Chapter 12 prepU
The nurse is describing pregnancy danger signs to a pregnant woman who is in her first trimester. Which danger sign might occur at this point in her pregnancy? dyspnea lower abdominal pressure swelling of extremities excessive vomiting
Excessive vomiting is a warning sign in the first trimester. Dyspnea, lower abdominal pressures, and swelling of face or extremities may occur late in pregnancy.
The nurse is preparing to administer a prescribed medication to the pregnant client. Which order should the nurse question? Penicillin Rubella Acetaminophen Folic acid
Most vaccines are contraindicated during pregnancy and are considered teratogenic, such as rubella. Penicillin and acetaminophen may be taken under provider supervision. Folic acid supplementation should be encouraged.
Why is a Papanicolau test done at the first prenatal visit? It predicts whether cervical cancer will occur. It helps to date the pregnancy. It detects if uterine cancer is present. It identifies abnormal cervical cells.
A Papanicolau test is a test for cervical cancer. Should abnormal cells be present, the woman may need to make a decision about her priorities of therapy for cervical disease or continuing the pregnancy.
A pregnant client is undergoing a fetal biophysical profile. Which parameter of the profile helps measure long-term adequacy of the placental function? amniotic fluid volume fetal heart rate fetal breathing record fetal reactivity
A biophysical profile combines five parameters (fetal reactivity, fetal breathing movements, fetal body movement, fetal tone, and amniotic fluid volume) into one assessment. The fetal heart and breathing record measures short-term central nervous system function; the amniotic fluid volume helps measure long-term adequacy of placental function.
The nurse is assisting a pregnant client who has just underwent a nonstress test that was ruled reactive. Which factor will the nurse point out when questioned by the client about the results? There is no evidence of congenital anomalies or deformities. The fetal heart rate increases with activity and indicates fetal well-being. The fetus is developing at a fast rate but doing fine. The results indicate a stress test is needed for further evaluation.
A nonstress test is a noninvasive way to monitor fetal well-being. A reactive NST is a positive sign the fetus is tolerating pregnancy well by demonstrating heart rate increase with activity and indicates fetal well-being. This test is not used to determine congenital anomalies or deformities. It does not determine the speed that the fetus is developing. Further evaluation would be necessary if the results were nonreactive.
The nurse discovers a new prescription for RhoGAM for a client who is about to undergo a diagnostic procedure. The nurse will administer the RhoGAM after which procedure? Contraction stress test Amniocentesis Nonstress test Biophysical profile
Amniocentesis is an invasive procedure whereby a needle is inserted into amniotic sac to obtain a small amount of fluid. This places the pregnancy at risk for a woman with Rh(D)-negative blood, since the puncture can allow the seepage of blood and amniotic fluid into the woman's system. She should receive RhoGAM after the procedure to protect her and future babies. The CST, NST, and a biophysical profile are noninvasive tests.
The health care provider has prescribed an over-the-counter antacid for a pregnant client in her first trimester who is having ongoing nausea, vomiting, and heartburn. Which instruction concerning the antacid should the nurse prioritize after noting the client is also prescribed a multivitamin supplement? Avoid caffeinated beverages. Take only at bedtime. Take antacid 1 hour after the multivitamin. Take with dairy products.
Antacids interfere with the uptake of the vitamin contents so the client should take the antacid 1 hour after taking the multivitamin. Caffeine should be avoided due to increases in blood pressure and diuretic effects. Antacids can be taken more often than solely at bedtime, and some clients need them after each meal. Antacids do not have to be taken with dairy products. The priority is to avoid allowing the antacid to cancel out the multivitamin.
