OB quiz 5

A pregnant client has tested positive for cytomegalovirus. What can this cause in the newborn?

microcephaly

A woman in labor is experiencing hypotonic uterine dysfunction. Assessment reveals no fetopelvic disproportion. Which group of medications would the nurse expect to administer?

uterine stimulants

A nurse is conducting a program for pregnant women with gestational diabetes about reducing complications. The nurse determines that the teaching was successful when the group identifies which factor as being most important in helping to reduce complications associated with pregnancy and diabetes?

degree of blood glucose control achieved during the pregnancy

A G2P1 woman with type 1 diabetes is determined to be at 8 weeks' gestation by her health care provider. The nurse should point out which factor will help the client maintain glycemic control?

Exercise

A pregnant woman comes to the clinic for her first evaluation. The woman is screened for hepatitis B (HBV) and tests positive. The nurse would anticipate administering which agent?

HBV immune globulin

After teaching a couple about what to expect with their planned cesarean birth, which statement indicates the need for additional teaching?

"I'm going to have to wait a few days before I can start breastfeeding."

A pregnant woman asks the nurse, "I'm a big coffee drinker. Will the caffeine in my coffee hurt my baby?" Which response by the nurse would be most appropriate?

"If you keep your intake to less than 200 mg/day, you should be okay"

A pregnant woman is diagnosed with iron-deficiency anemia and is prescribed an iron supplement. After teaching her about her prescribed iron supplement, which statement indicates successful teaching?

I need to eat foods high in fiber."

The nurse is assessing a multipara client who presents to the hospital after approximately 2 hours of labor and notes the fetus is in a transverse lie. After notifying the RN and primary care provider, which action should the LPN prioritize?

Prepare to assist with external version.

A 17-year-old primigravida with type 1 diabetes is at 37 weeks' gestation comes to the clinic for an evaluation. The nurse notes her blood sugar has been poorly controlled and the health care provider is suspecting the fetus has macrosomia. The nurse predicts which step will be completed next?

Preparing for amniocentesis and fetal lung maturity assessment

placental abruption

The most common cause of fetal death after a trauma is placental abruption (abruptio placentae), where the placenta separates from the uterus, and the fetus is not able to survive.

The nurse is assessing a mother who just delivered a 7 lb (3136 g) baby via cesarean delivery. Which assessment finding should the nurse prioritize if the mother has a history of controlled atrial fibrillation?

jugular distention

A client is entering her 42nd week of gestation and is being prepared for induction of labor. The nurse recognizes that the fetus is at risk for which condition?

macrosomia

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

maintain adequate hydration

A pregnant client has been diagnosed with gestational diabetes. Which are risk factors for developing gestational diabetes? Select all that apply.

obesity hypertension previous large-for-gestational-age (LGA) infant

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.

A woman with known cardiac disease is in labor. In what position would the nurse place the client?

Semi-recumbent with a pillow under one hip

A woman gave birth to a newborn via vaginal birth with the use of a vacuum extractor. The nurse would be alert for which possible effect in the newborn?

cephalhematoma

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.

After spontaneous rupture of membranes, the nurse notices a prolapsed cord. The nurse immediately places the woman in which position?

knee-chest

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 is reviewing the physical examination findings for a client who is to undergo labor induction. Which finding would indicate to the nurse that a woman's cervix is ripe in preparation for labor induction?

shortened

A nurse is teaching a woman diagnosed with gestational diabetes about meal planning and nutrition. The nurse determines that additional teaching is needed based on which client statement?

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

The nursing student doing a rotation in obstetrics is talking to her preceptor about dystocia. She asks what is meant by the term "expulsive forces," better known as the "powers." The preceptor correctly tells her that the "powers" include which factors? Select all that apply.

-presentation -position -fetal development

A neonate born to a mother who was abusing heroin is exhibiting signs and symptoms of withdrawal. Which signs would the nurse assess? Select all that apply

-hypertonicity -excessive sneezing -tremors

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 Explanation: As the blood volume doubles during pregnancy, heart failure can occur. The pregnant woman needs to obtain adequate rest to prevent overworking the heart. Fluid may need to be restricted.

A 15-year-old adolescent arrives at the office with a report of flu symptoms, including nausea and vomiting and recent weight loss. A pregnancy test is done and is positive. The client begins crying and tells the nurse her mother will be furious with her. What can the nurse do to assist this adolescent at this point?

Support her by respecting her right to privacy and confidentiality. Explanation: The nurse needs to be an advocate for the adolescent and respect her privacy and confidentiality. It would be advisable for the nurse to encourage the adolescent to talk to her mother or some other support person for help.

