chapter 7 testbank

53. A pregnant diabetic has been diagnosed with hydramnios. Which of the following would explain this finding? 1. Excessive fetal urination. 2. Recurring hypoglycemic episodes. 3. Fetal sacral agenesis. 4. Placental vascular damage.

1.

the woman should feel --1--- or more counts of kicks in 1 hour.

1. 3

If the 1-hour GCT results are above normal. She needs a ---1---?

1. 3-hour glucose tolerance test (GTT). GCT result of 130 mg/dL or higher are referred for a 3-hour glucose tolerance test in order to make a definitive diagnosis.

A woman has been diagnosed with a ruptured ectopic pregnancy. Which of the following signs/symptoms is characteristic of this diagnosis?

. Sharp unilateral pain is a common symptom of a ruptured ectopic.

High estrogen levels can lead to ----1-----, ----- and high progesterone levels can lead to ----2---,-----.

1. nosebleeds and gingivitis 2. constipation and gallbladder disease.

Obese clients are at high risk for --1---.

1.gestational diabetes

There is a strong association between low folic acid intake during the first trimester of pregnancy and --1---. As a result ---2--- is important.

1.spina bifida, a neural tube defect 2. This client is in need of nutrition counseling.

The L/S ratio indicates ---1--?

1.the maturity of the fetal lungs.

When counseling a preeclamptic client about her diet, what should the nurse encourage the woman to do? 1. Restrict sodium intake. 2. Increase intake of fluids. 3. Eat a well-balanced diet. 4. Avoid simple sugars.

3 Clients with preeclampsia are losing albumin through their urine. They should eat a well-balanced diet with sufficient protein to replace the lost protein. Even though preeclamptic clients are hypertensive, it is not recommended that they restrict salt—they should have a normal salt intake— because during pregnancy the kidney is salt sparing. When salt is restricted, the kidneys become stressed.

A major automobile accident can cause what in pregnant woman?

A major automobile accident, however, can cause anything from preterm premature rupture of the membranes, to a ruptured uterus, to placental abruption. The nurse should especially monitor the fetal heart beat for any variations.

what is the most common way gestational diabetic clients manage there illness?

About 95% of gestational diabetic clients are managed with diet and exercise alone. Gestational diabetic clients are first counseled regarding proper diet and exercise as well as blood glucose assessments. The vast majority of women are able to regulate their glucose levels with this intervention. If the glucose levels do not stabilize, the obstetrician will determine whether to order oral hypoglycemics or injectable insulin.

A gravid woman is carrying monochorionic twins. Which complication should this pregnancy be monitored?

Twin-to-twin transfusion. Because their blood supply is originating from the same source, the twins' circulations are connected. As a result, one twin may become the donor twin while the second twin may become the recipient. The donor grows poorly and develops severe anemia. The recipient becomes polycythemic and large.

Pregnant diabetics are high risk for?

UTIs because they often excrete glucose in their urine. The glucose is an excellent medium for bacterial growth.

A type 1 diabetic client has developed polyhydramnios. The client should be taught to report what?

Uterine contractions can be a sign of preterm labor

hydramnios?

a condition in which excess amniotic fluid accumulates during pregnancy. The majority of amniotic fluid is created as urine by the fetal kidneys. Fetuses of diabetic mothers often experience polyuria as a result of hyperglycemia. If the mother's diabetes is out of control, excess glucose diffuses across the placental membrane, resulting in the fetus becoming hyperglycemic. As a result the fetus exhibits the classic sign of diabetes—polyuria. If the mother's serum glucose levels are very high during the first trimester, it is likely that the fetus will develop structural congenital defects. Sacral agenesis is one of the most severe of these defects

A gestational diabetic, who requires insulin therapy to control her blood glucose levels, telephones the triage nurse complaining of dizziness and headache. Which of the following actions should the nurse take at this time? 1. Have the client proceed to the office to see her physician. 2. Advise the client to drink a glass of milk and then call back. 3. Instruct the client to inject herself with regular insulin. 4. Tell the client immediately to telephone her medical doctor.

