Chapter 21
A woman at 34 weeks' gestation presents to labor and delivery with vaginal bleeding. Which finding from the obstetric examination would lead to a diagnosis of placental abruption (abruptio placentae)? A. Onset of vaginal bleeding was sudden and painful B. Fetus is in a breech position C. Sonogram shows the placenta covering the cervical os D. Uterus is soft between contractions
A. Onset of vaginal bleeding was sudden and painful Sudden onset of abdominal pain and vaginal bleeding with a rigid uterus that does not relax are signs of a placental abruption (abruptio placentae). The other findings are consistent with a diagnosis of placenta previa.
A client in her 20th week of gestation develops HELLP syndrome. What are features of HELLP syndrome? Select all that apply. A.hyperthermia B. hemolysis C. elevated liver enzymes D. leukocytosis E. low platelet count
B. hemolysis C. elevated liver enzymes The HELLP syndrome is a syndrome involving hemolysis (microangiopathic hemolytic anemia), elevated liver enzymes, and a low platelet count. Hyperthermia and leukocytosis are not features of HELLP syndrome.
A primigravid at 35 weeks' gestation arrives at the emergency department and diagnosed with premature rupture of membranes. The nonstress test reveals a heart rate of 142 beats/minute and good variability. Occasional contractions are noted. What will the nurse include in the discharge teaching? Select all that apply. A. "Avoid douching until after the birth." B. "You may resume sex as desired." C."Take a tub bath at least once per day." D."Return to your normal teaching duties and rest at lunchtime." E. Measure oral temperature twice per day and report any elevation."
A. "Avoid douching until after the birth." The client with preterm rupture of membranes is at risk for developing an infection. The nurse should instruct the client to avoid douching and measure oral temperature twice per day. Sex and tub baths should be avoided because these could introduce an infection into the uterus. Activities that require the client to be on her feet for hours at a time, such as classroom teaching, are not suggested.
At 37 weeks' gestation, a woman presents to labor and delivery complaining of intense, knife-like abdominal pain that started suddenly about 1 hour ago and has not subsided. On palpation, the abdomen is rigid and board-like and no vaginal bleeding is evident. What should the nurse do next? A. Assess fetal heart rate B. Administer oxygen by face mask C. Insert a Foley catheter D. Prepare the client for an epidural
A. Assess fetal heart rate The presence of intense, knife-like abdominal pain with a sudden onset, a rigid and boardlike abdomen, and no vaginal bleeding is evidence of a placental abruption (abruptio placentae). The next action by the nurse is to assess the fetal heart rate to determine the fetus's status. The priority is saving the life of the fetus and the mother. Inserting a urinary catheter and administering oxygen can be done once the status of the fetus is known. This client is not an appropriate candidate for an epidural at this time.
A client with severe preeclampsia is receiving magnesium sulfate as part of the treatment plan. To ensure the client's safety, which compound would the nurse have readily available? A. calcium gluconate B. potassium chloride C. ferrous sulfate D. calcium carbonate
A. calcium gluconate The woman is at risk for magnesium toxicity. The antidote for magnesium sulfate is calcium gluconate, and this should be readily available in case the woman has signs and symptoms of magnesium toxicity.
A woman at 35 weeks' gestation with severe polyhydramnios is admitted to the hospital. The nurse recognizes that which concern is greatest regarding this client? A. preterm rupture of membranes followed by preterm birth B.development of eclampsia C.hemorrhaging D.development of gestational trophoblastic disease
A. preterm rupture of membranes followed by preterm birth Even with precautions, in most instances of polyhydramnios, there will be preterm rupture of the membranes because of excessive pressure, followed by preterm birth. The other answers are less concerning than preterm birth in this pregnancy.
After teaching a woman who has had an evacuation for gestational trophoblastic disease (hydatidiform mole or molar pregnancy) about her condition, which statement indicates that the nurse's teaching was successful? A."I will be sure to avoid getting pregnant for at least 1 year." B. "My intake of iron will have to be closely monitored for 6 months." C. "My blood pressure will continue to be increased for about 6 more months." D. "I won't use my birth control pills for at least a year or two."