The nurse is assessing a newborn of a woman who is suspected of abusing alcohol. Which newborn finding would provide additional evidence to support this suspicion?

thin upper lip

A client in her first trimester comes to the clinic for an evaluation. Assessment reveals reports of fatigue, anorexia, and frequent upper respiratory infections. The client's skin is pale and the client is slightly tachycardic. The client also reports drinking about 6 cups of coffee on average each day. A diagnosis of iron-deficiency anemia is suspected. The client is scheduled for laboratory testing and the results are as follows: • Hemoglobin 11.5 g/dL (115 g/L) • Hematocrit 35% (0.35) • Serum iron 32 µg/dL (5.73 µmol/L) • Serum ferritin 90 ng/dL (90 µg/L) Which laboratory finding would the nurse correlate with the suspected diagnosis?

. Serum ferritin level

. A client who is HIV-positive is in her second trimester and remains asympotomatic. She voices concern about her newborn's risk for the infection. Which statement by the nurse would be most appropriate?

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

. A woman with a history of systemic lupus erythematosus comes to the clinic for evaluation. The woman tells the nurse that she and her partner would like to have a baby but that they are afraid her lupus will be a problem. Which response would be most appropriate for the nurse to make?

"Be sure that your lupus is stable or in remission for 6 months before getting pregnant."

The nurse provides education to a postterm pregnant client. What information will the nurse include to assist in early identification of potential problems?

"Continue to monitor fetal movements daily."

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

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

A pregnant woman gives birth to a term fetus who has died in utero. She requests time after the birth to hold her baby. What is the best response by the nurse?

"Hold your baby as long as you like. Please let me know what I can do to help you."

A 14-year-old client and her parents have presented at the obstetrician's office in the second trimester; the teen had been hiding the pregnancy. The nurse is helping them develop a plan of care. What is the best thing the nurse can say to the clearly angry parents?

"I know you must be very upset and angry about your daughter's pregnancy, but because she's still an adolescent herself, she'll need your guidance in making nutritional and health choices that will be good for the baby and for herself."

A pregnant client with a history of asthma since childhood presents for a prenatal visit. What statement by the client alerts the nurse to perform further assessment?

"I sometimes get a bit wheezy."

A nurse is teaching a pregnant woman at risk for preterm labor about what to do if she experiences signs and symptoms. The nurse determines that the teaching was successful when the woman makes which statement?

"I'll drink several glasses of water"

A nurse is teaching a woman about measures to prevent preterm labor in future pregnancies because the woman just experienced preterm labor with her most recent pregnancy. The nurse determines that the teaching was successful based on which statement by the woman?

"I'll make sure to limit the amount of long distance traveling I do."

A woman has been in labor for the past 8 hours, and she has progressed to the second stage of labor. However, after 2 hours with no further descent, the provider diagnoses "arrest of labor." The woman asks, "Why is this happening?" Which response is the best answer to this question?

"More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal."

A pregnant client has tested positive for HIV using an enzyme-linked immunoassay (ELISA) test. When talking with the client about the results, she asks, "So what happens next?" Which response by the nurse would be appropriate as the next step?

"You will need to have another test to confirm the diagnosis."

A client with asthma is confused by her primary care provider continuing her medication while she is pregnant, since she read online the medications can cause birth defects. What is the nurse's best response?

"Your primary care provider will order safe doses of your medication."

A pregnant client's labor has been progressing slower than normal. The client is visibly anxious and tense, telling the nurse, "I am so worried about what is going to happen. And I am so tired and feel so helpless." Other underlying issues that may be contributing to the client's slow labor progress have been ruled out. Which response(s) by the nurse would be appropriate? Select all that apply.

-"Maybe dimming the lights or some soft music will help you relax a bit." -"I will keep you updated often on how you and your baby are doing." -"Things are moving along but sometimes it can take a little longer."

A woman has been progressing through labor uneventfully until the occurrence of an intense contraction, when she then develops signs of umbilical cord compression. The health care provider can feel a portion of the cord in the vagina. Which emergency intervention should the nurse implement? Select all that apply.

-Place a gloved hand in vagina and put upward pressure on presenting part to keep it off the cord. -Position the woman in a knee-chest position. -Apply oxygen mask at 10 L/min. -Administer terbutaline, a tocolytic, as prescribed.

After teaching a pregnant woman with iron deficiency anemia about nutrition, the nurse determines that the teaching was successful when the woman identifies which foods as being good sources of iron in her diet? Select all that apply.

-dried fruits -peanut butter -meats

A client with systemic lupus erythematosus is attending preconception counseling regarding their desire to get pregnant. The nurse explains that it would be best if the client is symptom-free or in remission for how long before getting pregnant?

6 months

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 client is 33 weeks' pregnant and has had diabetes since age 21. When checking her fasting blood glucose level, which value would indicate the client's disease is controlled?

