Passpoint Antepartum Period

A nurse is assessing a pregnant client in the second trimester. The nurse weighs the client, then compares the current and previous weights. During the second trimester, how much weight should the client gain per week?

1 lb (0.45 kg)

A nurse is assisting in developing a teaching plan for a client who is about to enter the third trimester of pregnancy. The teaching plan should note that which symptom should be reported immediately?

blurred vision

The fetus of a multigravid client at 38 weeks' gestation is determined to be in a frank breech presentation. The nurse describes this presentation to the client as which fetal part coming in contact with the cervix?

buttocks

A client is 8 weeks pregnant. Which teaching topic is most appropriate at this time?

common discomforts of pregnancy

After a prenatal class one week, a group of concerned mothers approach the nurse to tell her that one of the nurse facilitators has been sharing their personal stories with other parents outside the group. Which value within the American Nurses Association (Canadian Nurses' Association) Code of Ethics is the nurse violating?

confidentiality

A client with gestational hypertension receives magnesium sulfate 50% 4 g in 250 mL D5W over 20 minutes. What priority assessment should the nurse perform when administering this drug?

deep tendon reflexes

When teaching an antepartum client about the passage of the fetus through the birth canal during labor, the nurse describes the cardinal mechanisms of labor. Using a teaching pelvis and fetus, the nurse demonstrates which sequence during birth? Place these events in the proper sequence. All options must be used.

descent flexion internal rotation extension external rotation expulsion

An antenatal primigravid client has just been informed they are carrying twins. The plan of care includes educating the client concerning factors that put the client at risk for problems during the pregnancy. The nurse realizes the client needs further instruction when they indicate carrying twins puts the client at risk for which complication?

group B streptococcus

A 25-year-old client tells the nurse that she would like to become pregnant, but she has been diagnosed with blocked fallopian tubes due to pelvic inflammatory disease. When helping the client explore infertility treatment options, what is most appropriate for this client?

in vitro fertilization

A client who's 30 weeks pregnant has a corrected atrial septal defect and minor functional limitations. Which pregnancy-related physiologic change places the client at greatest risk for more severe cardiac problems?

increased plasma volume

A pregnant client's hepatitis B report reads "HBsAg = positive." Which correctly describes the client's hepatitis B status?

infected

Which medication is considered safe during pregnancy?

insulin

The health care provider prescribes clomiphene citrate for a client who has been having difficulty getting pregnant. When teaching the client about this drug, the nurse should discuss discuss the increased chance of which condition?

multiple gestation

A client at 28 weeks' gestation is complaining of contractions. Following admission and hydration, the physician writes an order for the nurse to give 12 mg of betamethasone I.M. This medication is given to:

promote fetal lung maturity.

A nurse is developing a care plan for a client in her 34th week of gestation who's experiencing premature labor. What nonpharmacologic intervention should the plan include to halt premature labor?

promoting adequate hydration

A 32-year-old multigravida client returns to the clinic for a routine prenatal visit at 36 weeks' gestation. The assessments during this visit include blood pressure, 140/90 mm Hg; pulse, 80 beats/min; and respiratory rate, 16 breaths/min. What further information should the nurse obtain to determine if this client is becoming preeclamptic?

proteinuria

When developing the plan of care for a multigravid client with class III heart disease, the nurse should expect to assess the client frequently for which problem?

tachycardia

A client who's 7 months pregnant reports severe leg cramps at night. Which nursing action would be most effective in helping the client cope with these cramps?

teaching her to dorsiflex her foot during the cramp

A client who is 28 weeks pregnant is admitted for testing. After reading the nursing notes, which rationale best explains why a pregnant client should lie on her left side when resting or sleeping in the later stages of pregnancy?

to prevent compression of the vena cava

A client who is 10 weeks pregnant develops spotting; however, the cervix remains closed. What should the nurse should suspect?

threatened abortion

When evaluating a pregnant client's fundal height, the nurse should measure in which way?

from the symphysis pubis notch to the highest level of the fundus

When teaching a group of pregnant adolescent clients about reproduction and conception, the nurse is correct when stating that fertilization occurs:

in the first third of the fallopian tube.