2. Because the signs and symptoms of hyperglycemia and hypoglycemia are very similar, it is important for the nurse to err on the side of caution. If the client should be hypoglycemic, this is a medical emergency. Drinking a glass of milk will stabilize the glucose in the woman's body. If she is hyperglycemic, the milk may increase the glucose levels, but not significantly. A blood glucose assessment can be done and insulin can be administered, if needed, shortly after consuming the milk.

A gravid client is admitted with a diagnosis of third-trimester bleeding. The nurse must carefully monitor for a change in which of the following vital signs? 1. Temperature. 2. Pulse. 3. Respirations. 4. Blood pressure.

2. TEST-TAKING TIP: The key to answering this question is the fact that the nursing care plan is for a client with thirdtrimester bleeding. By the end of the second trimester, pregnant women have almost doubled their blood volume. Because of this, if they bleed, they are able to maintain their blood pressures for a relatively long period of time. Their pulse rates, however, do rise. Nurses, therefore, must carefully attend to the pulse rate of pregnant women who have been injured or who are being observed for third-trimester bleeding. A drop in blood pressure is a very late and ominous sign.

An insulin-dependent diabetic, G3P0200, 38 weeks' gestation, is being seen in the labor and delivery suite in metabolic dysequillibrium. The nurse knows that which of the following maternal blood values is most high risk to her unborn baby? 1. Glucose 150 mg/dL. 2. pH 7.25. 3. pCO2 34 mm Hg. 4. Hemoglobin A1c 10%.

2. Acidosis is life threatening to the fetus. It is essential that the nurse monitor clients for situations that would put the fetus in jeopardy of being in an acidotic environment, including maternal hypoxia and diabetic ketoacidosis.

A woman, G5P0401, is in the postanesthesia care unit (PACU) after a cervical cerclage procedure. During the immediate postprocedure period, what should the nurse carefully monitor this client for? 1. Hyperthermia. 2. Hypotension. 3. Uterine contractions. 4. Fetal heart dysrhythmias.

3. 3. Preterm labor is a complication in the immediate postprocedure period. TEST-TAKING TIP: Cerclages are inserted when clients have a history of recurring pregnancy loss related to a cervical insufficiency. This client has had 5 pregnancies but only one living child. Unfortunately, with the manipulation of the cervix at the time of the cerclage, the clients may develop preterm labor. The clients should be monitored carefully with a tocometer to assess for labor contractions.

A client, 37 weeks' gestation, has been advised that she is positive for group B streptococci. Which of the following comments by the nurse is appropriate at this time? 1. "The doctor will prescribe intravenous antibiotics for you. A visiting nurse will administer them to you in your home." 2. "You are very high risk for an intrauterine infection. It is very important for you to check your temperature every day." 3. "The bacteria are living in your vagina. They will not hurt you but we will give you medicine in labor to protect your baby from getting sick." 4. "This bacteria causes scarlet fever. If you notice that your tongue becomes very red and that you feel feverish you should call the doctor immediately."

3. Group B strep can cause serious neonatal disease. Babies are at high risk for meningitis, sepsis, pneumonia, and even death. IV antibiotics are administered to the laboring mother every 4 hours to decrease the colonization in the mother's vagina and rectum. In addition, the antibiotics cross the placenta and act as a prophylaxis for the baby.

A woman with a diagnosis of ectopic pregnancy is to receive medical intervention rather than a surgical interruption. Which of the following intramuscular medications would the nurse expect to administer?

Amethopterin (methotrexate).

Headache is equal to?

Headache is a symptom of preeclampsia.

what is a normal HgbA1c level?

HgbA1c up to 5% is considered normal.

What is the goal of RhoGAM?

That the mother produces no Rh antibodies is the goal of RhoGAM administration.

What does Bishop scores mean and how can you increase it?

Bishop scores and/or to stimulate labor can increase by 1. Sexual intercourse has been recommended to women as a means of increasing their Bishop score. 2. Midwives have recommended that women employ breast stimulation as a means of stimulating labor. 3. Midwives have recommended that women ingest castor oil as a means of increasing their Bishop score.

Biophysical profile

The biophysical profile is a comprehensive assessment geared to evaluate fetal health. There should be a minimum of 2 fetal heart accelerations in 20 minutes (approximately 1 every 10 minutes) In addition to the fetus should exhibit 3 or more discrete body or limb movements in 30 minutes.

