OB exam 3 high risk antenatal
A pregnant woman tests positive for tuberculosis (TB). The nurse explains to the woman that additional tests are needed to confirm the diagnosis. When describing these tests, which one(s) would the nurse likely include? Select all that apply. abdominal ultrasound chest x-ray whole-body CT scan spirometry sputum culture
chest x-ray sputum culture Explanation: If a TB screening test is positive, the woman will need a follow-up chest x-ray with lead shielding over the abdomen, as well as sputum cultures to confirm the diagnosis. A whole-body CT scan, spirometry, or abdominal ultrasound are not used to confirm the diagnosis.
A pregnant 36-year-old woman has presented to the emergency department with vaginal bleeding. While reviewing the client's history, the nurse suspects placenta previa when which risk factors are found in her record? Select all that apply. infertility treatment smoking hypotension previous induced surgical abortion advancing maternal age
infertility treatment smoking advancing maternal age previous induced surgical abortion Explanation: Research has identified certain risk factors for placenta previa. They include advancing maternal age (more than 35 years), previous cesarean birth, multiparity, uterine insult or injury, cocaine use, prior placenta previa, infertility treatment, Asian ethnic background, multiple gestations, previous induced surgical abortion, smoking, previous myomectomy to remove fibroids, short interval between pregnancies, and hypertension or diabetes.
Which action(s) will the nurse take when asked to apply suprapubic pressure during a birth with shoulder dystocia? Select all that apply. Apply downward pressure just above the pubic bone. Apply downward pressure on the fundus of the uterus. Apply pressure at an angle toward the face of the fetus. Apply pressure with the contractions. Apply pressure between contractions.
Apply downward pressure just above the pubic bone. Apply pressure between contractions. Apply pressure at an angle toward the face of the fetus. Explanation: Suprapubic pressure during a birth with shoulder dystocia is used to move the anterior shoulder under the pubic bone. The nurse would apply downward pressure just above the pubic bone, exert pressure at an angle toward the face of the fetus, and apply pressure between contractions. Downward pressure on the fundus of the uterus with the contractions is called fundal pressure, which is used to augment the pushing effort of the mother.
A pregnant client with preterm premature rupture of the membranes is being discharged home. A nurse is preparing the client's discharge teaching plan. Which instructions would the nurse include? Select all that apply. "Take tub baths instead of showers." "Gently massage your breasts at least once each day." "If you notice your belly starting to tighten, call your health care provider." "Check your temperature each day, reporting any increase immediately." "Be sure to perform fetal kick counts about once every 3 days."
"If you notice your belly starting to tighten, call your health care provider." "Check your temperature each day, reporting any increase immediately." Explanation: Instructions should include monitoring the baby's activity by performing fetal kick counts daily; checking temperature daily and reporting any temperature increases to the health care provider; watching for signs related to the beginning of labor and reporting any tightening of the abdomen or contractions; avoiding any touching or manipulating of the breasts, which could stimulate labor; and taking showers for daily hygiene needs and avoiding sitting in a tub bath.
In preparing a class for a group of pregnant couples, the nurse includes information about possible newborn complications associated with smoking during pregnancy. Which complications will the nurse include? Select all that apply. Sudden infant death syndrome Cerebral palsy Low birth weight Cleft lip and palate Trisomy 21 SUBMIT ANSWER
Cerebral palsy Low birth weight Cleft lip and palate Sudden infant death syndrome Explanation: Smoking during pregnancy is associated with multiple perinatal and childhood risks including: Low birth weight, SIDS, cerebral palsy, cleft lip and palate, clubfoot, asthma, altered brainstem development, middle ear infections, and reduced head circumference. Trisomy 21, or Down syndrome, is a genetic disorder caused by abnormal cell division, not the effects of nicotine.
The nurse is doing meal planning with a pregnant woman with iron-deficiency anemia. What dietary recommendations would the nurse make to enhance the woman's intake of iron? Select all that apply. Drink orange juice with the iron supplement. Increase intake of dried beans and green leafy vegetables. Since fortified cereals are a poor source of iron, eat eggs or pancakes for breakfast. Limit intake of dried fruits, eating only fresh fruit. Cook food in an iron skillet, if possible.
Drink orange juice with the iron supplement. Increase intake of dried beans and green leafy vegetables. Cook food in an iron skillet, if possible. Explanation: Dried fruits, fortified grains and cereals, and animal protein are all good sources of iron for a pregnant woman. Cooking in an iron skillet also will increase the amount of iron ingested. Vitamin C, like what is found in orange juice, enhances absorption of iron and is recommended to drink when taking iron supplements. Folate also increases the effectiveness of iron supplements; foods high in folate include green leafy vegetables, fortified grains and dried beans.