A client wants to avoid methods of birth control that contain estrogen. Which method would be the nurse recommend?

injectable contraception

A client undergoes an amniotomy. Shortly afterward, the nurse detects large variable decelerations in the fetal heart rate (FHR) on the external electronic fetal monitor (EFM). These findings may signify:

umbilical cord prolapse.

A client at 36 weeks' gestation with type 1 diabetes has an abnormal biophysical profile and is scheduled for a contraction stress test. After explaining the purpose of the test, the nurse determines that the client understands the instruction when they state that the test is done to detect which problem?

uteroplacental sufficiency

The nurse is teaching a new prenatal client about their iron-deficiency anemia during pregnancy. Which statement indicates that the client needs further instruction about their anemia?

"I may have anemia because my family is of Asian descent."

A client in her first trimester of pregnancy comes to the prenatal clinic and states, "I feel nauseous and I'm vomiting all the time. I can't even keep down water." This client should be evaluated for what condition?

hyperemesis gravidarum

A multigravid client is admitted to the hospital with a diagnosis of ectopic pregnancy. Because the client's fallopian tube has not yet ruptured, the nurse anticipates that which medication may be prescribed?

methotrexate

On arrival at the emergency department, a client tells the nurse that they suspect they may be pregnant and they been experiencing a small amount of bleeding and severe pain in the lower abdomen. The client's blood pressure is 70/50 mm Hg, and the pulse rate is 120 bpm. The nurse notifies the primary health care provider (HCP) immediately because of the possibility of which complication?

ectopic pregnancy

A client makes a routine visit to the prenatal clinic. Although the client is 14 weeks pregnant, the size of her uterus approximates an 18- to 20-week pregnancy. The physician diagnoses gestational trophoblastic disease and orders ultrasonography. The nurse expects ultrasonography to reveal:

grapelike clusters.

A primigravid client at 8 weeks' gestation tells the nurse that since having had sexual relations with a new partner 2 weeks ago, the client has noticed flu-like symptoms, enlarged lymph nodes, and clusters of vesicles on their vagina. The nurse refers the client to a primary health care provider (HCP) because the nurse suspects which sexually transmitted infection?

herpes genitalis

A client is a 43-year-old G2 P1 at 16 weeks' gestation that has completed prenatal testing for chromosomal abnormalities. The results reveal the infant is a female with Down syndrome. The parents are seeking information about this syndrome. What should the nurse tell the parents? Select all that apply.

Down syndrome can occur in mothers of any age. Down syndrome occurs more frequently with advanced maternal age. Down syndrome results from a trisomy of chromosome 21.

A client is having a level 2 ultrasound. A nurse knows that physicians order this procedure

for diagnostic purposes when fetal development is in question.

During routine preconception counseling, a client asks how early a pregnancy can be diagnosed. What is the nurse's best response?

"8 days after conception."

A client who is 32 weeks pregnant is hospitalized with preterm labor. After preterm labor is arrested, she is discharged with a prescription for terbutaline. Which instruction should the nurse provide during discharge teaching?

"Abstain from sexual intercourse unless you use a condom."

A nurse in a prenatal clinic is assessing a client who is 28 weeks' pregnant. Which findings lead the nurse to suspect that the client has mild preeclampsia?

1+ protein, blood pressure 142/92 mmHg

Using Naegele's rule for a client whose last normal menstrual period began on May 10, the nurse determines that the client's estimated date of birth is what date?

February 17

A client at 24 weeks' gestation comes to the clinic for a prenatal check-up and reports that she has been "seeing double." The nurse checks the urine and determines that there is 3+ proteinuria. What does the nurse determine is the potential priority problem?

preeclampsia

The nurse is caring for a 38-year-old primigravida in the third trimester of pregnancy. The nurse plans to assess the client for manifestations of which complication?

preeclampsia

A 30-year-old multigravida client has missed three periods and now visits the prenatal clinic because they assume they are pregnant. The client is experiencing enlargement of the abdomen, a positive pregnancy test, and changes in the pigmentation on the face and abdomen. These assessment findings reflect this client is experiencing a cluster of which signs of pregnancy?

probable

A client who is 14 weeks pregnant states, "Ever since I've been pregnant, I've had a hard time moving my bowels." Increased levels of what hormone are responsible for this common discomfort of pregnancy?

progesterone

A client has come to the clinic for her first prenatal visit. The nurse should include which statement about using drugs safely during pregnancy in client teaching?

