ChapterS 19, 20 OB

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? A. hyperglycemia B. birth trauma C. hypoglycemia D. macrosomia

A R:Gestational diabetes is associated with either neonatal complications such as macrosomia, hypoglycemia, and birth trauma or maternal complications such as preeclampsia and cesarean birth.

A pregnant woman with gestational diabetes comes to the clinic for a fasting blood glucose level. When reviewing the results, the nurse determines that which result indicates good glucose control? A) 90 mg/dL B) 100 mg/dL C) 110 mg /dL D) 120 mg/dL

A) 90 mg/dL

A nurse has been invited to speak at a local high school about adolescent pregnancy. When developing the presentation, the nurse would incorporate information related to which of the following? (Select all that apply.) A) Peer pressure to become sexually active B) Rise in teen birth rates over the years. C) Latinas as having the highest teen birth rate D) Loss of self-esteem as a major impact E) Majority of teen pregnancies in the 1517-year-old age group

A) Peer pressure to become sexually active C) Latinas as having the highest teen birth rate D) Loss of self-esteem as a major impact

After reviewing a client's history, which factor would the nurse identify as placing her at risk for gestational hypertension? A) Mother had gestational hypertension during pregnancy. B) Client has a twin sister. C) Sister-in-law had gestational hypertension. D) This is the client's second pregnancy.

Ans: A A family history of gestational hypertension, such as a mother or sister, is considered a risk factor for the client. Having a twin sister or having a sister-in-law with gestational hypertension would not increase the client's risk. If the client had a history of preeclampsia in her first pregnancy, then she would be at risk in her second pregnancy.

A nurse suspects that a pregnant client may be experiencing abruption placenta based on assessment of which of the following? (Select all that apply.) A) Dark red vaginal bleeding B) Insidious onset C) Absence of pain D) Rigid uterus E) Absent fetal heart tones

Ans: A, D, E Feedback: Assessment findings associated with abruption placenta include a sudden onset, with concealed or visible bleeding, dark red bleeding, constant pain or uterine tenderness on palpation, firm to rigid uterine tone, and fetal distress or absent fetal heart tones.

The nurse is developing a plan of care for a woman who is pregnant with twins. The nurse includes interventions focusing on which of the following because of the woman's increased risk? A) Oligohydramnios B) Preeclampsia C) Post-term labor D) Chorioamnionitis

Ans: B Women with multiple gestations are at high risk for preeclampsia, preterm labor, hydramnios, hyperemesis gravidarum, anemia, and antepartal hemorrhage. There is no association between multiple gestations and the development of chorioamnionitis.

A pregnant woman is admitted with premature rupture of the membranes. The nurse is assessing the woman closely for possible infection. Which of the following would lead the nurse to suspect that the woman is developing an infection? (Select all that apply.) A) Fetal bradycardia B) Abdominal tenderness C) Elevated maternal pulse rate D) Decreased C-reactive protein levels E) Cloudy malodorous fluid

Ans: B, C, E Possible signs of infection associated with premature rupture of membranes include elevation of maternal temperature and pulse rate, abdominal/uterine tenderness, fetal tachycardia over 160 bpm, elevated white blood cell count and C-reactive protein levels, and cloudy, foul-smelling amniotic fluid.

A woman hospitalized with severe preeclampsia is being treated with hydralazine to control blood pressure. Which of the following would the lead the nurse to suspect that the client is having an adverse effect associated with this drug? A) Gastrointestinal bleeding B) Blurred vision C) Tachycardia D) Sweating

Ans: C Hydralazine reduces blood pressure but is associated with adverse effects such as palpitation, tachycardia, headache, anorexia, nausea, vomiting, and diarrhea. It does not cause gastrointestinal bleeding, blurred vision, or sweating. Magnesium sulfate may cause sweating.

A woman with hyperemesis gravidarum asks the nurse about suggestions to minimize nausea and vomiting. Which suggestion would be most appropriate for the nurse to make? A) "Make sure that anything around your waist is quite snug." B) "Try to eat three large meals a day with less snacking." C) "Drink fluids in between meals rather than with meals." D) "Lie down for about an hour after you eat"

Ans: C Suggestions to minimize nausea and vomiting include avoiding tight waistbands to minimize pressure on the abdomen, eating small frequent meals throughout the day, separating fluids from solids by consuming fluids in between meals; and avoiding lying down or reclining for at least 2 hours after eating.

