practice question 141 exam 3 (2/2) chapters 26, 27, 28, 29, 30
MATCHING Because most pregnant women continue their usual activities, trauma remains a common complication during pregnancy. Approximately 1 in 12 pregnancies in the United States are complicated by trauma each year. As a result of the physiologic alterations that accompany pregnancy, special considerations for the mother and fetus are necessary when trauma occurs. Match the maternal system adaptation in pregnancy with the clinical response to trauma. a. Increased oxygen consumption b. Increased heart rate c. Decreased gastric motility d. Displacement of abdominal viscera e. Increase in clotting factors match to: 1. Decreased placental perfusion in the supine position 2. Increased risk of thrombus formation 3. Altered pain referral 4. Increased risk of acidosis 5. Increased risk of aspiration
1-B 2-E 3-D 4-A 5-C
MATCHING Biophysical risks include factors that originate with either the mother or the fetus and affect the functioning of either one or both. The nurse who provides prenatal care should have an understanding of these risk factors. Match the specific pregnancy problem with the related risk factor. a. Polyhydramnios b. IUGR (maternal cause) c. Oligohydramnios d. Chromosomal abnormalities e. IUGR (fetoplacental cause) match to: 1. Premature rupture of membranes 2. Advanced maternal age 3. Fetal congenital anomalies 4. Abnormal placenta development 5. Smoking, alcohol, and illicit drug use
1-C 2-D 3-A 4-E 5-B
MATCHING The nurse is preparing to teach an antepartum client with GDM the correct method of administering an intermediate-acting insulin, such as neutral protamine Hagedorn (NPH), with a short-acting insulin (regular). In the correct order from 1 through 6, match the step number with the action needed to teach the client self-administration of this combination of insulin. a. Without adding air, withdraw the correct dose of NPH insulin. b. Gently rotate the insulin to mix it, and wipe the stopper. c. Inject air equal to the dose of NPH insulin into the vial, and remove the syringe. d. Inject air equal to the dose of regular insulin into the vial, and withdraw the medication. e. Check the insulin bottles for the expiration date. f. Wash hands. match to: 1. Step 1 2. Step 2 3. Step 3 4. Step 4 5. Step 5 6. Step 6
1-F 2-E 3-B 4-C 5-D 6-A
A 39-year-old primigravida woman believes that she is approximately 8 weeks pregnant, although she has had irregular menstrual periods all her life. She has a history of smoking approximately one pack of cigarettes a day; however, she tells the nurse that she is trying to cut down. Her laboratory data are within normal limits. What diagnostic technique would be useful at this time? a. Ultrasound examination b. Maternal serum alpha-fetoprotein (MSAFP) screening c. Amniocentesis d. Nonstress test (NST)
A
A client asks her nurse, My doctor told me that he is concerned with the grade of my placenta because I am overdue. What does that mean? What is the nurses best response? a. Your placenta changes as your pregnancy progresses, and it is given a score that indicates how well it is functioning. b. Your placenta isnt working properly, and your baby is in danger. c. We need to perform an amniocentesis to detect if you have any placental damage. d. Dont worry about it. Everything is fine.
A
A pregnant womans BPP score is 8. She asks the nurse to explain the results. How should the nurse respond at this time? a. The test results are within normal limits. b. Immediate delivery by cesarean birth is being considered. c. Further testing will be performed to determine the meaning of this score. d. An obstetric specialist will evaluate the results of this profile and, within the next week, will inform you of your options regarding delivery.
A
A woman is undergoing a nipple-stimulated CST. She is having contractions that occur every 3 minutes. The fetal heart rate (FHR) has a baseline heart rate of approximately 120 beats per minute without any decelerations. What is the correct interpretation of this test? a. Negative b. Positive c. Satisfactory d. Unsatisfactory
A
A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the client and documents the following findings: temperature of 37.1 C, pulse rate of 96 beats per minute, respiratory rate of 24 breaths per minute, BP of 155/112 mm Hg, 3+ DTRs, and no ankle clonus. The nurse calls the provider with an update. The nurse should anticipate an order for which medication? a. Hydralazine b. Magnesium sulfate bolus c. Diazepam d. Calcium gluconate
A
In caring for an immediate postpartum client, the nurse notes petechiae and oozing from her intravenous (IV) site. The client would be closely monitored for which clotting disorder? a. DIC b. Amniotic fluid embolism (AFE) c. Hemorrhage d. HELLP syndrome
A
In caring for the woman with DIC, which order should the nurse anticipate? a. Administration of blood b. Preparation of the client for invasive hemodynamic monitoring c. Restriction of intravascular fluids d. Administration of steroids
A
Of these psychosocial factors, which has the least negative effect on the health of the mother and/or fetus? a. Moderate coffee consumption b. Moderate alcohol consumption c. Cigarette smoke d. Emotional distress
A
Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the client mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. This fetus is at the greatest risk for which condition? a. Macrosomia b. Congenital anomalies of the central nervous system c. Preterm birth d. Low birth weight
A
The client is being induced in response to worsening preeclampsia. She is also receiving magnesium sulfate. It appears that her labor has not become active, despite several hours of oxytocin administration. She asks the nurse, Why is this taking so long? What is the nurses most appropriate response? a. The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor. b. I dont know why it is taking so long. c. The length of labor varies for different women. d. Your baby is just being stubborn.