"Consult with your health care provider before taking any medications."

A client has a cerclage placed at 16 weeks' gestation. She has had no contractions and her cervix is dilated 2 cm. The nurse is preparing the client for discharge. Which statement by the client should indicate to the nurse that the client needs further instruction?

"I can have sex again in about 2 weeks."

A nurse is caring for a client in her 34th week of pregnancy who wears an external monitor. Which statement by the client indicates an understanding of the nurse's teaching?

"I can lie in any comfortable position, but I should stay off my back."

An antenatal client is discussing their anemia with the nurse in the prenatal clinic. After a discussion about sources of iron to be incorporated into their daily meals, the nurse knows the client needs further instruction when they respond with which statement?

"I can meet two goals when I drink milk: lots of iron and meeting my calcium needs at the same time."

An obese 36-year-old multigravid client at 12 weeks' gestation has a history of chronic hypertension. The client was treated with methyldopa before becoming pregnant. When counseling the client about diet during pregnancy, the nurse realizes that the client needs additional instruction when they make which statement?

"I need to reduce my caloric intake to 1200 calories a day."

A client at 36 weeks' gestation tells the nurse, "I've been having a lot of backaches lately." After giving instructions about how to decrease the backaches, the nurse determines that the client needs further instruction when she makes which statement?

"I should walk with my pelvis tilted backward."

The obstetric nurse is performing a nonstress test on a 30 week primigravida client sent from a healthcare provider's office. The client reports a decrease in fetal movement over the past 24 hours. The nurse documents the above nursing note. Which nursing statement is appropriate at this time?

"I will check with the healthcare provider to see if further tests are needed."

A pregnant client is seeking information from the nurse about a home birth with registered midwives. Which of the following statements lets the nurse know that the client has considered the risks and benefits of using a midwife? Select all that apply.

"I will develop a list of questions to use in interviewing potential midwives." "I understand the complications that could occur in a home birth setting." "I realize that I may need to be transferred to a hospital if complications develop."

During a prenatal visit, a pregnant client with cardiac disease and slight functional limitations reports increased fatigue. The nurse knows that the client understands the management of the disorder when the client says

"I will eat five or six small meals each day and have some protein with each meal."

After the nurse instructs a primigravid client at 8 weeks' gestation about measures to overcome early morning nausea and vomiting, which client statement indicates the need for additional teaching?

"I will eat two large meals daily with frequent protein snacks."

A 15-year-old client who is 26 weeks pregnant has been admitted to the labor and delivery unit with reports of abdominal pain. Her parents want to speak with a nurse about her condition. How should the nurse respond?

"I'll need a signed consent from your daughter to give you medical information."

A nurse determines that a client is in false labor. After obtaining discharge orders, the nurse provides discharge teaching to the client. Which instruction is most appropriate at this time?

"Return to the facility if fever occurs."

A client asks the nurse if it is safe to have sex during the third trimester. How should the nurse respond?

"Sex is safe in any trimester."

Which statement by the nurse would be most appropriate when responding to a primigravid client who asks, "What should I do about this brown discoloration across my nose and cheeks?"

"This usually disappears after birth."

A client who's 4 months pregnant asks the nurse about quantity and types of exercise during pregnancy. How should the nurse counsel the client?

"Walk briskly for 10 to 15 minutes daily, and gradually increase this time."

A prenatal client tells the nurse that they have been eating ginger cookies to treat nausea and vomiting. Which response by the nurse is best?

"When consumed as a spice in foods, ginger is generally considered safe in pregnancy."

A primigravid client asks the nurse if they can continue to have a glass of wine with dinner during the pregnancy. Which statement would be the nurse's best response?

"You should abstain from drinking alcoholic beverages."

A client is at an ideal weight when she conceives. During a prenatal visit 2 months later, the client asks the nurse how much weight she should gain during pregnancy. What is the nurse's best response?

"You should gain 25 to 35 lb (11.3 to 15.9 kg)."

