OB - Antepartum - AQ

Which is an important nursing intervention for a patient with pregestational diabetes mellitus during the first trimester? 1 Increase the insulin dosage. 2 Encourage oral fluid intake. 3 Assess blood glucose levels. 4 Prevent nausea and vomiting.

Assess blood glucose levels During the first trimester of pregnancy, the maternal glucose levels reduce and the insulin response to glucose is enhanced. The nurse should assess the blood glucose levels in the patient and increase the dose accordingly.

During a physical assessment of an at-risk patient, the nurse notes generalized edema, crackles at the base of the lungs, and some pulse irregularity. These are most likely signs of: 1 euglycemia. 2 rheumatic fever. 3 pneumonia. 4 cardiac decompensation.

Cardiac decompensation Symptoms of cardiac decompensation may appear abruptly or gradually. Euglycemia is a condition of normal glucose levels. These symptoms indicate cardiac decompensation.

A pregnant female has a sudden increase in the blood sugar levels. Which intervention does the nurse perform to help manage the blood sugar levels? The nurse: 1 Administers aldosterone as prescribed. 2 Suggests reduced intake of carbohydrates. 3 Administers cortisol injection as prescribed. 4 Suggests fiber-rich food intake as prescribed

Cortisol injection as prescribed Cortisol hormone stimulates the production of insulin, which regulates the blood glucose levels in the body. Hence, the administration of cortisol injection is the better nursing intervention to treat high glucose levels in the patient.

In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes that the most important factor affecting pregnancy outcome is the: 1 mother's age. 2 number of years since diabetes was diagnosed. 3 amount of insulin required prenatally. 4 degree of glycemic control during pregnancy.

Degree of glycemic control during pregnancy Although advanced maternal age may pose some health risks, for the woman with pregestational diabetes the most important factor remains the degree of glycemic control during pregnancy. The number of years since diagnosis is not as relevant to outcomes as the degree of glycemic control. The key to reducing risk in the pregestational diabetic woman is not the amount of insulin required but rather the level of glycemic control. Women with excellent glucose control and no blood vessel disease should have good pregnancy outcomes.

What does the nurse tell a patient with gestational diabetes about the prescribed nonstress test (NST)? "The test is used to evaluate: 1 The weight of your fetus." 2 The fetus's well-being." 3 Fetal cardiac anomalies." 4 Defects in the neural tube."

The fetus's well-being NST is used after 32 weeks' gestation to evaluate fetal well-being in pregnant patients with diabetes. The test helps detect the effect of insulin and glucose levels on the fetus.

Which nursing interventions are included in the plan of care of a pregnant patient with mitral stenosis? Select all that apply. 1 Restrict dietary sodium. 2 Place the patient on bed rest. 3 Assess the echocardiogram. 4 Teach passive exercises. 5 Assess respiratory status.

Restrict dietary sodium Place patient on bed rest Assess the echocardiogram Assess respiratory status Dietary sodium is restricted in a pregnant patient with mitral stenosis to decrease preload. The patient is placed on bed rest to prevent tachycardia. The nurse evaluates echocardiogram reports to assess the atrial and ventricular size and heart valve function. The nurse should auscultate the patient's lung sounds to assess for fluid overload. The nurse does not teach any physical exercise, because activity needs to be limited to prevent tachycardia.

The nurse is assessing a pregnant woman who has a child and is in week 25 of pregnancy. What term is used to describe the woman? 1 Primipara 2 Multipara 3 Primigravida 4 Multigravida

2 Multipara A woman who has completed two or more pregnancies to 20 weeks' gestation or more is called a multipara. A woman who has completed one pregnancy with a fetus who reached 20 weeks' gestation is a primipara. A woman who is pregnant for the first time is a primigravida. A woman who has completed two or more pregnancies is called a multigravida.

The GTPAL (gravidity, term, preterm, abortions, and living children) of a patient is 3-1-2-1-3. What does the nurse infer from this? The patient has: 1 Three pregnancies with one miscarriage, one preterm birth, and three living children. 2 Three pregnancies with two miscarriages, one preterm birth, and three living children. 3 Three pregnancies with one miscarriage, two preterm births, and three living children. 4 Three pregnancies with no miscarriages, two preterm births, and three living children

3 Three pregnancies with one miscarriage, two preterm births, and three living children. The five-digit system GTPAL provides information on a woman's obstetric history. The GTPAL 3-1-2-1-3 indicates that the patient had three pregnancies, one term birth, two preterm births, one miscarriage, and three living children.