A
The nurse sees a woman for the first time when she is 30 weeks pregnant. The client has smoked throughout the pregnancy, and fundal height measurements now are suggestive of intrauterine growth restriction (IUGR) in the fetus. In addition to ultrasound to measure fetal size, what is another tool useful in confirming the diagnosis? a. Doppler blood flow analysis b. Contraction stress test (CST) c. Amniocentesis d. Daily fetal movement counts
A
What is the correct definition of a spontaneous termination of a pregnancy (abortion)? a. Pregnancy is less than 20 weeks. b. Fetus weighs less than 1000 g. c. Products of conception are passed intact. d. No evidence exists of intrauterine infection.
A
What is the highest priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy? a. Assessing FHR and maternal vital signs b. Performing a venipuncture for hemoglobin and hematocrit levels c. Placing clean disposable pads to collect any drainage d. Monitoring uterine contractions
A
What is the most common medical complication of pregnancy? a. Hypertension b. Hyperemesis gravidarum c. Hemorrhagic complications d. Infections
A
What nursing diagnosis is the most appropriate for a woman experiencing severe preeclampsia? a. Risk for injury to mother and fetus, related to central nervous system (CNS) irritability b. Risk for altered gas exchange c. Risk for deficient fluid volume, related to increased sodium retention secondary to the administration of magnesium sulfate d. Risk for increased cardiac output, related to the use of antihypertensive drugs
A
When is a prophylactic cerclage for an incompetent cervix usually placed (in weeks of gestation)? a. 12 to 14 b. 6 to 8 c. 23 to 24 d. After 24
A
Which analysis of maternal serum may predict chromosomal abnormalities in the fetus? a. Multiple-marker screening b. L/S ratio c. BPP d. Blood type and crossmatch of maternal and fetal serum
A
Which condition would require prophylaxis to prevent subacute bacterial endocarditis (SBE) both antepartum and intrapartum? a. Valvular heart disease b. Congestive heart disease c. Arrhythmias d. Postmyocardial infarction
A
Which information is an important consideration when comparing the CST with the NST? a. The NST has no known contraindications. b. The CST has fewer false-positive results when compared with the NST. c. The CST is more sensitive in detecting fetal compromise, as opposed to the NST. d. The CST is slightly more expensive than the NST.
A
Which information is the highest priority for the nurse to comprehend regarding the BPP? a. BPP is an accurate indicator of impending fetal well-being. b. BPP is a compilation of health risk factors of the mother during the later stages of pregnancy. c. BPP consists of a Doppler blood flow analysis and an amniotic fluid index (AFI). d. BPP involves an invasive form of an ultrasonic examination.
A
Which intervention is most important when planning care for a client with severe gestational hypertension? a. Induction of labor is likely, as near term as possible. b. If at home, the woman should be confined to her bed, even with mild gestational hypertension. c. Special diet low in protein and salt should be initiated. d. Vaginal birth is still an option, even in severe cases.
A
Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother? a. Hypoglycemia b. Hypercalcemia c. Hypobilirubinemia d. Hypoinsulinemia
A
Which neonatal complications are associated with hypertension in the mother? a. Intrauterine growth restriction (IUGR) and prematurity b. Seizures and cerebral hemorrhage c. Hepatic or renal dysfunction d. Placental abruption and DIC
A
Which order should the nurse expect for a client admitted with a threatened abortion? a. Bed rest b. Administration of ritodrine IV c. Nothing by mouth (nil per os [NPO]) d. Narcotic analgesia every 3 hours, as needed
A
Which statement concerning the complication of maternal diabetes is the most accurate? a. Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy. b. Hydramnios occurs approximately twice as often in diabetic pregnancies than in nondiabetic pregnancies. c. Infections occur about as often and are considered about as serious in both diabetic and nondiabetic pregnancies. d. Even mild-to-moderate hypoglycemic episodes can have significant effects on fetal well-being.
A
With regard to hemorrhagic complications that may occur during pregnancy, what information is most accurate? a. An incompetent cervix is usually not diagnosed until the woman has lost one or two pregnancies. b. Incidences of ectopic pregnancy are declining as a result of improved diagnostic techniques. c. One ectopic pregnancy does not affect a womans fertility or her likelihood of having a normal pregnancy the next time. d. Gestational trophoblastic neoplasia (GTN) is one of the persistently incurable gynecologic malignancies.
