OB PrepU Exam 1 (Ch. 4-12, 19, 20.)

A 35-year-old client is seen for her 2-week postoperative appointment after a suction curettage was performed to evacuate a hydatidiform mole. The nurse explains that the human chorionic gonadotropin (hCG) levels will be reviewed every 2 weeks and teaches about the need for reliable contraception for the next 6 months to a year. The client states, "I'm 35 already. Why do I have to wait that long to get pregnant again?" What is the nurse's best response?

"A contraceptive is used so that a positive pregnancy test resulting from a new pregnancy will not be confused with the increased level of hCG that occurs with a developing malignancy."

A nursing instructor is teaching students about preexisting illnesses and how they can complicate a pregnancy. The instructor recognizes a need for further education when one of the students makes which statement?

"A pregnant woman does not have to worry about contracting new illnesses during pregnancy."

A client asks why she should learn breathing patterns for labor. After instruction is given, the nurse determines teaching has been effective when the client states:

"Breathing patterns are distraction techniques taught to decrease pain in labor."

A woman at 15 weeks' gestation works at a daycare center thinks she may have just been exposed to rubella at work. The client asks how this may affect her fetus. What is the best response the nurse can give?

"By the end of the eighth week all of the organ systems and major structures are present, so exposure to any teratogen can lead to birth defects. More assessments are needed."

Which of the following would the nurse include in the teaching plan for a woman who is to have a screening mammogram?

"Don't use deodorant that day because it may interfere with the x-ray image."

The nursing student demonstrates an understanding of dystocia with which statement?

"Dystocia is diagnosed after labor has progressed for a time."

A client asks her nurse what effleurage means. After instruction is given, the nurse determines learning has taken place when the client states:

"Effleurage is light abdominal massage used to displace pain."

A woman opts to use a diaphragm for contraception. Which instruction would be most important for the nurse to provide?

"Have the diaphragm refitted if you lose 10 lbs or more"

A nurse is caring for a pregnant client at her 34-week checkup. The client has chosen the Lamaze method for her birthing plan but states that her partner does not agree. The client says she will just change her plan. Which response by the nurse would be appropriate to support the female client?

"Have you and your partner discussed what his/her role will be in the birth?"

A client is scheduled for a cesarean section under spinal anesthesia. After instruction is given by the anesthesiologist, the nurse determines the client has understood the instructions when the client states:

"I may end up with a severe headache from the spinal anesthesia."

A woman states that she does not want any medication for pain relief during labor. Her primary care provider has approved this for her. What the nurse's best response to her concerning this choice?

"I respect your preference whether it is to have medication or not."

A nurse is talking to a newly pregnant woman who had a mitral valve replacement in the past. Which statement by the client reveals an understanding about the preexisting condition?

"I understand that my fetus and I both are at risk for complications."

A woman is going to have in vitro fertilization. When preparing her for this, you would tell her which of the following?

"It can be done with frozen donor sperm."

A couple is seeking guidance for their inability to conceive a child after trying for 15 months. They are morbidly obese but state they have friends with the same weight problem who have had no difficulty conceiving. What education can the nurse provide this couple to increase their chances of success?

"Obesity may interfere with effective penetration and deposition of sperm. We will look at several factors to discover what issues you may be encountering."

A woman is documented on the labor and birth board to be 7 cm dilated. Her family wants to know how long she will be in labor. The nurse should provide which information to the family?

"She is in active labor; she is progressing at this point and we will keep you posted."

A client is 32 weeks pregnant and sent home on modified bedrest for preterm labor. She is on tocolytics and wants to know when she can have intercourse again with her husband. What is the most appropriate response by the nurse?

"That is a question to ask your health care provider; at this point you are on pelvic rest to try and stop any further labor."

The nurse is teaching a prenatal class about preparing for their expanding families. What is helpful advice from the nurse?

"The hormones of pregnancy may cause anxiety or depression postpartum."

A female client comes to the clinic and asks the nurse what would be the most cost effective method for her to determine her ovulation patterns. What is the best response by the nurse?

"The least costly method to determine ovulation patterns is to record the basal body temperature for at least 4 months."

Amanda is about 16 weeks pregnant and is concerned because she feels her "abdomen" contracting. She calls the doctors office and speaks to the nurse. What is the most appropriate response to Amanda's concern?

"What you are feeling are called Braxton Hicks contractions. They are considered practice contractions during pregnancy."

A student nurse asks the instructor about maternal pulse and blood pressure changes during the prenatal period. Which response from the nurse about cardiovascular changes during the first and second trimesters is accurate?

"Women experience increased pulse rate and decreased blood pressure." Pulse rate frequently increases during pregnancy, although the amount varies from a slight increase to 10 to 15 beats per minute. Blood pressure generally decreases slightly during pregnancy, reaching its lowest point during the second trimester.

A 38-year-old woman comes to the clinic to discuss discontinuing use of her birth control pills and attempting conception. She says to the nurse, "I know a lot of women who have waited later to have children and don't have any problem." What is the best response by the nurse?

"Women in their late 30s who use oral contraception may face a delay in conception for several months, because the body has to return to normal function before conception is possible."

A nurse is performing a vaginal examination of a woman in the early stages of labor. The woman has been at 2 cm dilated for the past 2 hours, but effacement has progressed steadily. Which statement by the nurse would best encourage the client regarding her progress?

"You are still 2 cm dilated, but the cervix is thinning out nicely."

A nurse is caring for a 45-year-old pregnant client with a cardiac disorder who has been instructed by her primary care provider to follow class I functional activity recommendations. The nurse correctly instructs the client to follow which limitations?

"You do not need to limit your physical activity unless you experience any problems such as fatigue, chest pain, or shortness of breath."

When a client is counseled about the advantages of epidural anesthesia, which statement made by the counselor would indicate the need for further teaching?

"You have no trouble walking around and using the bathroom after you receive the epidural."

A pregnant single mom living alone tells the nurse she is considering getting a cat for her two-year-old daughter. Which is the best response by the nurse?

"You should wait until after you give birth to obtain the cat for your daughter."

A 25-year-old pregnant client comes to the office for the first prenatal visit. During the history, the client tells the nurse she had tuberculosis 5 years ago. What is the nurse's best response?

"You will have to maintain an adequate level of calcium during your pregnancy."

A fetus is assessed at 2 cm above the ischial spines. How would the nurse document the fetal station?

-2

A woman's prepregnant weight is within the normal range. During her second trimester, the nurse would determine that the woman is gaining the appropriate amount of weight when her weight increases by which amount per week?

1 lb (.45 kg) The recommended weight gain pattern for a woman whose prepregnant weight is within the normal range would be 1 lb (.45 kg) per week during the second and third trimesters. Underweight women should gain slightly more than 1 lb (.45 kg) per week. Overweight women should gain about 2/3 lb (.30 kg) per week.

When discussing the many changes the woman's body undergoes during pregnancy, the nurse may include that the woman's total blood volume will increase by approximately how much by the 30th week gestation?

1,500 mL

A pregnant client is scheduled to undergo chorionic villi sampling (CVS) to rule out any birth defects. Ideally, when should this testing be completed?

10 to 12 weeks of gestation

The nurse is caring for a client after experiencing a placental abruption. Which finding is the priority to report to the health care provider?

45 ml urine output in 2 hours

A nurse is counseling a couple who have a 5-year-old daughter with Down syndrome. The nurse recognizes that their daughter's genome is represented by which chromosome combination?

47XX21+

A woman is to undergo labor induction. The nurse determines that the woman requires cervical ripening if her Bishop score is:

5

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?

6%

A pregnant woman with diabetes is having her glycosylated hemoglobin level evaluated. The nurse determines that the woman's glucose is under control and continues the woman's plan of care based on which result?

6.5%

A pregnant woman, multipara, has been in labor for several hours. She cries out that her contractions are getting harder and that she cannot do this. The client is really irritable, nauseated, annoyed, and fearful of being left alone. Considering the client's behavior, the nurse would expect the cervix to be dilated how many centimeters?

8 to 10

In which of the follow patients would the nurse first suspect cancer?

A 30-year-old with a mobile, rubbery, firm, well-circumscribed, nontender lump

Which woman is at greatest risk for developing cervical cancer?

A client whose high-risk HPV infection persists in genital skin cells

You care for a woman in a prenatal clinic who thinks she might be pregnant. Which of the following assessments is a probable sign of pregnancy?

A positive pregnancy test

You prepare a couple to have a karyotype performed. Which of the following describes a karyotype?

A visual presentation of the chromosome pattern of an individual

A woman in her third trimester has just learned that her fetus has been diagnosed with cri-du-chat syndrome. The nurse recognizes that this child will likely have which of the following characteristics?

Abnormal cat-like cry

Question 4: (see full question) A woman has just learned that she is pregnant and would like to know how soon she can find out via ultrasound the sex of her fetus. The nurse should respond with which of the following?

About 4 months

A nurse is teaching a class on preventing pregnancy to high school students. Which of the following would the nurse identify as the best method to prevent both pregnancy and sexually transmitted infections (STIs)?

Abstinence

A woman with a long history of controlled asthma has just had her first antenatal visit for her fourth child. She is late for a meeting and says she knows what to do. What is the best action the nurse can take?

Acknowledge her need to leave but ask her to demonstrate the use of her inhaler and her peak flow meter before she goes; make any necessary corrections to her technique. Remind her to take her regular medications.

A woman is going to have labor induced with oxytocin. Which statement reflects the induction technique the nurse anticipates the primary care provider will prescribe?

Administer oxytocin diluted as a "piggyback" infusion.

Primary prevention for HPV includes which of the following?

Administering HPV vaccine

A pregnant client has heard about Down syndrome and wants to know about the risk factors associated with it. Which of the following would the nurse include as a risk factor?

Advanced maternal age.

The nurse should administer Rhogam (Rh immune globulin) to the pregnant woman who is Rho(D)-, after which of the following tests?

Amniocentesis

A 24 year-old female presents with vulvar pruritus accompanied by irritation, pain on urination, erythema, and an odorless, thick, acid vaginal discharge. She denies sexual activity during the last six months. Her records show that she has diabetes mellitus and uses oral contraceptives. Which category of antimicrobial medication is most likely to clear her symptoms?

An azole antifungal agent

Which statement is true regarding analgesia versus anesthesia?

Analgesia only reduces pain, but anesthesia partially or totally blocks all pain in a particular area.

Which of the following instructions should the nurse give to a client with genital herpes to help control the infection?

Avoid sexual contact until sores heal

After teaching a client diagnosed with candidiasis about preventative measures, the nurse determines that the teaching was effective when the client states she will do which of the following?

Avoid vaginal trauma

The nurse recognizes that documenting accurate blood pressures is vital in the diagnosing of preeclampsia and eclampsia. The nurse suspects preeclampsia based on which finding?

BP of 140/90 mm Hg on two occasions 6 hours apart

When educating the postterm pregnant client, what should the nurse be sure to include to prevent fetal complications?

Be sure to monitor fetal movements daily.

When do condoms need to be applied to be effective?

Before penile and vulvar contact

You care for a child with Down syndrome (trisomy 21). This is an example of which type of inheritance?

Chromosome non disjunction

Which is the best way the nurse can facilitate an effective birth plan for the client to achieve adequate pain relief?

Client priorities and preferences are incorporated into the plan.

In which group is it most important for the client to understand the importance of an annual Papanicolaou test?

Clients infected with the human papillomavirus (HPV)

A nurse is teaching a preconception class discussing the process of conception. Which information would the nurse likely include?

Conception occurs when an ovum passes into a fallopian tube to unite with sperm.

A nurse is caring for a client administered general anesthesia for an emergency cesarean birth. The nurse notes the client's uterus is relaxed upon massage. What would the nurse do next?