A."I will be sure to avoid getting pregnant for at least 1 year." After evacuation of trophoblastic tissue (hydatiform mole), long-term follow-up is necessary to make sure any remaining trophoblastic tissue does not become malignant. Serial hCG levels are monitored closely for 1 year, and the client is urged to avoid pregnancy for 1 year because it can interfere with the monitoring of hCG levels. Iron intake and blood pressure are not important aspects of follow up after evacuation of a hydatiform mole. Use of a reliable contraceptive is strongly recommended so that pregnancy is avoided.
What is the common reason for oligohydramnios? A.Bladder or renal disorder in the fetus that interferes with voiding B.Decrease production of amniotic fluid C.A small uterine capacity to hold the amniotic fluid D.Perforation of the amniotic sac
A.Bladder or renal disorder in the fetus that interferes with voiding The fetus may have difficulty in voiding as it swallows the amniotic fluid leading to a decrease in the amount of amniotic fluid. The production of the amniotic fluid is normal. The uterine capacity does not affect the amount of amniotic fluid produced. There is no perforation of the amniotic sac in oligohydramnios
A pregnant client late in the second trimester comes to the emergency department with a report of painless, bright red vaginal bleeding. The client states, "It started all of a sudden and now it seems to have stopped." Placenta previa is suspected. Which action should the nurse implement immediately for this client? A.Determine fetal heart sounds using an external monitor. B.Prepare the client for an immediate cesarean birth. C.Assist with insertion of internal monitoring to assess uterine pressure. D. Prepare the client for a pelvic examination to assess rupture of membranes.
A.Determine fetal heart sounds using an external monitor. For placenta previa, the nurse should attach external monitoring equipment to record fetal heart sounds and uterine contractions. Internal monitoring is contraindicated. A pelvic or rectal examination should never be done with painless bleeding late in pregnancy because any agitation of the cervix when there is a placenta previa might tear the placenta further and initiate massive hemorrhage, which could be fatal to both the pregnant client and fetus. The decision to birth the fetus depends on the point at which a diagnosis of placenta previa is made and the age of the gestation. If labor has begun, bleeding is continuing, or the fetus is being compromised (measured by the response of the fetal heart rate to contractions), birth must be accomplished regardless of gestational age. If the bleeding has stopped, the fetal heart sounds are of good quality, pregnant client vital signs are good, and the fetus is not yet 36 weeks of age, a client is usually managed by expectant watching.
A gravida 2 para 1 client in preterm labor was administered terbutaline sulfate to stop the progression of labor and then discharged. What should the nurse teach the client to help prevent the reoccurrence of preterm labor? Select all that apply. A.Drink 8 to 10 glasses of fluid each day. B. Report any signs of ruptured membranes. C. Remain on bed rest except to use the bathroom. D. Lie flat on the back should uterine contractions occur. E. Engage in mild activities of daily living with frequent rest periods.
A.Drink 8 to 10 glasses of fluid each day. B. Report any signs of ruptured membranes. C. Remain on bed rest except to use the bathroom. To reduce the onset of preterm labor, the nurse should instruct the client to drink 8 to 10 glasses of fluid each day to remain hydrated. The client should also report any signs of ruptured membranes and remain on bed rest unless using the bathroom. Should uterine contractions begin, the client should be instructed to lie on either the right or left side to increase blood return to the uterus. The client should not engage in any activity other than bed rest with bathroom privileges.
The usual amount of amniotic fluid during pregnancy is 500 to 1000 mL at term. Excess fluid of more than 2000 mL is considered: A.hydramnios or polyhydramnios B.oligohydramnios C.amniocentesis D.chorioamnionitis
A.hydramnios or polyhydramnios
A client is admitted with a diagnosis of ruptured ectopic pregnancy. For what should the nurse anticipate preparing the client? A.immediate surgery B.internal uterine monitoring C.internal uterine monitoring D.intravenous administration of a tocolytic
A.immediate surgery An ectopic pregnancy is one in which implantation occurred outside the uterine cavity, usually within the fallopian tube. As the embryo grows, the fallopian tube can rupture. The therapy for ruptured ectopic pregnancy is laparoscopy to ligate the bleeding vessels and to remove or repair the damaged fallopian tube. There is no reason to begin uterine monitoring. The client does not need to be on bed rest for 4 weeks. A tocolytic is not needed because the client is not in labor.