Why should a nurse be concern if a patient is constipated with total placenta previa?

Clients diagnosed with complete placenta previa are usually maintained on bed rest. Because one of the many complications of bed rest is constipation, these clients must be monitored carefully. Many physicians order Colace (docusate sodium), a stool softener, to prevent this complication.

Which tests could be performed to determine whether the membranes had ruptured?

Fern test.

woman who is carrying monochorionic twins is complicated by twin-to-twin transfusion. The nurse should carefully monitor this client for what?

Fundal growth is accelerated for two reasons: (a) with two babies in utero, uterine growth is increased and (b) the recipient twin—the twin receiving blood from the other twin—often produces large quantities of urine resulting in polyhydramnios.

A client with 4 protein and 4 reflexes is admitted to the hospital with severe preeclampsia. The nurse must closely monitor the woman for what?

Grand mal seizure.

An insulin-dependent diabetic woman will require higher doses of insulin as which pregnancy hormones increases in her body?

Human placental lactogen is an insulin antagonist so the client will require higher doses of insulin as the level of placental lactogen increases.

A client has severe preeclampsia. The nurse would expect the primary health care practitioner to order tests to assess the fetus for what?

Intrauterine growth restriction.

Pregnant woman with type 1 diabetics often need less insulin during the first trimester than they did preconception, why?

Nausea and vomiting are common complaints of gravid clients during the first trimester. As a result, women, including diabetic women, consume fewer calories than before becoming pregnant. Their need for insulin drops commensurately. Therefore, it is very important that the women monitor their blood glucose regularly upon awakening and throughout the day.

Normal bicarb level?

Normal bicarbonate levels are: 23 to 30 mEq/L in adults.

One relatively easy way to determine the viability of the conceptus is by performing a----?

One relatively easy way to determine the viability of the conceptus is by performing a serum progesterone test; high levels indicate a viable baby while low levels indicate a pregnancy loss. Ultrasonography to assess for a beating heart may also be performed.

Which finding should the nurse expect when assessing a client with placenta previa?

Painless vaginal bleeding is often the only symptom of placenta previa.

toxemia is also known as?

The hypertensive illnesses of pregnancy used to be called toxemia of pregnancy as well as pregnancy induced hypertension (PIH).

What reduces the chance of gestational diabetes?

The likelihood of developing either gestational or type 2 diabetes is reduced when clients exercise regularly.

A patient, 32 weeks pregnant with severe headache, is admitted to the hospital with preeclampsia. In addition to obtaining baseline vital signs and placing the client on bed rest, what should the nurse perform first?

The nurse must assess for changes in the blood count, for evidence of marked weight gain, and for changes in the urinalysis. By assessing the patellar reflexes first, however, the nurse can make a preliminary assessment of the severity of the preeclampsia. For example, if the reflexes are 2, the client would be much less likely to become eclamptic than a client who has 4 reflexes with clonus.

A client is being taught fetal kick counting. What should the nurse teach the patient?

The woman should lie on her side with her head elevated about 30º it is the best position to prefuse the fetus

A 12-week-gravid client presents in the emergency department with abdominal cramps and scant dark red bleeding may be experiencing what?

This client is showing signs of spontaneous abortion.

The nurse is caring for a client who was just admitted to the hospital to rule out ectopic pregnancy. Which of the following orders is the most important for the nurse to perform? 1. Assess the client's temperature. 2. Document the time of the client's last meal. 3. Obtain urine for urinalysis and culture. 4. Report complaints of dizziness or weakness.

answer: 4 TEST-TAKING TIP: The nurse must prioritize care. When the question asks the test taker to decide which action is most important, all four possible responses are plausible actions. The test taker must determine which is the one action that cannot be delayed. In this situation, the most important action for the nurse to perform is to report complaints of dizziness or weakness. These symptoms are seen when clients develop hypovolemia from internal bleeding.

Clients who are dehydrated are at high risk for ---1---?

preterm labor

The most important thing to remember when answering questions about hydatiform mole is the fact that the client is high risk for?

the client is high risk for gynecological cancer.

What is the definition of a reactive NST?

the definition of a reactive NST, the nurse should see two fetal heart accelerations of 15 bpm lasting 15 or more seconds during a 20-minute period.