A
Which congenital anomalies can occur as a result of the use of antiepileptic drugs (AEDs) in pregnancy? (Select all that apply.) a. Cleft lip b. Congenital heart disease c. Neural tube defects d. Gastroschisis e. Diaphragmatic hernia
A, B, C
IUGR is associated with which pregnancy-related risk factors? (Select all that apply.) a. Poor nutrition b. Maternal collagen disease c. Gestational hypertension d. Premature rupture of membranes e. Smoking
A, B, C ,E
Which assessments are included in the fetal BPP? (Select all that apply.) a. Fetal movement b. Fetal tone c. Fetal heart rate d. AFI e. Placental grade
A, B, C, D
Transvaginal ultrasonography is often performed during the first trimester. While preparing a 6-week gestational client for this procedure, she expresses concerns over the necessity for this test. The nurse should explain that this diagnostic test may be indicated for which situations? (Select all that apply.) a. Multifetal gestation b. Obesity c. Fetal abnormalities d. Amniotic fluid volume e. Ectopic pregnancy
A, B, C, E
Cell-free deoxyribonucleic acid (DNA) screening is a new method of noninvasive prenatal testing (NIPT) that has recently become available in the clinical setting. This technology can provide a definitive diagnosis of which findings? (Select all that apply.) a. Fetal Rh status b. Fetal gender c. Maternally transmitted gene disorder d. Paternally transmitted gene disorder e. Trisomy 21
A, B, D, E
Diabetes refers to a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin action, insulin secretion, or both. Over time, diabetes causes significant changes in the microvascular and macrovascular circulations. What do these complications include? (Select all that apply.) a. Atherosclerosis b. Retinopathy c. Intrauterine fetal death (IUFD) d. Nephropathy e. Neuropathy f. Autonomic neuropathy
A, B, D, E
The reported incidence of ectopic pregnancy has steadily risen over the past 2 decades. Causes include the increase in sexually transmitted infections (STIs) accompanied by tubal infection and damage. The popularity of contraceptive devices such as the IUD has also increased the risk for ectopic pregnancy. The nurse suspects that a client has early signs of ectopic pregnancy. The nurse should be observing the client for which signs or symptoms? (Select all that apply.) a. Pelvic pain b. Abdominal pain c. Unanticipated heavy bleeding d. Vaginal spotting or light bleeding e. Missed period
A, B, D, E
One of the most important components of the physical assessment of the pregnant client is the determination of BP. Consistency in measurement techniques must be maintained to ensure that the nuances in the variations of the BP readings are not the result of provider error. Which techniques are important in obtaining accurate BP readings? (Select all that apply.) a. The client should be seated. b. The clients arm should be placed at the level of the heart. c. An electronic BP device should be used. d. The cuff should cover a minimum of 60% of the upper arm. e. The same arm should be used for every reading.
A, B, E
A serious but uncommon complication of undiagnosed or partially treated hyperthyroidism is a thyroid storm, which may occur in response to stress such as infection, birth, or surgery. What are the signs and symptoms of this emergency disorder? (Select all that apply.) a. Fever b. Hypothermia c. Restlessness d. Bradycardia e. Hypertension
A, C
In caring for a pregnant woman with sickle cell anemia, the nurse must be aware of the signs and symptoms of a sickle cell crisis. What do these include? (Select all that apply.) a. Fever b. Endometritis c. Abdominal pain d. Joint pain e. Urinary tract infection (UTI)
A, C, D
A lupus flare-up during pregnancy or early postpartum occurs in 15% to 60% of women with this disorder. Which conditions associated with systemic lupus erythematosus (SLE) are maternal risks? (Select all that apply.) a. Miscarriage b. Intrauterine growth restriction (IUGR) c. Nephritis d. Preeclampsia e. Cesarean birth
A, C, D, E
Approximately 10% to 15% of all clinically recognized pregnancies end in miscarriage. What are possible causes of early miscarriage? (Select all that apply.) a. Chromosomal abnormalities b. Infections c. Endocrine imbalance d. Systemic disorders e. Varicella
A, C, D, E
A client who has undergone a D&C for early pregnancy loss is likely to be discharged the same day. The nurse must ensure that her vital signs are stable, that bleeding has been controlled, and that the woman has adequately recovered from the administration of anesthesia. To promote an optimal recovery, what information should discharge teaching include? (Select all that apply.) a. Iron supplementation b. Resumption of intercourse at 6 weeks postprocedure c. Referral to a support group, if necessary d. Expectation of heavy bleeding for at least 2 weeks e. Emphasizing the need for rest
A, C, E
Which adverse prenatal outcomes are associated with the HELLP syndrome? (Select all that apply.) a. Placental abruption b. Placenta previa c. Renal failure d. Cirrhosis e. Maternal and fetal death
A, C, E
A 26-year-old pregnant woman, gravida 2, para 1-0-0-1, is 28 weeks pregnant when she experiences bright red, painless vaginal bleeding. On her arrival at the hospital, which diagnostic procedure will the client most likely have performed? a. Amniocentesis for fetal lung maturity b. Transvaginal ultrasound for placental location c. Contraction stress test (CST) d. Internal fetal monitoring
B
A 26-year-old primigravida has come to the clinic for her regular prenatal visit at 12 weeks. She appears thin and somewhat nervous. She reports that she eats a well-balanced diet, although her weight is 5 pounds less than it was at her last visit. The results of laboratory studies confirm that she has a hyperthyroid condition. Based on the available data, the nurse formulates a plan of care. Which nursing diagnosis is most appropriate for the client at this time? a. Deficient fluid volume b. Imbalanced nutrition: less than body requirements c. Imbalanced nutrition: more than body requirements d. Disturbed sleep pattern
B
A 41-week pregnant multigravida arrives at the labor and delivery unit after a NST indicated that her fetus could be experiencing some difficulties in utero. Which diagnostic tool yields more detailed information about the condition of the fetus? a. Ultrasound for fetal anomalies b. Biophysical profile (BPP) c. MSAFP screening d. Percutaneous umbilical blood sampling (PUBS)
B
A client with maternal phenylketonuria (PKU) has come to the obstetrical clinic to begin prenatal care. Why would this preexisting condition result in the need for closer monitoring during pregnancy? a. PKU is a recognized cause of preterm labor. b. The fetus may develop neurologic problems. c. A pregnant woman is more likely to die without strict dietary control. d. Women with PKU are usually mentally handicapped and should not reproduce.