The nurse is caring for a client who has a multifetal pregnancy. What topic should the nurse prioritize during health education? A.signs of preterm labor B.risk for blood incompatibilities C.risk for hypertension D.parenting skills
A.signs of preterm labor The client with a multifetal pregnancy must be made aware of the risks posed by preterm labor. There is no corresponding increase in the risk for hypertension or blood incompatibilities. Parenting skills are secondary to physiologic needs at this point.
A prenatal client who is 6 weeks' gestation calls the clinic to report vaginal bleeding. For what concern will the nurse further assess the client? A.spontaneous abortion (miscarriage) B.nuchal cord C.urinary tract infection D.Braxton-Hicks contractions
A.spontaneous abortion (miscarriage) Bleeding early in the pregnancy has several causes, including a spontaneous abortion (miscarriage). The other concerns would not be indicated by early pregnancy bleeding. Braxton Hicks would be indicated by contractions (but would be unexpected and concerning at this time). Urinary tract infection would be indicated by burning with urination, frequency, pain.
A woman who is Rh negative asks the nurse how many children she will be able to have before Rh incompatibility causes them to die in utero. The nurse's best response would be that: A. no more than three children is recommended. B. as long as she receives Rho(D) immune globulin, there is no limit. C. only her next child will be affected. D. she will have to ask her primary care provider.
B. as long as she receives Rho(D) immune globulin, there is no limit. Because Rho(D) immune globulin supplies passive antibodies, it prevents the woman from forming antibodies. Without antibodies that could affect the fetus, the woman could have as many children as she wants. RhoGAM is a medicine that stops your blood from making antibodies that attack Rhpositive blood cells. RhoGAM is a sterilized solution made from human blood that contains a very small amount of Rh-positive proteins. These proteins keep your immune system from making permanent antibodies to Rh-positive blood.
What would be the physiologic basis for a placenta previa? A.a loose placental implantation B.low placental implantation C.a placenta with multiple lobes D.a uterus with a midseptum
B. low placental implantation The cause of placenta previa is usually unknown, but for some reason the placenta is implanted low instead of high on the uterus.
A 24-year-old client presents in labor. The nurse notes there is an order to administer Rho(D) immune globulin after the birth of her infant. When asked by the client the reason for this injection, which reason should the nurse point out? A.promote maternal D antibody formation. B. prevent maternal D antibody C.formation. stimulate maternal D immune antigens. D.prevent fetal Rh blood formation.
B. prevent maternal D antibody Because Rho(D) immune globulin contains passive antibodies, the solution will prevent the woman from forming long-lasting antibodies which may harm a future fetus. The administration of Rho(D) immune globulin does not promote the formation of maternal D antibodies; it does not stimulate maternal D immune antigens or prevent fetal Rh blood formation.
The nurse is giving discharge instructions to a client who experienced a complete spontaneous abortion (miscarriage). Which question should the nurse prioritize at this time? A."Are you going to wait a while before you try to get pregnant again?" B."Do you have someone to talk to, or may I give you the names and numbers for some possible grief counselors?" C."Did you know that 75% of women who are trying to get pregnant experience this same thing?" D."May I give you some resources that you can use to try to prevent this from happening again?"
B."Do you have someone to talk to, or may I give you the names and numbers for some possible grief counselors?" After a miscarriage, the patient is prone to feel grief and anxiety. The nurse should provide emotional and psychological support which is the priority at this stage. The rest of the options are not appropriate at that stage.
