9. Antepartum Complications
placenta previa risk factors (6)
-previous placenta previa -uterine scarring (ex: previous c-section) -maternal age >35 yrs -multifetal gestation -multiple gestations or closely spaced pregnancies -smoking
The maternity nurse is preparing for the admission of a client in the third trimester of pregnancy who is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the health care provider's prescriptions and should question which prescription? 1. Prepare the client for an ultrasound. 2. Obtain equipment for a manual pelvic examination. 3. Prepare to draw a hemoglobin and hematocrit blood sample. 4. Obtain equipment for external electronic fetal heart rate monitoring.
2. Obtain equipment for a manual pelvic examination. (digital examination of the cervix can lead to hemorrhage) NCLEX
The nurse is caring for a client with a diagnosis of placenta previa. The nurse collects data knowing that which are characteristic of placenta previa? (Select all that apply) 1. A tender and rigid uterus 2. Painless, bright red vaginal bleeding 3. Location in the lower uterine segment 4. Greenish discoloration of the amniotic fluid 5. Vaginal bleeding accompanied by abdominal pain
2. Painless, bright red vaginal bleeding 3. Location in the lower uterine segment (abruptio placena = rigid, tender uterus and abdominal pain) NCLEX
The nurse reviews the assessment history for a client with a suspected ectopic pregnancy. Which assessment findings predispose the client to an ectopic pregnancy? (Select all that apply) 1. Use of diaphragm 2. Use of fertility medications 3. History of Chlamydia 4. Use of an intrauterine device 5. History of pelvic inflammatory disease (PID)
2. Use of fertility medications 3. History of Chlamydia 4. Use of an intrauterine device 5. History of pelvic inflammatory disease (PID) NCLEX
ectopic pregnancy risk factors (2)
-PID -IUD
pt teaching: placenta previa (2)
-bed rest -nothing inserted vaginally
The nurse is assessing a pregnant client in the second trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which assessment finding should the nurse expect to note if this condition is present? 1. Soft abdomen 2. Uterine tenderness 3. Absence of abdominal pain 4. Painless, bright red vaginal bleeding
2. Uterine tenderness NCLEX
Hgb level for iron-deficiency anemia
<11 mg/dL in 1st and 3rd trimesters <10.5 mg/dL in 2nd trimester
A nurse at an antepartum clinic is caring for a client who is at 4 months of gestation. The client reports continued nausea and vomiting and scant, prune-colored discharge. She has experienced no weight loss and has a fundal height larger than expected. Which of the following complications should the nurse suspect? A. Hyperemesis gravidarum B. Threatened abortion C. Hydatidiform mole D. Preterm labor
C. Hydatidiform mole ATI
cervical insufficiency
dilation of the cervix without contractions due to a structural or function defect of the cervix
oligohydramnios
scant amniotic fluid volume
A nurse is caring for a client who has hyperemesis gravidarum and is receiving IV fluid replacement. Which of the following findings should the nurse report to the provider? a. BUN 25 mg/dL b. serum creatinine 0.8 mg/dL c. urine output 280 mL in 8 hrs d. urine negative for ketones
a. BUN 25 mg/dL (elevated BUN indicates dehydration) ATI
The nurse has completed the initial assessment on four prenatal clients. Which client is at greatest risk for a spontaneous preterm birth? a. A 26-year-old client with a history of diabetes b. A 17-year-old client with a hyperthyroid disorder c. A 19-year-old client with twins d. A 40-year-old client with anemia
c. A 19-year-old client with twins text
The nurse is reviewing the lab tests of four prenatal clients. Which lab finding would support the diagnosis of hyperemesis gravidarum? a. Hypercalcemia b. Hyperkalemia c. Hypokalemia d. Hypocalcemia
c. Hypokalemia (K+ loss is characteristic of hyperemesis gravidarum) text
A client at 17 weeks' gestation is admitted to the labor and birth unit. Her chief complaint is abdominal cramping and vaginal spotting. What is the priority nursing diagnosis for this prenatal client? a. Risk for Ineffective Coping related to unknown outcome of pregnancy b. Knowledge Deficit related to management of vaginal bleeding c. Risk for Infection related to spontaneous abortion d. Impaired Physical Mobility related to continuous fetal monitoring
c. Risk for Infection related to spontaneous abortion text
placenta previa vs abruptio placentae: uterus
-placenta previa: soft, relaxed, nontender -abruptio placentae: firm, rigid, tender, contractions
hyperemesis gravidarum interventions (5)
-NPO for 48 hrs -lactated Ringer's (hydration) -vitamin B₆ (pyridoxine) -antiemetic medications -tube feeding, parenteral nutrition
ectopic pregnancy
-abnormal implantation of fertilized ovum outside uterine cavity, usually in a fallopian tube -can result in tubal rupture causing hemorrhage
cervical insufficiency pt teaching (6)
-activity restriction, bed rest -encourage hydration (promotes relaxed uterus) -avoid intercourse -avoid prolonged standing -avoid heavy lifting -signs of preterm labor (ROM, contractions, perineal pressure)
3 types of placenta previa
-complete or total: cervical os is completely covered by the placental attachment -incomplete or partial: cervical os is partially covered -marginal or low-lying: placenta is attached to lower uterine segment but does not reach cervical os
A prenatal woman with a history of heart disease has been instructed on care at home. Which statement, if made by the woman, would indicate that she understands her needs? 1. "My weight gain is not important." 2. "I should avoid stressful situations." 3. "I should rest by lying on my back." 4. "There is no restriction on people who visit me."