A nurse is conducting a class on the effects of nicotine during pregnancy. Which complications will the nurse include in the teaching? Select all that apply. Spontaneous abortion Spontaneous rupture of membranes Placenta previa Tubal ectopic pregnancy Preterm labor and birth
Spontaneous abortion Placenta previa Preterm labor and birth Tubal ectopic pregnancy Spontaneous rupture of membranes Explanation: Smoking during pregnancy increases the risk of spontaneous abortion, preterm labor and birth, maternal hypertension, placenta previa, and abruptio placenta. It has also been considered an important risk factor for low birth weight, sudden infant death syndrome, and cognitive defects.
A 17-year-old client comes to the clinic because of irregular menstrual bleeding and facial acne. The client is overweight, despite exercising daily, and has excessive hair growth on the chin and abdomen. The nurse explains to the client that blood will be drawn for which purposes? Select all that apply. To obtain fasting cholesterol levels To screen for insulin resistance To rule out polycystic ovary syndrome To measure androgen level To screen for hypertension
To screen for insulin resistance To obtain fasting cholesterol levels To measure androgen level Explanation: There is no single blood test to diagnose polycystic ovary syndrome (PCOS). However, a blood test to screen for insulin resistance, elevated androgen level, and elevated cholesterol level are used to identify clients with PCOS. There is no blood test to screen for hypertension.
A woman is admitted to the L & D unit for prostaglandin insertion along with IV oxytocin induction to begin 12 hours afterward. The nurse, preparing to insert the prostaglandin, questions this prescription for which of the women on the unit? Select all that apply. a 31-year-old primipara who is experiencing major anxiety about this procedure a 30-year-old female who developed diabetes at age 5 and is currently in prerenal failure a 24-year-old female with a history of asthma, diagnosed at age 9 a 40-year-old female who has remained active and continues to run half-marathons until 2 months ago a 38-year-old female who has developed preeclampsia within the past 2 weeks
a 24-year-old female with a history of asthma, diagnosed at age 9 a 30-year-old female who developed diabetes at age 5 and is currently in prerenal failure Explanation: Prostaglandins are usually well accepted by most women as a way to aid cervical ripening. They should be used with caution in women with asthma or a history of renal or cardiovascular disease. Excess physical exercise, anxiety, or preeclampsia are not reasons to question the use of prostaglandin insertion.
A nurse is assessing a newborn and suspects that newborn may have been exposed to alcohol during gestation. The nurse suspect this based on which newborn findings? Select all that apply. large inset eyes limb abnormality macrocephaly small head circumference thin upper lip
thin upper lip small head circumference limb abnormality Explanation: Characteristics of a fetal alcohol spectrum disorder include craniofacial dysmorphia (thin upper lip, small head circumference, and small eyes), intrauterine growth restriction, microcephaly, and congenital anomalies such as limb abnormalities and cardiac defects.
A nurse is teaching a prenatal client with class III heart failure the signs and symptoms which should be reported to the health care provider. The nurse determines the teaching has been effective when the client states which statement? "I will take an antibiotic throughout my pregnancy." "I will avoid dental work and other invasive procedures." "I will call the clinic when I get shortness of breath after exercising." "I will call the clinic when I have a cough at night."
"I will call the clinic when I have a cough at night." Explanation: The earliest warning sign of cardiac decompensation in clients with heart failure is persistent rales in the bases of the lungs. The client will probably notice a nocturnal cough as the first sign. A sudden decrease in the ability to perform normal duties, exertional dyspnea, and attacks of coughing are other signs of cardiac decompensation. The dentist should be informed of the client's status and procedures planned accordingly. Antibiotics will not address the decompensation issue but should only be used when there is an active infection or taken prophylactically with certain procedures to decrease the risk of developing an infection.
A client reports bright red, painless vaginal bleeding during her 32nd week of pregnancy. A sonogram reveals that the placenta has implanted low in the uterus and is partially covering the cervical os. Which immediate care measures are initiated? Select all that apply. Place the woman on bed rest maintaining the supine position. Attach external monitoring equipment to record fetal heart sounds and kick counts. Assist the client in stirrups and perform a pelvic examination. Determine the time the bleeding began and about how much blood has been lost. Obtain baseline vital signs and compare to those vital signs previously obtained.
Determine the time the bleeding began and about how much blood has been lost. Obtain baseline vital signs and compare to those vital signs previously obtained. Attach external monitoring equipment to record fetal heart sounds and kick counts. Explanation: Assessment is a priority in the immediate care period. Determining the extent of the blood loss, obtaining vital signs and monitoring the fetus provides data. With the exception of performing a pelvic examination and placing the client in the supine position, all of the answers are appropriate immediate care measures. The nurse should never attempt a pelvic or rectal examination with painless bleeding late in pregnancy because any agitation of the cervix might tear the placenta further and initiate massive hemorrhage, which is possibly fatal to both mother and child. The nurse should not place the client in the supine position for extended periods due to the possibility of supine hypotension. Left side lying is suggested.