The nurse is reviewing the medical record of a pregnant patient with diabetes mellitus and notices the patient has poor glycemic control throughout the early weeks of pregnancy. What does the nurse infer that the patient may be at risk for? 1 Polyhydramnios 2Fetal macrosomia 3Ketoacidosis 4Miscarriage

4 Miscarriage. Metabolic changes in the early weeks of pregnancy change the insulin and glucose levels in the body. This may result in poor glycemic control and may increase the chance of miscarriage. Polyhydramnios may occur in the third trimester of pregnancy because of hyperglycemia. There is an increased chance of fetal macrosomia if there is poor glycemic control in the later weeks of pregnancy. Ketoacidosis occurs during the second and third trimesters if the maternal metabolism is stressed by illness or infection.

The nurse is teaching a group of nursing students about the changes in shape, size, and position of the uterus during pregnancy. Arrange the shapes and sizes of the uterus during pregnancy in an ascending order. 1. Grapefruit-shaped uterus 2. Orange fruit-shaped uterus 3. Large hen's egg-shaped uterus 4. Upside-down pear-shaped uterus

4, 3, 2, 1 At conception the uterus has a small size and is in the shape of an upside-down pear. At week 7 of gestation the size of the uterus increases and the uterus takes the shape of a large hen's egg. At week 10 of gestation the uterus turns into a size of an orange. The uterus takes the shape of a grapefruit by week 12 of gestation.

Following the complete assessment and review of the medical reports of a pregnant female, the nurse concludes that the female is in week 32 of pregnancy. What findings are consistent with the nurse's conclusion? Select all that apply. 1 Fetal movements are clearly visible. 2 Cardiac output of the patient is increased. 3 Uterus is almost the size of a grapefruit. 4 Braxton Hicks contractions are observed. 5 Fetal heart tone is detected by ultrasound

Fetal movements are clearly visible. Cardiac output of the patient is increased. Braxton Hicks contractions are observed. The fetal movements are clearly visible on ultrasound during week 32 of pregnancy as the fetus is developed and active. An increase in the cardiac output around 30% to 50% is seen in week 32, which later declines by about 20% in week 40. Braxton Hicks contractions are irregular, painless contractions, which become definite after week 28 of pregnancy.

The nurse is caring for a pregnant woman with a vaginal infection. The vaginal smear culture reveals the presence of Candida albicans. Which condition during pregnancy may favor C. albicans growth in the patient? 1. Protein-rich environment of the vagina 2. Glucose-rich environment of the vagina 3. Lactose-rich environment of the vagina 4. Glycogen-rich environment of the vagina

Glycogen-rich environment of the vagina Candida albicans is a common yeast infection seen in pregnant women. Yeast use glycogen as a source of energy. Glycogen levels are high in the vagina during pregnancy, which helps yeast to feed and increases the risk for infection.

The nurse observes that the patient does not have any labor pain at the expected date of delivery. Which intervention would be helpful in inducing labor pain in the patient? Administration of: 1 Intravenous fluids 2 Intravenous insulin 3 Intravenous oxytocin 4 Intravenous diuretics

Intravenous oxytocin Oxytocin hormone stimulates uterine contractions and milk ejection from the breasts. These contractions cause labor pain in the pregnant woman. Therefore the administration of oxytocin would induce labor pain in the patient.

On assessing a pregnant patient, the nurse finds that the patient's fundal height is 27 cm at 28 weeks' gestation. What does the nurse conclude from this finding? This measurement indicates: 1 Polyhydramnios. 2 Multifetal gestation. 3 Ectopic pregnancy. 4 Normal development.

Normal development From the assessment, the nurse concludes that development of the fetus is normal at 28 weeks' gestation. According to the standard measurement, fundal height (in centimeters) is approximately equal to the number of weeks of gestation. The patient's bladder should be empty while the nurse measures the fundal height. An excessive increase in fundal height indicates polyhydramnios or multifetal gestation. Vaginal bleeding and abdominal cramping during the first trimester of pregnancy indicate the possibility of an ectopic pregnancy.

A patient reports to the nurse that she had missed her period this month and suspects that she is a pregnant. What would be the most suitable nursing action for this patient? 1 Assess for Hegar sign. 2 Assess for Chadwick sign. 3 Obtain an order for a urine pregnancy test. 4 Obtain an order for a serum pregnancy test.

Obtain an order for a serum pregnancy test Because the woman has missed her period, it is likely that the woman is 4 to 6 weeks pregnant. A serum pregnancy test helps in the earliest detection of pregnancy. This test can be used to detect pregnancy in women who are 4 weeks pregnant. Therefore the nurse should ask the patient to take the serum pregnancy test. It is performed during weeks 4 to 12 of pregnancy.