A nurse is teaching a pregnant woman with preterm premature rupture of membranes who is about to be discharged home about caring for herself. Which statement by the woman indicates a need for additional teaching? A) "I need to keep a close eye on how active my baby is each day." B) "I need to call my doctor if my temperature increases." C) "It's okay for my husband and me to have sexual intercourse." D) "I can shower but I shouldn't take a tub bath."

Ans: C Feedback: The woman with preterm premature rupture of membranes should monitor her baby's activity by performing fetal kick counts daily, check her temperature and report any increases to the health care provider, not insert anything into her vagina or vaginal area, such as tampons or vaginal intercourse, and avoid sitting in a tub bath.

It is determined that a client's blood Rh is negative and her partner's is positive. To help prevent Rh isoimmunization, the nurse anticipates that the client will receive RhoGAM at which time? A) At 34 weeks' gestation and immediately before discharge B) 24 hours before delivery and 24 hours after delivery C) In the first trimester and within 2 hours of delivery D) At 28 weeks' gestation and again within 72 hours after delivery

Ans: D To prevent isoimmunization, the woman should receive RhoGAM at 28 to 32 weeks gestation and again within 72 hours after delivery.

The nurse is providing care to a neonate whose mother abuses heroin. Which finding would the nurse expect to assess? A. easy consolability B. sneezing C. vigorous sucking D. hypotonicity

B

The nurse is assessing a newborn of a woman who is suspected of abusing alcohol. Which newborn finding would provide additional evidence to support this suspicion? A) Wide large eyes B) Thin upper lip C) Protruding jaw D) Elongated nose

B) Thin upper lip

A nurse is developing a program for pregnant women with diabetes about reducing complications. Which factor would the nurse identify as being most important in helping to reduce the maternal/fetal/neonatal complications associated with pregnancy and diabetes? A)Stability of the woman's emotional and psychological status B)Degree of glycemic control achieved during the pregnancy C)Evaluation of retinopathy by an ophthalmologist D)Blood urea nitrogen level (BUN. within normal limits

B)Degree of glycemic control achieved during the pregnancy

Many women develop iron-deficient anemia during pregnancy. What diagnostic criteria would the nurse monitor for to determine anemia in the pregnant woman? A. Hemoglobin of 13 or lower B. Heart rate of 84 C. Hematocrit of 32% or less D. Blood pressure of 100/68

C R: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.

The health care provider of a newly pregnant client determines the woman also has mitral stenosis and will need appropriate therapy. Which medication should the nurse prepare to teach this client to provide her with the best possible care? A. warfarin B. digoxin C. aspirin D. heparin

D R: This client has an increased risk for developing blood clots. If an anticoagulant is required, heparin is the drug of choice as it does not cross the placenta barrier. Warfarin crosses the placenta and may have teratogenic effects. Aspirin is not recommended in this situation. If digoxin is not used to prevent blood clots.

A nurse is providing care to several pregnant women at the clinic. The nurse would screen for group B streptococcus infection in a client at: A) 16 weeks gestation B) 28 week gestation C) 32 weeks gestation D) 36 weeks gestation

D) 36 weeks gestation

A nurse is counseling a pregnant woman with rheumatoid arthritis about medications that can be used during pregnancy. Which drug would the nurse emphasize as being contraindicated at this time? A) Hydroxychloroquine B) Nonsteroidal anti-inflammatory drug C) Glucocorticoid D) Methotrexate

D) Methotrexate

Which medication would the nurse question if ordered to control a pregnant woman's asthma? A) Budesonide B) Albuterol C) Salmeterol D) Oral prednisone

D) Oral prednisone

Assessment of a pregnant woman and her fetus reveals tachycardia and hypertension. There is also evidence suggesting vasoconstriction. The nurse would question the woman about use of which substance? A)Marijuana B)Alcohol C)Heroin D)Cocaine

D)Cocaine

A pregnant woman in her 39th week of pregnancy presents to the clinic with a vaginal infection. She tests positive for chlamydia. What would this disease make her infant at risk for? A. blindness B. neonatal laryngeal papillomas C.deafness D. chicken pox

A R:A pregnant woman who contracts chlamydia is at increased risk for spontaneous abortion (miscarriage), preterm rupture of membranes, and preterm labor. The postpartum woman is at higher risk for endometritis (Fletcher & Ball, 2006). The fetus can encounter bacteria in the vagina during the birth process. If this happens, the newborn can develop pneumonia or conjunctivitis that can lead to blindness.