A client in the first trimester of pregnancy comes to the facility for a routine prenatal visit. The client reports mixed feelings about readiness to have a baby, even though this was a planned pregnancy. Which response should the nurse offer?

"You're feeling ambivalent, which is normal during the first trimester."

When performing a vaginal examination on a pregnant client, the nurse determines the fetal head has reached the ischial spines. How would the nurse describe the station of the fetus at this time?

0 station

A nurse is using Doppler ultrasound to assess a pregnant client. When should the nurse expect to begin hearing fetal heart tones?

11 weeks' gestation

At what gestational age should a primigravida expect to start feeling quickening?

18 to 20 weeks

The primary health care provider (HCP) orders 1000 mL of Ringer's lactate solution intravenously over an 8-hour period for a 29-year-old primigravid client at 16 weeks' gestation with hyperemesis. The drip factor is 12 gtts/mL. The nurse should administer the IV infusion at how many drops per minute? Record your answer using one decimal place.

25

A primigravid client with severe preeclampsia exhibits hyperactive, very brisk patellar reflexes with two beats of ankle clonus present. How does the nurse document the patellar reflexes?

4+

A client who is 5 weeks' pregnant reports nausea and vomiting. The nurse reassures the client that these symptoms probably will subside by:

9 to 12 weeks' gestation.

When teaching a primigravid client about the diagnostic tests used in pregnancy, the nurse should include which information?

A fetal biophysical profile involves assessments of breathing movements, body movements, tone, amniotic fluid volume, and fetal heart rate reactivity.

A client is in the last trimester of pregnancy. The nurse should instruct the client to notify the primary health care provider immediately if she notices:

blurred vision.

During a childbirth preparation class, a primigravid client at 36 weeks' gestation tells the nurse, "My lower back has really been bothering me lately." Which exercise suggested would be most helpful?

pelvic rocking

A pregnant client is diagnosed with group B streptococcus chorioamnionitis. The nurse should expect to administer which medication to prevent fetal transmission?

penicillin G potassium I.V. to the client

While assessing a multigravid client at 10 weeks' gestation, the nurse notes a purplish color to the vagina and cervix. The nurse documents this as what finding?

Chadwick's sign

A 16-year-old primigravida client at 36 weeks' gestation who has had no prenatal care experienced a seizure at work and is being transported to the hospital by ambulance. What action should the nurse take upon the client's arrival?

Admit the client to a quiet, darkened room.

A client diagnosed with gestational hypertension must have weekly blood pressure checks and urine testing at a clinic. She does not have transportation. How can the nurse help this client be compliant with her care?

Ask the clinic case manager to speak with the client.

Assessment of a client in active labor reveals the following: moderate discomfort; cervix dilated 3 cm, 0 station, and completely effaced; and fetal heart rate of 136 bpm. What should the nurse plan to do next?

Assist the client with comfort measures and breathing techniques.

A 26-year-old primigravida visiting the prenatal clinic for their regular visit at 34 weeks' gestation tells the nurse that they take mineral oil for occasional constipation. What should the nurse should instruct the client to do?

Avoid taking mineral oil because it interferes with the absorption of fat-soluble vitamins.

When planning a class for primigravid clients about the common physiologic changes of pregnancy, the nurse should include which information in the teaching plan?

Cardiac output increases by 25% to 50% during pregnancy.

A primigravid client at 16 weeks' gestation visits the clinic for a routine examination. The client tells the nurse that they knows someone whose baby was born with congenital toxoplasmosis. What should the nurse instruct the client to do to prevent transmission of the toxoplasmosis protozoan?

Cook all meats, such as beef and pork, thoroughly.

When auscultating the heart sounds of a client who's 34 weeks pregnant, the nurse detects a systolic ejection murmur. Which action should the nurse take?

Document the finding, which is normal during pregnancy.

A 40-year-old primigravid client with AB-positive blood visits the outpatient clinic for an amniocentesis at 16 weeks' gestation. The nurse determines that the most likely reason for the client's amniocentesis is to determine if the fetus has which problem?

Down syndrome

A client, now 37 weeks pregnant, calls the clinic because she is concerned about being short of breath and is unable to sleep unless she places three pillows under her head. After listening to the client's concerns, the nurse should take which action?

Explain that these are expected problems for the latter stages of pregnancy.

