High-Risk Antepartum
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A nurse who is caring for a pregnant diabetic should carefully monitor the client for which of the following? Select all that apply. 1. Urinary tract infection. 2. Multiple gestation. 3. Metabolic acidosis. 4. Pathological hypotension. 5. Hypolipidemia
1 and 3 are correct. 1. Pregnant diabetic clients are particularly at high risk for urinary tract infections. 3. Pregnant diabetic clients are at high risk for acidosis.
An ultrasound is being done on an Rh-negative woman. Which of the following pregnancy findings would indicate that the baby has developed erythroblastosis fetalis? 1. Caudal agenesis. 2. Cardiomegaly. 3. Oligohydramnios. 4. Hyperemia.
2. Cardiomegaly is one of the common signs of erythroblastosis fetalis.
A 15-year-old client is being seen for her first prenatal visit. Because of this client's special nutritional needs, the nurse evaluates the client's intake of: 1. Protein and magnesium. 2. Calcium and iron. 3. Carbohydrates and zinc. 4. Pyroxidine and thiamine.
2. Pregnant adolescents' diets are often deficient in calcium and iron.
A client, 32 weeks' gestation with placenta previa, is on total bed rest. The physician expects her to be hospitalized on bed rest until her cesarean section, which is scheduled for 38 weeks' gestation. To prevent complications while in the hospital, the nurse should do which of the following? Select all that apply. 1. Perform passive range-of-motion exercises. 2. Restrict the fluid intake of the client. 3. Decorate the room with pictures of family. 4. Encourage the client to eat a high-fiber diet. 5. Teach the client deep-breathing exercises.
1, 3, 4, and 5 are correct. 1. Passive range-of-motion will help to decrease the potential for muscle atrophy and thrombus formation. 3. This client is separated from family. The separation can lead to depression. Decorating the room and enabling family to visit freely is very important. 4. A high-fiber diet will help to maintain normal bowel function. 5. Deep breathing exercises are important to maintain the client's respiratory function.
A 12-week-gravid client presents in the emergency department with abdominal cramps and scant dark red bleeding. Which of the following signs/symptoms should the nurse assess this client for? Select all that apply. 1. Tachycardia. 2. Referred shoulder pain. 3. Headache. 4. Fetal heart dysrhythmias. 5. Hypertension.
1, 3, 4, and 5 are correct. 1. The client should be assessed for tachycardia, which could indicate that the client is bleeding internally. 3. This client's signs and symptoms are consistent with both spontaneous abortion and hydatidiform mole. Although this client is only at 12 weeks' gestation, if she has a hydatidiform mole, she may be exhibiting signs of preeclampia, including headache and hypertension. 4. This client's signs and symptoms are consistent with both spontaneous abortion and hydatidiform mole. To determine whether or not the patient is carrying a viable fetus, the nurse should check the fetal heart rate. 5. This client's signs and symptoms are consistent with both spontaneous abortion and hydatidiform mole. Although this client is only 12 weeks' gestation, if she has a hydatidiform mole, she may be exhibiting signs of preeclampia, including headache and hypertension.
A woman, G1 P0000, is 40 weeks' gestation. Her Bishop score is 4. Which of the following complementary therapies do midwives frequently recommend to clients in similar situations? Select all that apply. 1. Sexual intercourse. 2. Aromatherapy. 3. Breast stimulation. 4. Ingestion of castor oil. 5. Aerobic exercise.
1, 3, and 4 are correct. 1. Sexual intercourse has been recommended to women as a means of increasing their Bishop score. 3. Midwives have recommended that women employ breast stimulation as a means of stimulating labor. 4. Midwives have recommended that women ingest castor oil as a means of increasing their Bishop score.
A 32-week-gestation client was last seen in the prenatal client at 28 weeks' gestation. Which of the following changes should the nurse bring to the attention of the certified nurse midwife? 1. Weight change from 128 pounds to 138 pounds. 2. Pulse rate change from 88 bpm to 92 bpm. 3. Blood pressure change from 120/80 to 118/78. 4. Respiratory rate change from 16 rpm to 20 rpm.
1. A weight gain of 10 pounds in a 4-week period is worrisome. The recommended weight gain during the second and third trimesters is approximately 1 pound per week.
A nurse works in a clinic with a high adolescent pregnancy population. The nurse provides teaching to the young women to prevent which of the following high-risk complications of pregnancy? 1. Preterm birth. 2. Gestational diabetes. 3. Macrosomic babies. 4. Polycythemia.
1. Adolescents are at high risk for preterm labor.
A nurse remarks to a 38-week-gravid client, "It looks like your face and hands are swollen." The client responds, "Yes, you're right. Why do you ask?" The nurse's response is based on the fact that the changes may be caused by which of the following? 1. Altered glomerular filtration. 2. Cardiac failure. 3. Hepatic insufficiency. 4. Altered splenic circulation.
1. Altered glomerular filtration leads to protein loss and, subsequently, to fluid retention, which can lead to swelling in the face and hands.
A nurse is about to inject RhoGAM into an Rh-negative mother. Which of the following is the preferred site for the injection? 1. Deltoid. 2. Dorsogluteal. 3. Vastus lateralis. 4. Ventrogluteal.
1. Although the dosage can be administered in the gluteal muscles, the deltoid is the preferred site of the RhoGAM injection.
A gravid client with 4+ proteinuria and 4+ reflexes is admitted to the hospital. The nurse must closely monitor the woman for which of the following? 1. Grand mal seizure. 2. High platelet count. 3. Explosive diarrhea. 4. Fractured pelvis.
1. Clients with severe preeclampsia are high risk for seizure.
On ultrasound, it is noted that the pregnancy of a hospitalized woman who is carrying monochorionic twins is complicated by twin-to-twin transfusion. The nurse should carefully monitor this client for which of the following? 1. Rapid fundal growth. 2. Vaginal bleeding. 3. Projectile vomiting. 4. Congestive heart failure.
1. Fundal growth is often accelerated.
In anticipation of a complication that may develop in the second half of pregnancy, the nurse teaches an 18-week-gravid client to call the office if she experiences which of the following? 1. Headache and decreased output. 2. Puffy feet. 3. Hemorrhoids and vaginal discharge. 4. Backache.