2. "I should avoid stressful situations." NCLEX
Which is the priority nursing action for the client with an ectopic pregnancy? 1. Assessing urine for proteinuria 2. Checking the electrolyte values 3. Monitoring for signs of infection 4. Monitoring the pulse and blood pressure
4. Monitoring the pulse and blood pressure (hypovolemic shock) NCLEX
A prenatal client with vaginal bleeding is being admitted to the labor unit. The labor room nurse is performing the admission assessment and would suspect a diagnosis of placenta previa if which finding is noted? 1. Back pain 2. Abdominal pain 3. Painful vaginal bleeding 4. Painless vaginal bleeding
4. Painless vaginal bleeding NCLEX
The nurse is caring for a third-trimester prenatal client admitted with bright red, painless vaginal bleeding. What nursing intervention is not recommended? a. Intravenous fluids with lactated Ringer's b. Assessment of the fetal heart rate with continuous monitoring c. Application of a pulse oximeter d. Vaginal exams
d. Vaginal exams text
A nurse is assessing a client who is at 34 weeks gestation and has a mild placental abruption. Which finding should the nurse expect? a. increased platelet count b. fetal distress c. decreased urinary output d. dark red vaginal bleeding
d. dark red vaginal bleeding (nurse should expect a reassuring fetal heart rate) ATI
hydramnios
excessive amniotic fluid volume
hyperemesis gravidarum
excessive nausea and vomiting prolonged past 1st trimester (12 weeks)
pt teaching: GTD
no pregnancy for at least 1 year
abruptio placentae
the premature separation of the placenta from the uterus
spontaneous abortion
when a pregnancy is terminated before 20 weeks aka miscarriage
placenta previa
when placenta abnormally implants in the lower segment of the uterus near or over the cervical os instead of attaching to the fundus
The nurse is performing an initial assessment on a client who has just been told that a pregnancy test is positive. Which assessment finding indicates that the client is at risk for preterm labor? 1. The client is a 35-year-old primigravida 2. The client has a history of cardiac disease 3. The client's hemoglobin level is 13.5 g/dL 4. The client is a 20-year-old primigravida of average weight and height
2. The client has a history of cardiac disease (risk factors: hx of medical conditions, hx of obstetric problems, social and environmental factors, substance abuse, multifetal pregnancy, anemia, younger than 18, older than 40) NCLEX
A nurse is caring for a client who is pregnant and reviewing signs of complications the client should promptly report to the provider. Which of the following complications should the nurse include in the teaching? A. Vaginal bleeding B. Swelling of the ankles C. Heartburn after eating D. Lightheadedness when lying on back
A. Vaginal bleeding ATI
During admission, a client in early active labor acts somewhat euphoric. During assessment and the admission interview, she admits to the nurse that before coming to the hospital, she smoked crack cocaine. In addition to constant monitoring of fetal heart rate, you should monitor for symptoms of which of the following? A. Placenta previa B. Abruptio placenta C. Ruptured uterus D. Maternal hypotension
B. Abruptio placenta (cocaine use is a risk for abruptio placenta) disc
The nurse is conducting an intake interview for a new prenatal client. A review of her records and self-reported history reveals she is a G6P1132 and the current pregnancy was diagnosed as a twin gestation in the emergency department the week before. What significant risk should be taken into account in the care of this client? a. Cervical insufficiency b. Postterm pregnancy c. Placenta previa d. Placental abruption
a. Cervical insufficiency (twin gestation, prior preterm delivery, multiple prior pregnancy losses are risk factors for cervical insufficiency) text
The nurse is caring for a client who is not in labor but has been diagnosed with ruptured membranes at 30 weeks' gestation. For what intervention should the nurse prepare? a. Induction of labor b. Administration of magnesium sulfate c. Digital vaginal examination d. Amnioinfusion
b. Administration of magnesium sulfate (Mg sulfate indicated for prevention of infant neurological impairment anytime preterm delivery is expected) text
A nurse is completing an assessment on a first-trimester prenatal client with a hemoglobin level of 10.8 g/dL. What is the priority nursing action at this time? a. Refer the client for nutritional counseling. b. Obtain an order for iron supplementation. c. Obtain an order for type and crossmatch. d. Evaluate the client for signs of infection.
