S2 Test 2

Which is an important nursing intervention when a client receives intravenous (IV) magnesium sulfate for preeclampsia? 1 Limiting IV fluid intake 2 Preparing for a possible precipitous birth 3 Maintaining a quiet, darkened environment 4 Obtaining magnesium gluconate as an antagonist

3 A quiet, darkened room reduces stimuli, which is essential for limiting or preventing seizures. IV fluid infusions are not limited. Infusions are monitored closely and usually maintained at a volume of 125 mL/h. Precipitous birth is not a usual side effect of magnesium therapy. Calcium gluconate, not magnesium gluconate, is the antagonist for magnesium sulfate and should be kept on hand in case signs of toxicity appear.

embolus

A clot, usually a thrombus, forced into smaller vessels by the blood circulation

Magnesium Sulfate

Can relieve constipation, inhibits contractions in preterm labor

Following an amniotomy, what is the priority nursing intervention?

Check fetal HR

Cord prolapse

Complication of pregnancy in which the umbilical cord emerges from the uterus during labor and may be compressed against the maternal pelvis or the vagina. This can cause obstructed blood supply to the fetus.

Bishop score

Determines maternal readiness for labor by evaluating whether the cervix is favorable by rating cervical dilation, effacement, consistency, position, and station

Furosemide

Diuretic

Hydrochlorothiazide

Diuretic

shoulder dystocia

Head is delivered but shoulders become impacted above mother's symphysis pubis.

Atenolol

beta blocker, lowers BP

Precipitous labor

Labor that lasts 3 hours or less from onset of contractions to time of delivery

Terbutaline

Prevent and reverse bronchospasm

Potassium Chloride

Prevent and treat potassium deficiencies

Misoprostol

Stomach acid reducer, protects stomach lining from damage, induction of pregnancy

List the nursing measures to promote normal labor when maternal pushing is ineffective for exhaustion

Teach the woman to push only when she feels the urge or with every other contraction; administer fluids as ordered; offer reassurance.

atony

lack of normal muscle tone

Spironolactone (Aldactone)

potassium sparing diuretic

abruptio placentae

premature separation of the placenta from the uterine wall

A young pregnant adolescent is diagnosed with an ectopic pregnancy. Which risk factors contribute to ectopic pregnancy? Select all that apply. One, some, or all responses may be correct. 1 Habit of smoking 2 Irregular menses 3 Use of contraceptive pills 4 Damage to the fallopian tubes 5 History of pelvic inflammatory disease

1, 4, 5

Which is a clinical manifestation of worsening preeclampsia? 1 Polyuria 2 Vaginal spotting 3 Proteinuria of 3+ 4 Blood pressure of 130/80 mm Hg

3 As preeclampsia worsens, blood pressure and edema increase and degenerative changes of the kidney cause increasing proteinuria (3+). With worsening preeclampsia, oliguria, not polyuria, is expected. Vaginal spotting is not a sign of worsening preeclampsia. A blood pressure of 130/80 mm Hg is within acceptable limits; however, there is insufficient information to determine whether it is increased in this client.

The nurse administers 2 serial intramuscular injections of betamethasone to a woman at 32 weeks' gestation admitted for preterm labor. The nurse explains to the client the medication is given to accomplish which purpose? 1 Stop the process of labor. 2 Increase placental perfusion. 3 Stimulate surfactant production. 4 Reduce intensity of contractions

3 Corticosteroids stimulate surfactant production; they also have been shown to reduce the incidence of intraventricular hemorrhage. Betamethasone does not affect the labor process, increase placental perfusion, or affect the intensity of contractions.

One side effect of oxytocin stimulation is hypertonic contractions. The nurse knows this can be detrimental to the fetus for what reason? A It causes a reduction of placental blood flow B It produces a prolapsed cord C It increases maternal renal blood flow D It decreases maternal blood pressure

A

Tocolytics

Act on uterine muscle to cease contractions. Used to stop preterm labor. Terbutaline sulfate (Brethine), ritodrine HCl (Yutopar), nifedipine (Procardia), magnesium sulfate

calcium gluconate

Antidote for magnesium sulfate Prevent or treat calcium deficiencies

augmentation of labor

Artificial stimulation of uterine contractions that have become ineffective.

In order to monitor for one of the side effects of oxytocin, which of the following assessments is priority? A monitor the patient's temperature B monitor the patient's intake and output C monitor the patient's respiratory rate D monitor the patient's deep tendon reflexes

B because it can cause fluid retention

Which clinical finding would the nurse anticipate when admitting a client with an extracellular fluid volume excess? 1 Rapid, thready pulse 2 Distended jugular veins 3 Elevated hematocrit level 4 Increased serum sodium level

Because of fluid overload in the intravascular space, the neck veins become visibly distended. Rapid, thready pulse and elevated hematocrit level occur with a fluid deficit. If sodium causes fluid retention, its concentration is unchanged; if fluid is retained independently of sodium, its concentration is decreased.

After the use of forceps during labor, what should the nurse assess the woman for? A bladder distention B uterine atony C vaginal lacerations D deep vein thrombosis

C

What factor is a contraindication for induction of labor? A Post term dates B Maternal hypertension C Previous cesarean section with a classic incision D Fetal death

C Previous cesarean section with a classic incision

Carboprost tromethamine

For postpartum bleeding

Methylergonovine maleate (Methergine)

Uterine stimulant; indicated for uterine atony; adverse reactions: hypertension; usual dose: 0.2mg IM followed by tabs of 0.2mg q4-6 hours; use with caution in clients with elevated BP or preeclampsia; take BP prior to administration and if 140/90 or above, notify MD

preeclampsia

abnormal condition associated with pregnancy, marked by high blood pressure, proteinuria, edema, and headache

The client with congestive heart failure is receiving furosemide 80 mg once daily. Which data collection assessment would be performed to evaluate medication effectiveness? Select all that apply. One, some, or all responses may be correct. 1 Daily weight 2 Intake and output 3 Monitor for edema 4 Daily pulse oximetry 5 Auscultate breath sounds

all

Which modifiable risk factor would the nurse include in a community presentation on cardiovascular risk factors? Select all that apply. One, some, or all responses may be correct. 1 Weight 2 Inactivity 3 Cholesterol 4 Tobacco use 5 Homocystein

all

hat two measures may be used to stimulate labor after it slows down?

amniotomy and oxytocin

Homocysteine

an amino acid normally found in the blood and used by the body to build and maintain tissues

thrombus

blood clot within a blood vessel

systemic lupus erythematosus (SLE)

chronic autoimmune inflammatory disease of collagen in skin, joints, and internal organs

hydramnios

excessive amniotic fluid

hypertonic dysfunction

frequent ineffective contractions (most common) resulting in an elevated resting uterine tone with small, short, frequent contractions - OR an increased frequency and intensity of contracts that result in precipitous labor what to do: Reposition, administer short acting tocolytics, stop oxytocin, administer analgesics

DASH (Dietary Approaches to Stop Hypertension)

high in fruits and vegetables and low-fat dairy products, reported improved calcium balance

Diltiazem (Cardizem)

hypertension calcium channel blocker

ist the nursing measures to promote normal labor when maternal pushing is ineffective for fear of injury

i. A warm compress can be applied to the perineum and tell the mom that her tissues can distend to accommodate for the fetus

placenta previa

implantation of the placenta over the cervical opening or in the lower region of the uterus

mastitis

inflammation of the breast; most commonly occurs in women who are breastfeeding mom might have to stop breastfeeding because engorgement and nipple trauma might cause an infection. Symptoms are purulent drainage, fever, and redness of the breast tissue. Antibiotics are given.

hypotonic labor

less the 2-3 contractions in 10 min. generally occurs in the active phase of labor. These are really weak contractions that dont result in dilation or effacement = maternal exhaustion and infection. and fetal intolerance of labor and asphyxia what to do: Assess mom and fetus, keep the mom calm, encourage ambulation, avoid laying supine Amniotomy can be done, administer oxytocin, assisted vaginal delivery, cesarean section