Continue to massage the client's fundus.

Which of the following is the gold standard for HSV diagnosis?

Culture

A woman with cardiac disease is 32 weeks' gestation and alerts the nurse she has been having spells of light-headedness and dizziness every few days. The nurse provides which intervention as an option to the client?

Decrease activity and rest more often.

A woman is 40 years old and a heavy smoker. She has a single sexual partner but has very irregular menstrual cycles. She wants a highly reliable contraceptive. Assuming that all of the following methods of birth control are acceptable to her, which of the following would be the best recommendation?

Diaphragm and spermicide

On what day during pregnancy does the embryo implant on the uterine surface?

Eight days after ovulation

Which of the following would the nurse include in the plan of care for a client diagnosed with breast cancer who has undergone a mastectomy?

Encouraging the client to perform arm exercises

A client expresses concerns that her grandmothers had complicated pregnancies. What principles of the Healthy People 2020 initiative should the nurse enact in order to allay the fears of the client? Select all that apply.

Ensure that birth of high-risk infants happens in settings able to care for them. Prenatal risk factors are identified early and reduced. Those at risk of having a preterm births are supported in order to delay early births. Infant illnesses, disabilities, and death will be reduced with proper care.

A 30-year-old female is attending a health fair for women. The nurse at the fair is reviewing risk factors for cervical cancer. Which of the following is an important risk factor for the nurse to include at the fair?

Exposure to diethylstilbestrol (DES) in utero

While assessing the progress of the labor, the nurse explains that the fetal heart rate variability is moderate. Which explanation is best to use with the parents?

FHR fluctuates from 6 to 25 beats per minute.

Which of the following best defines the term "subfertility/infertility"?

Failure to achieve pregnancy after one year of unprotected sex

Which of the following is a positive sign of pregnancy?

Fetal movement felt by the examiner

A young woman who has recently been married asks a nurse at the clinic for something to calm her nerves and help her sleep. When assessing the patient the nurse suspects that the husband is abusing the patient. This is confirmed when the patient states, "My husband will not let me look for a job and when I need money he will not give it to me." This patient is suffering from which type of abuse?

Financial abuse

Fetal circulation differs from the circulatory path of the newborn infant. In utero the fetus has a hole connecting the right and left atria of the heart. This allows oxygenated blood to quickly pass to the major organs of the body. What is this hole called?

Foramen ovale

Genetics-related health care is basic to the holistic practice of nursing. What should nursing practice in genetics include?

Gathering relevant family and medical history information

After teaching a group of students about sexually transmitted infections (STIs), the instructor determines that additional teaching is necessary when the students identify which STI as curable with treatment?

Genital Herpes

A physician tells a client to return 2 to 3 months after treatment to have a repeat culture done to verify the cure. This order would be appropriate for a woman with which condition?

Gonorrhea

You are counseling women on birth control choices. Which woman is the best candidate for an IUD? A woman who:

Has one partner, her husband, and 3 children

A nurse is documenting a dietary plan for a pregnant client with pregestational diabetes. What instruction should the nurse include in the dietary plan for this client?

Include complex carbohydrates in the diet.

You are asked to teach a woman to take her basal body temperature daily to assess the time of ovulation. She can detect her day of ovulation, following ovulation, because her temperature will

Increase a degree

The nurse is teaching a prenatal class the signs and symptoms of true labor. Identify the appropriate response by the class that shows an understanding of true labor contractions.

Increase even if I relax and take a shower. Correct Explanation: True labor contractions do not stop; they continue and strengthen, as well as increase in frequency. If the contractions subside while taking a shower or relaxing, then they are not labor contractions. The discomfort over the top of the uterus is normal for full term pregnancy.

On a follow-up visit, a woman who was a victim of rape states that she has joined a rape survivor advocacy group. The nurse interprets this as indicating that the woman is in which phase of rape recovery?

Integration and recovery

A couple wants to start a family. They are concerned that their child will be at risk for cystic fibrosis because they each have a cousin with cystic fibrosis. They are seeing a nurse practitioner for preconceptual counseling. What would the nurse practitioner tell them about cystic fibrosis?

It is an autosomal recessive disorder.

A male patient has requested information on vasectomy. Which of the following would you include in your education to him?

It is usually done as an office procedure

A woman is crying because she just recently received the results of her biopsies, and they confirm that she has invasive breast cancer. Which response by the nurse is the most appropriate?

Listen to the woman talk and remain silent for a while

A pregnant client is admitted to a maternity clinic for birth. Which assessment finding indicates that the client's fetus is in the transverse lie position?

Long axis of fetus is perpendicular to that of client.

What important instruction should the nurse give a pregnant client with tuberculosis?

Maintain adequate hydration.

A laboring client has been pushing without delivering the fetal shoulders. The primary care provider determines the fetus is experiencing shoulder dystocia. What intervention can the nurse assist with to help with the birth?

McRobert's maneuver

Shoulder dystocia is a true medical emergency that can cause fetal demise because the baby cannot be born. Stuck in the birth canal, the infant cannot take its first breath. What is the first maneuver tried to deliver an infant with shoulder dystocia?

McRoberts maneuver

Which of the following is the most effective treatment for trichominiasis?

Metronidazole (Flagyl)

A nurse caring for a pregnant client suspected substance use during pregnancy. What is the priority nursing intervention for this client?

Obtain a urine specimen for a drug screening.

Which of the following is the medication of choice for early syphilis?

Penicillin G benzathine

A woman calls the clinic to schedule an appointment because "I think I might be pregnant." Upon further assessment gathering of information from the woman, which of the following would be a probable sign of pregnancy?

Positive home pregnancy test

What is the difference between possible, probable, and positive signs of pregnancy?

Possible- Nausea, vomiting, weight gain, etc. Probable- Positive pregnancy test Positive- Ultrasound of baby

What is the main purpose of the chorionic villi?

Provide an exchange site for the exchange of nutrients and wastes.

A nurse is describing the use of Rho(D) immune globulin as the therapy of choice for isoimmunization in Rh-negative women and for other conditions to a group of nurses working at the women's health clinic. The nurse determines that additional teaching is needed when the group identifies which situation as an indication for Rho(D) immune globulin?

STIs

A client in her third trimester of pregnancy wishes to formula feed her baby. What instruction should the nurse provide?

Serve the formula at room temperature.

A woman in the last trimester of pregnancy complains of sleeping poorly. She becomes light-headed and dizzy whenever she sleeps on her back, but she can't sleep at all if she lies on her side. How would you suggest she try sleeping?

Sleep with a pillow under her right hip

Mitosis is the process of cell division for which cells?

Somatic

A client with syphilis did not receive treatment and has now progressed into the tertiary stage of the disorder. Which of the following would the nurse expect the client to exhibit?

Tabes dorsalis, ataxia, and Charcot's joints

A woman telephones you after taking an ovulation suppressant for 3 months to tell you that she has forgotten to take her pill two mornings in a row. What would be the best advice to give her regarding this?

Take two pills now and use a second method of contraception for the remainder of the month.

A pregnant woman of Jewish descent comes to the clinic for counseling and tells the nurse that she is worried her baby may be born with a genetic disorder. Which disease does the nurse identify to be a risk for this client's baby based on the family's ancestry?

Tay-Sachs

A pregnant woman of Jewish descent comes to the clinic for counseling and tells the nurse that she is worried her baby may be born with a genetic disorder. Which of the following diseases does the nurse identify to be a risk for this patient's baby based on the family's ancestry?

Tay-Sachs

During a routine antepartal visit, a pregnant woman reports a white, thick, vaginal discharge. She denies any itching or irritation. Which action would the nurse do next?

Tell the woman that this is entirely normal.

A baby is born with what the primary care provider believes is a diagnosis of trisomy 21. This means that the infant has three number 21 chromosomes. What factor describes this genetic change?

The client has a nondisjunction occurring during meiosis.

Labor can be indicated by which occurrence?

The client reports back pain, and the cervix is effacing and dilating.

A client has just arrived at the hospital, in early labor, showing signs of extreme anxiety over the birth to come. Why is it so important that the nurse help the client relax?

The client's anxiety can actually slow down the labor process and decrease the amount of oxygen reaching the uterus and the fetus.

When describing the role of a doula to a group of pregnant women, which of the following would the nurse include?

The doula primarily focuses on providing continuous labor support.

A breast tumor is most likely found in what part of the breast?

The upper, outer quadrant

Which signs signify that the second stage of labor has begun?

The urge to push occurs.

The pain of labor is influenced by many factors. What is one of these factors?

The woman is prepared for labor and birth.

What should the nurse explain to the pregnant patient about the importance of the fetal stage of development?

There is additional growth and development of the organs and body systems.

The nurse instructs the client about skin massage and the gate control theory of pain. Which statement would be appropriate for the nurse to include for client understanding of the nonpharmacologic pain relief methods?

These methods are a technique to prevent the painful stimuli from entering the brain.

A client desires protection from unwanted pregnancies. However, the client does not enjoy sex when her partner wears a male condom. Also, the client experiences breast tenderness, headache, and nausea after taking oral contraceptives. Which method would be the most likely choice for the couple to help them enhance their sexual experience as well as prevent any side effects?

Transdermal Contraceptive

Copious amounts of frothy, greenish vaginal discharge would be a symptom of which infection?

Trichomoniasis

If the monitor pattern of uteroplacental insufficiency were present, which action would the nurse do first?

Turn her or ask her to turn to her side.

A nurse is speaking to a local women's group about the various types of cancer affecting the female reproductive tract. The nurse explains that ovarian cancer is the leading cause of death from gynecologic malignancies based on the understanding that this type of cancer:

Typically manifest with vague symptoms resulting in late diagnosis

During a follow-up visit, a female client who underwent a mastectomy asks the nurse if she can work in her backyard or at least do some household work. Which suggestion would be most appropriate?

Wear gloves and protective clothing to avoid any injuries

A pregnant client in her second trimester informs the nurse that she needs to travel by air the following week. Which precaution should the nurse instruct the client to take during the flight?

Wear support hose Correct Explanation: The nurse should instruct the client to wear support hose while traveling by air. The nurse should also instruct the client to periodically exercise the legs and ankles, and walk in the aisles if possible. Wearing low-heeled shoes, cotton clothes or a padded bra will have no effect on the client during the flight.

A woman is to undergo karyotyping. The nurse best explains this testing as:

a picture-like analysis of the number, form, and size of the woman's chromosomes.

