Maternity 2c
Untreated hyperemesis can lead to preterm birth. What is the cause of the preterm birth?
severe dehydration resulting in hypoperfusion of the placenta
Cardiovascular changes that cause the foramen ovale to close at birth are a direct result of
Increased pressure in the left atrium
11. While assessing her patient, what does the nurse interpret as a positive sign of pregnancy?
Visualization of fetus by ultrasound
What is the best indicator that the client is experiencing an ectopic pregnancy?
adnexal tenderness
In the menstrual cycle of the human female, the direct response to the increase in the luteinizing hormone is:
ovulation.
Which of these cardiac variations, if found in the client who is pregnant, should the nurse recognize as a normal finding in pregnancy?
soft systolic murmur
A client states she has purchased home-use ovulation strips to help her know when she is ovulating. Which response by the nurse is most appropriate?
"You can also test your vaginal discharge to determine if you are ovulating"
Which statement is true about primary dysmenorrhea?
It may be due to excessive endometrial prostaglandin.
The nurse understands the need to be aware of the potential of bleeding disorders in pregnant clients. Which disorder should she be aware of that occurs in the second trimester?
Placenta previa
A follicle cell that remains behind after ovulation:
begins to produce progesterone.
A nurse suspects that a client is developing HELLP syndrome. The nurse notifies the health care provider based on which finding?
elevated liver enzymes
Which finding is most worrisome in a client in her 26th week of pregnancy?
facial edema
Women who are obese in pregnancy are at higher risk for developing all of the following except:
neural tube defects
Assessment of a pregnant woman reveals that she compulsively craves ice. The nurse documents this finding as:
pica.
One assessment parameter that the LPN/LVN is responsible for is fluid volume loss. It would be important to assess the umbilical cord for any sign of bleeding. What would be important to assess for if the infant has an unusually large cord?
A loose clamp
Which information provided by a client would be considered a presumptive sign of pregnancy?
Breast tenderness
A woman who is 10 weeks' pregnant calls the physician's office reporting "morning sickness" but, when asked about it, tells the nurse that she is nauseated and vomiting all the time and has lost 5 pounds. What interventions would the nurse anticipate for this client?
Lab work will be drawn to rule out acid-base imbalances.
A woman in labor suddenly reports sharp fundal pain accompanied by slight dark red vaginal bleeding. The nurse should prepare to assist with which situation?
Premature separation of the placenta
A multigravida client at 31 weeks' gestation is admitted with confirmed preterm labor. As the nurse continues to monitor the client now receiving magnesium sulfate, which assessment findings will the nurse prioritize and report immediately to the RN or health care provider?
Respiratory depression, hypotension, absent tendon reflexes
A pregnant client with a history of premature cervical dilatation undergoes cervical cerclage. Which outcome indicates that this procedure has been successful?
The client delivers a full-term fetus at 39 weeks' gestation.
A nurse is assessing pregnant clients for the risk of placenta previa. Which client faces the greatest risk for this condition?
a client who had a myomectomy to remove fibroids (also maternal age greater than 30 years)
Human papillomavirus (HPV) can cause condylomata acuminata that can develop in clusters on the vulva, within the vagina, on the cervix, or around the anus. What is their risk?
block a vaginal birth
A client is suspected of having a ruptured ectopic pregnancy. Which assessment would the nurse identify as the priority?
hemorrhage
TORCH is an acronym for maternal infections associated with congenital malformations and disorders. Which disorder does the H represent?
herpes simplex virus
A woman with gestational hypertension develops eclampsia and experiences a seizure. Which intervention would the nurse identify as the priority?
oxygenation
The nurse is assisting with a vaginal birth. The client is fully dilated, 100% effaced, and is pushing. The nurse observes the "turtle sign" with each push and there is no progress. What does the nurse suspect may be occurring with this fetus?
shoulder dystocia
A woman at 12 weeks' gestation comes to the clinic with vaginal bleeding. When assessing the woman further, the nurse would suspect a threatened abortion based on which finding?
slight vaginal bleeding
Which action would the nurse emphasize when teaching postmenopausal women about ways to reduce the risk of osteoporosis?
taking calcium supplements
A woman at 31 weeks' gestation presents to the emergency department with bright red vaginal bleeding, reporting that the onset of the bleeding was sudden and without pain. Which diagnostic test should the nurse prioritize?
A transvaginal ultrasound
The nurse is reviewing the plan of care for a pregnant client experiencing a threatened miscarriage. Which outcome would be appropriate for this client?
Bleeding spontaneously stops within 24 to 48 hours.
A pregnant client late in her second trimester comes to the emergency department with complaints of painless, bright red vaginal bleeding. She states, "It started all of a sudden and now it seems to have stopped. Placenta previa is suspected. Which action should the nurse implement immediately for this client?