Furosemide (Lasix)

loop diuretic

neural tube defects

malformations of the brain, spinal cord, or both during embryonic development that often result in lifelong disability or death not taking enough folic acid can cause this. If the neural tube does not close around 4 weeks it can lead to anencephaly and spina bifida.

hyperemesis gravidarum

severe nausea and vomiting in pregnancy that can cause severe dehydration in the mother and fetus

incompetent cervix

spontaneous, premature dilation of the cervix during the second trimester of pregnancy When the patient loses their fetus in the 2nd trimester due to painful cervical dilation. It can cause recurrent abortions.

episiotomy

surgical incision of the perineum to enlarge the vagina and so facilitate delivery during childbirth

cerclage

suturing of the cervix to prevent it from dilating prematurely during pregnancy, thus decreasing the chance of a spontaneous abortion

Rh incompatibility

the blood is screened to look for an incompatibility between the mom and fetus. It can be dangerous to the fetus. This could lead to hemolytic anemia in the baby. RhoGAM is given 72 hours after birth in an Rh+ baby.

polyhydramnios

too much amniotic fluid over 2000 ml. can happen when the fetus has something wrong with their CNS or GI tract.

venous thromboembolism

deep vein thrombosis and pulmonary embolism a blood clot in the vein that can lead to a pulmonary embolism. Inactivity, obesity, c-section, bed rest, sepsis, diabetes, smoking, dehydration, air travel, and forceps can increase the risk.

Subinvolution

failure of uterus to return to non-pregnant state the uterus takes longer than normal to return back to it pre-pregnant size. By the 14th day, the uterus should no longer be palpable.

What are three characteristics of effective uterine activity?

a. The intensity, frequency, and synchronization

A client with severe preeclampsia is receiving magnesium sulfate therapy. Which is the priority nursing assessment as the nurse monitors this client's response to therapy? 1 Urine output 2 Respiratory rate 3 Deep tendon reflexes 4 Level of consciousness

2 Respiratory depression occurs with toxic levels of magnesium sulfate; calcium gluconate should be readily available to counteract toxicity. Although the other assessments (urine output, deep tendon reflexes, and level of consciousness) are important, none is the priority.

Betamethasone

Corticosteroid Speeds up lung development in a premature fetus

Hematoma

a solid swelling of clotted blood within the tissues. localized collection of blood

List four intrapartum problems that are more likely if a woman has a multifetal pregnancy.

1. uterine overdistention with hypotonic dysfunction.2. abnormal fetal presentations3. fetal hypoxia4. postpartum hemorrhage caused by uterine overdistention.

Which dietary choice reflects the recommendations of the Dietary Approaches to Stop Hypertension (DASH) diet? Select all that apply. One, some, or all responses may be correct. 1 Salami 2 Pickles 3 Salmon 4 French fries 5 Canned soup

3 The DASH diet includes fruits, vegetables, low-fat/fat-free foods, fish, poultry, and reduced sugar. Salmon is a meal choice that aligns with the recommendations of the DASH diet. Food choices that would not align with the DASH diet include salami, a processed meat that is high in fat; pickles, which are high in sodium; french fries, which are high in fat and starch; and canned soups, which are high in sodium.

Which common indication for a cesarean birth would the nurse discuss in a class for expectant parents? 1 Placenta previa 2 Primary uterine inertia 3 Cervical insufficiency 4 Cephalopelvic disproportion

4 Statistically, cephalopelvic disproportion is the most common indication for a first-time cesarean birth. Complete placenta previa is a less common indication for a cesarean birth. Primary uterine inertia may be improved by rest and hydration followed by an infusion of oxytocin (Pitocin), which promotes vaginal birth. Cervical insufficiency is more likely to cause a preterm birth and is not an indication for a cesarean birth

After receiving a diagnosis of placenta previa, the client asks the nurse what this means. Which is an appropriate response? 1 "It's premature separation of a normally implanted placenta." 2 "Your placenta isn't implanted securely in place on the uterine wall." 3 "You have premature aging of a placenta that is implanted in your uterine fundus." 4 "The placenta is implanted in the lower uterine segment, and it's covering part or all of the cervical opening."

4 Implantation of the placenta in the lower uterine segment is the accepted definition of placenta previa. Premature separation of a normally implanted placenta is known as abruptio placentae; it occurs because the placenta is attached insecurely to the uterine wall. Premature aging of a placenta may not lead to placenta previa but will put the fetus in jeopardy.

A pregnant client at 30 weeks' gestation is admitted for active labor. Despite tocolytic therapy, it is determined that preterm birth is inevitable. Which medication would the nurse anticipate administering to the client?

Dexamethasone is a glucocorticoid that stimulates the production of fetal lung surfactants, which are needed for fetal lung maturity; administration is started 48 hours before the expected birth. Norgestrel is a contraceptive hormone; it is not used for preterm labor. Aminophylline is a bronchodilator; it is not used for preterm labor. Magnesium sulfate is used for tocolytic therapy and has been somewhat effective in delaying preterm labor. However, this client's labor is progressing, and the birth is inevitable.

psychosis

mental state in which a person's ability to recognize reality is impaired

Which clinical finding in a newborn indicates to the nurse that magnesium sulfate toxicity may have occurred? 1 Pallor 2 Tremor 3 Hypotonia 4 Tachycardia

3 Hypotonia occurs with magnesium sulfate toxicity because of skeletal and smooth muscle relaxation. Pallor, tremor, and tachycardia are not signs of magnesium sulfate toxicity.

After seeing the physician, the woman is confused about her upcoming induction. She states to the nurse, "The doctor said I would need a pill inserted into my vagina prior to going into labor. What does that mean?" What is the best response by the nurse? A "A pill is inserted prior to induction to help decrease your risk for infection." B "A pill is inserted prior to induction to help your water break." C "A pill is inserted prior to induction to ripen the cervix." D "A pill is inserted prior to induction to help decrease pain during labor."

c - so it will dilate easier

hemorrhage post partum

iIt is when there is over 1000 ml of blood loss, and it presents itself as hypovolemia within 24 hours after birth. Early postpartum hemorrhage is within 24 hours after birth and late postpartum hemorrhage is after 24 hours after giving birth.

Which baseline assessment is essential before the nurse initiates an infusion of magnesium sulfate for a client with preeclampsia? 1 Serum glucose 2 Respiratory rate 3 Body temperature 4 Level of consciousness

2 Magnesium sulfate toxicity depresses respiration; therefore, it is essential to obtain a baseline respiratory rate before initiating therapy. The serum glucose level is unrelated to magnesium sulfate toxicity. Deviations in body temperature do not indicate magnesium sulfate toxicity. A decreased level of consciousness may indicate worsening preeclampsia, not magnesium sulfate toxicity.

Which statement by a woman with preeclampsia indicates the need for further teaching about needed dietary changes? 1 "I should avoid excess salt." 2 "I should limit my fluid intake." 3 "I should eat whole grains and raw produce." 4 "I should eat 60 to 70 grams of protein each day."

2 Women with preeclampsia should not limit fluid intake and should drink between 6 and 8 cups of water each day. Salt should be limited to 1.5 g of sodium daily. The client also should eat plenty of fiber from whole grains and raw fruits and vegetables as well as 60 to 70 grams of protein each day.

A client at 38 weeks' gestation is admitted for induction of labor. Which medication would the nurse anticipate preparing to administer to this client? 1 Oxytocin 2 Estrogen 3 Ergonovine 4 Progesterone

1

For which complication would the nurse closely monitor a client with a diagnosis of abruptio placentae? 1 Cerebral hemorrhage 2 Pulmonary edema 3 Impending seizures 4 Hypovolemic shock

4 With abruptio placentae, uterine bleeding can result in massive internal hemorrhage, causing hypovolemic shock. A cerebral hemorrhage may occur with a dangerously high blood pressure; there is no information indicating the presence of a dangerously high blood pressure. Pulmonary edema may occur with severe preeclampsia or heart disease, and seizures are associated with severe preeclampsia; there is no information indicating the presence of these conditions.

