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A 20-year-old homeless client at 38 weeks' gestation visits the prenatal clinic for the first time. She is accompanied by her 21-year-old boyfriend, who is the father of the baby. The nurse becomes concerned because as they sit in the waiting room they are sneezing and yawning and have teary eyes. With what substance are these withdrawal signs associated? 1 Heroin 2 Cocaine 3 Morphine 4 Phenobarbital

A 20-year-old homeless client at 38 weeks' gestation visits the prenatal clinic for the first time. She is accompanied by her 21-year-old boyfriend, who is the father of the baby. The nurse becomes concerned because as they sit in the waiting room they are sneezing and yawning and have teary eyes. With what substance are these withdrawal signs associated? Correct1 Heroin Incorrect2 Cocaine 3 Morphine 4 Phenobarbital Research indicates that sneezing, yawning, and teary eyes are the first physical signs of withdrawal from heroin. Depression and irritability accompany withdrawal from cocaine. Restlessness, shakiness, hallucinations, and sometimes coma accompany withdrawal from morphine. Insomnia, seizures, weakness, sweating, and anxiety accompany withdrawal from phenobarbital.

A 23-year-old primigravida is at her first prenatal appointment today. Ultrasound indicates that she is at 9 weeks' gestation. She asks when she can first expect to feel her baby move. The best response by the nurse is: 1 "You should be able to feel the baby move any day now." 2 "You should feel your first light movement of the baby around 24 weeks." 3 "Most women can first detect movement of their babies by 12 to 14 weeks." 4 "Many women are able to first feel light movement between 18 and 20 weeks."

A 23-year-old primigravida is at her first prenatal appointment today. Ultrasound indicates that she is at 9 weeks' gestation. She asks when she can first expect to feel her baby move. The best response by the nurse is: 1 "You should be able to feel the baby move any day now." 2 "You should feel your first light movement of the baby around 24 weeks." Incorrect3 "Most women can first detect movement of their babies by 12 to 14 weeks." Correct4 "Many women are able to first feel light movement between 18 and 20 weeks." Fetal movement can be felt after 18 weeks and usually by 20 weeks in a primigravida. Fetal movement is normally not felt before 18 weeks' gestation, when the uterus has risen into the abdomen. Fetal movement should continue to be felt at 24 weeks' gestation but normally is felt 4 to 6 weeks before this time.

A client at 10 weeks' gestation phones the prenatal clinic to report that she is experiencing some vaginal bleeding and abdominal cramping. The nurse arranges for her to go to the local hospital. The vaginal examination reveals that her cervix is dilated 2 cm. What diagnosis should the nurse expect? 1 Septic abortion 2 Inevitable abortion 3 Threatened abortion 4 Incomplete abortion

A client at 10 weeks' gestation phones the prenatal clinic to report that she is experiencing some vaginal bleeding and abdominal cramping. The nurse arranges for her to go to the local hospital. The vaginal examination reveals that her cervix is dilated 2 cm. What diagnosis should the nurse expect? 1 Septic abortion Correct2 Inevitable abortion 3 Threatened abortion Incorrect4 Incomplete abortion Once cervical dilation has begun, the abortion is classified as inevitable. In septic abortion the cervix is dilated and there is bleeding; also, the discharge is malodorous. Bleeding and cramping may be present, but the cervix is still closed in a threatened abortion. The products of conception have been partially expelled in an incomplete abortion.

A client at 16 weeks' gestation calls the nurse at the prenatal clinic and states that her partner just told her that he has genital herpes. What should the nurse include when teaching the client about sexual activity? 1 Condoms must be used when the couple is having intercourse. 2 Sexual abstinence should be practiced during the last 6 weeks. 3 It will be necessary to refrain from sexual contact during pregnancy. 4 Meticulous cleaning of the vaginal area after intercourse is essential. Abstinence during the 4 to 6 weeks before term is the best way to avoid contracting the virus and having an outbreak before the birth. Because the herpes virus is smaller than the pores of a condom, this type of protection has limited effectiveness. Abstinence is necessary only when disease symptoms are present in the partner and during the last 4 to 6 weeks of pregnancy. Washing is not sufficient to prevent contraction of this virus; contact already has been made.

A client at 16 weeks' gestation calls the nurse at the prenatal clinic and states that her partner just told her that he has genital herpes. What should the nurse include when teaching the client about sexual activity? Incorrect1 Condoms must be used when the couple is having intercourse. Correct2 Sexual abstinence should be practiced during the last 6 weeks. 3 It will be necessary to refrain from sexual contact during pregnancy. 4 Meticulous cleaning of the vaginal area after intercourse is essential. Abstinence during the 4 to 6 weeks before term is the best way to avoid contracting the virus and having an outbreak before the birth. Because the herpes virus is smaller than the pores of a condom, this type of protection has limited effectiveness. Abstinence is necessary only when disease symptoms are present in the partner and during the last 4 to 6 weeks of pregnancy. Washing is not sufficient to prevent contraction of this virus; contact already has been made.

A client at 7 weeks' gestation tells a nurse in the prenatal clinic that she is sick every morning with nausea and vomiting and adds that she does not think she can tolerate it throughout her pregnancy. The nurse assures her that this is a common occurrence in early pregnancy and will probably disappear by the end of the: 1 Fifth month 2 Third month 3 Fourth month 4 Second month

A client at 7 weeks' gestation tells a nurse in the prenatal clinic that she is sick every morning with nausea and vomiting and adds that she does not think she can tolerate it throughout her pregnancy. The nurse assures her that this is a common occurrence in early pregnancy and will probably disappear by the end of the: 1 Fifth month Correct2 Third month Incorrect3 Fourth month 4 Second month Because of a decrease in chorionic gonadotropin, morning sickness seldom persists beyond the first trimester. Morning sickness usually ends at the end of the third month, when the chorionic gonadotropin level falls. It is still present in the second month because of the high level of chorionic gonadotropin.

