Maternal Child EAQ #2

Family history of genetic abnormalities

During their initial visit to the prenatal clinic, a couple asks the nurse whether the woman should have an amniocentesis for genetic studies. Which factor indicates that an amniocentesis may be indicated?

Assist the client's coach in helping her with the use of breathing techniques

Which is the appropriate nursing action for a client in active labor whose cervix is dilated 4 cm and 100% effaced with the fetal head at 0 station?

Checking for signs of preterm labor

Which is the most important nursing intervention for a client who is at 26 weeks' gestation with pyelonephritis?

Turn the head to one side

Which is the nurse's priority action when caring for an obstetrical client experiencing eclampsia?

Hemoglobin of 10g/dL

Which laboratory finding of a pregnant client would alert the nurse to the need for further assessment?

Hypotension Abdominal pain Vaginal bleeding

A primary health care provider suspects ectopic pregnancy in an adolescent and conducts further evaluation. Which signs and symptoms have led the prover to suspect ectopic pregnancy? Select all that apply.

Fetal movement

A nonstress test evaluates the condition of the fetus by comparing the fetal heart rate with which factor?

Choriocarcinoma

After the removal of a hydatidiform mole, the nurse assesses the client's serum human chorionic gonadotropin (hCG) laboratory data. This data monitors the client for risk for development of which complication?

It will prevent the woman from producing antibodies

An Rh-negative client has a spontaneous abortion at the end of the second trimester and is prescribed Rho(D) immune globulin. The client asks the nurse, "Why do I need this medication?" Which information would the nurse consider before answering the client's question?

Gravida 1 who had an intrauterine fetal death

Which postpartum client is at the highest risk for Disseminated Intravascular Coagulation (DIC)?

Chorionic villus sampling

Which prenatal test provides the earliest diagnosis of fetal defects?

Pudendal

The nurse is teaching prenatal class about the types of pain blocks that provide perineal anesthesia during labor. Which type of pain block identified by a client indicates understanding of the type that allows the client to feel contractions and push during the second stage of labor?

Late decelerations of the fetal heart rate are occurring with each contraction

Which conclusion is indicated by a positive contraction stress test (CST)?

Repeatedly drops abruptly to 90 beats per minute unrelated to contractions

Which fetal heart rate pattern on a client in labor would require immediate action from the nurse?

The fetus at this time is likely to tolerate the stress of labor.

How would the nurse explain a contraction stress test (CST) result interpreted as negative in a client at 41 weeks' gestation?

Iron Folic acid

In addition to the regular pregnancy diet and prenatal vitamins and minerals, which supplements may be needed by a pregnant client with rheumatic heart disease? Select all that apply?

B negative blood type

Which finding would the nurse be most concerned about when reviewing the chart of a client scheduled for an amniocentesis?

Weight gain of 6 lb (2.7 kg) in 1 month

Which finding, other than increased blood pressure, may indicate preeclampsia?

Dried prunes Boiled spinach

Which foods will the nurse include when suggesting dietary sources of iron to a client with anemia? Select all that apply

24 to 34 weeks

Which gestational period would the nurse identify as appropriate for the administration of corticosteroids during preterm labor?

The fetal heart rate will be monitored for about 20 minutes before the test begins

Which information would the nurse provide to the client who is being prepared for a contraction stress test (CST)?

Drink orange juice with an iron supplement

Which instruction would the nurse give to the pregnant client with anemia?

Drink water until bladder is full

Which instruction would the nurse provide to the client in early pregnancy scheduled for her first obstetric ultrasound?

External fetal monitoring and oxygen

Which intervention would the plan of care for a client with a tentative diagnosis of partial abruptio placentae include?

Epidural anesthesia

The anesthesiologist discusses several types of analgesia and anesthesia with an obese client in early labor and recommends a type. For which type would the nurse anticipate preparing teaching?

Monitoring deep tendon reflexes Maintaining a dark quiet environment Using a pump to regulate the medication Having calcium gluconate available at bedside

Which interventions would be included in the nursing care for a client receiving magnesium sulfate for severe preeclampsia? Select all that apply

Advising the client to limit stress, promoting rest after meals, and educating the client about the analgesia and anesthesia used during labor

Which interventions would be included in the plan of care for a client with class 1 cardiac disease during the last weeks or pregnancy?