A nurse is preparing a nursing care plan for a client who is admitted at 22 weeks' gestation with advanced cervical dilation (dilatation) to 5 cm, cervical insufficiency, and a visible amniotic sac at the cervical opening. Which primary goal should the nurse prioritize at this point? A.Give birth vaginally B.Bed rest to maintain pregnancy as long as possible C.Notification of social support for loss of pregnancy D.Education on causes of cervical insufficiency for the future
B.Bed rest to maintain pregnancy as long as possible. At 22 weeks' gestation, the fetus is not viable. The woman would be placed on total bed rest with every attempt made to halt any further progression of dilation (dilatation) of the cervix. The nurse would not want this fetus to be born vaginally at this stage of gestation. It is not the nurse's responsibility to notify the client's social support of a possible loss of the pregnancy. It is not appropriate at this time to educate the mother on causes of cervical insufficiency for future pregnancies.
After a regular prenatal visit, a pregnant client asks the nurse to describe the differences between placental abruption (abruptio placentae) and placenta previa. Which statement will the nurse include in the teaching? A.Placenta previa causes painful, dark red vaginal bleeding during pregnancy. B.Placenta previa is an abnormally implanted placenta that is too close to the cervix. C.Placental abruption results in painless, bright red vaginal bleeding during labor D.Placental abruption requires "watchful waiting" during labor and birth.
B.Placenta previa is an abnormally implanted placenta that is too close to the cervix. Placenta previa is a condition of pregnancy in which the placenta is implanted abnormally in the lower part of the uterus and is the most common cause of painless, bright red bleeding in the third trimester. Placental abruption is the premature separation of a normally implanted placenta that pulls away from the wall of the uterus either during pregnancy or before the end of labor. Placental abruption can result in concealed or apparent dark red bleeding and is painful. Immediate intervention is required for placental abruption.
A pregnant client at 32 weeks' gestation is treated with magnesium sulfate for seizure management. The nurse assesses which of the following for evidence of magnesium toxicity? A.frequency of micturition B.absence of knee jerk response C.increased blood pressure D.increased rate of respiration
B.absence of knee jerk response Magnesium sulfate toxicity is characterized by an absence of deep tendon reflexes like the knee jerk reflex. Urinary retention, not frequency of micturition, is seen with magnesium sulfate toxicity. Magnesium sulfate is given to treat seizures associated with hypertension and proteinuria in pregnancy, and therefore decreases the blood pressure. It does not cause an increase in blood pressure. There is respiratory depression, and not an increased rate of respiration, with magnesium sulfate toxicity
A client suffering a miscarriage at 12 weeks' gestation is very upset that the health care provider has ordered a dilatation and curettage (D&C). How should the nurse respond after the client states she didn't have a D&C the time she lost a previous baby at 5 weeks' gestation? A. "This is the procedure ordered by the doctor." B. "You have the option to refuse the surgery." C. "This procedure is needed to adequately remove all the fetal tissue." D. "Having the D&C will make it easier to get pregnant next time."
C. "This procedure is needed to adequately remove all the fetal tissue." By this stage of pregnancy, the placenta has adhered to the uterine wall. This was not the case when the client was only 5 weeks' pregnant. The total removal of the products of conception will be needed to ensure healing and prevent excessive bleeding and infection. To inform the client that the D&C is ordered by the health care provider is unprofessional and does not adequately explain the reason for the procedure. It also does not recognize the client's autonomy in choosing her health care. Informing the client that she can refuse the procedure would be unethical and could result in serious injury (including death if the client were to bleed to death). It would also be inappropriate for the nurse to imply the client will have an easier time getting pregnant again by having this procedure.
A pregnant woman is admitted to the hospital with a diagnosis of placenta previa. Which action would be the priority for this woman on admission? A.performing a vaginal examination to assess the extent of bleeding B.helping the woman remain ambulatory to reduce bleeding C.assessing fetal heart tones by use of an external monitor D.assessing uterine contractions by an internal pressure gauge
C. assessing fetal heart tones by use of an external monitor Not disrupting the placenta is a prime responsibility in caring for a patient with placenta previa, so an external fetal monitor would be used. An internal monitor, a vaginal examination, and remaining ambulatory could all disrupt the placenta and thus are contraindicated.