Determine fetal heart sounds using an external monitor.
A pregnant client arrives at the maternity clinic reporting constipation. Which factors could be the cause of constipation during pregnancy? Select all that apply.
decreased activity level use of iron supplements intestinal displacement
A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. The nurse determines that the medication is at a therapeutic level based on which finding?
deep tendons reflexes 2+
The nurse explains that the softening of the cervix and vagina is a probable sign of pregnancy. What is the appropriate term for this sign?
goodell
A nursing instructor is teaching students about fetal presentations during birth. The most common cause for increased incidence of shoulder dystocia is:
increasing birth weight.
Which measure would the nurse include in the plan of care for a woman with prelabor rupture of membranes if her fetus's lungs are mature?
labor induction
Which symptom may indicate a complication (not a common discomfort) in the second or third trimester of pregnancy?
pain underneath the ribs on the right side
A nursing instructor is teaching about fertility and realizes a need for further instruction when a student states:
"In most couples with a subfertility problem, it is the man who is subfertile."
A 40-year-old female client with a chronic pelvic infection expresses her desire to conceive post-treatment. When discussing this with the client the nurse keeps in mind that the client is at increased risk for which of the following?
ectopic pregnancy
The nurse is orientating in the Labor and Delivery unit and asks her preceptor how to differentiate a client with preeclampsia from one with eclampsia. Which symptoms would the preceptor describe to the new nurse as indicative of severe preeclampsia? Select all that apply.
Blood pressure above 160/110 mm Hg Nondependent edema Hyperactive deep tendon reflexes
A female client is complaining of vaginal spotting and sharp colicky pain. She informs the nurse that her period is 2 weeks late. The client should be investigated for which of the following
ectopic pregnancy
A female client is complaining of vaginal spotting and sharp colicky pain. She informs the nurse that her period is 2 weeks late. The client should be investigated for which of the following?
ectopic pregnancy
A pregnant woman notices that sometimes her heartbeat is irregular when she is lying down resting on her back. The provider suspects she is experiencing low blood pressure. Which intervention would the health care provider suggest to the woman to prevent this from occurring? Select all that apply.
"Change positions slowly to allow pooled blood to reenter the circulation slowly." "Try sleeping and resting on your side with a small pillow between the knees."
A pregnant woman has developed varicosities. Which statement would suggest she needs additional health teaching?
"I wear knee-highs rather than pantyhose."
Which statement by a pregnant client would validate that she understood the nurse's teaching regarding the risk of venous stasis during pregnancy?
"My clotting times and bleeding times will be unchanged during this pregnancy even though I am at higher risk of clots in my leg vein."
A nursing instructor is teaching about subfertility to nursing students and perceives their understanding when they define subfertility existing when a pregnancy has not occurred after how much time of engaging in unprotected sex?
12 months
A pregnant woman with type 2 diabetes is scheduled for a laboratory test of glycosylated hemoglobin (HbA1C). What does the nurse tell the client is a normal level for this test?
6%
A primipara at 36 weeks' gestation is being monitored in the prenatal clinic for risk of preeclampsia. Which sign or symptom should the nurse prioritize?
A dipstick value of 2+ for protein
A couple who has not conceived after 6 years of not using birth control are being seen in the infertility clinic. In assessing the client's psychosocial response to infertility, which might the nurse expect to find? Select all that apply.
Anger toward others who have conceived Fear of the possible outcome of the testing Guilt related to the lack of conception
A woman at the infertility clinic for the first time asks, "What could have caused my infertility?" After teaching the woman about possible causes, the nurse determines that the teaching was successful when the woman identifies which condition as a common cause? Select all that apply.
Endometriosis Pelvic inflammatory disease Anovulation (ovarian dysfunction, tubal and pelvic disorders, cervical mucus factors, and vaginal problems. A normal vaginal pH is 4-5.)
A client arrives to the clinic very excited and reporting a positive home pregnancy test. The nurse cautions that the home pregnancy test is considered a probable sign and will assess the client for which sign to confirm pregnancy?
Fetal movement felt by examiner
A client arrives to the clinic very excited and reporting a postive home pregnancy test. The nurse cautions that the home pregnancy test is considered a probable sign and will assess the client for which sign to confirm pregnancy?
Fetal movement felt by examiner
When conducting a health history with a couple who are experiencing subfertility, the nurse will include which of the following? Select all that apply.
General health Medication history Sexual history Surgical history
A client tells that nurse in the doctor's office that her friend developed high blood pressure on her last pregnancy. She is concerned that she will have the same problem. What is the standard of care for preeclampsia?
Have her blood pressure checked at every prenatal visit.
A 45-year-old client and her spouse are present in the clinic. Results of fertility testing indicate that the client has damage to her fallopian tubes. Which would be the most appropriate infertility option for this client?