During a prenatal visit, the nurse inspects the skin of the client's abdomen. Which of the following would the nurse identify as an abnormal finding?

a) Bruising Explanation: Bruising would not be a normal finding. Evidence of bruising might suggest domestic violence. Linea nigra, striae, and

A nurse is conducting an in-service program for staff nurses working in the labor and birth unit. The nurse is discussing ways to promote a positive birth outcome for the woman in labor. The nurse determines that additional teaching is necessary when the group identifies which measure?

allowing the woman time to be alone

Rho(D) immune globulin will be prescribed for an Rh negative mother undergoing which test?

amniocentesis

Immediately after giving birth to a full-term infant, a client develops dyspnea and cyanosis. Her blood pressure decreases to 60/40 mm Hg, and she becomes unresponsive. What does the nurse suspect is happening with this client?

amniotic fluid embolism

A nurse is caring for a pregnant client with heart disease in a labor unit. Which intervention is most important in the first 48 hours postpartum?

assessing for cardiac decompensation

The nurse is required to assess a pregnant client who is reporting vaginal bleeding. Which nursing action is the priority?

assessing the amount and color of the bleeding

A potential complication for the mother and fetus is Rh incompatibility; therefore, assessment should include blood typing. If the mother is Rh negative, her antibody titer should be evaluated. If treatment with Rho(D) immune globulin is indicated, the nurse would expect to administer it at which time?

at 28 weeks

The labor client is prepared for natural birth and has brought with her a picture to use as her object for imagery during labor. What type of nonpharmacologic pain management is this considered?

attention focusing

The nurse is assessing a woman who had a forceps-assisted birth for complications. Which condition would the nurse assess in the fetus?

caput succedaneum

There are four essential components of labor. The first is the passageway. It is composed of the bony pelvis and soft tissues. What is one component of the passageway?

cervix

When providing counseling on early pregnancy loss, the nurse should discuss which factor as the most common cause for spontaneous abortion?

chromosomal abnormality

Which intervention would be most important when caring for the client with breech presentation confirmed by ultrasound?

continuing to monitor maternal and fetal status

During pregnancy a woman has many psychological adaptations that must be made. The nurse must remember that the baby's father is also experiencing the pregnancy and has adaptations that must be made. Some fathers actually have symptoms of the pregnancy along with the mothers. What is this called?

couvade syndrome

A pregnant client has received general anesthesia for the birth of her neonate. The client manifests tachycardia, decreased oxygen saturation, cyanosis, and muscle rigidity. The nurse anticipates the primary care provider will prescribe what medication?

dantrolene sodium

A client in the active phase of labor is diagnosed as having a protracted labor pattern. Which pattern would the nurse assess as indicative of a protracted labor pattern?

delayed descent of the fetal head

The nurse explains Leopold's maneuvers to a pregnant client. For which purposes are these maneuvers performed? Select all that apply.

determining the lie of the fetus determining the position of the fetus determining the presentation of the fetus

Which effect would the nurse identify as a normal physiologic change in the renal system due to pregnancy?

dilation of the renal pelvis

When caring for a pregnant woman with cardiac problems, the nurse must be alert for signs and symptoms of cardiac decompensation (congestive heart failure), which include:

dyspnea, crackles, and irregular weak pulse.

A woman is lightly stroking her abdomen in rhythm with her breathing during contractions. The nurse identifies this technique as:

effleurage.

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

The nursing student correctly identifies which risk factors for developing dystocia? Select all that apply.

epidurals high fetal station at complete cervical dilation excessive analgesia multiple gestation shoulder dystocia maternal exhaustion

A woman is in the fourth stage of labor. During the first hour of this stage, the nurse would assess the woman's fundus at which frequency?

every 15 minutes

The nurse assesses that the fetus of a woman is in an occiput posterior position. Which description identifies the way the nurse would expect the client's labor to differ from others?

experience of additional back pain

A client in week 38 of her pregnancy has an ultrasound performed at a routine office visit and learns that her fetus has not moved out of a breech position. Which intervention does the nurse anticipate for this client?

external cephalic version

A nurse is monitoring a client with PROM who is in labor and observes meconium in the amniotic fluid. What does the observation of meconium indicate?

fetal distress related to hypoxia

If a fetus were not receiving enough oxygen during labor because of uteroplacental insufficiency, which pattern would the nurse anticipate seeing on the monitor?

fetal heart rate declining late with contractions and remaining depressed

The RN in labor and birth documents the fetus as ROA. To what does this documentation refer for a fetus?

fetal position

Fetal circulation differs from the circulatory path of the newborn infant. In utero the fetus has a hole connecting the right and left atria of the heart. This allows oxygenated blood to quickly pass to the major organs of the body. What is this hole called?

foramen ovale

To give birth to her infant, a woman is asked to push with contractions. Which pushing technique is the most effective and safest?

head elevated, grasping knees, breathing out

A nurse assesses a 32-year-old primigravida client with twin gestation in her second trimester. The client reports constipation from iron supplements. Which condition should the nurse assess for in this client as a result of the constipation?

hemorrhoids

A nursing instructor highlights which risk factors associated with preterm labor? Select all that apply.

history of previous preterm birth uterine or cervical abnormalities current multiple gestation pregnancy

The nurse is explaining the process of conception and implantation to a group of women attending a preconception planning education program. When describing the hormones involved in these events, the nurse would identify which hormone as being responsible for ensuring implantation of the embryo at the beginning of conception?

human chorionic gonadotropin (hCG)

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.

The nurse is assisting a client through labor, monitoring her closely, now that she has received an epidural. The nurse would report which finding to the anesthesiologist?

inability to push

The nurse is teaching a prenatal class the signs and symptoms of true labor. What is the appropriate response by the class that shows an understanding of true labor contractions?

increase even if I relax and take a shower

A nurse is caring for a pregnant client with rhythmic uterine contractions. Which feature should the nurse identify as associated with true labor?

increase in frequency of the contractions

The nurse is reviewing the laboratory test results of a client in labor. Which finding would the nurse consider normal?

increased white blood cell count

When educating a client about pregestational diabetes on how to control blood sugar, the nurse knows there are three main facets to glycemic control. In addition to diet and exercise, which is a main facet?

insulin

When genetics and genomics were incorporated into nursing, the decision was made to include them in what part of the nursing process?

interventions that support identification of the genetics-related health needs of people

Early in labor, a pregnant client asks why contractions hurt so much. Which answer should the nurse provide?

lack of oxygen to the muscle fibers of the uterus due to compression of blood vessels

At the hospital, a client is attached to the fetal monitor for uterine rupture. The nurse would assess for which pattern indicating change in the uterus impacting the fetus?

late decelerations

The nurse is working with a client in labor. She is happy and cheerful and states she is "ready to see her baby." What stage or phase of labor would she anticipate the client to be in right now?

latent phase

A nurse informs a pregnant woman with cardiac disease that she will need two rest periods each day and a full night's sleep. The nurse further instructs the client that which position for this rest is best?

left lateral recumbent

The infant born to a woman with untreated tuberculosis (TB) is more likely to have which conditions? Select all that apply.

low Apgar score perinatal death postnatal TB underweight

A woman is taking vaginal progesterone suppositories during her first trimester because her body does not produce enough of it naturally. She asks the nurse what function this hormone has in her pregnancy. What should the nurse explain is the primary function of progesterone?

maintains the endometrial lining of the uterus during pregnancy

A pregnant woman with chronic hypertension comes to the clinic for evaluation. The last several blood pressure readings were gradually increasing. On today's visit her blood pressure is 166/100 mm Hg. The health care provider prescribes an antihypertensive agent. The nurse anticipates which agent as being most commonly prescribed?

methyldopa

During a routine prenatal visit, a client is found to have proteinuria and a blood pressure rise to 140/90 mm Hg. The nurse recognizes that the client has which condition?

mild preeclampsia

A nurse is conducting a presentation for a group of pregnant women about labor and the importance of being well prepared and having good labor support. The nurse determines that additional discussion is needed when the group identifies which possible outcome as the result of being prepared?

need for someone to control the situation

A woman with an artificial mitral valve develops heart failure at the 20th week of pregnancy. Which measure would the nurse stress with her during the remainder of the pregnancy?

obtaining enough rest

Assessment reveals that the fetus of a client in labor is in the vertex presentation. The nurse determines that which part is presenting?

occiput

The nurse explains to a pregnant client that she will need to take iron during her pregnancy after being diagnosed with iron-deficiency anemia. The nurse suggests that absorption of the supplemental iron can be increased by taking it with which substance?

orange juice

The nurse explains to a pregnant client that she will need to take iron during her pregnancy after being diagnosed with iron-deficiency anemia. The nurse suggests that absorption of the supplemental iron can be increased by taking it with:

orange juice.

The five "Ps" of labor are:

passageway, passenger, position, powers, psych.

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 broccoli raisins

The nurse is assessing a woman with class III heart disease who is in for a prenatal visit. What would be the first recognizable sign that this client is in heart failure?

persistent rales in the bases of the lungs

A client in her fifth month of pregnancy is having a routine clinic visit. The nurse should assess the client for which common second trimester condition?

physiological anemia

On a routine hematocrit screen during a prenatal visit, the nurse notices that the client is mildly anemic. When discussing this with the couple, the husband hints that she might be eating unusual things. The nurse recognizes the need for the woman to be evaluated for which condition?

pica

When caring for a client requiring a forceps-assisted birth, the nurse would be alert for:

potential lacerations and bleeding.

A client has presented in the early phase of labor. She is experiencing abdominal pain and shows signs of growing anxiety about the pain. What is the best pain management technique the nurse can suggest at this stage?

practicing effleurage on the abdomen

A client is admitted to labor and birth for management of severe preeclampsia. An IV infusion of magnesium sulfate is started. What is the primary goal for magnesium sulfate therapy?

prevent maternal seizures

She says, "I know my breasts are going to get bigger, but I didn't think that it would be uncomfortable." The nurse offers suggestions to address this discomfort, based on the understanding that this change is the result of which hormones? Select all that apply.

progesterone estrogen

The nurse explains to the pregnant client that the placenta is important for many reasons, but one function it has is to secrete hormones to sustain the pregnancy. Which hormones does the nurse inform the client that the placenta secretes? Select all that apply.

progesterone estrogen human chorionic gonadotropin human placental lactogen

The hormone responsible for the initiation of lactation is what?

prolactin

When assessing fetal heart rate patterns, which finding would alert the nurse to a possible problem?

prolonged decelerations

A pregnant woman comes to the emergency department because she thinks she is in labor. The nurse determines that the client is in true labor when assessment of contractions reveals which finding?

radiating to the front of the abdomen from the back

After assessing a client's progress of labor, the nurse suspects the fetus is in a persistent occiput posterior position. Which finding would lead the nurse to suspect this condition?

reports of severe back pain

A pregnant client is admitted to a maternity clinic after experiencing contractions. The assigned nurse observes that the client experiences pauses between contractions. The nurse knows that which event marks the importance of the pauses between contractions during labor?

restoration of blood flow to uterus and placenta

The placenta is the site where antibodies in the mother's blood pass into the fetal circulation. These antibodies give passive immunity to the fetus for several common childhood diseases. There are some infections for which the mother does not provide antibodies to the fetus. What infection is the fetus not protected from?

rubella

The health care provider is evaluating a high-risk woman for a continuous internal monitoring. It would be most appropriate to meet which criterion?

rupture of membranes

Which medication is not an opioid that is commonly used during labor and birth?

secobarbital

Girls with Turner syndrome will usually exhibit:

short stature.

Assessment of a woman in labor reveals that the scapula of the fetus is the presenting part. The nurse interprets this finding as indicating which fetal presentation?

shoulder

During pregnancy, there are many psychological changes. What is the most critical component for a positive psychological experience with pregnancy by the woman?

social support All options are correct and play a role pregnancy, but the most critical for a positive psychological experience is for the woman to have a social support system. Early care, maternal age, and planned pregnancy all affect fetal and maternal health, but are not necessarily linked to positive psychological experiences.

A nurse is conducting a presentation at a community health center about congenital malformations. The nurse describes that some common congenital malformations can occur and are recognized to be caused by multiple genetic and environmental factors. Which example would the nurse most likely cite?

spina bifida

What is a nursing intervention that helps prevent the most frequent side effect from epidural anesthesia in a pregnant client?

starting an IV and hanging IV fluids

What is the role of the nurse during the preconception counseling of a pregnant client with chronic hypertension?

stressing the positive benefits of a healthy lifestyle

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

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 identifies which findings as suggesting an amniotic fluid embolism? Select all that apply.

sudden onset of respiratory distress hypotension tachycardia

Nurses are expected to know how to use the first genetic test. What is it?

the family history

In preparing for a preconception class, the nurse plans to include a discussion of potential risk factors. Which risk factor would be most important to include?

the use of OTC drugs with teratogens

A client has just given birth to a healthy baby boy, but the placenta has not yet delivered. What stage of labor does this scenario represent?

third

Which change in the breasts should a nurse recognize as a normal change associated with pregnancy?

tingling sensations and tenderness Normal changes in the breasts associated with pregnancy include tingling sensations and tenderness, enlargement of the breast and nipples, hyperpigmentation of the areola and nipples, enlargement of Montgomery tubercles, prominence of superficial veins, development of striae, and expression of colostrum in the second and third trimesters.