85 mg/dl

A pregnant woman with gestational diabetes comes to the clinic for a fasting blood glucose level. When reviewing the results, the nurse determines that the woman is achieving good glucose control based on which result?

88mg/dL

The nurse is caring for a client in the transition stage of labor. In which scenario would the nurse predict the use of forceps may be used to assist with the birth?

Abnormal position of the fetal head

A postpartum mother has the following lab data recorded: a negative rubella titer. What is the appropriate nursing intervention?

Administer rubella vaccine before discharge. -The illness is mild to the adult but can result in the infant being born deaf and blind.

A pregnant client is screened for tuberculosis during her first prenatal visit. An intradermal injection of purified protein derivative (PPD) of the tuberculin bacilli is given. Which sign would indicate a positive test result?

An indurated wheal over 10 mm in diameter appears in 48 to 72 hours.

A woman with cardiac disease at 32 weeks' gestation reports she has been having spells of light-headedness and dizziness every few days. Which instruction should the nurse prioritize?

Decrease activity and rest more often.

. A woman receives magnesium sulfate as treatment for preterm labor. The nurse assess and maintains the infusion at the prescribed rate based on which finding?

Decreased fetal heart rate variability

The nurse assesses that a fetus is in an occiput posterior position. The nurse predicts the client will experience which situation related to this assessment?

Experience of additional back pain

The nurse is caring for a 2-day-old newborn whose mother was diagnosed with cytomegalovirus during the first trimester. On which health care provider prescription should the nurse place the priority?

Perform a hearing screen test.

The nurse is monitoring a client in labor who has had a previous birth via cesarean and is trying a vaginal birth with an epidural. The nurse observes a sudden drop in blood pressure, increased heart rate, and deep variable deceleration on the fetal monitor. The client reports severe pain in the abdomen and shoulder. What should the nurse prepare to do?

Prepare the client for a cesarean birth.

The maternal health nurse is caring for a group of high-risk pregnant clients. Which client condition will the nurse identify as being the highest risk for pregnancy?

Pulmonary hypertension Explanation: Pulmonary hypertension is considered the greatest risk to a pregnancy because of the hypoxia that is associated with the condition.

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

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

A pregnant woman tests positive for tuberculosis (TB). The nurse explains to the woman that additional tests are needed to confirm the diagnosis. When describing these tests, which one(s) would the nurse likely include? Select all that apply.

chest XR sputum culture

A woman with cardiac disease has come to the office for prenatal counseling. Assessment supports the decision to caution the woman against pregnancy. The woman most likely fits the criteria for which functional risk classification?

class IV Explanation: A woman with class IV disease should avoid pregnancy because she has an extremely high risk of maternal mortality or severe morbidity. The pregnancy may put too much stress on the woman's body increasing her risk of serious complications or even death

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 nurse is preparing a presentation for a group of young adult pregnant women about common infections and their effect on pregnancy. When describing the infections, which infection would the nurse include as the most common congenital and perinatal viral infection in the world?

cytomegalovirus

The nurse is monitoring the uterine contractions of a woman in labor. The nurse determines the woman is experiencing hypertonic uterine dysfunction based on which contraction finding?

erratic.

A nurse is conducting a presentation about prenatal care and preexisting maternal conditions. When discussing the various risks to the mother and infant, the nurse would include information about which condition as the leading cause of intellectual disability in the United States?

fetal alcohol spectrum disorder

A client at 35 weeks' gestation is now in stable condition after being admitted for vaginal bleeding. Which assessment should the nurse prioritize?

fetal heart tones

A primigravida whose labor was initially progressing normally is now experiencing a decrease in the frequency and intensity of her contractions. The nurse would assess the woman for which condition?

fetopelvic disproportion

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

formula Explanation: It is possible to transmit HIV via breastfeeding, and formula is the only option for feeding

Which assessment finding will alert the nurse to be on the look out for possible placental abruption during labor?

gestational HTN

Which changes in pregnancy would the nurse identify as a contributing factor for arterial thrombosis, especially for the woman with atrial fibrillation?

hypercoagulable state

Cytomegalovirus infection can result in different congenital anomalies. It can also be transmitted via different routes. When discussing this infection with a pregnant woman, the nurse integrates understanding that permanent fetal disability can occur with which type of transmission of CMV?

in utero transmission

A pregnant woman diagnosed with cardiac disease 4 years ago is told that her pregnancy is a high-risk pregnancy. The nurse then explains that the danger occurs primarily because of the increase in circulatory volume. The nurse informs the client that the most dangerous time for her is when?

in weeks 28 to 32 Explanation: The danger of pregnancy in a woman with cardiac disease occurs primarily because of the increase in circulatory volume. The most dangerous time for a woman is in weeks 28 to 32, just after the blood volume peaks.