A student nurse measures the blood pressure (BP) of a patient and records it as 170/90 mm Hg. On reassessment the charge nurse finds that the BP of the patient is 110/70 mm Hg. What could be the reason for the error made by the student nurse in recording the BP of the patient? 1 Using a very large sized cuff for measuring BP 2 Using a very small sized cuff for measuring BP 3 Measuring the BP with the patient in lying position 4 Measuring the BP 30 minutes after tobacco consumption

Using a very small sized cuff for measuring BP Proper cuff size is essential for obtaining accurate readings of blood pressure. False high readings are obtained by using a very small sized cuff. Because the student nurse used a very small cuff for measuring BP, the BP reading was falsely measured as 170/90 mm Hg. False low readings can be a result of using a very large cuff.

Thalassemia is a relatively common anemia in which: 1 an insufficient amount of hemoglobin is produced to fill the red blood cells (RBCs). 2 RBCs have a normal life span but are sickled in shape. 3 folate deficiency occurs. 4 there are inadequate levels of vitamin B12.

an insufficient amount of hemoglobin is produced to fill the red blood cells (RBCs). Thalassemia is a hereditary disorder that involves the abnormal synthesis of the α or β chains of hemoglobin

The nurse is assessing a pregnant female who has signs of ballottement and increased pulse rate. The nurse is able to visualize the fetus by radiography images, but the laboratory reports show a negative urine pregnancy report. What is the most probable age of the fetus? A. 6 weeks B. 16 weeks C. 26 weeks D, 36 weeks

16 Weeks An increase in the pulse rate is seen in between 14 and 20 weeks of gestation in a pregnant female. Ballottement is a sign of passive movements in the fetus, which is generally observed between weeks 16 and 18 of pregnancy. The fetus can be visualized by radiographic images during week 16 of pregnancy. Human chorionic gonadotropin (hCG) levels in the urine decline after 60 days of pregnancy (week 12), which results in a negative urine pregnancy test. Therefore the probable age of the fetus is 16 weeks.

A patient who is pregnant used a home pregnancy test that showed a negative result. What will the nurse check for in the medication history of the patient? 1 Diuretics 2 Analgesics 3 Tranquilizers 4 Anticonvulsants

Diuretics Diuretics are the medications that are usually prescribed to a patient with hypertension. These drugs may interfere with the levels of human chorionic gonadotropin (hCG) hormone. This may give a false-negative home pregnancy test result. Analgesics are the group of drugs used for pain relief. These drugs do not affect the hCG levels and therefore do not show a false report in the home pregnancy test. Tranquilizers are the drugs used for reducing anxiety, fear, and tension. The use of a tranquilizer results in a false-positive pregnancy test result because it increases hCG levels. Anticonvulsants are a group of drugs used in treating epileptic seizures; they affect the hCG levels and create a false-positive test result.

The nurse is caring for a 3-month pregnant woman who reports, "I always feel very thirsty." What does the nurse infer from the patient's statement? The patient: 1 Consumes less fiber in the diet. 2 Takes high amounts of fat in the diet. 3 Has high sodium content in the blood. 4 Has increased loss of water from the body.

Has increased loss of water from the body In early pregnancy, the kidneys have increased capacity to excrete water. Therefore the patient may feel thirsty because of increased loss of water.

The nurse reviews the laboratory reports of a female patient and infers that the patient has an ectopic pregnancy. What finding would prompt the nurse to consider this clinical diagnosis? Very low levels of: 1 Insulin 2 Anemia 3 Thrombocytopenia 4 Human chorionic gonadotropin (hCG)

Human chorionic gonadotropin (hCG) Human chorionic gonadotropin (hCG) is produced by the fertilized ovum. Abnormally low levels of hCG indicate impending miscarriage or ectopic (tubal) pregnancy.

The biochemical reports of a pregnant woman show a decrease in the metabolism of glucose and increased fatty acid deposition of the body. Which hormone is responsible for these changes in the patient? 1 Insulin 2 Estrogen 3 Parathyroid 4 Human chorionic somatotropin

Human chorionic somatotropin Human chorionic somatotropin decreases the maternal metabolism of glucose and increases the production of fatty acids for metabolic needs. A decrease in the metabolism of glucose and increased fatty acid deposition is caused by the decrease in human chorionic somatotropin.

Which form of heart disease in women of childbearing years usually has a benign effect on pregnancy? 1 Cardiomyopathy 2 Mitral valve prolapse 3 Rheumatic heart disease 4 Congenital heart disease

Mitral valve prolapse Mitral valve prolapse is a benign condition that is usually asymptomatic. Cardiomyopathy produces congestive heart failure during pregnancy. Rheumatic heart disease can lead to heart failure during pregnancy. Some congenital heart diseases will produce pulmonary hypertension or endocarditis during pregnancy.