A client in her 34th week of pregnancy presents with sudden onset of bright red vaginal bleeding. Her uterus is soft, and she's experiencing no pain. Fetal heart rate is 120 beats/minute. Based on this history, what should the nurse suspect?

placenta previa

A multigravid client at 36 weeks' gestation who is visiting the clinic for a routine visit begins to sob and tells the nurse, "My partner has been beating me up once in a while since I became pregnant, but I can't bring myself to leave them because I don't have a job and I don't know how I would take care of my other children." What is the priority action by the nurse at this time?

Help the client make concrete plans for the safety of the client and their children.

The nurse is teaching a pregnant client about exercises that may be helpful during pregnancy. Which points should the nurse include in the instruction? Select all that apply.

Pelvic rocking may help relieve lower back pain. Abdominal breathing lifts the abdominal wall off of the uterus. Kegel exercises help improve vaginal contractility and bladder control.

A primigravid adolescent client at approximately 15 weeks' gestation is visiting the prenatal clinic to undergo maternal quad screening. What information should the nurse include in the teaching plan for this client?

Increased levels of alpha-fetoprotein (AFP) are associated with neural tube defects.

At an initial prenatal visit, the client tells the nurse that their last menstrual period started on April 14. Using the Naegele rule, the nurse determines the woman's estimated due date is when?

January 21

After receiving large doses of an ovulatory stimulant such as menotropins, a client comes in for her office visit. Assessment reveals the following: 6-lb (3-kg) weight gain, ascites, and pedal edema. Based on this assessment, what should the nurse do next?

Notify the healthcare provider.

A client has meconium-stained amniotic fluid. Fetal scalp sampling indicates a blood pH of 7.12; fetal bradycardia is present. Based on these findings, the nurse should take which action?

Prepare for cesarean birth.

A pregnant client calls the nurse at 22 weeks gestation to report that she is experiencing some edema of her face and hands, with puffiness in her eyelids in the morning. What is the priority action by the nurse?

Refer the client to her physician.

A client at 22 weeks' gestation has right upper quadrant pain radiating to their back. The client rates the pain as 9 on a scale of 0 to 10 and says that it has occurred two times in the last week for about 4 hours at a time. The client does not associate the pain with food. Which nursing measure is the highest priority for this client?

Refer the client to their health care provider for evaluation and treatment of the pain.

At the 28th week visit, the prenatal client's hemoglobin is 13 g/dl (130 g/L) (reference range 12-16 g/dl [120-160 g/L]). What is the best intervention?

Reinforce that the client should continue taking prenatal vitamins for the entire pregnancy.

A client is in the 38th week of her first pregnancy. She calls the prenatal facility to report occasional tightening sensations in the lower abdomen and pressure on the bladder from the fetus, which she says seems lower than usual. The nurse should take which action?

Review premonitory signs of labor with the client.

A 30-week pregnant client with premature uterine contractions was successfully treated with IV fluids. She is eager to be discharged. The nurse's discharge examination reveals vaginal blood pooling under the client's buttocks, and the client denies pain. Which is the nurse's priority action?

Stop the discharge process, and notify the healthcare provider.

A nurse is providing care for a pregnant client. The client asks the nurse how she can best deal with her fatigue. What instructions would the nurse give to this client?

Take an afternoon nap.

A multigravida client who stands for long periods while working in a factory visits the prenatal clinic at 35 weeks' gestation, stating, "The varicose veins in my legs have really been bothering me lately." Which instruction would be most helpful?

Take frequent rest periods with the legs elevated above the hips.

A nurse is reviewing a client's prenatal history. Which finding indicates a genetic risk factor?

The client has a child with cystic fibrosis.

The nurse is performing a health history for a client in her first trimester of pregnancy who lives alone with two cats. What education should the nurse provide so that the client can protect herself from illness?

The client should wear disposable gloves to clean the litter box and wash hands with soap and warm water after cat litter exposure.

During the first trimester, a nurse evaluates a pregnant client for factors that suggest that she might abuse a child. Which parental characteristic is of most concern to the nurse?

The client states she is stupid and ugly.