b. Obtain an order for iron supplementation. text
A pregnant client calls her nurse-midwife's office to report nagging, one-sided calf pain. The nurse notes a history of varicose veins in the client's chart. What is the most appropriate nursing response? a. Tell the client to put on support stockings. b. Schedule the client for an open appointment in the upcoming week. c. Request that the on-call nurse-midwife examine the client immediately. d. Advise the client to decrease her exercise.
c. Request that the on-call nurse-midwife examine the client immediately. (symptoms of thromboembolism) text
A client presents to the primary healthcare provider's office with complaints of right-sided abdominal pain, dizziness, and vaginal bleeding. A pelvic exam determines the client to be at 10 weeks' gestation with adnexal tenderness. What diagnosis should the nurse suspect? a. Threatened abortion b. Appendicitis c. Cholelithiasis d. Ectopic pregnancy
d. Ectopic pregnancy (pt with a threatened abortion would have complaints of unexplained bleeding, cramping, or backache) text
A nurse is assessing a client who is at 26 weeks of gestation. Which of the following clinical manifestations should the nurse report to the provider? a. leukorrhea b. supine hypotension c. periodic numbness of the fingers d. decreased urine output
d. decreased urine output (could indicate preeclampsia) ATI
The nurse is assessing a woman in the second trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which findings should the nurse expect to note if abruptio placentae is present? (Select all that apply) 1. Soft uterus 2. Abdominal pain 3. Nontender uterus 4. Firm uterus by palpation 5. Painless vaginal bleeding
2. Abdominal pain 4. Firm uterus by palpation (classic symptoms of abruptio placentae: vaginal bleeding, abdominal pain, uterine tenderness, contractions, uterine hypertonicity) NCLEX
The nurse is planning to admit a pregnant client who is obese. In planning care for this client, which potential client needs should the nurse anticipate? (Select all that apply) 1. Bed rest as a necessary preventive measure may be prescribed. 2. Routine administration of subcutaneous heparin may be prescribed. 3. An overbed lift may be necessary if the client requires a cesarean section. 4. Less frequent cleansing of a cesarean incision, if present, may be prescribed. 5. Thromboembolism stockings or sequential compression devices may be prescribed.