A 38-year-old client and partner are carriers of the Tay-Sachs gene, have one child with Tay-Sachs, and are concerned to learn she is pregnant again. The nurse predicts the health care provider will order which test if the couple wants to know if this baby will also be born with Tay-Sachs? A multiple marker screening test Amniocentesis Chorionic villus sampling Percutaneous umbilical blood sampling
Chorionic villus sampling (CVS) is a newer procedure and can provide information on fetal chromosomal studies similar to an amniocentesis, but earlier in pregnancy. The CVS is typically performed between 8 and 12 weeks gestation. Multiple marker screen tests are done later in the pregnancy, as is amniocentesis. Percutaneous umbilical blood sampling examines the blood and is not the best source for chromosomal studies.
When describing the role of a doula to a group of pregnant women, the nurse would include which information? The doula is a professionally trained nurse hired to provide physical and emotional support. The doula can perform any necessary clinical procedures. The doula primarily focuses on providing continuous labor support. The doula is capable of handling high-risk births and emergencies.
Doulas provide the woman with continuous support throughout labor. The doula is a laywoman trained to provide women and families with encouragement, emotional and physical support, and information through late pregnancy, labor, and birth. A doula does not perform any clinical procedures and is not trained to handle high-risk births and emergencies.
The nurse discovers a soft systolic murmur when auscultating the heart of a client at 32 weeks' gestation. Which action would be most appropriate? Refer her for cardiac catheterization. Ask another nurse to assess the heart. Inquire if the client has chest pain. Document this and continue to monitor the murmur at future visits.
Due to the increased blood volume that occurs with pregnancy, soft systolic murmurs may be heard and are considered normal.
The nurse takes a call from a worried client who was seen several hours earlier for her 35-weeks' gestation visit, which included a pelvic examination. Which instruction should the nurse prioritizeif the client is reporting a small amount of vaginal spotting? Return right away. Watch it and report if heavy increase in bleeding. The bleeding, called Chadwick sign, is a normal part of pregnancy. The cervical mucous plug may have been expelled.
During the third trimester, if the provider completes a vaginal exam it can be normal to have a small amount of spotting. If the bleeding becomes active or increases, the patient needs to be seen immediately. Chadwick sign is a change of color in the vaginal area. The loss of the mucous plug would lead to a much greater amount of blood.
Which signs/symptoms can be associated with CMV infection in an infant? Select all that apply. pulmonary stenosis patent ductus arteriosus hydrocephalus hearing impairment leading to deafness chronic liver disease
If a woman acquires a primary CMV infection during pregnancy, and if the virus crosses the placenta, the infant may be born with severe neurologic challenges (e.g., hydrocephalus, microcephaly, or spasticity) or with eye damage, hearing impairment, or chronic liver disease. The rubella virus has teratogenic effects on a fetus such as hearing impairment, cognitive and motor challenges, cataracts, and cardiac defects (most commonly patent ductus arteriosus and pulmonary stenosis).
A 41-year-old pregnant woman and her husband are anxiously awaiting the results of various blood tests to evaluate the fetus for potential Down syndrome, neural tube defects, and spina bifida. Client education should include which information? Further testing will be required to confirm any diagnosis. The blood tests are definitive. Treatment can be started once the test results are back. A second set of screening tests can be obtained to confirm results.
Nursing management related to marker screening tests consists primarily of providing education about the tests. Remind the couple that a definitive diagnosis is not made without further tests such as an amniocentesis. The blood tests are not definitive but only strongly suggest the possibility of a defect. For some conditions there are no treatments. The couple may request a second set, but the health care provider will probably suggest proceeding with the more definitive methods to confirm the diagnosis.
A woman who is 4 months pregnant has pyrosis. Which suggestion would the nurse give her? Take 30 mL of milk of magnesia after every meal. Eat small meals and do not lie down after meals. Try to include complex carbohydrates in meals. Increase vitamin intake by adding more citrus fruit.
Pyrosis, or heartburn, occurs in pregnancy because the uterine pressure against the stomach causes regurgitation into the esophagus. Eating small meals and remaining upright limits the possibility of regurgitation
A 31-year-old client at 28 weeks' gestation reports frequent low back pain and ankle edema by the end of the day. Which suggestion should the nurse prioritize for this client? Soak feet every night and perform pelvic rocks. Lie on right side with feet elevated and a heating pad on the back. Sit semi-Fowler's with feet below for breaks at work. Rest when possible with feet elevated at or above the heart.
