Exam 4 Ch. 11, 19 (evolve chapters: 27, 28, 29, 34)

Which of the following presentations is associated with early pregnancy loss, occurring in less than 12 weeks gestation? (Select all that apply.) A. Chromosomal abnormalities B. Infection C. Cystitis D. Antiphospholipid syndrome E. Hypothyroidism F. Caffeine use

50% of early pregnancy loss results from genetic abnormalities. Hypothyroidism and antiphospholipid syndrome are associated with early pregnancy loss. Caffeine use is associated with second-trimester losses as a result of maternal behavior. Infection is not a likely source of early pregnancy loss. Cystitis in not associated with early pregnancy loss. A, D, E

The nurse is caring for a client who gave birth vaginally two days ago. The nurse finds that the client has a blood pressure of 160/105 mm Hg. For what complications does the nurse monitor the client to ensure her safety? Select all that apply. A Renal failure B Hypovolemia C Liver damage D Brain damage E Pulmonary edema

A blood pressure reading of 160/105 mm Hg two days after delivery indicates chronic hypertension. The nurse should closely monitor the client for complications of chronic hypertension such as renal failure, pulmonary edema, and hypertensive encephalopathy. Hypovolemia does not occur in chronic hypertension. In fact, hypertension is associated with edema, resulting in hypervolemia. Liver damage may not be directly caused by chronic hypertension. Brain damage may also not be a direct complication of chronic hypertension after delivery. A, E

The nurse is assessing a pregnant client at 6 weeks of gestation. Upon reviewing the client's medical history, the nurse finds that the client had undergone a large cone biopsy. Which treatment strategy does the nurse expect to be most beneficial to prevent miscarriage in the client? A Administering misoprostol (Cytotec) orally for 7 days B Performing abdominal cerclage at 11 weeks of gestation C Placing a rescue cerclage in the cervix at 23 weeks of gestation D Administering ergonovine (Methergine) during the 3rd trimester

A client who has undergone a large cone biopsy may be at risk of miscarriage due to the presence of an extremely short cervix. Therefore, the primary health care provider would perform an abdominal cerclage at 11 or 13 weeks of gestation in order to prevent the opening of the cervical os. Misoprostol (Cytotec) is a prostaglandin analogue that induces miscarriage. Therefore, misoprostol (Cytotec) does not help to prevent miscarriage in the patient. Ergonovine (Methergine) causes uterine contractions and helps prevent excessive bleeding, but it does not prevent miscarriage. A rescue cerclage cannot be performed in a client who has undergone a large cone biopsy, because the client has a short cervix. B

Which manifestation does the nurse relate to hypoglycemia in a diabetic client? A Clammy skin B Rapid breathing C Nausea or vomiting D Increased urination

A client with hypoglycemia experiences sweating, pallor, and clammy skin. The hypoglycemic client has shallow respirations, whereas the hyperglycemic client takes rapid breaths. Hyperglycemia causes nausea and vomiting. The client with hypoglycemia experiences hunger. In cases of hyperglycemia, the kidneys excrete large volumes of urine in an attempt to regulate excess vascular volume. A

A pregnant client with pregestational insulin-dependent diabetes is going for a week's vacation to another state. What should the nurse ask the client to carry with her in order to prevent complications? Select all that apply. A Antibiotics B Insulin vials C Glucose tablets D Antihypertensives E Blood glucose meter

A client with pregestational diabetes should be very careful and should be prepared to tackle any complications associated with high or low blood sugar levels. The nurse should ask the client to carry the routine insulin medications. Hormonal effects of pregnancy can also cause hypoglycemia, which can be normalized by taking glucose tablets. The client should be able to find out her blood sugar levels any time. Therefore, the nurse should ask the client to take a glucometer for routine monitoring of blood sugar levels. Antibiotics should be taken only if the client has an infection. Antihypertensives would be required if the client has high blood pressure. B, C, E

A nurse is working with a diabetic client who recently found out she is pregnant. In coordinating an interdisciplinary team to help manage the client throughout the pregnancy, the nurse would include whom? Select all that apply. A Family practice physician B Dietician C Perinatologist D Occupational therapist E Nephrologist F Speech therapist

A dietician would be included in the interdisciplinary care team to help the client with dietary planning. A perinatologist would be included in the interdisciplinary care team to take care of both the mother and the fetus. A nephrologist would be included in the interdisciplinary care team to monitor renal function. A family practice physician would not be included but, rather, an internal medicine practitioner would be a member of the interdisciplinary care team. There is no need for an occupational therapist to be included unless there are other issues presented. There is no need for a speech therapist to be included unless there are other issues presented. B, C, E

*A pregnant client with gestational hypertension has very high blood pressure. The nurse learns that the gestational age of the fetus is 37 weeks. What is the best intervention to prevent complications in the client? A Instruct the client to stay on bed B Provide the client with a nutritious dietary plan C Prepare the client for induction of labor D Instruct the client to come next week

A gestational age of 37 weeks in a client with gestational hypertension and dangerously high blood pressure indicates that labor should be induced as soon as possible. After 37 weeks of gestation, there may be detrimental effects of gestational hypertension on the fetus. Bed rest may not help relieve high blood pressure and therefore is not beneficial to the fetus. Nutritious food is essential for the client throughout pregnancy irrespective of the fetus' gestational age, but not as important as inducing labor in this client at 37 weeks of gestation. Instructing the client to come next week may worsen the condition and may be fatal to the fetus. C

*A client gains excessive weight during pregnancy, her laboratory reports reveal low levels of placental growth factors, and she is expected to deliver during the colder months of the year. Which medication would help in reducing risk of preeclampsia in the patient? A Nifedipine (Adalat) B Low-dose aspirin (Anacin) C Magnesium sulfate (Sulfamag) D Vitamin C supplement (Vita-C)

A non-obese client who gains excessive weight during pregnancy is at an increased risk of developing preeclampsia. The low levels of placental growth factor and expected delivery during colder months of the year also increase the risk for preeclampsia. Low-dose aspirin (Anacin) helps lower the risk of preeclampsia and maintain general health. Nifedipine (Adalat) is an antihypertensive drug, not highly effective in preventing preeclampsia. Magnesium sulfate (Sulfamag) is the drug of choice for treating eclamptic seizures and preventing repeated seizures. A vitamin C supplement (Vita-C) does not help prevent preeclampsia. B

Which maternal risk is associated with placenta previa? A Preeclampsia B Placental abruption C Surgery-related trauma D Gestational hypertension

A patient with placenta previa has a cesarean birth, and is at risk for surgery-related trauma to the sutures adjacent to the uterus. Preeclampsia is a condition in which the patient has hypertension and proteinuria after 20 weeks of gestation. The patient is at risk for a placental abruption if the patient experiences a trauma. Gestational hypertension is a hypertensive disorder in a pregnant patient and is not related to placenta previa. C

Upon reviewing the ultrasonography reports of a pregnant client, the nurse finds that the placenta is at a distance of 2.5 cm from the internal cervical os. What complication is likely if the client has a vaginal delivery? A Hemorrhage B Hyperthyroidism C Thrombocytopenia D Hypofibrinogenemia

A placenta implanted in the lower uterine segment 2.5 cm from the internal cervical os indicates that the client has marginal placenta previa. In placenta previa, disruption of placental blood vessels occurs with stretching and thinning of the lower uterine segment, which results in bleeding. Therefore, the major maternal complication associated with placenta previa is hemorrhage. Hyperthyroidism is one of the serious complications of hydatidiform mole. Thrombocytopenia and hypofibrinogenemia are complications of abruptio placentae. A

Which of the following antihypertensive medications would cause a pregnant woman to have a positive Coombs test result? A. Nifedipine (Procardia) B. Methyldopa (Aldomet) C. Labetalol hydrochloride (Trandate) D. Hydralazine (Apresoline)

A positive Coombs test result can occur in about 20% of patients taking methyldopa (Aldomet). None of the other drugs listed would have this effect. B

The nurse is caring for a postpartum client with preeclampsia. What teaching does the nurse give the client before discharge from the hospital? A "Return to the hospital if you have epigastric pain." B "Take an analgesic if you have epigastric pain." C "If you get a headache, relax. It will subside in a while." D "Get an eye exam done if you have blurred vision."

A postpartum client with preeclampsia may have headache, visual disturbances, and epigastric pain. The epigastric pain may worsen the client's condition if left untreated, and therefore, the nurse should ask the client to return to the hospital or contact the health care provider. The client should not take analgesics unassisted because delaying the appropriate clinical treatment for the epigastric pain may worsen the symptoms of preeclampsia. The client should immediately report to the primary health care provider if she experiences headache and blurred vision, because these conditions may indicate worsening of the preeclampsia or indicate other reasons for concern. A

After assessing a client, the nurse concludes that the client has threatened miscarriage. What signs in the client would be consistent with the diagnosis? Select all that apply. A Blood spotting B Heavy bleeding C Closed cervical os D Mild uterine cramping E Decreased urine output

A pregnancy that ends from natural causes before 20 weeks of gestation results in miscarriage, or spontaneous abortion. Blood spotting, a closed cervical os, and mild uterine cramping are signs of a threatened miscarriage. Heavy bleeding is observed in inevitable and incomplete miscarriages. A threatened miscarriage does not affect urine output. Decreased urine output is a sign of placenta previa. A, C, D

FIX *What instruction does the nurse provide to parents of a preterm infant who has physiologic immaturity?* A "The child will have irreparable physiologic deformities." C "The child may be vulnerable to fluid and electrolyte imbalances later." D "The infant may need neurologic and developmental interventions later." E "The infant will have attention deficit hyperactivity disorder (ADHD)."

A preterm infant may have neurologic impairment after birth, which may result in behavioral and developmental problems later in life. Therefore the nurse instructs the parents that the infant may need neurologic and developmental interventions later. Telling the parents that the infant will have irreparable physiologic deformities will make the parents anxious. There may or may not be any deformities depending on the size and gestational age of infants at birth. Fluid and electrolyte imbalances are caused by fluid overload or dehydration and are treated with appropriate fluid replacement. The child may have ADHD or other neurologic problems, depending on the degree of immaturity at birth. C

*A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits what? A. A sleepy, sedated affect. B. A respiratory rate of 10 breaths/min. C. Deep tendon reflexes of 2+. D. Absent ankle clonus.

A respiratory rate of 10 breaths per minute indicates that the patient is experiencing respiratory depression (bradypnea) from magnesium toxicity. Because magnesium sulfate is a central nervous system (CNS) depressant, the woman will most likely become sedated when the infusion is initiated. Deep tendon reflexes of 2+ are a normal finding. Absent ankle clonus is a normal finding. B

A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits: A. A sleepy, sedated affect. B. A respiratory rate of 10 breaths/min. C. Deep tendon reflexes of 2+. D. Absence of ankle clonus.

A respiratory rate of 10 breaths/min indicates that the client is experiencing respiratory depression (bradypnea) from magnesium toxicity. Because magnesium sulfate is a central nervous system (CNS) depressant, the client will most likely become sedated when the infusion is initiated. Deep tendon reflexes of 2+ are a normal finding, as is absence of ankle clonus. B

Which infant has a higher possibility of sustaining a birth trauma? An infant who: A Was delivered by a vaginal birth B Has low glucose levels at birth C Has inborn errors of metabolism D Was born to a patient with a urinary tract infection

A vaginal birth increases the chance of injuries due to the use of forceps or vacuum extraction or from pressure of the fetal skull against the maternal pelvis. An infant with low glucose levels at birth is hypoglycemic. Inborn errors of metabolism refer to an inherited disease and are not a birth trauma. An infant born to a patient with a urinary tract infection has a higher chance of acquiring the infection, but this is not a birth trauma. A

The nurse is preparing to discharge a 30-year-old woman who has experienced a miscarriage at 10 weeks of gestation. Which statement by the woman indicates a correct understanding of the discharge instructions? A "I will not experience mood swings, because I was only at 10 weeks of gestation." B "I will avoid sexual intercourse for 6 weeks and pregnancy for 6 months." C "I should eat foods that are high in iron and protein to help my body heal." D "I should expect the bleeding to be heavy and bright red for at least 1 week."

A woman who has experienced a miscarriage should be advised to eat foods that are high in iron and protein to help replenish her body after the loss. After a miscarriage a woman may experience mood swings and depression from the reduction of hormones and the grieving process. Sexual intercourse should be avoided for 2 weeks or until the bleeding has stopped, and pregnancy should be avoided for 2 months. The woman should not experience bright red, heavy, profuse bleeding; this should be reported to the health care provider. C

A woman presents to the emergency department complaining of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary health care provider finds that the cervix is closed. The anticipated plan of care for this woman is based on a probable diagnosis of which type of spontaneous abortion? A. Incomplete B. Inevitable C. Threatened D. Septic

A woman with a threatened abortion presents with spotting, mild cramps, and no cervical dilation. Heavy bleeding, mild to severe cramping, and cervical dilation are the presentation for both incomplete abortion and inevitable abortion. A woman with a septic abortion presents with malodorous bleeding and, typically, a dilated cervix. C

What does the nurse include in the plan of care of a pregnant client with mild preeclampsia? Select all that apply. A Ensure prolonged bed rest. B Provide diversionary activities. C Encourage the intake of adequate fluids. D Restrict sodium and zinc in the diet. E Refer to Internet-based support group.