The nurse is performing a physical assessment of a pregnant patient. What precaution will the nurse take to prevent supine hypotension in the patient? 1 Place a small wedge under the patient's right hip. 2 Give a back massage to the patient before assessment. 3 Instruct the patient to empty her bladder before assessment. 4 Instruct the patient to drink warm milk before assessment.

Place a small wedge under the patient's right hip. An abdominal examination is part of a physical assessment. For abdominal examination, the patient lies on her back, and the weight of her abdominal contents compresses the vena cava and aorta, which results in supine hypotension. Therefore, during a physical assessment the nurse should place a small wedge under the patient's right hip to prevent supine hypotension. A back massage is helpful for promoting sleep, not for preventing supine hypotension. The nurse should instruct the patient to empty her bladder for fundal assessment, but emptying the bladder does not prevent supine hypotension. Intake of warm milk promotes sleep, but it does not prevent supine hypotension during a physical assessment.

Which factor is known to increase the risk of gestational diabetes mellitus? 1 Previous birth of large infant 2 Maternal age younger than 25 3 Underweight before pregnancy 4 Previous diagnosis of type 2 diabetes mellitus

Previous birth of a large infant

Which conditions does the nurse ask the pregnant patient with a cardiac disorder to report immediately? Select all that apply. 1 Urinary tract infection 2 Palpitations and pain 3 Shortness of breath 4 Onset of constipation 5 Orthostatic hypotension

Urinary tract infection Palpitations and pain Shortness of breath If a patient with a cardiac disorder acquires infection, the patient's condition worsens because infection can increase the heart rate, and organisms can spread to the heart structure. Therefore the nurse instructs the patient to report signs of a urinary tract infection immediately. The patient should report palpitations, pain, and shortness of breath because it could also be a sign of heart failure.

A pregnant woman is the mother of two children. Her first pregnancy ended in a stillbirth at 32 weeks of gestation, her second pregnancy with the birth of her daughter at 36 weeks, and her third pregnancy with the birth of her son at 41 weeks. Using the 5-digit system (#-#-#-#-#) to describe this woman's current obstetric history, the nurse records_________

4-1-2-0-2 Gravida (the first number) is 4 because this woman is now pregnant and was pregnant 3 times before. Para (the next 4 numbers) represents the outcomes of the pregnancies and is described as: 4T: 1 = Term birth at 41 weeks of gestation (son) 4P: 2 = Preterm birth at 32 weeks of gestation (stillbirth) and 36 weeks of gestation (daughter) 4A: 0 = Abortion: none occurred 4L: 2 = Living children: her son and her daughter.

What does the nurse inform a breastfeeding patient who is taking propylthiouracil (Propacil) for hyperthyroidism? 1 "The medication is likely to decrease milk production." 2 "Stop breastfeeding the child, and start infant formula." 3 "It can adversely affect the neonate's thyroid function." 4 "Take the medication immediately after breastfeeding."

Take the medication immediately after breastfeeding The nurse advises the patient to take the medication immediately after breastfeeding to allow a 3- to 4-hour period for the medication to absorb before nursing again. Milk production decreases if there is poor metabolic control, not because of antithyroid medications. It is not necessary to stop breastfeeding or provide infant formula, because there are no side effects of the medication in the infant.

The nurse is informing the pregnant patient with a cardiac disorder about the dietary changes that are needed. What should the nurse include in the teaching? Select all that apply. 1 "Take iron and folic acid supplements daily." 2 "Increase your daily intake of dietary fiber." 3 "Take the stool softener daily as prescribed." 4 "Cut intake of dark, green leafy vegetables." 5 "Include potassium-rich foods in the diet."

1 "Take iron and folic acid supplements daily." 2 "Increase your daily intake of dietary fiber." 3 "Take the stool softener daily as prescribed." 5 "Include potassium-rich foods in the diet." The nurse instructs the patient to take iron and folic acid supplements to prevent anemia. Iron supplements may cause constipation. Therefore the nurse advises the patient to increase fiber and fluid intake. The nurse also advises the patient to take the prescribed stool softeners to prevent straining during defecation, because forced expiration causes blood to rush to the heart and overload the cardiac system. Patients with a cardiac history may be taking diuretics, which may cause loss of potassium. Therefore the nurse should teach the patient to include foods high in potassium in the diet. Dark, green leafy vegetables contain folate and are included in the patient's diet.

Which nursing interventions does the nurse implement when assessing a patient with gestational diabetes? Select all that apply. 1 Tells the patient to follow a diabetic diet 2 Explains the importance of exercising daily 3 Tells the patient to not take any oral hypoglycemics 4 Demonstrates how to monitor blood glucose levels 5 Explains the effects of diabetes on the pregnancy and fetus

1 Tells the patient to follow a diabetic diet 4 Demonstrates how to monitor blood glucose levels 5 Explains the effects of diabetes on the pregnancy and fetus The nurse tells the patient to follow a diabetic diet to promote self-management and compliance with the treatment. The nurse demonstrates how to monitor blood glucose levels to establish the patient's ability to perform the procedure. The nurse explains the effects of diabetes on the pregnancy and the fetus to promote the patient's compliance with the treatment plan. The nurse instructs the patient to take oral hypoglycemic medications as prescribed to control blood glucose levels.