Which sites would the nurse prefer while assessing for turgor in an older adult? Select all that apply. One, some, or all responses may be correct. 1 Back of the neck 2 Back of the hand 3 Palm of the hand 4 On the sternal area 5 Back of the forearm

4, 5 Turgor indicates the elasticity of the skin. The ideal site to assess the skin for turgor in an older adult is back of the forearm or the sternal area. The back of the neck contains redundant skin and may not be reliable. The skin on the back of the hand is normally loose and thin; turgor assessed at that site may not be reliable. The palm of the hand is not an ideal site for the assessment of turgor. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation.

Placenta accreta

Improper implantation of placenta into the myometrium with little or no intervening decidua

The nurse administers a medication to a pregnant woman to treat preterm labor; this medication requires an additional prescription for calcium gluconate to counter the effects of the drug. Which medication was administered?

magnesium sulfate Magnesium sulfate is used to stop or slow preterm labor and relax the uterus. Misoprostol, prostaglandin F, and methylergonovine cause the uterus to contract and decrease bleeding in the postpartum client.

A client who experienced extensive burns is receiving intravenous fluids to replace fluid loss. The nurse would monitor for which initial symptom of fluid overload? 1 Crackles in the lungs 2 Decreased heart rate 3 Decreased blood pressure 4 Cyanosis of nailbeds

1 Crackles, or rales, in the lungs are an early sign of pulmonary congestion and edema caused by fluid overload. Clients with fluid overload will usually demonstrate an increased heart rate and increased blood pressure. A decreased heart rate and decreased blood pressure and cyanosis in a client with fluid overload would be very late and fatal signs.

Which problem would the nurse anticipate when a client with class 1 heart disease is in her third trimester? 1 Dyspnea at rest 2 Vasovagal syncope 3 Progressive dependent edema 4 Shortness of breath on exertion

1 Dyspnea at rest is associated with cardiopulmonary disorders and may be a sign of impending decompensation. Vasovagal syncope is an expected physiologic change. The client with heart disease is more likely to have exertional syncope. Dependent edema commonly occurs in women with uncomplicated pregnancies as they progress toward term. The client with heart disease is more likely to experience generalized edema. In the third trimester, clients with uncomplicated pregnancies complain of shortness of breath on exertion; this is caused by compression of the diaphragm by the enlarging uterus.

Furosemide has been prescribed as part of the medical regimen for a client with hypertension. Which client statement indicates a need for medication education? 1 "This can decrease my vitamin K level." 2 "I will take the medication in the morning." 3 "I will contact my health care provider if I notice muscle weakness." 4 "I plan to take the medication even when my blood pressure is normal."

1 Furosemide can produce hypokalemia, not vitamin K deficiency. A well-balanced diet should provide all the necessary vitamins and nutrients. Further teaching is necessary. The morning is the desirable time to take furosemide; early administration prevents nocturia. The client's statement to call the health care provider at signs of muscle weakness is appropriate because muscle weakness may indicate hypokalemia. The client's response to take the medicine even when the blood pressure is normal demonstrates an understanding that the medication should be taken as prescribed, independent of how the client feels, because hypertension is often asymptomatic.

Hydrochlorothiazide (HCTZ) has been prescribed for a client with hypertension. The client reports hearing that furosemide is more effective and requests a prescription change. How will the nurse respond? 1 "HCTZ has fewer side effects." 2 "HCTZ does not cause dizziness." 3 "HCTZ is only taken when needed." 4 "HCTZ does not cause dehydration."

1 Side effects from thiazides generally are minor and rarely result in discontinuation of therapy. Dizziness is a side effect of all diuretics. There is a potential for dehydration with all diuretics. All diuretic medications are taken regularly as directed.

A client has had surgery for a ruptured fallopian tube from an ectopic pregnancy. Which information would be included in the postoperative teaching plan? 1 Effect on future pregnancies 2 How to prevent another tubal pregnancy 3 Need for Rho (D) immune globulin to prevent isoimmunization 4 Importance of not douching after intercourse, because this may dislodge a fertilized egg

1 Removing a fallopian tube does not impair the ovaries' ability to release an egg, which may be fertilized in the remaining tube if it is undamaged. There is no known way to prevent future tubal pregnancies. There is no information to indicate that the client is Rh negative, requiring the administration of Rho (D) immune globulin. Liquid from a douche does not reach the fallopian tube or dislodge a fertilized egg; in addition, douching is no longer recommended at any time.

Which clinical finding is most important for the nurse to assess if a client has had a precipitous birth? 1 Sudden chilling 2 Profuse bleeding 3 Decrease in heart rate 4 Increased blood pressure

2 A precipitate birth may be injurious to both mother and neonate. The maternal morbidity rate is increased by hemorrhage and/or an infection resulting from the trauma of a rapid, forceful birth in a contaminated field. Sudden chilling is common to all clients after all types of birth; the exact cause is unknown. If the client is bleeding profusely, she should be observed for shock, which is evidenced by a weak, rapid pulse. Increased blood pressure may be a result of the use of oxytocin or preeclampsia, not precipitous birth.

Which food would the nurse instruct a client taking diltiazem to avoid? Select all that apply. One, some, or all responses may be correct. 1 Alcohol 2 Grapefruit juice 3 Cheddar cheese 4 Summer sausage 5 Dark green vegetables

2 Clients taking calcium-channel blockers such as diltiazem would be instructed to avoid drinking grapefruit juice or eating grapefruit because it can interfere with metabolism of the medication. Clients taking acetaminophen would be instructed to avoid alcohol. Aged cheese and meat, such as sausage, should be avoided in clients taking monoamine oxidase inhibitors (MAOIs). Clients taking anticoagulants, such as warfarin, should avoid dark green vegetables.

The nurse is caring for two clients with a below-the-knee amputation. The first client was in a motor vehicle collision. The second client has a history of chronically decreased arterial perfusion. Which information would cause the nurse to conclude that the postoperative courses of these two clients may differ? 1 The first client probably will adjust more quickly. 2 The second client's incision will take longer to heal. 3 These clients are likely to have very different occupations. 4 The first client is more likely to have phantom limb sensations.

2 Decreased arterial circulation in the second client will delay healing. The first client received an amputation without preoperative preparation for the loss of the limb and will most likely have greater difficulty adapting. Clients with chronic limb pain before surgery (e.g., the second client with chronically decreased arterial perfusion) are more likely to have phantom limb sensations. Both clients' responses may be influenced by their occupations, but there is no data to support this conclusion.

A client with hypertension tells the nurse, "I took the blood pressure pills for a few weeks, but I didn't feel any different, so I decided I'd only take them when I feel sick." Which is the best action for the nurse to take? 1 Educate the client about the complications associated with high blood pressure. 2 Ask the client questions to determine the current understanding of high blood pressure. 3 Emphasize the importance of taking blood pressure medications now to continue to feel well. 4 Show the client the current blood pressure and compare that with normal blood pressure levels.

2 Further assessment of the client's understanding of hypertension and treatment is important before the nurse can develop an effective plan to change the client's behavior. Education about complications of hypertension may be helpful, but first the nurse needs to know what the client already understands about the long-term effects of high blood pressure. An emphasis on taking medications now to ensure future health may be appropriate for this client, but further assessment is needed before using this strategy. Many clients may respond to actually seeing the difference between their blood pressures and the expected normals, but more information about the client's knowledge is needed to know if this will be a useful strategy for this client.

Which pregnant client would be at increased risk of placenta previa? 1 19 years old, gravida 1, para 0 2 30 years old, gravida 6, para 5 3 25 years old, gravida 2, para 1 4 29 years old, gravida 3, para 0

2 Multiple past pregnancies can scar the endometrial lining, rendering it vulnerable to an abnormal implantation. Primigravidas are the least prone to placenta previa; the endometrium is receptive to normal implantation. Two or three pregnancies usually have not compromised the endometrium to the extent that an abnormal implantation is likely to occur.