A pregnant woman in her second trimester comes to the prenatal clinic for a routine visit. She reports that she has a new kitten. The nurse would have the woman evaluated for which infection?

toxoplasmosis

During the second stage of labor, a woman is generally:

turning inward to concentrate on body sensations.

Which fetal structure has the highest oxygen concentration?

umbilical vein

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?

use of IUD for contraception

A nurse is caring for a client who is scheduled to undergo an amnioinfusion. The nurse would question this prescription if which finding is noted upon client assessment?

uterine hypertonicity

When providing education on pre-conceptual considerations to a female client and her spouse, the nurse knows that teratogens during the embryonic stage pose the greatest risk to the fetus. The nurse describes this stage as occurring during which time frame?

weeks 2 to 8

A woman in the last trimester of pregnancy reports sleeping poorly. She becomes light-headed and dizzy whenever she sleeps on her back, but she cannot sleep at all if she lies on her side. How would the nurse suggest she try sleeping?

with a pillow under her right hip Pregnancy places strain on the cardiovascular system with increased fluid in the lungs and heart. When the woman lies flat on her back the uterus and contents can compress the vena cava and aorta and reduce blood flow resulting in the light-headed and dizzy spells. Removal of the pillow would not affect the effects on the vena cava. A pillow under the shoulders would hurt the neck, and a pillow under both hips would exacerbate the light-headedness.

Which of the following body system changes would the nurse associate with menopause? Select all that apply.

• Hot flashes • Increased abdominal fat • Vaginal dryness • Decreased bone density

A 47-year-old woman was just diagnosed with a cancer of her reproductive tract. The public health nurse is aiding in counseling. Which of the following nursing interventions would be supportive in counseling this woman? Select all that apply.

• Validate the client's feelings and provide realistic hope • Give post-operative care and instructions when prescribed • Use sincere basic communication techniques

Yvonne, a 27-year-old client, is in the first trimester of an unplanned pregnancy. She acknowledges that it would be best if she were to quit smoking now that she is pregnant, but states that it would be too difficult given her 13 pack-year history and circle of friends who also smoke. She asks the nurse, "Why exactly is it so important for me to quit? I know lots of smokers who have happy, healthy babies." What can the nurse tell Yvonne about the potential effects of smoking in pregnancy?

"Babies of women who smoke tend to weigh significantly less than other infants."

A couple has just learned that their son will be born with Down's syndrome. The nurse shows a lack of understanding when making which of the following statements?

"I will alert your entire family, so that you don't have to"

After teaching a pregnant woman how to count fetal movements, the nurse determines that the teaching was successful when the client makes which statement?

"I'll sit comfortably in a recliner or lie on my side when I do the counts."

At 40 weeks' gestation, a woman in for her prenatal visits states to the nurse "I am tired of being pregnant." What is the appropriate response by the nurse?

"That is a very normal feeling, especially at this point in pregnancy." During the third trimester, the client is preparing for parenthood and is often tired and ready for a break. The woman may feel large and unable to do any normal activities and be ready to have her baby in her arms rather than in her uterus. This is not an abnormal statement, and the provider should not overreact. Deciding to induce is something that should be done in consultation with the care provider, and only when it failing to do so would have a negative impact on the mother or baby.

A client in her second trimester of pregnancy is anxious about the blotchy, brown pigmentation appearing on her forehead and cheeks. She also reports increased pigmentation on her breasts and genitalia. Which statement by the nurse is most appropriate?

"This is called facial melasma and should fade after the birth."

A mother comes in with her 17-year-old daughter to find out why she has not had a menstrual cycle for a few months. Examination confirms the daughter is pregnant with a fundal height of approximately 24 cm. The nurse interprets this finding as indicating that the daughter is approximately how many weeks pregnant?

24

A woman comes to the clinic for her first prenatal checkup. The woman has a body mass index (BMI) of 22. The nurse would anticipate that this client should gain approximately how much weight during her pregnancy?

25 to 35 lbs (11 to 16 kg)

A married couple, both age 27, is in the reproductive clinic and have been trying for a year to become pregnant. In a year, what percent of couples usually do conceive?

90%

A client has been admitted with primary syphilis. Which signs or symptoms should the nurse expect to see with this diagnosis?

A painless genital ulcer that appeared about 3 weeks after unprotected sex

A client has just received IV sedation. What must the nurse tell the client to do?

Ambulate only with assistance from the nurse or caregiver.

A young woman is having trouble conceiving and has come in to the office for fertility testing. She states that she has irregular and unpredictable menstrual cycles. On blood testing, it is found that her ovaries are producing excess testosterone, which is lowering her follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels. Which of the following is the most likely cause of her subfertility?

Anovulation

During a routine antepartal visit, a pregnant woman reports a white thick vaginal discharge. Which of the following would the nurse do next?

Ask the women if she is having any irritation or itching

The nurse understands that the maternal uterus should be at what location at 20 weeks' gestation?

At the level of the umbilicus

Which nursing intervention is appropriate when preparing a woman for an amniocentesis?

Be certain she knows that there are risks of complication, such as premature labor, from amniocentesis.

Which change related to the vital signs is expected in pregnant women?

Blood pressure decreases. Pulse and temperature often increase, while lung space is decreased in pregnant women. It is common for blood pressure to decrease during pregnancy.

A 25-year-old client wants to know if her baby boy is at risk for Down syndrome because one of her distant relatives was born with it. Which information would the nurse share with the client while counseling her about Down syndrome?

Children with Down syndrome have extra genetic material in the 21 chromosome that occurs during development of the sperm or egg.

Between her regularly scheduled visits, a woman in her first trimester of pregnancy who is taking iron supplements for anemia calls the nurse at her obstetrician's office reporting constipation. She reports that she has never had this problem before and asks for some advice about how to get relief. What is the best advice the nurse can give her?

Continue taking iron supplements but increase fluids and high-fiber foods; exercise more.

A client in her third trimester of pregnancy arrives at a health care facility with a report of cramping and low back pain; she also notes that she is urinating more frequently and that her breathing has become easier the past few days. Physical examination conducted by the nurse indicates that the client has edema of the lower extremities, along with an increase in vaginal discharge. What should the nurse do next?

Continue to monitor the client.

An intrauterine device has been inserted into a client as a requested birth control method. Which of the following is an advantage of intrauterine devices (IUDs)?

Continuous protection without client's active participation

When preparing a class for a group of pregnant women about nicotine use during pregnancy, the nurse describes the major risks associated with nicotine use including:

Decreased birth weight in neonates Explanation: The nurse should inform the client that children born of mothers who use nicotine will have a decreased birth weight. Spontaneous abortion is associated with caffeine use. Increased risks of stillbirth and placenta abruptio are associated with mothers addicted to cocaine.

Which of the following would the nurse identify as a normal physiologic change in the renal system due to pregnancy?

Dilation of the renal pelvis

The nurse is assessing a couple who has come to the health care facility because they have been unable to conceive a child. When assessing the woman, which factor would the nurse identify as increasing the woman's risk for infertility?

Endometriosis

A client in her 39th week of gestation arrives at the maternity clinic stating that earlier in her pregnancy, she experienced shortness of breath. However, for the past few days, she has been able to breathe easily, but she has also begun to experience increased urinary frequency. A nurse is assigned to perform the physical examination of the client. Which observation is most likely?

Fundal height has dropped since the last recording. Between 38 and 40 weeks of gestation, the fundal height drops as the fetus begins to descend and engage into the pelvis. Because it pushes against the diaphragm, many women experience shortness of breath. By 40 weeks, the fetal head begins to descend and engage into the pelvis. Although breathing becomes easier because of this descent, the pressure on the urinary bladder now increases, and women experience urinary frequency. The fundus reaches its highest level at the xiphoid process at approximately 36, not 39, weeks. By 20 weeks' gestation, the fundus is at the level of the umbilicus and measures 20 cm. At between 6 and 8 weeks of gestation, the cervix begins to soften (Goodell sign) and the lower uterine segment softens (Hegar's sign).

Amanda makes an appointment with an obstetrician. During the exam, the obstetrician notes that the uterine isthmus is soft. What is the name of this sign, and how is it classified?

Hegar's sign; probable

A client is in active labor. Checking the EFM tracing, the nurse notes variables that are abnormal. What would be the nurse's first nursing intervention?

Help the woman change positions.

During contractions, the electronic fetal monitor (EFM) shows variable V-shaped decelerations in the FHR lasting about 30 seconds with accelerations of about 5 bpm before and after each deceleration. Overshoot is absent, and the baseline FHR is within normal limits. What should the nurse do first?

Help the woman change positions.

A pregnant woman is experiencing morning sickness. Which response indicates a need for further teaching?

I'll take antacid between meals. Correct Explanation: The patient should avoid use of medications unless prescribed by the provider. Avoiding an empty stomach, snacking on a cracker, or eating small servings of bland food are better options and may manage the morning sickness.

A pregnant client with sickle cell anemia is at an increased risk for having a sickle cell crisis during pregnancy. Aggressive management for a client experiencing a sickle cell crisis with severe pain includes which measure?

I.V. fluids

A pregnant client is admitted to a maternity clinic for birth. The client wishes to adopt the kneeling position during labor. The nurse knows that which to be an advantage of adopting a kneeling position during labor?

It helps to rotate fetus in a posterior position.

Why is a Papanicolaou smear done at the first prenatal visit?

It identifies abnormal cervical cells. Correct Explanation: A Pap smear is a test for cervical cancer. Should abnormal cells be present, the woman may need to make a decision about her priorities of therapy for cervical disease or continuing the pregnancy.

When the nurse is assisting the parents in the grieving process after the death of their neonate, what is the nurse's most important action?

Keep the communication lines open.

A middle-aged woman is seen in the OB/GYN clinic and complains of abdominal bloating, fatigue, abdominal pain, urinary frequency, and constipation. She also says that she had lost 24 pounds in the last month without trying to lose. For which disease should the physician screen this patient?

Ovarian cancer

A woman is pregnant and has asthma. Her primary care provider has told her to continue taking prednisone during pregnancy, but she is concerned the drug may be teratogenic. What advice would be best to give her regarding this?

Prednisone is considered safe in the doses prescribed by her care provider.

A 32-year-old woman presents to the labor and birth suite in active labor. She is multigravida, relaxed, and talking with her husband. When examined by the nurse, the fetus is found to be in a cephalic presentation. His occiput is facing toward the front and slightly to the right of the mother's pelvis, and he is exhibiting a flexed attitude. How does the nurse document the position of the fetus?

ROA

The nurse has been asked to present information to a group of civic leaders concerning women's health issues. In preparing the information, the nurse includes what goal from Healthy People 2020 related to women in labor?

Reduce the rate of cesarean births among low-risk births.

A nurse is caring for a client in her second trimester of pregnancy. During a regular follow-up visit, the client reports varicosities of the legs. Which instruction should the nurse provide to help the client alleviate varicosities of the legs?

Refrain from crossing legs when sitting for long periods.

A primigravida client has come to the clinic for a prenatal checkup. What teaching topics would help to promote a healthy pregnancy for this client?