A client comes to the clinic reporting swelling in the hands and feet, blurred vision, a pounding headache and nausea and vomiting. The client had a positive pregnancy test 15 weeks ago, but has had no prenatal care. This is the client's third pregnancy, and she says that her uterus never grew this big or this fast with the previous pregnancies. Based on the client's reason for seeking care, the nurse would collect additional data to rule out the presence of which conditions? Select all that apply. Missed abortion Preeclampsia Molar pregnancy Placental abruption (abruptio placentae) Ectopic pregnancy
Preeclampsia Molar pregnancy Explanation: Given the timing of the positive pregnancy test, the client's presenting report is consistent with preeclampsia; however, she is too early in gestation for the typical onset of the disorder. In addition, the client has nausea and vomiting, which combined with the early-onset preeclampsia means the presence of a molar pregnancy needs to be considered. A placental abruption (abruptio placentae) occurs in the second half of pregnancy and characteristic presenting signs are acute abdominal pain and a boardlike abdomen. A missed abortion is associated with the disappearance of pregnancy symptoms, because the hormones of pregnancy are no longer being produced. An ectopic pregnancy is in the fallopian tube; therefore, uterine enlargement is not evident.
A woman at 38 weeks' gestation with a history of heroin use disorder has given birth to a newborn several hours ago. Upon assessment, the nurse determines that the newborn is experiencing withdrawal based on which findings? Select all that apply. high-pitched shrill cry nasal stuffiness poor sucking reflex flaccid extremities almost constant sneezing
high-pitched shrill cry almost constant sneezing nasal stuffiness poor sucking reflex Explanation: The most common harmful effect of heroin and other narcotics on newborns is withdrawal, or neonatal abstinence syndrome. This collection of symptoms may include irritability, hypertonicity, jitteriness, fever, excessive and often high-pitched cry, vomiting, diarrhea, feeding disturbances, respiratory distress, disturbed sleeping, excessive sneezing and yawning, nasal stuffiness, diaphoresis, fever, poor sucking, tremors, and seizures.
The nurse is preparing the plan of care for a woman hospitalized for hyperemesis gravidarum. Which interventions would the nurse most likely include? Select all that apply. preparing the woman for insertion of a feeding tube obtaining baseline blood electrolyte levels maintaining NPO status for the first day or two administering antiemetic agents monitoring intake and output
maintaining NPO status for the first day or two administering antiemetic agents obtaining baseline blood electrolyte levels monitoring intake and output Explanation: When hospitalization is necessary, oral food and fluids are withheld to allow the gut to rest. Antiemetic agents are ordered to help control nausea and vomiting. The woman is likely to be dehydrated, so the nurse would obtain baseline blood electrolyte levels and administer intravenous fluid and electrolyte replacement therapy as indicated. Once the nausea and vomiting subside, oral food and fluids are gradually reintroduced. Total parenteral nutrition or a feeding tube is used to prevent malnutrition only if the client does not improve with these interventions.
During a routine prenatal checkup, the nurse interviews a pregnant client to identify possible risk factors for developing gestational diabetes. Which factor(s) will the nurse identify as increasing the woman's risk? Select all that apply. previous birth of small-for-gestational-age neonate younger maternal age at pregnancy previous history of spontaneous abortion (miscarriage) maternal obesity with body mass index more than 35 African heritage
previous history of spontaneous abortion (miscarriage) maternal obesity with body mass index more than 35 African heritage Explanation: The risk factors for gestational diabetes include previous history of spontaneous abortion, maternal obesity with body mass index (BMI) more than 35, and client of a high-risk ethnic group such as Black, Native American/First Nations, Latino, and Asian. The other risk factors for gestational diabetes are previous history of stillbirth, birth of large-for-gestational-age neonate, and advancing maternal age.
The nurse is teaching a pregnant woman with iron deficiency anemia about foods high in iron. Which foods if selected by the woman indicate a successful teaching program? Select all that apply. peanut butter corn broccoli raisins yogurt potatoes
raisins broccoli peanut butter Explanation: Foods high in iron include dried fruits such as raisins, whole grains, green leafy vegetables such as broccoli and spinach, peanut butter, and iron-fortified cereals. Potatoes and corn are high in carbohydrates. Yogurt is a good source of calcium.
A pregnant client is experiencing dystocia resulting from persistent occiput posterior position. The client, in the first stage of labor, is reporting significant back pain. The nurse encourages the client to change positions frequently for comfort and to help promote rotation of the fetal head. Which position(s) would be appropriate for the nurse to suggest? Select all that apply. hands and knees Trendelenburg squatting modified Sims side-lying
side-lying hands and knees squatting Explanation: Appropriate maternal position changes to promote fetal head rotation include hands and knees, rocking pelvis back and forth, side-lying position, side lunges during contractions, sitting, kneeling, or standing while leaning forward, and the squatting position (to give birth and enlarge the pelvic outlet). Modified Sims and Trendelenburg are appropriate for umbilical cord prolapse.