2. Routine administration of subcutaneous heparin may be prescribed. 3. An overbed lift may be necessary if the client requires a cesarean section. 5. Thromboembolism stockings or sequential compression devices may be prescribed. (obese pregnant pt is at risk for venous thromboembolism and increased need for c-section) NCLEX
The nurse reviews the plan of care for a woman at 37 weeks' gestation who has sickle cell anemia. The nurse determines that which problem listed on the nursing care plan will receive the highest priority? 1. Pain 2. Disturbed body image 3. Insufficient fluid volume 4. Inability to tolerate activity
3. Insufficient fluid volume NCLEX
pt with cardiac disease: symptoms (8)
-cough -respiratory congestion -dyspnea -fatigue -palpitations -chest pain -tachycardia -peripheral edema
A nurse is providing care for a client who is diagnosed with a marginal abruptio placentae. The nurse is aware that which of the following findings are risk factors for developing the condition? (Select all that apply) A. Fetal position B. Blunt abdominal trauma C. Cocaine use D. Maternal age E. Cigarette smoking
B. Blunt abdominal trauma C. Cocaine use E. Cigarette smoking ATI
An ultrasound is performed on a client with suspected abruptio placentae, and the results indicate that a placental abruption is present. Which intervention should the nurse prepare the client for? 1. Delivery of the fetus 2. Strict monitoring of intake and output 3. Complete bed rest for the remainder of the pregnancy 4. The need for weekly monitoring of coagulation studies until the time of delivery
1. Delivery of the fetus (goal of management in abruptio placentae is to control the hemorrhage and deliver the fetus as soon as possible - delivery of the fetus is necessary) NCLEX
The nurse is assessing a client with a diagnosis of gestational trophoblastic disease (hydatidiform mole). The nurse understands that which findings are associated with this condition? (Select all that apply) 1. Vaginal bleeding 2. Excessive fetal activity 3. Excessive nausea and vomiting 4. Larger-than-normal uterus for gestational age 5. Elevated levels of human chorionic gonadotropin (hCG)
1. Vaginal bleeding 3. Excessive nausea and vomiting 4. Larger-than-normal uterus for gestational age 5. Elevated levels of human chorionic gonadotropin (hCG) NCLEX
The clinic nurse has provided home care instructions to a client with a history of cardiac disease who has just been told that she is pregnant. Which statement, if made by the client, indicates a need for further instructions? 1. "It is best that I rest lying on my side to promote blood return to the heart." 2. "I need to avoid excessive weight gain to prevent increased demands on my heart." 3. "I need to try to avoid stressful situations because stress increases the workload on the heart." 4. "During the pregnancy, I need to avoid contact with other individuals as much as possible to prevent infection."
4. "During the pregnancy, I need to avoid contact with other individuals as much as possible to prevent infection." NCLEX
The nurse is providing instructions to a maternity client with a history of cardiac disease regarding appropriate dietary measures. Which statement, if made by the client, indicates an understanding of the information provided by the nurse? 1. "I should increase my sodium intake during pregnancy." 2. "I should lower my blood volume by limiting my fluids." 3. "I should maintain a low-calorie diet to prevent any weight gain." 4. "I should drink adequate fluids and increase my intake of high-fiber foods."
4. "I should drink adequate fluids and increase my intake of high-fiber foods." NCLEX
A nurse is caring for a client who is at 14 weeks of gestation and has hyperemesis gravidarum. The nurse should identify that which of the following are risk factors for the client? (Select all that apply) A. Obesity B. Multifetal pregnancy C. Maternal age greater than 40 D. Migraine headache E. Oligohydramnios
A. Obesity B. Multifetal pregnancy D. Migraine headache ATI
hyperemesis gravidarum complications (4)
-dehydration -weight loss (5%) -electrolyte imbalance (hypokalemia) -ketonuria (ketones in urine)
iron-deficiency anemia symptoms (9)
-fatigue, weakness -headache -irritability -dizziness, lightheadedness -SOB with exertion -palpitations -tachycardia -pallor -pica (craving unusual food)
gestational trophoblastic disease (GTD)
-hydatidiform mole (molar pregnancy) -grape-like clusters of trophoblastic cells in the placenta -associated with choriocarcinoma
abruptio placentae risk factors (7)
-maternal hypertension -blunt abdominal trauma -cocaine use -previous abruptio placenta -cigarette smoking -premature rupture of membranes -multifetal pregnancy
placenta previa symptoms (5)
-painless, bright red vaginal bleeding (3rd trimester) -soft, relaxed, nontender uterus -fundal height >gestational age -fetus in breech, oblique, or transverse position -vital signs WNL
placenta previa vs abruptio placentae: pain
-placenta previa: painless -abruptio placentae: intense localized uterine pain
abruptio placentae symptoms (7)
-sudden onset of intense localized uterine pain -dark red vaginal bleeding -uterine tenderness -boardlike abdomen; firm, rigid uterus -contractions -fetal distress -symptoms of hypovolemic shock (hypotension, tachycardia, pallor)
prophylactic cervical cerclage