Which is the most important intervention that the nurse implements for a pregnant patient with uncorrected tetralogy of Fallot in the late third trimester of pregnancy? 1 Monitor respiratory function. 2 Monitor heart valve function. 3 Apply pressure support hose. 4 Assess pedal and radial pulses

Apply pressure support hose If a patient with uncorrected tetralogy of Fallot becomes pregnant, there is a reduction in blood flow through the pulmonary circulation, which increases hypoxemia. This can lead to syncope or death. Hence, the nursing priority is the maintenance of venous return in the patient, because venous return is reduced by the large pregnant uterus. The best way to do this is to have the patient wear compression support hose.

The most important instruction to include in a teaching plan for a woman in early pregnancy who has class I heart disease is: 1 She must report any nausea or vomiting. 2 She may experience mild fatigue in early pregnancy. 3 She must report any chest discomfort or productive cough. 4 She should plan to increase her daily exercise gradually throughout pregnancy.

She must report any chest discomfort or productive cough. Angina or a productive cough may signal congestive heart failure or pulmonary edema.

Which hematocrit (Hct) and hemoglobin (Hgb) results represent the lowest acceptable values for a woman in the third trimester of pregnancy? 1 38% Hct; 14 g/dL Hgb 2 35% Hct; 13 g/dL Hgb 3 33% Hct; 11 g/dL Hgb 4 32% Hct; 10.5 g/dL Hgb

33% Hct; 11 g/dL Hgb represents the lowest acceptable value during the first and the third trimesters. 38% Hct; 14 g/dL Hgb is within normal limits in the nonpregnant woman. 35% Hct; 13 g/dL Hgb is within normal limits for a nonpregnant woman. 32% Hct; 10.5 g/dL Hgb represents the lowest acceptable value for the second trimester when the hemodilution effect of blood volume expansion is at its peak.

The hormonal reports of a pregnant female reveal increased estrogen levels in the body. Which related signs would the nurse find in the patient? Select all that apply. 1 Mucoid discharge from the cervix 2 Heaviness in the patient's breasts 3 Milk discharge from the patient's nipples 4 Decreased chest expansion of the patient 5 Well-defined pink blotches on the palm

1 Mucoid discharge from the cervix 2 Heaviness in the patient's breasts 5 Well-defined pink blotches on the palm

The nurse examines the blood pressure (BP) of a patient and records it as 180/80 mm Hg. What could be the mean arterial pressure of the patient? Record your answer using a whole number. _______ mm Hg

113 mm Hg The mean arterial pressure of the patient is calculated using this formula: systolic blood pressure + 2(diastolic blood pressure)/3. Thus the mean arterial pressure of the patient would be [180 + 2 (80)/3] = 113 mm Hg.

A pregnant female has a sudden increase in the blood sugar levels. Which intervention does the nurse perform to help manage the blood sugar levels? The nurse: 1 Administers aldosterone as prescribed. 2 Suggests reduced intake of carbohydrates. 3 Administers cortisol injection as prescribed. 4 Suggests fiber-rich food intake as prescribed.

Administers cortisol injection as prescribed Cortisol hormone stimulates the production of insulin, which regulates the blood glucose levels in the body. Hence, the administration of cortisol injection is the better nursing intervention to treat high glucose levels in the patient. The administration of aldosterone is useful in controlling blood pressure as it stimulates excess sodium reabsorption from the kidneys. Reduction of carbohydrates intake helps control blood sugar in patients with diabetes and is not useful in controlling sudden rises in the blood glucose levels. Fiber-rich foods reduce the blood glucose levels after a very long time.

The nurse is teaching a pregnant patient who complains of vomiting about the use of dry carbohydrate in the morning. The patient asks the nurse, "My husband has similar problems. Will it be useful for my husband as well?" What can the nurse interpret from this? The husband has: 1 Vena cava syndrome. 2 Couvade syndrome. 3 Carpal tunnel syndrome. 4 Brachial plexus traction syndrome.

Couvade syndrome Intake of dry carbohydrate is recommended in pregnant patient's diet to suppress the vomiting observed during early pregnancy. Sometimes pregnancy symptoms are also experienced by the male partner. This is called couvade syndrome. Vena cava syndrome (supine hypotension) and carpal tunnel syndrome are not affected by intake of dry carbohydrate. Brachial plexus traction syndrome is manifested as drooping of the shoulder, which eventually disappears after childbirth. A dry carbohydrate diet has no effect on brachial plexus traction syndrome.