Trichamoniasis Symptoms

large amounts of foamy, yellow-green vaginal discharge. treated with metronidazole -treat partner as well

Which change in insulin is most likely to occur in a woman during pregnancy?

less effective than normal

. When teaching a class of pregnant women about the effects of substance use during pregnancy, the nurse would include which effect?

low-birthweight infants

A nursing student doing a rotation in labor and birth correctly identifies which medications as most commonly used for tocolysis? Select all that apply.

magnesium sulfate atosiban indomethacin nifedipine

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

obtain urine sample for drug screening

A pregnant client is reporting of a large amount of malodorous vaginal discharge that is foamy and yellow-green in color, vaginal itching and painful intercourse. When asked, she also reports that urination is somewhat painful. She is diagnosed with trichomoniasis. What treatment would the nurse anticipate the client receiving?

oral metronidazole

During their experience in labor & delivery, a group of nursing students are observing a woman who is having uncoordinated contractions where the monitor shows some contractions close together, followed by a long period without any contractions. The nurse asks the students, "Which medication may help to stimulate a more effective, consistent pattern of contractions?" Which medication would be considered the best answer?

oxytocin

After only 45 minutes of labor, the client feels the urge to push. She pushes once and the baby's head is visible. With the next push, the head emerges. What is the immediate risk when the head is delivered too fast?

perineal tearing

A nurse is preparing an Inservice education program for a group of nurses about dystocia involving problems with the passenger. Which problem would the nurse likely include as the most common?

persistent 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

The nurse is admitting a client at 23 weeks' gestation in preparation for induction and delivery after it was determined the fetus had died secondary to trauma. When asked by the client to explain what went wrong, the nurse can point out which potential cause for this loss?

placental abruption

A woman with a history of asthma comes to the clinic for evaluation for pregnancy. The woman's pregnancy test is positive. When reviewing the woman's medication therapy regimen for asthma, which medication would the nurse identify as problematic for the woman now that she is pregnant?

prednisone

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

providing a comfortable environment with dim lighting Explanation: Comfort measures minimize the woman's stress and promote relaxation so that she can work more effectively with the forces of labor.

A 19-year-old nulliparous woman is in early labor with erratic contractions. An assessment notes that she is remaining at 3 cm. There is also a concern that the uterus is not fully relaxing between contractions. The nurse suspects which complication?

reduced oxygen to the fetus

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

A client is diagnosed with peripartum cardiomyopathy (PPCM). Which therapy should the nurse expect to administer to the client?

restricted sodium intake

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 primigravida 21-year-old client at 24 weeks' gestation has a 2-year history of HIV. As the nurse explains the various options for delivery, which factor should the nurse point out will influence the decision for a vaginal birth?

the viral load

A pregnant client at 28 weeks' gestation in preterm labor has received a dose of betamethasone IM today at 1400. The client is scheduled to receive a second dose. At which time would the nurse expect to administer that dose?

tmw at 1400

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 Explanation: Toxoplasmosis is transferred by hand to mouth after touching cat feces while changing the litter box or through gardening in contaminated soil.

A pregnant woman is receiving misoprostol to ripen her cervix and induce labor. The nurse assesses the woman closely for which effect?

uterine hyperstimulation

. A woman with a history of crack cocaine use disorder is admitted to the labor and birth area. While caring for the client, the nurse notes a sudden onset of fetal bradycardia. Inspection of the abdomen reveals an irregular wall contour. The client also reports acute abdominal pain that is continuous. Which condition would the nurse suspect?

uterine rupture

The nurse is caring for a pregnant client who has condylomata acuminata (anogenital warts) as a result of HPV infection. The nurse should educate the client about:

the need to discuss surgical options with her care provider.

A pregnant woman diagnosed with diabetes should be instructed to perform which action?

Notify the primary care provider if unable to eat because of nausea and vomiting.

A pregnant client has a history of asthma. After reviewing the possible medications that may be prescribed during her pregnancy to control her asthma, the nurse determines additional teaching is needed when the client identifies which drug as being used?

misoprostol

A nursing student correctly identifies the most desirable position to promote an easy birth as which position?

occiput anterior

The fetus of a client in labor is determined to be in a persistent occiput posterior position. Which intervention will the nurse prioritize?

pain relief measures

A pregnant client at 30 weeks' gestation calls the clinic because she thinks that she may be in labor. To determine if the client is experiencing labor, which questions would be appropriate for the nurse to ask? Select all that apply

"Are you feeling any pressure or heaviness in your pelvis?" "Are you having contractions that come and go, off and on?" "Have you noticed any fluid leaking from your vagina?" "Have you been having any nausea or vomiting?"

A pregnant client is diagnosed with syphilis. Which response would demonstrate respect for the client and therapeutic communication?

"I am sure it is frightening to you to be diagnosed with a disease that can affect your baby."