-surgical reinforcement of the cervix to strengthen it and prevent premature cervical dilation -a stitch is placed in the cervix to prevent spontaneous abortion or premature birth
A nurse is providing care for a client who is at 32 weeks of gestation and who has a placenta previa. The nurse notes that the client is actively bleeding. Which of the following types of medications should the nurse anticipate the provider will prescribe? A. Betamethasone B. Indomethacin C. Nifedipine D. Methylergonovine
A. Betamethasone (to promote lung maturity if delivery is anticipated) ATI
A nurse in the ED is caring for a client who reports abrupt, sharp, right-sided lower quadrant abdominal pain and bright red vaginal bleeding. The client states she missed one menstrual cycle and cannot be pregnant because she has an IUD. The nurse should suspect which of the following? A. Missed abortion B. Ectopic pregnancy C. Severe preeclampsia D. Hydatidiform mole
B. Ectopic pregnancy ATI
A nurse is caring for a client who has suspected hyperemesis gravidarum and is reviewing the client's laboratory reports. Which of the following findings is a manifestation of this condition? A. Hgb 12.2 g/dL B. Urine ketones present C. Alanine amniotransferase 20 IU/L D. Serum glucose 114 mg/dL
B. Urine ketones present ATI
The nurse is assessing a prenatal client diagnosed with possible placenta previa. What signs and symptoms should the nurse expect this client to demonstrate? a. Dark red vaginal bleeding b. Severe abdominal pain c. Absence of fetal heart sounds d. Bright red vaginal bleeding
d. Bright red vaginal bleeding text
A pregnant client admits during a prenatal visit to using heroin and asks for help to stop using. What is the best advice the nurse can give her? a. "We need to get you admitted to the hospital because you need monitoring and medication." b. "Stop using all drugs right now and just stay at home till the withdrawal symptoms have passed." c. "There is nothing we can do during the pregnancy, but we can help the baby with withdrawal after he's born." d. "Let me call the social worker to find you a Narcotics Anonymous group."
a. "We need to get you admitted to the hospital because you need monitoring and medication." text
A client at 30 weeks' gestation is admitted to the maternity unit with vaginal bleeding. What should be the nurse's initial action? a. Assess blood pressure and pulse. b. Count and weigh peripads. c. Observe for pallor, clammy skin, and perspiration. d. Start an intravenous infusion drip.
a. Assess blood pressure and pulse. text
Which of the following is true of asthma management in pregnancy? a. The medication regimen should be modified to reduce danger to the fetus. b. It usually improves in pregnancy, so the mother can stop her medications. c. Treatment approaches are the same as those for nonpregnant women. d. Medications can be reduced because of the increased oxygen-carrying capacity of fetal hemoglobin.
a. The medication regimen should be modified to reduce danger to the fetus. text
A nurse is teaching a group of prenatal clients about hazards in the workplace during pregnancy. The nurse correctly teaches that pregnant women who have jobs requiring long periods of standing have higher incidences of: a. Prolapsed cord. b. Placenta previa. c. Preterm birth. d. Abruptio placentae.
c. Preterm birth. text
A prenatal nurse is assessing a client at 34 weeks' gestation who complains of vaginal irritation and thin, vaginal discharge that is "a funny color." What should be the nurse's initial action? a. Prepare for a nonstress test. b. Obtain vaginal cultures for STIs. c. Test the fluid with nitrazine paper. d. Test the urine for bacteria.
c. Test the fluid with nitrazine paper. text
A prenatal client at 16 weeks' gestation presents to the clinic with unexplained, bright red bleeding; cramping; and backache for the past 2 days. A pelvic exam reveals a closed cervix. What type of abortion does this indicate? a. Imminent b. Missed c. Threatened d. Incomplete
c. Threatened text
spontaneous abortion symptoms (6)
-uterine cramping -vaginal bleeding -backache -abdominal tenderness -fever -dilation of cervix
ectopic pregnancy symptoms (6)
-unilateral stabbing pain -referred shoulder pain -tenderness in lower abdominal quadrant -delayed (1-2 weeks), lighter than usual, or irregular menses -scant, dark red, or brown vaginal spotting (red vaginal bleeding if rupture has occurred) -symptoms of hemorrhage and shock (dizziness, hypotension, tachycardia, pallor)
hydatidiform mole symptoms (5)
-vaginal bleeding/discharge resembling prune juice -fundal height >gestational age -hyperemesis gravidarum -↑ hCG levels -signs of preeclampsia that occur before 20 weeks
A 25-year-old woman arrives on the maternity unit on February 2. She states that her estimated date of delivery (EDD) is March 22. She is verbalizing complaints of dull lower back pain, pelvic heaviness, and diarrhea for the past few days. On admission for observation, the client's blood pressure is 128/80 mm Hg, pulse is 100 beats/minute, respirations are 16 breaths per minute, and temperature is 99° F. The nurse plans care based on which interpretation? 1. The woman requires further evaluation for preterm labor. 2. The woman is suffering from an intestinal bacterial infection. 3. The woman is exhibiting signs and symptoms of gestational hypertension. 4. The woman needs instruction on pelvic tilts to decrease her lower back pain.