Dark leafy green vegetables Legumes Dried fruits Ground beef patty

Which iron rich foods would the nurse encourage the client with mild anemia in early pregnancy to eat? Select all that apply

Maintaining bed rest

What is the priority nursing intervention for a client with placenta previa who is having vaginal bleeding at this time?

I have been using cough drops to try and get rid of my cough

When caring for a client in the third trimester of pregnancy with a history of myocardial infarction, which statement made by the client would concern the nurse the most?

About 6 weeks into the pregnancy

When do the initial symptoms of a tubal pregnancy begin?

Prevent injury

Which action would be the highest priority for the nurse to initiate for a client in eclampsia?

Smoking is one of the risk factors for ectopic pregnancy Ectopic pregnancy occurs when the fertilized eggs implants in the fallopian tubes When a young woman exhibits abdominal pain, ectopic pregnancy is suspected If the adolescent exhibits abdominal pain and hypotension, the ectopic pregnancy may have ruptured

Which statements are true regarding ectopic pregnancy? Select all that apply

'I'll start limiting my carbohydrates' 'I'll lie down for at least 2 hrs after I eat'

Which statements by a client with hyperemesis gravidarum would confirm that the client requires further teaching? Select all that apply

Deep tendon reflexes of +2

A client admitted with preeclampsia is receiving magnesium sulfate. Which assessment finding indicates to the nurse that a therapeutic level has been reached?

Intrauterine growth restriction (IUGR)

A client exhibits oligohydramnios at 36 weeks' gestation. For which newborn complication would the nurse monitor?

Stillbirth Spontaneous abortion Intellectual disabilities

A pregnant woman continues to consume alcohol during pregnancy. Which teratogenic effects might the nurse expect to see in the fetus or neonate? Select all that apply

Estimate fetal age

For which reason is an ultrasound done during the first trimester?

Low birth weight

Which is a consequence on the neonate of maternal smoking during pregnancy?

Drink a glass of orange juice and time 10 fetal movements

A client at 35 weeks' gestation calls the prenatal clinic, concerned that she has 'not felt the baby move as much as usual.' The nurse would direct the client to call back after taking which action?

Placental insufficiency

A client at 42 weeks' gestation is admitted for a nonstress test. The nurse concludes that this test is being done because of which possible complication related to prolonged pregnancy?

Hydatidiform mole

A client at her first visit to the prenatal clinic states that she has missed three menstrual periods and thinks that she is carrying twins because her abdomen is so large. She now has a brownish vaginal discharge. Her blood pressure is increased, indicating that she may have gestational hypertension. Which condition is suggested by this client profile?

First

A client in active labor is 100% effaced, dilated 3 cm, and at +1 station. Which stage of labor has this client reached?

Betamethasone

A client in preterm labor has a dilated cervix, and birth appears inevitable, despite medication. Which medication prescription would the nurse anticipate preparing to administer to increase the chance of the newborns survival?

Change nothing

A client who reports that she has been following the recommended pregnancy diet is diagnosed with gestational hypertension. Which instruction would the nurse give about her diet at this time?

Headache Abdominal pain Visual disturbances

A client with a blood pressure of 150/90 mm Hg, 3+ proteinuria and edema of the hands and face is diagnosed with severe preeclampsia. Which other clinical findings support this diagnosis? Select all that apply

Semi- Fowler

A client with a history of a congenital heart defect is admitted to the birthing unit in early labor. Which position would the nurse encourage the client to assume?

Transition

A few hours after being admitted in early labor, a primigravida perspires profusely and becomes restless, flushed, and irritable and says she is going to vomit. Which phrase of the first stage of labor does the nurse suspect the client has entered?

Turning the client on her side

A laboring client receiving epidural anesthesia has a sudden episode of sever nausea, and her skin becomes pale and clammy. Which would be the nurse's immediate action?

Dexamethasone

A pregnant client at 30 weeks gestation is admitted for active labor. Despite tocolytic therapy, it is determined that preterm birth is inevitable. Which medication would the nurse anticipate administering to the client?

