Antepartum

A 28-year-old client is admitted to the labor and delivery unit for severe preeclampsia. She is started on IV magnesium sulfate. Which signs indicate that the client has developed magnesium sulfate toxicity? Select all that apply. 1. 0/4 patellar reflex. 2. Blood pressure is 156/84 mm HG. 3. Client voided 600 mL in 8 hours. 4. Respirations are 10/min. 5. Serum magnesium level is 5 mEq/L (2.5 mmol/L)

1. 0/4 patellar reflex. 4. Respirations are 10/min.

A client who reports sudden-onset severe right lower abdominal pain and dizziness is being evaluated for suspected ectopic pregnancy. Which assessment findings should the nurse anticipate? Select all that apply. 1. Blood pressure 82/64 mm Hg. 2. Crackles on auscultation. 3. Distended jugular veins. 4. Pulse 120/min. 5. Shoulder pain.

1. Blood pressure 82/64 mm Hg. 4. Pulse 120/min. 5. Shoulder pain.

During the first prenatal assessment, the client reports the last normal menstrual period starting on March 1 and ending on March 5, but also slight spotting on March 23. The client had unprotected intercourse on March 15. Using Naegele's rule, what is the estimated date of birth? 1. December 8 2. December 12 3. December 22 4. December 30

1. December 8

A 37-weeks-pregnant woman comes to the emergency department with a fractured ankle. Which assessment finding is most concerning and requires the nurse to follow up? 1. Fetal heart rate remains 206/min. 2. Fetus kicked 4 times in the past hour. 3. Mother reports feeling 2 contradictions every hour. 4. Mother's hemoglobin is 11 g/dL (110 g/L).

1. Fetal heart rate remains 206/min.

The initial prenatal laboratory screening results of a client at 12 weeks gestation indicate a rubella titer status of nonimmune. What will the nurse anticipate as the plan of care for this client? 1. Administer measles-mumps-rubella (MMR) vaccine now. 2. Administer MMR vaccine immediately postpartum. 3. Administer MMR vaccine in the third trimester. 4. An MMR vaccine is not indicated for this client.

2. Administer MMR vaccine immediately postpartum.

A nurse is caring for a pregnant client at 33 weeks gestation. The diagnosis of placenta previa is made via ultrasound. What should the nurse include in the plan of care? Select all that apply. 1. Activity as tolerated. 2. Biophysical profile 1 or 2 times a week. 3. Prepare for cesarean birth at any time. 4. Type and screen blood. 5. Vaginal examinations twice weekly.

2. Biophysical profile 1 or 2 times a week. 3. Prepare for cesarean birth at any time. 4. Type and screen blood.

A 14-year-old client confides to the school nurse that she is about 22 weeks pregnant and has not had prenatal care. Which topics are most important and priorities for the nurse to discuss with the client in anticipation of referral for prenatal care? Select all that apply. 1. Adoption planning. 2. Family and social support. 3. Future education plans. 4. Nutrition and prenatal vitamins. 5. Sexual abuse.

2. Family and social support. 4. Nutrition and prenatal vitamins. 5. Sexual abuse.

A client at 30 weeks gestation is hospitalized for preeclampsia. Which assessment finding requires priority intervention? 1. Elevated liver enzymes. 2. Lower abdominal pain and vaginal bleeding. 3. Swelling of the hands, feet, and face. 4. Urine output of 25 mL/hr.

2. Lower abdominal pain and vaginal bleeding.

The nurse is caring for a client in the first trimester during an initial prenatal clinic visit. Based on the information provided by the client, which factor places the client at an increased risk for preterm labor? 1. Age 25. 2. Periodontal disease. 3. Vegetarian diet. 4. White ethnicity.

2. Periodontal disease.

Which client in a prenatal clinic should the nurse assess first? 1. Client at 11 weeks gestation with backache and pelvic pressure. 2. Client at 16 weeks gestation with earache and sinus congestion. 3. Client at 27 weeks gestation with headache and facial edema. 4. Client at 37 weeks gestation with white vaginal discharge and urinary frequency.

3. Client at 27 weeks gestation with headache and facial edema.

A pregnant client comes in for a routine first prenatal examination. According to the last menstrual period, the estimated gestational age is 12 weeks. Where would the nurse expect to palpate the uterine fundus in this client? 1. 12 cm above the umbilicus. 2. At the level of the umbilicus. 3. Halfway between the symphysis pubis and the umbilicus. 4. Just above the symphysis pubis.