Because a pregnant clients diabetes has been poorly controlled throughout her pregnancy, the nurse would be alert for which of the following in the neonate at birth? A)Macrosomia B)Hyperglycemia C)Low birth weight D)Hypobilirubinemia

A)Macrosomia

When preparing a schedule of follow-up visits for a pregnant woman with chronic hypertension, which of the following would be most appropriate? A) Monthly visits until 32 weeks, then bi-monthly visits B) Bi-monthly visits until 28 weeks, then weekly visits C) Monthly visits until 20 weeks, then bi-monthly visits D) Bi-monthly visits until 36 weeks, then weekly visits

B) Bi-monthly visits until 28 weeks, then weekly visits

A group of nursing students are preparing a presentation for their class about measures to prevent toxoplasmosis. Which of the following would the students be least likely to include? Select all that apply. A) Washing raw fruits and vegetables before eating them B) Cooking all meat to an internal temperature of 140 F C) Wearing gardening gloves when working in the soil D) Avoiding contact with a cats litter box.

B) Cooking all meat to an internal temperature of 140 F

A nurse is preparing a presentation for a group of young adult pregnant women about common infections and their effect on pregnancy. When describing the infections, which infection would the nurse include as the most common congenital and perinatal viral infection in the world? A) Rubella B) Hepatitis B C) Cytomegalovirus D) Parvovirus B19

C) Cytomegalovirus

After teaching a pregnant woman with iron deficiency anemia about her prescribed iron supplement, which statement indicates successful teaching? A) I should take my iron with milk. B) I should avoid drinking orange juice. C) I need to eat foods high in fiber. D) I'll call the doctor if my stool is black and tarry.

C) I need to eat foods high in fiber.

10.When assessing a pregnant woman with heart disease throughout the antepartal period, the nurse would be especially alert for signs and symptoms of cardiac decompensation at which time? A) 16 to 20 weeks gestation B) 20 to 24 weeks gestation C) 24 to 28 weeks gestation D) 28 to 32 weeks gestation

D) 28 to 32 weeks gestation

A pregnant woman tests positive for HBV. Which of the following would the nurse expect to administer? A) HBV immune globulin B) HBV vaccine C) Acylcovir D) Valacyclovir

Hepatitis B A) HBV immune globulin

What criteria would the physician base his decision on to begin insulin therapy for a gestational diabetic mother? A. Urine is 2+ for glucose and serum blood glucose is 120. B. A 2-hour postprandial glucose level cannot be kept below 120 mg/dL. C. Weight gain is over 30 pounds (13.6 kg) and blood sugars are fluctuating between 95 and 130 throughout the day. D. Client cannot keep fasting blood sugar lower than 90 mg/dL.

B R: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.

A nurse is preparing a teaching program for a group of pregnant women about preventing infections during pregnancy. When describing measures for preventing cytomegalovirus infection, which of the following would the nurse most likely include? A) Frequent handwashing B) Immunization C) Prenatal screening D) Antibody titer screening

A) Frequent handwashing

A pregnant woman tests positive for HBV. Which of the following would the nurse expect to administer? A) HBV immune globulin B) HBV vaccine C) Acylcovir D) Valacyclovir

A) HBV immune globulin

A 10-week pregnant woman with diabetes has a glycosylated hemoglobin (HbA1C. level of 13%. At this time the nurse should be most concerned about which of the following possible fetal outcomes? A)Congenital anomalies B)Incompetent cervix C)Placenta previa D)Abruptio placentae

A)Congenital anomalies

When teaching a class of pregnant women about the effects of substance abuse during pregnancy, which of the following would the nurse most likely include? A)Low-birth-weight infants B)Excessive weight gain C)Higher pain tolerance D)Longer gestational periods

A)Low-birth-weight infants

After teaching a group of students about the use of antiretroviral agents in pregnant women who are HIV- positive, the instructor determines that the teaching was successful when the group identifies which of the following as the underlying rationale? A)Reduction in viral loads in the blood B)Treatment of opportunistic infections C)Adjunct therapy to radiation and chemotherapy D)Can cure acute HIV/AIDS infections

A)Reduction in viral loads in the blood

Which of the following data on a client's health history would the nurse identify as contributing to the client's risk for an ectopic pregnancy? A) Use of oral contraceptives for 5 years B) Ovarian cyst 2 years ago C) Recurrent pelvic infections D) Heavy, irregular menses

Ans: C In the general population, most cases of ectopic pregnancy are the result of tubal scarring secondary to pelvic inflammatory disease. Oral contraceptives, ovarian cysts, and heavy, irregular menses are not considered risk factors for ectopic pregnancy.