1. Headache and decreased output are signs of preeclampsia.
A gravid client, 25 years old, is diagnosed with gallstones. She asks her nurse, "Aren't I too young to get gallstones?" The nurse bases her response on which ofthe following? 1. Progesterone slows emptying of the gallbladder, making gravid women high risk for the disease. 2. Gallbladder disease has a strong genetic component, so the woman should be advised to see a genetic counselor. 3. Older women are no more prone to gallstones than are younger women. 4. Gallbladder disease is related to a high dietary intake of carbohydrates.
1. Progesterone is a hormone that relaxes smooth muscle. This action leads to the delayed emptying of the gallbladder during pregnancy.
A child has been diagnosed with rubella. What must the pediatric nurse teach the child's parents to do? 1. Notify any exposed pregnant friends. 2. Give penicillin po every 6 hours for 10 full days. 3. Observe the child for signs of respiratory distress. 4. Administer diphenhydramine every 4 hours as needed.
1. Rubella is a teratogenic disease. The parents should notify any pregnant friends.
A woman's glucose challenge test (GCT) results are 155 mg/dL at 1 hour post-glucose ingestion. Which of the following actions, as ordered by the physician, is appropriate? 1. Send the woman for a glucose tolerance test. 2. Teach the woman how to inject herself with insulin. 3. Notify the woman of the normal results. 4. Provide the woman with oral hypoglycemic agents.
1. The 1-hour GCT results are above normal. She needs a 3-hour glucose tolerance test (GTT).
The laboratory reported the L/S ratio results from an amniocentesis as 1:1. How should the nurse interpret the result? 1. The baby is premature. 2. The mother is high risk for hemorrhage. 3. The infant has kernicterus. 4. The mother is high risk for eclampsia.
1. The baby is preterm.
A type 1 diabetic gravida has developed polyhydramnios. The client should be taught to report which of the following? 1. Uterine contractions. 2. Reduced urinary output. 3. Marked fatigue. 4. Puerperal rash.
1. The client should be taught to observe for signs of preterm labor.
A client who works as a waitress and is 35 weeks' gestation telephones the labor suite after getting home from work and states, "I am feeling tightening in my groin about every 5 to 6 minutes." Which of the following comments by the nurse is appropriate at this time? 1. "Please lie down and drink about four full glasses of water or juice." 2. "You are having false labor pains so you need not worry about them." 3. "It is essential that you get to the hospital immediately." 4. "That is very normal for someone who is on her feet all day."
1. The first intervention for preterm labor is hydration. Clients who are dehydrated are at high risk for preterm labor.
A pregnant diabetic has been diagnosed with hydramnios. Which of the following would explain this finding? 1. Excessive fetal urination. 2. Recurring hypoglycemic episodes. 3. Fetal sacral agenesis. 4. Placental vascular damage.
1. The hydramnios is likely a result of excessive fetal urination.
A patient, 32 weeks pregnant with severe headache, is admitted to the hospital with preeclampsia. In addition to obtaining baseline vital signs and placing the client on bed rest, the physician ordered the following four items. Which of the orders should the nurse perform first? 1. Assess deep tendon reflexes. 2. Obtain complete blood count. 3. Assess baseline weight. 4. Obtain routine urinalysis.
1. The nurse should check the client's patellar reflexes. The most common way to assess the deep tendon reflexes is to assess the patellar reflexes.
The physician has ordered a nonstress test (NST) to be done on a 41-week-gestation client. During the half-hour test, the nurse observed three periods of fetal heart accelerations that were 15 beats per minute above the baseline and that lasted 15 seconds each. No contractions were observed. Based on these results, what should the nurse do next? 1. Send the client home and report positive results to the MD. 2. Perform a nipple stimulation test to assess the fetal heart in response to contractions. 3. Prepare the client for induction with IV oxytocin or endocervical prostaglandins. 4. Place the client on her side with oxygen via face mask.
1. The nurse should report the positive results to the doctor.
An ultrasound has identified that a client's pregnancy is complicated by oligohydramnios. The nurse would expect that an ultrasound may show that the baby has which of the following structural defects? 1. Dysplastic kidneys. 2. Coarctation of the aorta. 3. Hydrocephalus. 4. Hepatic cirrhosis.
1. The nurse would expect that the baby has dysplastic kidneys.
A gravid woman has been diagnosed with listeriosis. She eats rare meat and raw smoked seafood. Which of the following signs/symptoms would this woman exhibit? 1. Fever and muscle aches. 2. Rash and thrombocytopenia. 3. Petechiae and anemia. 4. Amnionitis and epistaxis.
1. The symptoms of listeriosis are similar to symptoms of the flu and include fever and muscle aches.
A gravid woman, 36 weeks' gestation with type 1 diabetes, has just had a biophysical profile (BPP). Which of the following results should be reported to the obstetrician? 1. One fetal heart acceleration in 20 minutes. 2. Three episodes of fetal rhythmic breathing in 30 minutes. 3. Two episodes of fetal extension and flexion of 1 arm. 4. One amniotic fluid pocket measuring 3 cm.
1. There should be a minimum of 2 fetal heart accelerations in 20 minutes (approximately 1 every 10 minutes).
A 30-week-gestation multigravida, G3 P1011, is admitted to the labor suite. She is contracting every 5 minutes × 40 seconds. Which of the comments by the client would be most informative regarding the etiology of the client's present condition? 1. "For the past day I have felt burning when I urinate." 2. "I have a daughter who is 2 years old." 3. "I jogged 11/2 miles this morning." 4. "My miscarriage happened a year ago today."
1. This is the most important statement made by the client.
A hospitalized gravida's blood work is: hematocrit 30% and hemoglobin 10 gm/dL. In light of the laboratory data, which of the following meal choices should the nurse recommend to this patient? 1. Chicken livers, sliced tomatoes, and dried apricots. 2. Cheese sandwich, tossed salad, and rice pudding. 3. Veggie burger, cucumber salad, and wedge of cantaloupe. 4. Bagel with cream cheese, pear, and hearts of lettuce.
1. This meal choice is high in iron and ascorbic acid. It would be an excellent lunch choice for this client who has a below normal hematocrit and hemoglobin.
Which of the following clients is at highest risk for developing a hypertensive illness of pregnancy? 1. G1 P0000, age 44 with history of diabetes mellitus. 2. G2 P0101, age 27 with history of rheumatic fever. 3. G3 P1102, age 25 with history of scoliosis. 4. G3 P1011, age 20 with history of celiac disease.