4. Just above the symphysis pubis.

The nurse is admitting a client at 41 weeks gestation for induction of labor due to oligohydramnios. Considering the client's indication for induction, what should the nurse anticipate? 1. Additional mental personnel present for birth. 2. Intermittent fetal monitoring during labor. 3. Need for forceps-assisted vaginal birth. 4. Need for uterotonic drugs for postpartum hemorrhage.

1. Additional mental personnel present for birth.

A client at 38 weeks gestation is brought to the emergency department after a motor vehicle crash. She reports severe, continuous abdominal pain. The nurse notes frequent uterine contractions and mild, dark vaginal bleeding. What actions should the nurse take? Select all that apply. 1. Anticipate emergent cesarean birth. 2. Apply continuous external fetal monitoring. 3. Assess routine vital signs every 4 hours. 4. Draw blood for type and crossmatch. 5. Initiate IV access with a 22-gauge catheter.

1. Anticipate emergent cesarean birth. 2. Apply continuous external fetal monitoring. 4. Draw blood for type and crossmatch.

A pregnant client arrives in the labor and delivery unit with mild contractions and brisk, painless vaginal bleeding. The client received no prenatal care and reports being "about 7-8 months." Which actions should the nurse anticipate? Select all that apply. 1. Blood draw for type and screen. 2. Electronic fetal monitoring. 3. Initiation of 2 large-bore IV catheters. 4. Pad counts to assess bleeding. 5. Vaginal examination for cervical dilation.

1. Blood draw for type and screen. 2. Electronic fetal monitoring. 3. Initiation of 2 large-bore IV catheters. 4. Pad counts to assess bleeding.

A client visits the prenatal clinic for the first time. Which of the following are presumptive signs of pregnancy that the client may report during the intake assessment by the nurse? Select all that apply. 1. Breast fullness and tenderness. 2. Last menstrual period 8 weeks ago. 3. Nausea and vomiting that are worsening every day. 4. Painless contractions at irregular intervals. 5. Positive home pregnancy test 3 weeks ago.

1. Breast fullness and tenderness. 2. Last menstrual period 8 weeks ago. 3. Nausea and vomiting that are worsening every day.

The nurse reviews laboratory test results for a pregnant client at 32 weeks gestation. What is the nurse's best action based on these results? Click on the exhibit button for additional information. 1. Complete the client assessment and documentation. 2. Draw another sample for repeat complete blood count. 3. Prepare for transfusion of packed red blood cells. 4. Request a prescription for iron supplementation.

1. Complete the client assessment and documentation.

A client at 20 weeks gestation states that she started consuming an increased amount of cornstarch about 3 weeks ago. Based on this assessment, the nurse should anticipate that the health care provider will order which laboratory test(s)? 1. Hemoglobin and hematocrit levels. 2. Human chorionic gonadotropin level. 3. Serum folate level. 4. White blood cell count.

1. Hemoglobin and hematocrit levels.

The nurse is preparing to assess a client visiting the women's health clinic. The client's obstetric history is documented as G5T1P2A1L2. Which interpretation of this notation is correct? 1. The client had 1 birth at 37 wk 0 d gestation or beyond. 2. The client had 3 births between 20 wk 0 d and 36 wk 6 d gestation. 3. The client has 3 currently living children. 4. The client is currently not pregnant.

1. The client had 1 birth at 37 wk 0 d gestation or beyond.

A client at 21 weeks gestation has intense heartburn (pyrosis). What should the nurse recommend? Select all that apply. 1. Avoid dairy products. 2. High-protein, low-fat diet. 3. Lie on the left side after meals. 4. Six small meals a day. 5. Sodium bicarbonate antacid.

2. High protein, low-fat diet. 4. Six small meals a day.

A client at 39 weeks gestation with preeclampsia has a blood pressure of 170/100 mm Hg, 2+ proteinuria, and moderate peripheral edema. Immediately after hospital admission, she develops seizures and uterine contractions. Magnesium sulfate is prescribed. Which finding indicates that the drug has achieved the desired therapeutic effect? 1. Blood pressure <130/80 mm Hg. 2. Seizure activity stops. 3. Urine has 1+ protein. 4. Uterine contractions stop.

2. Seizure activity stops.

A couple is excited about finding out the sex of their baby during ultrasound at 14 weeks gestation. What is the nurse's best response? 1. "Basic structures of major organs are not yet formed." 2. "External genitalia are not usually visualized until 21-24 weeks. 3. "If the baby is in the right position, the genitalia may be visualized." 4. "Sex cannot be determined until fetal movement is felt."

3. "If the baby is in the right position, the genitalia may be visualized."