Resting in the recumbent position helps alleviate stress on the back, and elevating the legs will help relieve the edema. Soaking the feet or lying on the right side will not alleviate the edema. Sitting semi-Fowler's is not enough to alleviate the edema.
The nurse will be assisting a client during an amniocentesis. Which nursing intervention should the nurse prioritize? Caution about the narcotic premedication. Be certain she is aware of potential complications. Ensure she understands the need for 2 days of bed rest. Expect test results within 1 week.
The client should be aware of the potential complications and risks, and should sign an informed consent. Narcotics are contraindicated for pregnant woman due to side effects. She should maintain bed rest for the remainder of the day, with light housework the following day and a return to normal activities on the third day. It may take 2 or 3 weeks before the test results come back from the laboratory.
The blood tests for a primigravida client indicate that the client is Rh-negative and her partner is Rh-positive. What is an appropriate nursing intervention for this client? Arrange for Rho immune globulin at 28 weeks' gestation. Make necessary arrangements for blood transfusion. Inform the client about the possibility of a cesarean section. Prepare the client for the possibility of a spontaneous abortion.
The nurse should inform the client that Rh-negative mothers should receive Rho immune globulin at 28 weeks' gestation and with antepartum testing to prevent isoimmunization. Positive antibody screens need to be followed up to identify antibodies detected in the blood to prevent fetal complications. The nurse need not make arrangements for blood transfusions, inform the client about the possibility of a cesarean section, or prepare the client for the possibility of a spontaneous abortion.
When preparing a class for a group of pregnant women about nicotine use during pregnancy, the nurse describes the major risks associated with nicotine use including: increased risk of spontaneous abortion. decreased birth weight in neonates. increased risk of stillbirth. increased risk of placenta abruptio.
The nurse should inform the client that children born of mothers who use nicotine will have a decreased birth weight. Spontaneous abortion is associated with caffeine use. Increased risks of stillbirth and placenta abruptio are associated with mothers addicted to cocaine.
A client in her third trimester of pregnancy wishes to formula feed her baby. What instruction should the nurse provide? Mix one scoop of powder with an ounce of water. Feed the infant every 8 hours. Serve the formula at room temperature. Refrigerate any leftover formula.
The nurse should instruct the client to serve the formula to her infant at room temperature. The nurse should instruct the client to follow the directions on the package when mixing the powder because different formulas may have different instructions. The infant should be fed every 3 to 4 hours, not every 8 hours. The nurse should specifically instruct the client to avoid refrigerating the formula for subsequent feedings. Any leftover formula should be discarded.
A client in the first trimester reports having nausea and vomiting, especially in the morning. Which instruction would be most appropriate to help prevent or reduce the client's compliant? Drink plenty of fluids at bedtime. Avoid foods such as cheese. Avoid eating spicy food. Eat dry crackers or toast before rising.
The nurse should recommend the client eat dry crackers or toast before rising to prevent nausea and vomiting in the morning. Drinking plenty of fluids at bedtime could cause nocturia. Foods such as cheese should be avoided to prevent constipation. Spicy foods could cause heartburn.
A woman is in her early second trimester of pregnancy. The nurse would instruct the woman to return for a follow-up visit every: 4 weeks. 3 weeks. 2 weeks. 1 week.
The recommended follow-up visit schedule is every 4 weeks up to 28 weeks, every 2 weeks from 29 to 36 weeks, and then every week from 37 weeks to birth.
A client who is in her first trimester is anxious to have an ultrasound at each visit. The nurse explains that it is not necessary and schedules a second ultrasound to be performed when she is about: 18 to 20 weeks pregnant. 15 to 17 weeks pregnant. 21 to 23 weeks pregnant. 24 to 26 weeks pregnant.