B
A laboring woman with no known risk factors suddenly experiences spontaneous ROM. The fluid consists of bright red blood. Her contractions are consistent with her current stage of labor. No change in uterine resting tone has occurred. The fetal heart rate (FHR) begins to decline rapidly after the ROM. The nurse should suspect the possibility of what condition? a. Placenta previa b. Vasa previa c. Severe abruptio placentae d. Disseminated intravascular coagulation (DIC)
B
A new mother with a thyroid disorder has come for a lactation follow-up appointment. Which thyroid disorder is a contraindication for breastfeeding? a. Hyperthyroidism b. PKU c. Hypothyroidism d. Thyroid storm
B
A perinatal nurse is giving discharge instructions to a woman, status postsuction, and curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. What is the bestresponse by the nurse? a. If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if you desire a future pregnancy, it would be better for you to use the most reliable method of contraception available. b. The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, then it would make the diagnosis of this cancer more difficult. c. If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy is rare. Therefore, to improve your chance of a successful pregnancy, not getting pregnant at this time is best. d. Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pregnancy.
B
A pregnant woman is being discharged from the hospital after the placement of a cervical cerclage because of a history of recurrent pregnancy loss, secondary to an incompetent cervix. Which information regarding postprocedural care should the nurse emphasize in the discharge teaching? a. Any vaginal discharge should be immediately reported to her health care provider. b. The presence of any contractions, rupture of membranes (ROM), or severe perineal pressure should be reported. c. The client will need to make arrangements for care at home, because her activity level will be restricted. d. The client will be scheduled for a cesarean birth.
B
An 18-year-old client who has reached 16 weeks of gestation was recently diagnosed with pregestational diabetes. She attends her centering appointment accompanied by one of her girlfriends. This young woman appears more concerned about how her pregnancy will affect her social life than her recent diagnosis of diabetes. A number of nursing diagnoses are applicable to assist in planning adequate care. What is the most appropriate diagnosis at this time? a. Risk for injury, to the fetus related to birth trauma b. Deficient knowledge, related to diabetic pregnancy management c. Deficient knowledge, related to insulin administration d. Risk for injury, to the mother related to hypoglycemia or hyperglycemia
B
An MSAFP screening indicates an elevated level of alpha-fetoprotein. The test is repeated, and again the level is reported as higher than normal. What is the next step in the assessment sequence to determine the well-being of the fetus? a. PUBS b. Ultrasound for fetal anomalies c. BPP for fetal well-being d. Amniocentesis for genetic anomalies
B
Bell palsy is an acute idiopathic facial paralysis, the cause for which remains unknown. Which statement regarding this condition is correct? a. Bell palsy is the sudden development of bilateral facial weakness. b. Women with Bell palsy have an increased risk for hypertension. c. Pregnant women are affected twice as often as nonpregnant women. d. Bell palsy occurs most frequently in the first trimester.
B
In contrast to placenta previa, what is the most prevalent clinical manifestation of abruptio placentae? a. Bleeding b. Intense abdominal pain c. Uterine activity d. Cramping
B
In terms of the incidence and classification of diabetes, which information should the nurse keep in mind when evaluating clients during their ongoing prenatal appointments? a. Type 1 diabetes is most common. b. Type 2 diabetes often goes undiagnosed. c. GDM means that the woman will receive insulin treatment until 6 weeks after birth. d. Type 1 diabetes may become type 2 during pregnancy.