Valsartan, an angiotensin II receptor antagonist, is prescribed for a client. The nurse will monitor the client for which adverse effect? 1 Constipation 2 Hyperkalemia 3 Hypertension 4 Change in visual acuity

2 Hyperkalemia may occur with valsartan. Angiotensin II receptor antagonists, such as valsartan, block vasoconstrictor and aldosterone-producing effects of angiotensin II at receptor sites to decrease blood pressure. Hypotension, not hypertension, may occur. Diarrhea, not constipation, may occur with valsartan. Valsartan does not cause altered visual acuity.

The nurse is caring for a client with diarrhea. The nurse anticipates a decrease in which clinical indicator? 1 Pulse rate 2 Tissue turgor 3 Specific gravity 4 Body temperature

2 Skin elasticity will decrease because of a decrease in interstitial fluid. The pulse rate will increase to oxygenate the body's cells. Specific gravity will increase because of the greater concentration of waste particles in the decreased amount of urine. The temperature will increase, not decrease.

The nurse pulls up on the client's skin and releases it to determine whether the skin returns immediately to its original position. Which is the nurse assessing for? 1 Pain tolerance 2 Skin turgor 3 Ecchymosis formation 4 Tissue mass

2 skin turgor is assessed by gently pinching the skin and releasing it while observing the degree of elasticity. If the skin pinch remains elevated or is slow to return to its original position, this may be an indication of dehydration or deficient fluid volume. This assessment technique is not appropriate for assessing pain tolerance, checking for ecchymosis formation, or measuring tissue mass.

A resident primary health care provider in the birthing unit asks the nurse to prepare for a vaginal examination on a client with a partial placenta previa in early labor. Which action would the nurse take at this time? 1 Preparing an intravenous piggyback of oxytocin 2 Explaining why a vaginal examination should not be performed 3 Obtaining an internal monitor to be applied during the examination 4 Having equipment ready for a fetal scalp pH after the examination

2 A vaginal examination may cause separation of the placenta, resulting in hemorrhage. The nurse would discuss the situation with the resident, away from the client, because it is imperative that a vaginal examination not be performed without preparation for a cesarean birth. There is not enough data to indicate the need to stimulate labor with oxytocin. An internal monitor is contraindicated, because its placement may damage the placenta. Fetal scalp pH monitoring is contraindicated because it may damage the placenta.

Which information obtained by the nurse about a client would represent risk factors for the client's admission diagnosis of hypertension? Select all that apply. One, some, or all responses may be correct. 1 Daily use of 1 aspirin 2 Occasional cocaine use 3 Reduced hemoglobin level 4 African American heritage 5 Increased high-density lipoprotein (HDL

2, 4 Cocaine is a stimulant that causes tachycardia and hypertension. Hypertension is more prevalent in African Americans in the United States. Aspirin decreases platelet aggregation, thus reducing the risk for cardiovascular disease, but does not affect blood pressure. Lowered hemoglobin may increase the heart rate, not the blood pressure. Increased HDL reduces the risk for cardiovascular disease, and it does not affect hypertension.

The nurse is assessing the perfusion and circulatory status of a postpartum client 3 hours after the birth of her child. Which clinical finding does the nurse expect? 1 Irregular heartbeat 2 Thready peripheral pulses 3 Capillary refill less than 3 seconds 4 Urinary output of less than 20 mL

3 Capillary refill less than 3 seconds indicates good perfusion of the peripheral tissues and is an expected finding. An irregular heartbeat may be a sign of cardiac decompensation that requires further investigation. A thready pulse may be a sign of postpartum hemorrhage with impending shock. Urine output of 30 mL/hr is expected, so less than 20 mL/hr could be a result of poor perfusion to the kidney caused by hypovolemia.

A client with severe preeclampsia has audible crackles in the lower left lobe, slight blurring of vision in the right eye, generalized facial edema, and epigastric discomfort. Which of these clinical manifestations is most indicative of an impending seizure? 1 Audible crackles 2 Blurring of vision 3 Epigastric discomfort 4 Generalized facial edema

3 Epigastric discomfort suggests liver edema; it is an ominous symptom that indicates an impending seizure. Audible crackles indicate pulmonary edema, but although they are a sign of severe preeclampsia they are not as definitive as epigastric pain. Blurred vision is a sign of retinal edema; although it is a sign of severe preeclampsia, it is not as definitive as epigastric pain. Although generalized facial edema is an indication of severe preeclampsia, it is not as definitive as epigastric pain.

The nurse assesses an older adult client with a diagnosis of dehydration. Which finding is an early sign of dehydration? 1 Sunken eyes 2 Dry, flaky skin 3 Change in mental status 4 Decreased bowel sounds

3 Older adults are sensitive to changes in fluid and electrolyte levels, especially sodium, potassium, and chloride. These changes will manifest as a change in mental status and confusion. It is difficult to assess dehydration in older adults based on sunken eyes, dry skin, and decreased bowel sounds because these can be prominent as general normal findings in the older adult client.

Which is the most therapeutic instruction for the nurse to provide to a client with preeclampsia regarding methods for improving her health? 1 "Eat a sodium-restricted diet." 2 "Walk at least 1 mile (2.2 km) every day." 3 "Rest often in the side-lying position." 4 "Limit fluid intake to 1000 mL daily."

3 Rest is advised to reduce arteriolar spasm, and the side-lying positionpromotes more efficient venous return to the heart; this improves cardiac output and placental perfusion. Sodium is necessary to maintain circulatory volume and should not be restricted in the diet. Excessive walking is contraindicated; too much walking may increase general arteriolar spasm. Fluid restriction is contraindicated, and because of the increased circulatory volume during pregnancy, the client needs 2000 mL of fluid per day.

A pregnant client with severe preeclampsia is receiving an infusion of magnesium sulfate. Which explanation would the nurse give the client as the reason she is receiving this medication? 1 "It acts as a diuretic." 2 "It has a sedative effect." 3 "It acts as an anticonvulsant." 4 "It has an antihypertensive effect.

3 The target tissue of magnesium sulfate is the myoneural junction; it decreases secretion of acetylcholine, thereby depressing neuromuscular transmission, which acts as an anticonvulsant and prevents seizures. Although diuresis occurs, this is not the purpose of giving magnesium sulfate. Magnesium sulfate does not have a sedative effect. It has a minimum hypotensive effect.

A client who is receiving atenolol for hypertension frequently reports feeling dizzy. Which effect of atenolol is responsible for this response? 1 Depleting acetylcholine 2 Stimulating histamine release 3 Blocking the adrenergic response 4 Decreasing adrenal release of epinephrine

3 The beta-adrenergic blocking effect of atenolol decreases the heart's rate and contractility; it may result in orthostatic hypotension and decreased cerebral perfusion, causing dizziness. Depleting acetylcholine is not an action of atenolol. Stimulating histamine release is not an action of atenolol. Decreasing adrenal release of epinephrine is not an action of atenolol.

Which assessment finding would the nurse expect in a client with untreated preeclampsia? 1 Increased blood pressure of 150/100 mm Hg 2 Increased blood pressure that is accompanied by a headache 3 Blood pressure above the baseline that fluctuates with each reading 4 Blood pressure higher than 140 mm Hg systolic accompanied by proteinuria

4 A blood pressure higher than 140 mm Hg systolic and 90 mm Hg diastolic along with proteinuria is diagnostic of preeclampsia; assessments should be performed twice, 4 to 6 hours apart. Hypertension alone does not support a diagnosis of preeclampsia. Hypertension accompanied by a headache is not necessarily indicative of preeclampsia. Blood pressure above the baseline and fluctuating with each reading may occur at any time, not specifically in a client with untreated preeclampsia.