A client visiting the prenatal clinic for the first time asks a nurse about the probability of having twins because her husband is one of a pair of fraternal twins. What is the appropriate response by the nurse? 1 "A sonogram will tell us if there's a twin pregnancy." 2 "There's a 25 percent probability of you having twins." 3 "The husband's history of being a twin increases the chance of having twins." 4 "There's no greater probability of you having twins than in the general population."

A client visiting the prenatal clinic for the first time asks a nurse about the probability of having twins because her husband is one of a pair of fraternal twins. What is the appropriate response by the nurse? 1 "A sonogram will tell us if there's a twin pregnancy." 2 "There's a 25 percent probability of you having twins." Incorrect3 "The husband's history of being a twin increases the chance of having twins." Correct4 "There's no greater probability of you having twins than in the general population." Fraternal twins may occur as a result of a hereditary trait, but it is related to the release of two eggs during one ovulation; the fact that the father is a fraternal twin would not influence the female's ovaries to release two eggs during one ovulation. Although this response is true, it does not answer the client's question. If there is no maternal family history of twin pregnancies, this client's pregnancy with twins would be a chance occurrence equal to the probability found in the general population.

A client with a history of three spontaneous abortions is now at 16 weeks' gestation and attending the high-risk prenatal clinic. She expresses concerns about remaining at home during this pregnancy. Which questions will elicit responses most helpful to the nurse developing the client's plan of care? Select all that apply. 1 "Do you have a support system available to help you?" 2 "Have you been told about the status of your pregnancy?" 3 "Do you know the causes related to spontaneous abortions?" 4 "Are you aware of how a healthy lifestyle affects a pregnancy?" 5 "What are the characteristics of an impending spontaneous abortion?"

A client with a history of three spontaneous abortions is now at 16 weeks' gestation and attending the high-risk prenatal clinic. She expresses concerns about remaining at home during this pregnancy. Which questions will elicit responses most helpful to the nurse developing the client's plan of care? Select all that apply. Correct1 "Do you have a support system available to help you?" Correct2 "Have you been told about the status of your pregnancy?" 3 "Do you know the causes related to spontaneous abortions?" 4 "Are you aware of how a healthy lifestyle affects a pregnancy?" Incorrect5 "What are the characteristics of an impending spontaneous abortion?" The availability of support persons is important when the client is deciding how to try to maintain the pregnancy. Knowing the status of her pregnancy is helpful to the nurse planning her care. If the status is not known, the nurse can correct any misconceptions and assist the client in focusing on reality while helping ease her anxiety. The causes of spontaneous abortion are not always known; theoretic knowledge of the causes will not help the client maintain her pregnancy. Questions about the interrelationship of lifestyle and a healthy pregnancy may add to the client's anxiety; they are not relevant at this time. Questioning the client's knowledge of an impending spontaneous abortion may add to the client's anxiety; after three abortions the client probably knows what to expect before there is a spontaneous abortion.

A client with mild preeclampsia is admitted to the high-risk prenatal unit because her blood pressure is progressively increasing. The nurse reviews the practitioner's prescriptions. What prescriptions does the nurse expect? Select all that apply. 1 Daily weight 2 Side-lying bed rest 3 2-gram-sodium diet 4 Deep tendon reflexes 5 Glucose tolerance test

A client with mild preeclampsia is admitted to the high-risk prenatal unit because her blood pressure is progressively increasing. The nurse reviews the practitioner's prescriptions. What prescriptions does the nurse expect? Select all that apply. Correct1 Daily weight Correct2 Side-lying bed rest 3 2-gram-sodium diet Correct4 Deep tendon reflexes Incorrect5 Glucose tolerance test Rapid weight gain is a sign of increasing edema. One liter of fluid is equal to 2.2 lb. Maintaining bedrest promotes fluid shift from the interstitial spaces to the intravascular space, which enhances blood flow to the kidneys and uterus; the side-lying position promotes placental perfusion. A 2 g/day sodium diet will deplete the circulating blood volume, limiting blood flow to the placenta. A moderate sodium intake (≤6 g) is permitted as long as the client is alert and has no nausea or indication of an impending seizure. Deep tendon reflexes should be monitored. Reflexes of +2 are indicative of mild preeclampsia; +4 indicates severe preeclampsia. There is no data indicating that a glucose tolerance test is needed.

A nurse is teaching a prenatal class about the changes that occur during the second trimester of pregnancy. What cardiovascular changes should the nurse include? Select all that apply. 1 Cardiac output increases. 2 Blood pressure decreases. 3 The heart is displaced upward. 4 The blood plasma volume peaks. 5 The hematocrit level is lowered.

A nurse is teaching a prenatal class about the changes that occur during the second trimester of pregnancy. What cardiovascular changes should the nurse include? Select all that apply. Correct 1 Cardiac output increases. Correct 2 Blood pressure decreases. Correct 3 The heart is displaced upward. 4 The blood plasma volume peaks. 5 The hematocrit level is lowered. Cardiac output increases during the second trimester because of an increasing plasma volume. The blood pressure decreases because of the enlarged intravascular compartment and hormonal effects on peripheral resistance. As the fetus grows and the enlarging uterus outgrows the pelvic cavity, it displaces the heart upward and to the left. The blood volume starts to increase earlier but does not peak until the third trimester. The reduction in hematocrit occurs in the first trimester; the erythrocyte increase may not be in direct proportion to the blood volume, lowering hematocrit and hemoglobin levels, which remain lower throughout pregnancy.