1. The woman requires further evaluation for preterm labor. (Classic signs and symptoms of preterm labor include lower abdominal cramping, possibly accompanied by diarrhea; dull and intermittent low back pain; painful menstrual-like cramps; suprapubic pain or pressure; pelvic pressure or heaviness; urinary frequency; change in character and amount of vaginal discharge; and rupture of amniotic membranes.) NCLEX
The nurse is reviewing the record of a pregnant client seen in the health care clinic for the first prenatal visit. Which data, if noted on the client's record, would alert the nurse that the client is at risk for a spontaneous abortion? 1. Age of 35 years 2. History of syphilis 3. History of genital herpes 4. History of diabetes mellitus
2. History of syphilis NCLEX
The charge nurse on a labor and delivery unit has numerous admissions of laboring clients and must transfer one of the clients to the postpartum/gynecological unit, where the nurse-to-client ratio will be 1:4. Which antepartum client would be the most appropriate one to transfer? 1. The 36-year-old, gravida I, para 0 client who is at 24 weeks' gestation and is being monitored for preterm labor 2. The 26-year-old, gravida I, para 0 client who is at 10 weeks' gestation and is experiencing vaginal bleeding 3. The 40-year-old, gravida III, para 0 client who is at 38 weeks' gestation and is complaining of decreased fetal movement 4. The 29-year-old, gravida I, para 0 client who is at 42 weeks' gestation and had a biophysical profile score of 5 earlier today
2. The 26-year-old, gravida I, para 0 client who is at 10 weeks' gestation and is experiencing vaginal bleeding (The fetus of the client at 10 weeks' gestation is in a previability stage, whereas those of the other clients are at a stage of viability) NCLEX
The nurse in a maternity unit is reviewing the clients' records. Which clients should the nurse identify as being at the most risk for developing disseminated intravascular coagulation (DIC)? (Select all that apply) 1. A primigravida with mild preeclampsia 2. A primigravida who delivered a 10-lb infant 3 hrs ago 3. A gravida II who has just been diagnosed with dead fetus syndrome 4. A gravida IV who delivered 8 hours ago and has lost 500 mL of blood 5. A primigravida at 29 weeks of gestation who was recently diagnosed with severe preeclampsia
3. A gravida II who has just been diagnosed with dead fetus syndrome 5. A primigravida at 29 weeks of gestation who was recently diagnosed with severe preeclampsia NCLEX
A 35-week-gestation pregnant woman is transferred to the maternity unit from the emergency department, where she was treated for minor injuries sustained in a motor vehicle crash. The maternal nurse's priority will be to assess for which complication? 1. Placenta previa 2. Polyhydramnios 3. Abruptio placentae 4. Gestational hypertension
3. Abruptio placentae NCLEX
A pregnant client tells the nurse that she has been craving "unusual foods." The nurse gathers additional assessment data and discovers that the client has been ingesting daily amounts of white clay dirt from her backyard. Laboratory studies are performed and the nurse determines that which finding indicates a physiological consequence of the client's practice? 1. Hematocrit 38% 2. Glucose 86 mg/dL 3. Hemoglobin 9.1 g/dL 4. White blood cell count 12,400 cells/mm3
3. Hemoglobin 9.1 g/dL NCLEX
A prenatal client with severe abdominal pain is admitted to the maternity unit. The nurse is monitoring the client closely because concealed bleeding is suspected. Which assessment findings indicate the presence of concealed bleeding? (Select all that apply) 1. Back pain 2. Heavy vaginal bleeding 3. Increase in fundal height 4. Hard, boardlike abdomen 5. Persistent abdominal pain 6. Early deceleration on the fetal heart monitor
3. Increase in fundal height 4. Hard, boardlike abdomen 5. Persistent abdominal pain NCLEX
The nurse is preparing to care for a client who is being admitted to the hospital with a possible diagnosis of ectopic pregnancy. The nurse develops a plan of care for the client and determines that which nursing action is the priority? 1. Checking for edema 2. Monitoring daily weight 3. Monitoring the apical pulse 4. Monitoring the temperature
3. Monitoring the apical pulse (nursing care is focused on hypovolemic shock) NCLEX
Which medication, if present in the client's history, indicates a need for teaching related to the woman's potential risk for carrying a fetus with a congenital cleft lip or cleft palate? 1. Methyldopa 2. Folic acid 3. Phenytoin 4. Bupropion
3. Phenytoin NCLEX
The clinic nurse is performing a prenatal assessment on a pregnant client. The nurse should plan to implement teaching related to the risk of abruptio placentae if which information is obtained on assessment? 1. The client is 28 years of age. 2. This is the second pregnancy. 3. The client has a history of hypertension. 4. The client performs moderate exercise on a regular daily schedule.