Activity is restricted in clients with preeclampsia, so it is necessary to provide diversionary activities to such clients to prevent boredom. The nurse encourages the client to increase fluid intake to an adequate level (six to eight 8-ounce glasses of water per day) to enhance renal perfusion and bowel function. The nurse can suggest Internet-based support groups to reduce boredom and stress in the client. Clients need to restrict activity, but complete bed rest is not advised, because it may cause cardiovascular deconditioning, muscle atrophy, and psychologic stress. The client needs to include adequate zinc and sodium in the diet for proper fetal development. B, C, E

*In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes what as the most important factor affecting pregnancy outcome? A Mother's age B Number of years since diabetes was diagnosed C Amount of insulin required prenatally D Degree of glycemic control during pregnancy

Although advanced maternal age may pose some health risks, for the woman with pregestational diabetes the most important factor remains the degree of glycemic control during pregnancy. The number of years since diagnosis is not as relevant to outcomes as the degree of glycemic control. The key to reducing risk in the pregestational diabetic woman is not the amount of insulin required but rather the level of glycemic control. Women with excellent glucose control and no blood vessel disease should have good pregnancy outcomes. D

The nurse is caring for an infant born after 38 6⁄7 weeks of gestation. Which term would best describe the infant's birth condition? A Preterm infant B Full-term infant C Postterm infant D Late preterm infant

An infant who is born between 39 and 40 weeks of gestation is considered full-term. This infant is born after 38 6⁄7 weeks of gestation, so it is a full-term infant. Preterm infants are those born before the completion of 37 weeks of gestation. Postterm infants are those born after 42 weeks of gestational age. Late preterm infant refers to an infant born between 34 and 36 6⁄7 weeks of gestation. B

A nurse is working with a diabetic patient who recently found out she is pregnant. In coordinating an interdisciplinary team to help manage the patient throughout the pregnancy, the nurse would include: (Select all that apply.) A. Family practice physician B. Dietician C. Perinatologist D. Occupational therapist E. Nephrologist F. Speech therapist

An internal medicine practitioner rather than family practice physician would be included on the interdisciplinary care team. A dietician would be included to help the patient with dietary planning, a perinatologist to take care of the maternal-fetal unit, and a nephrologist to monitor renal function. There is no need for an occupational therapist or a speech therapist unless other issues arise. B, C, E

A nurse is evaluating several obstetric patients for their risk for cervical insufficiency. Which patient would be considered to be most at risk? A. Primipara B. Grandmultip who has previously had all vaginal deliveries without a problem C. Primip who undergoes a cervical cone biopsy for cervical dysplasia prior to the pregnancy D. Multip who had her previous delivery via C section due to cephalopelvic disproportion (CPD)

Any patient who has had previous surgical interventions (cone biopsy) is at greater risk for cervical insufficiency. There is no indication that a primip is at risk for cervical insufficiency. A grandmultip who has previously had vaginal deliveries without incidence is not necessarily at an increased risk for cervical insufficiency. A multip who has delivered via C section as a result of CPD would not necessarily be at an increased risk as the issue involves pelvic adequacy as determined by pelvic measurements in relationship to the fetus. C

A pregnant woman who is at 21 weeks of gestation has an elevated blood pressure of 140/98. Past medical history reveals that the woman has been treated for hypertension. On the basis of this information, the nurse would classify this patient as having: A. Preeclampsia. B. Gestational hypertension. C. Superimposed preeclampsia. D. Chronic hypertension.

Because this patient already has a medical history of hypertension and is now exhibiting hypertension after to the 20th week of gestation, she would be considered to have superimposed preeclampsia. Preeclampsia would be the classification in a patient without a history of hypertension who was hypertensive following the 20th week of pregnancy. Gestational hypertension occurs after the 20th week of pregnancy in a patient who was previously normotensive. Even though the patient has chronic hypertension, the fact that she is now pregnant determines that she would be classified as having superimposed preeclampsia C

*The majority of ectopic pregnancies are located in the: A. Uterine fundus. B. Cervical os. C. Ampulla. D. Fimbriae.

Because this patient is most likely in the early stages of pregnancy, FHT would not be able to be auscultated at this time. Scant vaginal bleeding would not be a priority concern but should still be monitored by the nurse. Ecchymosis around the umbilicus indicates Cullen sign, which indicates hematoperitoneum, and may also develop in an undiagnosed, ruptured intraabdominal ectopic pregnancy. C

The primary health care provider requests that the nurse test for proteinuria in a pregnant client. What preliminary examination does the nurse perform before testing for proteinuria in order to get accurate results? Select all that apply. A Presence of blood in the urine B Presence of bacteria in the urine C Presence of sodium in the urine D Presence of uric acid in the urine E Presence of amniotic fluid in the urine

Before testing for the presence of proteinuria in a pregnant client, the nurse collects the urine sample for laboratory assessment to detect the presence of blood, bacteria, or amniotic fluid. These substances may interfere with the diagnostic results, leading to a false report. The presence of sodium and uric acid in the urine may help identify the condition of preeclampsia but does not give a false positive result in the test for protein in the urine. A, B, E

A woman at 37 weeks of gestation is admitted with a placental abruption after a motor vehicle accident. Which assessment data are most indicative of her condition worsening? A P 112, R 32, BP 108/60; FHR 166-178 B P 98, R 22, BP 110/74; FHR 150-162 C P 88, R 20, BP 114/70; FHR 140-158 D P 80, R 18, BP 120/78; FHR 138-150

Bleeding, which impacts the mother's well-being as well as that of her fetus, is the most dangerous problem. The decreasing blood volume would cause increases in pulse and respirations and a decrease in blood pressure. The fetus often responds to decreased oxygenation as a result of bleeding, causing a decrease in perfusion. This causes the fetus' heart rate to increase above the normal range of 120-160 beats per minute. The other options have measurements that are in the "normal" range and would not reflect a deterioration of the patient's physical status.

Which instruction about feeding does the nurse give to the parent of a low-birth-weight infant with septicemia? A "Don't breastfeed before administering the medications." B "You should breastfeed the infant every 3 hours." C "Use infant formulas for the first 2 weeks." D "You may choose not to breastfeed at all."

Breast milk contains iron-binding proteins that exert a bacteriostatic effect on E. coli. Breast milk also serves as a barrier to infection, because it contains macrophages and lymphocytes. The infant can be breastfed every 3 hours to ensure proper rest between the feeding intervals. It is not necessary to stop breastfeeding while administering medications, because the medicines do not interact with breast milk. Infant formulas are not advised, because they do not contain protective mechanisms against infection. The nurse should encourage the mother to breastfeed, because it is beneficial for the infant. B

What does the nurse tell the parent of a preterm infant who has birth asphyxia and is at risk of necrotizing enterocolitis? A "Breast milk will be given enterally." B "Probiotics are not given after birth." C "Report skin rashes immediately." D "Provide skin-to-skin (kangaroo) contact."

Breast milk provides passive immunity, macrophages, and lysosomes to the infant and helps prevent NEC. Probiotics like Lactobacillus acidophilus and Bifidobacterium infantis are given enterally to reduce the severity of NEC in infants after birth. Lethargy and abdominal distention, not skin rashes, are symptoms of NEC. Skin-to-skin care does not help prevent NEC; it is used to help infants maintain thermal stability. A

*Nurses should be aware that what is associated with HELLP syndrome? A Is a mild form of preeclampsia B Can be diagnosed by a nurse alert to its symptoms C Is characterized by hemolysis, elevated liver enzymes, and low platelets D Is associated with preterm labor but not perinatal mortality

C

Which TORCH infection could be contracted by the infant because the mother owned a cat? A. Toxoplasmosis B. Varicella-zoster C. Parvovirus B19 D. Rubella

Cats that eat birds infected with the Toxoplasma gondii protozoan excrete infective oocysts. Humans (including pregnant women) can become infected if they fail to wash their hands after cleaning a cat's litter box. The infection is passed through the placenta. The varicella-zoster virus is responsible for chickenpox and shingles. Approximately 90% of childbearing women are immune. During pregnancy, infection with parvovirus can result in abortion, fetal anemia, hydrops, intrauterine growth restriction (IUGR), and stillbirth; this virus is spread by vertical transmission, not by felines. Since vaccination for rubella was begun in 1969, cases of congenital rubella infection have been reduced significantly. Vaccination failures, lack of compliance, and the migration of nonimmunized persons result in periodic outbreaks of rubella (German measles). A

Which of the following would be considered to be an intrapartum risk factor for neonatal sepsis? A. Mechanical ventilation B. Chorioamnionitis C. Galactosemia D. Meconium aspiration

Chorioamnionitis would be considered to be an intrapartum risk factor. The other conditions described are neonatal risk factors B

What are the possible causes of miscarriage during early pregnancy? Select all that apply. A Premature dilation of cervix B Chromosomal abnormalities C Endocrine imbalance D Hypothyroidism E Antiphospholipid antibodies

Chromosomal abnormalities account for 50% of all early pregnancy losses. Endocrine imbalance is caused by luteal phase defects, hypothyroidism, and diabetes mellitus in pregnant patients and results in miscarriage. Antiphospholipid antibodies also increase the chances of miscarriage in pregnant patients. Premature dilation of the cervix may cause a second-trimester loss, and is usually seen in patients between 12 and 20 weeks of gestation. B, C, D, E

Which hypertensive disorders can occur during pregnancy? Select all that apply. A Chronic hypertension B Preeclampsia-eclampsia C Hyperemesis gravidarum D Gestational hypertension E Gestational trophoblastic disease

Chronic hypertension refers to hypertension that developed in the pregnant patient before 20 weeks of gestation. Preeclampsia refers to hypertension and proteinuria that develops 20 weeks after gestation. Eclampsia is the onset of seizure activity in a pregnant patient with preeclampsia. Gestational hypertension is the onset of hypertension after 20 weeks of gestation. Gestational trophoblastic disease and hyperemesis gravidarum are not hypertensive disorders. Gestational trophoblastic disease refers to a disorder without a viable fetus that is caused by abnormal fertilization. Hyperemesis gravidarum is excessive vomiting during pregnancy that may result in weight loss and electrolyte imbalance. A, B, D

*The nurse observes that a pregnant client with gestational hypertension who is on magnesium sulfate therapy is prescribed nifedipine (Adalat). What action does the nurse take? Evaluates the client's renal function test Obtains a prescription for a change of drug Reduces the nifedipine (Adalat) dose by 50% Administers both medications simultaneously

Concurrent use of nifedipine (Adalat) and magnesium sulfate can result in skeletal muscle blockade in the client. Therefore the nurse needs to report immediately to the primary health care provider (PHP) and obtain a prescription for a change of drug. The nurse assesses the client's renal function to determine the risk for toxicity after administering any drug. However, it is not a priority in this case. Reducing the nifedipine (Adalat) dose is not likely to prevent the drug interaction in the client. The nurse does not administer both drugs simultaneously, because it may be harmful for the client. B

Diabetes in pregnancy puts the fetus at risk in several ways. Nurses should be aware that: A. With good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern. B. The most important cause of perinatal loss in diabetic pregnancy is congenital malformations. C. Infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring. D. At birth, the neonate of a diabetic mother is no longer in any greater risk.

Congenital malformations account for 30% to 50% of perinatal deaths in diabetic pregnancies. Even with good control, sudden and unexplained stillbirth remains a major concern. Infants of diabetic mothers are at increased risk for respiratory distress syndrome, and the transition to extrauterine life is often marked by hypoglycemia and other metabolic abnormalities. B

*Diabetes in pregnancy puts the fetus at risk in several ways. What should nurses be aware of? A With good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern. B The most important cause of perinatal loss in diabetic pregnancy is congenital malformations. C Infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring. D At birth, the neonate of a diabetic mother is no longer at any greater risk.

Congenital malformations account for 30% to 50% of perinatal deaths. Even with good control, sudden and unexplained stillbirth remains a major concern. Infants of diabetic mothers are at increased risk for respiratory distress syndrome. The transition to extrauterine life often is marked by hypoglycemia and other metabolic abnormalities. B

Diabetes in pregnancy puts the fetus at risk in several ways. Of what should the nurse be aware regarding this? A With good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern B The most important cause of perinatal loss in diabetic pregnancy is congenital malformations C Infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring D At birth, the neonate of a diabetic mother is no longer in any greater risk

Congenital malformations account for 30% to 50% of perinatal deaths. Even with good control, sudden and unexplained stillbirth remains a major concern. Infants of diabetic mothers are at increased risk for respiratory distress syndrome. The transition to extrauterine life often is marked by hypoglycemia and other metabolic abnormalities. B

When a pregnant woman with diabetes experiences hypoglycemia while hospitalized, what should the nurse have the woman do? A Eat a candy bar. B Eat 5 or 6 hard candies or drink 8 oz of milk. C Drink 4 oz of orange juice followed by 8 oz of milk. D Drink 8 oz of orange juice with 2 teaspoons of sugar added.