Swimming in a pool is a recommended exercise during pregnancy. Correct Explanation: Swimming in a pool is good exercise for a pregnant woman. However, swimming in a lake can be harmful because of the danger of infection, especially in the latter months. Douching can increase the risk of vaginal infections. Increased salivation or ptyalism, seen in some women during pregnancy, does not cause tooth decay and necessitate more frequent brushing. Lanolin ointments may damage the areola and nipple and have not been shown to be effective in preventing sore and cracked nipples.

A pregnant client wants to know why the labor of a first-time-pregnant woman usually lasts longer than that of a woman who has already given birth once and is pregnant a second time. What explanation should the nurse offer the client?

The cervix takes around 12 to 16 hours to dilate during first pregnancy.

A woman with ovarian cancer has been told that she is in stage three of the cancer. The nurse is reviewing the information with her. Which of the following statements would help in the woman's understanding of stage three ovarian cancer?

The growth has spread to the lymph nodes and other areas/organs in the abdominal cavity.

Which possible outcome would be a major disadvantage of any pain-relief method that also affects awareness of the mother?

The mother may have difficulty working effectively with contractions.

Which statement describes why hypertonic contractions tend to become very painful?

The myometrium becomes sensitive from the lack of relaxation and anoxia of uterine cells.

Which event will result in zygote formation?

The nucleus of the ovum and sperm make contact and combine chromosomes.

An OB/GYN nurse is teaching a new female client how to perform breast self-examination. Which of the following is a recommended step for this examination?

To examine the right breast, put a pillow or folded towel under the right shoulder

A nurse is preparing a patient for rhythm strip testing. She places the woman into a semi-Fowler's position. What is the appropriate rationale for this measure?

To prevent supine hypotension syndrome

A young woman says she is needs a temporary contraceptive but has a latex allergy. She mentions that she has a papillomavirus infection. Also, she says she is terrible about remembering to take pills. Which method should the nurse recommend?

Transdermal contraception

A number of inherited diseases can be detected in utero by amniocentesis. Which of the following diseases can be detected by this method?

Trisomy 21

Body joints become more relaxed with pregnancy because of relaxin, a hormone produce by the placenta.

True

Smoking may be a cause of ectopic (tubal) pregnancy.

True

A nurse is assessing a client diagnosed with bacterial vaginosis. Which of the following is a symptom of bacterial vaginosis?

Vaginal odor smelling of fish

The generation-to-generation continuum of violence refers to the fact that

Violence is a learned behavior, and children who witness abuse are more likely to become abusers themselves

Which of the following would alert the nurse to suspect that a client has a yeast infection?

Vulvar burning and itching

The nurse is caring for a client experiencing a prolonged second stage of labor. The nurse would place priority on preparing the client for which intervention?

a forceps and vacuum-assisted birth

A woman experiences an amniotic fluid embolism as the placenta is delivered. The nurse's first action would be to:

administer oxygen by mask.

The nurse caring for a client in preterm labor observes abnormal fetal heart rate (FHR) patterns. Which nursing intervention should the nurse perform next?

administration of oxygen by mask

During pregnancy, one of progesterone's actions is to allow sodium to be "wasted" or lost in the urine. The nurse would expect to see which hormone increased to help counteract this loss?

aldosterone

After teaching a review class to a group of perinatal nurses about various methods for cervical ripening, the nurse determines that the teaching was successful when the group identifies which method as surgical?

amniotomy

The clinic nurse teaches a pregestational type 1 diabetic client that constant insulin levels are very important in during pregnancy. The nurse tells the client that the best way to maintain a constant insulin level is to use:

an insulin pump.

A woman whose fetus in in the occiput-posterior position is experiencing increased back pain. Which is the best way for the nurse to help alleviate this back pain?

applying counter pressure to the back

Cystic fibrosis is an example of which type of inheritance?

autosomal recessive

A client is admitted at 22 weeks' gestation with advanced cervical dilatation to 5 centimeters, cervical insufficiency, and a visible amniotic sac at the cervical opening. What is the primary goal for this client at this point?

bed rest to maintain pregnancy as long as possible

Human papillomavirus (HPV) can cause condylomata acuminata that can develop in clusters on the vulva, within the vagina, on the cervix, or around the anus. What is their risk?

block a vaginal birth

A client is experiencing shoulder dystocia during birth. The nurse would place priority on performing which assessment postbirth?

brachial plexus assessment

The nurse is examining a woman who came to the clinic because she thinks she is pregnant. Which data collected by the nurse are presumptive signs of her pregnancy? Select all that apply.

breast changes amenorrhea morning sickness

A young mother has tested positive for HIV. When discussing the situation with the client, the nurse should advise the mother that she should avoid which activity?

breastfeeding

A fetus is in the LST position. The nurse interprets this as indicating which presenting part?

buttocks

A 16-year-old client has been in the active phase of labor for 14 hours. An ultrasound reveals that the likely cause of delay in dilatation is cephalopelvic disproportion. Which intervention should the nurse most expect in this case?

cesarean birth

What are the two fetal membranes?

chorion and amnion

A nurse is assessing a pregnant client for the possibility of preexisting conditions that could lead to complications during pregnancy. The nurse suspects that the woman is at risk for hydramnios based on which preexisting condition?

diabetes

A woman's nurse-midwife tells her that the woman has developed dystocia. The nurse explains that this term means:

difficult or abnormal labor.

When assessing a woman in the first stage of labor, the nurse recognizes that the most conclusive assessment that uterine contractions are effective would be:

dilatation of cervix.

A nurse is caring for a pregnant client in labor in a health care facility. The nurse knows that which sign marks the termination of the first stage of labor in the client?

dilation of cervix diameter to 10 cm

A woman is being closely monitored and treated for severe preeclampsia with magnesium sulfate. Which finding would alert the nurse to the development of magnesium toxicity in this client?

diminished reflexes

A 28-year-old woman presents in the emergency department with severe abdominal pain. She has not had a normal period for 2 months, but she reports that that is not abnormal for her. She has a history of endometriosis. What might the nurse suggest to the primary care provider as a possible cause of the client's abdominal pain?

ectopic pregnancy

When teaching a group of nursing students about the stages of labor, the nurse explains that softening, thinning, and shortening of the cervical canal occur during the first stage of labor. Which term is the nurse referring to in the explanation?

effacement

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

The third stage of labor is considered to be expulsion of the placenta. This stage can last anywhere from five to 20 minutes. What is a sign that the placenta is separating from the wall of the uterus?

globular shape to the fundus

A client has been admitted with abruptio placentae. She has lost 1,200 mL of blood, is normotensive, and ultrasound indicates approximately 30% separation. The nurse documents this as which classification of abruptio placentae?

grade 2

A pregnant client has come to the labor and birth suite in labor. The nurse reviews the client's medical record and determines that a vaginal birth is favorable based on which finding related to the client's pelvic shape?

gynecoid

Which type of pelvis has a roomy, round inlet and is most favorable for vaginal birth?

gynecoid

A client has arrived to the birthing center in labor, requesting a VBAC. The nurse knows that she would be a good candidate after reading the client's previous history based on which finding?

has previous lower abdominal incision

A nursing instructor is teaching students about fetal presentations during birth. The most common cause for increased incidence of shoulder dystocia is:

increasing birth weight.

A pregnant client arrives at the maternity clinic reporting constipation. Which factors could be the cause of constipation during pregnancy? Select all that apply.

intestinal displacement use of iron supplements decreased activity level

A nurse who has been caring for a pregnant client understands that the client has pica and has been regularly consuming soil. For which condition should the nurse monitor the client?

iron-deficiency anemia

A nurse is caring for a pregnant adolescent client, who is in her first trimester, during a visit to the maternal child clinic. Which important area should the nurse address during assessment of the client?

knowledge of child development

The nurse assesses a client in labor and finds that the fetal long axis is longitudinal to the maternal long axis. How should the nurse document this finding?

lie

A woman in her third trimester shows the nurse a narrow, brown line that has formed on her abdomen, running from her belly button down to her pubic region. She expresses concern about this and asks the nurse whether it is normal. The nurse explains that this is a normal occurrence of pregnancy and that it results from the release of melanocyte-stimulating hormone from the pituitary, causing the appearance of extra pigmentation on the skin. What is the name of this phenomenon?

linea nigra

A nurse is reviewing the medical record of a pregnant client diagnosed with placenta previa. The physical exam reveals that the placenta is implanted near the internal os but does not reach it. The nurse interprets this as which type of placenta previa?

low-lying

When assessing newborns for chromosomal disorders, which assessment would be most suggestive of a problem?

low-set ears

An 18-year-old pregnant woman asks the nurse why she has to have a routine alpha-fetoprotein serum level drawn. The nurse explains that this:

may reveal chromosomal abnormalities.

The nurse explains to a pregnant client, who is anemic, that she will need to take vitamins with iron during her pregnancy. What foods would the nurse include on the client's diet plan?

meats

Which medication would the nurse prepare to administer if prescribed as treatment for an unruptured ectopic pregnancy?

methotrexate

A nursing student correctly identifies that a person's outward appearance or expression of genes is referred to as the:

phenotype

While providing an education to a prenatal class for first-time mothers and fathers during the first trimester, the nurse includes information that the father may experience which occurrence as normal during the pregnancy?

physical symptoms similar to the mother Couvade syndrome is the occurrence of physical symptoms by the male, similar to the physical symptoms of the mother. Other emotional symptoms may occur, but they are typically on a person-to-person basis.

When a woman is pregnant she often craves specific things, like pickles or ice cream. There is one craving that is associated with iron deficiency anemia and should be reported to the registered nurse if it occurs. What is this craving called?

pica craving

A nurse is providing care to a multiparous client. The client has a history of cesarean births. The nurse anticipates the need to closely monitor the client for which condition?

placenta accreta

Early in pregnancy, frequent urination results mainly from which cause?

pressure on the bladder from the uterus

During the assessment of a laboring client, the nurse learns that the client has cardiovascular disease (CVD). Which assessment would be priority for the newborn?

respiratory function

When assessing a pregnant woman with vaginal bleeding, the nurse would suspect a threatened abortion based on which finding?

slight vaginal bleeding

A nurse is conducting a class for a group of pregnant women about the risk of substance use during pregnancy. When discussing the effects of nicotine on a pregnancy, which complications would the nurse include? Select all that apply.

spontaneous abortion placenta previa premature rupture of membranes

A nurse is assessing the following antenatal clients. Which client is at highest risk for having a multiple gestation?

the 41-year-old client who conceived by in vitro fertilization

During the examination, the health care provider mentions the fetus has a good attitude. The nurse explains to the parents that this means:

the posture of the fetus is with all joints flexed for birth.

A multigravid client has been in labor for several hours and is becoming anxious and distressed with the intensity of her frequent contractions. The nurse observes moderate bloody show and performs a vaginal examination to assess the progress of labor. The cervix is 9 cm dilated. The nurse knows that the client is in which phase of labor?

transition phase

A client with a pendulous abdomen and uterine fibroid tumors had just begun labor and arrived at the hospital. After examining the client, the primary care provider informs the nurse that the fetus appears to be malpositioned in the uterus. Which fetal position or presentation should the nurse most expect in this woman?

transverse lie

A young mother gives birth to twin boys who shared the same placenta. What serious complication are they at risk for?

twin-to-twin transfusion syndrome (TTTS)

Which factor would contribute to a high-risk pregnancy?

type 1 diabetes

A pregnant client has tested positive for hepatitis B virus. When discussing the situation with the client, the nurse explains that her infant should be vaccinated with an initial HBV vaccine dose at which time?

within 12 hours of birth

How should the nurse instruct a woman to perform a breast self-examination? Select all that apply.