The nurse administers intravenous magnesium sulfate to a client with preeclampsia. Which effect would signal the nurse to notify the health care provider? 1 2+ patellar reflex response 2 Respiratory rate of 18 breaths/min 3 Blood pressure of 112/76 mm Hg 4 Urine output of less than 100 mL in 4 hour

4 A decreased urine output of less than 25 mL/h may be indicative of kidney damage, a result of the preeclampsia, and impending renal failure. Magnesium sulfate is excreted by the kidneys, and magnesium toxicity may occur. Loss of the patellar reflex is suggestive of magnesium sulfate toxicity; a 2+ reflex is within the expected range. Respirations at the rate of 18 breaths/min are within the expected range; a rate of at least 16 breaths/min should be present before each dose of magnesium sulfate. A blood pressure of 112/76 mm Hg is within normal limits.

Which finding indicates that a client's kidney transplant is successful? 1 Increased specific gravity 2 Correction of hypotension 3 Elevated serum potassium 4 Decreasing serum creatinine

4 As the transplanted organ functions, nitrogenous wastes are eliminated, lowering the serum creatinine. As more urine is produced by the transplanted kidney, the specific gravity and concentration of the urine will decrease. With end-stage renal disease, fluid retention causes hypertension; there should be a correction of hypertension, not hypotension. After the transplant, the serum potassium should correct to within expected limits for an adult.

After the nurse provides education about hydrochlorothiazide, the client will agree to notify the health care provider regarding the development of which symptom? 1 Insomnia 2 Nasal congestion 3 Increased thirst 4 Generalized weakness

4 Generalized weakness is a symptom of significant hypokalemia, which may be a sequela of diuretic therapy. Insomnia is not known to be related to hypokalemia or hydrochlorothiazide therapy. Although a stuffy nose is unrelated to hydrochlorothiazide therapy, it can occur with other antihypertensive medications. Increased thirst is associated with hypernatremia. Because this medication increases excretion of water and sodium in addition to potassium and chloride, hyponatremia, not hypernatremia, may occur.

Which factor would cause a rise in temperature to 102°F (38.9°C) after a seizure in a client with eclampsia? 1 Excessive muscular activity 2 Development of a systemic infection 3 Dehydration caused by rapid fluid loss 4 Irregularity in the cerebral thermal center

4 Increased electrical charges in the brain during a seizure may disturb the cerebral thermoregulation center in the hypothalamus. Excessive muscular activity usually causes perspiration, leading to a drop in body temperature. One increased reading is not a conclusive sign of infection. Rapid fluid loss does not occur during a seizure; clients with preeclampsia have fluid retention.

The nurse would intervene to prevent unlicensed assistive personnel (UAP) from providing which food to a woman with hyperemesis gravidarum? 1 Crackers 2 Dry toast 3 Baked chicken 4 Scrambled eggs

4 Once her vomiting stops, a woman with hyperemesis should start eating bland foods like crackers, dry toast, and baked chicken. Scrambled eggs are too rich for a woman who has been vomiting, at least in the beginning stage of her recovery.

A client arrives at the hospital in the second stage of labor. The head of the fetus is crowning, the client is bearing down, and birth appears imminent. Which instruction would the nurse provide to the client in this situation? 1 Pant while pushing gently. 2 Breathe with her mouth closed. 3 Hold her breath while bearing down. 4 Pant while resisting the urge to bear down

4 Panting prevents the mother from putting pressure on the fetal head by pushing. The nurse applies gentle pressure against the fetus's head as it emerges to prevent a precipitous birth, which could result in central nervous system injury to the fetus and vaginal lacerations in the mother. It is impossible to pant and push at the same time. Breathing with the mouth closed promotes the bearing-down reflex. Bearing down during the birth is unsafe because both fetus and mother could be injured.

The nurse monitors a client's deep tendon reflexes while she is receiving magnesium sulfate therapy for preeclampsia. Which reason would the nurse give to the client to explain the purpose of this monitoring? 1 "It reveals your level of consciousness." 2 "It reveals the mobility of the extremities." 3 "It identifies your response to painful stimuli." 4 "It identifies your potential for respiratory depression."

4 Respiratory distress or arrest may occur when the serum level of magnesium sulfate reaches 12 to 15 mg/dL. Deep tendon reflexes disappear when the serum level is 10 to 12 mg/dL. The medication is withheld in the absence of deep tendon reflexes. The therapeutic serum level of magnesium sulfate is 5 to 8 mg/dL. Deep tendon reflexes do not reveal a client's level of consciousness, mobility of the extremities, or the response to painful stimuli. Deep tendon reflexes can be associated with muscle strengthening.

Assessment of a client at 39 weeks' gestation reveals ruptured membranes, mild irregular contractions 10 to 15 minutes apart, and a fetal heart rate (FHR) of 186 beats/min between contractions. Which conclusion would the nurse draw from these findings? 1 The fetus is not at risk. 2 A precipitous birth is imminent. 3 An infectious process has begun. 4 A further assessment is necessary.

4 The fetal heart rate should be 110 to 160 beats/min; an FHR of 186 is tachycardic, and further evaluation is necessary because the fetus may be at risk. The data indicate that the client is in early labor. Although fetal tachycardia is associated with infection, there are other causes, so further assessment is necessary.

For which complication is a client with gestational hypertension at risk? 1 Placenta previa 2 Polyhydramnios 3 Isoimmunization 4 Abruptio placentae

4 Vasospasms of placental vessels occur because of increased blood pressure. As a result, the placenta may separate prematurely (abruptio placentae). Placenta previa is an abnormal placental implantation and is not related to hypertension. Polyhydramnios, an excessive amount of amniotic fluid, is not associated with hypertensive disorders of pregnancy. Isoimmunization in pregnancy is associated with Rh incompatibility, not hypertension.

A pregnant client at 30 weeks' gestation with a partial placenta previa had experienced vaginal bleeding, which has now resolved. Which client activity will be the nurse's primary focus when providing discharge instructions? 1 Stay on bed rest. 2 Maintain a calm and quiet environment. 3 Do daily home fetal movement counts. 4 Avoid anything that may stimulate the cervix or uterus.

4 Stimulation of the cervix or uterus may cause bleeding or hemorrhage and should be avoided. This is the primary focus for discharge instruction. This would mean teaching the client to avoid intercourse or orgasm at this time. The usual recommendation for home care activity in this case is bed rest with bathroom privileges, although the recommendation may vary depending on individual circumstances. Bed rest is being reconsidered at this time as possibly a harmful intervention with limited or no benefit. A calm, quiet environment is desired for all clients, not just those with placenta previa. The client may be taught to do fetal movement counts daily at home. She would be instructed as to what is normal and how to contact her provider with a decrease in fetal movement.

At 12 weeks' gestation a client who is Rh negative expels the total products of conception. Which action would the nurse take after it has been determined that the client has not been previously sensitized to Rh-positive red blood cells? 1 Administering Rho(D) immune globulin within 72 hours 2 Making certain that Rho(D) immune globulin is administered at the first clinic visit 3 Withholding the Rho(D) immune globulin because the gestation lasted only 12 weeks 4 Withholding the Rho(D) immune globulin because it is not indicated after fetal death

1 Rho(D) immune globulin must be given within 72 hours of delivery if the client has not been sensitized previously, regardless of the duration of the gestation. It would not be effective at the first clinic visit, because antibodies have been produced already. Rho(D) immune globulin is always indicated at the termination of a pregnancy, even with a short-term pregnancy or one involving fetal demise.

Which nursing intervention promotes perfusion and healing of the surgical wound for an older adult? 1 Minimize the use of tape on the skin. 2 Keep the client adequately hydrated. 3 Change the dressings as soon as they get wet. 4 Provide rest for the client throughout the day.