The nurse is doing meal planning with a pregnant woman with iron-deficiency anemia. What dietary recommendations would the nurse make to enhance the woman's intake of iron? Select all that apply.

-Drink orange juice with the iron supplement. -Increase intake of dried beans and green leafy vegetables. -Cook food in an iron skillet, if possible.

. A nurse is reading a journal article about cesarean births and the indications for them. Place the indications for cesarean birth below in the proper sequence from most frequent to least frequent. All options must be used.

1. Labor dystocia 2. Abnormal fetal heart rate tracing 3. Fetal malpresentation 4. Multiple gestation 5. Suspected macrosomia

A 32-year-old black woman in her second trimester has come to the clinic for an evaluation. While interviewing the client, she reports a history of fibroids and urinary tract infection. The client states, "I know smoking is bad and I have tried to stop, but it is impossible. I have cut down quite a bit though, and I do not drink alcohol." Complete blood count results reveal a low red blood cell count, low hemoglobin, and low hematocrit. When planning this client's care, which factor(s) would the nurse identify as increasing the client's risk for preterm labor? Select all that apply.

-African heritage -History of fibroids -Cigarette smoking -History of urinary tract infections -Complete blood count results

A nurse is obtaining a medication history from a pregnant client with a history of systemic lupus erythematosus (SLE). Which medication(s) would the nurse expect the woman to report to be currently using? Select all that apply.

-Ibuprofen -Hydroxychloroquine -Prednisone

A nurse is conducting an in-service program for a group of labor and birth unit nurses about cesarean birth. The group demonstrates understanding of the information when they identify which conditions as appropriate indications? Select all that apply

-active genital herpes infection -placenta previa -previous cesarean birth -fetal distress

Recommendations for nutrition and diet with gestational diabetes:

-eating small frequent feedings throughout the day -having bedtime snacks -protein and fat at each meal. -eating three meals a day plus three snacks to promote glycemic control with: --> 40% of calories from good-quality complex carbohydrates -->35% of calories from protein sources, --> 25% of calories from unsaturated fats

A pregnant client has received dinoprostone. Following administration of this medication, the nurse assesses the client and determines that the client is experiencing an adverse effect of the medication based on which client report? Select all that apply

-headache -nausea -diarrhea

A nursing instructor teaching about risk factors associated with preterm labor should discuss which demographic and lifestyle issues? Select all that apply.

-low socioeconomic status -smoking -high level of stress -alcohol use

A nurse has been invited to speak at a local high school about adolescent pregnancy. When developing the presentation, the nurse would incorporate information related to which aspects? Select all that apply

-peer pressure to become sexually active -loss of self-esteem as a major impact

A multipara woman is experiencing a prolonged descent while trying to rest and increase her fluid intake. The nurse suggests that she change position. Which position(s) will be effective for pushing to speed up the descent? Select all that apply

-semi-Fowler position -squatting position

A woman with preterm labor is receiving magnesium sulfate. Which finding would require the nurse to intervene immediately?

1+ deep tendon reflexes

A nurse is providing care to several pregnant women at different weeks of gestation. The nurse would expect to screen for group B streptococcus infection in the client who is at:

36 wks gestation

. The nurse notifies the obstetrical team immediately because the nurse suspects that the pregnant woman may be exhibiting signs and symptoms of amniotic fluid embolism. When reporting this suspicion, which finding(s) would the nurse include in the report? Select all that apply.

-significant difficulty breathing -tachycardia -pulmonary edema -bleeding with bruisin

A mother is talking to the nurse and is concerned about managing her asthma while she is pregnant. Which response to the nurse's teaching indicates that the woman needs further instruction?

"I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring." Explanation: A pregnant woman with a history of asthma needs to be proactive, taking her inhalers and other asthma medications to prevent an acute asthma attack. She needs to understand that it is far more dangerous to not take the medications and have an asthma attack. She also needs to monitor her peak flow for decreases, be aware of triggers, and avoid them if possible. However, a pregnant woman should never begin allergy shots if she has not been taking them previously, due to the potential of an adverse reaction.

A nurse is teaching a prenatal client with class III heart failure the signs and symptoms which should be reported to the health care provider. The nurse determines the teaching has been effective when the client makes which statement?

"I will call the clinic when I have a cough at night." Explanation: The earliest warning sign of cardiac decompensation in clients with heart failure is persistent rales in the bases of the lungs. The client will probably notice a nocturnal cough as the first sign. A sudden decrease in the ability to perform normal duties, exertional dyspnea, and attacks of coughing are other signs of cardiac decompensation

The nurse is teaching a pregnant woman with type 1 diabetes about her diet during pregnancy. Which client statement indicates that the nurse's teaching was successful?

. "Pregnancy affects insulin production, so I'll need to make adjustments in my diet."