B
It is extremely rare for a woman to die in childbirth; however, it can happen. In the United States, the annual occurrence of maternal death is 12 per 100,000 cases of live birth. What are the leading causes of maternal death? a. Embolism and preeclampsia b. Trauma and motor vehicle accidents (MVAs) c. Hemorrhage and infection d. Underlying chronic conditions
B
Preconception counseling is critical in the safe management of diabetic pregnancies. Which complication is commonly associated with poor glycemic control before and during early pregnancy? a. Frequent episodes of maternal hypoglycemia b. Congenital anomalies in the fetus c. Hydramnios d. Hyperemesis gravidarum
B
The client being cared for has severe preeclampsia and is receiving a magnesium sulfate infusion. Which new finding would give the nurse cause for concern? a. Sleepy, sedated affect b. Respiratory rate of 10 breaths per minute c. DTRs of 2 d. Absent ankle clonus
B
The client makes an appointment for preconception counseling. The woman has a known heart condition and is unsure if she should become pregnant. Which is the only cardiac condition that would cause concern? a. Marfan syndrome b. Eisenmenger syndrome c. Heart transplant d. Ventricular septal defect (VSD)
B
The nurse is planning the care for a laboring client with diabetes mellitus. This client is at greater risk for which clinical finding? a. Oligohydramnios b. Polyhydramnios c. Postterm pregnancy d. Chromosomal abnormalitie
B
The nurse who is caring for a woman hospitalized for hyperemesis gravidarum would expect the initial treatment to involve what? a. Corticosteroids to reduce inflammation b. Intravenous (IV) therapy to correct fluid and electrolyte imbalances c. Antiemetic medication, such as pyridoxine, to control nausea and vomiting d. Enteral nutrition to correct nutritional deficits
B
What is the correct terminology for an abortion in which the fetus dies but is retained within the uterus? a. Inevitable abortion b. Missed abortion c. Incomplete abortion d. Threatened abortion
B
Which clinical finding is a major use of ultrasonography in the first trimester? a. Amniotic fluid volume b. Presence of maternal abnormalities c. Placental location and maturity d. Cervical length
B
Which information regarding the care of antepartum women with cardiac conditions is most important for the nurse to understand? a. Stress on the heart is greatest in the first trimester and the last 2 weeks before labor. b. Women with class II cardiac disease should avoid heavy exertion and any activity that causes even minor symptoms. c. Women with class III cardiac disease should get 8 to 10 hours of sleep every day and limit housework, shopping, and exercise. d. Women with class I cardiac disease need bed rest through most of the pregnancy and face the possibility of hospitalization near term.
B
Which information should the nurse take into consideration when planning care for a postpartum client with cardiac disease? a. The plan of care for a postpartum client is the same as the plan for any pregnant woman. b. The plan of care includes rest, stool softeners, and monitoring of the effect of activity. c. The plan of care includes frequent ambulating, alternating with active range-of-motion exercises. d. The plan of care includes limiting visits with the infant to once per day.
B
Which laboratory marker is indicative of DIC? a. Bleeding time of 10 minutes b. Presence of fibrin split products c. Thrombocytopenia d. Hypofibrinogenemia
B
Which maternal condition always necessitates delivery by cesarean birth? a. Marginal placenta previa b. Complete placenta previa c. Ectopic pregnancy d. Eclampsia
B
Which nursing intervention is necessary before a first-trimester transabdominal ultrasound? a. Place the woman on nothing by mouth (nil per os [NPO]) for 12 hours. b. Instruct the woman to drink 1 to 2 quarts of water. c. Administer an enema. d. Perform an abdominal preparation.
B
Autoimmune disorders often occur during pregnancy because a large percentage of women with an autoimmune disorder are of childbearing age. Which disorders fall into the category of collagen vascular disease? (Select all that apply.) a. Multiple sclerosis b. SLE c. Antiphospholipid syndrome d. Rheumatoid arthritis e. Myasthenia gravis
B, C, D, E
A 30-year-old gravida 3, para 2-0-0-2 is at 18 weeks of gestation. Which screening test should the nurse recommend be ordered for this client? a. BPP b. Chorionic villi sampling c. MSAFP screening d. Screening for diabetes mellitus
C
A client in the third trimester has just undergone an amniocentesis to determine fetal lung maturity. Which statement regarding this testing is important for the nurse in formulating a care plan? a. Because of new imaging techniques, an amniocentesis should have been performed in the first trimester. b. Despite the use of ultrasonography, complications still occur in the mother or infant in 5% to 10% of cases. c. Administration of Rho(D) immunoglobulin may be necessary. d. The presence of meconium in the amniotic fluid is always a cause for concern.
C
A number of metabolic changes occur throughout pregnancy. Which physiologic adaptation of pregnancy will influence the nurses plan of care? a. Insulin crosses the placenta to the fetus only in the first trimester, after which the fetus secretes its own. b. Women with insulin-dependent diabetes are prone to hyperglycemia during the first trimester because they are consuming more sugar. c. During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus. d. Maternal insulin requirements steadily decline during pregnancy.
C
A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment, the nurse finds the following vital signs: temperature 37.3 C, pulse rate 88 beats per minute, respiratory rate 10 breaths per minute, BP 148/90 mm Hg, absent deep tendon reflexes (DTRs), and no ankle clonus. The client complains, Im so thirsty and warm. What is the nurses immediate action? a. To call for an immediate magnesium sulfate level b. To administer oxygen c. To discontinue the magnesium sulfate infusion d. To prepare to administer hydralazine
C
A primigravida is being monitored at the prenatal clinic for preeclampsia. Which finding is of greatest concern to the nurse? a. Blood pressure (BP) increase to 138/86 mm Hg b. Weight gain of 0.5 kg during the past 2 weeks c. Dipstick value of 3+ for protein in her urine d. Pitting pedal edema at the end of the day
C
A woman arrives at the emergency department with complaints of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary care provider finds that the cervix is closed. The anticipated plan of care for this woman would be based on a probable diagnosis of which type of spontaneous abortion? a. Incomplete b. Inevitable c. Threatened d. Septic
C
A woman arrives for evaluation of signs and symptoms that include a missed period, adnexal fullness, tenderness, and dark red vaginal bleeding. On examination, the nurse notices an ecchymotic blueness around the womans umbilicus. What does this finding indicate? a. Normal integumentary changes associated with pregnancy b. Turner sign associated with appendicitis c. Cullen sign associated with a ruptured ectopic pregnancy d. Chadwick sign associated with early pregnancy
C
A woman at 28 weeks of gestation experiences blunt abdominal trauma as the result of a fall. The nurse must closely observe the client for what? a. Alteration in maternal vital signs, especially blood pressure b. Complaints of abdominal pain c. Placental absorption d. Hemorrhage
C
A woman has experienced iron deficiency anemia during her pregnancy. She had been taking iron for 3 months before the birth. The client gave birth by cesarean 2 days earlier and has been having problems with constipation. After assisting her back to bed from the bathroom, the nurse notes that the womans stools are dark (greenish-black). What should the nurses initial action be? a. Perform a guaiac test, and record the results. b. Recognize the finding as abnormal, and report it to the primary health care provider. c. Recognize the finding as a normal result of iron therapy. d. Check the womans next stool to validate the observation.