Crackers provide carbohydrates in the form of polysaccharides. A candy bar provides only monosaccharides. Milk is a disaccharide and orange juice is a monosaccharide. This will provide an increase in blood sugar but will not sustain the level. Orange juice and sugar will increase the blood sugar, but not provide a slow-burning carbohydrate to sustain the blood sugar. B

*Which conditions during pregnancy can result in preeclampsia in the client? Select all that apply. A Genetic abnormalities B Dietary deficiencies C Abnormal trophoblast invasion D Cardiovascular changes E Maternal hypotension

Current theories consider that genetic abnormalities and dietary deficiencies can result in preeclampsia. Abnormal trophoblast invasion causes fetal hypoxia and results in maternal hypertension. Cardiovascular changes stimulate the inflammatory system and result in preeclampsia in the pregnant client. Maternal hypertension, and not hypotension, after 20 weeks of gestation is known as preeclampsia. A, B, C, D

The nurse is caring for a woman who is at 24 weeks of gestation with suspected severe preeclampsia. Which signs and symptoms should the nurse expect to observe? Select all that apply. A Decreased urinary output and irritability B Transient headache and +1 proteinuria C Ankle clonus and epigastric pain D Platelet count of less than 100,000/mm3 and visual problems E Seizure activity and hypotension

Decreased urinary output and irritability are signs of severe eclampsia. Ankle clonus and epigastric pain are signs of severe eclampsia. Platelet count of less than 100,000/mm3 and visual problems are signs of severe preeclampsia. A transient headache and +1 proteinuria are signs of preeclampsia and should be monitored. Seizure activity and hyperreflexia are signs of eclampsia. A, C, D

A pregnant woman has contacted the nurse about severe nausea and vomiting. What is the priority assessment in evaluating a pregnant woman with severe nausea and vomiting? A Fasting blood glucose level B Ketonuria C Bilirubin D White Blood cell count

Determination of ketonuria would be a critical assessment that would lead toward determination of hyperemesis. A pregnant client with severe nausea and vomiting may have hyperemesis gravidarum and, as such, requires critical monitoring to determine the nature of the problem. A FBS, although informative would not be the priority assessment at this time. Although a bilirubin level would be needed, it would not be the priority assessment. A WBC count would indicate the possibility of an infectious source but it would not be a priority assessment in terms of the client's presentation. B

The priority assessment in evaluating a pregnant woman with severe nausea and vomiting is: A. Fasting blood glucose level. B. Ketonuria. C. Bilirubin. D. White blood cell count.

Determination of ketonuria would be a critical assessment that would lead towards determination of hyperemesis. A pregnant patient with severe nausea and vomiting may have hyperemesis gravidarum and as such requires critical monitoring to determine the nature of the problem. An FBS measurement, although informative, would not be the priority assessment at this time, nor would a bilirubin measurement. A WBC count would indicate the possibility of an infectious source but it would not be a priority assessment in terms of the patient's presentation. B

The blood glucose level of a pregnant client is 325 mg/dl. Which test should be performed on the patient to assess the risk of maternal or intrauterine fetal death? A Ketones in urine B Glucose in urine C Arterial blood gases D Abdominal ultrasound

Diabetic ketoacidosis is a potentially fatal complication of diabetes that can lead to fetal death. This complication may occur if the client's blood glucose levels rise above 200mg/dl. Diabetic ketoacidosis can be confirmed by assessing the presence of ketones in the urine. The client's blood glucose level is 325 mg/dl and, hence, the patient has poorly controlled diabetes. Therefore, the nurse need not assess the urine glucose levels. Arterial blood gases and abdominal ultrasound are not useful for diagnosis of intrauterine fetal death. A

A nurse is examining a client who has been admitted for possible ectopic pregnancy who is approximately 8 weeks pregnant. Which finding would be a priority concern? A No FHT heard via Doppler B Scant vaginal bleeding noted on peri pad C Ecchymosis noted around umbilicus D Blood pressure 100/80

Ecchymosis around the umbilicus indicates Cullen's sign, which could represent a ruptured intrabdominal ectopic pregnancy. Because the client is most likely in the early stages of pregnancy, FHT would not be able to be auscultated at this time. Scant vaginal bleeding would not be a priority concern but should still be monitored by the nurse. C

*A pregnant client has a sudden onset of seizures during the 3rd trimester of pregnancy. After reviewing the client's medical history, the nurse learns that the client had hypertension and proteinuria since 21 weeks of gestation. What will the nurse infer from these findings? A The client has eclampsia. B The client has preeclampsia. C The client has chronic hypertension. D The client has gestational hypertension.

Eclampsia is a serious complication of pregnancy that is associated with the sudden onset of seizures. Eclampsia is usually preceded by premonitory signs and symptoms, including headache, blurred vision, abdominal pain, and altered mental status. However, convulsions can appear suddenly and without warning in a seemingly stable woman with only minimally elevated blood pressure. Preeclampsia is a condition in which the client has hypertension and proteinuria after 20 weeks of gestation, but preeclampsia is not associated with seizures. If the client has hypertension for more than 12 weeks after delivery, it indicates that client has chronic hypertension. Gestational hypertension is not associated with onset of seizures and proteinuria. Therefore, the nurse would not infer that the client has gestational hypertension. A

*Which condition is characterized by implantation of fertilized ovum outside the uterine cavity? A Placenta previa B Molar pregnancy C Ectopic pregnancy D Cervical insufficiency

Ectopic pregnancy is a condition in which the fertilized ovum is implanted outside the uterine cavity. Placenta previa is a condition in which the placenta is implanted in the lower uterine segment. Molar pregnancy is a benign proliferative growth of the placental trophoblast. In this condition, the chorionic villi develop into cystic and avascular transparent vesicles that hang in a grapelike cluster. Cervical insufficiency is characterized by passive and painless dilation of the cervix. It may lead to recurrent preterm birth during the second trimester in the absence of other causes. C

**Which medication should be administered to manage excessive bleeding in a woman after a miscarriage? Select all that apply. A Oxytocin (Pictoin) B Ampicillin (Amcill) C Ergonovine (Methergine) D Magnesium sulfate (Sulfamag) E Misoprostol (Cytotec)

Ergonovine (Methergine) is used to promote uterine contractions (UCs), which, in turn, prevent excessive bleeding following a miscarriage. Oxytocin (Pitocin) is used to prevent uterine hemorrhage. Ampicillin (Amcill) is an antibiotic used to treat infection, but it does not prevent bleeding. Magnesium sulfate (Sulfamag) is used to suppress UCs. Misoprostol (Cytotec) is a prostaglandin medication that can be used to manage the miscarriage, but only if there is no bleeding and infection. A, C

*Which patients with diabetes may develop complications if they perform exercises? Select all that apply. A A client who is on insulin B A client with diabetic ketoacidosis C A client with uncontrolled hypertension D A client with severe peripheral neuropathy E A client who has lost 5 kg weight after diagnosis

Exercise is usually prescribed for the prevention of complications in diabetic clients. However, a client with ketoacidosis should not do exercises, because exercises burn more fats and proteins, thereby increasing the blood ketone levels. Blood pressure increases with exercise; therefore, a client with uncontrolled blood pressure should not perform exercises. A client with severe peripheral neuropathy is susceptible to injury because of loss of sensations. Therefore, exercise is contraindicated in this client. A client with insulin dependent diabetes mellitus can perform exercises under supervision. Weight loss is a common complication associated with diabetes. A client who has lost weight can perform exercises to prevent complications of diabetes.B, C, D,

*Which infant is a likely candidate for receiving exogenous surfactant? A An infant with hypoglycemia born to a diabetic mother B preterm infant with a soft cranium at risk of cranial molding C An infant at risk for inborn error of metabolism, like galactosemia D A preterm infant with respiratory distress syndrome at birth

Exogenous surfactant helps to maintain lung expansion in infants with respiratory distress syndrome. Oral glucose is used for an infant with hypoglycemia at birth. A preterm infant is placed on a waterbed or a gel mattress to minimize the risk of cranial molding. Galactosemia is managed by eliminating lactose-containing food and milk from the infant's diet. D

Which client may need a cesarean delivery because of complications related to gestational diabetes? A A client with a big fetus B A client with uterine growth C A client with reduced fetal movement D A client with less than normal pelvic brim

Fetal macrosomia is a common complication associated with gestational diabetes. Hypersecretion of fetal insulin hormone as a response to maternal hyperglycemia results in an increased size of the fetus. Maternal hyperglycemia does not cause the development of uterine growths. Fetal movements may be cause for a cesarean, but they are not associated with the client's gestational diabetes. The size of the pelvic brim is not altered by maternal hyperglycemia. A

A pregnant woman at 14 weeks of gestation is admitted to the hospital with a diagnosis of hyperemesis gravidarum. The primary goal of her treatment at this time is to: A. Rest the gastrointestinal (GI) tract by restricting all oral intake for 48 hours. B. Reduce emotional distress by encouraging the woman to discuss her feelings. C. Reverse fluid, electrolyte, and acid-base imbalances. D. Restore the woman's ability to take and retain oral fluid and foods.

Fluid, electrolyte, and acid-base imbalances present the greatest immediate danger to the well-being of the mother and fetus and should be corrected as soon as possible. Resting the GI tract and discussing her feelings are components of treatment but are not immediate goals for this client. The ability to retain oral fluid and foods is a longer-term goal of treatment for this condition. C

The nurse is providing gavage feeding to an infant. What instruction should the nurse give to the parents to promote nutrition in the infant? A Provide a pacifier for sucking. B Place the infant in a polyethylene bag. C Provide kangaroo care to rest the infant. D Place the infant in different positions while feeding.

Gavage feeding is provided to an infant who experiences fatigue during sucking or to an infant who has respiratory depression (RD). The nurse should instruct the parents to provide a pacifier to the infant for nonnutritive sucking. Pacifiers enhance the oxygenation and sucking reflex in the infant. A polyethylene bag prevents heat and water loss from the infant's body and is unrelated to nutrition. Kangaroo care is skin-to-skin contact between the mother and the infant. Kangaroo care helps maintain the infant's body temperature. Placing the infant in different positions would disturb the baby while feeding and may not be helpful in promoting nutrition. A

*What are the manifestations of HELLP syndrome? Select all that apply. A Hemolysis B Tachycardia C Hyperventilation D Low platelet count E Elevated liver enzymes

HELLP syndrome is a serious condition that may develop during pregnancy in a client with preeclampsia. It is characterized by hemolysis due to the breakdown of red blood cells. The client may have a low platelet count, increasing the risk of bleeding and elevated liver enzymes due to impaired functioning of the liver. HELLP is not associated with an increase in heart rate, and may not result in tachycardia. The pulmonary functioning is not impaired in the client with HELLP syndrome. Therefore, hyperventilation is not a manifestation of HELLP syndrome. A, D, E

With regard to the classification of neonatal bacterial infection, nurses should be aware that: A. Congenital infection progresses slower than health care-associated infection. B. Health care-associated infection can be prevented by effective handwashing; early-onset infection cannot. C. Infections occur with about the same frequency in boy and girl infants, although female mortality is higher. D. The clinical sign of a rapid, high fever makes infection easier to diagnose.

Handwashing is an effective preventive measure for late-onset (health care-associated) infections because these infections come from the environment around the infant. Early-onset (congenital) infections are caused by the normal flora at the maternal vaginal tract. Congenital (early-onset) infections progress more rapidly than health care-associated (late-onset) infections. Infection occurs about twice as often in boys and results in higher mortality. Clinical signs of neonatal infection are nonspecific and similar to noninfectious problems, making diagnosis difficult. B

The nurse is assessing a client who is 18 weeks pregnant. The client reports heavy bleeding, infection, and excessive cramping. Which treatment strategy should be included in the treatment plan? A Suction curettage B McDonald technique C Administration of methotrexate (MTX) D Administration of misoprostol (Cytotec)

Heavy bleeding, infection, and excessive cramping are signs and symptoms of miscarriage. In this situation, fetal or placental tissue must be removed from the uterus by suction curettage. McDonald technique is used in case of cervical insufficiency. In this technique, suture is placed around the cervix beneath the mucosa to constrict the internal os of the cervix. MTX is used in the treatment of ectopic pregnancy. Misoprostol (Cytotec) is prostaglandin drug. If bleeding and infection are absent, then misoprostol (Cytotec) is used for miscarriage. A

A woman diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At present she is at the greatest risk for: A. Hemorrhage. B. Infection. C. Urinary retention. D. Thrombophlebitis.