A pregnant woman who has had cardiovascular disease for the last 3 years asks the nurse why this disorder makes her pregnancy an "at-risk" pregnancy. What is the nurse's best response?

"Pregnancy taxes the circulatory system of every woman." Explanation: Pregnancy taxes the circulatory system of every woman because both the blood volume and cardiac output increase by approximately 30% to 50%. Half of these increases occur by 8 weeks; they are maximized by mid-pregnancy.

After teaching a group of nurses working at the women's health clinic the impact of pregnancy on the older woman, which statement by the group indicates that the teaching was successful?

"Women over age 35 and are pregnant have an increased risk for spontaneous abortions."

. A young adult woman comes to the clinic for a routine check-up. During the visit, the woman who works in a day care facility tells the nurse that she and her partner are considering having a baby. "We are concerned that I might be exposed to common childhood illnesses." The woman undergoes testing and finds out that she is not immune from chicken pox. Based on this information, which information would the nurse give to the client?

"You will need to be vaccinated now and wait at least 1 month before getting pregnant."

The nurse reviews the medical record of a woman who has come to the clinic for an evaluation. The client has a history of mitral valve prolapse and is listed as risk class II. During the visit, the woman states, "We want to have a baby, but I know I am at higher risk. But what is my risk, really?" Which response by the nurse would be appropriate?

"Your risk during pregnancy is small, but you should see your cardiologist first before getting pregnant."

. A pregnant woman at 31-weeks' gestation calls the clinic and tells the nurse that she is having contractions sporadically. Which instructions would be most appropriate for the nurse to give the woman? Select all that apply.

-"Drink two or three glasses of water." -"Try emptying your bladder." -"Stop what you are doing and rest."

A pregnant woman with chronic hypertension is entering her second trimester. The nurse is providing anticipatory guidance to the woman about measures to promote a healthy outcome. The nurse determines that the teaching was successful based on which client statement(s)? Select all that apply.

-"I should try to lie down and rest on my left side for about an hour each day." -"I will start doing daily counts of my baby's activity at about 24 weeks' gestation." "I should take my blood pressure frequently at home and report any high readings."

A nurse is taking a history on a woman who is at 20 weeks' gestation. The woman reports that she feels some heaviness in her thighs since yesterday. The nurse suspects that the woman may be experiencing preterm labor based on which additional assessment findings? Select all that apply.

-dull low backache -viscous vaginal discharge -dysuria

A nurse is conducting a review course on tocolytic therapy for perinatal nurses. After teaching the group, the nurse determines that the teaching was successful when they identify which drugs as being used for tocolysis? Select all that apply.

-nifedipine -magnesium sulfate -indomethacin

A nurse is reviewing the medical record of a pregnant client. The nurse suspects that the client may be at risk for dystocia based on which factors? Select all that apply.

-short maternal stature -Body mass index 30.2 -breech fetal presentation

When providing education to a prenatal care class for teenagers, the nurse states that infants born to teenage mothers are more likely to have which outcome?

low-birth-weight

The nurse is providing care to several pregnant women who may be scheduled for labor induction. The nurse identifies the woman with which Bishop score as having the best chance for a successful induction and vaginal birth?

11

A client is admitted to the unit in preterm labor. In preparing the client for tocolytic drug therapy, the nurse anticipates that the client's pregnancy may be prolonged for how long when this therapy is used?

2 to 7 days

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

24-28 wks

The health care provider has determined that the source of dystocia for a woman is related to the fetus size. The nurse understands that macrosomia would indicate the fetus would weigh:

4000g-4500g

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

45 ml urine output in 2 hours

A client's membranes rupture. The nurse observes the fetal heart rate drop from 156 to 110. The nurse inspects the client's perineum and sees a loop of umbilical cord. What is the nurse's priority concern in this situation?

Decreased fetal oxygenation

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.

Which postoperative intervention should a nurse perform when caring for a client who has undergone a cesarean birth?

Assess uterine tone to determine fundal firmness.

The nurse is assessing a 35-year-old woman at 22 weeks' gestation who has had recent laboratory work. The nurse notes fasting blood glucose 146 mg/dl (8.10 mmol/L), hemoglobin 13 g/dl (130 g/L), and hematocrit 37% (0.37). Based on these results, which instruction should the nurse prioritize?

Check blood sugar levels daily.

The nurse is monitoring a woman who is receiving IV oxytocin to assist with uterine irritability. Which action should the nurse prioritize if the woman's contractions are determined to be 80 seconds in length after 1 hour of administration of the oxytocin?

Discontinue the oxytocin infusion.

A pregnant client with iron-deficiency anemia is prescribed an iron supplement. After teaching the woman about using the supplement, the nurse determines that more teaching is needed based on which client statement?