Explaining why a vaginal examination should not be performed

A resident primary health care provider in the birthing unit asks the nurse to prepare for a vaginal examination on a client with a partial placenta previa in early labor. Which action would the nurse take at this time?

Abruptio Placentae

A woman in the third trimester of pregnancy presents with vaginal bleeding and states she snorted cocaine approximately 2 hours ago. Which complication would this client profile suggest?

Incompetent cervix

A woman is admitted to the high-risk unit in preterm labor at 30 weeks' gestation. Which factor would the nurse suspect precipitated this preterm labor?

A decrease in fetal movement necessitates an evaluation of fetal well-being

During a prenatal education class, the nurse discusses the importance of fetal movement awareness. Who is this an important concept to teach?

Based on that history you are probably Rh positive and the baby would not be at risk for Rh incompatibility.

During her first prenatal visit a client tells the nurse that she needed an exchange transfusion when she was born because of Rh incompatibility. How would the nurse respond to the client's question asking if her baby will also need a blood transfusion?

Monitor and control blood glucose levels

For a pregnant client with type 1 diabetes, which action is most likely to reduce the risks of disease related complications?

To reduce the probability of tonic-clonic seizures

For which reason is a client with worsening preeclampsia placed in a non stimulating environment?

A full bladder may inhibit the progress of labor

For which reason would the nurse encourage a client to void during the first stage of labor?

Undigested food and fluid may cause nausea and vomiting and limit the choice of anesthesia

For which reason would the nurse limit food and oral fluids as a laboring client approaches the second stage of labor?

Two urine samples showing proteinuria

The nurse is assessing a pregnant client at the end of her second trimester. Which clinical finding causes the nurse to suspect that the client has preeclampsia?

Loss of patellar reflexes Respirations of 10 breaths/min

The nurse is caring for a client receiving magnesium sulfate for treatment of preeclampsia. Which findings alert the nurse to signs of magnesium sulfate toxicity? Select all that apply

Instrument extraction to ease a vaginal birth

The nurse is caring for a client with class III heart disease who is beginning the second stage of labor. For which medical intervention would the nurse prepare the client at this time?

Several punctures are needed to obtain amniotic fluid

The nurse is preparing a pregnant 39 year old client for an amniocentesis. Which factor increases the risk of problems after an amniocentesis?

Tocolytics inhibit labor and maintain a pregnancy

The nurse is teaching a nursing student about tocolytics. Which statement by the student indicates teaching was effective?

Record the fetal response to contractions and continue to monitor the heart rate.

Which action would the nurse take when a 15 beat per minute acceleration of the fetal heart rate above baseline occurs during contraction?

Preterm birth Hypertension Cesarean birth

Which are risk factors of diabetes in pregnancy? Select all that apply

Anemia Poor maternal weight gain Pregnancy-induced hypertension

Which are the medical concerns in adolescent pregnancies? Select all that apply

Unilateral abdominal pain History of sexually transmitted infection (STI)

Which assessment findings correlate with a diagnosis of unruptured tubal pregnancy? Select all that apply

Maintain intravenous fluid administration Have oxygen available in case of hypotension Check the bladder for distention every 2 hours Monitor fetal heart rate and labor progress per hospital

Which assessments and interventions are needed once an epidural catheter has been inserted? Select all that apply

Evidence of urinary tract infection Presence of hyperemesis gravidarum

Which assessments beyond the standard would be made at every prenatal visit when the client has sickle cell anemia. Select all that apply

Patent ductus arteriosus

Which cardiac disease has the lowest risk for maternal mortality?

Obese primigravida

Which client would the nurse identify as being at the greatest risk for a hypertensive disorder or pregnancy?

"Insulin dosage and dietary needs will be adjusted in accordance with the results of blood glucose monitoring"

Which is an appropriate response to a 24 year old client with type 1 diabetes who asks how her pregnancy will affect her diet and insulin needs?

Maintenance dosages of cardiac medications will probably be increased

Which medication teaching would the nurse provide to a first trimester pregnant client with cardiac disease?

Oxytocin Misoprostol Dinoprostone

Which medications would the nurse identify as being used to induce labor in pregnant clients? Select all that apply

Lateral positioning

Which position increases cardiac output in the obstetrical client with cardiac disease?