A client who is 8 weeks' pregnant comes to the emergency department reporting abdominal pain and spotting. The client also reports breast tenderness and fatigue. Additional assessment suggests a possible ectopic pregnancy and diagnostic evaluation is scheduled. The nurse would prepare the client for which test(s) to aid in confirming this diagnosis? Select all that apply. platelet level urine for protein complete blood count transvaginal ultrasound beta-human chorionic gonadotropin (hCG) level
transvaginal ultrasound beta-human chorionic gonadotropin (hCG) level Explanation: The use of transvaginal ultrasound to visualize the misplaced pregnancy and low levels of serum beta-hCG assist in diagnosing an ectopic pregnancy. The ultrasound determines whether the pregnancy is intrauterine, assesses the size of the uterus, and provides evidence of fetal viability. The visualization of an adnexal mass and the absence of an intrauterine gestational sac are diagnostic of ectopic pregnancy. In a normal intrauterine pregnancy, beta-hCG levels typically double every 2 to 4 days until peak values are reached 60 to 90 days after conception. Concentrations of hCG decrease after 10 to 11 weeks and reach a plateau at low levels by 100 to 130 days. Therefore, low beta-hCG levels are suggestive of an ectopic pregnancy. Urine for protein, platelet level, and complete blood count would provide no information about an ectopic pregnancy.
A nurse is conducting a class for a group of pregnant women about ways to minimize the risk of infection during pregnancy. One of the infections that the nurse is discussing is toxoplasmosis. The nurse determines that the class was successful when the group identifies which action(s) as helpful in preventing this infection. Select all that apply. "A house cat should be kept outside to prevent bringing things inside the house." "Peeling any raw vegetables is a good idea before eating them." "It is important to cook any meat that we will eat to at least a temperature of 145°F (62.8°C)." "Any cutting surface used for raw meats should be washed afterwards with hot, soapy water." "It is important to wear gardening gloves when digging in the soil."
"Any cutting surface used for raw meats should be washed afterwards with hot, soapy water." "Peeling any raw vegetables is a good idea before eating them." "It is important to wear gardening gloves when digging in the soil." Explanation: Pregnant women should do the following to prevent toxoplasmosis: avoid eating raw or undercooked meat, especially lamb or pork. Cook all meat to an internal temperature of 160°F (71°C) throughout; clean cutting boards, work surfaces, and utensils with hot, soapy water after contact with raw meat or unwashed fruits and vegetables. Peel or thoroughly wash all raw fruits and vegetables before eating them; keep the cat indoors to prevent it from hunting and eating birds or rodents; and wear gardening gloves when in contact with outdoor soil.
A pregnant client at 30 weeks' gestation calls the clinic because she thinks that she may be in labor. To determine if the client is experiencing labor, which question(s) would be appropriate for the nurse to ask? Select all that apply. "Are you having contractions that come and go, off and on?" "Have you noticed any fluid leaking from your vagina?" "Have you been having any nausea or vomiting?" "Are you having problems with heartburn?" "Are you feeling any pressure or heaviness in your pelvis?"
"Are you feeling any pressure or heaviness in your pelvis?" "Are you having contractions that come and go, off and on?" "Have you noticed any fluid leaking from your vagina?" "Have you been having any nausea or vomiting?" Explanation: Frequently, women are unaware that uterine contractions, effacement, and dilation are occurring, thus making early intervention ineffective in arresting preterm labor and preventing the birth of a premature newborn. The nurse should ask the client about any signs/symptoms, being alert for subtle symptoms of preterm labor, which may include: a change or increase in vaginal discharge with mucous, water, or blood in it; pelvic pressure (pushing-down sensation); low dull backache; menstrual-like cramps; urinary tract infection symptoms; feeling of pelvic pressure or fullness; gastrointestinal upset like nausea, vomiting, and diarrhea; general sense of discomfort or unease; heaviness or aching in the thighs; uterine contractions with or without pain; more than six contractions per hour; intestinal cramping with or without diarrhea. Contractions also must be persistent, such that four contractions occur every 20 minutes or eight contractions occur in 1 hour. A report of heartburn is unrelated to preterm labor.
A 32-year-old black woman in her second trimester has come to the clinic for an evaluation. While interviewing the client, she reports a history of fibroids and urinary tract infection. The client states, "I know smoking is bad and I have tried to stop, but it is impossible. I have cut down quite a bit though, and I do not drink alcohol." Complete blood count results reveal a low red blood cell count, low hemoglobin, and low hematocrit. When planning this client's care, which factor(s) would the nurse identify as increasing the client's risk for preterm labor? Select all that apply. maternal age history of fibroids cigarette smoking African heritage history of urinary tract infections complete blood count results
African heritage history of fibroids cigarette smoking history of urinary tract infections complete blood count results Explanation: For this client, risk factors associated with preterm labor and birth would include African heritage, cigarette smoking, uterine abnormalities, such as fibroids, urinary tract infection, and possible anemia based on her complete blood count results. Maternal age extremes (younger than 16 years and older than 35 years) are also a risk factor but do not apply to this client.
