Ch 20
Part of the assessment of the first prenatal visit includes screening for rubella antibodies. The nurse determines that a client with which titer shows evidence of immunity against rubella? 1:8 1:6 1:0 1:4
1:8 Explanation: A rubella antibody titer of 1:8 or greater proves evidence of immunity. Women with titers of less than 1:8 should be immunized.
A woman calls the obstetrician's office to inquire how long she needs to wait to get pregnant following a seizure she had last week. The nurse would tell her to wait how long?
It is recommended that she wait 6 months after seizures are under control before getting pregnant.
A woman with diabetes is in labor. To reduce the likelihood of neonatal hypoglycemia, the nurse monitors the client's blood glucose level closely with the goal to maintain which level? below 110 mg/dL below 105 mg/dL below 115 mg/dL below 120 mg/dL
below 110 mg/dL Explanation: For the laboring woman with diabetes, the blood glucose levels are monitored every 1 to 2 hours with the goal to maintain the levels below 110 mg/dL throughout the labor to reduce the likelihood of neonatal hypoglycemia. If necessary, an infusion of regular insulin may be given to maintain this level.
A woman who immigrated here from a third world country presents to the clinic to find out if she is pregnant. Which signs and/or symptoms would the nurse assess as possible indicators that she might have an active case of tuberculosis as well? Select all that apply. fatigue night sweats hemoptysis anorexia weight gain
fatigue night sweats hemoptysis anorexia
The infant born to a woman with untreated tuberculosis (TB) is more likely to have which conditions? Select all that apply. low Apgar score overweight perinatal death postnatal TB underweight
low Apgar score perinatal death postnatal TB underweight Explanation: Pregnant women with untreated TB are more likely to have an underweight infant, an infant with a low Apgar score, and perinatal death (Mehta, Chen, Hardy, & Powrie, 2015). The newborn is at risk of postnatally acquired TB if the mother still has active TB at the time of birth.
A client with rheumatoid arthritis (RA) is in week 38 of her pregnancy. Which intervention should the nurse make with this client?
Ask the client to decrease her intake of salicylates. Explanation: Although women with RA should continue to take their medications during pregnancy to prevent joint damage, large amounts of salicylates have the potential to lead to increased bleeding at birth or prolonged pregnancy. The infant may be born with a bleeding defect and may also experience premature closure of the ductus arteriosus because of the drug's effects. For this reason, a woman is asked to decrease her intake of salicylates approximately 2 weeks before term. A number of women also take low-dose methotrexate, a carcinogen. As a rule, they should stop taking this prepregnancy because of the danger of head and neck defects in the fetus.
What criteria would the physician base his decision on to begin insulin therapy for a gestational diabetic mother?
A 2-hour postprandial glucose level cannot be kept below 120 mg/dL. Explanation: A physician usually recommends beginning a woman with gestational diabetes on insulin therapy when exercise and diet are ineffective and if she is unable to keep her fasting blood sugar levels below 95 mg/dL or her 2-hour postprandial glucose levels below 120 mg/dL.
Many women develop iron-deficient anemia during pregnancy. What diagnostic criteria would the nurse monitor for to determine anemia in the pregnant woman? Hemoglobin of 13 or lower Hematocrit of 32% or less Blood pressure of 100/68 Heart rate of 84
Hematocrit of 32% or less Explanation: Iron-deficiency anemia is diagnosed in a pregnant woman if the hematocrit is less that 33% or the hemoglobin is less than 11 g/dL. Tachycardia, hypotension and tachypnea are all symptoms of iron-deficiency anemia but are not diagnostic criteria.
A nurse is conducting a class on gestational diabetes for a group of pregnant women who are at risk for the condition. The nurse determines that additional teaching is needed when the class identifies which complication as affecting the neonate? hyperglycemia macrosomia hypoglycemia birth trauma
hyperglycemia Explanation: Gestational diabetes is associated with either neonatal complications such as macrosomia, hypoglycemia, and birth trauma or maternal complications such as preeclampsia and cesarean birth.
The nurse is teaching a pregnant woman with iron deficiency anemia about foods high in iron. Which foods if selected by the woman indicate a successful teaching program? Select all that apply. raisins potatoes corn broccoli peanut butter yogurt
raisins broccoli peanut butter
A pregnant client has tested positive for hepatitis B virus. When discussing the situation with the client, the nurse explains that her infant should be vaccinated with an initial HBV vaccine dose at which time?
within 12 hours of birth
After conducting a refresher class on possible congenital infections with a group of perinatal nurses, the nurse recognizes the class was successful when the group identifies which congenital viral infection as the most common?