• "You will need to visually inspect both breasts and palpate them for changes." • "It doesn't matter which pattern you use to palpate the breast as long as you cover the entire breast." • "Look for any changes in shape, size, contour, or symmetry between the breasts, as well as any skin discoloration."

Which of the following body system changes would the nurse associate with menopause? Select all that apply.

• Hot flashes • Decreased bone density • Increased abdominal fat • Vaginal dryness

A couple comes to the clinic and states to the nurse, "I don't think we are ever going to be able to have children. We have been trying but have had no luck." What three assessments does the nurse anticipate will be performed for this couple? (Select all that apply.)

• Ovulation monitoring • Tubal patency • Semen analysis

A woman has just confided in the nurse that her partner slapped and kicked her that morning. What is the best response by the nurse?

"That was very brave of you to tell me that. Help is available if you wish to have it."

A woman's baby is HIV positive at birth. She asks the nurse if this means the baby will develop AIDS. Which statement would be the nurse's best answer?

"The antibodies may be those transferred across the placenta; the baby may not develop AIDS."

A client who is 32 weeks gestation tells the nurse that she has been experiencing shortness of breath when walking up the steps at home. She is concerned that something is wrong. What is the nurse's best response?

"The enlarging uterus pushes against your diaphragm and this makes breathing shallow"

A client is having a routine prenatal visit and asks the nurse what the birth education teacher meant when she used the term zero station. What is the best response by the nurse?

"The presenting part is at the true pelvis and is engaged."

Which statement made by parents at a genetic counseling session indicate understanding of the risks to their child for the disorder of dwarfism?

"There is a 25% chance our newborn may be affected by the disorder if we are carriers."

After administration of epidural anesthesia during labor, the client develops a temperature of 100.2°F (37.9°C). The client's husband is asking if she is "getting sick". How should the nurse respond to the client and her husband?

"This elevation in temperature is a possible side effect of the anesthesia. We will notify the provider and assess temperature again in an hour."

A client in her second trimester of pregnancy arrives at the health care facility for a routine follow-up visit. The nurse is required to educate the client so that the client knows what to expect during her second trimester. Which information should the nurse offer?

"You will experience quickening, and you will actually feel the baby."

A client in her second trimester of pregnancy arrives at the health care facility for a routine follow-up visit. The nurse is required to educate the client so that the client knows what to expect during her second trimester. Which of the following information should the nurse offer?

"You will experience quickening, and you will actually feel the baby."

A woman at 39 weeks gestation has been in labor for 8 hours and is asking how far she is dilated. She attended childbirth classes and is aware of the stages and phases of labor. She had a vaginal exam 30 minutes prior to her asking again. How should the nurse respond to her question?

"Your labor signs have not changed; we are looking for changes in your labor pattern before we check you again."

During labor, progressive fetal descent occurs. Place the stations listed in their proper sequence from first to last. All options must be used.

-4 station -2 station 0 station +2 station +4 station

The nurse is providing care to a client in labor. On examination, the nurse determines the fetus is at -1 station. The nurse interprets this as indicating that the fetus is:

1 cm above the ischial spines.

The experienced labor and birth nurse knows to evaluate progress in active labor by using which simple rule?

1 cm/hour for cervical dilation

What is the normally accepted fetal heart rate range?

110-160 bpm

A woman at 26 weeks' gestation is undergoing screening for diabetes with a 1-hour oral glucose challenge test. On the client's return visit, the nurse anticipates the need to schedule a 3-hour glucose challenge test based on which result of the previous test?

146 mg/dL

A woman is to undergo quad screening testing. The nurse would anticipate that this test would be done at which time?

16 weeks gestation

Part of the assessment of the first prenatal visit includes screening for rubella antibodies. The nurse determines that a client with which titer shows evidence of immunity against rubella?

1:8

A client gave birth to a child 3 hours ago and noticed a triangular-shaped gap in the bones at the back of the head of her newborn. The attending nurse informs the client that it is the posterior fontanelle. The client is anxious to know when the posterior fontanelle will close. Which time span is the normal duration for the closure of the posterior fontanelle?

8 to 12 weeks

A client is in the first stage of labor and asks the nurse what type of pain she should expect at this stage. What is the nurse's most appropriate response?

A client is in the first stage of labor and asks the nurse what type of pain she should expect at this stage. What is the nurse's most appropriate response?

A female patient is having a procedure this morning that involves radiologic examination of the fallopian tubes using a radiopaque medium. What procedure should the nurse document as being performed?

A hysterosalpingography

What advice should the nurse provide to a pregnant patient who admits to continuing to drink alcohol 1 to 2 times a week?

Alcohol should not be consumed during pregnancy

A client in the third trimester of pregnancy has to travel a long distance by car. The client is anxious about the effect the travel may have on her pregnancy. Which instruction should the nurse provide to promote easy and safe travel for the client?

Always wear a three-point seat belt.

When preparing a teaching plan for a woman with mastitis, which of the following would the nurse include?

Applying a warm compress to the breast

A woman tells the nurse that she is going to use a home pregnancy test to determine whether she is pregnant. Which precautions should the nurse give her?

Arrange for prenatal care if the test is positive. Correct Explanation: Home pregnancy testing can be accurate as soon as a period is missed; it should not take the place of prenatal care.

A nurse suspects that a 6-year-old girl is being sexually maltreated by her father, based on some comments made by the girl. Which of the following methods would be most effective in confirming the nurse's suspicion?

Ask the girl to draw a picture of what happened

A pregnant client and her husband are at their first prenatal visit. While performing the admission history, the nurse notes several new and old bruises on the woman's neck and body. She is silent and withdrawn. The husband answers all the questions. Based on these observations, the nurse suspects intimate partner violence. Which of the following is the most appropriate nursing intervention at this time?

Ask the husband to wait in the lobby while the client is being examined.

During a routine antepartal visit, a pregnant woman reports a white, thick vaginal discharge. What would the nurse do next?

Ask the woman if she is having any itching or irritation. Although vaginal secretions increase during pregnancy, the nurse would need to ascertain if this discharge is the normal leukorrhea of pregnancy or if it is a monilial vaginitis, which is common during pregnancy. The nurse needs additional information to conclude that the woman's report is normal. A culture may or may not be necessary. There is no evidence to suggest that her membranes have ruptured.

A nurse caring for a pregnant client in labor observes that the fetal heart rate (FHR) is below 110 beats per minute. Which interventions should the nurse perform? Select all that apply.

Assess client for underlying causes. Turn the client on her left side. Administer oxygen by mask.

As a woman enters the second stage of labor, her membranes spontaneously rupture. When this occurs, what would the nurse do next?

Assess fetal heart rate for fetal safety.

A client's membranes have just ruptured. Her fetus is presenting breech. Which action should the nurse do immediately to rule out prolapse of the umbilical cord in this client?

Assess fetal heart sounds.

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.

A client has just received combined spinal epidural. Which nursing assessment should be performed first?

Assess vital signs.

There are many steps in the process of genetic counseling and testing. Below are some of the key ones. Put them in the correct chronological order.

Assessment of family history Physical examination of parents Nuchal translucency screening Amniocentesis Explain results of genetic testing Support couple in adjusting to diagnosis

A woman has just learned that she is pregnant and would like to know how soon she can find out via ultrasound the sex of her fetus. The nurse should respond with which of the following?

At about four months

A woman is 20 weeks pregnant. The nurse would expect to palpate the fundus at which of the following locations?

At the umbilicus Correct Explanation: At 20 weeks' gestation, the fundus can be palpated at the umbilicus. A fundus of 12 weeks' gestation is palpated at the symphysis pubis. At 16 weeks' gestation, the fundus is midway between the symphysis pubis and umbilicus. At 36 weeks' gestation, the fundus can be palpated just below the ensiform cartilage.

As a pregnant woman lies on the examining table, she grows very short of breath and dizzy. This phenomenon probably happens because:

Blood is trapped in the vena cava in a supine position Correct Explanation: Supine hypotension syndrome, or an interference with blood return to the heart, occurs when the weight of the fetus rests on the vena cava. Cerebral arteries should not be affected. Mean arterial pressure is high enough to maintain perfusion of the uterus in any orientation. The sympathetic nervous system will not be affected by the supine position.

Braxton Hicks contractions are termed "practice contractions" and occur throughout pregnancy. When the woman's body is getting ready to go into labor, it begins to show anticipatory signs of impending labor. Among these signs are Braxton Hicks contractions that are more frequent and stronger in intensity. What differentiates Braxton Hicks contractions from true labor?

Braxton Hicks contractions usually decrease in intensity with walking.

Your patient wants to discuss birth control options. She is a 36-year-old woman who is in a long-term, monogamous relationship. She runs 2 miles a day but also smokes a pack of cigarettes a day. Which birth control method would you discourage her from using?

Combination oral contraceptives

The nurse is preparing a young couple for the upcoming birth of their child, and the mother expresses concern for needing pain medications and the effects on the fetus. When counseling the couple about pain relief, the nurse would incorporate which information in the teaching about measures to help to decrease the requests for pain medication?

Continuous support through the labor process helps decrease the need for pain medication.

A client who has just given a blood sample for pregnancy testing in the health care provider's office asks the nurse what method of confirming pregnancy is the most accurate. The nurse explains the difference between presumptive symptoms, probable signs, and positive signs. What should the nurse mention as an example of a positive sign, which may be used to diagnose pregnancy?

D) Visualization of the fetus by ultrasound Explanation: There are only three documented or positive signs of pregnancy: 1) demonstration of a fetal heart separate from the mother's, 2) fetal movements felt by an examiner, and 3) visualization of the fetus by ultrasound. The absence of a period is an example of a presumptive symptom, which is a symptom that, when taken as a single entity, could easily indicate other conditions. Laboratory tests of either urine or blood serum for human chorionic gonadotropin (hCG) are examples of probable signs of pregnancy, which are objective and so can be verified by an examiner.

A woman, who is 18 weeks' gestation, is at a follow-up appointment regarding the positive test results of alpha-fetoprotein testing. Which would the nurse suspect with the positive test result?

Down syndrome

The nurse encourages a woman with gestational diabetes to maintain an active exercise period during pregnancy. Prior to this exercise period, the nurse would advise her to do which action?

Eat a sustaining-carbohydrate snack.

A client in the first trimester complains to the nurse of nausea and vomiting, especially in the morning. Which instruction would be most appropriate to help prevent or reduce the client's compliant?

Eat dry crackers or toast before rising

A woman who is 4 months pregnant has pyrosis. Which suggestion would the nurse give her?

Eat small meals and do not lie down after meals.

Patients who have had PID are prone to which of the following complications?

Ectopic pregnancy

A nursing student studying sexual violence makes the following statement in class, "A man who has sex with his wife even though she did not want it cannot be charged with sexual abuse." Is this statement true or false?

False

How does a woman who feels in control of the situation during labor influence her pain?

Feelings of control are inversely related to the client's report of pain.

At a prenatal checkup with a client at 7 weeks' gestation, the nurse would identify what as a normal finding?

Fetal heart sounds are heard.

A multigravida client is pregnant for the third time. Her previous two pregnancies ended in an abortion in the first and third month of pregnancy. How will the nurse classify her pregnancy history?

G3 P0020

The nurse is performing an assessment of a woman who has come to a health care facility for a diagnosis of pregnancy. The women is positive for breast changes, nausea, and amenorrhea. On physical exam, it is noted that the client has softening of the cervix. How should the nurse document this in her notes?

Goodell's sign The description of Goodell's sign is softening of the cervix. Ballottement is when tapping the lower uterine segment on a bimanual exam illicits the fetus to rise against the abdominal wall. Chadwick's sign is when the vagina changes color from pink to violet, and Hegar's sign is softening of the lower uterine segment.