A woman in active labor suddenly sits up, clutches her chest, screams with pain, and then collapses back on the bed. The RN notes she is unconscious and a bluish-gray color. Which interventions are considered the priority for the nurse to implement? Select all that apply. Begin CPR immediately. Call lab and request 4 units of whole blood stat. Apply oxygen mask and start oxygen at 10 L/min. Place stethoscope on the abdomen to verify fetal heart rate. Start oxytocin at 4 mu/min and titrate upward every 5 minutes.
Apply oxygen mask and start oxygen at 10 L/min. Begin CPR immediately. Explanation: Amniotic fluid embolism occurs when amniotic fluid is forced into an open maternal uterine blood sinus after a membrane rupture or partial premature separation of the placenta. The clinical picture is dramatic. The immediate management is oxygen administration by face mask or cannula. Within minutes, she will need CPR; however, CPR may be ineffective because these procedures do not relieve the pulmonary constriction. Blood still cannot circulate to the lungs. Death may occur within minutes. Taking time to listen to FHR is not the priority. Oxytocin will not help with embolism. If the woman survives and develops DIC, fibrinogen is the blood product of choice.
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. Hyperactive deep tendon reflexes Nondependent edema Glycosuria Seizure Blood pressure above 160/110 mm Hg
Blood pressure above 160/110 mm Hg Nondependent edema Hyperactive deep tendon reflexes Explanation: Preeclampsia occurs when a pregnant woman develops hypertension occurring after 20 weeks' gestation and only resolves after the fetus is delivered. Preeclampsia is exhibited by 2+ or more proteinuria, nondependent edema, blood pressure greater than 140 mm Hg systolic and above 90 mm Hg diastolic, and CNS irritability demonstrated by hyperactive deep tendon reflexes. If the client has a seizure, she has moved to eclampsia. Glycosuria is not associated with preeclampsia.
A 20-year-old pregnant client is positive for hemoglobin S. The nurse explains to the client that she will need perform which actions during her pregnancy? Select all that apply. Drink lots of fluids. Avoid conditions of low oxygen tension, such as high altitudes. Eat high-protein meals. Be on bed rest.
Drink lots of fluids. Avoid conditions of low oxygen tension, such as high altitudes. Explanation: When oxygen tension becomes reduced, as occurs at high altitudes, or blood becomes more viscid than usual, such as occurs with dehydration, the cells of a client with hemoglobin S clump together because of their irregular shape, resulting in vessel blockage with reduced blood flow to organs. Drinking fluids and avoiding high altitudes will help to prevent this occurrence. High-protein meals and bed rest will have no effect.
A pregnant client is admitted to a health care facility after her laboratory results reveal elevated liver enzymes, thrombocytopenia, and low hemoglobin and hematocrit. Which assessment findings should the nurse prioritize for this client? Select all that apply. Watery diarrhea Generalized edema Excessive weight loss Nausea and vomiting Epigastric pain and tenderness
Nausea and vomiting Generalized edema Epigastric pain and tenderness Explanation: The findings of anemia, elevated liver enzymes, and low platelets are indications of HELLP syndrome. The symptoms are similar to preeclampsia and can include epigastric or right upper quadrant pain and tenderness, nausea and vomiting, and generalized edema. Watery diarrhea and excessive weight loss are not symptoms of HELLP syndrome. Instead, weight gain may be seen in HELLP syndrome.
A woman with known cardiac disease from childhood presents at the obstetrician's office 6 weeks' pregnant. What recommendations would the nurse make to the client to address the known cardiac problems for this pregnancy? Select all that apply. Plan periods of rest into the workday. Receive pneumococcal and influenza vaccines. Continue taking the scheduled warfarin. Increase the amount of sodium in your diet to compensate for the expanding fluid needs of the fetus. Let the physician know if you become short of breath or have a nighttime cough.
Plan periods of rest into the workday. Receive pneumococcal and influenza vaccines. Let the physician know if you become short of breath or have a nighttime cough. Explanation: Women with known heart conditions need to be closely followed by both the obstetrician and a cardiologist. Recommendations would include rest periods, reduction of stress, getting immunizations, and monitoring for heart failure as demonstrated by a nighttime cough and shortness of breath. Consuming more sodium in the diet is not recommended due of the potential of developing hypertension. Warfarin is contraindicated during pregnancy since it crosses the placental barrier and can cause spontaneous abortion, stillbirth or preterm birth.
A nurse is presenting an in-service program about complications that can arise during labor. The nurse determines that the teaching was successful when the group correctly chooses which findings as suggesting an amniotic fluid embolism? Select all that apply. Acute, continuous abdominal pain Slow onset of fetal distress Sudden onset of respiratory distress Maternal hypotension Maternal tachycardia
Sudden onset of respiratory distress Maternal hypotension Maternal tachycardia Explanation: The client with an amniotic fluid embolism commonly reports difficulty breathing. Other signs include hypotension, tachycardia, cyanosis, seizures, coagulation difficulties, and uterine atony with subsequent hemorrhage. If the mother is still in labor, the fetus may demonstrate distress with bradycardia occurring in most cases. A sudden onset of fetal distress and acute continuous abdominal pain is more often associated with uterine rupture.