C
A woman who is 30 weeks of gestation arrives at the hospital with bleeding. Which differential diagnosis would not be applicable for this client? a. Placenta previa b. Abruptio placentae c. Spontaneous abortion d. Cord insertion
C
A woman with asthma is experiencing a postpartum hemorrhage. Which drug should be avoided when treating postpartum bleeding to avoid exacerbating asthma? a. Oxytocin (Pitocin) b. Nonsteroidal antiinflammatory drugs (NSAIDs) c. Hemabate d. Fentanyl
C
A woman with worsening preeclampsia is admitted to the hospitals labor and birth unit. The physician explains the plan of care for severe preeclampsia, including the induction of labor, to the woman and her husband. Which statement by the husband leads the nurse to believe that the couple needs further information? a. I will help my wife use the breathing techniques that we learned in our childbirth classes. b. I will give my wife ice chips to eat during labor. c. Since we will be here for a while, I will call my mother so she can bring the two boys2 years and 4 years of ageto visit their mother. d. I will stay with my wife during her labor, just as we planned.
C
At 35 weeks of pregnancy, a woman experiences preterm labor. Although tocolytic medications are administered and she is placed on bed rest, she continues to experience regular uterine contractions and her cervix is beginning to dilate and efface. What is an important test for fetal well-being at this time? a. PUBS b. Ultrasound for fetal size c. Amniocentesis for fetal lung maturity d. NST
C
During a prenatal visit, the nurse is explaining dietary management to a woman with pregestational diabetes. Which statement by the client reassures the nurse that teaching has been effective? a. I will need to eat 600 more calories per day because I am pregnant. b. I can continue with the same diet as before pregnancy as long as it is well balanced. c. Diet and insulin needs change during pregnancy. d. I will plan my diet based on the results of urine glucose testing.
C
In the past, factors to determine whether a woman was likely to develop a high-risk pregnancy were primarily evaluated from a medical point of view. A broader, more comprehensive approach to high-risk pregnancy has been adopted today. Four categories have now been established, based on the threats to the health of the woman and the outcome of pregnancy. Which category should not be included in this group? a. Biophysical b. Psychosocial c. Geographic d. Environmental
C
The American College of Obstetricians and Gynecologists (ACOG) has developed a comprehensive list of risk factors associated with the development of preeclampsia. Which client exhibits the greatest number of these risk factors? a. 30-year-old obese Caucasian with her third pregnancy b. 41-year-old Caucasian primigravida c. 19-year-old African American who is pregnant with twins d. 25-year-old Asian American whose pregnancy is the result of donor insemination
C
The indirect Coombs test is a screening tool for Rh incompatibility. If the titer is greater than ______, amniocentesis may be a necessary next step. a. 1:2 b. 1:4 c. 1:8 d. 1:12
C
The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the oxytocin (Pitocin) infusion, the nurse reviews the womans latest laboratory test findings, which reveal a platelet count of 90,000 mm3, an elevated aspartate aminotransaminase (AST) level, and a falling hematocrit. The laboratory results are indicative of which condition? a. Eclampsia b. Disseminated intravascular coagulation (DIC) syndrome c. Hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome d. Idiopathic thrombocytopenia
C
The management of the pregnant client who has experienced a pregnancy loss depends on the type of miscarriage and the signs and symptoms. While planning care for a client who desires outpatient management after a first-trimester loss, what would the nurse expect the plan to include? a. Dilation and curettage (D&C) b. Dilation and evacuation (D&E) c. Misoprostol d. Ergot products
C
The nurse is preparing to administer methotrexate to the client. This hazardous drug is most often used for which obstetric complication? a. Complete hydatidiform mole b. Missed abortion c. Unruptured ectopic pregnancy d. Abruptio placentae
C
To manage her diabetes appropriately and to ensure a good fetal outcome, how would the pregnant woman with diabetes alter her diet? a. Eat six small equal meals per day. b. Reduce the carbohydrates in her diet. c. Eat her meals and snacks on a fixed schedule. d. Increase her consumption of protein
C
What condition indicates concealed hemorrhage when the client experiences abruptio placentae? a. Decrease in abdominal pain b. Bradycardia c. Hard, boardlike abdomen d. Decrease in fundal height
C
What is the primary purpose for magnesium sulfate administration for clients with preeclampsia and eclampsia? a. To improve patellar reflexes and increase respiratory efficiency b. To shorten the duration of labor c. To prevent convulsions d. To prevent a boggy uterus and lessen lochial flow
C
Which finding on a prenatal visit at 10 weeks of gestation might suggest a hydatidiform mole? a. Complaint of frequent mild nausea b. Blood pressure of 120/80 mm Hg c. Fundal height measurement of 18 cm d. History of bright red spotting for 1 day, weeks ago
C
Which important component of nutritional counseling should the nurse include in health teaching for a pregnant woman who is experiencing cholecystitis? a. Assess the womans dietary history for adequate calories and proteins. b. Teach the woman that the bulk of calories should come from proteins. c. Instruct the woman to eat a low-fat diet and to avoid fried foods. d. Instruct the woman to eat a low-cholesterol, low-salt diet.