1. This primigravid client—age 44 and with a history of diabetes—is very high risk for preeclampsia.
A type 1 diabetic is being seen for preconception counseling. The nurse should emphasize that during the first trimester the woman may experience which of the following? 1. Need for less insulin than she normally injects. 2. An increased risk for hyperglycemic episodes. 3. Signs and symptoms of hydramnios. 4. A need to be hospitalized for fetal testing.
1. Type 1 diabetics often need less insulin during the first trimester than they did preconception.
A gravid woman has sickle cell anemia. Which of the following situations could precipitate a vaso-occlusive crisis in this woman? 1. Hypoxia. 2. Alkalosis. 3. Fluid overload. 4. Hyperglycemia.
1. Vaso-occlusive crises are precipitated by hypoxia in pregnant as well as nonpregnant sickle cell clients.
The nurse is evaluating the effectiveness of bed rest for a client with mild preeclampsia. Which of the following signs/symptoms would the nurse determine is a positive finding? 1. Weight loss. 2. 2+ proteinuria. 3. Decrease in plasma protein. 4. 3+ patellar reflexes.
1. Weight loss is a positive sign.
Which of the following pregnant clients is most high risk for preterm premature rupture of the membranes (PPROM)? Select all that apply. 1. 31 weeks' gestation with prolapsed mitral valve (PMV). 2. 32 weeks' gestation with urinary tract infection (UTI). 3. 33 weeks' gestation with twins post-in vitro fertilization (IVF). 4. 34 weeks' gestation with gestational diabetes (GDM). 4. 35 weeks' gestation with deep vein thrombosis (DVT).
2 and 3 are correct. 2. Clients with UTIs are high risk for PPROM. 3. Clients carrying twins, whether spontaneous or post-IVF, are at high risk for PPROM.
An obese gravid woman is being seen in the prenatal clinic. The nurse will monitor this client carefully throughout her pregnancy because she is high risk for which of the following complications of pregnancy? Select all that apply. 1. Placenta previa. 2. Gestational diabetes. 3. Abruptio placentae. 4. Preeclampsia. 5. Chromosomal defects.
2 and 4 are correct. 2. Obese clients are at high risk for gestational diabetes. 4. Obese clients are at high risk for preeclampsia.
A nurse is interviewing a prenatal client. Which of the following factors in the client's history should the nurse highlight for the health care practitioner? 1. That she is eighteen years old. 2. That she owns a cat and a dog. 3. That she eats peanut butter daily. 4. That she works as a surgeon.
2. Cat feces are a potential source of toxoplasmosis.
A client, 8 weeks pregnant, has been diagnosed with a bicornuate uterus. Which of the following signs should the nurse teach the client to carefully monitor for? 1. Hyperthermia. 2. Palpitations. 3. Cramping. 4. Oliguria.
3. A bicornuate uterus will predispose a client to cramping and preterm labor.
An ultrasound has identified that a client's pregnancy is complicated by hydramnios. The nurse would expect that an ultrasound may show that the baby has which of the following structural defects? 1. Pulmonic stenosis. 2. Tracheoesophageal fistula. 3. Ventriculoseptal defect. 4. Developmental hip dysplasia.
2. The nurse would expect to find that the baby has tracheoesophageal fistula.
A 29-week-gestation woman diagnosed with severe preeclampsia is noted to have blood pressure of 170/112, 4+ proteinuria, and a weight gain of 10 pounds over the past 2 days. Which of the following signs/symptoms would the nurse also expect to see? 1. Fundal height of 32 cm. 2. Papilledema. 3. Patellar reflexes of +2. 4. Nystagmus.
2. The nurse would expect to see papilledema.
A gravid client is admitted with a diagnosis of third-trimester bleeding. It is priority for the nurse to assess for a change in which of the following vital signs? 1. Temperature. 2. Pulse. 3. Respirations. 4. Blood pressure.
2. The pulse is the highest priority in this situation.
A client's 32-week clinic assessment was: BP 90/60; TPR 98.6°F, P 92, R 20; weight 145 lb; and urine negative for protein. Which of the following findings at the 34-week appointment should the nurse highlight for the certified nurse midwife? 1. BP 110/70; TPR 99.2°F, 88, 20. 2. Weight 155 lb; urine protein +2. 3. Urine protein trace; BP 88/56. 4. Weight 147 lb; TPR 99.0°F, 76, 18.
2. There has been a 10-lb weight gain in 2 weeks and a significant amount of protein is being spilled in the urine. This client should be brought to the attention of the primary caregiver.
A client is being admitted to the labor suite with a diagnosis of eclampsia. The fetal heart rate tracing shows moderate variability with early decelerations. Which of the following actions by the nurse is appropriate at this time? 1. Tape a tongue blade to the head of the bed. 2. Pad the side rails and head of the bed. 3. Provide the client with needed stimulation. 4. Provide the client with grief counseling.
2. This is appropriate. The side rails and the headboard should be padded.
A diabetic client is to receive 5 units regular and 15 units NPH insulin at 0800. To administer the medication appropriately, what should the nurse do? 1. Draw 5 units regular in one syringe and 15 units NPH in a second syringe and inject in different locations. 2. Draw 5 units regular first and 15 units NPH second into the same syringe and inject. 3. Draw 15 units NPH first and 5 units regular second into the same syringe and inject. 4. Mix 5 units regular and 15 units NPH in a vial before drawing the full 20 units into a syringe and inject.
2. This is the appropriate method. The regular insulin should be drawn up first and then the NPH insulin in the same syringe.
A client is being taught fetal kick counting. Which of the following should be included in the patient teaching? 1. The woman should choose a time when her baby is least active. 2. The woman should lie on her side with her head elevated about 30°. 3. The woman should report fetal kick counts of greater than 10 in an hour. 4. The woman should refrain from eating immediately before counting.
2. This is the best position for perfusing the placenta.
A woman is to receive RhoGAM at 28 weeks' gestation. Which of the following actions must the nurse perform before giving the injection? 1. Validate that the baby is Rh-negative. 2. Assess that the direct Coombs' test is positive. 3. Verify the identity of the woman. 4. Reconstitute the globulin with sterile water.
3. Although this is an important action that must be taken before the administration of any medication, it is especially critical in this situation.
A nurse is performing an assessment on four 22-week-pregnant clients. The nurse reports to the obstetrician that which of the clients may be carrying twins? 1. The client who states that she feels huge. 2. The client with a weight gain of 13 pounds. 3. The client whose fundal height measurement is 26 cm. 4. The client whose alpha-fetoprotein level is one-half normal.