A high-risk 43-year-old client is scheduled to receive amnioinfusion due to oligohydramnios. Which prescription by the provider should the nurse question before implementing it? Assist the woman to lie in a lateral recumbent position to prevent compression on the inferior vena cava. Warm the solution of normal saline before opening the clamp on the infusion. Use clean technique when handling the double-lumen catheter and IV tubing. Record woman's temperature hourly, watching for infection.
Use clean technique when handling the double-lumen catheter and IV tubing. Explanation: Amnioinfusion is the addition of a sterile fluid into the uterus to supplement the amniotic fluid and reduce compression on the cord. This is a strict aseptic procedure. For this, a sterile double-lumen catheter is introduced through the cervix into the uterus. It is then attached to IV tubing, and a solution of warmed normal saline is rapidly infused. Throughout the procedure, the nurse should urge the woman to lie in a lateral recumbent position to prevent supine hypotension syndrome. The nurse should also record maternal temperature hourly to detect infection.
A client who is 10 weeks' pregnant reports during a social assessment interview that she has two indoor cats, lives alone, fixes her own meals and enjoys gardening. What precautions would the nurse recommend the woman take to prevent the possibility of contracting toxoplasmosis? Select all that apply. Use gloves when planting her vegetable garden. Wash all fruits and vegetables in hot, soapy water before eating. Make sure meats are cooked to 152ºF (66.7℃); do not eat raw or rare meats. Hire someone to empty the litter box in the house. Receive the vaccination as soon as possible to prevent contracting the disease.
Use gloves when planting her vegetable garden. Make sure meats are cooked to 152ºF (66.7℃); do not eat raw or rare meats. Explanation: Toxoplasmosis is protozoan infection transmitted through contact with undercooked meats, contaminated soil and cat feces. There is no vaccination for toxoplasmosis. Since the woman lives alone, she needs to wear gloves when she is gardening or when she empties the litter box, then wash her hands thoroughly before and after coming in contact with the raw meat, soil or cat litter. It is not advised to wash the fruits and vegetables in hot, soapy water but they do need to be rinsed carefully before eating them.
The nurse manager is reviewing all the L & D clients on the unit in order to prepare assignments to the nursing staff. For which clients would augmentation of labor with oxytocin be considered contraindicated or used cautiously? Select all that apply. a 44-year-old primipara diagnosed with gestational diabetes in active labor for the past 6 hours a 33-year-old female who is 32 weeks' gestation in labor with twins a 30-year-old multipara woman who has experienced premature rupture of membranes 5 days ago but is just now reporting it to the health care provider a 27-year-old primipara in active labor for the past 4 hours an 18-year-old primipara client who is experiencing acute pain and refusing an epidural catheter
a 44-year-old primipara diagnosed with gestational diabetes in active labor for the past 6 hours a 33-year-old female who is 32 weeks' gestation in labor with twins a 30-year-old multipara woman who has experienced premature rupture of membranes 5 days ago but is just now reporting it to the health care provider Explanation: Augmentation or initiation of labor carries risks; it must be used cautiously in women with multiple gestation, polyhydramnios, grand parity, or those who are older than 40 years. Prolonged rupture of the membranes might make induction necessary before the usual 39 weeks' gestation period. Four hours of active labor is a normal occurrence. An 18-year-old woman in labor experiencing acute pain is also a normal occurrence.
A nurse is conducting a class for a local community clinic that has a large adolescent and young adult pregnant women population. The nurse is focusing on the effects of various substances on the fetus. The nurse determines that the class was successful when the group identifies which condition(s) as associated with cigarette smoking? Select all that apply. attention-deficit/hyperactivity disorder (ADHD) cerebral palsy macrosomia cleft lip sudden infant death syndrome (SIDS)
attention-deficit/hyperactivity disorder (ADHD) sudden infant death syndrome (SIDS) cleft lip cerebral palsy Explanation: Smoking increases the risk of spontaneous abortion, preterm labor and birth, fetal growth restriction, stillbirth, low fetal iron stores, and SIDS. Perinatal and childhood risks associated with mothers smoking during their pregnancies include increased risk of cleft lip and palate, clubfoot, asthma, middle ear infections, reduced head circumference, altered brain stem development, and cerebral palsy. Smoking is considered an important risk factor for low birth weight, SIDS, and cognitive deficits, especially in language, reading, and vocabulary, as well as poorer performances on tests of reasoning and memory. Researchers have also reported behavior problems, such as increased activity, attention-deficit/hyperactivity disorder (ADHD), impulsivity, opposition, and aggression.
Which assessment findings, experienced by the client at 36 weeks' gestation, would the nurse document as diagnostic signs of severe preeclampsia? Select all that apply. edema elevated liver enzymes Elevated serum creatinine +1 proteinuria blood pressure of 164/110 mm Hg
blood pressure of 164/110 mm Hg elevated liver enzymes +1 proteinuria Elevated serum creatinine Explanation: Clinical manifestations of severe preeclampsia include blood pressure elevated to 160/110 mm Hg or higher, 15% increase in baseline blood pressure, +1 proteinuria, elevated liver enzymes and elevated serum creatinine. Although no longer considered a diagnostic sign of preeclampsia, edema is common in most pregnancies.