Leah is 28 weeks pregnant. In preparing for discomforts that occur during the final trimester of pregnancy, you would teach her about?

Increased shortness of breath and dyspnea before lightening

A 28-year-old client in her first trimester of pregnancy reports conflicting feelings. She expresses feeling proud and excited about her pregnancy while at the same time feeling fearful and anxious of its implications. Which action should the nurse do next?

Inform the client this is a normal response to pregnancy that many women experience. The maternal emotional response experienced by the client is ambivalence. Ambivalence, or having conflicting feelings at the same time, is universal and is considered normal when preparing for a lifestyle change and new role. Pregnant women commonly experience ambivalence during the first trimester.

The nurse explains to a client diagnosed with trichomoniasis that the disease is caused by the parasitic protozoan Trichomonas vaginalis. What would the nurse say is a factor that triggers growth of trichomoniasis?

Irritation of vaginal walls

A nurse is conducting prenatal classes and is reviewing the stages of fetal development. When discussing the preembryonic stage, the nurse informs the group that this stage begins and ends at which time?

It begins at fertilization and lasts through the end of the second week after fertilization.

A nurse is conducting prenatal classes and is reviewing the stages of fetal development. When discussing the pre-embryonic stage, what should the nurse inform the group about when this stage begins and ends?

It begins at fertilization and lasts through the end of the second week of gestation

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?

Keep the suction equipment readily available.

Which of the following best explains the action of the lactational amenorrhea method (LAM) of fertility control?

LAM causes suppression of the ovulation process

The second-year nursing student taking an obstetrics course correctly attributes which descriptions to the term dystocia? Select all that apply.

Labor is slow. Progress of labor deviates from normal.

The nurse is educating women on risk factors of preterm labor. Which would the nurse include in the teaching? Select all that apply.

Lack of prenatal care Victim of intimate partner violence Alcohol use during pregnancy

A woman with class II heart disease is in the third trimester of her pregnancy. She has been taking good care of herself and has had little difficulty, but to be on the safe side the obstetrician has prescribed bed rest for her for the final month. For her own and the baby's safety, in what position should the nurse advise the client to sleep?

Lie in a semirecumbent position.

A young woman presents with vaginal itching and irritation of recent onset. Her labia are swollen, and she has a frothy yellowish discharge with an unpleasant smell and a pH of 6.8. She has been celibate during the last six months and has been taking antibiotics for a throat infection. Which medication is most likely to clear her symptoms?

Metronidazole

During her 12 week prenatal check up, the client informs the nurse on interview that she has developed bumps on the dark part of her nipples. She wants to know what these bumps are. What is the nurse's appropriate answer?

Montgomery's tubercles, secrete lubricant for the nipples

General anesthesia is not used frequently in obstetrics because of the risks involved. There are physiologic changes that occur during pregnancy that make the risks of general anesthesia higher than it is in the general population. What is one of those risks?

Neonatal depression is possible.

When caring for a client in the third stage of labor, the nurse notices that the expulsion of the placenta has not occurred within 5 minutes after birth of the infant. What should the nurse do?

Nothing. Normal time for stage three is 5 to 30 minutes.

The nursing instructor is discussing violence and abuse that is seen in women with a student. She realizes that the student needs further instruction when the student states which of the following?

Nurses only come in contact with violence in the ER.

In preparing for a prenatal class to discuss the hormonal changes during pregnancy, which information would the nurse most likely include?

Over-the-counter antacids can be used to treat acid reflux with the health care provider's knowledge.

A woman has just been prescribed clomiphene citrate to stimulate ovulation. Which of the following is an effect of the drug that the nurse should warn the woman about?

Overstimulation of the ovary resulting in potential multiple births

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?

Palpate the fundus, and check fetal heart rate.

A pregnant client discloses to the nurse that she has been abused by her husband for the past 4 years. Which of the following is true regarding violence against pregnant women?

Partner abuse may increase during pregnancy.

A client in her 29th week of gestation reports dizziness and clamminess when assuming a supine position. During the assessment, the nurse observes there is a marked decrease in the client's blood pressure. Which intervention should the nurse implement to help alleviate this client's condition?

Place the client in the left lateral position.

A client in her 29th week of gestation reports dizziness and clamminess when assuming a supine position. During the assessment, the nurse observes there is a marked decrease in the client's blood pressure. Which intervention should the nurse implement to help alleviate this client's condition?

Place the client in the left lateral position. The symptoms experienced by the client indicate supine hypotension syndrome. When the pregnant woman assumes a supine position, the expanding uterus exerts pressure on the inferior vena. The nurse should place the client in the left lateral position to correct this syndrome and optimize cardiac output and uterine perfusion. Elevating the client's legs, placing the client in an orthopneic position, or keeping the head of the bed elevated will not help alleviate the client's condition.\

Which measure is recommended to prevent transmission of HIV to a newborn if the mother has AIDS?

Prepare for cesarean birth.

A client is admitted to the health care facility. The fetus has a gestational age of 42 weeks and is suspected to have cephalopelvic disproportion. Which should the nurse do next?

Prepare the client for a cesarean birth.

Amanda's menstrual period is two weeks late. She has been feeling tired and has had bouts of nausea in the morning. What classification of pregnancy symptoms is Amanda experiencing?

Presumptive Explanation: The most common presumptive sign of pregnancy is a missed menstrual period, or amenorrhea. Other presumptive signs include nausea, fatigue, swollen, tender breasts, and frequent urination

The nurse working in an OB clinic realizes that a pregnant patient who has been abused before can expect to be abused during her pregnancy. What is the strongest predictor that a pregnant woman will be abused during her pregnancy?

Prior abuse

A nurse is coaching a woman during the second stage of labor. Which action should the nurse encourage the client to do at this time?

Push with contractions and rest between them.

The nurse is teaching a class about sexually transmitted diseases to a middle school class. Which of the following is a misconception about condom use that needs to be clarified?

Put the condom on just before the orgasm

A couple has just experienced intrauterine fetal demise. Which action by the nurse would be least effective in assisting them?

Refrain from discussing the situation with the couple.

A nurse working in the Family Birthing Center is answering the nurse hot line phone. A client calls in to schedule her annual Pap smear procedure. Which of the following strategies would be best to educate the client on before her procedure to make sure results are not affected?

Refrain from sexual intercourse 48 hours before testing to ensure clear results.

A nurse is preparing a client for intrauterine device (IUD) insertion. What should the nurse inform the client when educating her on IUDs?

Regular check of threads must be done

A 28-year-old woman had a pap smear 4 weeks ago. The results of the test are classified as ASC-HUS as per the 2001 Bethesda System. Which of the following therapeutic management interventions should the nurse expect the health care provider to order?

Repeat the Pap smear in 4 to 6 months, or refer for a colposcopy.

A woman with cardiac disease gave birth to a 7 lb (3.2 kg) baby by cesarean birth. Which intervention should be implemented during the immediate postpartum period?

Rest, use stool softeners, and monitor tolerance of activity.

When teaching a group of nursing students about uterine contractions, which of the following would the instructor include as a typical feature?

Retracting of the lower segment

A pregnant client and her husband have had a session with a genetic specialist. What is the role of the nurse after the client has seen a specialist?

Review what has been discussed with the specialist.

A nurse is conducting a presentation for a group of pregnant women about conditions that can occur during pregnancy and that place the woman at high-risk. When discussing blood incompatibilities, which measure would the nurse explain as most effective in preventing isoimmunization during pregnancy?

Rho(D) immune globulin administration to Rh-negative women

The nurse would prepare a client for amnioinfusion when which action occurs?

Severe variable decelerations occur and are due to cord compression.

A woman visits your family-planning clinic to request a prescription for birth-control pills. Which of the following factors would indicate that an ovulation suppressant would not be the best contraceptive method for her?

She has a family history of thromboembolism

A nurse is client teaching with a 28 weeks' gestation woman who has tested positive for gestational diabetes mellitus (GDM). What would be important for the nurse to include in the client teaching?

She is at increased risk for type II diabetes mellitus after her baby is born.

A woman who has sickle cell anemia asks the nurse if her infant will develop sickle cell disease. The nurse would base the answer on which information?

Sickle cell anemia is recessively inherited.

The nurse midwife is performing a pelvic examination on a client who came to her following a positive home pregnancy test. The nurse checks the woman's cervix for the probable sign of pregnancy known as Goodell's sign. Which description illustrates this alteration?

The cervix softens. At about the eighth week of gestation, the cervix softens, a probable sign known as Goodell's sign. The cervix also looks blue or purple when examined; this is Chadwick's sign, and may occur as early as the sixth week of pregnancy. At about 6 weeks, the lower uterine segment softens, a probable sign called Hegar's sign. A softening of the uterine fundus, where the embryo has implanted, also occurs by about the seventh week, and the fundus enlarges by the eighth week.

The fetus receives blood flow from the mother via the placenta and umbilical cord. What is the route of fetal circulation through the umbilical cord?

The one umbilical vein carries oxygen rich blood to the fetus from the placenta

A client experiencing contractions presents at a health care facility. Assessment conducted by the nurse reveals that the client has been experiencing Braxton Hicks contractions. The nurse has to educate the client on the usefulness of Braxton Hicks contractions. Which role do Braxton Hicks contractions play in aiding labor?

These contractions help in softening and ripening the cervix.

A postbirth complete blood count (CBC) has noted an elevated white blood cell (WBC) count of 22,000/mm3. Which rationale is accurate regarding the elevated WBC count?

This is a normal variation due to the stress of labor.

The nurse instructs the client about skin massage and the gate-control theory of pain. Which statement would be appropriate for the nurse to include for client understanding of the nonpharmacologic pain relief methods?

This is a technique to prevent the painful stimuli from entering the brain.

The laboring client who is at 3 cm dilation and 25% effaced is asking for analgesia. The nurse explains the analgesia usually is not administered prior to the establishment of the active phase. What is the appropriate rationale for this practice?

This may prolong labor and increase complications.

A nurse urges a pregnant patient at the first prenatal office visit to begin taking iron supplements immediately. What is the rationale for this intervention?

To avoid anemia

Couples who engage in coitus daily, hoping to cause early impregnation, may actually have more difficulty conceiving than those who space coitus to every other day.

True

Morning sickness is associated with rising levels of human chorionic gonadotropin (hCG) and progesterone.

True

There is a strong correlation between poor oral health and preterm birth.

True

A pregnant woman states that she would like to take a tub bath but has heard from her aunt that this could be dangerous to the baby. Which instruction should the nurse give to the client?

Tub baths are fine unless you are unstable on your feet or are experiencing vaginal bleeding.

The nurse is assisting with the birth of the second child of a healthy young woman. Her pregnancy has been uneventful, and labor has been progressing well. The fetal head begins to emerge, but instead of continuing to emerge, it retracts into the vagina. What should the nurse try first?

Use McRobert's maneuver.

A nurse is assessing a full-term client in labor and determines the fetus is occiput posterior. The client states that all her discomfort is in her lower back. What intervention can the nurse provide that will help alleviate this discomfort?

Use a fist to apply counter pressure to the lower back.

Which factor in a client's history indicates she's at risk for candidiasis?

Use of corticosteroids

An elderly woman is seen in the clinic complaining of a lesion on her labia majora and states that she has experienced some bleeding and itching as well. She states that this has been going on for approximately three months. She tells the nurse that she has not been to a doctor in over 10 years. What diagnosis would the nurse expect the physician to make?

Vulvar cancer

There has been much research done on pain and the perception of pain. What is the result of research done on levels of satisfaction with the control of labor pain?

Women report higher levels of satisfaction when they felt they had a high degree of control over the pain experience.

As part of a presentation on breast cancer being given to a local woman's group, the nurse describes the need for early detection through screening. Which recommendation would the nurse emphasize?