The nurse is documenting assessments of pregnant clients in the antepartum unit. Which client's assessment findings are most important to report to the health care provider? 1. Client at 28 weeks gestation with an asymptomatic systolic murmur. 2. Client at 34 weeks gestation with 1+ edema of bilateral lower extremities. 3. Client at 35 weeks gestation with painful genital lesions. 4. Client at 39 weeks gestation with brownish, mucoid vaginal discharge.

3. Client at 35 weeks gestation with painful genital lessons.

A nurse is caring for a pregnant client who has hyperemesis gravidarum. Which assessment findings should the nurse anticipate? Select all that apply. 1. Blood pressure 160/94 mm Hg. 2. Large urine protein. 3. Positive urine ketones (moderate). 4. Pulse 106/min. 5. Urine specific gravity 1.010.

3. Positive urine ketones (moderate). 4. Pulse 106/min.

The nurse is counseling a pregnant client who is HIV positive. Which information is appropriate to discuss? 1. Infant should be exclusively breastfed for 6 months to receive maternal antibodies. 2. Infant will not require treatment for HIV after birth. 3. Prescribed antiretroviral therapy should be continued during pregnancy. 4. Tetanus-diphtheria-pertussis vaccine should be avoided until after birth.

3. Prescribed antiretroviral therapy should be continued during pregnancy.

A client is at 20 weeks gestation. The client reports having to "run to the bathroom all the time," "it hurts to pee," and my urine "smells bad." Which statement by the nurse is the most appropriate? 1. "Drink cranberry juice to relieve the symptoms." 2. "Make sure to wipe from the front to the back after voiding." 3. "Most women have urinary frequency at this stage and it is normal." 4. "You may need to be checked for a urinary tract infection."

4. "You may need to be checked for a urinary tract infection."

A nurse is measuring a uterine fundal height for a client who is at 36 weeks gestation in supine position. The client suddenly reports dizziness and the nurse observes pallor and damp, cool skin. What should the nurse do first? 1. Assess fetal heart rate and pattern. 2. Assess heart and lung sounds. 3. Notify the health care provider immediately. 4. Reposition the client into a lateral position.

4. Reposition the client into a lateral position.

When triaging 4 pregnant clients in the obstetric clinic, the nurse should alert the health care provider to see which client first? 1. First-trimester client reporting frequent nausea and vomiting. 2. Second-trimester client with dysuria and urinary frequency. 3. Second-trimester client with obesity reporting decrease in fetal movement. 4. Third-trimester client with right upper quadrant pain and nausea.

4. Third-trimester client with right upper quadrant pain and nausea.

A client comes to the clinic indicating that a home pregnancy test was positive. The client's last menstrual period was September 7. Today is December 7. Which are true statements for this client? Select all that apply. 1. According to Naegeles's rule, the expected date of delivery is June 14. 2. Detection of the fetal heart rate via Doppler is possible. 3. Fundal height should be 24 cm above the symphysis pubis. 4. The client should be feeling fetal movement. 5. Urinary frequency is a common symptom.

1. According to Naegeles's rule, the expected date of delivery is June 14. 2. Detection of the fetal heart rate via Doppler is possible. 5. Urinary frequency is a common symptom.

Which meal should the nurse recommend for a pregnant client at 13 weeks gestation? 1. Baked chicken, turnip greens, peanut butter cookie, and grape juice. 2. Baked swordfish, fires, baked apples, and fat-free milk. 3. Chilled ham and cheese sandwich, broccoli, orange slices, and water. 4. Fried liver and onions, pasteurized cheese squares, fresh fruit cup, and water.

1. Baked chicken, turnip greens, peanut butter cookie, and grape juice.

A nurse is admitting a client at 42 weeks gestation to the labor and delivery unit for induction of labor. What is a predictor of a successful induction? 1. Bishop score of 10. 2. Firm and posterior cervix. 3. History of precipitous labor. 4. Reactive nonstress test.

1. Bishop score of 10.

The nurse is providing nutrition counseling during a preconception visit to a client who does not eat green vegetables. In addition to a daily prenatal vitamin, which foods can the client add to decrease the risk of neural tube defects? Select all that apply. 1. Black beans and rice. 2. Breakfast cereal and milk. 3. Medium baked sweet potato. 4. Peanut butter on whole wheat toast. 5. Raw carrots with dip.

1. Black beans and rice. 2. Breakfast cereal and milk. 4. Peanut butter on whole wheat toast.

A client who is 8 weeks pregnant reports morning sickness. What is the most appropriate response by the nurse? 1. Advise the client to consume hot, versus cold, foods. 2. Instruct the client to drink 2 glasses of water with each meal. 3. Suggest the client consume high-protein snacks on awakening. 4. Tell the client that morning sickness should pass in a few weeks.

3. Suggest the client consume high-protein snacks on awakening.