Hemorrhage is the most immediate risk because the lower uterine segment has limited ability to contract to reduce blood loss. Infection is a risk because of the location of the placental attachment site; however, it is not a priority concern at this time. Placenta previa poses no greater risk for urinary retention or thrombophlebitis than does a normally implanted placenta. A

The quantitative human chorionic gonadotropin (β-hCG) levels are high in a client who is on methotrexate therapy for dissolving abdominal pregnancy. Which instruction does the nurse give to this client? A "Avoid sexual activity." B "Avoid becoming pregnant again." C "Avoid feeling sad and low." D "Take folic acid without fail."

High β-hCG levels indicate that the abdominal pregnancy is not yet dissolved. Therefore the nurse advises the client to avoid sexual activity until the β-hCG levels drop and the pregnancy is dissolved completely. If the client engages in vaginal intercourse, the pelvic pressure may rupture the mass and cause pain. Abdominal pregnancy increases the chances of infertility or recurrent ectopic pregnancy in clients. However, the nurse need not instruct the client to avoid further pregnancy, because it may increase the feelings of sadness and guilt in the client. The nurse encourages the client to share feelings of guilt or sadness related to pregnancy loss. Folic acid is contraindicated with methotrexate therapy, because it may exacerbate ectopic rupture. A

The nurse is working in an obstetric ward. Which client in the ward is at the highest risk of developing hydatidiform mole? A A client with hypothyroidism B A client with diabetes mellitus C A client with lupus erythematosus D A client with prior molar pregnancy

Hydatidiform mole is a benign proliferative growth of the placental trophoblast. In this condition the chorionic villi develop into edematous or avascular transparent vesicles, which hang in a grapelike cluster. A client with prior molar pregnancy is at a higher risk of developing hydatidiform mole. The presence of growing tissue in a molar pregnancy increases the risk of hydatidiform mole. Clients with hypothyroidism, diabetes mellitus, and lupus erythematosus are not at a higher risk of developing hydatidiform mole. D

*Which sign would the nurse observe in a client with hydatidiform mole? A Clear vaginal discharge B A small uterus C Decreased fetal heart rate E Dark brown vaginal discharge

Hydatidiform mole is characterized by the degeneration of the chorionic villi, in which the villi become vesicle-like. These vesicle-like substances are expelled from the vagina through a dark-brown or bright-red discharge. These are definite signs that the client has hydatidiform mole. Clear vaginal discharge may be a normal finding during pregnancy and may not indicate any complications. The fundal height is unusually more in molar pregnancy. The fetal heartbeat is absent as there is no viable fetus. D

*A client with severe gestational hypertension is prescribed hydralazine (Apresoline). What is a priority nursing intervention in this case? A Assess for visual disturbances. B Assess airway, breathing, and pulse. C Assess blood pressure frequently. D Prepare the patient for nonstress testing.

Hydralazine (Apresoline) is an antihypertensive medication. The nurse assesses the client's BP frequently, because a precipitous drop in BP can lead to shock and placental abruption. Visual disturbances are symptoms of severe preeclampsia, not a side effect of hydralazine (Apresoline). The nurse needs to assess airway, breathing, and pulse to stabilize a pregnant client after a convulsion. Nonstress testing is performed once or twice weekly to assess fetal well being. C

A woman with severe preeclampsia has been receiving magnesium sulfate by IV infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature 37.1° C, pulse rate 96 beats/min, respiratory rate 24 breaths/min, blood pressure 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for: A. Hydralazine. B. Magnesium sulfate bolus. C. Diazepam. D. Calcium gluconate.

Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. An additional bolus of magnesium sulfate may be ordered for increasing signs of central nervous system irritability related to severe preeclampsia (e.g., clonus) or if eclampsia develops. Diazepam sometimes is used to stop or shorten eclamptic seizures. Calcium gluconate is used as the antidote for magnesium sulfate toxicity. The client is not currently displaying any signs or symptoms of magnesium toxicity. A

The nurse is informing a diabetic pregnant client about the dietary changes, need for exercise and possible risks to the fetus. Which fetal risks does the nurse need to inform the client about? Select all that apply. A Fetal microsomia B Hypoglycemia C Respiratory distress syndrome D Galactosemia E Phenylketonuria

Hypoglycemia is seen in infants of diabetic women at birth, because the infant's glucose supply is removed abruptly at the time of birth. Fetal macrosomia (not microsomia) is seen in some infants born to diabetic women due to maternal hyperlipidemia and increased lipid transfer to the fetus. Hyperinsulinemia and hyperglycemia reduce fetal surfactant synthesis and cause respiratory distress syndrome in the infant of a diabetic woman. Galactosemia is an autosomal recessive disorder that results from various gene mutations. Phenylketonuria is an inborn error of metabolism. B, C

What are the manifestations associated with hypoglycemia? Select all that apply. A Dizziness B Fruity breath C Blurred vision D Excessive hunger E Presence of acetone in urine

Hypoglycemia refers to decreased blood sugar levels. Decreased availability of glucose impairs brain function, which results in dizziness and blurred vision. Decreased glucose levels stimulate the satiety center of the brain, which results in excessive hunger. Fruity breath and the presence of acetone in urine result from increased ketone levels in the blood. This complication may occur when the blood glucose increases over 300 mg/dl in the non-pregnant client and 200 mg/dl in the pregnant client. A, C, D

The nurse is caring for a neonate with intrauterine growth restriction (IUGR). The nurse observes that the neonate is restless, lethargic, and hypothermic. What immediate intervention does the nurse provide to ensure the neonate's safety? A Administer water feeding. B Provide ventilator support. C Stop formula feeding for 2 days. D Immediately assess the newborn's blood sugar level.

IUGR causes restricted growth patterns in the neonate, resulting in complications like hypoglycemia and polycythemia. Reduced body temperature (hypothermia) is characteristic of hypoglycemia. Restlessness and lethargy are other symptoms that indicate hypoglycemia. The nurse should immediately assess the blood sugar levels, and administer dextrose the blood sugar is found to be less. Water feeding is avoided in neonates, as it may cause water intoxication. Ventilator support is provided in the case of neonatal respiratory depression. Immediate formula feed or mother's milk should be encouraged for neonates with hypoglycemia. D

*What signs in a pregnant preeclamptic client would indicate the invasion stage of the tonic-clonic seizures? Select all that apply. A Fixed eyes B Bloodshot eyes C Protruding eyes D Stertorous inhalation E Twitching of facial muscles

If a pregnant client with preeclampsia is in the tonic-clonic convulsion stage, the nurse may observe signs such as fixed eyes and twitching of facial muscles. These signs last for only 2 to 3 seconds. Bloodshot eyes and protruding eyes are signs of the stage of contraction. Stertorous inhalation can be observed in the stage of convulsion but is not seen in the stage of invasion. A, E

The nurse is caring for a pregnant client with preeclampsia. The client reports severe and persistent epigastric pain. The primary health care provider orders a blood test. What result may indicate a worsening liver function? A Increased red blood cell levels B Decreased serum creatinine levels C Decreased platelet count D Increased liver transaminase levels

If a pregnant client with preeclampsia reports severe and persistent epigastric pain, it often indicates impaired liver function. An increase in liver transaminases to twice the normal levels in the blood confirms liver damage. Preeclampsia is characterized by a decrease in red blood cells. An increase in serum creatinine levels indicates renal insufficiency and is not related to liver damage. A decreased platelet count does occur in preeclampsia, but this does not cause severe persistent epigastric pain. Epigastric pain is pathognomonic of liver damage. D

Which pregnant patient is a likely candidate for expectant management? A A molar pregnancy that has a risk for vaginal bleeding B A patient who is 32 6⁄7 weeks of gestation, who is likely to deliver soon C A patient diagnosed with preeclampsia who is on an antihypertensive medication D A patient with a threatened miscarriage that has no bleeding or infection

If bleeding and infection does not occur after a threatened miscarriage, then the patient is managed expectantly to continue the pregnancy successfully. Molar pregnancy is terminated as soon as it is identified and hence there is no need for expectant management. A patient with 32 6⁄7 weeks of gestation who is likely to deliver soon does not need to be managed expectantly. A patient with preeclampsia who is on an antihypertensive medication does not need expectant management as the condition can be managed at home. D

A pregnant client reports painless vaginal bleeding at 22 weeks of gestation. The client's ultrasonographic reports reveal a normally implanted placenta. What examination does the nurse perform immediately in the client? A Non-stress test (NST) B Speculum examination C Biophysical profile (BPP) D Kleihauer-Betke (KB) test

If the client has a normally implanted placenta, then a speculum examination should be performed immediately to rule out local causes of bleeding. NST and BPP are performed every 2 to 3 weeks for fetal surveillance. A KB test is performed to determine the presence of transplacental hemorrhage. B

With regard to injuries to the infant's plexus during labor and birth, nurses should be aware that: A. If the nerves are stretched with no avulsion, they should recover completely in 3 to 6 months. B. Erb palsy is damage to the lower plexus. C. Parents of children with brachial palsy are taught to pick up the child from under the axillae. D. Breastfeeding is not recommended for infants with facial nerve paralysis until the condition resolves.

If the ganglia are disconnected completely from the spinal cord, the damage is permanent. Erb palsy is damage to the upper plexus and is less serious than brachial palsy. Parents of children with brachial palsy are taught to avoid picking up the child under the axillae or by pulling on the arms. Breastfeeding is not contraindicated in facial nerve paralysis, but both mother and infant will need help from the nurse at the start. A

*Which is an important nursing intervention when a client has an incomplete miscarriage with heavy bleeding? A Initiate expectant management at once. B Prepare the client for dilation and curettage. C Administer the prescribed oxytocin (Pitocin). D Obtain a prescription for ergonovine (Methergine).

In the case of an incomplete miscarriage, sometimes there is heavy bleeding and excessive cramping and some part of fetal tissue remains in the uterus. Therefore the nurse needs to prepare the client for dilation and curettage for the removal of the fetal tissue. Expectant management is initiated if the pregnancy continues after a threatened miscarriage. Oxytocin (Pitocin) is administered to prevent hemorrhage after evacuation of the uterus. Ergonovine (Methergine) is administered to contract the uterus. B

*Which conditions is the nurse alert for in a preterm infant with respiratory distress syndrome? Select all that apply. A Hypoxemia B Metabolic acidosis C Pulmonary hemorrhage D Mucus plugging E Jaundice

Inadequate pulmonary perfusion and ventilation produce hypoxemia and hypercapnia in the preterm infant. Prolonged hypoxemia increases the amounts of lactic acid and results in metabolic acidosis. Pulmonary hemorrhage and mucus plugging are side effects of surfactant therapy used in an infant with respiratory distress syndrome. Jaundice is not caused by respiratory distress syndrome. It occurs due to an increase in bilirubin levels in the blood. A, B

The nurse is assessing an infant born at 35 weeks of gestation. The nurse observes that the infant has delayed gastric emptying and the mother reports the infant has had very few bowel movements. What other sign should the nurse monitor in the infant? A Hypotonia B Periodic breathing C Acrocyanosis of the skin D Yellow discoloration of eyes

Infants born between 34 and 36 weeks of pregnancy are called "late preterm infants." Stomach fullness and reduced bowel movements are the signs and symptoms of slow gastric function. Decreased gastric motility causes excretion of bilirubin, which may result in hyperbilirubinemia in newborns because of an underdeveloped liver. Therefore, the nurse must monitor the infant for yellow discoloration of the eyes, which is a sign of jaundice. Hypotonia and periodic breathing may indicate meconium aspiration syndrome (MAS); however, they may not be related to hyperbilirubinemia. Acrocyanosis of the skin is a normal observation in the newborn D

Which statement by the nursing student about the prevention of health care-associated infections (HAIs) in a nursery unit indicates effective learning? A "Changing used equipment often may cause HAIs." B "Hand washing helps to prevent HAIs in a nursery unit." C "Nursery visitors are allowed if they wear masks." D "Soiled diapers are kept far from the children's beds."

Infants in the nursery unit are at a high risk for infections. Hence the most effective way to prevent infection is effective hand washing. The equipment used for the infants, such as nasogastric or intravenous tubing, needs to be changed frequently because they may get contaminated and cause infections. Visitors should be instructed not to overcrowd the nursery and to wash their hands before entering. Keeping soiled diapers away from the children is not enough, because only proper disposal will help to prevent infections. B

A male infant at 26 weeks of gestation arrives from the delivery room intubated. The nurse weighs the infant, places him under the radiant warmer, and attaches him to the ventilator at the prescribed settings. A pulse oximeter and cardiorespiratory monitor are placed. The pulse oximeter is recording oxygen saturations of 80%. The prescribed saturations are 92%. The nurse's most appropriate action is to: A listen to breath sounds and ensure the patency of the endotracheal tube, increase oxygen, and notify the physician. B continue to observe and make no changes until the saturations are 75%. C continue with the admission process to ensure that a thorough assessment is completed. D notify the parents that their infant is not doing well.