Yearly mammogram in women over the age of 40

The nursing student correctly identifies which of the following as risk factors for developing dystocia?

a) excessive analgesia b) maternal exhaustion d) high fetal station at complete cervical dilation e) multiple gestation f) epidurals g) shoulder dystocia Rationale: Early identification and prompt interventions for dystocia are essential to minimize risk to the woman and fetus. Factors associated with increased risk for dystocia include epidurals, excessive analgesia, multiple gestations, maternal exhaustion, ineffetive pushing technique, longer first stage of labor, fetal birth weight, maternal age of >35, ineffective uterine contractions, and high fetal station at complete cervical dilation.

The coach of a client in labor is holding the client's hand and appears to be intentionally applying pressure to the space between the first finger and thumb on the back of the hand. The nurse recognizes this as which form of therapy?

acupressure

A woman with Class II heart disease is in the third trimester of her pregnancy. She's been taking good care of herself and has had little difficulty, but to be on the safe side the obstetrician has ordered bed rest for her for the final month. For her own and the baby's safety, in what position should the nurse advise the patient to sleep?

c) Lie in a semirecumbent position. Rationale: Semirecumbent position is the best position for circulation of the mother and fetus. Laying flat on the back can induce supine hypotensive syndrome and fully recumbent impedes other circulation. Therefore options A, B, and D are incorrect answers for this question.

When explaining to a class of pregnant women why labor begins, the nurse will include the fact that there are several theories that have been proposed to explain why labor begins, although none have been proven scientifically. Which idea is one of those theories?

change in estrogen-to-progesterone ratio

Many changes occur in the body of a pregnant woman. Some of these are changes in the integumentary system. What is one change in the integumentary system called?

chloasma

A nurse is caring for woman in labor. The woman's membranes just ruptured. The nurse assesses the characteristics of the fluid. Which finding would the nurse identify as normal?

clear

The nurse notes that the fetal head is at the vaginal opening and does not regress between contractions. The nurse interprets this finding as which process?

crowning

A nurse is interviewing a pregnant woman who has come to the clinic for her first prenatal visit. During the interview, the client tells the nurse that she works in a day care center with 2- and 3-year olds. Based on the client's history, the nurse would be alert for the development of which condition?

cytomegalovirus

A pregnant client with sickle cell anemia is at an increased risk for having a sickle cell crisis during pregnancy. Aggressive management for a client experiencing a sickle cell crisis with severe pain includes which measure?

d) Prepare for cesarean delivery. Rationale: When a patient is HIV positive, the method of delivery preferred is cesarean. This method has the lowest transmission rate for passage of the HIV infection to the infant. The nurse should educate the woman on the standard of care for delivery in an HIV or AIDS positive mother. Avoiding scalp electrodes for internal fetal monitoring, admitting the infant to NICU, and performing an amniotomy are not recommended methods for preventing transmission of HIV to a newborn.

A nurse is caring for a client who is in labor. For which fetal response should the nurse monitor?

decrease in circulation and perfusion to the fetus

A woman received morphine during labor to help with pain control. Which finding would the nurse need to monitor the newborn for after birth?

decreased alertness

A nurse working in the newborn nursery hears an innocent murmur on auscultation of a 24-hour-old infant's chest. The nurse recognizes this as most likely the result of which condition?

delayed fetal shunt closure

The patient has just been diagnosed with cervical cancer and after discussing her options with her physician and husband she chooses to have cryotherapy. This procedure does which of the following?

destroys abnormal cervical tissue by freezing it with liquid nitrogen

Which assessment finding in the pregnant woman at 12 weeks of gestation should the nurse find most concerning? The inability to:

detect fetal heart sounds with a Doppler. Fetal heart sounds are audible with a Doppler at 10 to 12 weeks of gestation but cannot be heard through a stethoscope until 18 to 20 weeks of gestation. Fetal movements can be felt by a woman as early as 16 weeks of pregnancy and felt by the examiner around 20 weeks' gestation. The fetal outline is also palpable around 20 weeks of gestation.

A pregnant woman is being evaluated for HELLP. The nurse reviews the client's diagnostic test results. Which result would the nurse interpret as helping to confirm this diagnosis?

elevated LDH

A client in her 20th week of gestation develops HELLP syndrome. What are features of HELLP syndrome? Select all that apply.

elevated liver enzymes hemolysis low platelet count

The nurse is assisting a primary care provider to attempt to manipulate the position of the fetus in utero from a breech to cephalic position. What does the nurse inform the client the procedure is called?

external version

The nurse is counseling a young woman who has just entered her second trimester. The client had an uneventful first trimester, with no symptoms of morning sickness. She tells the nurse, "It still doesn't seem real. It's just hard to believe that I will really have a baby." From experience, the nurse knows that which events are likely to help the woman accept the fact that she is having a baby? Select all that apply.

feeling the baby kick seeing an ultrasound image of the baby setting up a crib for the baby

As a woman enters the second stage of labor, which would the nurse expect to assess?

feelings of being frightened by the change in contractions

A nurse performs an initial assessment of a laboring woman and reports the following findings to the primary care provider: fetal heart rate is 152 bpm, cervix is 100% effaced and 5 cm dilated, membranes are intact, and presenting part is well applied to the cervix and at -1 station. The nurse recognizes that the client is in which stage of labor?

first, active

The nurse is determining how often contractions occur measuring from the beginning of the one contraction to the beginning of the next contraction. The nurse documents this finding as:

frequency.

Genetics-related health care is basic to the holistic practice of nursing. What should nursing practice in genetics include?

gathering relevant family and medical history information

A client who is 37 years of age presents to the health care clinic for her first prenatal checkup. Due to her advanced age, the nurse should prepare to talk with the client about her increased risk for what complication?

genetic disorders

At 31 weeks' gestation, a 37-year-old woman who has a history of preterm birth reports cramps, vaginal pain, and low, dull backache accompanied by vaginal discharge and bleeding. Her cervix is 2.1 cm long; she has fetal fibronectin in her cervical secretions, and her cervix is dilated 3 to 4 cm. For what does the nurse prepare her?

hospitalization, tocolytic therapy, and IM corticosteroids

The nurse is providing care to a neonate. Review of the maternal history reveals that the mother is suspected of abusing heroin. The nurse would be alert for which finding when assessing the neonate?

hypertonicity

A pregnant woman has just found out that she is having twin girls. She asks the nurse the difference between fraternal and identical twins. The nurse explains that with one set of twins there is fertilization of two ova, and with the other set one fertilized ovum splits. What type of twins result from the split ovum?

identical

A nurse is interviewing the family members of a pregnant client to obtain a genetic history. While asking questions, which information would be most important?

if couples are related to each other or have blood ties

A nurse is caring for a pregnant client who is in labor. Which maternal physiologic responses should the nurse monitor for in the client as the client progresses through birth? Select all that apply.

increase in heart rate increase in blood pressure increase in respiratory rate

A nurse sees a pregnant client at the clinic. The client is close to her due date. During the visit the nurse would emphasize that the client get evaluated quickly should her membranes rupture spontaneously based on the understanding of which possibility?

increased risk of infection

A 26-year-old primigravida has brought her doula to the birthing center for support during her labor and birth. The doula has been helping her through the past 16 hours of labor. The laboring woman is now 6 cm. dilated. She continues to report severe pain in her back with each contraction. The client finds it comforting when her doula uses the ball of her hand to put counterpressure on her lower back. What is the likely cause of the woman's back pain?

occiput posterior position

A 40-year-old woman comes to the clinic reporting having missed her period for two months. A pregnancy test is positive. What is she and her fetus at increased risk for?

placental abnormalities

A client is at 23 weeks' gestation and was admitted for induction and birth after noting the infant was an intrauterine fetal death. The client had fallen 3 days prior to the diagnosis and landed on her side. What is the most likely attributable cause to the fetal death?

placental abruption

While discussing labor with a client and her partner, the nurse is asked what the best position is for giving birth to the baby. The nurse provides them with information that indicates research has shown which position as the best?

position of comfort for the mother

A woman calls the clinic to schedule an appointment because "I think I might be pregnant." Upon further assessment gathering of information from the woman, which finding would be a probable sign of pregnancy?

positive home pregnancy test A positive home pregnancy test is confirmed by hCG in the urine. This is considered a probable sign of pregnancy. Fatigue, amenorrhea, and vomiting can all have other causes.

Based on the incidence of disease in women, which assessment of lower extremities would be most important to make in a pregnant woman?

presence of varicosities

A client presents to the emergency department reporting regular uterine contractions. Examination reveals that her cervix is beginning to efface. The client is in her 36th week of gestation. The nurse interprets the findings as suggesting which condition is occurring?

preterm labor

A woman in week 35 of her pregnancy with severe hydramnios is admitted to the hospital. The nurse recognizes that which concern is greatest regarding this client?

preterm rupture of membranes followed by preterm birth

A woman is experiencing dystocia that appears related to psyche problems. Which intervention would be most appropriate for the nurse initiate?

providing a comfortable environment with dim lighting

A nurse knows that a doula can be part of a laboring client's health care team. Which intervention would the nurse explain to the client is part of the doula's responsibility?

providing support and explanations during labor and birth

A woman in the third trimester of her first pregnancy expresses fear about the birth canal being wide enough for her to push the baby through it during labor. She is a petite person, and the baby seems so large. She asks the nurse how this will be possible. To help alleviate the client's fears, the nurse should mention the role of the hormone that softens the cervix and collagen in the joints, which allows dilation and enlargement of the birth canal. What is this hormone?

relaxin Relaxin, secreted by the corpus luteum of the ovary as well as the placenta, is responsible for helping to inhibit uterine activity and to soften the cervix and the collagen in joints. Softening of the cervix allows for dilatation at birth; softening of collagen allows for laxness in the lower spine and so helps enlarge the birth canal. The effect of estrogen is to cause breast and uterine enlargement. Progesterone has a major role in maintaining the endometrium, inhibiting uterine contractility, and aiding in the development of the breasts for lactation. Human placental lactogen (hPL), also known as human chorionic somatomammotropin, serves as an antagonist to insulin, making insulin less effective, thereby allowing more glucose to become available for fetal growth.

A multigravida presents at 31 weeks' gestation with signs and symptoms of preterm labor. The diagnosis is confirmed, and she is admitted and given magnesium sulfate. What must the nurse report as part of her care?

respiratory depression, hypotension, absent tendon reflexes

The nurse is examining a woman who came to the clinic because she thinks she is pregnant. Which data collected by the nurse are presumptive signs of her pregnancy? Select all that apply.

• Breast changes • Morning sickness • Amenorrhea Explanation: Presumptive signs are possible signs of pregnancy that appear in the first trimester, often only noted subjectively by the mother (e.g., breast changes, amenorrhea, morning sickness). Probable signs are signs that appear in the first and early second trimesters, seen via objective criteria, but can also be indicators of other conditions (e.g., hydatidiform mole). Positive signs affirm that proof exists that there is a developing fetus in any trimester and are objective criteria seen by a trained observer or diagnostic study, (e.g., ultrasound.)

A pregnant client arrives at the maternity clinic reporting constipation. Which factors could be the cause of constipation during pregnancy?

• Decreased activity level • Use of iron supplements • Intestinal displacement Constipation during pregnancy is due to changes in the gastrointestinal system. Constipation can result from decreased activity level, use of iron supplements, intestinal displacement secondary to a growing uterus, slow transition time of food throughout the GI tract, a low-fiber diet, and reduced fluid intake. Increase in progesterone, not estrogen levels, causes constipation during pregnancy. Reduced stomach acidity does not cause constipation. Morning sickness has been linked to stomach acidity.