After teaching a pregnant woman with iron deficiency anemia about nutrition, the nurse determines that the teaching was successful when the woman identifies which of the following as being good sources of iron in her diet? (Select all that apply.) A) Dried fruits B) Peanut butter C) Meats D) Milk E) White bread

A) Dried fruits B) Peanut butter C) Meats

The nurse is teaching a pregnant woman about how to prevent contracting cytomegalovirus (CMV) during pregnancy. What tips would the nurse share with this client? Select all that apply. A. Do not share food or drinks with young children, especially if they are in daycare. B. If you develop any flu-like symptoms, notify your physician immediately to be evaluated for CMV. C. Wash your hands thoroughly with soap and water after touching saliva or urine. D. If you have CMV, it is suggested that you not breast-feed your infant. E. If you contract CMV, your doctor will give you some oral medicine to treat it.

A,B,C R: Cytomegalovirus (CMV) is a mild infection and women may not know they have contracted it. The problem arises when a pregnant woman contracts it during the first 20 weeks of gestation. Prevention is the key, so the nurse would reinforce handwashing, not eating or drinking from a container after a small child has done so, and notifying the physician if the client develops mild flu-like symptoms so she can be tested to rule out CMV.

A woman with known cardiac disease from childhood presents at the obstetrician's office 6 weeks' pregnant. What recommendations would the nurse make to the client to address the known cardiac problems for this pregnancy? Select all that apply. A. Plan periods of rest into the workday. B. Receive pneumococcal and influenza vaccines. Continue taking the scheduled warfarin. C. Let the physician know if you become short of breath or have a nighttime cough. D. Increase the amount of sodium in your diet to compensate for the expanding fluid needs of the fetus.

A,B,C R: Women with known heart conditions need to be closely followed by both the obstetrician and a cardiologist. Recommendations would include rest periods, reduction of stress, getting immunizations, and monitoring for heart failure as demonstrated by a nighttime cough and shortness of breath. Consuming more sodium in the diet is not recommended due of the potential of developing hypertension. Warfarin is contraindicated during pregnancy since it crosses the placental barrier and can cause spontaneous abortion, stillbirth or preterm birth.

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. A. Eat meat cooked to 160° F (71° C). B. Avoid cleaning the cat's litter box. C. Avoid contact with children when they have a cold. D. Avoid outdoor activities such as gardening. E. Keep the cat outdoors at all times.

A,B,D R: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 educating a client with type 1 diabetes about the complications associated with diabetes and pregnancy. Which problems would the nurse include in her teaching? Select all that apply. A. Decreased birth weight B. Polyhydramnios C. Increased risk of spontaneous abortion D. Hypertension E. Cystic fibrosis

A,B,D R:Women with pregestational diabetes, which is type 1 diabetes, are at a higher risk of having an infant with complications during the pregnancy and at delivery. Spontaneous abortion is higher in women who have pregestational diabetes. Also, they run a higher risk of having a pregnancy with polyhydramnios, and of developing maternal hypertension. The birth weight of an infant born to a mother with diabetes is increased, not decreased. Cystic fibrosis is not associated with maternal diabetes.

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. A. anorexia B. hemoptysis C. weight gain D. night sweats E. fatigue

A,B,D,E R: Women emigrating from developing countries are at high risk for tuberculosis. Clinical manifestations include fatigue, fever or night sweats, nonproductive cough, weakness, slow weight loss, anemia, hemoptysis, and anorexia.

Which of the following would the nurse have readily available for a client who is receiving magnesium sulfate to treat severe preeclampsia? A) Calcium gluconate B) Potassium chloride C) Ferrous sulfate D) Calcium carbonate

Ans: A 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.

In a woman who is suspected of having a ruptured ectopic pregnancy, the nurse would expect to assess for which of the following as a priority? A) Hemorrhage B) Jaundice C) Edema D) Infection

Ans: A With a ruptured ectopic pregnancy, the woman is at high risk for hemorrhage. Jaundice, edema, and infection are not associated with a ruptured ectopic pregnancy.