Listening to breath sounds, ensuring the patency of the endotracheal tube, increasing oxygen, and notifying the physician are appropriate nursing interventions to assist in optimal O2 saturation of the infant. Oxygenation of the infant is crucial. O2 saturation should be maintained at more than 92%. The nurse should delay other tasks to stabilize the infant. Notifying the parents is not appropriate. Further assessment and intervention are warranted before determination of fetal status. A

Which synthetic surfactant would be beneficial for treatment of respiratory distress syndrome (RDS) in a premature infant? A Beractant (Survanta) B Calfactant (Infrasurf) C Lucinactant (Surfaxin) D Poractant alpha (Curosurf)

Lucinactant (Surfaxin) is a synthetic surfactant that is used to treat RDS in premature infants. Beractant (Survanta) is an exogenous surfactant that is derived from bovine lung extract. Calfactant (Infrasurf) is a natural surfactant extracted from calf lung lavage. Poractant alpha (Curosurf) is a modified porcine-derived minced lung extract. Beractant (Survanta), calfactant (Infrasurf), and poractant alpha (Curosurf) are used to correct deficiency in lung immaturity from RDS. C

The nurse is caring for a client with severe preeclampsia who is on an intravenous (IV) infusion of magnesium sulfate (Sulfamag). What assessment parameter indicates that the treatment is a success? A Edema is reduced B Seizures do not occur C Blood pressure is reduced D Respiratory rate is reduced

Magnesium sulfate (Sulfamag) is administered to a client with preeclampsia to prevent seizures. The treatment is evaluated as successful if the seizures cease. A decrease in edema and blood pressure indicates reduced severity of preeclampsia in the client but is not caused by the magnesium sulfate (Sulfamag). A decreased respiratory rate in the client is considered an adverse effect of magnesium sulfate (Sulfamag) and requires the primary health care provider to attend to the client immediately. B

A woman with severe preeclampsia is being treated with an IV infusion of magnesium sulfate. This treatment is considered successful if: A. Blood pressure is reduced to prepregnant baseline. B. Seizures do not occur. C. Deep tendon reflexes become hypotonic. D. Diuresis reduces fluid retention.

Magnesium sulfate is a central nervous system (CNS) depressant given primarily to prevent seizures. A temporary decrease in blood pressure can occur but is not the purpose of administering this medication. Hypotonia is a sign of an excessive serum level of magnesium. It is critical that calcium gluconate be on hand to counteract the depressant effects of magnesium toxicity. Diuresis is not an expected outcome of magnesium sulfate administration. B

=====A nurse providing care to preterm infants should understand that nasogastric and orogastric tubes are used to assist in what? A Help maintain body temperature B Provide oxygen and ventilation C Replace surfactants D Feed the infant

Nasogastric and orogastric tubes are used in gavage feeding, providing breast milk or formula directly to an infant unable to nipple feed. Nasogastric and orogastric tubes are not used in order to help maintain body temperature. This infant should be placed on a warmer. Nasogastric and orogastric tubes cannot provide O2 and ventilation. Supplemental oxygen, continuous positive airway pressure (CPAP), and a ventilator are used for O2 and ventilation. Surfactants are not replaced by using nasogastric or orogastric tubes. D

The nurse places a newborn weighing 1400 g in a polyethylene bag. Why would the nurse do this? A To prevent heat loss. B To prevent infections. C To avoid electrolyte loss. D To avoid bluish discoloration.

Newborns weighing 1400 g are considered very low birth weight babies, and these infants are at a higher risk for hypothermia. Therefore, the nurse places the newborn in a polyethylene bag to decrease heat and water loss. The nurse should constantly monitor the neonate for an increase in body temperature to assess if the infant is developing an infection. The nurse administers antibiotics as ordered by the primary health care provider to treat infections. Total parenteral nutrition (TPN) is administered to avoid electrolyte loss in newborns and is unrelated to polyethylene bags. Using a polyethylene bag is not useful for improving the oxygen saturation levels in the baby. Therefore, its use would not help to prevent cyanosis or bluish discoloration. A

*The nurse is caring for a client with preeclampsia who gave birth by cesarean section. The primary health care provider prescribes a nonsteroidal antiinflammatory pain medication to the client. What parameter does the nurse closely monitor in this client? A White blood cell (WBC) count B Respiratory rate C Blood pressure D Prothrombin time

Nonsteroidal antiinflammatory drugs should be used with caution in clients with preeclampsia. Because preeclampsia is associated with hypertension, these medications may have the potential to further increase such clients' blood pressure. Therefore, the nurse should closely monitor the client's blood pressure. White blood cells are unaffected by nonsteroidal antiinflammatory drugs, and monitoring the WBC count is not required. Monitoring the respiratory rate is essential in preeclampsia associated with seizures and is unrelated to the use of nonsteroidal antiinflammatory drugs. The prothrombin time is usually unchanged in preeclampsia and is not a complication of the administration of nonsteroidal antiinflammatory drugs. C

Which is a priority nursing intervention when providing care for a high risk infant? A Touching the infant often B Providing enteral feeding C Helping the infant conserve energy D Encouraging breastfeeding

Nursing interventions should be implemented in a way that facilitates the conservation of energy in a high risk infant. The infant can then use this energy for growth and development. To prevent stress the nurse avoids touching the infant often. Enteral feeding may be contraindicated in some infants to prevent complications. Breastfeeding may not be possible in infants with respiratory distress syndrome and therefore parenteral nutrition may be required. C

The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is: A. Bleeding. B. Intense abdominal pain. C. Uterine activity. D. Cramping.

Pain is absent with placenta previa and may be agonizing with abruptio placentae. Bleeding, uterine activity, and cramping may be present in varying degrees for both placental conditions. B

**The nurse is preparing a diet plan for a pregnant client with preeclampsia. What does the nurse include in the client's diet? Select all that apply. A Food with low fiber content B Four to five cups of coffee per day C Food with low sodium content D Food with high zinc content E Six to eight glasses of water per day

Patients with preeclampsia may have edema, which may worsen with excessive salt intake. Therefore, the diet plan of a pregnant client with preeclampsia should include not more than 1.5 gm of sodium per day. The diet plan should also include food with high zinc content to prevent anemia caused by preeclampsia. The patient should drink six to eight 8-ounce glasses (approximately a liter) of water per day to maintain adequate fluid in her body. A pregnant patient should consume fiber-rich food to prevent constipation. The pregnant client with preeclampsia should limit her caffeine intake and should not consume excessive coffee. C, D, E

A client reports painless, bright-red vaginal bleeding during the second trimester of pregnancy. Upon assessment, the nurse finds that the client's urine output has decreased, the fundal height has increased, and the uterus is nontender with normal tone. What does the nurse interpret from these findings? A The client has placenta previa. B The client has ectopic pregnancy. C The client has hydatidiform mole. D The client has normal development.

Placenta previa is an obstetric complication in which the placenta is implanted partially or completely in the lower uterine segment (near to or covering the cervix). Painless, bright-red vaginal bleeding takes place during the second trimester. Decreased urine output, greater-than-expected fundal height, and a nontender uterus with normal tone are signs of placenta previa. In ectopic pregnancy the fertilized ovum is implanted outside the uterine cavity. Hydatidiform mole is a benign proliferative growth of the placental trophoblast in which the chorionic villi develop into cystic vesicles that hang in a grapelike cluster. Decreased urine output is a complication seen in clients with diffused intravascular coagulopathy (DIC). A

A pregnant client after 20 weeks of gestation reports painless bright red vaginal bleeding. Upon assessment the nurse finds that the client's vital signs are normal. Which condition does the nurse suspect in the patient? A Eclampsia B Preeclampsia C Pyelonephritis D Placenta previa

Placenta previa is indicated by painless bright red vaginal bleeding during the second or third trimester of pregnancy. The client's vital signs may be normal even after blood loss, because a pregnant client can lose up to 40% of the blood volume without any signs of shock. Eclampsia is the onset of seizure activity in a client with preeclampsia. Preeclampsia is indicated by hypertension and proteinuria after 20 weeks of gestation. Pyelonephritis, which is identified by fever, shaking chills, and aching in the lumbar area of the back, is an infection caused by the E. coli organism. D

What are the risk factors for necrotizing enterocolitis (NEC) in preterm infants? Select all that apply. A Hypovolemia B Polycythemia C Hydrops fetalis D Myelomeningocele E Maternal steroid therapy

Polycythemia and myelomeningocele are the two factors that can pose risk of NEC in preterm infants. Hypovolemia, hydrops fetalis, and maternal steroid therapy with drugs like betamethasone place an infant at increased risk for respiratory distress syndrome (RDS). B, D

*For what condition is a client at risk in early pregnancy due to poorly controlled hyperglycemia? A Miscarriage B Hydramnios C Preeclampsia D Ketoacidosis

Poorly controlled hyperglycemia at the time of conception and early pregnancy often leads to miscarriage. The risk of having a miscarriage increases with the duration and severity of the client's diabetes. Hydramnios occurs in the third trimester of pregnancy in the diabetic client. It may be due to increased glucose concentration in the amniotic fluid from maternal and fetal hyperglycemia, which induces fetal polyuria. Preeclampsia occurs in later pregnancy and in the postpartum period. Pregnant clients with poorly controlled hyperglycemia at the beginning of pregnancy, especially if combined with nephropathy and hypertension, are at higher risk of developing preeclampsia. Ketoacidosis occurs in the second and third trimesters. This is the accumulation of ketones in the body due to hyperglycemia, and it may lead to metabolic acidosis. A

A nurse is monitoring a patient's reflexes (DTRs) while receiving magnesium sulfate therapy for treatment of preeclampsia. Which assessment finding indicates a cause for concern? A. Bilateral DTRs noted at 2+ B. DTRs response has been noted at 1+ since onset of therapy C. Positive clonus response elicited unilaterally D. Patient reports no pain upon examination of DTRs by nurse

Positive clonus response elicited unilaterally is a cause for concern as it suggests a hyperactive response. Typically, there is no pain associated with determination of DTRs so this finding would be considered to be normal, as would bilateral DTRs noted at 2+. Even though DTRs at 1+ indicate a sluggish or decreased response, this finding is unchanged since the initiation of therapy. The nurse would continue to monitor. C

A nurse is monitoring a client's reflexes (DTRs) while receiving magnesium sulfate therapy for treatment of preeclampsia. Which assessment finding indicates a cause for concern? A Bilateral DTRs noted at 2+ B DTRs response has been noted at 1+ since onset of therapy C Positive clonus response elicited unilaterally D Client reports no pain upon examination of DTRs by nurse.

Positive clonus response elicited unilaterally is a cause for concern, because it suggests a hyperactive response. Bilateral DTRs noted at 2+ would indicate a normal finding. Even though this finding indicates a sluggish or decreased response, this is unchanged since the initiation of therapy. The nurse would continue to monitor. Typically, there is no pain associated with determination of DTRs so this finding would be considered normal. C

A nurse caring for pregnant women must be aware that the most common medical complication of pregnancy is: A. Hypertension. B. Hyperemesis gravidarum. C. Hemorrhagic complications. D. Infections.

Preeclampsia and eclampsia are two noted, deadly forms of hypertension, which is the most common medical complication of pregnancy. A large percentage of pregnant women have nausea and vomiting, but a relative few have the severe form called hyperemesis gravidarum. Hemorrhagic complications are the second most common medical complication of pregnancy. A

**Which condition can be predicted in a pregnant client if uterine artery Doppler measurements in the second trimester of pregnancy are abnormal? Preeclampsia HELLP syndrome Molar pregnancy Gestational hypertension

Preeclampsia is a condition in which clients develop hypertension and proteinuria after 20 weeks of gestation. It can be predicted if uterine artery Doppler measurements in the second trimester of pregnancy are abnormal. HELLP syndrome is characterized by hemolysis (H), elevated liver enzymes (EL), and low platelet count (LP) in a patient with preeclampsia. Molar pregnancy refers to the growth of the placental trophoblast due to abnormal fertilization. Gestational hypertension is a condition in which hypertension develops in a client after 20 weeks of gestation. A

A patient who is pregnant already has Type 2 diabetes with a hemoglobin A1c value of 7. The nurse would categorize this patient as having: A. Gestational diabetes. B. Insulin-dependent diabetes complicated by pregnancy. C. Pregestational diabetes mellitus. D. Non-insulin-dependent diabetes with complications.