C
Which information should nurses provide to expectant mothers when teaching them how to evaluate daily fetal movement counts (DFMCs)? a. Alcohol or cigarette smoke can irritate the fetus into greater activity. b. Kick counts should be taken every hour and averaged every 6 hours, with every other 6-hour stretch off. c. The fetal alarm signal should go off when fetal movements stop entirely for 12 hours. d. A count of less than four fetal movements in 1 hour warrants future evaluation.
C
Which neurologic condition would require preconception counseling, if at all possible? a. Eclampsia b. Bell palsy c. Epilepsy d. Multiple sclerosis
C
Which preexisting factor is known to increase the risk of GDM? a. Underweight before pregnancy b. Maternal age younger than 25 years c. Previous birth of large infant d. Previous diagnosis of type 2 diabetes mellitus
C
Which statement most accurately describes the HELLP syndrome? a. Mild form of preeclampsia b. Diagnosed by a nurse alert to its symptoms c. Characterized by hemolysis, elevated liver enzymes, and low platelets d. Associated with preterm labor but not perinatal mortality
C
Which statement regarding the laboratory test for glycosylated hemoglobin Alc is correct? a. The laboratory test for glycosylated hemoglobin Alc is performed for all pregnant women, not only those with or likely to have diabetes. b. This laboratory test is a snapshot of glucose control at the moment. c. This laboratory test measures the levels of hemoglobin Alc, which should remain at less than 7%. d. This laboratory test is performed on the womans urine, not her blood.
C
While working with the pregnant client in her first trimester, what information does the nurse provide regarding when CVS can be performed (in weeks of gestation)? a. 4 b. 8 c. 10 d. 14
C
Women with mild gestational hypertension and mild preeclampsia can be safely managed at home with frequent maternal and fetal evaluation. Complete or partial bed rest is still frequently ordered by some providers. Which complication is rarely the result of prolonged bed rest? a. Thrombophlebitis b. Psychologic stress c. Fluid retention d. Cardiovascular deconditioning
C
Hypothyroidism occurs in 2 to 3 pregnancies per 1000. Because severe hypothyroidism is associated with infertility and miscarriage, it is not often seen in pregnancy. Regardless of this fact, the nurse should be aware of the characteristic symptoms of hypothyroidism. Which do they include? (Select all that apply.) a. Hot flashes b. Weight loss c. Lethargy d. Decrease in exercise capacity e. Cold intolerance
C, D, E
A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Which information assists the nurse in developing the plan of care? a. Bed rest and analgesics are the recommended treatment. b. She will be unable to conceive in the future. c. A D&C will be performed to remove the products of conception. d. Hemorrhage is the primary concern.
D
A pregnant woman at 33 weeks of gestation is brought to the birthing unit after a minor automobile accident. The client is experiencing no pain and no vaginal bleeding, her vital signs are stable, and the FHR is 132 beats per minute with variability. What is the nurses highest priority? a. Monitoring the woman for a ruptured spleen b. Obtaining a physicians order to discharge her home c. Monitoring her for 24 hours d. Using continuous EFM for a minimum of 4 hours
D
A woman arrives at the clinic seeking confirmation that she is pregnant. The following information is obtained: She is 24 years old with a body mass index (BMI) of 17.5. She admits to having used cocaine several times during the past year and occasionally drinks alcohol. Her blood pressure is 108/70 mm Hg. The family history is positive for diabetes mellitus and cancer. Her sister recently gave birth to an infant with a neural tube defect (NTD). Which characteristics places this client in a high-risk category? a. Blood pressure, age, BMI b. Drug and alcohol use, age, family history c. Family history, blood pressure (BP), BMI d. Family history, BMI, drug and alcohol abuse
D
A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes, dark red vaginal bleeding, and a tense, painful abdomen. Which clinical change does the nurse anticipate? a. Eclamptic seizure b. Rupture of the uterus c. Placenta previa d. Abruptio placentae
D
A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. The client shows the nurse her readings for the past few days. Which reading signals the nurse that the client may require an adjustment of insulin or carbohydrates? a. 75 mg/dl before lunch. This is low; better eat now. b. 115 mg/dl 1 hour after lunch. This is a little high; maybe eat a little less next time. c. 115 mg/dl 2 hours after lunch. This is too high; it is time for insulin. d. 50 mg/dl just after waking up from a nap. This is too low; maybe eat a snack before going to sleep.