While assessing a pregnant woman, the nurse suspects that the client may be at risk for hydramnios based on which of the following? (Select all that apply.) A) History of diabetes B) Complaints of shortness of breath C) Identifiable fetal parts on abdominal palpation D) Difficulty obtaining fetal heart rate E) Fundal height below that for expected gestational age

Ans: A, B, D Factors such as maternal diabetes or multiple gestations place the woman at risk for hydramnios. In addition, there is a discrepancy between fundal height and gestational age, such that a rapid growth of the uterus is noted. Shortness of breath may result from overstretching of the uterus due to the increased amount of amniotic fluid. Often, fetal parts are difficult to palpate and fetal heart rate is difficult to obtain because of the excess fluid present.

A woman with gestational hypertension experiences a seizure. Which of the following would be the priority? A) Fluid replacement B) Oxygenation C) Control of hypertension D) Delivery of the fetus

Ans: B As with any seizure, the priority is to clear the airway and maintain adequate oxygenation both to the mother and the fetus. Fluids and control of hypertension are addressed once the airway and oxygenation are maintained. Delivery of fetus is determined once the seizures are controlled and the woman is stable.

A neonate born to a mother who was abusing heroin is exhibiting signs and symptoms of withdrawal. Which of the following would the nurse assess? (Select all that apply.) A) Low whimpering cry B) Hypertonicity C) Lethargy D) Excessive sneezing E) Overly vigorous sucking F) Tremors

B) Hypertonicity C) Lethargy D) Excessive sneezing

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. A. potatoes B. broccoli C. peanut butter D. corn E. yogurt F. raisins

B,C,F R:Foods high in iron include dried fruits such as raisins, whole grains, green leafy vegetables such as broccoli and spinach, peanut butter, and iron-fortified cereals. Potatoes and corn are high in carbohydrates. Yogurt is a good source of calcium.

After teaching a group of nursing students about the impact of pregnancy on the older woman, the instructor determines that the teaching was successful when the students state which of the following? A) The majority of women who become pregnant over age 35 experience complications. B) Women over the age of 35 who become pregnant require a specialized type of assessment. C) Women over age 35 and are pregnant have an increased risk for spontaneous abortions. D) Women over age 35 are more likely to have substance abuse problems.

C) Women over age 35 and are pregnant have an increased risk for spontaneous abortions.

The nurse is teaching a pregnant woman with type 1 diabetes about her diet during pregnancy. Which client statement indicates that the nurses teaching was successful? A)I'll basically follow the same diet that I was following before I became pregnant. B)Because I need extra protein, I'll have to increase my intake of milk and meat. C)Pregnancy affects insulin production, so I'll need to make adjustments in my diet. D)I'll adjust my diet and insulin based on the results of my urine tests for glucose.

C)Pregnancy affects insulin production, so I'll need to make adjustments in my diet.

The nurse is doing meal planning with a pregnant woman with iron-deficiency anemia. What dietary recommendations would the nurse make to enhance the woman's intake of iron? Select all that apply. A. Since fortified cereals are a poor source of iron, eat eggs or pancakes for breakfast. B. Limit intake of dried fruits, eating only fresh fruit. C. Drink orange juice with the iron supplement. D. Cook food in an iron skillet, if possible. E. Increase intake of dried beans and green leafy vegetables.

C,D,E R:Dried fruits, fortified grains and cereals, and animal protein are all good sources of iron for a pregnant woman. Cooking in an iron skillet also will increase the amount of iron ingested. Vitamin C, like what is found in orange juice, enhances absorption of iron and is recommended to drink when taking iron supplements. Folate also increases the effectiveness of iron supplements; foods high in folate include green leafy vegetables, fortified grains and dried beans.

Many women develop iron-deficient anemia during pregnancy. What diagnostic criteria would the nurse monitor for to determine anemia in the pregnant woman? A. Blood pressure of 100/68 B. Heart rate of 84 C.Hemoglobin of 13 or lower D. Hematocrit of 32% or less

D R: 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 client who is HIV-positive is in her second trimester and remains asymptomatic. She voices concern about her newborns risk for the infection. Which of the following statements by the nurse would be most appropriate? A)Youll probably have a cesarean birth to prevent exposing your newborn. B)Antibodies cross the placenta and provide immunity to the newborn. C)Wait until after the infant is born and then something can be done. D)Antiretroviral medications are available to help reduce the risk of transmission.

D)Antiretroviral medications are available to help reduce the risk of transmission.