Which medication does the primary health care provider ask the nurse to administer to a patient during labor in a vaginal delivery, who has a history of a myocardial infarction (MI)? 1 Oxytocin 2 Diuretics 3 Anticoagulant 4 Epidural analgesia

Epidural analgesia Epidural analgesia is administered during labor to a patient with MI to prevent pain, which can result in tachycardia and increased cardiac demands. Oxytocin is administered to a patient after birth to prevent hemorrhage. Diuretics are administered to prevent fluid retention in a pregnant patient with a heart disease. Anticoagulant therapy is administered for recurrent venous thrombosis in pregnancy.

The nurse is assessing a pregnant female who is in the second trimester. What postural changes will the nurse observe in the patient? Select all that apply. 1 Forward pelvic tilt 2 Backward pelvic tilt 3 Increased lumbar lordosis 4 Decreased lumbar lordosis 5 Increased thoracic curvature

Forward pelvic tilt Increased lumbar lordosis Increased thoracic curvature n pregnant females the enlarged uterus increases the abdominal girth. Therefore the center of gravity moves forward. This causes realignment of the spinal curvatures. The pelvis tilts anteriorly because of the enlargement of the abdomen anteriorly. This forward pelvic tilt increases the lumbar lordosis. To maintain the position of the center of gravity, the anterior concavity of the thoracic curvature increases. These postural compensations help in maintaining balance in a pregnant female. Backward pelvic tilt and decreased lumbar lordosis may be caused by weak back muscles in a healthy individual. Decreased thoracic curvature is seen in patients with weak anterior trunk musculature.

Cardiovascular system changes occur during pregnancy. Which finding is considered normal for a woman in her second trimester? 1 Less audible heart sounds (S1, S2) 2 Increased pulse rate 3 Increased blood pressure 4 Decreased red blood cell (RBC) production

Increased pulse rate Between 14 and 20 weeks of gestation, the pulse increases about 10 to 15 beats/min, which persists to term. Splitting of S1 and S2 is more audible. In the first trimester, blood pressure usually remains the same as the prepregnancy level, but it gradually decreases up to about 20 weeks of gestation. During the second trimester, both the systolic and diastolic pressures decrease by about 5 to 10 mm Hg. Production of RBCs accelerates during pregnancy.

The nurse has advised a pregnant female to always sleep on the right side-lying position while sleeping. What are the possible reasons for giving this instruction? Select all that apply. This position: 1 Decreases the pulse rate. 2 Increases the renal function. 3 Increases the cardiac output. 4 Increases the uterine blood flow. 5 Increases the venous blood pressure.

Increases renal function Increases cardiac output Increases uterine blood flow A side-lying position increases the renal perfusion, which increases urine output and decreases edema. In supine position the large and heavy uterus often impedes the venous return to the heart and affects the blood pressure. Right side-lying position helps in relieving the pressure on the heart, which helps in effective contraction of the heart. Increased contraction of the heart improves the cardiac output. As the cardiac output is reduced in supine position, the uterine blood flow is also reduced. Therefore the side-lying position would help in improving the uterine blood flow.

The nurse reviews the obstetric history of a woman and notes the GTPAL (gravidity, term, preterm, abortions, living children) for the woman is "1-0-1-0-1." What does the nurse infer from this? The woman was pregnant: 1 Twice, gave birth at week 35, and the baby survived. 2 Once and gave birth to twins at week 36 of pregnancy. 3 Once, gave birth at week 35, and the baby survived. 4 Twice and had a miscarriage at 10 weeks during the second pregnancy.

Once, gave birth at week 35, and the baby survived. If the woman was pregnant only (gravidity: 1), gave birth at week 35 (term: 0), had one preterm delivery (preterm: 1), had no abortions (abortion: 0), and the baby survived (living children: 1), then the GTPAL should be 1-0-1-0-1. If the woman was pregnant twice, gave birth at week 35 during both pregnancies, and both babies survived, then the GTPAL would be 2-0-2-0-2. If the woman was pregnant once, gave birth to twins at week 36, then the GTPAL would be 1-0-2-0-2. The GTPAL would be 2-1-0-1-1 if the woman was pregnant twice and had one term pregnancy, but the second pregnancy ended in a miscarriage at 10 weeks.

A woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability is called a: 1 primipara. 2 primigravida. 3 multipara. 4 nulligravida.

Primipara A primipara is a woman who has completed one pregnancy with a viable fetus. Gravida is a pregnant woman; para comes from parity, meaning a viable fetus; primi means first; multi means many; and null means none. A primigravida is a woman pregnant for the first time. A multipara is a woman who has completed two or more pregnancies with a viable fetus. A nulligravida is a woman who has never been pregnant.