The nurse is caring for a pregnant woman with diabetes mellitus. Which potential fetal complications should the nurse monitor the client for as she presents for her scheduled visits? Select all that apply. fetus with juvenile diabetes smaller than gestational age baby macrosomia respiratory disorder congenital malformations
congenital malformations macrosomia respiratory disorder Explanation: Potential problems during pregnancy involving maternal diabetes mellitus include fetal death, macrosomia (oversized fetus), a fetus with a respiratory disorder, difficult labor, preeclampsia or eclampsia, polyhydramnios, and congenital malformations.
A graduate nurse (GN) is caring for a woman being induced via oxytocin infusion. The client is currently reporting a headache and is vomiting. The graduate nurse thinks that the client is getting near the end of labor. However, the GNs preceptor intervenes by performing which interventions immediately after hearing this report? discontinuing the oxytocin infusion calling respiratory therapy to obtain ABGs on this client increasing IV fluid rate notifying the health care provider immediately administering IV ondansetron for the nausea/vomiting
discontinuing the oxytocin infusion notifying the health care provider immediately Explanation: A second side effect of oxytocin is that it can result in decreased urine flow, possibly leading to water intoxication. This is first manifested by headache and vomiting. If the nurse observes these danger signs in a woman during induction of labor, she should report them immediately and halt the infusion. Ondansetron may be appropriate but is not the priority. The headache and vomiting are due to water intoxication, so fluids should be decreased not increased. At this point, ABGs are not the priority intervention.
A home health care nurse is visiting a pregnant client with preeclampsia who is being managed at home. The nurse is reviewing the situations for which the client should contact the nurse. The nurse determines that the client demonstrates understanding when identifying which situation(s) as needing to be reported? Select all that apply. sinus headache excessive heartburn increased urination dizziness blurred vision
dizziness blurred vision excessive heartburn Explanation: The client should contact the home health nurse if any of the following occurs: increase in blood pressure; burning or frequency on urination; decrease in fetal activity or movement; headache in the forehead or posterior neck region (not a sinus headache); dizziness or visual disturbances such as blurred vision; stomach pain, excessive heartburn, or epigastric pain; decreased or infrequent urination; contractions or low back pain; easy or excessive bruising; a sudden onset of abdominal pain; or nausea and vomiting.
A client visits a health care facility reporting amenorrhea for 10 weeks, fatigue, and breast tenderness. Which assessment findings should the nurse prioritize for immediate intervention? Select all that apply. whitish discharge from the vagina hyperemesis gravidarum absence of fetal heart sound dyspareunia elevated hCG levels
elevated hCG levels absence of fetal heart sound hyperemesis gravidarum Explanation: This client presents with signs and symptoms suspicious for hydatidiform mole. The signs and symptoms of molar pregnancy include an elevated hCG level, absence of fetal heart sounds, and hyperemesis gravidarum. Whitish discharge from the vagina and dyspareunia (painful sexual intercourse) are seen in cases of infection. In molar pregnancy, a brownish vaginal bleeding is often seen.
A woman who immigrated here from a third world country presents to the clinic to find out if she is pregnant. Which signs and/or symptoms would the nurse assess as possible indicators that she might have an active case of tuberculosis as well? Select all that apply. hemoptysis weight gain night sweats anorexia fatigue
fatigue night sweats hemoptysis anorexia Explanation: Women emigrating from developing countries are at high risk for tuberculosis. Clinical manifestations include fatigue, fever or night sweats, nonproductive cough, weakness, slow weight loss, anemia, hemoptysis, and anorexia.
A nurse is admitting a pregnant woman with sickle cell anemia to the emergency department. Which findings would lead the nurse to suspect the client is in crisis? Select all that apply. fever increased skin turgor joint pain fatigue pallor
fever joint pain fatigue Explanation: Signs and symptoms of a sickle cell crisis commonly include severe abdominal pain, muscle spasm, leg pains, joint pain, fever, stiff neck, nausea and vomiting, and seizures. Skin turgor would most likely be poor because the client would probably be dehydrated. The client may also be fatigued during the crisis. Pallor would be the result of the anemia but not necessarily indicative of a crisis.
A nurse is obtaining a medication history from a pregnant client with a history of systemic lupus erythematosus (SLE). Which medication(s) would the nurse expect the woman to report to be currently using? Select all that apply. hydroxychloroquine ibuprofen methotrexate prednisone leflunomide
ibuprofen hydroxychloroquine prednisone Explanation: Treatment of SLE in pregnancy is generally limited to NSAIDs like ibuprofen, prednisone, and an antimalarial agent, hydroxychloroquine. Methotrexate and leflunomide are used to treat rheumatoid arthritis but are contraindicated for use in pregnancy because of the potential for fetal toxicity.