A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. The nurse determines that the medication is at a therapeutic level based on which finding? A. urinary output of 20 mL per hour B. respiratory rate of 10 breaths/minute C. deep tendons reflexes 2+ D. difficulty in arousing
C. deep tendons reflexes 2+ With magnesium sulfate, deep tendon reflexes of 2+ would be considered normal and therefore a therapeutic level of the drug. Urinary output of less than 30 mL, a respiratory rate of less than 12 breaths/minute, and a diminished level of consciousness would indicate magnesium toxicity
A client with a history of cervical insufficiency is seen for reports of pinktinged discharge and pelvic pressure. The primary care provider decides to perform a cervical cerclage. The nurse teaches the client about the procedure. Which client response indicates that the teaching has been effective? A."Staples are put in the cervix to prevent it from dilating." B."The cervix is glued shut so no amniotic fluid can escape." C."Purse-string sutures are placed in the cervix to prevent it from dilating." D."A cervical cap is placed so no amniotic fluid can escape."
C."Purse-string sutures are placed in the cervix to prevent it from dilating." The cerclage, or purse string suture, is inserted into the cervix to prevent preterm cervical dilation (dilatation) and pregnancy loss. Staples, glue, or a cervical cap will not prevent the cervix from dilating.
A primipara at 36 weeks' gestation is being monitored in the prenatal clinic for risk of preeclampsia. Which sign or symptom should the nurse prioritize? A.A systolic blood pressure increase of 10 mm Hg B.Weight gain of 1.2 lb (0.54 kg) during the past 1 week C.A dipstick value of 2+ for protein D. Pedal edema
C.A dipstick value of 2+ for protein The increasing amount of protein in the urine is a concern the preeclampsia may be progressing to severe preeclampsia. The woman needs further assessment by the health care provider. Dependent edema may be seen in a majority of pregnant women and is not an indicator of progression from preeclampsia to eclampsia. Weight gain is no longer considered an indicator for the progression of preeclampsia. A systolic blood pressure increase is not the highest priority concern for the nurse, since there is no indication what the baseline blood pressure was.
The nurse is comforting and listening to a young couple who just suffered a spontaneous abortion (miscarriage). When asked why this happened, which reason should the nurse share as a common cause? A.Maternal smoking B.Lack of prenatal care C.Chromosomal abnormality D.The age of the mother
C.Chromosomal abnormality The most common cause for the loss of a fetus in the first trimester is associated with a genetic defect or chromosomal abnormality. There is nothing that can be done and the mother should feel no fault. The nurse needs to encourage the parents to speak with a health care provider for further information and questions related to genetic testing. Early pregnancy loss is not associated with maternal smoking, lack of prenatal care, or the age of the mother.
A client at 27 weeks' gestation is admitted to the obstetric unit after reporting headaches and edema of her hands. Review of the prenatal notes reveals blood pressure consistently above 136/90 mm Hg. The nurse anticipates the health care provider will prescribe magnesium sulfate to accomplish which primary goal? A.Decrease blood pressure B.Decrease protein in urine C.Prevent maternal seizures D.Reverse edema
C.Prevent maternal seizures The primary therapy goal for any client with preeclampsia is to prevent maternal seizures. Use of magnesium sulfate is the drug therapy of choice for severe preeclampsia and is only used to manage and attempt to prevent progression to eclampsia. Magnesium sulfate therapy does not have as a primary goal of decreasing blood pressure, decreasing protein in the urine, or reversing edema.
The nurse is monitoring a pregnant client who is receiving intravenous magnesium sulfate for eclampsia. During the last assessment, the nurse was unable to elicit a patellar reflex. What should the nurse do? A.Check the fetal heart rate B.Measure blood pressure. C.Stop the current infusion D.Increase the infusion rate.
C.Stop the current infusion When infusing magnesium sulfate, the nurse should stop the infusion if deep tendon reflexes are absent. Checking the fetal heart rate and measuring blood pressure could waste time and provide the client with more magnesium sulfate. The infusion rate should not be increased because this could lead to cardiac dysrhythmias and respiratory depression.