A nurse is teaching a prenatal class about the types of pain blocks that provide perineal anesthesia during labor. Which type of pain block should the nurse include in the discussion that will provide perineal anesthesia but allow the client to feel contractions and push during the second stage of labor? 1 Saddle 2 Epidural 3 Pudendal 4 Paracervical

A nurse is teaching a prenatal class about the types of pain blocks that provide perineal anesthesia during labor. Which type of pain block should the nurse include in the discussion that will provide perineal anesthesia but allow the client to feel contractions and push during the second stage of labor? 1 Saddle Incorrect2 Epidural Correct3 Pudendal 4 Paracervical The pudendal block relieves vaginal and perineal pain but does not impair the ability to push during the second stage of labor. The saddle block relieves pain from the umbilicus to the lower perineum and inner thigh; the client may have difficulty pushing during the second stage of labor. The epidural block relieves pain from the umbilicus to the midthigh; the client may have difficulty pushing during the second stage of labor. The paracervical block relieves uterine pain; it does not relieve perineal pain.

A primigravida at 8 weeks' gestation is visiting the prenatal clinic for the first time. What should an assessment reveal at this time? 1 Lightening 2 Quickening 3 Goodell's sign 4 Braxton Hicks sign

A primigravida at 8 weeks' gestation is visiting the prenatal clinic for the first time. What should an assessment reveal at this time? Incorrect1 Lightening 2 Quickening Correct3 Goodell's sign 4 Braxton Hicks sign Goodell's sign, or softening of the cervix, occurs at 8 to 9 weeks' gestation. Lightening or settling of the fetal presenting part into the pelvis usually occurs about 2 weeks before the onset of labor in nulliparas. Quickening refers to fetal movement, usually perceived by the mother between the 16th and 20th weeks of gestation. Braxton Hicks (preparatory) contractions consist of intermittent cramplike contractions that start at the 16th week and grow stronger and more frequent as pregnancy progresses.

A woman visits the prenatal clinic because an over-the-counter pregnancy test has rendered a positive result. After the initial examination verifies the pregnancy, the nurse explains some of the metabolic changes that occur during the first trimester of pregnancy. Select all that apply. 1 Sleep needs increase. 2 Fluid retention increases. 3 Body temperature decreases. 4 Calcium requirements increase. 5 The need for carbohydrates decreases.

A woman visits the prenatal clinic because an over-the-counter pregnancy test has rendered a positive result. After the initial examination verifies the pregnancy, the nurse explains some of the metabolic changes that occur during the first trimester of pregnancy. Select all that apply. Correct1 Sleep needs increase. Correct2 Fluid retention increases. 3 Body temperature decreases. Correct4 Calcium requirements increase. Incorrect5 The need for carbohydrates decreases. Estrogen increases the secretion of corticosteroids, which decrease the basal metabolic rate, resulting in fatigue. Sodium is retained, and fluid retention increases to meet total needs. During the first trimester approximately 1.2 g of calcium is needed each day; this need continues throughout pregnancy as the fetal skeleton is being formed. Body temperature increases because of the increased metabolism related to the growth of the fetus. Carbohydrate needs increase because the secretion of insulin by the pancreas is increased; however, insulin is destroyed rapidly by the placenta. The stress of pregnancy may precipitate gestational diabetes.

At her first prenatal clinic visit a primigravida has blood drawn for a rubella antibody screening test, and the results are positive. What intervention is important when the nurse discusses this finding with the client? 1 Asking her whether she has had German measles and when she had the disease 2 Arranging for her to receive the rubella booster vaccine after the birth 3 Planning for her to receive the rubella booster vaccine at her next visit 4 Informing her that the result was expected and that treatment will not be needed

At her first prenatal clinic visit a primigravida has blood drawn for a rubella antibody screening test, and the results are positive. What intervention is important when the nurse discusses this finding with the client? Correct1 Asking her whether she has had German measles and when she had the disease Incorrect2 Arranging for her to receive the rubella booster vaccine after the birth 3 Planning for her to receive the rubella booster vaccine at her next visit 4 Informing her that the result was expected and that treatment will not be needed The positive result indicates that the client has had rubella or was vaccinated. The nurse should determine whether she has had the disease, because it is important to know whether it was before or after she became pregnant; if she had rubella at the start of her pregnancy, the fetus is at risk. A rubella booster, either at the next visit or after the birth, is not necessary because the client has active immunity. More information is needed before the client can be told that no treatment will be needed.

During a prenatal visit, a client at 37 weeks' gestation tells a nurse that she has painful, irregular contractions. What should the nurse recommend? 1 Lying down until they stop 2 Timing them for at least 1 hour 3 Walking around until they subside 4 Taking 1 over-the-counter analgesic tablet

During a prenatal visit, a client at 37 weeks' gestation tells a nurse that she has painful, irregular contractions. What should the nurse recommend? 1 Lying down until they stop Incorrect2 Timing them for at least 1 hour Correct3 Walking around until they subside 4 Taking 1 over-the-counter analgesic tablet Ambulation eases irregular contractions (i.e., preparatory or Braxton Hicks contractions). Preparatory contractions increase in number and intensity when the client is resting. These contractions are not indicative of true labor and need not be timed. Medications should not be recommended by the nurse; this is a dependent nursing function.

During a routine visit to the prenatal clinic a client listens to the fetal heartbeat for the first time. The client, commenting on how rapid it is, appears frightened and asks whether this is normal. The nurse should explain: 1 "The heart rate is usually rapid, and this one is in the expected range." 2 "The heart rate is usually rapid and twice the mother's pulse rate." 3 "The heart rate is rapid, but I'd be more concerned if it were slow." 4 "The heart rate is rapid, but it accommodates the fetus's nutritional needs."

During a routine visit to the prenatal clinic a client listens to the fetal heartbeat for the first time. The client, commenting on how rapid it is, appears frightened and asks whether this is normal. The nurse should explain: Correct1 "The heart rate is usually rapid, and this one is in the expected range." 2 "The heart rate is usually rapid and twice the mother's pulse rate." 3 "The heart rate is rapid, but I'd be more concerned if it were slow." Incorrect4 "The heart rate is rapid, but it accommodates the fetus's nutritional needs." With spontaneous or stimulated activity, the fetal heart rate (FHR) is usually between 110 and 160 beats/min. This is to be expected, and the client should be made aware of this. The normal heart rate for a fetus is not twice the mother's heart rate. Stating that the FHR is rapid implies that this one is too rapid; this misinformation may cause more concerns. The FHR is rapid to accommodate the metabolic, not nutritional, needs of the fetus.