CMV Explanation: Cytomegalovirus (CMV) is the most common congenital and perinatal viral infection in the world. Human immunodeficiency virus (HIV), human papillomavirus (HPV), and herpes simplex virus (HSV) are other potential viruses.
A nurse is caring for a client with cardiovascular disease who has just given birth. What nursing interventions should the nurse perform when caring for this client? Select all that apply. Assess for shortness of breath. Assess for a moist cough. Assess for edema and note any pitting. Auscultate heart sounds for abnormalities. Monitor the client's hemoglobin and hematocrit.
Assess for shortness of breath. Assess for a moist cough. Assess for edema and note any pitting. Auscultate heart sounds for abnormalities.
A 38-year-old client, G4P3, at 10 weeks' gestation with an unplanned pregnancy, has concerns the fetus may have a genetic defect. The nurse should point out which test would be the best current choice to investigate the possibility of a chromosomal abnormality? Amniocentesis Chorionic villus sampling Maternal Serum Alpha-fetoprotein Triple screening
Chorionic villus sampling Explanation: Chorionic villus sampling is the earliest method (8 to 10 weeks gestation) to test the fetal genetics for anomalies. This testing might be offered if the mother wants specific information on the genetics of the fetus as early as possible in pregnancy. Amniocentesis is generally done between 14 and 18 weeks' gestation, but can be done as early as 10 weeks' gestation. Maternal serum alpha-fetoprotein are usually done at 16 to 20 weeks' gestation, and triple screening is performed between 15 and 20 weeks' gestation.
A 20-year-old pregnant client is positive for hemoglobin S. The nurse explains to the client that she will need perform which actions during her pregnancy? Select all that apply. Drink lots of fluids. Eat high-protein meals. Be on bed rest. Avoid conditions of low oxygen tension, such as high altitudes.
Drink lots of fluids. Avoid conditions of low oxygen tension, such as high altitudes. Explanation: When oxygen tension becomes reduced, as occurs at high altitudes, or blood bcomes more viscid than usual, such as occurs with dehydration, the cells of a client with hemoglobin S clump together because of their irregular shape, resulting in vessel blockage with reduced blood flow to organs. Drinking fluids and avoiding high altitudes will help to prevent this occurrence. High-protein meals and bed rest will have no effect.
The nurse is caring for a pregnant client who indicates that she is fond of meat, works with children, and has a pet cat. Which instructions should the nurse give this client to prevent toxoplasmosis? Select all that apply. Eat meat cooked to 160° F (71° C). Avoid cleaning the cat's litter box. Keep the cat outdoors at all times. Avoid contact with children when they have a cold. Avoid outdoor activities such as gardening.
Eat meat cooked to 160° F (71° C). Avoid cleaning the cat's litter box. Avoid outdoor activities such as gardening. Explanation: To minimize risk of toxoplasmosis, the nurse should instruct the client to eat meat that has been cooked to an internal temperature of 160° F (71° C) throughout and to avoid cleaning the cat's litter box or performing activities such as gardening. Avoiding children with colds is unreasonable when working with children, and contact with children with colds is not a cause of toxoplasmosis. The cat should be kept indoors to prevent it from hunting and eating birds or rodents.
The nurse is assessing a primigravida woman who reports vaginal itching, a great deal of foamy yellow-green discharge, and pain during intercourse. The nurse suspects the woman has contracted which disorder?
Trichomoniasis Explanation: Trichomoniasis is caused by a one-celled protozoa. The symptoms include large amounts of foamy, yellow-green vaginal discharge. Treatment is with metronidazole, and her partner needs to be treated as well. A yeast infection presents with a cottage cheese-like discharge. Chlamydia often has no symptoms. If the woman does experience symptoms, these may include vaginal discharge, abnormal vaginal bleeding, and abdominal or pelvic pain. Gonorrhea may have symptoms so mild that they go unnoticed in the woman. The woman who contracts gonorrhea may have vaginal bleeding during sexual intercourse, pain and burning while urinating, and a yellow or bloody vaginal discharge.