The nurse is appraising the medical record of a pregnant client who is resting in a darkened room and receiving betamethasone and magnesium sulfate. The nurse recognizes the client is being treated for which condition? A.gestational hypertension B.estational diabetes C.severe preeclampsia D.postterm pregnancy
C.severe preeclampsia This woman is in severe preeclampsia and must be monitored for progression to eclampsia. The administration of magnesium sulfate is to relax the skeletal muscles and raise the threshold for a seizure. The administration of the betamethasone is to try and hasten the maturity of the fetus's lungs for birth for a preterm fetus. The scenario described does not indicate a client with hypertension, gestational diabetes, or post-term (>42 weeks) pregnancy.
A woman of 16 weeks' gestation telephones the nurse because she has passed some "berry-like" blood clots and now has continued dark brown vaginal bleeding. Which action would the nurse instruct the woman to do? A."Maintain bed rest, and count the number of perineal pads used." B. 1% "Come to the health care facility if uterine contractions begin." C. "Continue normal activity, but take the pulse every hour." D. "Come to the health facility with any vaginal material passed."
D. "Come to the health facility with any vaginal material passed." This is a typical time in pregnancy for gestational trophoblastic disease to present. Asking the woman to bring any material passed vaginally would be important so the material can be assessed for this.
A client is 11 weeks' pregnant after many years trying to conceive. After arriving home from a normal prenatal visit, she experiences mild cramping and has a gush of bright red vaginal bleeding. She calls the nurse and reports having soaked a pad with fresh blood in fewer than 30 minutes. The uterine cramping is worsening. What is the most appropriate response from the nurse? A. "This is nothing to worry about. Many women bleed during pregnancy." B. "Lie down and call your health care provider tomorrow if symptoms continue." C. "I am sorry. There is nothing you can do because you are likely miscarrying." D. "You need to seek immediate attention from the primary care provider."
D. "You need to seek immediate attention from the primary care provider." Pregnancy loss during the early weeks of pregnancy may seem like a heavy menstrual period. A primary care provider should assess blood loss of this amount with or without uterine cramping as soon as possible.
A client reporting she recently had a positive pregnancy test has reported to the emergency department stating one-sided lower abdominal pain. The health care provider has prescribed a series of tests. Which test will provide the most definitive confirmation of an ectopic pregnancy? A.Quantitative human chorionic gonadotropin (hCG) test B.Qualitative human chorionic gonadotropin (hCG) test C.Pelvic examination D.Abdominal ultrasound
D. Abdominal ultrasound An ectopic pregnancy refers to the implantation of the fertilized egg in a location other than the uterus. Potential sites include the cervix, uterus, abdomen, and fallopian tubes. The confirmation of the ectopic pregnancy can be made by an ultrasound, which would confirm that there was no uterine pregnancy. A quantitative hCG level may be completed in the diagnostic plan. hCG levels in an ectopic pregnancy are traditionally reduced. While this would be an indication, it would not provide a positive confirmation. The qualitative hCG test would provide evidence of a pregnancy, but not the location of the pregnancy. A pelvic exam would be included in the diagnostic plan of care. It would likely show an enlarged uterus and cause potential discomfort to the client but would not be a definitive finding.
A client who is 16 weeks' pregnant is passing pieces of body tissue along with blood clots and dark red blood from the vagina. What should the nurse direct the client to do at this time? A.Begin immediate bed rest. B.Count the number of perineal pads that are saturated with blood. C.Continue with normal daily activity and monitor pulse rate every hour. D.Seek immediate medical attention and bring the expressed vaginal material.
D. Seek immediate medical attention and bring the expressed vaginal material. Gestational trophoblastic disease is abnormal proliferation and then degeneration of the trophoblastic villi. The embryo fails to develop beyond a primitive start. At approximately week 16 of pregnancy, vaginal bleeding will begin as spotting of dark-brown blood accompanied by discharge of the clear fluid-filled vesicles. The pregnant client who begins to miscarry at home needs to bring any clots or tissue passed to the hospital because the presence of clear fluid-filled cysts identifies gestational trophoblastic disease. The client needs to seek immediate medical attention and not stay at home on bed rest, count perineal pads, or continue with normal activity and count pulse rates every hour.