While a client is being interviewed on her first prenatal visit she states that she has a 4-year-old son who was born at 41 weeks' gestation and a 3-year-old daughter who was born at 35 weeks' gestation and lost one pregnancy at 9 weeks and another at 18 weeks. Using the GTPAL system, how would you record this information? 1 G5 T1 P1 A2 L2 2 G4 T1 P1 A2 L2 3 G4 T2 P0 A0 L2 4 G5 T2 P1 A1 L2

While a client is being interviewed on her first prenatal visit she states that she has a 4-year-old son who was born at 41 weeks' gestation and a 3-year-old daughter who was born at 35 weeks' gestation and lost one pregnancy at 9 weeks and another at 18 weeks. Using the GTPAL system, how would you record this information? Correct1 G5 T1 P1 A2 L2 Incorrect2 G4 T1 P1 A2 L2 3 G4 T2 P0 A0 L2 4 G5 T2 P1 A1 L2 The client is gravida (G) 5: the current pregnancy, the 41-week pregnancy, the 35-week pregnancy, the 9-week pregnancy, and the 18-week pregnancy. She has had one term (T) pregnancy (one that lasts 40 weeks plus or minus 2 weeks): the 41-week pregnancy. The 35-week pregnancy is considered preterm (P). Pregnancies that end before 20 weeks are considered abortions, so the losses at 9 and 18 weeks would be scored as A2. The other options do not consider the present pregnancy or the correct definitions of term and preterm or do not include the abortions.

An adolescent at 10 weeks' gestation visits the prenatal clinic for the first time. The nutrition interview indicates that her dietary intake consists mainly of soft drinks, candy, French fries, and potato chips. Why does the nurse consider this diet inadequate? 1 The caloric content will result in too great a weight gain. 2 The ingredients in soft drinks and candy can be teratogenic in early pregnancy. 3 The salt in this diet will contribute to the development of gestational hypertension. 4 The nutritional composition of the diet places her at risk for a low-birthweight infant.

An adolescent at 10 weeks' gestation visits the prenatal clinic for the first time. The nutrition interview indicates that her dietary intake consists mainly of soft drinks, candy, French fries, and potato chips. Why does the nurse consider this diet inadequate? Incorrect1 The caloric content will result in too great a weight gain. 2 The ingredients in soft drinks and candy can be teratogenic in early pregnancy. 3 The salt in this diet will contribute to the development of gestational hypertension. Correct4 The nutritional composition of the diet places her at risk for a low-birthweight infant. The diet does not reflect a healthy balance of foods and nutrients, especially protein; adequate nutrition is necessary for the birth of a healthy full-term infant whose weight is appropriate for gestational age. The caloric content of these foods is not high if small amounts are consumed; in addition, this client's weight gain may not be reflective of an adequate weight gain in the developing fetus. No data are available to support the assertion that the ingredients of candy and soft drinks are teratogenic. Unrestricted salt intake does not contribute to the development of gestational hypertension.

On her first visit to the prenatal clinic a client with rheumatic heart disease asks the nurse whether she has special nutritional needs. What supplements in addition to the regular pregnancy diet and prenatal vitamin and minerals will she need? Select all that apply. 1 Iron 2 Calcium 3 Folic acid 4 Vitamin C 5 Vitamin B12

On her first visit to the prenatal clinic a client with rheumatic heart disease asks the nurse whether she has special nutritional needs. What supplements in addition to the regular pregnancy diet and prenatal vitamin and minerals will she need? Select all that apply. Correct1 Iron Incorrect2 Calcium Correct3 Folic acid Incorrect4 Vitamin C 5 Vitamin B12 Because pregnant women with heart disease are more likely to have anemia, there may be an additional need for iron and also for folic acid. If the pregnant client with heart disease is eating the recommended pregnancy diet and taking prenatal vitamin and mineral supplements, there is no additional need for calcium, vitamin C, and vitamin B12.

A nurse is being oriented to a prenatal clinic after graduation. The new nurse takes a course on several tests during pregnancy. Place the tests in the order in which they should be performed during pregnancy. 1. Serum glucose for gestational diabetes 2. Fetal movement test 3. Sickle cell screening Incorrect 4. α-Fetoprotein (AFP) testing for neural tube defects 5. Group B Streptococcus culture

Group B Streptococcus culture Sickle cell screening, particularly for black women, should be done on the initial visit. AFP testing for neural tube defects should be done between 14 and 16 weeks. Serum glucose testing for gestational diabetes should be done between 26 and 28 weeks. Fetal movement tests may be started at 28 weeks' gestation because the fetus' pattern of movement becomes stabilized at this time. Group B Streptococcus culture should be done between 36 and 38 weeks.

A 16-year-old girl at 28 weeks' gestation arrives at the prenatal clinic with her mother for a routine sonogram. Before the procedure, the girl asks that the nurse not reveal the fetus's sex if it should become apparent. Afterward, the mother asks the nurse the sex of the fetus. In light of the mother-daughter relationship, the best response by the nurse is: 1 "That information is not available at this time." 2 "I'm not allowed to divulge confidential information." 3 "Your daughter asked me not to give that information to anyone." 4 "The sex of the baby isn't the most important information at this time."