2 The best practice of the nurse to improve perfusion of the wound to promote healing for an older client after surgery is to keep the client adequately hydrated. The nurse would minimize the use of tape on the skin to protect the fragile skin of the client. The nurse would also change the dressing as soon as it gets wet during the protection of fragile skin. The nurse would provide rest to the client throughout the day to conserve the energy required for healing.

A pregnant client has a history of preterm births followed by neonatal deaths. Which is an indication of preterm labor that this client would be instructed to report? 1 Leg cramps 2 Pelvic pressure 3 Nausea after 11 AM 4 No fetal movement at 12 weeks

2 Pelvic pressure or a feeling that the fetus is pushing down is one symptom of preterm labor and should be taught to the client so that she may seek care immediately. Leg cramps are not a danger sign of preterm labor, nor is nausea. Fetal movement is not felt until approximately 16 weeks.

A client is receiving hydrochlorothiazide. Which physiological alteration will the nurse monitor to best determine the effectiveness of the client's hydrochlorothiazide therapy? 1 Blood pressure 2 Decreasing edema 3 Serum potassium level 4 Urine specific gravity

1 Diuretics promote urinary excretion, which reduces the volume of fluid in the intravascular compartment, thus lowering blood pressure. The measure of blood pressure is the best determination of effectiveness because it is a direct measure of the desired outcome. A reduction in edema reflects effectiveness; however, multiple physiological processes, including venous competence, gravity, and disuse, maintain a significant degree of edema even when the diuretic is optimally effective. A lowered potassium level would indirectly indicate that the medication is working; however, this does not provide a good measure of effectiveness. Although specific gravity decreases with increased urinary output, and thus would demonstrate that the medication is working, it is not a direct measure of the desired outcome. A measure of the reduction in intravascular pressure is preferable.

After a client has a spontaneous abortion at 12 weeks' gestation, the nurse notes that both she and her partner are visibly upset and crying. Which statement would be a therapeutic response? 1 "I'll be here if you want to talk." 2 "Try to relax—it'll speed the healing process." 3 "With any luck you'll get pregnant again soon." 4 "It's best that this happened early rather than having the baby die after it was born."

1 Saying, "I'll be here if you want to talk" gives the client and her partner room to comfort each other while letting them know that the nurse is available; it also gives the couple time and space in which to recognize and accept their feelings of loss. Telling the couple to relax denies their feelings and may cut off communication. Telling the client that she will become pregnant again soon minimizes the couple's grief over this loss and cuts off further communication. Also, an assumption is made that another pregnancy will occur. Telling the client that it is best that the miscarriage happened early rather than having the baby die after it was born is an insensitive statement. Grieving for a loss is not confined to when the loss occurs, either during the pregnancy or after the birth.

The nurse provides instruction when the beta-blocker (BB) atenolol is prescribed for a client with moderate hypertension. Which client statement indicates to the nurse that further teaching is needed? 1 "I must take the medication before going to bed." 2 "This medication will make me feel drowsy." 3 "I need to count my pulse before taking the medication." 4 "I will move slowly when changing positions from sitting to standing."

1 This medication should be taken early in the morning to maximize its therapeutic effect. Orthostatic hypotension is a side effect of BBs, and the client should change positions slowly from sitting to standing to prevent dizziness and falls. Drowsiness is a side effect of BBs, and the client should be taught precautions to prevent injury. The pulse rate should be taken before administration because ventricular dysrhythmias and heart block may occur with BBs.

Which dietary choices will the nurse instruct the client taking spironolactone to avoid increasing? Select all that apply. One, some, or all responses may be correct. 1 Potatoes 2 Red meat 3 Cantaloupe 4 Wheat bread 5 Flavored yogurt

1, 3 Spironolactone is potassium-sparing, and beverages and foods containing potassium such as potatoes, cantaloupe, bananas, avocados, oranges, dates, apricots, and raisins should not be increased beyond the client's ordinary consumption to prevent hyperkalemia. Red meat may need to be limited for other reasons not related to spironolactone. Whole grains are associated with prevention of constipation and should not be avoided. Dairy products are rich in sodium and calcium; spironolactone may cause hyponatremia.

A client with a blood pressure of 150/90 mm Hg, 3+ proteinuria, and edema of the hands and face is diagnosed with severe preeclampsia. Which other clinical findings support this diagnosis? Select all that apply. One, some, or all responses may be correct. 1 Headache 2 Constipation 3 Abdominal pain 4 Vaginal bleeding 5 Visual disturbances

1, 3, 5 Headache in severe preeclampsia is related to cerebral edema. Abdominal pain in severe preeclampsia is related to decreased circulating blood volume and generalized edema. Visual disturbances in severe preeclampsia are related to retinal edema. Constipation and vaginal bleeding are not related to preeclampsia.

Which topics would the nurse include in teaching for a client with a new diagnosis of hypertension? Select all that apply. One, some, or all responses may be correct. 1 Reason for daily low-dose aspirin use 2 Use of a home blood pressure monitor 3 Adverse effects of tobacco on blood pressure 4 Avoidance of any alcohol consumption 5 Benefits of moderate daily exercise

2, 3, 5 Lifestyle management of blood pressure includes monitoring blood pressure at home frequently using a home blood pressure monitor, avoiding tobacco products, and a physically active lifestyle that includes moderate daily exercise. Daily aspirin is not recommended for clients who have hypertension, although it may be recommended for clients with known coronary artery disease or additional risk factors for cardiovascular disease. Although excessive alcohol use should be avoided, moderate alcohol consumption (2 alcoholic drinks/day for men and 1 alcoholic drink/day for women and lighter weight men) is acceptable for clients with hypertension.

The nurse is caring for a client with severe preeclampsia who is receiving magnesium sulfate. Which adverse effects indicate the serum magnesium level may be excessive? Select all that apply. One, some, or all responses may be correct. 1 Urine output of 100 mL/h 2 Absence of the knee-jerk reflex 3 Apical pulse of 80 beats/min 4 Blood pressure of 140/90 mm Hg 5 Respiratory rate of 11 breaths/min

2, 5 An absence of the knee-jerk reflex is a manifestation of hyporeflexia; it is a possible indication of magnesium sulfate toxicity. A respiratory rate of 11 breaths/min is cause for concern; any rate slower than 12 breaths/min is a sign of magnesium sulfate toxicity. A urinary output of 100 mL/h is adequate; output of less than 30 mL/h indicates inadequate excretion of magnesium sulfate and the potential for toxicity. A pulse rate of 80 beats/min is an expected pulse rate, not an indicator of toxicity.The maternal blood pressure is not directly related to magnesium sulfate administration or toxicity; however, decreased blood pressure indicates that the treatment has been effective.

The client's serum sodium is 123 mEq/L (123 mmol/L). Which prescription would the nurse question? 1 Add table salt to each meal. 2 Fluid restriction of 1000 mL per day. 3 Assess neurological status every 2 hours. 4 Provide 0.45% sodium chloride (NaCL) intravenously at 125 mL/h

4 Because 0.45 % NaCl (one-half normal saline) is a hypotonic solution, it is contraindicated. It would actually compound the issue instead of correcting the hyponatremia. Treatment for hyponatremia can include restricting fluid intake and increasing sodium intake either via oral intake or, in severe cases, intravenous fluids. The presence of hyponatremia, as well as correction of hyponatremia if done too quickly, can cause fluid shifts in the brain, resulting in altered mental status. It is important for the nurse to assess for neurological changes.

A client was prescribed furosemide. The nurse would instruct the client to include which food in the diet? 1 Liver 2 Apples 3 Cabbage 4 Bananas

4 Furosemide is a loop diuretic that increases potassium excretion by preventing renal absorption. Bananas have a significant amount of potassium. Bananas: 450 mg; cabbage: 243 mg; liver: 73.6 mg; apples: 100 to 120 mg

Labetalol

Management of hypertension

Nifedipine

Treats high BP and chest pain. Can stop labor before 37 weeks of pregnancy.