D
A woman with preeclampsia has a seizure. What is the nurses highest priority during a seizure? a. To insert an oral airway b. To suction the mouth to prevent aspiration c. To administer oxygen by mask d. To stay with the client and call for help
D
Another common pregnancy-specific condition is pruritic urticarial papules and plaques of pregnancy (PUPPP). A client asks the nurse why she has developed this condition and what can be done. What is the nurses bestresponse? a. PUPPP is associated with decreased maternal weight gain. b. The rate of hypertension decreases with PUPPP. c. This common pregnancy-specific condition is associated with a poor fetal outcome. d. The goal of therapy is to relieve discomfort.
D
How does the nurse document a NST during which two or more FHR accelerations of 15 beats per minute or more occur with fetal movement in a 20-minute period? a. Nonreactive b. Positive c. Negative d. Reactive
D
In comparing the abdominal and transvaginal methods of ultrasound examination, which information should the nurse provide to the client? a. Both require the woman to have a full bladder. b. The abdominal examination is more useful in the first trimester. c. Initially, the transvaginal examination can be painful. d. The transvaginal examination allows pelvic anatomy to be evaluated in greater detail.
D
Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy. Which statement regarding monitoring techniques is the most accurate? a. Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis. b. MSAFP screening is recommended only for women at risk for NTDs. c. PUBS is one of the triple-marker tests for Down syndrome. d. MSAFP is a screening tool only; it identifies candidates for more definitive diagnostic procedures.
D
Postoperative care of the pregnant woman who requires abdominal surgery for appendicitis includes which additional assessment? a. Intake and output (I&O) and intravenous (IV) site b. Signs and symptoms of infection c. Vital signs and incision d. Fetal heart rate (FHR) and uterine activity
D
Since the gene for cystic fibrosis was identified in 1989, data can be collected for the purposes of genetic counseling for couples regarding carrier status. According to the most recent statistics, how often does cystic fibrosis occur in Caucasian live births? a. 1 in 100 b. 1 in 1000 c. 1 in 2000 d. 1 in 3200
D
The client has been on magnesium sulfate for 20 hours for the treatment of preeclampsia. She just delivered a viable infant girl 30 minutes ago. What uterine findings does the nurse expect to observe or assess in this client? a. Absence of uterine bleeding in the postpartum period b. Fundus firm below the level of the umbilicus c. Scant lochia flow d. Boggy uterus with heavy lochia flow
D
The nurse has evaluated a client with preeclampsia by assessing DTRs. The result is a grade of 3+. Which DTR response most accurately describes this score? a. Sluggish or diminished b. Brisk, hyperactive, with intermittent or transient clonus c. Active or expected response d. More brisk than expected, slightly hyperactive
D
The nurse who elects to practice in the area of womens health must have a thorough understanding of miscarriage. Which statement regarding this condition is most accurate? a. A miscarriage is a natural pregnancy loss before labor begins. b. It occurs in fewer than 5% of all clinically recognized pregnancies. c. Careless maternal behavior, such as poor nutrition or excessive exercise, can be a factor in causing a miscarriage. d. If a miscarriage occurs before the 12th week of pregnancy, then it may be observed only as moderate discomfort and blood loss.
D
What form of heart disease in women of childbearing years generally has a benign effect on pregnancy? a. Cardiomyopathy b. Rheumatic heart disease c. Congenital heart disease d. Mitral valve prolapse
D
When caring for a pregnant woman with cardiac problems, the nurse must be alert for the signs and symptoms of cardiac decompensation. Which critical findings would the nurse find on assessment of the client experiencing this condition? a. Regular heart rate and hypertension b. Increased urinary output, tachycardia, and dry cough c. Shortness of breath, bradycardia, and hypertension d. Dyspnea, crackles, and an irregular, weak pulse
D
Which physiologic alteration of pregnancy most significantly affects glucose metabolism? a. Pancreatic function in the islets of Langerhans is affected by pregnancy. b. Pregnant women use glucose at a more rapid rate than nonpregnant women. c. Pregnant women significantly increase their dietary intake. d. Placental hormones are antagonistic to insulin, thus resulting in insulin resistance.
D
Which statement best describes chronic hypertension? a. Chronic hypertension is defined as hypertension that begins during pregnancy and lasts for the duration of the pregnancy. b. Chronic hypertension is considered severe when the systolic BP is higher than 140 mm Hg or the diastolic BP is higher than 90 mm Hg. c. Chronic hypertension is general hypertension plus proteinuria. d. Chronic hypertension can occur independently of or simultaneously with preeclampsia.
D
A pregnant woman at term is transported to the emergency department (ED) after a severe vehicular accident. The obstetric nurse responds and rushes to the ED with a fetal monitor. Cardiopulmonary arrest occurs as the obstetric nurse arrives. What is the highest priority for the trauma team? a. Obtaining IV access, and starting aggressive fluid resuscitation b. Quickly applying the fetal monitor to determine whether the fetus viability c. Starting cardiopulmonary resuscitation (CPR) d. Transferring the woman to the surgical unit for an emergency cesarean delivery in case the fetus is still alive
c