Lippincott: Gestational Complications

A client has a cerclage placed at 16 weeks' gestation. She has had no contractions and her cervix is dilated 2 cm. The nurse is preparing the client for discharge. Which statement by the client should indicate to the nurse that the client needs further instruction? "I'll need more frequent prenatal visits." "I should call if I'm leaking fluid or have bleeding or contractions." "I can have sex again in about 2 weeks." "I can have nothing in my vagina until I'm at term."

"I can have sex again in about 2 weeks."

A nurse is teaching a client who is 28 weeks pregnant and has gestational diabetes how to control her blood glucose levels. Diet therapy alone has been unsuccessful in controlling this client's blood glucose levels, so she has started insulin therapy. The nurse should consider the teaching effective when the client says: "I won't use insulin if I'm sick." "I need to use insulin each day." "If I give myself an insulin injection, I don't need to watch what I eat." "I'll monitor my blood glucose levels twice per week."

"I need to use insulin each day."

A primigravid client at 38 weeks' gestation diagnosed with mild preeclampsia calls the clinic nurse to say she has had a continuous headache for the past 2 days accompanied by nausea. The client does not want to take aspirin. What should the nurse should tell the client? "Take two acetaminophen tablets. They are not as likely to upset your stomach." "I think the health care provider should see you today. Can you come to the clinic this morning?" "You need to lie down and rest. Have you tried placing a cool compress over your head?" "I'll ask the health care provider to call in a prescription for nausea medications. What is your pharmacy's number?"

"I think the health care provider should see you today. Can you come to the clinic this morning?"

When evaluating a pregnant client's knowledge of symptoms to report immediately, which statement indicates to the nurse that the client understands the information given to her? "I'll report increased frequency of urination." "If I have blurred or double vision, I should call the clinic immediately." "If I feel tired after resting, I should report it immediately." "Nausea should be reported immediately."

"If I have blurred or double vision, I should call the clinic immediately."

The primary health care provider (HCP) orders 1,000 mL of Ringer's lactate intravenously over an 8-hour period for a 29-year-old primigravid client at 16 weeks' gestation with hyperemesis. The drip factor is 12 gtt/mL. The nurse should administer the IV infusion at how many drops per minute? Record your answer as a whole number.

25

A multigravid client in active labor at term suddenly sits up and says, "I can't breathe! My chest hurts really bad!" The client's skin begins to turn a dusky gray color. After calling for assistance, which action should the nurse take next? Administer oxygen by face mask. Begin cardiopulmonary resuscitation. Administer intravenous oxytocin. Obtain an prescription for intravenous fibrinogen.

Administer oxygen by face mask.

A 16-year-old primigravida at 36 weeks' gestation who has had no prenatal care experienced a seizure at work and is being transported to the hospital by ambulance. What should the nurse do upon the client's arrival? Position the client in a supine position. Auscultate breath sounds every 4 hours. Monitor the vital signs every 4 hours. Admit the client to a quiet, darkened room.

Admit the client to a quiet, darkened room.

A 29-year-old multigravida at 37 weeks' gestation is being treated for severe preeclampsia and has magnesium sulfate infusing at 3 g/h. What is the priority intervention to maintain safety for this client? Maintain continuous fetal monitoring. Encourage family members to remain at bedside. Assess reflexes, clonus, visual disturbances, and headache. Monitor maternal liver studies every 4 hours.

Assess reflexes, clonus, visual disturbances, and headache

As the nurse enters the room of a newly admitted primigravid client diagnosed with severe preeclampsia, the client begins to experience a seizure. Which action should the nurse take first? Insert an airway to improve oxygenation. Note the time when the seizure begins and ends. Call for immediate assistance. Turn the client to her left side.

Call for immediate assistance.

A 28-year-old multigravida at 32 weeks' gestation is admitted to the hospital because of vaginal bleeding. Which action should the nurse do first? Perform a sterile vaginal examination. Administer a cleansing enema. Witness a consent for immediate cesarean birth. Check fetal heart rate and maternal blood pressure.

Check fetal heart rate and maternal blood pressure.

A client who is 34 weeks pregnant is experiencing bleeding caused by placenta previa. The fetal heart sounds are normal and the client is not in labor. Which nursing intervention should the nurse perform? Allow the client to ambulate with assistance. Perform a vaginal examination to check for cervical dilation. Monitor the amount of vaginal blood loss. Notify the physician for a fetal heart rate of 130 beats/minute.

Monitor the amount of vaginal blood loss.

A client, 7 months pregnant, is admitted to the unit with abdominal pain and bright red vaginal bleeding. Which action should the nurse take? Place the client on her left side and start supplemental oxygen, as ordered. Administer I.V. oxytocin, as ordered. Ease the client's anxiety by assuring her that everything will be all right. Massage the client's fundus.

Place the client on her left side and start supplemental oxygen, as ordered.

A pregnant adolescent admitted with premature uterine contractions was successfully treated with I.V. fluids. She is eager to return to high school to take a math test. The nurse's discharge examination reveals vaginal blood pooling under the adolescent's buttocks that's painless to the client. Which action should the nurse take? Encourage developmental growth by wishing the client luck on her math test. Teach the client to measure the amount of bleeding and when to notify the physician. Stop the discharge process and notify the physician immediately. Reassure the client that she doesn't need to be concerned about the bleeding because she had I.V. fluids.