Pregestational diabetes mellitus is a term used to describe patients with type 1 or type 2 diabetes in whom diabetes existed prior to pregnancy. Gestational diabetes occurs when a woman becomes diabetic during the pregnancy state. Type 2 diabetes is non-insulin-dependent. None of the information presented indicates complications at this point, because the hemoglobin A1c is within normal range, signifying adequate glycemic control. C

*The insulin dose of a client in the second trimester of pregnancy has been increased. When does the nurse expect the client's prepregnant dose of insulin to be recommended again? A When the client starts lactating B When the client delivers the baby C When the client is in the third trimester D When the client weans the baby from breastfeeding

Pregnancy hormones cause increased glucose tolerance and decreased sensitivity to insulin. This results in an increased need of insulin to obtain glycemic control. In this case, the client's glucose metabolism would reach its prepregnant state only when the client stops breastfeeding the baby. During lactation, the maternal glucose is utilized and, therefore, the client would require a low dose of insulin. When the client delivers the baby, the insulin-glucose levels do not return to their nonpregnant state immediately. Therefore, the client still has to continue with the recommended high insulin dose for some time. During the third trimester, the diabetogenic effect of hormones is excessive, and maternal insulin requirements may double. D

The nurse is assessing a pregnant client who is a chronic smoker and lives in a high altitude area. Which pregnancy-related risk may be high in the client? A Placental previa B Molar pregnancy C Abruptio placenta D Ectopic pregnancy

Pregnant women who live at high altitudes or are smokers have lower blood oxygenation. A decrease in the uteroplacental oxygenation leads to an increase in the placental surface area. Therefore, the client is more likely to have placenta previa. Molar pregnancy is more common in pregnant women who have had a prior molar pregnancy and those who are in their early teens or older than 40 years of age. Pregnant clients with hypertension may have a high risk of having abruptio placenta. Clients with tubal infection or damage are at risk of having ectopic pregnancies. A

The nurse finds diuresis, weight loss, and muscle atrophy in a pregnant client with mild preeclampsia. What could the nurse conclude from these findings? A The client was mostly on a liquid diet. B The client was on prolonged bed rest. C The client has developed HELLP syndrome. D The client is at risk for placental abruption.

Prolonged bed rest in clients with preeclampsia may result in diuresis and fluid, electrolyte, and weight loss. Therefore the nurse advises the client to restrict activity instead of taking complete bed rest. A liquid diet may contribute to weight loss, but does not cause diuresis or muscle atrophy. HELLP syndrome is characterized by hemolysis (H), elevated liver enzymes (EL), and low platelet count (LP) in a patient with preeclampsia. Vaginal bleeding will indicate placental abruption in the client. B

*What does the nurse assess to detect the presence of a hypertensive disorder in a pregnant client? Select all that apply. A Proteinuria B Epigastric pain C Placenta previa D Presence of edema E Blood pressure (BP)

Proteinuria indicates hypertension in a pregnant client. Proteinuria is concentration ≥300 mg/24 hours in a 24-hour urine collection. The nurse needs to assess the client for epigastric pain, because it indicates severe preeclampsia. Hypertension is likely to cause edema or swollen ankles due to greater hydrostatic pressure in the lower parts of the body. Therefore the nurse needs to assess the client for the presence of edema. Accurate measurement of BP will help detect the presence of any hypertensive disorder. A systolic BP >140 mm Hg or a diastolic BP >90 mm Hg will indicate hypertension. Placenta previa is a condition wherein the placenta is implanted in the lower uterine segment covering the cervix, which causes bleeding when the cervix dilates. A, B, D, E

*Which finding in a urine specimen of a pregnant patient indicates the client has proteinuria? A Value of greater than or equal to 0.5+ protein in a dipstick testing B Protein concentration that is greater than 300 mg/24 hours C Concentration of greater than or equal to 1 g protein in a 24-hour urine collection D Protein concentration at 10 mg/dl in random urine specimen

Proteinuria is determined from dipstick testing on a clean-catch or catheterized urine specimen or evaluation of a 24-hour urine collection. Protein concentration that is greater than 300 mg/24 hours in a 24-hour urine specimen indicates proteinuria. A concentration of greater than or equal to 5 g protein in a 24-hour urine collection will indicate severe preeclampsia. Protein concentration greater than 30 mg/dl in at least two random urine specimens collected at least 6 hours apart will indicate proteinuria. Value of greater than or equal to 1+ on dipstick measurement indicates proteinuria. B

*Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. What is an appropriate management approach for this type of abortion? A. Prepare the woman for a dilation and curettage (D&C). B. Put the woman on bed rest for at least 1 week and reevaluate. C. Prepare the woman for an ultrasound and blood work. D. Comfort the woman by telling her that if she loses this baby, she may attempt to get pregnant again in 1 month.

Repetitive transvaginal ultrasounds and measurement of human chorionic gonadotropin (hCG) and progesterone levels may be performed to determine whether the fetus is alive and within the uterus. Bed rest is recommended for 48 hours initially. D&C is not considered until signs of the progress to inevitable abortion are noted or the contents are expelled and incomplete. If the pregnancy is lost, the woman should be guided through the grieving process. Telling the client that she can get pregnant again soon is not a therapeutic response because it discounts the importance of this pregnancy. C

The nurse is caring for an infant born at 28 weeks of gestation. Which complication can the nurse expect to observe during the course of the infant's hospitalization? Select all that apply. A Polycythemia B Respiratory distress syndrome C Meconium aspiration syndrome D Periventricular hemorrhage E Persistent pulmonary hypertension F Patent ductus arteriosus

Respiratory distress syndrome, periventricular hemorrhage, and a patent ductus arteriosus are common complications with preterm infants. Polycythemia, meconium aspiration syndrome, and persistent pulmonary hypertension are complications of postmaturity. B, D, F

*Upon reviewing the mother's record, the nurse identifies a prenatal fever and rupture of membranes 36 hours prior to admission. Which finding in the newborn's clinical presentation does the nurse find as normal, rather than an indication of possible sepsis? A Grunting, nasal flaring B Increased oxygen saturation C Bradycardia D Temperature instability

Respiratory system manifestations of sepsis in the neonate include decreased O2 saturation, apnea, tachypnea, grunting, nasal flaring, retractions, and metabolic acidosis. Cardiovascular indicators include: Decreased cardiac output, tachycardia or bradycardia, hypotension and decreased perfusion. Temperature instability, lethargy, hypotonia, irritability and seizures are all central nervous system manifestations of sepsis. The earliest clinical signs of neonatal sepsis are characterized by their lack of specificity. If a thorough assessment of the infant indicates possible sepsis, the physician should be notified in order for appropriate lab work to be ordered. B

*Which conditions does the nurse remain alert for in a pregnant client with preeclampsia? Select all that apply. A Seizures B Scotoma C Renal disease D Cerebral edema E Chronic hypertension

Seizures may be seen due to the central nervous system irritability in the patient. Scotoma is a visual disturbance that is seen in a patient with preeclampsia due to arteriolar vasospasms and decreased blood flow to the retina. Cerebral edema is a neurologic complication associated with preeclampsia. Chronic hypertension is seen in pregnant clients before pregnancy and is not associated with preeclampsia. Renal disease is a risk factor that may cause preeclampsia in the client. A, B, D

Which condition in a pregnant client with severe preeclampsia is an indication for administering magnesium sulfate? A Seizure activity B Renal dysfunction C Pulmonary edema D Low blood pressure (BP)

Severe preeclampsia may cause seizure activity or eclampsia in the client, which is treated with magnesium sulfate. Magnesium sulfate is not administered for renal dysfunction and can cause magnesium toxicity in the patient. Pulmonary enema can be prevented by restricting the client's fluid intake to 125 ml/hr. Increasing magnesium toxicity can cause low BP in the client. A

*After placing an infant in the radiant warmer bed, the nurse observes that the infant has cyanosis, bradycardia, and 90% oxygen saturation. What immediate care should the nurse provide? A Provide oxygen hood therapy. B Provide rapid heat therapy. C Administer dextrose intravenously. D Administer antibiotics as prescribed.

Signs such as cyanosis, bradycardia and low oxygen saturation indicate that the infant is hypoxic. Therefore, the nurse should provide hood therapy to supply oxygen to the infant. The nurse should avoid providing rapid heat when the infant is hypoxic, and, instead, should provide oxygen supply to maintain oxygen saturation levels (greater than 92%). Dextrose should be administered if the infant has reduced glucose levels (less than 40 mg/dl). Antibiotics are prescribed when the infant has unregulated respiratory depression and it is suspected that sepsis might develop. A

A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes. The nurse caring for this client understands that: A. Oral hypoglycemic agents can be used if the woman is reluctant to give herself insulin. B. Dietary modifications and insulin are both required for adequate treatment. C. Glucose levels are monitored by testing urine four times a day and at bedtime. D. Dietary management involves distributing nutrient requirements over three meals and two or three snacks.

Small frequent meals over a 24-hour period help decrease the risk for hypoglycemia and ketoacidosis. In some women gestational diabetes can be controlled with dietary modifications alone. Blood, not urine, glucose levels are monitored several times a day. Urine is tested for ketone content; results should be negative. D

******A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes. Of what should the nurse be aware regarding this? A Oral hypoglycemic agents can be used if the woman is reluctant to give herself insulin B Dietary modifications and insulin are both required for adequate treatment C Glucose levels are monitored by testing urine four times a day and at bedtime D Dietary management involves distributing nutrient requirements over three meals and two or three snacks

Small frequent meals over a 24-hour period help decrease the risk for hypoglycemia and ketoacidosis. Oral hypoglycemic agents can be harmful to the fetus and less effective than insulin in achieving tight glucose control. In some women gestational diabetes can be controlled with dietary modifications alone. Blood, not urine, glucose levels are monitored several times a day. Urine is tested for ketone content; results should be negative. D

A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes. The nurse caring for this woman understands what? A Oral hypoglycemic agents can be used if the woman is reluctant to give herself insulin. B Dietary modifications and insulin are both required for adequate treatment. C Glucose levels are monitored by testing urine 4 times a day and at bedtime. E Dietary management involves distributing nutrient requirements over three meals and two or three snacks.

Small frequent meals over a 24-hour period help decrease the risk for hypoglycemia and ketoacidosis. Oral hypoglycemic agents can be harmful to the fetus and less effective than insulin in achieving tight glucose control. In some women gestational diabetes can be controlled with dietary modifications alone. Blood, not urine, glucose levels are monitored several times a day. Urine is tested for ketone content; results should be negative. D

Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. Some generalized signs include what? A Hypertonia, tachycardia, and metabolic alkalosis. B Abdominal distention, temperature instability, and grossly bloody stools. C Hypertension, absence of apnea, and ruddy skin color. D Scaphoid abdomen, no residual with feedings, and increased urinary output.

Some generalized signs of NEC include decreased activity, hypotonia, pallor, recurrent apnea and bradycardia, decreased oxygen saturation values, respiratory distress, metabolic acidosis, oliguria, hypotension, decreased perfusion, temperature instability, cyanosis, abdominal distention, residual gastric aspirates, vomiting, grossly bloody stools, abdominal tenderness, and erythema of the abdominal wall. The infant may display hypotonia, bradycardia, and metabolic acidosis. Hypotension, apnea, and pallor are signs of NEC. Abdominal distention, residual gastric aspirates, and oliguria are signs of NEC. B

In caring for a mother who has abused (or is abusing) alcohol and for her infant, nurses should be aware that: A. The pattern of growth restriction of the fetus begun in prenatal life is halted after birth, and normal growth takes over. B. Two thirds of newborns with fetal alcohol syndrome (FAS) are boys. C. Alcohol-related neurodevelopmental disorders (ARNDs) not sufficient to meet FAS criteria (learning disabilities, speech and language problems) are often not detected until the child goes to school. D. Both the distinctive facial features of the FAS infant and the diminished mental capacities tend toward normal over time.

Some learning problems do not become evident until the child is in school. The pattern of growth restriction persists after birth. Two thirds of newborns with FAS are girls. Although the distinctive facial features of the FAS infant tend to become less evident with growth, the mental capacities never become normal. C

*Which test is used to determine the presence of fetal-to-maternal bleeding in a pregnant patient? A D-dimer test B Non-stress test (NST) C Kleihauer-Betke (KB) test D Biophysical profile (BPP) test

The KB test is used to determine the presence of fetal-to-maternal bleeding or transplacental hemorrhage. The D-dimer test is used to diagnose blood disorders, such as disseminated intravascular coagulation (DIC). The NST and BPP tests are used to determine fetal surveillance. C

Nurses should be aware that HELLP syndrome: A. Is a mild form of preeclampsia. B. Can be diagnosed by a nurse alert to its symptoms. C. Is characterized by hemolysis, elevated liver enzymes, and low platelets. D. Is associated with preterm labor but not perinatal mortality.