3. The client has a history of hypertension. NCLEX
The nurse is interviewing a 16-year-old client during her initial prenatal clinic visit. The client is beginning week 18 of her first pregnancy. Which statement, if made by the client, indicates an immediate need for further investigation? 1. "I don't like my figure anymore. My clothes are all too tight." 2. "I don't like my breasts anymore. These silver lines are ugly." 3. "I don't like my stomach anymore. That brown line is disgusting." 4. "I don't like my face any more. I always look like I have been crying."
4. "I don't like my face any more. I always look like I have been crying." (implication of periorbital and facial edema, which could be indicative of gestational hypertension) NCLEX
A client arrives at the health care clinic and tells the nurse that her last menstrual period was 9 weeks ago. The client tells the nurse that a home pregnancy test was positive but that she began to have mild cramps and is now having moderate vaginal bleeding. On physical examination of the client, it is noted that she has a dilated cervix. Which statement, if made by the client, indicates that the client is interpreting the situation correctly? 1. "I will need to remain on bed rest for 2 weeks." 2. "I will need to take a full course of antibiotic treatment." 3. "I will need to take tocolytic medication to halt the labor process." 4. "I will need to prepare myself and my family for the loss of this pregnancy."
4. "I will need to prepare myself and my family for the loss of this pregnancy." (pt is experiencing a spontaneous abortion, which cannot be prevented and will terminate her pregnancy) NCLEX
The nurse is performing an assessment on a client diagnosed with placenta previa. Which of these assessment findings would the nurse expect to note? Select all that apply. 1. Uterine rigidity 2. Uterine tenderness 3. Severe abdominal pain 4. Bright red vaginal bleeding 5. Soft, relaxed, nontender uterus 6. Fundal height may be greater than expected for gestational age.
4. Bright red vaginal bleeding 5. Soft, relaxed, nontender uterus 6. Fundal height may be greater than expected for gestational age. (abruptio placentae = uterine rigidity, tenderness, pain) NCLEX
A nurse is reviewing discharge teaching with a client who has premature rupture of membranes at 26 weeks gestation. Which of the following instructions should the nurse include in the teaching? A. Use a condom with sexual intercourse B. Avoid bubble bath solution when taking a tub bath C. Wipe from the back to front when performing perineal hygiene D. Keep a daily record of fetal kick counts
D. Keep a daily record of fetal kick counts ATI
A nurse is caring for a client who has a diagnosis of ruptured ectopic pregnancy. Which of the following findings is seen with this condition? A. No alteration in menses B. Transvaginal ultrasound indicating a fetus in the uterus C. Serum progesterone greater than the expected reference range D. Report of severe shoulder pain
D. Report of severe shoulder pain ATI
Your client in her fourth month of her pregnancy is suspected to have an incompetent cervix. Which diagnostic measures might the nurse expect to be ordered to confirm the diagnosis? (Select all that apply.) a. Determining a history of second-trimester abortions b. Serial pelvic examinations c. Serial ultrasounds d. Determining a history of drug abuse
a. Determining a history of second-trimester abortions b. Serial pelvic examinations c. Serial ultrasounds text
A client at 15 weeks' gestation presents to the prenatal clinic with painless, thin, brown vaginal bleeding. Other assessment data include a hemoglobin of 10 and complaints of severe nausea and vomiting. What diagnosis should the nurse suspect? a. Hydatidiform mole b. Placenta previa c. Prolapsed cord d. Abruptio placentae
a. Hydatidiform mole (symptoms: prune juice-like vaginal bleeding, anemia, severe nausea, vomiting) text
A prenatal client is receiving home care for severe hyperemesis gravidarum. If the client does not respond to standard treatment, the nurse will anticipate adding which of the following therapies on an outpatient basis? a. Total parenteral nutrition b. IV fluids c. Low-fat soft diet d. Complex carbohydrates with limited liquids
b. IV fluids text