Severe Preeclampsia

Assessment of a primigravida at 32 weeks' gestation shows a blood pressure of 170/110 mm Hg, 4+ proteinuria, and edema of the face and extremities. With which complication are these findings consistent?

Accompanied by progressive cervical dilation

At 39 weeks' gestation a client asks the nurse about the difference between true and false labor. Which information regarding true labor contractions would the nurse include in a response to the client's question?

Hemodilution

At term a client's hemoglobin level is 10.6 g/dL and her hematocrit is 31%. Which physiological factor accounts for these values?

Uteroplacental insufficiency

Which problem is indicated by a positive contraction stress test (CST)?

Ultrasound examination

Which procedure would the nurse anticipate when caring for a client with a tentative diagnosis of placenta previa?

"Tell me more about your feelings"

Which response is MOST therapeutic to give to a client who has been sexually abused and tearfully says, "I'm no good now; there's nothing to live for"?

A vaginal birth is possible

Which response would the nurse give to a client who asks what having a fetus in longitudinal lie means in relation to her labor and birth of the baby?

Normal because of increases in fetal heart rate (FHR) with fetal movement

Which statement indicates a client understands the meaning of having a reactive nonstress test?

Uterine tenderness and increased fetal activity

Which would the nurse expect to find when assessing a client suspected of having abruptio placentae?

It ends at the time of birth

While caring for a client during labor, which would the nurse remember about the second stage of labor?

Down Syndrome

With which problem is a low maternal serum alpha-fetoprotein associated?

Amniocentesis

Which test would be used to determine fetal lung maturity in a client in preterm labor?

Fetal tone Fetal movement Amniotic fluid index Fetal breathing movements

Which variables are scored on a biophysical profile? Select all that apply

24th and 28th weeks of gestation

Between which weeks of gestation would a client with type 1 diabetes expect to increase her insulin dosage?

Epigastric Discomfort

A client with severe preeclampsia has audible crackles in the lower left lobe, slight blurring of vision in the right eye, generalized facial edema, and epigastric discomfort. Which of these clinical manifestations is most indicative of an impending seizure?

Headache Right upper quadrant abdominal pain Nausea and vomiting

A client with mild preeclampsia is admitted to the labor and birthing suite. Which signs or symptoms would the client be likely to display if she were developing hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome)? Select all that apply

Informing the primary health care provider of this finding

The nurse is admitting a client to the unit after fetal death was confirmed by ultrasound. While initiating intravenous (IV) therapy, the nurse notes blood continually oozing from the puncture site. Which is the nurse's next action?

"Do you have a support system available to help you?" "Have you been told about the status of your pregnancy?"

A client with a history of three spontaneous abortions is now at 16 weeks' gestation and expresses a concern about remaining at home during this pregnancy. Which questions will elicit responses most helpful to the nurse developing the clients plan of care? Select all that apply.

The client should be given time to discuss her feelings about the decision

A client elects to have her pregnancy terminated at 16 weeks' gestation after learning that she is carrying a fetus with Down Syndrome. Which factor would the nurse consider in the plan of care at this time?

Preterm Labor Placenta Previa Cervical insufficiency Premature rupture of membranes

The health care provider prescribes a contraction test (CST) for a client at 33 weeks' gestation whose nonstress test (NST) was nonreactive and whose biophysical profile (BPP) was inconclusive. Which maternal conditions would prompt the nurse to question the prescription? Select all that apply

Respiratory depression

The nurse administers magnesium sulfate to a client with severe preeclampsia. Which adverse effect would the nurse address when evaluating the client's response to the medication?

The client has injuries to the breast and abdomen The partner answers questions that are asked of the woman The client has visited the clinic several times in the past month

The nurse caring for a pregnant client at 28 weeks' gestation suspects intimate partner violence. Which assessments support this suspicion? Select all that apply

Open Neural Tube Defects

The nurse explains to the pregnant client that the Serum Alpha-fetoprotein test screens for which condition?

Growth of the fetus, body changes, and nutritional guidance

Which prenatal teaching is most applicable for a client who is between 13 and 24 weeks' gestation?