A 16-year-old girl at 28 weeks' gestation arrives at the prenatal clinic with her mother for a routine sonogram. Before the procedure, the girl asks that the nurse not reveal the fetus's sex if it should become apparent. Afterward, the mother asks the nurse the sex of the fetus. In light of the mother-daughter relationship, the best response by the nurse is: Correct1 "That information is not available at this time." Incorrect2 "I'm not allowed to divulge confidential information." 3 "Your daughter asked me not to give that information to anyone." 4 "The sex of the baby isn't the most important information at this time." Stating that the information is not available at this time supports the client's right to confidentiality without antagonizing the client's mother. Stating that the sex of the baby isn't the most important information at this time is a judgmental, nontherapeutic statement. Although the other responses protect the client's right to confidentiality, they could disrupt the relationship between the client and her mother.

A client attending a prenatal class about nutrition tells the nurse that she is a strict vegetarian (vegan). What should the nurse encourage the client to eat that includes all the essential amino acids? 1 Macaroni and cheese 2 Whole-grain cereals and nuts 3 Scrambled eggs and buttermilk 4 Brown rice and whole-wheat bread

A client attending a prenatal class about nutrition tells the nurse that she is a strict vegetarian (vegan). What should the nurse encourage the client to eat that includes all the essential amino acids? 1 Macaroni and cheese Correct2 Whole-grain cereals and nuts 3 Scrambled eggs and buttermilk Incorrect4 Brown rice and whole-wheat bread

A nurse in the prenatal clinic is caring for a client with heart disease who is in her second trimester. What hemodynamic change of pregnancy may affect the client at this time? 1 Decreased red blood cell count 2 Gradually increasing size of the uterus 3 Heart rate acceleration in the last half of pregnancy 4 Increase in cardiac output during the third trimester

A nurse in the prenatal clinic is caring for a client with heart disease who is in her second trimester. What hemodynamic change of pregnancy may affect the client at this time? 1 Decreased red blood cell count Incorrect2 Gradually increasing size of the uterus Correct3 Heart rate acceleration in the last half of pregnancy 4 Increase in cardiac output during the third trimester

A woman in labor with no known complications rings the call bell to say she has had a "gush" from her vagina. The nurse identifies a large amount of bright-red blood. In what order should the nurse perform these interventions? 1. Call for help. 2. Check fetal heart tones. 3. Start oxygen at 8 L/mask. 4. Increase the maintenance IV infusion rate. 5. Call the health care provider.

A woman in labor with no known complications rings the call bell to say she has had a "gush" from her vagina. The nurse identifies a large amount of bright-red blood. In what order should the nurse perform these interventions? Correct 1. Call for help. Correct 2. Check fetal heart tones. Incorrect 3. Start oxygen at 8 L/mask. Incorrect 4. Increase the maintenance IV infusion rate. Correct 5. Call the health care provider. Calling for help will allow all other actions to be completed more quickly. This is especially critical during an emergency situation. Next the nurse should assess the fetal heart tones to identify the effect of the bleeding on the fetus, because the fetus often shows signs of distress before the mother does. After checking the fetal heart tone the nurse should increase the IV infusion rate, which should take only seconds and can have a significant effect on circulation. Oxygen can be instituted after the IV infusion rate has been increased; this will be of benefit to both mother and fetus. Calling the primary health care provider is important, but instituting lifesaving measures takes precedence.

During a routine examination at the prenatal clinic the nurse notes significant increases in the client's blood pressure and edema of the face and hands. The diagnostic criterion for preeclampsia is a blood pressure of 140/90 mm Hg, but what is the lowest blood pressure that should prompt the nurse to monitor the client for other signs and symptoms of preeclampsia? 1 130/85 mm Hg 2 125/80 mm Hg 3 115/75 mm Hg 4 110/70 mm Hg

During a routine examination at the prenatal clinic the nurse notes significant increases in the client's blood pressure and edema of the face and hands. The diagnostic criterion for preeclampsia is a blood pressure of 140/90 mm Hg, but what is the lowest blood pressure that should prompt the nurse to monitor the client for other signs and symptoms of preeclampsia? Correct1 130/85 mm Hg 2 125/80 mm Hg 3 115/75 mm Hg Incorrect4 110/70 mm Hg A blood pressure of 130/85 mm Hg is a concern even though it does not meet the diagnostic criterion of 140/90 mm Hg, especially when there are other signs of preeclampsia, such as edema; further assessment and possible treatment are warranted. Although 130/85 mm Hg is insufficient to meet the diagnostic criterion of preeclampsia, it is not the lowest one to warrant further investigation. A reading of 115/75 mm Hg is insufficient to indicate a hypertensive disorder of pregnancy, as is a reading of 110/70 mm Hg. The most significant finding is the increase in the client's blood pressure from previous visits.

During a routine prenatal visit, a client tells a nurse that she gets leg cramps. What condition does the nurse suspect, and what suggestion is made to correct the problem? 1 Hypercalcemia; avoid eating hard cheeses. 2 Hypocalcemia; increase her intake of milk. 3 Hyperkalemia; consult her health care provider. 4 Hypokalemia; increase intake of green leafy vegetables.

During a routine prenatal visit, a client tells a nurse that she gets leg cramps. What condition does the nurse suspect, and what suggestion is made to correct the problem? 1 Hypercalcemia; avoid eating hard cheeses. Correct2 Hypocalcemia; increase her intake of milk. 3 Hyperkalemia; consult her health care provider. Incorrect4 Hypokalemia; increase intake of green leafy vegetables. The most likely cause is a disturbance in the ratio of calcium to phosphorus, with the amount of serum calcium reduced and the serum phosphorus increased; milk and other dairy products are excellent sources of calcium. Leg cramps are related to hypocalcemia, not to hypercalcemia. An increased potassium level manifests as muscle weakness. A low potassium level is evidenced by fatigue and muscle weakness.

On her first visit to the prenatal clinic a woman is to have a pelvic examination. What information should the nurse include when discussing the examination? 1 She should direct her questions to the health care provider. 2 She should relax during the examination to prevent discomfort. 3 A douche will be necessary before the examination for the biopsy. 4 A rectal examination may be performed after the pelvic examination.