The acronym HELLP stands for hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). HELLP syndrome is a variant of severe preeclampsia. It is difficult to identify, because the symptoms often are not obvious. It must be diagnosed in the laboratory. Preterm labor is greatly increased with HELLP syndrome, and so is perinatal mortality. C

The nurse is caring for a diabetic client who is breastfeeding her infant. Within what time frame following childbirth do the client's insulin requirements return to prepregnancy levels? A Immediately after childbirth B Seven to 10 days after childbirth C On completion of weaning D During the lactation period

The breastfeeding mother's insulin requirements return to prepregnancy levels after the infant has been completely weaned. At birth, there is a sudden drop in the levels of insulinase following expulsion of the placenta, but they do not return to prepregnancy levels. When the mother is not breastfeeding, the insulin carbohydrate balance returns in 7 to 10 days. Maternal glucose is used up during lactation; therefore the breastfeeding mother's insulin requirement remains low. C

The nurse is assessing a client with hyperemesis gravidarum during the early stages of pregnancy. Which nonpharmacologic measure is appropriate to alleviate the discomforts associated with nausea and vomiting? A Having the client cook her favorite foods B Allowing frequent visits from friends C Providing environment that is free from odors D Having the client eat warm, low-fat, soupy foods

The client must be allowed to rest in an environment that is free from odors. This helps to alleviate the discomforts associated with hyperemesis gravidarum. Most clients find exposure to cooking odors nauseating; it is better to have other family members cook for the client. It is important for the client to have limited periods of visitation and receive adequate rest, because sleep disturbances accompany hyperemesis. The client is able to tolerate dry, cold foods better than warm, soupy foods. C

A client with ectopic pregnancy has received medical treatment for an ectopic pregnancy. The primary health care provider prescribed methotrexate (Amethopterin) therapy to the client. Which of the client's actions helps to prevent complications? A The client takes an opioid analgesic for pain relief. B The client gets her β-hCG level measured monthly. C The client gets her insulin level measured monthly. D The client uses a contraceptive method for 3 months.

The client should use a contraceptive method for 3 months because it provides time for the body to heal. The client should not take strong analgesics, such as opioids, because these medications mask the symptoms of tubal rupture. The client who is on methotrexate (Amethopterin) therapy should get her β-hCG level measured weekly to make sure that β-hCG levels continue to drop steadily until they become undetectable. Insulin levels are not altered in the client who has methotrexate (Amethopterin) therapy. Therefore, the client need not get her insulin levels measured monthly. D

An infant weighing 4.1 kg was born 2 hours ago at 37 weeks of gestation. The infant appears chubby with a flushed complexion and is very tremulous. The tremors are most likely the result of: A. Birth injury. B. Hypocalcemia. C. Hypoglycemia. D. Seizures.

The description is indicative of a macrocosmic infant. Hypoglycemia is common in the infant with macrosomia. The tremors are jitteriness that is associated with hypoglycemia. Other signs of hypoglycemia are apnea, tachypnea, and cyanosis. C

Which factor increases the risk of complications for infants of diabetic mothers? A. Glycemic control B. Hemoglobin A1c level of 7 C. Duration of maternal disease D. Hemoglobin A1c level of 7 prior to pregnancy

The duration and severity of maternal disease are significant factors in increasing the risk for complications in infants of diabetic mothers. Glycemic control would be a positive factor indicating that blood glucose levels were maintained within normal range. A hemoglobin A1c level of 7 is within normal range. D

After reviewing the blood glucose levels of a client, the nurse finds that the client is hypoglycemic and gives three glucose tablets to the client. After 15 minutes, the nurse finds that the client is still hypoglycemic, and again administers three glucose tablets. What should the nurse do next, if the client's blood glucose is 60 mg/dl after 15 minutes? A Notify the primary health care provider. B Administer 50% dextrose intravenous push. C Obtain blood samples for blood gas analysis. D Give three more glucose tablets to the client.

The hypoglycemic client's blood sugar level has not risen after giving three glucose tablets twice over an interval of 15 minutes each. In this situation, the nurse should notify the primary health care provider so that emergency intervention can be provided. Administering three more glucose tablets would not be of use, because this intervention had not been useful to improve the client's blood sugar level previously. An intravenous push of 50% dextrose should be done if the hypoglycemic client has become unconscious. In this case, arterial blood gas analysis would not be helpful in finding out the cause of persistent low blood sugar. A

The nurse is caring for an infant with a body temperature of 34°C and a body weight of 1400 g. What other parameter is most important to monitor to prevent complications related to low birth weight? A Increased urinary output B Decreased respiratory rate C Cold extremities D Golden brown patches on skin

The normal birth weight of an infant should be more than 2500 g and the normal body temperature should be 36°C. A birth weight of 1400 g indicates low birth weight and temperature less than 35°C signifies that the infant has hypothermia. The nurse maintains the infant's body temperature by generating heat using radiant heaters. Heat generation increases the oxygen consumption in the infant, which may result in hypoxia. Therefore, the nurse should monitor the infant's respiratory rate. Decreased respiratory rate causes respiratory depression (RD). Increased urinary output is observed when the infant is administered dextrose for hyperglycemia. Hypothermia is characterized by cold extremities. Golden brown patches on the skin are usually observed in postpartum infants and are unrelated to hypothermia. B

The nurse is assessing a client for gestational diabetes mellitus (GDM) using the oral glucose tolerance test (OGTT). What intervention by the nurse is appropriate while caring for this client? A Teach the client to eat an unrestricted diet the day before the test. B Instruct the client to avoid caffeine for 6 hours before the test. C Draw blood for a fasting blood glucose level just before the test. D Obtain the plasma glucose level an hour after a 50 g oral glucose load.

The nurse must draw blood for a fasting blood glucose level just before the test begins. This is the first sample, after which blood is drawn 1, 2, and 3 hours after providing the glucose load. The nurse must teach the client to eat an unrestricted diet that includes at least 150 g of carbohydrates for at least 3 days before the test. The client must be instructed to avoid caffeine for 12 hours before the test because it increases glucose levels. The client is given a 100 g oral glucose load, and then the client's blood glucose levels are determined every hour for up to 3 hours. The plasma glucose level is obtained after a 50 g oral glucose load in the first step of screening for GDM. C

A cesarean birth is planned for a diabetic client with fetal macrosomia. Which intervention by the nurse is appropriate when preparing the client for surgery? A Instruct the client to avoid insulin the night before the surgery. B Administer a full dose of insulin on the morning of the surgery. C Ensure the client has nothing by mouth on the morning of the surgery. D Infuse intravenous 5% dextrose if the client's glucose level is below 100 mg/dl.

The nurse must ensure the client is not given anything by mouth on the morning of the surgery. The client must take a full dose of insulin at bedtime the night before surgery. The client is fasting; therefore insulin is not administered on the morning of the surgery. The client is given intravenous 5% dextrose if her glucose levels fall below 70 mg/dl during active labor. C

*The nurse is caring for a client with gestational diabetes. What does the nurse teach the client about using insulin? A Store unused vials of insulin in the freezer. B Shake the prepared syringes well before use. C Administer long-acting insulin before meals. D Inject insulin in the abdomen.

The nurse must teach the client that the abdomen is the preferred site for injecting insulin, because insulin is best absorbed in the abdominal area. Other suitable sites include the upper outer arm, the thighs, and the buttocks. Insulin must not be frozen, so unused vials of insulin are stored in the refrigerator, but not in the freezer. Syringes containing mixed insulin may be stored for up to 2 weeks in the refrigerator. The syringe must not be shaken; it must be gently rotated 20 times before injection. Long-acting insulin is usually administered at bedtime, because it provides glucose control for a longer duration. D

*The nurse observes that intravenous (IV) administration of magnesium sulfate has resulted in magnesium toxicity in a pregnant client with preeclampsia. The nurse immediately discontinues the infusion and reports to the primary health care provider (PHP). For which drug does the nurse obtain a prescription from the PHP? A Calcium gluconate B Nifedipine (Adalat) C Hydralazine (Apresoline) D Labetalol hydrochloride (Normodyne)

The nurse needs to obtain a prescription for calcium gluconate, because it acts as an antidote to magnesium toxicity. Nifedipine (Adalat) and labetalol hydrochloride (Normodyne) are antihypertensive medications, which are prescribed for gestational hypertension or severe preeclampsia. Hydralazine (Apresoline) is also an antihypertensive medication used for treating hypertension intrapartum. A

*Which actions would the nurse take when a pregnant client has convulsions? Select all that apply. A Obtain a prescription for magnesium sulfate B Assess the client's airway, breathing, and pulse C Lower the bed and turn the client onto one side D Not leave the client for more than 10 minutes E Raise the side rails of the bed and pads with pillows

The nurse obtains a prescription for magnesium sulfate to prevent further convulsions. The nurse assesses the client's airway, breathing, and pulse to understand the maternal condition. The nurse may need to suction secretions to clear the airway and administer oxygen to maintain sufficient oxygenation in the client. The nurse lowers the bed and turns the client onto one side to prevent aspiration of vomitus. The nurse raises the side rails of the bed and pads with pillows to prevent a fall. The nurse may call for help, but should not leave the client's bedside, because the patient is in a serious condition. A, B, C, E

What does the nurse include in the plan of care of a high risk preterm infant? Select all that apply. A Routinely monitor blood pressure. B Assess intake and output records. C Assess for respiratory distress. D Maintain room temperature. E Encourage skin-to-skin (kangaroo) contact.

The nurse routinely monitors the infant's blood pressure to assess whether the values are increasing normally in the first month of life. Accurate intake and output records are necessary to understand the infant's fluid status. The preterm infant is at risk of respiratory distress. Therefore the nurse needs to assess the infant's respiratory function so that prompt actions can be taken. The nurse encourages the parents to provide skin-to-skin (kangaroo) contact with the infant to maintain thermal stability. A preterm infant needs application of external warmth. The room temperature may not be effective to maintain thermal stability. Therefore the infant is placed in a heated environment to prevent cold stress. A, B, C, E

**The primary health care provider orders magnesium sulfate (Sulfamag) for a pregnant client who is being transported to the tertiary care center. What actions does the nurse follow according to the protocol? Select all that apply. A Administer the drug intravenously. B Mix the drug with a local anesthetic agent. C Administer 5 g to each buttock as a loading dose. D Administer 5 g as a maintenance dose every 8 hours. E Administer 5 g as a maintenance dose alternately to each buttock.

The nurse should administer the magnesium sulfate (Sulfamag) intramuscularly to a pregnant client who is being transported to the tertiary care center. The medication should be mixed with a local anesthetic to reduce the pain caused by injection. The nurse should administer 5 g of magnesium sulfate (Sulfamag) to each buttock as a loading dose of 10 g total. A maintenance dose of 5 g should be administered alternately to each buttock every 4 hours. The intravenous route is not preferred in clients who are being transported to the tertiary care center. The nurse should not administer the maintenance dose every 8 hours, because it may lead to insufficient action of the medication. B, C, E

The nurse is caring for a pregnant client with gestational diabetes. What does the nurse teach the client about diet during pregnancy? A Eat three meals a day with two or three snacks. B Avoid meals or snacks just before bedtime. C Use artificial sweeteners instead of sugar. D Avoid foods that are high in dietary fiber.

The nurse should teach the client to distribute her daily required calories into three meals with two or three snacks. In order to prevent hypoglycemia, the client should eat meals on time and never skip meals. The client should consume a bedtime snack of at least 25 g of complex carbohydrate with some protein or fat to prevent hypoglycemia and starvation ketosis during the night. The nurse should teach the client to avoid the use of sweeteners that are nonnutritive and foods high in refined sugar. The client should eat foods that are high in dietary fiber. A

Which intervention does the nurse include when providing care for a high risk infant who is receiving supplemental parenteral fluids? A Uses continuous infusion pumps and monitors hourly B Administers a one-time bolus infusion of 10% dextrose C Avoids phototherapy sessions when administering fluids D Uses the median cubital vein to administer medications

The nurse uses continuous infusion pumps that deliver fluids at a preset flow rate. The nurse also monitors the infusion hourly to prevent tissue damage from extravasation, fluid overload, or dehydration. A high risk infant may not be able to tolerate dextrose and may be at risk of glycosuria and osmotic diuresis. Infants receiving phototherapy have increased water loss. Therefore fluids are adjusted according to their needs. The peripheral veins, scalp veins, and antecubital veins, not the median cubital vein, are used to administer fluids intravenously. A

What are premature infants who exhibit 5 to 10 seconds of respiratory pauses followed by 10 to 15 seconds of compensatory rapid respiration experiencing? A Suffering from sleep or wakeful apnea B Experiencing severe swings in blood pressure C Trying to maintain a neutral thermal environment D Breathing in a respiratory pattern common to premature infants

The pattern of 5 to 10 seconds of respiratory pauses followed by 10 to 15 seconds is called periodic breathing, which is common in premature infants. It may require nursing intervention of oxygen and/or ventilation. Apnea is a cessation of respirations for 20 seconds or longer. It should not be confused with periodic breathing, which is common in the premature infant. An infant who presents with fluctuation of systemic blood pressure may have experienced a central nervous system injury. An infant attempting to maintain his or her body temperature is likely to have hypoglycemia, shivering, and mottled color. D

*The nurse is teaching a pregnant client how to recognize signs of preeclampsia and when to report to the primary health care provider. Which statements by the client indicate effective learning? Select all that apply. A "I should report if I see an increase in urinary output." B "I should report if a dipstick test shows proteinuria less than 1+." C "I should report if I experience blurred vision or headache." D "I should report if I feel a decrease in the baby's movements." E "I should sit and use my right arm to accurately measure my blood pressure."