A woman with diabetes is considering becoming pregnant. She asks the nurse whether she will be able to take oral hypoglycemics when she is pregnant. The nurses response is based on the understanding that oral hypoglycemics: A)Can be used as long as they control serum glucose levels B)Can be taken until the degeneration of the placenta occurs C)Are usually suggested primarily for women who develop gestational diabetes D)Show promising results but more studies are needed to confirm their effectiveness

D)Show promising results but more studies are needed to confirm their effectiveness

Which assessment finding would lead the nurse to suspect infection as the cause of a client's PROM? A) Yellow-green fluid B) Blue color on Nitrazine testing C) Ferning D) Foul odor

Ans: D A foul odor of the amniotic fluid indicates infection. Yellow-green fluid would suggest meconium. A blue color on Nitrazine testing and ferning indicate the presence of amniotic fluid.

A pregnant client has been diagnosed with gestational diabetes. Which are risk factors for developing gestational diabetes? Select all that apply. A. previous large for gestational age (LGA) infant B. hypertension C. maternal age less than 18 years D. obesity E. genitourinary tract abnormalities

A,B,D R: Obesity, hypertension, and a previous infant weighing more than 9 lb (4 kg) are risk factors for developing gestational diabetes. Maternal age less than 18 years and genitourinary tract abnormalities do not increase the risk of developing gestational diabetes.

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? A. below 110 mg/dL B. below 115 mg/dL C. below 105 mg/dL D. below 120 mg/dL

A R: 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 pregnant client with diabetes in the hospital reports waking up with shakiness and diaphoresis. Which action should the nurse prioritize after discovering the client's fasting blood sugar is 60 mg/dL? A. Provide the client some milk to drink. B. Withhold her insulin, and notify the health care provider. C. Stay with her, and ask another nurse to bring her insulin. D. Recheck her blood sugar for accuracy.

A R: The client is hypoglycemic when awakening in the morning. The nurse should provide glucose in the form of carbohydrate, such as crackers, and milk, and be prepared to reassess. The nurse should not recheck at this point, since the client is symptomatic. She does not need insulin, and she will have her morning dose adjusted after breakfast.

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. A. Assess for shortness of breath. B. Assess for edema and note any pitting. C. Monitor the client's hemoglobin and hematocrit. D. Auscultate heart sounds for abnormalities. E. Assess for a moist cough.

A,B,D,E R: The nurse should assess for possible fluid overload in a client with cardiovascular disease who has just given birth. Signs of fluid overload in the client who has just labored include cough, progressive dyspnea, edema, palpitations, and crackles in the lung bases. Hemoglobin and hematocrit levels are not affected by laboring of the client with cardiovascular disease.

A nurse is assessing a newborn and suspects that the mother may have abused alcohol during her pregnancy. The nurse suspect this based on which newborn findings? Select all that apply. A. small head circumference B. thin upper lip C. large inset eyes D. macrocephaly E. limb abnormality

A,B,E R: Characteristics of FASD include craniofacial dysmorphia (thin upper lip, small head circumference, and small eyes), IUGR, microcephaly, and congenital anomalies such as limb abnormalities and cardiac defects.

A nurse is conducting a class for a group of pregnant women about the risk of substance use during pregnancy. When discussing the effects of nicotine on a pregnancy, which complications would the nurse include? Select all that apply. A. premature rupture of membranes B. ectopic pregnancy C. macrosomia D. placenta previa E. spontaneous abortion

A,D,E R: Smoking increases the risk of spontaneous abortion, tubal ectopic pregnancy, preterm labor and birth, fetal growth restriction, stillbirth, premature rupture of membranes, low fetal iron stores, maternal hypertension, placenta previa, and abruptio placentae.

After teaching a woman who has had an evacuation for a hydatidiform mole (molar pregnancy) about her condition, which of the following statements 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."

Ans: A After evacuation of a hydatidiform 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 hydatidiform mole. Use of a reliable contraceptive is strongly recommended so that pregnancy is avoided.

A woman is receiving magnesium sulfate as part of her treatment for severe preeclampsia. The nurse is monitoring the woman's serum magnesium levels. Which level would the nurse identify as therapeutic? A) 3.3 mEq/L B) 6.1 mEq/L C) 8.4 mEq/L D) 10.8 mEq/L

Ans: B Although exact levels may vary among agencies, serum magnesium levels ranging from 4 to 7 mEq/L are considered therapeutic, whereas levels more than 8 mEq/dL are generally considered toxic.

A woman with placenta previa is being treated with expectant management. The woman and fetus are stable. The nurse is assessing the woman for possible discharge home. Which statement by the woman would suggest to the nurse that home care might be inappropriate? A) "My mother lives next door and can drive me here if necessary." B) "I have a toddler and preschooler at home who need my attention." C) "I know to call my health care provider right away if I start to bleed again." D) "I realize the importance of following the instructions for my care."