On her first visit to the prenatal clinic a woman is to have a pelvic examination. What information should the nurse include when discussing the examination? 1 She should direct her questions to the health care provider. Incorrect2 She should relax during the examination to prevent discomfort. 3 A douche will be necessary before the examination for the biopsy. Correct4 A rectal examination may be performed after the pelvic examination. A rectal examination is usually is conducted to palpate any masses or detect abnormalities in the rectum; it is performed after the vaginal examination to avoid contamination. Gloves are changed between vaginal and rectal examinations. The client should be encouraged to ask questions of both the health care provider and the nurse so that nursing care and treatment plans based on client needs can be developed. The client may be unable to relax and will feel powerless if told that she must do so. Douching or vaginal irrigation is contraindicated unless specifically prescribed; there are no data to indicate that there will be a biopsy.

The nurse in the prenatal clinic is providing nutritional counseling for a pregnant woman with a cardiac problem. What should the nurse advise the client to do? 1 Limit the intake of fat. 2 Increase sodium in the diet. 3 Eat a moderate amount of protein. 4 Control the number of calories consumed.

The nurse in the prenatal clinic is providing nutritional counseling for a pregnant woman with a cardiac problem. What should the nurse advise the client to do? 1 Limit the intake of fat. Incorrect2 Increase sodium in the diet. 3 Eat a moderate amount of protein. Correct4 Control the number of calories consumed. Controlling caloric intake is recommended to keep weight gain to no more than 25 lb so the increased cardiac workload that occurs during pregnancy may be controlled as much as possible. Fats are not specifically limited; however, they should be eaten in moderation to control the total number of calories consumed. Increased sodium and moderate protein are not advised for clients with cardiac problems.

A nurse in the prenatal clinic determines the fundal height of a healthy multipara at 16 weeks' gestation to be one fingerbreadth above the umbilicus. What should the nurse do next? 1 Check for two distinct fetal heart rates. 2 Ascertain the birth weights of the client's other children. 3 Inform the client that she may be mistaken about her due date. 4 Instruct the client about appropriate weight gain during pregnancy.

A nurse in the prenatal clinic determines the fundal height of a healthy multipara at 16 weeks' gestation to be one fingerbreadth above the umbilicus. What should the nurse do next? Correct1 Check for two distinct fetal heart rates. 2 Ascertain the birth weights of the client's other children. Incorrect3 Inform the client that she may be mistaken about her due date. 4 Instruct the client about appropriate weight gain during pregnancy. Twins should be suspected with a faster-than-expected increase in fundal height; the nurse should assess the client for two distinct heartbeats. Fundal height, not the size of the fetus, should prompt the nurse to suspect a multiple pregnancy. The due date cannot be determined until ultrasonography has been performed. Weight gain does not influence the height of the fundus.

The nurse in the prenatal clinic is providing nutritional counseling for a pregnant woman with a cardiac problem. What should the nurse advise the client to do? 1 Limit the intake of fat. 2 Increase sodium in the diet. 3 Eat a moderate amount of protein. 4 Control the number of calories consumed

The nurse in the prenatal clinic is providing nutritional counseling for a pregnant woman with a cardiac problem. What should the nurse advise the client to do? Incorrect1 Limit the intake of fat. 2 Increase sodium in the diet. 3 Eat a moderate amount of protein. Correct4 Control the number of calories consumed

A 37-year-old woman agrees to have a prenatal test done to diagnose fetal defects. There is a history of Down syndrome in her family, and this is her first pregnancy. Which invasive prenatal test provides the earliest diagnosis and rapid test results? 1 Nonstress test 2 Amniocentesis 3 Chorionic villus sampling 4 Percutaneous umbilical blood sampling

A 37-year-old woman agrees to have a prenatal test done to diagnose fetal defects. There is a history of Down syndrome in her family, and this is her first pregnancy. Which invasive prenatal test provides the earliest diagnosis and rapid test results? 1 Nonstress test Incorrect2 Amniocentesis Correct3 Chorionic villus sampling 4 Percutaneous umbilical blood sampling Chorionic villus sampling may be performed between 10 and 12 weeks' gestation. Amniocentesis may be performed after 14 weeks' gestation, when sufficient amniotic fluid is available. Direct access to the fetal circulation with percutaneous umbilical blood sampling may be performed during the second and third trimesters. The nonstress test, which is not invasive, is a technique used for antepartum evaluation of the fetus; it does not reveal fetal defects.

A client at 38 weeks' gestation is admitted to the high-risk prenatal unit with a diagnosis of severe preeclampsia. The nurse obtains the vital signs, performs a health history and physical assessment, and reviews the client's laboratory results. What is the priority nursing intervention? 1 Monitoring intake and output 2 Providing a dark private room 3 Measuring the extent of edema 4 Preparing for an immediate cesarean birth

A client at 38 weeks' gestation is admitted to the high-risk prenatal unit with a diagnosis of severe preeclampsia. The nurse obtains the vital signs, performs a health history and physical assessment, and reviews the client's laboratory results. What is the priority nursing intervention? 1 Monitoring intake and output Correct2 Providing a dark private room 3 Measuring the extent of edema Incorrect4 Preparing for an immediate cesarean birth Increasing cerebral edema may predispose the client to seizures; therefore, stimuli of any kind should be minimized. Although intake and output should be monitored to identify oliguria, this will not limit the occurrence of a seizure. Although edema should be measured, it will not limit the occurrence of a seizure. A cesarean birth may not be needed.

A client at 6 weeks' gestation who has type 1 diabetes is attending the prenatal clinic for the first time. The nurse explains that during the first trimester insulin requirements may decrease because: 1 Body metabolism is sluggish in the first trimester. 2 Morning sickness may lead to decreased food intake. 3 Fetal requirements of glucose in this period are minimal. 4 Hormones of pregnancy increase the body's need for insulin.