There are no hard-and-fast rules as to how many ultrasounds a woman should have during her pregnancy; however, the first ultrasound is usually performed during the first trimester to confirm the pregnancy. A second scan may be performed at about 18 to 20 weeks to look for congenital malformations. A third one may be done at around 34 weeks to evaluate fetal size and verify placental position.
When discussing infection prevention with a group of prenatal women, which interventions should the nurse emphasize to prevent toxoplasmosis in this population? Select all that apply. Apply bug spray to exposed skin every time one goes outside. Use condoms regularly when having sex with different partners. Cook meat thoroughly before eating. Avoid crowds of young children at daycare facilities. Have a significant other change the litter box throughout the pregnancy.
Toxoplasmosis, a protozoan infection, is spread most commonly through contact with uncooked meat, although it may also be contracted through handling cat stool in soil or cat litter. Malaria is caused by mosquitos primarily in Africa and South America. Insect repellant helps to prevent malaria. Sexually transmitted diseases can be prevented with condom use. Avoiding crowds of young children at daycare facilities can prevent exposure to CMV.
The client states that the first day of her last menstrual period is March 23. The nurse is most correct to calculate using Naegele rule that the estimated date of delivery is: January 30 December 30 December 16 November 23
Using Naegele rule, since the first day of the client's last menstrual period is March 23, 7 days are added leading to the 30th. Subtracting 3 months from March is December. Thus, December 30 is the estimated date of delivery.
A pregnant client is planning a vacation to a different state and questions the nurse concerning precautions. Which suggestion should the nurse prioritize for this client who will be traveling by automobile? Travel no more than 120 miles daily. Sit in the back seat with feet elevated. Stop and walk every 2 hours. Limit trips away from home, greater than 200 miles.
Walking increases venous return and reduces the possibility of thrombophlebitis, a risk for pregnant women who sit for extended periods of time. Limiting mileage, sitting in the back with the feet elevated, and limiting trips may help, but they are not enough to prevent phlebitis.
A client in her second trimester of pregnancy arrives at a health care facility reporting heartburn. What instructions should the nurse offer to help the client deal with heartburn? Select all that apply. Limit consumption of food before bedtime. Consume lots of liquids before bedtime. Sleep in a semi-Fowler's position. Avoid use of antacids. Avoid overeating.
When caring for a pregnant client with heartburn, the nurse should instruct the client to limit consuming foods before bedtime. The nurse should also instruct the client to sleep in a semi-Fowler's position and to avoid overeating. The nurse need not instruct the client to avoid the use of antacids. On the contrary, antacids are known to be useful for heartburn even during pregnancy, so the nurse need not instruct the client to avoid them. The nurse should not instruct the client to consume lots of fluids before bedtime. Along with food, even fluids should be limited before bedtime.
A client in her second trimester of pregnancy visits a health care facility. The client frequently engages in aerobic exercise and asks the nurse about doing so during her pregnancy. Which precaution should the nurse instruct the pregnant client to take when practicing aerobic exercises? Begin a new exercise regimen. Wear support hose when exercising. Maintain tolerable intensity of exercise. Reduce the amount of exercise.
Women accustomed to exercise before pregnancy are instructed to maintain a tolerable intensity of exercise. They are instructed not to begin a new exercise regimen. A nurse does not tell the client to wear a support hose when exercising or to reduce the amount of exercises.
CMV infection
hearing loss in babies retinitis, esophagitis, pneumonia, fever, diarrhea, hepatitis... especially in IMMUNOSUPPRESSED (transplant/immunosuppressants, babies, HIV) will find CMV in WBC (buffy coat) = multinucleated giant cells with hyaline inclusions polyneuropathy, transverse myelitis, encephalitis in immunocompetent pts, can look like MONO (but without heterophil Ab's, Monospot negative) tx: ganciclovir - viral DNA polymerase inhibitor