A patient during the second trimester of pregnancy asks the nurse about the date of delivery. Which sign would help the nurse to find the probable date of delivery? 1 Ballottement 2 Lightening 3 Quickening 4 Chadwick sign

Quickening The nurse should assess for quickening, which is the first sign of the recognition of fetal movements by the pregnant woman. The week in which quickening occurs provides a tentative clue about the duration of gestation.

A pregnant woman in her first trimester with a history of epilepsy is transported to the hospital via ambulance after suffering a seizure in a restaurant. Which health care provider orders should the nurse expect to be included in the plan of care? Select all that apply. 1 valproate (Depakote) 2 Serum lab levels of medications 3 Abdominal ultrasounds 4 Prenatal vitamins with vitamin D 5 carbamazepine (Tegretol)

Serum lab levels of medications Abdominal ultrasounds Prenatal vitamins with vitamin D

A patient reports that she has bleeding gums during the prenatal visit. On assessment, the nurse finds a single raised bleeding nodule on the gums of the patient. Which specific advice does the nurse give to the patient? 1 "Drink a glass of milk daily." 2 "Use vitamin supplements." 3 "Take citrus fruits regularly." 4 "Use a soft-bristled toothbrush."

Use a soft-bristled toothbrush Red, raised nodules on the gums are referred to as epulis. They occur as a result of gum hypertrophy during pregnancy and can be managed by avoiding trauma to the gums by using a soft toothbrush.

Adequate insulin is the primary factor in the maintenance of euglycemia during pregnancy. Insulin requirements during pregnancy change dramatically as the pregnancy progresses. For the patient with pregestational diabetes that is accustomed to one injection per day of intermediate-acting insulin, multiple daily injections of mixed type insulin is a new experience. You are working as a nurse in a busy OB/GYN practice and have been assigned the task of instructing a patient on the procedure for mixing NPH (intermediate-acting) and regular (short-acting) insulin. In which order should the insulin be mixed? 1. Check insulin bottles for type and expiration. 2. Wipe off rubber stopper with alcohol. 3. Wash hands thoroughly and gather supplies. 4. Inject air equal to the NPH dose into the NPH vial. Remove needle. 5. Gently rotate insulin vial to mix. 6. Draw into the syringe the amount of air equal to the total dose. 7. Invert regular insulin bottle and withdraw the dose. 8. Without adding more air to NPH vial, carefully withdraw the dose. 9. Inject air equal to regular insulin dose into the vial.

Wash hands. Check insulin. Gently rotate. Wipe off rubber stopper. Draw into syringe amount of air equal to total dose. Inject air equal to NPH dose. Inject air equal to regular insulin dose. Invert regular and withdraw. Without adding more air to NPH vial...

Hypothyroidism occurs in 2 to 3 pregnancies per 1000. Pregnant women with untreated hypothyroidism are at risk for: Select all that apply. 1 miscarriage. 2 macrosomia. 3 gestational hypertension. 4 placental abruption. 5 stillbirth.

miscarriage gestational hypertension placental abruption stillbirth Hypothyroidism is often associated with both infertility and an increased risk for miscarriage. These outcomes can be improved with early diagnosis and treatment. Pregnant women with hypothyroidism are more likely to experience both preeclampsia and gestational hypertension. Placental abruption and stillbirth are risks associated with hypothyroidism. Placental abruption and stillbirth are risks associated with hypothyroidism. Infants born to mothers with hypothyroidism are more likely to be of low birth weight or preterm.

Which interventions does the nurse implement while providing care for a pregnant patient with cystic fibrosis? Select all that apply. 1 Assess the patient's weight daily. 2 Assess for pulmonary infection. 3 Assess for vitamin A, D, E, or K deficiency. 4 Encourage exposure to sunlight. 5 Monitor the fetal movements.

1 Assess the patient's weight daily. 2 Assess for pulmonary infection. 3 Assess for vitamin A, D, E, or K deficiency. 5 Monitor the fetal movements. The nurse assesses the patient's weight daily as a weight gain of 11 to 12 kg is recommended during pregnancy. If the patient does not gain an appropriate amount of weight, nasogastric tube feedings at night are prescribed. The patient is at an increased risk for pulmonary infections, so the nurse is alert for infections so that prompt treatment can be initiated. Fat-soluble vitamins (A, D, E, and K) are not absorbed adequately in the patient with cystic fibrosis. Therefore the nurse needs to monitor for any deficiency for prompt action. Fetal movement counts are recommended from 28 weeks' gestation to assess fetal well-being.