A woman at 8 weeks' gestation is admitted for ectopic pregnancy. She is asking why this has occurred. The nurse knows that which factor is a known risk factor for ectopic pregnancy? A. high number of pregnancies B. multiple gestation pregnancy C. use of oral contraceptives D. history of endometriosis
D. history of endometriosis The nurse needs to complete a full history of the client to determine if she had any other risk factors for an ectopic pregnancy. Adhesions, scarring, and narrowing of the tubal lumen may block the zygote's progress to the uterus. Any condition or surgical procedure that can injure a fallopian tube increases the risk. Examples include salpingitis, infection of the fallopian tube, endometriosis, history of prior ectopic pregnancy, any type of tubal surgery, congenital malformation of the tube, and multiple abortions (elective terminations of pregnancy). Conditions that inhibit peristalsis of the tube can result in tubal pregnancy. A high number of pregnancies, multiple gestation pregnancy, and the use of oral contraceptives are not known risk factors for ectopic pregnancy.
A primigravida 28-year-old client is noted to have Rh negative blood and her husband is noted to be Rh positive. The nurse should prepare to administer RhoGAM after which diagnostic procedure? A.Contraction test B.Nonstress test C.Biophysical profile D.Amniocentesis
D.Amniocentesis Amniocentesis is a procedure requiring a needle to enter into the amniotic sac. There is a risk of mixing of the fetal and maternal blood which could result in blood incompatibility. A contraction test, a nonstress test, and biophysical profile are not invasive, so there would be no indication for Rho(D) immune globulin to be administered.
What precipitates meconium aspiration in a fetus? A.Hydramnios B.Oligohydramnios C.Preterm labor D.Post term birth
D.Post term birth Post term birth can cause meconium aspiration because the fetal contents are more likely to reach the rectum. Hydramnios refers to excessive amniotic fluid and does not lead to meconium aspiration. Oligohydramnios refers to the less than average amount of amniotic fluid and does not cause meconium aspiration. preterm labor cannot precipitate meconium aspiration because the fetal contents are still up in the fetus' intestines.
What is the first sign of polyhydramnios in a pregnant woman? A.Shortness of breath B.Varicosities and hemorrhoids C.Difficulty in auscultating the fetal heart rate D.Rapid growth of the uterus
D.Rapid growth of the uterus Rapid growth of the uterus is the first noticeable sign of polyhydramnios. The other options are also symptoms yet develops later in the progress of the disease.
The nurse is transcribing messages from the answering service. Which phone message should the nurse return first? A.an 18-year-old, 38-week G2P1 client with intermittent cramping; the client's last blood pressure was 98/50 mm Hg, and proteinuria was 1+ B.a 25-year-old, 31-week G1P0 client with blood pressure of 100/80 mm Hg and left flank pain; the client's last blood pressure was 100/77 mm Hg and she had no proteinuria C.a 20-year-old, 31-week G1P0 client with malaise and rhinitis; the client's last blood pressure was 120/80 mm Hg, and she had no proteinuria D.a 35-year-old, 21-week G3P2 client with blood pressure of 160/110 mm Hg, blurred vision, and whose last blood pressure was 143/99 mm Hg and urine dipstick showed a +2 proteinuria
D.a 35-year-old, 21-week G3P2 client with blood pressure of 160/110 mm Hg, blurred vision, and whose last blood pressure was 143/99 mm Hg and urine dipstick showed a +2 proteinuria The nurse should call the at-risk 35-year-old client first. She is 21 weeks and has symptoms (blurred vision) of preeclampsia. She also had an increase of protein in her urine (2+) and a 15% increase in her BP. The nurse will need more information to determine if the 38-week client may be in the early stages of labor, and if the 31-week client with flank pain has a kidney infection. The client with malaise and rhinitis will need to talk to the nurse last to find out what over-the-counter medication she is able to take.