3. It is possible that this client is carrying twins.
A woman has just been admitted to the emergency department subsequent to a head-on automobile accident. Her body appears to be uninjured. The nurse carefully monitors the woman for which of the following complications of pregnancy? Select all that apply. 1. Placenta previa. 2. Transverse fetal lie. 3. Placental abruption. 4. Severe preeclampsia. 5. Preterm labor
3. Placental abruption may develop as a result of the auto accident. 5. The woman may go into preterm labor after an auto accident.
A woman, G5 P0401, is in the post-anesthesia care unit (PACU) after a cervical cerclage procedure. During the immediate postprocedure period, what should the nurse carefully monitor this client for? 1. Hyperthermia. 2. Hypotension. 3. Uterine contractions. 4. Fetal heart dysrhythmias.
3. Preterm labor is a complication in the immediate postprocedure period.
Which of the following would indicate that a nipple stimulation test is creating the desired effect? 1. The woman's inverted nipples become erect. 2. The woman's nipple and breast tissue hypertrophy. 3. The woman's uterus contracts 3 times in 10 minutes. 4. The woman's cervix dilates 2 centimeters in 3 hours.
3. The nipples are stimulated with the goal of achieving a q 3-minute contraction pattern.
A 16-year-old woman is being seen for the first time in the obstetric office. Which of the following comments by the young woman is highest priority for the nurse to respond to? 1. "My favorite lunch is a burger with fries." 2. "I've been dating my new boyfriend for 2 weeks." 3. "On weekends we go out and drink a few beers." 4. "I dropped out of school about 3 months ago."
3. The nurse must respond to this comment. This young woman is repeatedly exposing her fetus to alcohol.
A client, 37 weeks' gestation, has been advised that she is positive for group B streptococci. Which of the following comments by the nurse is appropriate at this time? 1. "The doctor will prescribe intravenous antibiotics for you. A visiting nurse will administer them to you in your home." 2. "You are very high risk for an intrauterine infection. It is important for you to check your temperature every day." 3. "The bacteria are living in your vagina. They will not hurt you but we will give you medicine in labor to protect your baby from getting sick." 4. "This bacteria causes scarlet fever. If you notice that your tongue becomes very red and that you feel feverish you should call the doctor immediately."
3. This answer is correct. Exposure to group B strep is very dangerous for neonates.
It is discovered that a 28-week-gestation gravid is leaking amniotic fluid. Before the client is sent home on bed rest, the nurse teaches her which of the following? 1. Perform a nitrazine test every morning upon awakening. 2. Immediately report any breast tenderness to the primary health care practitioner. 3. Abstain from engaging in vaginal intercourse for the rest of the pregnancy. 4. Carefully weigh all of her saturated peripads.
3. This client must abstain from vaginal intercourse for the remainder of the pregnancy.
A gravid woman, who is 42 weeks' gestation, has just had a 20-minute nonstress test (NST). Which of the following results would the nurse interpret as a reactive test? 1. Moderate fetal heart baseline variability. 2. Maternal heart rate accelerations to 140 bpm lasting at least 20 seconds. 3. Two fetal heart accelerations of 15 bpm lasting at least 15 seconds. 4. Absence of maternal premature ventricular contractions.
3. This is the definition of a reactive nonstress test—there are two fetal heart accelerations of 15 bpm lasting 15 or more seconds during a 20-minute period.
A woman enters the prenatal clinic accompanied by her partner. When she is asked by the nurse about her reason for seeking care, the woman looks down as her partner states, "She says she thinks she's pregnant. She constantly complains of feeling tired. And her vomiting is disgusting!" Which of the following is the priority action for the nurse to perform? 1. Ask the woman what times of the day her fatigue seems to be most severe. 2. Recommend to the couple that they have a pregnancy test done as soon as possible. 3. Continue the interview of the woman in private. 4. Offer suggestions on ways to decrease the vomiting.
3. This is the priority action. The nurse should escort the client to a location where the partner cannot follow.
A client is admitted to the hospital with severe preeclampsia. The nurse is assessing for clonus. Which of the following actions should the nurse perform? 1. Strike the woman's patellar tendon. 2. Palpate the woman's ankle. 3. Dorsiflex the woman's foot. 4. Position the woman's feet flat on the floor.
3. To assess clonus, the nurse should dorsiflex the woman's foot.
An insulin-dependent diabetic woman will require higher doses of insulin as which of the following pregnancy hormones increases in her body? 1. Estrogen. 2. Progesterone. 3. Human chorionic gonadotropin. 4. Human placental lactogen.
4. Human placental lactogen is an insulin antagonist, so the client will require higher doses of insulin as the level of placental lactogen increases.
A woman, 8 weeks pregnant, is admitted to the obstetric unit with a diagnosis of threatened abortion. Which of the following tests would help to determine whether the woman is carrying a viable or a nonviable pregnancy? 1. Luteinizing hormone level. 2. Endometrial biopsy. 3. Hysterosalpinogram. 4. Serum progesterone level.
4. Serum progesterone will provide information on the viability of a pregnancy.
Which of the following nursing diagnoses would be most appropriate for a 15-year-old woman who is in her first trimester of pregnancy? 1. Sleep pattern disturbance related to discomforts of pregnancy. 2. Knowledge deficit related to care of infants. 3. Anxiety related to fear of labor and delivery. 4. Ineffective individual coping related to developmental level.
4. The developmental tasks of adolescence are often in conflict with the tasks of pregnancy. This nursing diagnosis is the most appropriate.
A client has severe preeclampsia. The nurse would expect the primary health care practitioner to order tests to assess the fetus for which of the following? 1. Severe anemia. 2. Hypoprothrombinemia. 3. Craniosynostosis. 4. Intrauterine growth restriction.
4. The fetus should be assessed for intrauterine growth restriction.
A client has been admitted with a diagnosis of hyperemesis gravidarum. Which of the following lab values would be consistent with this diagnosis? 1. pO2 90, pCO2 35, HCO3 19 mEq/L, pH 7.30. 2. pO2 100, pCO2 30, HCO3 21 mEq/L, pH 7.50. 3. pO2 60, pCO2 50, HCO3 28 mEq/L, pH 7.30. 4. pO2 90, pCO2 45, HCO3 30 mEq/L, pH 7.50.