Kayexalate

Treats high levels of potassium in the blood

Preterm Premature Rupture of Membranes (PPROM)

rupture of membranes before 37 weeks Can be caused by infection, no prenatal care, STI's, vaginal bleeding, smoking, and having a previous preterm labor. It is when the amniotic sac ruptures

BPP

-Fetal breathing movement -Fetal movements of body or limbs -Fetal tone -Amniotic fluid volume Reactive fetal heart rate (FHR) with activity (reactive non-stress test [NST]) *Scores of 8 (with normal amniotic fluid) and 10 considered normal*

The nurse is explaining insulin needs to a client with gestational diabetes who is in her second trimester of pregnancy. Which information would the nurse give to this client? 1 Insulin needs will increase during the second trimester. 2 Insulin needs will decrease during the second trimester. 3 Insulin needs will not change during the second trimester. 4 Insulin will be switched to an oral antidiabetic medication during the second trimester.

1 The second trimester of pregnancy exerts a diabetogenic effect on the maternal metabolic status. Major hormonal changes result in decreased tolerance of glucose, increased insulin resistance, decreased hepatic glycogen stores, and increased hepatic production of glucose. Increasing levels of human chorionic somatomammotropin, estrogen, progesterone, prolactin, cortisol, and insulinase increase insulin resistance through their actions as insulin antagonists. Insulin resistance is a glucose-sparing mechanism that ensures an abundant supply of glucose for the fetus. Maternal insulin requirements gradually increase from about 18 to 24 weeks of gestation to about 36 weeks' gestation. The use of oral antidiabetic agents is currently not recommended by the American Diabetes Association for use during pregnancy.

Which statements are true regarding ectopic pregnancy? Select all that apply. One, some, or all responses may be correct. 1 Smoking is one of the risk factors for ectopic pregnancy. 2 Ectopic pregnancy is directly related to fetopelvic incompatibility. 3 Ectopic pregnancy occurs when the fertilized egg implants in the fallopian tubes. 4 When a young woman exhibits abdominal pain, ectopic pregnancy is suspected. 5 If the adolescent exhibits abdominal pain and hypotension, the ectopic pregnancy may have ruptured.

1, 3, 4, 5 Smoking is a risk factor for ectopic pregnancy. Ectopic pregnancy occurs when the fertilized egg implants outside the uterus, usually in the fallopian tubes. An adolescent exhibiting severe abdominal pain with hypotension is indicative of rupture of ectopic pregnancy and may need immediate surgery. Fetopelvic incompatibility is related to prolonged labor in younger teenagers of 12 to 16 years of age. However, it is not associated with ectopic pregnancy. Abdominal pain associated with or without bleeding, may indicate possible ectopic pregnancy. A pregnancy test and further assessment is needed.

A 37-year-old G3P2001 client with hypertension and type 1 diabetes with good glycemic control is seen in the antepartum testing unit for a nonstress test (NST) at 36 weeks. Her obstetric (OB) history includes an intrauterine fetal death at 38 weeks. What risk factors in the client's history indicate the need for an NST? Select all that apply. One, some, or all responses may be correct. 1 Age older than 35 years 2 The risk for placenta previa 3 The risk for placental insufficiency 4 A history of stillbirth from her last pregnancy 5 Hypertension 6 Type 1 diabetes

1, 3, 4, 5, 6, This client has multiple risk factors that would indicate the need for an NST to evaluate fetal status. Maternal age over 35 is considered advanced maternal age and is associated with a slightly increased risk of stillbirth and fetal growth restriction. The history of a prior stillbirth increases her risk of stillbirth in the current pregnancy. This client also has diabetes and hypertension, both of which put her at risk for placental insufficiency. Although advanced maternal age increases the risk of placenta previa, it is not the primary reason for having an NST.

Betamethasone, 12 mg is prescribed for a client at 32 weeks' gestation in active labor. Which response would the nurse give the client when asked why the medication is being given? 1 "It increases cervical dilation." 2 "Fetal lung maturity is accelerated." 3 "The risk of a precipitous birth is reduced." 4 "The potential for maternal hypertension is minimized."

2

Which instruction is beneficial for an aging African-American client with hypertension? 1 "Check the pulse daily." 2 "Have an annual urinalysis." 3 "Record blood pressure weekly." 4 "Visit an ophthalmologist monthly."

2 African-American clients have 20% less blood flow to the kidneys because of high sodium consumption. This causes anatomical changes in the blood vessels, thereby increasing the risk of kidney failure. Instructing the client with hypertension to have an annual urine examination would be beneficial. If the client has protein in the urine, this is a sign of high blood pressure and can signify kidney damage. Checking the pulse daily poses no harm to the individual but does not determine if the client has hypertension. Recording the blood pressure weekly is not a good indicator of an aging African-American client with hypertension. The client's blood pressure should be taken at least daily to determine if the client has problems. If the client has an eye-related problem, visiting an ophthalmologist should be suggested.

A client who is pregnant with twins is scheduled for a cesarean birth. Which information would the nurse give the client? 1 "We'll give you an enema before the surgery." 2 "We'll be encouraging you to ambulate early after surgery." 3 "You'll be discharged from the hospital in a week." 4 "You should take sponge baths until the incision is healed."

2 Early postoperative ambulation helps prevent such postpartum complications as thrombophlebitis and constipation. An enema is not necessary. Clients who have had uncomplicated cesarean births are generally discharged by the third postpartum day. Clients are permitted to shower after 48 hours or even sooner.

An Rh-negative client has a spontaneous abortion at the end of the second trimester and is prescribed Rho(D) immune globulin. The client asks the nurse, "Why do I need this medication?" Which information would the nurse consider before answering the client's question? 1 It will expand the woman's antibody pool. 2 It will prevent the woman from producing antibodies. 3 The woman's production of immune bodies will be accelerated. 4 The activity of the mother's Rh-negative antibodies will be suppressed.

2 Rho(D) immune globulin attacks fetal red cells that have gained access to the maternal bloodstream at the time of birth; it prevents antibody formation. Antibody formation is undesirable; it sensitizes the woman and contributes to fetal red cell destruction in future pregnancies. There is no production of immune bodies. Rho(D) immune globulin prevents the woman's immune system from responding to the fetal Rh-positive blood.

A 78-year-old client who has hypertension is beginning treatment with furosemide. Considering the client's age, which would the nurse teach the client to do? 1 Limit fluids at bedtime. 2 Change positions slowly. 3 Take the medication between meals. 4 Assess the skin for breakdown daily.

2 With aging there is a decreased vasomotor response and diminished elasticity of blood vessels, which do not respond quickly to changes from horizontal to vertical; orthostatic hypotension may occur. Changing positions slowly allows the body to adjust, which prevents dizziness and loss of balance. Usual fluid intake patterns can be maintained. Furosemide should be taken with meals to prevent gastric irritation. It is best to take it in the morning rather than at night so that sleep is not interrupted with the need to void. There is no link between furosemide and skin breakdown.

Which nursing interventions would the nurse provide to an older client with hypertension? Select all that apply. One, some, or all responses may be correct. 1 Provide skin care. 2 Advise the client to limit salt intake. 3 Teach stress management. 4 Instruct the client to quit smoking. 5 Advise the client to eat finger foods.

2, 3, 4 Proper nursing interventions for an older client with hypertension include advising the client to limit salt intake, teaching stress management, and instructing the client to quit smoking. Skin care is an appropriate intervention for clients at risk of pressure injuries. The nurse would advise a client with dementia to eat finger foods such as sandwiches because these foods are easy to eat.

Which prenatal condition would the nurse expect to find in the history of a client with an abruptio placentae? 1 Cardiac disease 2 Hyperthyroidism 3 Gestational hypertension 4 Cephalopelvic disproportion

3 Hypertension during pregnancy leads to vasospasm; this in turn causes the placenta to tear away from the uterine wall (abruptio placentae). Generally cardiac disease does not cause abruptio placentae. Hyperthyroidism may cause an endocrine disturbance in the infant but does not affect blood supply to the uterus. Cephalopelvic disproportion may affect the birth of the fetus but does not affect the placenta.