I will take the iron with milk instead of orange or grapefruit juice

The nurse is preparing information for a client who has just been diagnosed with gestational diabetes. Which instruction should the nurse prioritize in this information?

Maintain a daily blood glucose log

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?

Keeping the communication lines open.

A woman with class II heart disease is experiencing an uneventful pregnancy and is now prescribed bed rest at 36 weeks' gestation by her health care provider. The nurse should point out that this is best accomplished with which position?

Lie in a semi-recumbent position.

The maternal health nurse is caring for a pregnant client with a history of asthma who requires maintenance medication for the management of the disease. Which action by the nurse best reinforces information provided to the client regarding maintenance of her health?

Observe the client taking her inhaler.

A woman presents at Labor and Delivery very upset. She reports that she has not felt her baby moving for the last 6 hours. The nurse listens for a fetal heart rate and cannot find a heartbeat. An ultrasound confirms fetal death and labor induction is started. What intervention by the nurse would be appropriate for this mother at this time?

Offer to take pictures and footprints of the infant once it is delivered.

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.

The nurse is admitting a client in labor. The nurse determines that the fetus is in a transverse lie by performing Leopold maneuvers. What intervention should the nurse provide for the client?

Prepare the client for a cesarean birth.

The most common cause of fetal death after a trauma is placental abruption (abruptio placentae), where the placenta separates from the uterus, and the fetus is not able to survive.

Resp Rate 16 bpm

A 39-year-old multigravida with diabetes presents at 32 weeks' gestation reporting she has not felt movement of her fetus. Assessment reveals the fetus has died. The nurse shares with the mother that the institution takes pictures after the birth and asks if she would like one. What is the best response if the mother angrily says no and starts crying?

Tell her that the hospital will keep the photos for her in case she changes her mind.

A woman in active labor suddenly experiences a sharp, excruciating low abdominal pain, which the nurse suspects may be a uterine rupture since the shape of the abdomen has changed. The nurse calls a code, and a cesarean birth is performed stat, but the infant does not survive the trauma. A few hours later, after the woman has stabilized, she asks to hold and touch her infant, and the nurse arranges this. Later, the nurse's documentation should include which outcome statement?

The parents are beginning to demonstrate positive grieving behaviors.

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 counterpressure to the lower back.

A G2P1 woman is in labor attempting a VBAC, when she suddenly complains of light-headedness and dizziness. An increase in pulse and decrease in blood pressure is noted as a change from the vital signs obtained 15 minutes prior. The nurse should investigate further for additional signs or symptoms of which complication?

Uterine rupture

A nurse is counseling a pregnant woman with rheumatoid arthritis about medications that can be used during pregnancy. The nurse would emphasize the need to avoid which medication at this time?

methotrexate

A nurse is preparing a teaching program for a group of pregnant women about preventing infections during pregnancy. When describing measures for preventing cytomegalovirus infection, which measure would the nurse include as a priority?

freq handwashing

A nurse is conducting an in-service presentation to a group of perinatal nurses about sexually transmitted infections and their effect on pregnancy. The nurse determines that the teaching was successful when the group identifies which infection as being responsible for ophthalmia neonatorum?

gonorrhea

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

administer oxygen by mask.

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

A nurse is teaching a 30-year-old gravida 1 who has sickle cell anemia. Providing education on which topic is the highest nursing priority?

avoidance of infection

A woman with type 2 diabetes is considering becoming pregnant and asks the nurse whether she will be able to continue taking her current oral hypoglycemics. The nurse's response will point out which factor?

have been shown to be effective and safe in recent short term studies.

When preparing a schedule of follow-up visits for a pregnant woman with chronic hypertension, which schedule would be most appropriate?

bi-monthly visits until 28 weeks, then weekly visits

A pregnant woman in her 39th week of pregnancy presents to the clinic with a vaginal infection. She tests positive for chlamydia. What would this disease make her infant at risk for?

blindness

A fetus is experiencing shoulder dystocia during birth. The nurse would place priority on performing which fetal assessment post-birth?

brachial plexus assessment

Symptoms of CMV in the fetus and newborn:

hepatomegaly thrombocytopenia IUGR jaundice microcephaly hearing loss, chorioretinitis intellectual disability.