4. This client is in metabolic alkalosis. This is consistent with a diagnosis of hyperemesis gravidarum.
An insulin-dependent diabetic, G3 P0200, 38 weeks' gestation, is being seen in the labor and delivery suite in metabolic disequilibrium. The nurse knows that which of the following maternal blood values is most high risk to her unborn baby? 1. Glucose 150 mg/dL. 2. pH 7.25. 3. pCO2 34 mm Hg. 4. Hemoglobin A1c 10%.
2. Acidosis is fatal to the fetus. This is the most important finding.
A woman is to receive methotrexate IM for an ectopic pregnancy. The nurse should teach the woman about which of the following common side effects of the therapy? Select all that apply. 1. Nausea and vomiting. 2. Abdominal pain. 3. Fatigue. 4. Light-headedness. 5. Breast tenderness.
1, 2, 3, and 4 are correct. 1. Nausea and vomiting are common side effects. 2. Abdominal pain is a common side effect. The pain associated with the medication needs to be carefully monitored to differentiate it from the pain caused by the ectopic pregnancy itself. 3. Fatigue is a common side effect. 4. Light-headedness is a common side effect.
A 39-year-old, 16-week-gravid woman has had an amniocentesis. Before discharge, the nurse teaches the woman to call her doctor if she experiences any of the following side effects? Select all that apply. 1. Fever or chills. 2. Lack of fetal movement. 3. Abdominal pain. 4. Rash or pruritus. 5. Vaginal bleeding.
1, 2, 3, and 5 are correct. 1. The client should call her practitioner if she experiences fever or chills. 2. Because the fetus can be injured during an amniocentesis, the client should report either a decrease or an increase in fetal movement. 3. The client should report abdominal pain or cramping. An amniocentesis can precipitate preterm labor. 5. The client should report any vaginal loss—blood or amniotic fluid. The placenta may become injured or the membranes may rupture during an amniocentesis.
A 32-week-gestation client states that she "thinks" she is leaking amniotic fluid. Which of the following tests could be performed to determine whether the membranes had ruptured? 1. Fern test. 2. Biophysical profile. 3. Amniocentesis. 4. Kernig assessment.
1. A fern test is performed to assess for the presence of amniotic fluid.
A client has just done a fetal kick count assessment. She noted 6 movements during the past hour. If taught correctly, what should her next action be? 1. Nothing, because further action is not warranted. 2. Call the doctor to set up a nonstress test. 3. Redo the test during the next half hour. 4. Drink a glass of orange juice and redo the test.
1. She should do nothing because the woman should feel 3 or more counts in 1 hour.
Which of the following long-term goals is appropriate for a client, 10 weeks' gestation, who is diagnosed with gestational trophoblastic disease (hydatidiform mole)? 1. Client will be cancer free 1 year from diagnosis. 2. Client will deliver her baby at full term without complications. 3. Client will be pain free 3 months after diagnosis. 4. Client will have normal hemoglobin and hematocrit at delivery.
1. This long-term goal is appropriate.
The nurse is caring for a 32-week G8 P7007 with placenta previa. Which of the following interventions would the nurse expect to perform? Select all that apply. 1. Daily contraction stress tests. 2. Blood type and cross match. 3. Bed rest with passive range-of-motion exercises. 4. Daily serum electrolyte assessments. 5. Weekly biophysical profiles.
2, 3, and 5 are correct. 2. There should be blood available in the blood bank in case the woman begins to bleed. 3. The nurse would expect to keep the woman on bed rest with bathroom privileges only. 5. The nurse would expect that weekly biophysical profiles would be done to assess fetal well-being.
A pregnant woman, 24 weeks' gestation, who has been diagnosed with severe choledocholithiasis is scheduled for a cholecystectomy. In addition to routine surgical and post-surgical care, the nurses should pay special attention to which of the following? Select all that apply. 1. The baby will be delivered by cesarean section at the same time as the cholescystectomy surgery. 2. The woman should be placed in the lateral recumbent position during the surgical procedure. 3. The post-anesthesia care nurse should monitor the woman carefully for nausea and vomiting. 4. The post-anesthesia care nurse should monitor the woman carefully for hemorrhage at the surgical site. 5. Antiembolic stockings should be placed on the woman's legs in the post-anesthesia care unit.
2, 3, and 5 are correct. 2. This response is correct. The woman should be maintained in the lateral recumbent position during the surgery because, if laid flat, the gravid uterus would compress the great vessels and impede the return of blood to the heart. 3. This response is correct. The woman would be at high risk for postoperative vomiting and for postoperative gas pains for 2 reasons: progesterone slows gastric motility and the stomach and intestines are displaced by the gravid uterus. 5. This response is correct. After the surgery antiembolic stockings should be placed on the client for the entire time that she is immobile.
A pregnant woman mentions to the clinic nurse that she and her husband enjoy working together on projects around the house and says, "I always wear protective gloves when I work." The nurse should advise the woman that even when she wears gloves, which of the following projects could be high risk to the baby's health? 1. Replacing a light fixture in the nursery. 2. Sanding the paint from an antique crib. 3. Planting tulip bulbs in the side garden. 4. Shoveling snow from the driveway.
2. Antique cribs are often painted with lead-based paint. This is a dangerous activity.
A woman with a diagnosis of ectopic pregnancy is to receive medical intervention rather than a surgical interruption. Which of the following intramuscular medications would the nurse expect to administer? 1. Decadron (dexamethasone). 2. Amethopterin (methotrexate). 3. Pergonal (metotropin). 4. Prometrium (progesterone).
2. Methotrexate is the likely medication.
A client has been admitted with a diagnosis of hyperemesis gravidarum. Which of the following orders written by the primary health care provider is highest priority for the nurse to complete? 1. Obtain complete blood count. 2. Start intravenous with multivitamins. 3. Check admission weight. 4. Obtain urine for urinalysis.
2. Starting an intravenous with multivitamins takes priority.
A client has been diagnosed with pseudocyesis. Which of the following signs/symptoms would the nurse expect to see? 1. 4+ pedal edema. 2. No fetal heartbeat. 3. Hematocrit above 40%. 4. Denial of quickening.
2. There will be no fetal heartbeat when a client has pseudocyesis.
A woman, G4 P0210 and 12 weeks' gestation, has been admitted to the labor and delivery suite for a cerclage procedure. Which of the following long-term outcomes is appropriate for this client? 1. The client will gain less than 25 pounds during the pregnancy. 2. The client will deliver after 38 weeks' gestation. 3. The client will have a normal blood glucose throughout the pregnancy. 4. The client will deliver a baby that is appropriate for gestational age.
