ketonuria Document the client's blood pressure

Notify the health care provider

Which symptom may indicate a complication (not a common discomfort) in the second or third trimester of pregnancy? Dyspnea on exertion or while lying supine Backache after long periods of standing Lower extremity edema in the evening in the absence of proteinuria Braxton Hicks contractions at 38 weeks Pain underneath the ribs on the right side

Pain underneath the ribs on the right side

A client at 37 weeks' gestation presents to the emergency department with a BP 150/108 mm Hg, 1+ pedal edema, 1+ proteinuria, and normal deep tendon reflexes. Which assessment should the nurse prioritize as the client is administered magnesium sulfate IV? Urine protein Ability to sleep Hemoglobin Respiratory rate

Respiratory rate

A 25-year-old pregnant client has just been diagnosed with hyperemesis gravidarum. Which instruction should the nurse prioritize during a teaching session? Eat mainly high-fat foods to supply sufficient calories. Increase fluid intake with meals to increase retention of food. Do all your own cooking so you will build up a tolerance for food odors. Take your anti-nausea medicine around the clock.

Take your anti-nausea medicine around the clock.

A woman who is 8 months' pregnant comes to the clinic with urinary frequency and pain on urination. The client is diagnosed with a urinary tract infection (UTI). Which medication would the nurse anticipate the physician will prescribe? tetracycline amoxicillin bactrim septra

amoxicillin

A client who is 30 weeks' gestation has recently been diagnosed with polihydramnios. What would be a priority nursing action? blood sugar monitoring blood pressures Q1H assessment for vaginal bleeding weight assessment

blood sugar monitoring

A pregnant woman with diabetes at 10 weeks' gestation has a glycosylated hemoglobin (HbA1c) level of 13%. At this time the nurse should be most concerned about which possible fetal outcome? congenital anomalies incompetent cervix placenta previa abruptio placentae

congenital anomalies

A 40-year-old female client with a chronic pelvic infection expresses her desire to conceive post-treatment. When discussing this with the client the nurse keeps in mind that the client is at increased risk for which of the following? Ectopic pregnancy Symptoms of menopause Decreased menses Gestational diabetes

ectopic pregnancy

A nurse is conducting a refresher program for a group of perinatal nurses. Part of the program involves a discussion of HELLP. The nurse determines that the group needs additional teaching when they identify which aspect as a part of HELLP? elevated lipoproteins hemolysis liver enzyme elevation low platelet count

elevated lipoproteins

A nurse suspects that a client is developing HELLP syndrome. The nurse notifies the health care provider based on which finding? hyperglycemia elevated platelet count disseminated intravascular coagulopathy (DIC) elevated liver enzymes

elevated liver enzymes

Which STI could be transmitted perinatally? herpes simplex chlamydia gonorrhea trichomoniasis

herpes simplex

While assessing a pregnant woman, the nurse suspects that the client may be at risk for hydramnios based on which factor? Select all that apply. history of diabetes reports shortness of breath identifiable fetal parts on abdominal palpation difficulty obtaining fetal heart rate fundal height below that for expected gestational age

history of diabetes reports shortness of breath difficulty obtaining fetal heart rate

A nurse is providing care to a client who has been diagnosed with a common benign form of gestational trophoblastic disease. The nurse identifies this as: hydatidiform mole. ectopic pregnancy. placenta accrete. hydramnios.

hydatidiform mole

A pregnant patient is being admitted for severe preeclampsia. In which room location should the nurse place this patient? Near the nursery Next to the elevator In the back private room Across from the nurse's station

in the back private room

A pregnant client has tested positive for cytomegalovirus. What can this cause in the newborn? microcephaly bicuspid valve stenosis hypertension clubbed fingers and toes

microcephaly

A woman with gestational hypertension experiences a seizure. Which intervention would the nurse identify as the priority? fluid replacement oxygenation control of hypertension birth of the fetus

oxygenation

Assessment of a pregnant woman reveals oligohydramnios. The nurse would be alert for the development of which condition? maternal diabetes placental insufficiency neural tube defects fetal gastrointestinal malformations

placental insufficiency

Which information on a client's health history would the nurse identify as contributing to the client's risk for an ectopic pregnancy? use of oral contraceptives for 5 years ovarian cyst 2 years ago recurrent pelvic infections heavy, irregular menses

recurrent pelvic infections

The nurse is caring for a client who has a multifetal pregnancy. What topic should the nurse prioritize during health education? Signs of preterm labor Risk for blood incompatibilities Risk for hypertension Parenting skills

signs of preterm labor

When assessing a pregnant woman with vaginal bleeding, the nurse would suspect a threatened abortion based on which finding? slight vaginal bleeding cervical dilation strong abdominal cramping passage of fetal tissue

slight vaginal bleeding

A pregnant woman has arrived to the office reporting vaginal bleeding. Which finding during the assessment would lead the nurse to suspect an inevitable abortion? strong abdominal cramping slight vaginal bleeding closed cervical os no passage of fetal tissue

strong abdominal cramping

A primigravida 21-year-old client at 24 weeks' gestation has a 2-year history of HIV. As the nurse explains the various options for delivery, which factor should the nurse point out will influence the decision for a vaginal birth? The viral load Amniocentesis results at 34 weeks The mother's age Prophylactic ART to infant at birth

the viral load

A woman at 8 weeks' gestation is admitted for ectopic pregnancy. She is asking why this has occurred. The nurse knows that which factor is a known risk factor for ectopic pregnancy? high number of pregnancies multiple gestation pregnancy use of oral contraceptives use of IUD for contraception

use of IUD for contraception