A new antenatal G6, T4, P0, A1, L4 client attends their first prenatal visit with their partner. The nurse is assessing this couple's psychological response to the pregnancy. Which finding requires the most immediate follow-up?

The client's spouse is irritated that the client is not like they were before pregnancy.

During a nonstress test (NST), a nurse notes three fetal heart rate (FHR) increases of 15 beats/minute, each lasting 15 seconds. These increases occur only with fetal movement. How should the nurse interpret this finding?

The fetus is not in distress at this time.

A primigravida at 8 weeks' gestation tells the nurse that they want an amniocentesis because there is a history of hemophilia A in their family. The nurse informs the client that she will need to wait until 15 weeks' gestation for the amniocentesis. Which is the most appropriate rationale for the nurse's statement regarding amniocentesis at 15 weeks' gestation?

The volume of amniotic fluid needed for testing will be available by 15 weeks.

Lower back pain is a common concern among pregnant clients. Which comfort measure should a nurse include in the teaching plan for a pregnant client?

Use an ergonomically correct desk chair.

A nurse is caring for a 16-year-old pregnant adolescent. The client is taking an iron supplement. What should this client drink to increase the absorption of iron?

a glass of orange juice

A client is admitted to the facility with a suspected ectopic pregnancy. When reviewing the client's health history for risk factors for this abnormal condition, what would the nurse most expect to find?

a history of pelvic inflammatory disease

A client at 15 weeks' gestation presents to the obstetrical triage unit with dark brown vaginal bleeding and continuous nausea and vomiting. The client's blood pressure is 142/98 mm Hg and the fundal height is 19 cm. Which prescription is most important for the nurse to request from the primary health care provider?

a stat ultrasound

A client at 36 weeks' gestation, begins to exhibit signs of labor after an eclamptic seizure. The nurse should assess the client for:

abruptio placentae

A primigravid client visits the clinic for a routine examination at 35 weeks' gestation. The client's blood pressure is near the baseline of 120/74 mm Hg with no proteinuria or evidence of facial edema. The client asks the nurse, "What should I take if I get an occasional headache after looking at my computer at work all day?" Which over-the-counter medicine does the nurse consider to be safest for occasional use by a pregnant client with no known risks?

acetaminophen

A 30-year-old multiparous client has been prescribed oral contraceptives as a method of birth control. The nurse instructs the client that decreased effectiveness may occur if the client is prescribed which drug?

ampicillin

A client, 11 weeks pregnant, is admitted to the facility with hyperemesis gravidarum. The client tells the nurse she has never known anyone who had such severe morning sickness. The nurse understands that hyperemesis gravidarum results from:

an unknown cause.

A pregnant client states that they frequently ingest laundry starch. The nurse should assess the client for which condition?

anemia

A client who is 22 weeks' pregnant is scheduled for amniocentesis. When preparing the client for the procedure, the nurse should:

ask the client to void.

In which maternal location would the nurse place the ultrasound transducer of the external electronic fetal heart rate monitor if a fetus at 34 weeks' gestation is in the left occiput anterior (LOA) position?

below the umbilicus on the left side

At a preconception visit a 24-year-old client is found to have malformation of the uterus. The nurse uses the accompanying figure to explain which type of uterine malformation?

bicornate uterus

A hospitalized client who is 26 weeks' pregnant has been diagnosed with gestational diabetes. She is overweight and doesn't understand the diet that the healthcare provider has prescribed. To help the client understand the diet, the nurse would teach the client to choose what food types for a typical meal?

brown rice, spinach, pork tenderloin

A 19-year-old unmarried college student who is approximately 8 weeks pregnant asks the nurse, "If I have an abortion in the next 2 or 3 weeks, how will it be done?" The nurse instructs the client that at this gestational age, an abortion is usually performed by which technique?

dilatation and curettage

A client at 32 weeks of gestation has mild preeclampsia. She is discharged home with instructions to remain in bed rest. She is also instructed to call her healthcare provider if she experiences which of the following symptoms? Select all that apply.

headache blurred vision epigastric pain severe nausea and vomiting

The topic of physiologic changes that occur during pregnancy is to be included in a parenting class for primigravid clients who are in their first half of pregnancy. Which of the following topics would be important for the nurse to include in the teaching plan?

increased risk for urinary tract infections