The nurse is caring for a client in preterm labor who reports that she fell down the stairs. Bruises are apparent on the left part of the client's lower abdomen, the back of each shoulder, and on both wrists. After instituting electronic fetal monitoring, starting tocolytic therapy, and examining the monitor strips, which action would the nurse take next? 1 Ambulating the client to promote circulation 2 Inserting two small-bore intravenous catheters 3 Determining whether the client feels safe at home 4 Ensuring that the client has her glasses to ambulate

3 Bruising on the backs of both shoulders and both wrists indicates potential abuse; asking the client whether she feels safe at home will open a dialogue to discuss the possible physical abuse. Whether or not the client admits abuse, the nurse is required to report the finding. A client in preterm labor should have a large-bore intravenous catheter. Ambulation is not appropriate for a client in preterm labor, and bed rest should be maintained. Reporting should not be delayed.

A client is admitted to the hospital with a long history of uncontrolled hypertension. Which laboratory result will be most important for the nurse to review? 1 Blood glucose level 2 White blood cell count 3 Blood urea nitrogen 4 Lactic dehydrogenase

3 Hypertension leads to changes in renal blood flow and eventually to decreased renal function, which is tested with blood urea nitrogen levels. All of the other results would also be reviewed by the nurse, but they are not associated with complications of hypertension. Changes in blood glucose level are not associated with hypertension, although if the client also has diabetes then there will be more risk for kidney disease. White blood cell count is not affected by hypertension, but it would be assessed for any possible infectious or inflammatory process. Lactic dehydrogenase is an enzyme associated with multiple other diagnoses, but it is not affected by hypertension.

Which nursing assessment is important in determining the causative factors in a client with a history of spontaneous abortions? 1 Use of sex hormones 2 Use of contraceptive pills 3 Presence of heart problems 4 History of alcohol consumption

4 Alcohol consumption during pregnancy may cause fetal abnormalities and increase the risk of spontaneous abortions. The presence of heart problems may not cause spontaneous abortions. The use of sex hormones in pregnancy may cause fetal abnormalities. Contraceptive pills may inhibit the ovulation process, but they rarely affect the embryo.

A multiparous client with a history of gestational hypertension and previous history of abruption is in the transition phase of labor. The electronic fetal monitor shows bradycardia, and a change is seen in the contour of the client's abdomen. Which is the nurse's immediate action? 1 Checking the client's vital signs 2 Placing the client on her left side 3 Applying an internal scalp electrode on the fetus 4 Alerting staff to the need for immediate cesarean delivery

4 Client history, fetal bradycardia, and change of abdominal contour indicate uterine rupture, which requires immediate cesarean delivery. Another nurse would be immediately enlisted to notify the operating room staff, primary health care provider, anesthesiologist, and neonatal team to prepare. Vital signs may be checked immediately after another nurse has been asked to bring the team together. Positioning on the left side does not address uterine rupture. Placing an internal fetal monitor is a poor use of valuable time and requires a prescription from the primary health care provider.

Which intervention would the plan of care for a client with a tentative diagnosis of partial abruptio placentae include? 1 Bed rest with sedation 2 Trendelenburg position and hydration 3 Preparation for emergency cesarean birth 4 External fetal monitoring and oxygenation

4 Fetal monitoring and oxygen administration should be instituted to protect the fetus. Sedation is contraindicated; it may further stress an already compromised fetus. The Trendelenburg position may shift the heavy uterus against the diaphragm and lead to compromised maternal respiratory function, further depriving the fetus of oxygen. Hydration is not a priority at this time. Further assessment of fetal status and progression of abruption placentae is needed before a cesarean birth is considered.

Which over-the-counter medication would the nurse teach a client taking antihypertensive medication to avoid? 1 Omeprazole 2 Acetaminophen 3 Docusate sodium 4 Pseudoephedrine

4 Pseudoephedrine stimulates the sympathetic nervous system and may increase blood pressure; it should be avoided by clients with hypertension. Omeprazole does not interact with antihypertensives. Acetaminophen does not have to be avoided when receiving an antihypertensive. Docusate sodium does not have to be avoided when receiving an antihypertensive.

A client with systemic lupus erythematosus (SLE) is at 39 weeks' gestation. Which would the nurse anticipate regarding this client? 1 A newborn large for gestational age 2 The possible need for postpartum dialysis 3 Greater prominence of the butterfly-shaped rash 4 A need to discontinue the client's salicylate therapy

4 Salicylate therapy is used because clients with SLE have an increased risk of thrombus formation; as the time of birth approaches salicylate therapy should be discontinued to reduce the possibility of bleeding in the newborn. There is a greater probability that the newborn will be small for gestational age. There is no need for dialysis during the postpartum period. The butterfly-shaped rash that may occur with SLE does not become more prominent during late pregnancy.

The nurse is caring for a woman being admitted for labor induction. The woman's Bishop score is 9. What is this number indicative of? A a high likelihood of successful induction B a decreased likelihood of successful induction C a high likelihood of developing gestational diabetes D a decreased likelihood of developing gestational diabetes

A - need a 7 for the first baby

glucose tolerance test

A test of the body's ability to metabolize glucose that involves the administration of a measured dose of glucose to the fasting stomach and the determination of blood glucose levels in the blood or urine at intervals thereafter and that is used especially to detect diabetes.

amniotic fluid embolism

An extremely rare, life-threatening condition that occurs when amniotic fluid and fetal cells enter the pregnant woman's pulmonary and circulatory system through the placenta via the umbilical veins, causing an exaggerated allergic response from the woman's body

Valsartan

Antihypertensive

Which mechanism of action explains how hydrochlorothiazide increases urine output? 1 Increases the excretion of sodium 2 Increases the glomerular filtration rate 3 Decreases the reabsorption of potassium 4 Increases renal perfusion

Hydrochlorothiazide inhibits sodium reabsorption in the nephrons, causing increased excretion of sodium, which increases urine excretion. The glomerular filtration rate is not affected. The loss of potassium is a side effect, not the mechanism of action. Renal perfusion is not affected.

oligohydramnios

Not enough amniotic fluid. The fetus can have physical deformities because there is not enough cushion from fluid and it can also affect lung development.

cephalopelvic disproportion (CPD)

a condition in which the fetal head is too large for the mother's pelvis

List the nursing measures for the woman having prolonged labor and for her fetus.

a. Mom - promote comfort and support, position changes, assess for infection b. Fetus - assess for infection and oxygenation

Which statement from a pregnant client with premature rupture of membranes (PROM) demonstrates an understanding of the infection risk? Select all that apply. One, some, or all responses may be correct. 1 "I will report a fever to my doctor." 2 "I will wipe from front to back when using the bathroom." 3 "If I have contractions, medications will be administered." 4 "If I develop chorioamnionitis, my doctor will induce labor." 5 "I will let my doctor know if I experience foul-smelling vaginal discharge."

all The nurse would provide thorough education on signs of infection, infection prevention, and possible outcomes of infection for pregnant clients with PROM. The client would be instructed on how to keep the genital area clean and advised that nothing is to be introduced into the vagina. The client would be made aware of the importance of being vigilant for signs of infection, such as fever and foul-smelling vaginal discharge, and that these signs would be reported immediately. Clients would be made aware that labor will need to be induced if chorioamnionitis develops. If preterm labor occurs, tocolytic medications can be administered to "buy time" enough for transporting the client to a hospital capable of providing preterm infant care. The additional time also allows antenatal corticosteroids or antibiotics to reach effective levels.

Hydralazine

hypertension

amniocentesis

needle puncture of the amniotic sac to withdraw amniotic fluid for analysis look at the fetal cells in the amniotic fluid to look for chromosomal abnormalities. It is the aspiration of amniotic fluid during the 2nd or 3rd trimester and if the fluid is taken too early in pregnancy, it can lead to fetal foot deformities.