In vitro fertilization
A number of cardiovascular system changes occur during pregnancy. Which finding is considered normal for a woman during pregnancy?
Increased pulse rate
The nurse is explaining the various evaluations used to determine infertility to a young couple who have been trying to get pregnant for 5 years. Which instruction should the nurse prioritize when teaching about the postcoital test?
It is performed close to the time of ovulation.
The nurse is caring for a pregnant client with severe preeclampsia. Which nursing intervention should a nurse perform to institute and maintain seizure precautions in this client?
Keep the suction equipment readily available
A woman has heard that hypotension can be a problem during pregnancy, but she is not sure what it is or what causes it. The nurse explains that it is simply a temporary bout of low blood pressure due to impaired blood return to the heart. It is commonly caused by sleeping in a position that causes compression of the vena cava blood vessel. To avoid this condition, which suggestion should the nurse make?
Sleep on your side.
The nurse is caring for a woman at 32 weeks' gestation with severe preeclampsia. Which assessment finding should the nurse prioritize after the administration of hydralazine to this client?
Tachycardia
The nurse is assessing a pregnant client in her third trimester who is reporting a first-time occurrence of constipation. When asked why this is happening, what is the best response from the nurse?
The intestines are displaced by the growing fetus.
The nurse is preparing discharge instructions for several clients after their admission for emergent care of a pregnancy complication. The nurse will stress the importance of frequent and continuous office visits to the client with:
a molar pregnancy.
The client appears at the clinic stating that she is 8 months pregnant and has had no prenatal care due to a lack of health insurance. She states not feeling well with blurred vision and a terrible headache. The client's blood pressure is 190/100 and edema is present in her lower extremities. Which diagnostic test will provide additional pertinent data?
a urine dipstick test to check for protein
A client at 32 weeks' gestation has been admitted to the labor and birth unit with preterm labor. Which medication would the nurse be likely to administer to reduce the risk of complications in the preterm newborn?
corticosteroids
A nurse is taking a history on a woman who is at 20 weeks' gestation. The woman reports that she feels some heaviness in her thighs since yesterday. The nurse suspects that the woman may be experiencing preterm labor based on which additional assessment findings? Select all that apply.
dull low backache viscous vaginal discharge dysuria (change or increase in vaginal discharge with mucus, water, or blood in it; pelvic pressure; low, dull backache; nausea, vomiting or diarrhea, and heaviness or aching in the thighs.)
A nurse is conducting a refresher program for a group of perinatal nurses. Part of the program involves a discussion of HELLP. The nurse determines that the group needs additional teaching when they identify which aspect as a part of HELLP?
elevated lipoproteins
The nurse is assessing the health history of a male partner. Which data is most likely to be related to an infertility problem?
employment as a taxi driver
A nurse is reviewing the history and physical examination of a client diagnosed with secondary dysmenorrhea for possible associated causes. Which etiology would the nurse need to keep in mind as being the most common?
endometriosis
When teaching a group of postmenopausal women about hot flashes and night sweats, the nurse would address which primary cause?
estrogen deficiency
A client at 35 weeks' gestation is now in stable condition after being admitted for vaginal bleeding. Which assessment should the nurse prioritize?
fetal heart tones
A pregnant woman is diagnosed with placental abruption (abruptio placentae). When reviewing the woman's physical assessment in her medical record, which finding would the nurse expect?
firm, rigid uterus on palpation
A pregnant client is admitted to a health care facility with a diagnosis of premature rupture of membranes (PROM). Which test would the nurse expect to be used to predict fetal lung maturity when the client goes into labor?
lecithin/sphingomyelin ratio
Which measure would the nurse include in the teaching plan for a woman to reduce the risk of osteoporosis after menopause?
participating in regular daily exercise
A client with a multiple gestation has come to a health care facility for a regular antenatal check-up. When educating the client on pregnancy, about which complication should the nurse inform the client?
placental dysfunction
A antepartum client at 35 weeks' gestation arrives at the clinic stating bright, red vaginal spotting occurred in the morning but has seemed to have stopped. An ultrasound indicates that the placenta is partially covering the cervical os. Which nursing intervention is intiated first?
positioning client on bedrest in a side-lying position
The obstetric nurse is caring for a pregnant client who has been diagnosed with a hydatidiform mole. What assessment should the nurse prioritize?
vaginal bleeding
The nurse is teaching a client who is diagnosed with preeclampsia how to monitor her condition. The nurse determines the client needs more instruction after making which statement?
"If I have changes in my vision, I will lie down and rest."
A nurse is caring for a client with hyperemesis gravidarum. Which nursing action is the priority for this client?
Administer IV normal saline with vitamins and electrolytes.
Before calling the health care provider to report a slow progression or an arrest of labor, several assessments need to be made. What other maternal assessment does the nurse need to make prior to calling the health care provider?