A client at 6 weeks' gestation who has type 1 diabetes is attending the prenatal clinic for the first time. The nurse explains that during the first trimester insulin requirements may decrease because: 1 Body metabolism is sluggish in the first trimester. Correct2 Morning sickness may lead to decreased food intake. Incorrect3 Fetal requirements of glucose in this period are minimal. 4 Hormones of pregnancy increase the body's need for insulin. Morning sickness, a common occurrence during pregnancy, contributes to decreased food intake; the insulin dosage must be reduced to prevent hypoglycemia. The body's metabolism increases during pregnancy because the needs of the fetus, as well as those of the mother, must be met. Rapid organogenesis requires large amounts of glucose. During the first trimester the blood glucose level is reduced and glycemic control is enhanced; glycemic control is more difficult to maintain later in the pregnancy.

A client at 9 weeks' gestation asks the nurse in the prenatal clinic whether she may have chorionic villi sampling (CVS) performed during this visit. What should the nurse keep in mind as the optimal time for CVS while formulating a response? 1 At 8 weeks but no later than 10 weeks 2 At 10 weeks but no later than 12 weeks 3 At 12 weeks but no later than 14 weeks 4 At 14 weeks but no later than 16 weeks

A client at 9 weeks' gestation asks the nurse in the prenatal clinic whether she may have chorionic villi sampling (CVS) performed during this visit. What should the nurse keep in mind as the optimal time for CVS while formulating a response? 1 At 8 weeks but no later than 10 weeks Correct2 At 10 weeks but no later than 12 weeks Incorrect3 At 12 weeks but no later than 14 weeks 4 At 14 weeks but no later than 16 weeks At 8 weeks but no later than 12 weeks is the ideal time for CVS; this gives the client time to consider other options if a problem is discovered. CVS is no longer performed before 10 weeks because it has been associated with digit reduction. At 12 weeks but no later than 14 weeks is too late for CVS. At 14 weeks but no later than 16 weeks is when genetic amniocentesis is performed.

A client in the prenatal clinic is diagnosed with preeclampsia. What clinical findings support this diagnosis? 1 Increased blood pressure of 150/100 mm Hg 2 Increased blood pressure that is accompanied by a headache 3 Blood pressure above the baseline that fluctuates with each reading 4 Blood pressure higher than 140 mm Hg systolic accompanied by proteinuria

A client in the prenatal clinic is diagnosed with preeclampsia. What clinical findings support this diagnosis? 1 Increased blood pressure of 150/100 mm Hg Incorrect2 Increased blood pressure that is accompanied by a headache 3 Blood pressure above the baseline that fluctuates with each reading 4 Blood pressure higher than 140 mm Hg systolic accompanied by proteinuria A blood pressure higher than 140 mm Hg systolic and 90 mm Hg diastolic along with proteinuria is diagnostic of preeclampsia; assessments should be performed twice, 4 to 6 hours apart. Hypertension alone does not support a diagnosis of preeclampsia. Hypertension accompanied by a headache is not necessarily indicative of preeclampsia. Blood pressure above the baseline and fluctuating with each reading may occur at any time, not specifically in a client with gestational hypertension.

A client tells a nurse in the prenatal clinic that she has vaginal staining but no pain. Her history reveals amenorrhea for the last 2 months and pregnancy confirmation after her first missed period. What type of abortion is suspected? 1 Missed 2 Inevitable 3 Threatened 4 Incomplete

A client tells a nurse in the prenatal clinic that she has vaginal staining but no pain. Her history reveals amenorrhea for the last 2 months and pregnancy confirmation after her first missed period. What type of abortion is suspected? Incorrect1 Missed 2 Inevitable Correct3 Threatened 4 Incomplete Spotting in the first trimester may indicate that the client is having a threatened abortion; any client with the possibility of hemorrhage should not be left alone, so her admission to the hospital helps ensure her safety. A missed abortion may not cause any outward signs or symptoms, except that the signs of pregnancy disappear. An inevitable abortion can be confirmed only if vaginal examination reveals cervical dilation. With an incomplete abortion some, but not all, of the products of conception have been expelled.

A client who is at 26 weeks' gestation tells a nurse at the prenatal clinic that she has pain during urination, back tenderness, and pink-tinged urine. A diagnosis of pyelonephritis is made. What is the most important nursing intervention at this time? 1 Limiting fluid intake 2 Examining the urine for protein 3 Checking for signs of preterm labor 4 Maintaining her on a moderate-sodium diet

A client who is at 26 weeks' gestation tells a nurse at the prenatal clinic that she has pain during urination, back tenderness, and pink-tinged urine. A diagnosis of pyelonephritis is made. What is the most important nursing intervention at this time? 1 Limiting fluid intake Incorrect2 Examining the urine for protein Correct3 Checking for signs of preterm labor 4 Maintaining her on a moderate-sodium diet Pyelonephritis often causes preterm labor, leading to increased neonatal morbidity and mortality. Fluids should be increased; the inflammatory process may lead to fever, dehydration, and an accumulation of toxins. Proteinuria occurs with preeclampsia; the client's signs and symptoms are indicative of a kidney infection. A moderate-sodium diet is not relevant to the client's problem.

A newly arrived Russian immigrant attends the prenatal clinic for the first time. Although she states that she has had immunizations, she does not know which ones. Which immunizations should the nurse recommend? Select all that apply. 1 Mumps 2 Measles 3 Diphtheria 4 Hepatitis B 5 Chickenpox

A newly arrived Russian immigrant attends the prenatal clinic for the first time. Although she states that she has had immunizations, she does not know which ones. Which immunizations should the nurse recommend? Select all that apply. 1 Mumps 2 Measles Correct3 Diphtheria Correct4 Hepatitis B 5 Chickenpox The diphtheria vaccine and hepatitis B vaccine contain dead viruses and can be administered safely. The mumps, measles, and chickenpox vaccines are all contraindicated because they contains live virus, which is teratogenic.