When describing the stages of labor to a pregnant woman, which of the following would the nurse identify as the major change occurring during the first stage?

cervical dilation

A pregnant client at 42 weeks' gestation is undergoing a scheduled induction of labor based on consideration of which factors? Select all that apply.

cervical ripeness fetal size gestational age

The nurse plays a major role in assessing the progress of labor. The nurse integrates understanding of the typical rule for monitoring labor progress. Which finding would the nurse correlate with this rule?

cervix dilates 1 cm per hour

A pregnant client with a history of heart disease has been admitted to a health care center reporting breathlessness. The client also reports shortness of breath and easy fatigue when doing ordinary activity. The client's condition is markedly compromised. The nurse would document the client's condition using the New York Heart Association (NYHA) classification system as which class?

class III

Assessment of a pregnant woman and her fetus reveals tachycardia and hypertension. There is also evidence suggesting vasoconstriction. The nurse would question the woman about use of which substance?

cocaine

A pregnant woman comes to the birthing center, stating she is in labor and does not know how far along her pregnancy is because she has not had prenatal care. A primary care provider performs an ultrasound that indicates oligohydramnios. When the client's membranes rupture, meconium is in the amniotic fluid. What does the nurse suspect may be occurring with this client?

complications of a post-term pregnancy

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

congenital anomalies

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

continuing to monitor maternal and fetal status

A nurse is conducting a presentation for a group of pregnant women about measures to prevent toxoplasmosis. The nurse determines that additional teaching is needed when the group identifies which measure as preventive?

cooking all meat to an internal temperature of 125° F (52° C)

A client is giving birth when shoulder dystocia occurs in the fetus. The nurse recognizes that which condition in the client is likely to increase the risk for shoulder dystocia?

diabetes

Shoulder Dystocia is most apt to occur in women with:

diabetes multiparas postdate pregnancies

A nurse is describing the risks associated with post-term pregnancies as part of an inservice presentation. The nurse determines that more teaching is needed when the group identifies which factor as an underlying reason for problems in the fetus?

increased amniotic fluid volume

A nurse is explaining to a group of nurses new to the labor and birth unit about methods used for cervical ripening. The group demonstrates understanding of the information when they identify which method as a mechanical one?

laminaria

macrosomia

large-bodied baby commonly seen in diabetic pregnancies

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

Which should the nurse identify as a risk associated with anemia during pregnancy?

preterm birth

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 nurse is conducting a review class for a group of perinatal nurses working at the local clinic. The clinic sees a high population of women who are HIV positive. After discussing the recommendations for antiretroviral therapy with the group, the nurse determines that the teaching was successful when the group identifies which rationale as the underlying principle for the therapy?

reduction in viral loads in the blood

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 experiencing dystocia resulting from persistent occiput posterior position. The client, in the first stage of labor, is reporting significant back pain. The nurse encourages the client to change positions frequently for comfort and to help promote rotation of the fetal head. Which position(s) would be appropriate for the nurse to suggest? Select all that apply.

side-lying hands and knees squatting

Over the past 20 weeks, the following blood pressure readings are documented for a pregnant client with chronic hypertension: week 16 - 130/86 mm Hg; week 20 - 138/88 mm Hg; week 24 - 136/82 mm Hg; and week 28 - 138/88 mm Hg. The nurse interprets these findings as indicating which classification of her blood pressure?

stage 1

The nurse is caring for a client in active labor. Which assessment finding should the nurse prioritize and report to the team?

sudden SOB

A nurse working at the local health district clinic assists numerous adolescents who become pregnant. Which factor will the nurse tell the teens is crucial for a positive pregnancy outcome?

support network

The nurse is caring for a pregnant client who is in her 30th week of gestation and has congenital heart disease. Which finding should the nurse recognize as a symptom of cardiac decompensation with this client?

swelling of the face

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

The nurse is assessing a primigravida woman who reports vaginal itching, a great deal of foamy yellow-green discharge, and pain during intercourse. The nurse suspects the woman has contracted which disorder?

trichomoniasis

Which factor would contribute to a high-risk pregnancy?

type 1 diabetes Explanation: A woman with a history of diabetes has an increased risk for perinatal complications, including hypertension, preeclampsia, and neonatal hypoglycemia

A pregnant client at 24 weeks' gestation comes to the clinic for evaluation. The client called the clinic earlier in the day stating that she had not felt the fetus moving since yesterday evening. Further assessment reveals absent fetal heart tones. Intrauterine fetal demise is suspected. The nurse would expect to prepare the client for which testing to confirm the suspicion?

ultrasound

. A pregnant client undergoing labor induction is receiving an oxytocin infusion. Which finding would require immediate intervention?

urine output of 20 mL/hour

A client in active labor with a history of two previous cesarean births is being monitored frequently as they try to have a vaginal birth. Suddenly, the client grabs the nurse's hand and states, "Something inside me is tearing." The nurse notes the client's blood pressure is 80/50 mm Hg, pulse rate is 130 beats/min and weak, the skin is cool and clammy, and the fetal monitor shows bradycardia. The nurse activates the code team because the nurse suspects the client may be experiencing which complication?

uterine rupture

A pregnant woman at 36 weeks' gestation comes to the care center for a follow-up visit. The woman is to be screened for group B streptococcus (GBS) infection. When describing this screening to the woman, the nurse would explain that a specimen will be taken from which area(s)? Select all that apply.

vagina rectum