The nurse who works at the local health department is preparing to give a talk on post-term pregnancies. She wants to include the fetal risks. Which risks should she include? Select all that apply. macrosomia brachial plexus injuries shoulder dystocia failure to thrive cephalopelvic disproportion
macrosomia shoulder dystocia brachial plexus injuries cephalopelvic disproportion Explanation: Fetal risks associated with a postterm pregnancy include macrosomia, shoulder dystocia, brachial plexus injuries, and cephalopelvic disproportion. Failure to thrive is more frequently associated with newborns who are of a low birth weight.
A nursing student doing a rotation in labor and birth correctly identifies which medications as most commonly used for tocolysis? Select all that apply. atosiban indomethacin nitroglycerin nifedipine magnesium sulfate
magnesium sulfate atosiban indomethacin nifedipine Explanation: Medications commonly used for tocolysis include magnesium sulfate, atosiban, indomethacin, and nifedipine. These drugs are used "off label," meaning that they are effective but have not been officially tested and developed for this purpose by the Food and Drug Administration.
The nurse is giving a transition-of-care report to the nurse coming on duty. Based on the above report, what would cause the nurse to be prepared for shoulder dystocia during the birth? Select all that apply. maternal obesity previously birthed a 9 lb (4100 g) neonate gestational diabetes prolonged second stage female gender
maternal obesity prolonged second stage Explanation: Based on the transition-of-care report, the risk factors for shoulder dystocia in this situation are maternal obesity and a prolonged second stage. Diabetes is a risk factor, but this client does not have diabetes. The incidence of shoulder dystocia is higher with male gender. The client's history of previously birthing a 9 lb (4100 g) neonate is evidence that her pelvis is able to accommodate a large neonate.
A nurse is conducting a teaching program for pregnant woman who are older than age 35. The nurse explains that although most women in their age group have healthy pregnancies and healthy newborns, they are at increased risk for possible complications. Which complications would the nurse include? Select all that apply. type 1 diabetes preeclampsia abruptio placentae postpartum hemorrhage preterm labor
postpartum hemorrhage preterm labor preeclampsia Explanation: Numerous studies have shown that increasing maternal age is a risk factor for infertility and spontaneous abortions, gestational diabetes, chronic hypertension, postpartum hemorrhage, preeclampsia, preterm labor and birth, multiple pregnancy, genetic disorders and chromosomal abnormalities, placenta previa, fetal growth restriction, low Apgar scores, and surgical births.
A pregnant client is brought to the health care facility with signs of premature rupture of the membranes (PROM). Which conditions and complications are associated with PROM? Select all that apply. prolapsed cord spontaneous abortion preterm labor placenta previa abruptio placenta
prolapsed cord abruptio placenta preterm labor Explanation: The associated conditions and complications of premature rupture of the membranes are infection, prolapsed cord, abruptio placenta, and preterm labor. Spontaneous abortion and placenta previa are not associated conditions or complications of premature rupture of the membranes.
A nursing instructor is conducting a session exploring the signs and symptoms of eclampsia to a group of student nurses. The instructor determines the session is successful after the students correctly choose which signs indicating eclampsia? Select all that apply. auditory hallucinations hyperglycemia blurring of vision proteinuria hyperreflexia
proteinuria hyperreflexia blurring of vision Explanation: Eclampsia is usually preceded by an acute increase in blood pressure as well as worsening signs of multiorgan system failure seen as increasing liver enzymes, proteinuria, and symptoms such as blurred vision and hyperreflexia. Hyperglycemia and auditory hallucinations are not seen with an acute increase in maternal blood pressure or eclampsia.
A nullipara woman has been in labor for 24 hours with a uterine resting tone of 25 mm Hg. A nursing student asks the preceptor, "What can be done for this woman since she is exhausted?" Which interventions would be appropriate for the nurse to share with this student? Select all that apply. preparing for immediate cesarean birth since this is an emergency increasing IV fluid rate to maintain hydration offering a diet high in protein for energy providing additional pain medication like morphine sulfate darkening room, decreasing noise by closing the door, and encouraging rest
providing additional pain medication like morphine sulfate increasing IV fluid rate to maintain hydration darkening room, decreasing noise by closing the door, and encouraging rest Explanation: Management of a prolonged latent phase in labor that has been caused by hypertonic contractions involves helping the uterus to rest, providing adequate fluid for hydration, and pain relief with a drug such as morphine sulfate. A high protein diet will not help with the labor at this point. This is not considered an "emergency," so an amniotomy and oxytocin infusion to assist labor may be tried prior to scheduling a cesarean birth.
A multipara woman is experiencing a prolonged descent while trying to rest and increase her fluid intake. The nurse suggests that she change position. Which position(s) will be effective for pushing to speed up the descent? Select all that apply. standing, leaning against a door frame semi-Fowler position supine with knees pulled up to chest lithotomy position squatting position
semi-Fowler position squatting position Explanation: A semi-Fowler position or a squatting, kneeling position will be most effective for pushing and may speed descent. The other positions will not help speed the descent.