Which conditions are common in infants born to mothers with diabetes mellitus? Select all that apply. 1 Brachial plexus palsy 2 Cephalhematoma 3 Marfan syndrome 4 Shoulder dystocia 5 Hypoglycemia

1 Brachial plexus palsy 2 Cephalhematoma 4 Shoulder dystocia 5 Hypoglycemia Brachial plexus palsy and cephalhematoma may occur in the child as a result of a difficult vaginal birth. The brachial plexus is a group of nerves that originate from the spinal cord. They can be damaged because of a difficult birth. A cephalhematoma is a hemorrhage of blood between the skull and the periosteum. Shoulder dystocia is a risk associated with diabetic pregnancy because the infants born to women with diabetes tend to have a disproportionate increase in shoulder, trunk, and chest size. Hypoglycemia is a risk if the patient does not control her blood glucose during the last half of pregnancy.

When providing preconception counseling, what instructions does the nurse give to a patient with diabetes mellitus? Select all that apply. 1 Inform the patient about the potential risks. 2 Instruct the patient about the expenses involved. 3 Explain the need for frequent obstetrical visits. 4 Advise the patient to use effective contraception. 5 Advise the patient against trying to conceive a child.

1 Inform the patient about the potential risks. 2 Instruct the patient about the expenses involved. 3 Explain the need for frequent obstetrical visits. 4 Advise the patient to use effective contraception. The nurse should inform the patient about the potential risks of pregnancy as a result of diabetes mellitus. This helps the patient make an informed decision about becoming pregnant. The nurse also provides information about the financial implications of a diabetic pregnancy so that the patient is able to plan accordingly. When a patient with diabetes becomes pregnant, the patient will need to see the obstetrician more frequently than a patient without diabetes. This is done to assess the health of the patient and the fetus. Therefore the nurse informs the patient about this in advance. The use of contraception is advised to help the patient plan effectively for the pregnancy.

A patient whose GTPAL in old medical records is "1-0-1-0-1" underwent a test that showed that the patient is pregnant again. What does the nurse write in the present records? 1 "1-1-0-0-1" 2 "3-1-2-1-3" 3 "2-0-1-0-1" 4 "2-1-0-0-1"

2-0-1-0-1

After reviewing the laboratory reports of a 5-month pregnant female, the nurse tells the patient that her condition is normal. Which findings enabled the nurse to conclude that the patient is healthy? Select all that apply. 1 The patient's bladder has a capacity of 1000 mL. 2 The hemoglobin value is 13 g/dL in the patient. 3 The total serum proteins value is 5.1 g/dL in the patient. 4 The mean corpuscular hemoglobin value is 30 pg. 5 The mean corpuscular hemoglobin concentration is 34 g/dL.

2. The hemoglobin value is 13 g/dl in the patient. 4. The mean corpuscular hemoglobin value is 30 pg. 5. The mean corpuscular hemoglobin concentration is 34 g/dl. The laboratory findings may indicate the health condition of the patient. The hemoglobin value is 13 g/dl, which is within the normal range (greater than 11 g/dl). The mean corpuscular hemoglobin value of 30 pg (normal range = 27-31 pg) and the mean corpuscular hemoglobin concentration of 34 g/dl (normal range = 32-36 g/dl) also imply normal findings. The bladder capacity of 1000 ml is less than the normal value (1500 ml). The total serum protein value of 5.1 g/dl is not within the normal range (5.5-7.5 g/dl). These findings would not indicate that the patient is normal.

A pregnant woman tells the nurse, "I feel nauseated at the sight of meat." What specific response does the nurse give in relation to the patient's query? 1 "You should get your blood checked for iron." 2 "You should get your blood estrogen tested." 3 "You will be relieved of this condition in 3 months." 4 "You will feel relieved by the administration of antiemetics."

3 "You will be relieved of this condition in 3 months."

After reviewing the laboratory reports of a female patient, the nurse informs that the patient is pregnant. Which laboratory finding indicates that the female is pregnant? 1 Decreased levels of insulin hormone in the patient 2 Increased levels of thyroxine hormone in the patient 3 Increased levels of follicle-stimulating hormone (FSH) 4 Increased levels of human chorionic gonadotropin (hCG)

Increased levels of human chorionic gonadotropin (hCG) Human chorionic gonadotropin hormone is the earliest biologic marker for pregnancy. The production of β-subunit of hCG can be detected in the maternal serum or urine within 7 to 8 days after fertilization. Thus the nurse can confirm the pregnancy status of a female by the increased levels of hCG. Decreased levels of insulin hormone indicate the presence of diabetes. Thyroid abnormalities are confirmed by the increased levels of thyroxine hormone. Follicle-stimulating hormone (FSH) blood test is used in diagnosing abnormal menstrual bleeding and infertility.