The pregnant client should report to the primary health care provider if she experiences blurred vision, dizziness, and headache. These are the common clinical signs of preeclampsia. The client should report to the primary health care provider if she observes fewer fetal movements per hour, because it may be indicative of fetal compromise due to preeclampsia. To obtain accurate recordings, the pregnant client should use her right arm while in a sitting position to measure her blood pressure. The pregnant client should report to the primary health care provider in case of decreased urinary output, because a decrease in the glomerular filtration rate leads to degenerative glomerular changes and oliguria. The pregnant client should inform the primary health care provider if a dipstick test shows the value of 1+ or more, because it indicates proteinuria, an important sign of preeclampsia. C, D, E

*A pregnant client at 30 weeks of gestation has preterm labor. The nurse understands that the preterm baby may be born with immature lungs. What medication would be administered to help in lung maturation? A Hydralazine (Apresoline) B Calcium gluconate (Kalcinate) C Low-dose aspirin (Anacin) D Betamethasone (Celestone)

The primary health care provider prescribes corticosteroids such as betamethasone (Celestone) to enhance fetal lung maturation for gestations less than 34 weeks. Hydralazine (Apresoline) is an antihypertensive, which is not used to develop fetal lungs. Calcium gluconate (Kalcinate) is used as an antidote for magnesium sulfate (Sulfamag) toxicity. Low-dose aspirin (Anacin) prevents preeclampsia but does not help develop the fetus' lungs. D

**A pregnant client in the first trimester reports spotting of blood with the cervical os closed and mild uterine cramping. What else does the nurse need to assess? Select all that apply. A Progesterone levels B Transvaginal ultrasounds C Human chorionic gonadotropin (hCG) measurement D Blood pressure E Kleihauer-Betke (KB) test reports

The spotting of blood with the cervical os closed and mild uterine cramping in the first trimester indicate a threatened miscarriage. Therefore the nurse needs to assess progesterone levels, transvaginal ultrasounds, and measurement of hCG to determine if the fetus is alive and within the uterus. BP measurements do not help determine the fetal status. KB assay is prescribed to identify fetal-to-maternal bleeding, usually after a trauma. A, B, C,

Which factors predispose an infant to birth injuries? (Select all that apply.) A. Multip between the ages of 25 and 30 B. Vertex presentation C. Application of an internal fetal scalp electrode D. Vacuum-assisted birth

The use of an internal fetal scalp electrode could result in a scalp injury, which would be evident upon birth. The use of vacuum extraction could lead to a birth injury. Very young age (less than 16) and older age (more than 35) in a primipara are more likely to predispose an infant to birth injuries. Vertex presentation is a normal finding and as such would not typically lead to a birth injury. C, D

An infant weighing 4.1 kg was born 2 hours ago at 37 weeks of gestation. The infant appears chubby with a flushed complexion and is very tremulous. The tremors are most likely the result of what? A Birth injury B Hypocalcemia C Hypoglycemia D Seizures

This infant is macrosomic and at risk for hypoglycemia. The tremors are jitteriness, which is associated with hypoglycemia. Signs of hypoglycemia include jitteriness, apnea, tachypnea, and cyanosis. C

Which laboratory values would present in a client diagnosed with preeclampsia? Select all that apply. A Hemoglobin 8g/dl B Platelet count of 75,000 C LDH 100 units/L D Burr cells E BUN 25 mg/dl

Thrombocytopenia below 100,000 would be noted. An increase in LDH and an increase in BUN would be noted. Hemoglobin levels would be increased and this would be a decreased level. Burr cells would not be present in preeclampsia but would be present with HELLP syndrome. B, C, E

Which laboratory values would be found in a patient diagnosed with preeclampsia? (Select all that apply.) A. Hemoglobin 8g/dL B. Platelet count of 75,000 C. LDH 100 units/L D. Burr cells E. BUN 25 mg/dL

Thrombocytopenia below 100,000, an increase in LDH, and an increase in BUN would be noted. Hemoglobin levels would be increased, but 8 g/dL reflects a decreased level. Burr cells would not be present in preeclampsia but would in HELLP syndrome. B, C, E

*The nurse is caring for a postpartum client. The primary health care provider prescribes intravenous magnesium sulfate (Sulfamag). Which other medications does the nurse check for in the treatment regimen to ensure the client's safety? Select all that apply. A Narcotics B Diuretics C Analgesics D Calcium channel blockers E Central nervous system (CNS) depressants

To ensure the client's safety, the nurse should check the treatment regimen before administering intravenous magnesium sulfate (Sulfamag). This drug may synergize the action of drugs such as narcotics, calcium channel blockers, and CNS depressants. Therefore, narcotics, calcium channel blockers, and CNS depressants should be used with caution in a client undergoing intravenous magnesium sulfate (Sulfamag) treatment. Diuretics and analgesics are not affected by magnesium sulfate (Sulfamag). Therefore, checking for these medications before administering intravenous magnesium sulfate (Sulfamag) is not necessary. A, D, E

The nurse is teaching a student nurse about the various positions for an infant who has difficulty breathing. Which statement by the student nurse indicates effective learning? A "Prone position will facilitate mucus aspiration." B "Side lying position will promote mucus aspiration." C "Supine position will decrease optimum air exchange." D "Trendelenburg position will reduce lung capacity."

Trendelenburg position increases the intracranial pressure and reduces lung capacity. Therefore, Trendelenburg position should be avoided. Prone position is unrelated to expectoration of mucus. Moreover, prone position and supine position will promote optimum air exchange in infants. Side lying position is preferred after feeding in order to avoid mucus aspiration. D

A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency to every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of: A. Eclamptic seizure. B. Rupture of the uterus. C. Placenta previa. D. Placental abruption.

Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption). Women with hypertension are at increased risk for an abruption. Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture manifests with hypotonic uterine activity, signs of hypovolemia, and in many cases the absence of pain, and placenta previa with bright red, painless vaginal bleeding. D

With regard to preeclampsia and eclampsia, nurses should be aware that: A. Preeclampsia is a condition of the first trimester; eclampsia is a condition of the second and third trimesters. B. Preeclampsia results in decreased function in such organs as the placenta, kidneys, liver, and brain. C. The causes of preeclampsia and eclampsia are well documented. D. Severe preeclampsia is defined as preeclampsia plus proteinuria.

Vasospasms diminish the diameter of blood vessels, which impedes blood flow to all organs. Preeclampsia occurs after week 20 of gestation and can run the duration of the pregnancy. The causes of preeclampsia and eclampsia are unknown, although several have been suggested. Preeclampsia includes proteinuria; severe cases are characterized by greater proteinuria or any of nine other conditions. B

The nurse is assessing a newborn who weighs 1350 g and observes that the newborn has a blood glucose level of 38 mg/dL. What sign should the nurse monitor in the newborn while providing parenteral nutrition? A Heart rate B Muscle tone C Skin Integrity D Urine output

Very low birth weight (VLBW) infants who weigh less than 1500 g are more likely to have hypoglycemia (less than 40 mg/dL) due to inadequate nutrition. So, the infants are provided with 5% intravenous dextrose, which may result in hyperglycemia. Therefore, the nurse has to closely monitor the symptoms of increased urine output in the infant. Hypotonia (poor muscle tone) is associated with meconium aspiration syndrome (MAS); however, it is not related to hyperglycemia. Dry and peeled skin is present in a postmature infant, unlike VLBW infants. Decreased heart rate is a sign of hypothermia that occurs due to cold stress. It is unrelated to glucose levels. D

The nurse is caring for a hypertensive pregnant client who is on magnesium sulfate therapy. The nurse finds that the client has drowsiness, slurred speech, and depressed respiration. What medication would help in treating magnesium toxicity? A Intravenous diazepam (Valium) B Intravenous nifedipine (Adalat) C Intravenous hydralazine (Apresoline) D Intravenous calcium gluconate (Kalcinate)

When treating a hypertensive pregnant client with magnesium sulfate therapy, the nurse should be alert for possible magnesium toxicity. Manifestations of magnesium toxicity include drowsiness, lethargy, slurred speech, depressed respiration, loss of deep tendon reflexes, and in severe cases, cardiac arrest. The effects of magnesium toxicity can be reversed by administering calcium gluconate (Kalcinate) intravenously. Diazepam (Valium) is an anticonvulsant drug; it is not used to reverse the effects of magnesium toxicity. Nifedipine (Adalat) is an antihypertensive drug; if used along with magnesium sulfate, it leads to muscle blockade. Hydralazine (Apresoline) is an antihypertensive drug; it does not reverse the symptoms of magnesium toxicity. D

The nurse is preparing to administer intravenous magnesium sulfate to a client with preeclampsia. Meanwhile, the student nurse positions the client in a supine position, monitors the fetal heart rate (FHR), checks for baseline variability, and monitors for the absence of late decelerations. Which action by the student nurse needs correction? A Checking for baseline variability B Monitoring of the fetal heart rate (FHR) C Placing the client in a supine position D Monitoring for the absence of late decelerations

While caring for a pregnant client with preeclampsia and ineffective tissue perfusion, the nurse should place the client on her side, not in a supine position. This is done to maximize the uteroplacental blood flow and ensure efficient uteroplacental oxygenation. This intervention also helps decrease the client's blood pressure, promote diuresis, and prevents supine hypotension. The student nurse should check for baseline variability, monitor the fetal heart rate (FHR), and check for the absence of late decelerations. These interventions promote the safety of the fetus. C

The nurse is caring for a client with preeclampsia who is receiving an intravenous (IV) magnesium sulfate (Sulfamag) infusion. The nurse assesses the client every 20 minutes. Which maternal findings require immediate intervention by the nurse? A Deep tendon reflex of 2+ B Urinary output of 30 ml/hr C Blood pressure of 130/90 mm Hg D Respiratory rate of 9 breaths/minute

While caring for a pregnant client with preeclampsia on IV magnesium sulfate infusion therapy, the nurse should report a respiratory rate below 12 breaths per minute to the primary health care provider. Magnesium sulfate (Sulfamag) has the potential to decrease the respiratory rate. Any respiratory rate less than 12 breaths/minute in this client indicates decreased respiration and should be reported to the primary health care provider. A deep tendon reflex of 2+ is an expected response and a normal finding in the client. Urinary output of 30 ml/hr and blood pressure of 130/90 mm Hg are also normal findings. These conditions need not to be reported to the primary health care provider. D

*In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes that which is the most important factor affecting pregnancy outcome? A Mother's age B Number of years since diabetes was diagnosed C Amount of insulin required prenatally D Degree of glycemic control during pregnancy

Women with excellent glucose control and no blood vessel disease should have good pregnancy outcomes. Although advanced maternal age may pose some health risks, for the woman with pregestational diabetes the most important factor remains the degree of glycemic control during pregnancy. The number of years since diagnosis is not as relevant to outcomes as the degree of glycemic control. The key to reducing risk in the pregestational diabetic woman is not the amount of insulin required but rather the level of glycemic control. D

In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes that the most important factor affecting pregnancy outcome is the: A. Mother's age. B. Number of years since diabetes was diagnosed. C. Amount of insulin required prenatally. D. Degree of glycemic control during pregnancy.

Women with excellent glucose control and no blood vessel disease should have good pregnancy outcomes. Although advanced maternal age may pose some health risks, the most important factor for the woman with pregestational diabetes remains the degree of glycemic control during pregnancy. The number of years since diagnosis and the amount of insulin required are not as relevant to outcomes as the degree of glycemic control. D

What are maternal and neonatal risks associated with gestational diabetes mellitus? A Maternal premature rupture of membranes and neonatal sepsis. B Maternal hyperemesis and neonatal low birth weight. C Maternal preeclampsia and fetal macrosomia. D Maternal placenta previa and fetal prematurity.

Women with gestational diabetes have twice the risk of developing hypertensive disorders such as preeclampsia, and the baby usually has macrosomia. Premature rupture of membranes and neonatal sepsis are not risks associated with gestational diabetes. Hyperemesis is not seen with gestational diabetes, nor is there an association with low birth weight of the infant. Placental previa and subsequent prematurity of the neonate are not risks associated with gestational diabetes. C

*A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of what? A Eclamptic seizure B Rupture of the uterus C Placenta previa D Abruptio placentae

Women with hypertension are at increased risk for an abruption. Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture presents as hypotonic uterine activity, signs of hypovolemia, and in many cases the absence of pain. Placenta previa presents with bright red, painless vaginal bleeding. Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption). D