Ans: B Having a toddler and preschooler at home needing attention suggest that the woman would have difficulty maintaining bed rest at home. Therefore, expectant management at home may not be appropriate. Expectant management is appropriate if the mother and fetus are both stable, there is no active bleeding, the client has readily available access to reliable transportation, and can comprehend instructions.

A nursing student is reviewing an article about preterm premature rupture of membranes. Which of the following would the student expect to find as factor placing a woman at high risk for this condition? (Select all that apply.) A) High body mass index B) Urinary tract infection C) Low socioeconomic status D) Single gestations E) Smoking

Ans: B, C, E High-risk factors associated with preterm PROM include low socioeconomic status, multiple gestation, low body mass index, tobacco use, preterm labor history, placenta previa, abruptio placenta, urinary tract infection, vaginal bleeding at any time in pregnancy, cerclage, and amniocentesis.

Upon entering the room of a client who has had a spontaneous abortion, the nurse observes the client crying. Which of the following responses by the nurse would be most appropriate? A) "Why are you crying?" B) "Will a pill help your pain?" C) "I'm sorry you lost your baby." D) "A baby still wasn't formed in your uterus."

Ans: C Telling the client that the nurse is sorry for the loss acknowledges the loss to the woman, validates her feelings, and brings the loss into reality. Asking why the client is crying is ineffective at this time. Offering a pill for the pain ignores the client's feelings. Telling the client that the baby wasn't formed is inappropriate and discounts any feelings or beliefs that the client has.

After teaching a group of nursing students about the possible causes of spontaneous abortion, the instructor determines that the teaching was successful when the students identify which of the following as the most common cause of first trimester abortions? A) Maternal disease B) Cervical insufficiency C) Fetal genetic abnormalities D) Uterine fibroids

Ans: C The causes of spontaneous abortion are varied and often unknown. The most common cause for first-trimester abortions is fetal genetic abnormalities, usually unrelated to the mother. Chromosomal abnormalities are more likely causes in first trimester and maternal disease is more likely in the second trimester. Those occurring during the second trimester are more likely related to maternal conditions, such as cervical insufficiency, congenital or acquired anomaly of the uterine cavity (uterine septum or fibroids), hypothyroidism, diabetes mellitus, chronic nephritis, use of crack cocaine, inherited and acquired thrombophilias, lupus, polycystic ovary syndrome, severe hypertension and acute infection such as rubella virus, cytomegalovirus, herpes simplex virus, bacterial vaginosis, and toxoplasmosis.

A client with hyperemesis gravidarum is admitted to the facility after being cared for at home without success. Which of the following would the nurse expect to include in the client's plan of care? A) Clear liquid diet B) Total parenteral nutrition C) Nothing by mouth D) Administration of labetalol

Ans: C Typically, on admission, the woman with hyperemesis has oral food and fluids withheld for the first 24 to 36 hours to rest the gut and receives parenteral fluids to rehydrate and reduce the symptoms. Once the condition stabilizes, oral intake is gradually increased. Total parenteral nutrition may be used if the client's condition does not improve with several days of bed rest, gut rest, IV fluids, and antiemetics. Labetalol is an antihypertensive agent that may be used to treat gestational hypertension, not hyperemesis.

The health care provider orders PGE2 for a woman to help evacuate the uterus following a spontaneous abortion. Which of the following would be most important for the nurse to do? A) Use clean technique to administer the drug. B) Keep the gel cool until ready to use. C) Maintain the client for 1/2 hour after administration. D) Administer intramuscularly into the deltoid area.

Ans: C When PGE2 is ordered, the gel should come to room temperature before administering it. Sterile technique should be used and the client should remain supine for 30 minutes after administration. RhoGAM is administered intramuscularly into the deltoid area.

A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. Which finding would the nurse interpret as indicating a therapeutic level of medication? A) Urinary output of 20 mL per hour B) Respiratory rate of 10 breaths/minute C) Deep tendons reflexes 2+ D) Difficulty in arousing

Ans: C 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.

Which of the following findings on a prenatal visit at 10 weeks might lead the nurse to suspect a hydatidiform mole? A) Complaint of frequent mild nausea B) Blood pressure of 120/84 mm Hg C) History of bright red spotting 6 weeks ago D) Fundal height measurement of 18 cm

Ans: D Findings with a hydatidiform mole may include uterine size larger than expected. Mild nausea would be a normal finding at 10 weeks' gestation. Blood pressure of 120/84 would not be associated with hydatidiform mole and depending on the woman's baseline blood pressure may be within acceptable parameters for her. Bright red spotting might suggest a spontaneous abortion.