2. This client is at high risk for pregnancy loss. This is an appropriate long-term goal.
A 30-year-old gravida, G3 P1101, 6 weeks' gestation, states that her premature baby boy, born 8 years ago, died shortly after delivery from an infection secondary to spina bifida. Which of the following interventions is most important for this client? 1. Grief counseling. 2. Nutrition counseling. 3. Infection control counseling. 4. Genetic counseling.
2. This client is in need of nutrition counseling.
A client being seen in the ED has an admitting medical diagnosis of: third-trimester bleeding: rule out placenta previa. Each time a nurse passes by the client's room, the woman asks, "Please tell me, do you think the baby will be all right?" Which of the following is an appropriate nursing diagnosis for this client? 1. Hopelessness related to possible fetal loss. 2. Anxiety related to inconclusive diagnosis. 3. Situational low self-esteem related to blood loss. 4. Potential for altered parenting related to inexperience.
2. This client is very anxious.
Which of the following findings would the nurse expect to see when assessing a first trimester gravida suspected of having gestational trophoblastic disease (hydatidiform mole) that the nurse would not expect to see when assessing a first-trimester gravida with a normal pregnancy? Select all that apply. 1. Hematocrit 39%. 2. Grape-like clusters passed from the vagina. 3. Markedly elevated blood pressure. 4. White blood cell count 8,000/mm3. 5. Hypertrophied breast tissue.
2. Women with hydatidiform mole often expel grape-like clusters from the vagina. 3. Although signs and symptoms of preeclampsia usually appear only after a pregnancy has reached 20 weeks or later, preeclampsia is seen in the first trimester of pregnancy in women with hydatidiform mole
The nurse has assessed four primigravid clients in the prenatal clinic. Which of the women would the nurse refer to the nurse midwife for further assessment? 1. 10 weeks' gestation, complains of fatigue with nausea and vomiting. 2. 26 weeks' gestation, complains of ankle edema and chloasma. 3. 32 weeks' gestation, complains of epigastric pain and facial edema. 4. 37 weeks' gestation, complains of bleeding gums and urinary frequency.
3. Epigastric pain and facial edema are not normal. This client should be referred to the nurse midwife.
A woman is recovering at the gynecologist's office following a late first-trimester spontaneous abortion. At this time, it is essential for the nurse to check which of the following? 1. Maternal rubella titer. 2. Past obstetric history. 3. Maternal blood type. 4. Cervical patency.
3. It is essential that the woman's blood type be assessed.
The nurse caring for a type 1 diabetic client who wishes to become pregnant notes that the client's glycohemoglobin, or glycosylated hemoglobin (HgbA1c), result was 15% today and the fasting blood glucose result was 100 mg/dL. Which of the following interpretations by the nurse is correct in relation to these data? 1. The client has been hyperglycemic for the past 3 months and is hyperglycemic today. 2. The client has been normoglycemic for the past 3 months and is normoglycemic today. 3. The client has been hyperglycemic for the past 3 months and is normoglycemic today. 4. The client has been normoglycemic for the past 3 months and is hyperglycemic today.
3. The client has been hyperglycemic for 3 months but is normoglycemic today.
A 14-year-old woman is seeking obstetric care. Which of the following vital signs must be monitored very carefully during this woman's pregnancy? 1. Heart rate. 2. Respiratory rate. 3. Blood pressure. 4. Temperature.
3. The client's blood pressure is the most important vital sign.
Which of the following findings should the nurse expect when assessing a client, 8 weeks' gestation, with gestational trophoblastic disease (hydatidiform mole)? 1. Protracted pain. 2. Variable fetal heart decelerations. 3. Dark brown vaginal bleeding. 4. Suicidal ideations.
3. The condition is usually diagnosed after a client complains of brown vaginal discharge early in the "pregnancy."
A patient who is 24 weeks pregnant has been diagnosed with syphilis. She asks the nurse how the infection will affect the baby. The nurse's response should be based on which of the following? 1. She is high risk for premature rupture of the membranes. 2. The baby will be born with congenital syphilis. 3. Penicillin therapy will reduce the risk to the fetus. 4. The fetus will likely be born with a cardiac defect.
3. Usually a single shot of penicillin, administered to the mother, will cure her and protect the baby.
The nurse suspects that a client is third spacing fluid. Which of the following signs will provide the nurse with the best evidence of this fact? 1. Client's blood pressure. 2. Client's appearance. 3. Client's weight. 4. Client's pulse rate.
3. Weight is the most important sign for the nurse to assess.
Which of the following clients is highest risk for pseudocyesis? 1. The client with lymphatic cancer. 2. The client with celiac disease. 3. The client with multiple miscarriages. 4. The client with grand multiparity.
3. Women who have had a number of miscarriages are at high risk for pseudocyesis.
A gravid woman with sickle cell anemia is admitted in vaso-occlusive crisis. Which of the following is the priority intervention that the nurse must perform? 1. Administer narcotic analgesics. 2. Apply heat to swollen joints. 3. Place on strict bed rest. 4. Infuse intravenous solution.
4. Administering intravenous fluids is the priority action.
A 25-year-old client is admitted with the following history: 12 weeks pregnant, vaginal bleeding, no fetal heartbeat seen on ultrasound. The nurse would expect the doctor to write an order to prepare the client for which of the following? 1. Cervical cerclage. 2. Amniocentesis. 3. Nonstress testing. 4. Dilation and curettage.
4. Dilation and curettage (D&C) is performed on a client with an incomplete abortion.
Which finding should the nurse expect when assessing a client with placenta previa? 1. Severe occipital headache. 2. History of thyroid cancer. 3. Previous premature delivery. 4. Painless vaginal bleeding.
4. Painless vaginal bleeding is often the only symptom of placenta previa.
Nurses working in obstetric clinics know that, in general, teen pregnancies are high risk because of which of the following? 1. High probability of chromosomal anomalies. 2. High oral intake of manganese and zinc. 3. High numbers of post-term deliveries. 4. High incidence of late prenatal care registration.
4. Teens are likely to delay entry into the health care system.
A pregnant Latina is being seen in the prenatal clinic with diarrhea, fever, stiff neck, and headache. Upon inquiry, the nurse learns that the woman drinks unpasteurized milk and eats soft cheese daily. For which of the following bacterial infections should this woman be assessed? 1. Staphylococcus aureus. 2. Streptococcus albicans. 3. Pseudomonas aeruginosa. 4. Listeria monocytogenes.