Stop the discharge process and notify the physician immediately

A pregnant client is diagnosed with partial placenta previa. The nurse should prepare the client for which intervention? a. activity limited to bed rest b. platelet infusion c. cesarean birth d. labor induction with oxytocin

a. activity limited to bed rest

The nurse is assessing a multigravid client at 12 weeks' gestation who has been admitted to the emergency department with sharp right-sided abdominal pain and vaginal spotting. Which information should the nurse obtain about the client's history? Select all that apply. a. history of sexually transmitted infections b. number of sexual partners c. last menstrual period d. cesarean section e. contraceptive use

a. history of sexually transmitted infections b. number of sexual partners c. last menstrual period e. contraceptive use

Early detection of an ectopic pregnancy is paramount in preventing a life-threatening rupture. Which symptoms should alert the nurse to the possibility of an ectopic pregnancy? abdominal pain, vaginal bleeding, and a positive pregnancy test nausea and vomiting amenorrhea and a negative pregnancy test copious discharge of clear mucous and prolonged epigastric pai

abdominal pain, vaginal bleeding, and a positive pregnancy test

A client at 36 weeks' gestation, begins to exhibit signs of labor after an eclamptic seizure. The nurse should assess the client for: abruptio placentae transverse lie placenta accreta uterine atony

abruptio placentae

A client who is 32 weeks pregnant presents to the emergency department with bright red bleeding and no abdominal pain. A nurse should: a. perform a pelvic examination. b. assess the client's blood pressure. c. assess the fetal heart rate. d. order a stat hemoglobin and hematocrit.

c. assess the fetal heart rate.

How does the nurse identify the type of presentation shown in the figure? frank breech compound breech complete breech incomplete breech

complete breech

A nurse is caring for a client after evacuation of a hydatidiform mole. The nurse should tell the client to: a. wait 1 month before trying to become pregnant again. b. make an appointment for follow-up human chorionic gonadotropin (hCG) level monitoring at the end of 1 year. c. discuss options for sterilization with the physician. d. use birth control for at least 1 year.

d. use birth control for at least 1 year.

A 24-year-old client admitted to the hospital is suspected of having an ectopic pregnancy. On admission, which factor would be most important to assess? sexual practices use of a diaphragm type of oral contraceptives date of last menstrual period

date of last menstrual period

A client, age 39, attends a regular prenatal check-up. She's 32 weeks pregnant. When assessing the client, the nurse should stay especially alert for signs and symptoms of: gestational hypertension. iron deficiency anemia. cephalopelvic disproportion. sexually transmitted diseases (STDs).

gestational hypertension.

A client makes a routine visit to the prenatal clinic. Although the client is 14 weeks pregnant, the size of her uterus approximates an 18- to 20-week pregnancy. The physician diagnoses gestational trophoblastic disease and orders ultrasonography. The nurse expects ultrasonography to reveal: an empty gestational sac. grapelike clusters. a severely malformed fetus. an extrauterine pregnancy.

grapelike clusters.

A nurse is providing care for a pregnant client with gestational diabetes. The client asks the nurse if her gestational diabetes will affect the birth. The nurse should know that: labor may need to be induced early. the birth must be cesarean. the mother will carry to term safely. it's too early to tell.

labor may need to be induced early.

A multiparous client is admitted to the labor and delivery area with painless vaginal bleeding. Ultrasonography shows that an edge of her placenta meets but doesn't occlude the rim of the cervical os. This finding suggests partial placenta previa. a low-lying placenta. marginal placenta previa. abruptio placentae.

marginal placenta previa.

A primigravid client with diabetes at 39 weeks' gestation is seen in the high-risk clinic. The primary health care provider (HCP) estimates that the fetus weighs at least 10 lb (4,500 g). The client asks, "What causes the baby to be so large?" The nurse's response is based on the understanding that fetal macrosomia is usually related to which factor? family history of large infants fetal anomalies maternal hyperglycemia maternal hypertension

maternal hyperglycemia

A multigravid client is admitted to the hospital with a diagnosis of ectopic pregnancy. The nurse anticipates that, because the client's fallopian tube has not yet ruptured, which medication may be prescribed? progestin contraceptives medroxyprogesterone methotrexate dyphylline

methotrexate

A client in her 34th week of pregnancy presents with sudden onset of bright red vaginal bleeding. Her uterus is soft, and she's experiencing no pain. Fetal heart rate is 120 beats/minute. Based on this history, what should the nurse suspect? abruptio placentae preterm labor placenta previa threatened abortion

placenta previa

A 32-year-old multigravida returns to the clinic for a routine prenatal visit at 36 weeks' gestation. The assessments during this visit include: blood pressure 140/90 mm Hg; pulse 80 beats/min; respiratory rate 16 breaths/min. What further information should the nurse obtain to determine if this client is becoming preeclamptic? headaches blood glucose level proteinuria peripheral edema

proteinuria

The nurse is assessing a pregnant client with abruptio placenta. The nurse should notify the primary care provider about which finding? excessive vaginal bleeding rigid, board-like abdomen tetanic uterine contractions premature rupture of membranes

rigid, board-like abdomen

A client who's 12 weeks pregnant is complaining of severe left lower quadrant pain and vaginal spotting. She is admitted for treatment of an ectopic pregnancy. The nurse should give the highest priority to which nursing diagnosis? risk for deficient fluid volume anxiety acute pain impaired gas exchange

risk for deficient fluid volume

A cerclage procedure is performed on a client at 20 weeks' gestation who is diagnosed with cervical incompetence. When preparing the discharge teaching plan, the nurse should expect to instruct the client to monitor herself for which problem? Braxton Hicks contractions nausea and vomiting symptoms of infection transient hypotension

symptoms of infection