Which of the following findings would the nurse interpret as suggesting a diagnosis of gestational trophoblastic disease? A) Elevated hCG levels, enlarged abdomen, quickening B) Vaginal bleeding, absence of FHR, decreased hPL levels C) Visible fetal skeleton on ultrasound, absence of quickening, enlarged abdomen D) Gestational hypertension, hyperemesis gravidarum, absence of FHR

Ans: D Gestational trophoblastic disease may be manifested by early development of preeclampsia (gestational hypertension), severe morning sickness due to high hCG levels, and absence of fetal heart rate or activity. There is no fetus, so 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 reviewing the laboratory test results of a pregnant client. Which one of the following findings would alert the nurse to the development of HELLP syndrome? A) Hyperglycemia B) Elevated platelet count C) Leukocytosis D) Elevated liver enzymes

Ans: D HELLP is an acronym for hemolysis, elevated liver enzymes, and low platelets. Hyperglycemia or leukocytosis is not a part of this syndrome.

A nurse is assessing a pregnant woman with gestational hypertension. Which of the following would lead the nurse to suspect that the client has developed severe preeclampsia? A) Urine protein 300 mg/24 hours B) Blood pressure 150/96 mm Hg C) Mild facial edema D) Hyperreflexia

Ans: D Severe preeclampsia is characterized by blood pressure over 160/110 mm Hg, urine protein levels greater than 500 mg/24 hours and hyperreflexia. Mild facial edema is associated with mild preeclampsia.

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? A. below 105 mg/dL B. below 110 mg/dL C. below 120 mg/dL D. below 115 mg/dL

B R: 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 group of students are reviewing information about sexually transmitted infections and their effect on pregnancy. The students demonstrate understanding of the information when they identify which infection as being responsible for ophthalmia neonatorum? A) Syphilis B) Gonorrhea C) Chlamydia D) HPV

B) Gonorrhea

During a routine prenatal check up, the nurse interviews a pregnant client to identify possible risk factors for developing gestational diabetes. Which factor would the nurse identify as increasing the woman's risk? Select all that apply. A. younger maternal age at pregnancy B. previous birth of small for gestational age baby C. maternal obesity with body mass index more than 35 D. client of African-American lineage E. previous history of spontaneous abortion

C,E R:The risk factors for gestational diabetes include previous history of spontaneous abortion, maternal obesity with body mass index (BMI) more than 35, and client of a high-risk ethnic group such as Native American, Hispanic, Asian. The other risk factors for gestational diabetes are previous history of stillbirth, birth of large for gestational age infant, and advancing maternal age.

A woman with type 2 diabetes is considering becoming pregnant and asks the nurse whether she will be able to continue taking her current oral hypoglycemics. The nurse's response will point out which factor? A. are usually suggested primarily for women who develop gestational diabetes. B. can be taken until the degeneration of the placenta occurs. C. can be used as long as they control serum glucose levels. D. have been shown to be effective and safe in recent short term studies.

D R: Recent studies have examined the use of oral hypoglycemic medications in pregnancy with much success. Several studies have used glyburide with promising results. Many health care providers are using glyburide and metformin as an alternative to insulin therapy because they do not cross the placenta and therefore do not cause fetal/neonatal hypoglycemia. Some oral hypoglycemic medications are considered safe and may be used if nutrition and exercise are not adequate alone. Maternal and newborn outcomes are similar to those seen in women who are treated with insulin. Oral hypoglycemic agents, however, must be further investigated to determine their safety with confidence and provide better treatment options for diabetes in pregnancy. Currently, there is a growing acceptance of glyburide use as a primary therapy for gestational diabetes. Glyburide and metformin have also been found to be safe, effective, and economical for the treatment of gestational diabetes, although neither drug has been approved by the FDA for use in pregnancy.

A pregnant woman asks the nurse, I'm a big coffee drinker. Will the caffeine in my coffee hurt my baby? Which response by the nurse would be most appropriate? A) The caffeine in coffee has been linked to birth defects. B) Caffeine has been shown to cause growth restriction in the fetus. C) Caffeine is a stimulant and needs to be avoided completely. D) If you keep your intake to less than 300 mg/day, you should be okay.

D) If you keep your intake to less than 300 mg/day, you should be okay.