4. The client is likely suffering from listeriosis, an infection caused by Listeria monocytogenes bacteria.
During a prenatal examination, the nurse notes scarring on and around the woman's genitalia. Which of the following questions is most important for the nurse to ask in relation to this observation? 1. "Have you ever had surgery on your genital area?" 2. "Have you worn any piercings in your genital area?" 3. "Have you had a tattoo removed from your genital area?" 4. "Have you ever been forced to have sex without your permission?"
4. This is an essential question for the nurse to ask.
During a prenatal interview, a client tells the nurse, "My mother told me she had toxemia during her pregnancy and almost died!" Which of the following questions should the nurse ask in response to this statement? 1. "Does your mother have a cardiac condition?" 2. "Did your mother tell you what she was toxic from?" 3. "Does your mother have diabetes now?" 4. "Did your mother say whether she had a seizure or not?"
4. This is the appropriate question. The nurse is asking whether or not the client's mother developed eclampsia.
The nurse is caring for a client who was just admitted to the hospital to rule out ectopic pregnancy. Which of the following orders is the most important for the nurse to perform? 1. Take the client's temperature. 2. Document the time of the client's last meal. 3. Obtain urine for urinalysis and culture. 4. Assess for complaint of dizziness or weakness.
4. It is most important for the nurse to assess for complaints of dizziness or weakness.
Which of the following would be the best approach to take with an unmarried 14-year-old girl who tells the nurse that she is undecided whether or not to maintain an unplanned pregnancy? 1. "You should consider an abortion since you are so young." 2. "It is a difficult decision. What have you thought about so far?" 3. "Studies show that babies living with teen mothers often become teen parents." 4. "Why don't you keep the pregnancy? You could always opt for adoption later."
2. This is an excellent response. The question opens the door for the teenager to discuss her feelings and thoughts.
A woman with a history of congestive heart disease is 36 weeks pregnant. Which of the following findings should the nurse report to the primary health care practitioner? 1. Presence of striae gravidarum. 2. Dyspnea on exertion. 3. 4-pound weight gain in a month. 4. Patellar reflexes +2.
2. A client who is complaining of dyspnea on exertion is likely going into leftsided congestive heart failure.
A nurse is caring for four prenatal clients in the clinic. Which of the clients is high risk for placenta previa? Select all that apply. 1. Jogger with low body mass index. 2. Primigravida who smokes 1 pack of cigarettes per day. 3. Infertility client who is carrying in vitro triplets. 4. Registered professional nurse who works 12-hour shifts. 5. Police officer on foot patrol.
2. A smoker is high risk for placenta previa. 3. A woman carrying triplets is high risk for placenta previa.
A gravid client, 27 weeks' gestation, has been diagnosed with gestational diabetes. Which of the following therapies will most likely be ordered for this client? 1. Oral hypoglycemic agents. 2. Diet control with exercise. 3. Regular insulin injections. 4. Inhaled insulin.
2. About 95% of gestational diabetic clients are managed with diet and exercise alone.
At 28 weeks' gestation, an Rh-negative woman receives RhoGAM. Which of the following would indicate that the medication is effective? 1. The baby's Rh status changes to Rh-negative. 2. The mother produces no Rh antibodies. 3. The baby produces no Rh antibodies. 4. The mother's Rh status changes to Rh-positive.
2. That the mother produces no Rh antibodies is the goal of RhoGAM administration.
A lecithin:sphingomyelin (L/S) ratio has been ordered by a pregnant woman's obstetrician. Which of the following data will the nurse learn from this test? 1. Coagulability of maternal blood. 2. Maturation of the fetal lungs. 3. Potential for fetal development of erythroblastosis fetalis. 4. Potential for maternal development of gestational diabetes.
2. The L/S ratio indicates the maturity of the fetal lungs.
Prenatal teaching for a pregnant woman should include instructions to do which of the following? 1. Refrain from touching her pet bird. 2. Wear gloves when gardening. 3. Cook pork until medium well done. 4. Avoid sleeping with the dog.
2. The client should be advised to wear gloves when gardening.
A gestational diabetic, who requires insulin therapy to control her blood glucose levels, telephones the triage nurse complaining of dizziness and headache. Which of the following actions should the nurse take at this time? 1. Have the client proceed to the office to see her physician. 2. Advise the client to drink a glass of juice and then call back. 3. Instruct the client to inject herself with regular insulin. 4. Tell the client immediately to telephone her medical doctor.
2. The client should drink a 4-ounce glass of juice.
A client, G2 P1001, telephones the gynecology office complaining of left-sided pain. Which of the following questions by the triage nurse would help to determine whether the one-sided pain is due to an ectopic pregnancy? 1. "When did you have your pregnancy test done?" 2. "When was the first day of your last menstrual period?" 3. "Did you have any complications with your first pregnancy?" 4. "How old were you when you first got your period?"
2. The date of the last menstrual period will assist the nurse in determining how many weeks pregnant the client is.
In analyzing the need for health teaching in a client, G5 P4004 with gestational diabetes, the nurse should ask which of the following questions? 1. "How old were you at your first pregnancy?" 2. "Do you exercise regularly?" 3. "Is your partner diabetic?" 4. "Do you work outside of the home?"
2. The likelihood of developing either gestational or type 2 diabetes is reduced when clients exercise regularly.
A 24-week-gravid client is being seen in the prenatal clinic. She states, "I have had a terrible headache for the past 2 days." Which of the following is the most appropriate action for the nurse to perform next? 1. Inquire whether or not the client has allergies. 2. Take the woman's blood pressure. 3. Assess the woman's fundal height. 4. Ask the woman about stressors at work.
2. The nurse should assess the client's blood pressure.
A client, G8 P3406, 14 weeks' gestation, is being seen in the prenatal clinic. During the nurse's prenatal teaching session, the nurse will emphasize that the woman should notify the obstetric office immediately if she notes which of the following? 1. Change in fetal movement. 2. Signs and symptoms of labor. 3. Swelling of feet and ankles. 4. Appearance of spider veins.
2. The nurse should emphasize the need for the client to notify the office of signs of preterm labor.
A 25-week-pregnant client, who had eaten a small breakfast, has been notified that her glucose challenge test results were 142 mg/dL 1 hour after ingesting the glucose. Which of the following is appropriate for the nurse to say at this time? 1. "Because you ate before the test, the results are invalid and will need to be repeated." 2. "Because your test results are higher than normal, you will have to have another, more specific test." 3. "Because of the results you will have to have weekly glycohemoglobin testing done." 4. "Because your results are within normal limits you need not worry about gestational diabetes."