A nurse in the prenatal clinic assesses clients for signs of preeclampsia. What sign, other than increased blood pressure, may indicate preeclampsia? 1 Positive nonstress test 2 Negative contraction stress test 3 Weight gain of 6 lb in 1 month 4 Fetal heart rate below 120 beats/min

A nurse in the prenatal clinic assesses clients for signs of preeclampsia. What sign, other than increased blood pressure, may indicate preeclampsia? 1 Positive nonstress test Incorrect2 Negative contraction stress test Correct3 Weight gain of 6 lb in 1 month 4 Fetal heart rate below 120 beats/min In preeclampsia, renal blood flow and the glomerular filtration rate are decreased, resulting in fluid retention and rapid weight gain. A positive nonstress test and negative contraction stress test each indicate fetal well-being. The fetal heart rate in a healthy fetus ranges from 110 to 160 beats/min.

A nurse in the prenatal clinic is caring for a client with heart disease who is in her second trimester. What hemodynamic change of pregnancy may affect the client at this time? 1 Decreased red blood cell count 2 Gradually increasing size of the uterus 3 Heart rate acceleration in the last half of pregnancy 4 Increase in cardiac output during the third trimester

A nurse in the prenatal clinic is caring for a client with heart disease who is in her second trimester. What hemodynamic change of pregnancy may affect the client at this time? Incorrect1 Decreased red blood cell count 2 Gradually increasing size of the uterus Correct3 Heart rate acceleration in the last half of pregnancy 4 Increase in cardiac output during the third trimester The heart rate increases by about 10 beats/min in the last half of pregnancy; this increase, plus the increase in total blood volume, can strain a damaged heart beyond the point at which it can efficiently compensate. The number of red blood cells does not decrease during pregnancy. The increased size of the uterus is related to the growth of the fetus, not to any hemodynamic change. Cardiac output begins to decrease by the 34th week of gestation.

A woman is being seen in the prenatal clinic at 36 weeks' gestation. The nurse is reviewing signs and symptoms that should be reported to health care provider with the mother. Which signs and symptoms require further evaluation by the health care provider? Select all that apply. 1 Decreased urine output 2 Blurred vision with spots 3 Urinary frequency without dysuria 4 Heartburn after eating a fatty meal 5 Contractions that are regular and 5 minutes apart 6 Shortness of breath after climbing a flight of stairs

A woman is being seen in the prenatal clinic at 36 weeks' gestation. The nurse is reviewing signs and symptoms that should be reported to health care provider with the mother. Which signs and symptoms require further evaluation by the health care provider? Select all that apply. Correct 1 Decreased urine output Correct 2 Blurred vision with spots 3 Urinary frequency without dysuria 4 Heartburn after eating a fatty meal Correct 5 Contractions that are regular and 5 minutes apart 6 Shortness of breath after climbing a flight of stairs Decreased urine output, blurred vision, and severe headache may occur with pregnancy-associated hypertension. Contractions that become regular are associated with the onset of labor. Preparatory (Braxton Hicks) contractions ease when the client walks. Swelling of the face and hands is a warning sign. Urinary frequency occurs in the first trimester and again in the third trimester as the uterus settles back into the pelvis. The weight of the uterus may delay emptying of the stomach and make heartburn a more frequent problem. Shortness of breath would be expected after the client climbs a flight of stairs.

A woman in labor with no known complications rings the call bell to say she has had a "gush" from her vagina. The nurse identifies a large amount of bright-red blood. In what order should the nurse perform these interventions? 1. Call for help. 2. Increase the maintenance IV infusion rate. 3. Start oxygen at 8 L/mask. 4. Check fetal heart tones. 5. Call the health care provider.

Calling for help will allow all other actions to be completed more quickly. This is especially critical during an emergency situation. Next the nurse should assess the fetal heart tones to identify the effect of the bleeding on the fetus, because the fetus often shows signs of distress before the mother does. After checking the fetal heart tone the nurse should increase the IV infusion rate, which should take only seconds and can have a significant effect on circulation. Oxygen can be instituted after the IV infusion rate has been increased; this will be of benefit to both mother and fetus. Calling the primary health care provider is important, but instituting lifesaving measures takes precedence.

What prenatal teaching is applicable for a client who is between 13 and 24 weeks' gestation? 1 Infant care, travel to the hospital, and signs of labor 2 Growth of the fetus, personal hygiene, and nutritional guidance 3 Interventions for nausea and vomiting, urinary frequency, and anticipated care 4 Danger signs of preeclampsia, relaxation breathing techniques, and signs of labor

What prenatal teaching is applicable for a client who is between 13 and 24 weeks' gestation? 1 Infant care, travel to the hospital, and signs of labor Correct2 Growth of the fetus, personal hygiene, and nutritional guidance Incorrect3 Interventions for nausea and vomiting, urinary frequency, and anticipated care 4 Danger signs of preeclampsia, relaxation breathing techniques, and signs of labor

While conducting prenatal teaching, a nurse should explain to clients that there is an increase in vaginal secretions during pregnancy called leukorrhea. What causes this increase? 1 Decreased metabolic rate 2 Increased production of estrogen 3 Secretion from the Bartholin glands 4 Supply of sodium chloride to the vaginal cells

While conducting prenatal teaching, a nurse should explain to clients that there is an increase in vaginal secretions during pregnancy called leukorrhea. What causes this increase? 1 Decreased metabolic rate Correct2 Increased production of estrogen Incorrect3 Secretion from the Bartholin glands 4 Supply of sodium chloride to the vaginal cells Increased estrogen production during pregnancy causes hyperplasia of the vaginal mucosa, which leads to increased production of mucus by the endocervical glands. The mucus contains exfoliated epithelial cells. Increased metabolism leads to systemic changes but does not increase vaginal discharge. The amount of secretion from the Bartholin glands, which lubricates the vagina during intercourse, remains unchanged during pregnancy. There is no additional supply of sodium chloride to the vaginal cells during pregnancy.