It is determined that a client's blood Rh is negative and her partner's is Rh positive. To help prevent Rh isoimmunization, the nurse would expect to administer Rho(D) immune globulin at which time? A.at 32 weeks' gestation and immediately before discharge B.24 hours before birth and 24 hours after birth C.in the first trimester and within 2 hours of birth D.at 28 weeks' gestation and again within 72 hours after birth
D.at 28 weeks' gestation and again within 72 hours after birth To prevent isoimmunization, the woman should receive Rho(D) immune globulin at 28 weeks and again within 72 hours after birth.
A woman has been diagnosed as having gestational hypertension. Which symptom for this condition is the most typical? A.increased perspiration B.weight loss C.susceptibility to infection D.blood pressure elevation
D.blood pressure elevation The symptom of gestational hypertension is blood pressure elevation (140/90 mm Hg) identified after 20 weeks' gestation without proteinuria
A nurse suspects that a client is developing HELLP syndrome. The nurse notifies the health care provider based on which finding? A.hyperglycemia B.elevated platelet count C.disseminated intravascular coagulation (DIC) D.elevated liver enzymes
D.elevated liver enzymes HELLP is an acronym for hemolysis, elevated liver enzymes, and low platelets. Hyperglycemia is not a part of this syndrome. HELLP may increase the woman's risk for DIC but it is not an assessment finding.
The nurse is assessing a client at 12 weeks' gestation at a routine prenatal visit who reports something doesn't feel right. Which assessment findings should the nurse prioritize? A.elevated hCG levels, enlarged abdomen, quickening B.vaginal bleeding, increased hPL levels C.visible fetal skeleton on ultrasound, absence of quickening, enlarged abdomen D.gestational hypertension, hyperemesis gravidarum, absence of FHR
D.gestational hypertension, hyperemesis gravidarum, absence of FHR The early development of gestational hypertension/preeclampsia, hyperemesis gravidarum, and the absence of FHR are suspicious for gestational trophoblastic disease. The elevated levels of hCG lead to the severe morning sickness. There is no fetus, so FHR, quickening, and evidence of a fetal skeleton would not be seen. The abdominal enlargement is greater than expected for pregnancy dates, but hCG, not hPL, levels are increased
The nurse is identifying nursing diagnoses for a client with gestational hypertension. Which diagnosis would be the most appropriate for this client? A.risk for injury related to fetal distress B.imbalanced nutrition related to decreased sodium levels C.ineffective tissue perfusion related to poor heart contraction D.ineffective tissue perfusion related to vasoconstriction of blood vessels
D.ineffective tissue perfusion related to vasoconstriction of blood vessels In gestational hypertension, vasospasm occurs in both small and large arteries during pregnancy. This can lead to ineffective tissue perfusion. There is no evidence to suggest that the fetus is in distress. There is no enough information to support imbalanced nutrition. Gestational hypertension does not affect heart contractions.
Which medication will the nurse anticipate the health care provider will prescribe as treatment for an unruptured ectopic pregnancy and H. mole? A.oxytocin B.promethazine C.ondansetron D.methotrexate
D.methotrexate Methotrexate, a folic acid antagonist that inhibits cell division in the developing embryo, is most commonly used to treat ectopic pregnancy and GTD or H. mole. Oxytocin is used to stimulate uterine contractions and would be inappropriate for use with an ectopic pregnancy. Promethazine and ondansetron are antiemetics that may be used to treat hyperemesis gravidarum.
A pregnant client at 34 weeks gestation is diagnosed with amnionitis due to group B streptococcus. The nurse monitors the client closely based on the understanding that the client is at risk for which of the following? A.fetal hydrops B.fetal macrosomia C.preterm birth D.neural tube defect
D.neural tube defect The complication that may occur due to infection of pregnant clients with GBS is preterm birth. Pregnant clients infected with GBS may be asymptomatic or they may develop urinary tract infection, amnionitis, and endometritis. Fetal hydrops, fetal macrosomia, and fetal neural tube defects are not complications occurring with the infection of a pregnant client with GBS. Infection with parvovirus during pregnancy may result in fetal non-immune hydrops. Fetal macrosomia is seen in gestational diabetes. Fetal neural tube defect is seen due to folic acid deficiency in pregnant clients