2. This comment is appropriate. The client will be referred for a 3-hour glucose tolerance test.
The nurse is grading a woman's reflexes. Which of the following grades would indicate reflexes that are slightly brisker than normal? 1. +1. 2. +2. 3. +3. 4. +4.
3. +3 reflexes are defined as slightly brisker than normal or slightly hyperreflexic.
A client with mild preeclampsia who has been advised to be on bed rest at home asks why doing so is necessary. Which of the following is the best response for the nurse to give the client? 1. "Bed rest will help you to conserve energy for your labor." 2. "Bed rest will help to relieve your nausea and anorexia." 3. "Reclining will increase the amount of oxygen that your baby gets." 4. "The position change will prevent the placenta from separating."
3. Bed rest, especially side-lying, helps to improve perfusion to the placenta.
A nurse is counseling a preeclamptic client about her diet. Which should the nurse encourage the woman to do? 1. Restrict sodium intake. 2. Increase intake of fluids. 3. Eat a well-balanced diet. 4. Avoid simple sugars.
3. It is important for the client to eat a well-balanced diet.
A 14-year-old woman is seeking obstetric care. Which of the following is an appropriate nursing care goal for this young woman? The young woman will: 1. Bring her partner to all prenatal visits. 2. Terminate the pregnancy. 3. Continue her education. 4. Undergo prenatal chromosomal analysis.
3. It is important for the young woman to work toward completing the tasks of adolescence at the same time that she is engaged in maintaining a healthy pregnancy. She should continue her education.
A woman has been diagnosed with a ruptured ectopic pregnancy. Which of the following signs/symptoms is characteristic of this diagnosis? 1. Dark brown rectal bleeding. 2. Severe nausea and vomiting. 3. Sharp unilateral pain. 4. Marked hyperthermia.
3. Sharp unilateral pain is a common symptom of a ruptured ectopic.
A gravid client, G6 P5005, 24 weeks' gestation, has been admitted to the hospital for placenta previa. Which of the following is an appropriate long-term goal for this client? 1. The client will state an understanding of need for complete bed rest. 2. The client will have a reactive nonstress test on day 2 of hospitalization. 3. The client will be symptom free until at least 37 weeks' gestation. 4. The client will call her children shortly after admission.
3. That the client be symptom-free until at least 37 weeks' gestation is a long-term goal.
A 26-week-gestation woman is diagnosed with severe preeclampsia with HELLP syndrome. The nurse will assess for which of the following signs/symptoms? 1. Low serum creatinine. 2. High serum protein. 3. Bloody stools. 4. Epigastric pain.
4. Epigastric pain is associated with the liver involvement of HELLP syndrome.
The nurse notes that the results of a gravid woman's contraction stress test are equivocal. How should the nurse interpret the findings? 1. Baby is acidotic and should be delivered. 2. Fetal heart rate accelerated once during the test. 3. Baby is preterm but the heart rate is normal. 4. Additional data are needed to make a diagnosis.
4. Equivocal results are difficult to interpret. Additional information is needed.
A client has just been diagnosed with gestational diabetes. She cries, "Oh no! I will never be able to give myself shots!!" Which of the following responses by the nurse is appropriate at this time? 1. "I am sure you can learn for your baby." 2. "I will work with you until you feel comfortable giving yourself the insulin." 3. "We will be giving you pills for the diabetes." 4. "If you follow your diet and exercise you will probably need no insulin."
4. It is unlikely that this client will need any medication. Diet and exercise will probably control the diabetes.
The nurse is providing health teaching to a group of women of childbearing age. One woman, who states that she is a smoker, asks about smoking's impact on the pregnancy. The nurse responds that which of the following fetal complications can develop if the mother smokes? 1. Genetic changes in the fetal reproductive system. 2. Extensive central nervous system damage. 3. Addiction to the nicotine inhaled from the cigarette. 4. Fetal intrauterine growth restriction.
4. Smoking in pregnancy does cause fetal intrauterine growth restriction.
Which of the following statements is appropriate for the nurse to say to a patient with a complete placenta previa? 1. "During the first phase of labor you will do slow chest breathing." 2. "You should ambulate in the halls at least two times each day." 3. "The doctor will deliver you once you reach 25 weeks' gestation." 4. "It is important that you inform me if you become constipated."
4. Straining at stool can result in enough pressure to result in placental bleeding.
A nurse is caring for a 25-year-old client who has just had a spontaneous first trimester abortion. Which of the following comments by the nurse is appropriate? 1. "You can try again very soon." 2. "It is probably better this way." 3. "At least you weren't very far along." 4. "I'm here to talk if you would like."
4. This statement is appropriate. The nurse is offering his or her assistance to the client.
An obese client is being seen by the nurse during her prenatal visit. Which of the following comments by the nurse is appropriate at this time? 1. "We will want you to gain the same amount of weight we would encourage any pregnant woman to gain." 2. "To have a healthy baby we suggest that you go on a weight reduction diet right away." 3. "To prevent birth defects we suggest that you gain weight during the first trimester and then maintain your weight for the rest of the pregnancy." 4. "We suggest that you gain weight throughout your pregnancy but not quite as much as other women."
4. This statement is true. Normal weight clients are encouraged to gain between 25 and 35 pounds.
A gravid woman is carrying monochorionic twins. For which of the following complications should this pregnancy be monitored? 1. Oligohydramnios. 2. Placenta previa. 3. Cephalopelvic disproportion. 4. Twin-to-twin transfusion.
4. Twin-to-twin transfusion is a relatively common complication of monozygotic twin pregnancies.
A woman is to receive methotrexate IM for an ectopic pregnancy. The drug reference states that the recommended safe dose of the medicine is 50 mg/m2. She weighs 52 kg and is 148 cm tall. What is the maximum safe dose, in mg, of methotrexate that this woman can receive? (If rounding is needed, please round to the nearest tenth.) ______ mg
73 mg
A woman who has been diagnosed with an ectopic pregnancy is to receive methotrexate 50 mg/m2 IM. The woman weighs 136 lb and is 5 ft 4 in tall. What is the maximum safe dose, in mg, of methotrexate that this woman can receive? (If rounding is needed, please round to the nearest tenth.) ______ mg
83.5 mg