Check for a full bladder.
A woman in her 20s has experienced a spontaneous abortion (miscarriage) at 10 weeks' gestation and asks the nurse at the hospital what went wrong. She is concerned that she did something that caused her to lose her baby. The nurse can reassure the woman by explaining that the most common cause of miscarriage in the first trimester is related to which factor?
Chromosomal defects in the fetus
A woman asked the nurse what protects my baby's umbilical cord from being pinched while the baby is inside. The nurse best response is..
Your baby's cord is surrounded by connective tissue called Wharton jelly which prevents compression of the blood vessels and ensure continuous nutrient & oxygen to your baby
A nurse is conducting an in-service program for a group of nurses working at the women's health facility about the causes of spontaneous abortion (miscarriage). The nurse determines that the teaching was successful when the group identifies which condition as the most common cause of first-trimester miscarriage?
fetal genetic abnormalities
A 47-year-old woman is being seen at the local clinic reporting irregular menstrual cycles. The nurse would explain to the client that the irregularity is most likely due to:
menopause.
A nurse is reviewing a client's history and physical examination findings. Which information would the nurse identify as contributing to the client's risk for an ectopic pregnancy?
recurrent pelvic infections
A young woman experiencing contractions arrives at the emergency department. After examining her, the nurse learns that the client is at 33 weeks' gestation. What treatment can the nurse expect this client to be prescribed?
tocolytic therapy
A pregnant woman at 31 weeks' gestation calls the clinic and tells the nurse that she is having contractions sporadically. Which instructions would be most appropriate for the nurse to give the woman? Select all that apply.
"Drink two or three glasses of water." "Try emptying your bladder." "Stop what you are doing and rest."
A client with diabetes is in the first trimester of pregnancy and is currently having difficulty keeping blood glucose levels within normal limits. The client explains that she has been "eating for two" so the baby is healthy. How should the nurse respond to the client?
"Elevated blood glucose levels in the first trimester have been linked to congenital anomalies."
Which question would be most appropriate for a nurse to ask a client to assist in establishing a nursing diagnosis of Deficient knowledge related to measure to promote fertility?
"How often do you and your partner engage in intercourse?"
The nurse is conducting a health history on a couple planning to become pregnant over the next few months. Which statement by the male client most concerns the nurse?
"I have a degree as a chemical engineer and work at the local plant."
A nurse is conducting a class on various issues that might develop after going home with a new infant. After discussing how to care for hemorrhoids, the nurse understands that which statement by the class would indicate the need for more information?
"I only eat a low-fiber diet."
A nurse is teaching a pregnant woman at risk for preterm labor about what to do if she experiences signs and symptoms. The nurse determines that the teaching was successful when the woman makes which statement?
"I'll drink several glasses of water."
A nurse is teaching a woman about measures to prevent preterm labor in future pregnancies because the woman just experienced preterm labor with her most recent pregnancy. The nurse determines that the teaching was successful based on which statement by the woman?
"I'll make sure to limit the amount of long distance traveling I do."
A pregnant client with preterm premature rupture of the membranes is being discharged home. A nurse is preparing the client's discharge teaching plan. Which instructions would the nurse include? Select all that apply.
"If you notice your belly starting to tighten, call your health care provider." "Check your temperature each day, reporting any increase immediately."
The nurse is meeting with a young couple who have undergone the initial screenings for infertility. The man is questioning the possibility of using intrauterine (artificial) insemination if he is found to be infertile. Which response should the nurse prioritize?
"Intrauterine (artificial) insemination is your best option if you are found to be infertile."
A woman is going to have in vitro fertilization. When preparing her for this, the nurse would make which statement?
"It can be done with frozen donor sperm."
A pregnant patient at 32 weeks' gestation calls the clinic and informs the nurse that she thinks her membranes are leaking. She states that some clear fluid has run down her leg. What is the best response by the nurse?
"It is best for you to visit a hospital immediately. They can use a nitrazine strip to determine if it is amniotic fluid."
A nurse is teaching a pregnant woman with preterm premature rupture of membranes (PPROM) about caring for herself after she is discharged home (which is to occur later this day). Which statement by the woman indicates a need for additional teaching?
"It's okay for my husband and I to have sexual intercourse."
A woman experiencing menopausal symptoms asks the nurse about herbal remedies for managing her symptoms. Which response by the nurse would be most appropriate?
"Most of the information about herbal therapies is based on reports by those who have used them, not scientific studies."
A male is diagnosed as being infertile, but he wants to have children with his spouse. Which response should the nurse provide to this client?
"You need to consider donor-alternative insemination."
A couple is undergoing fertility testing. The male partner is scheduled for semen analysis. When teaching the male partner about this procedure, the nurse would instruct him to refrain from sexual intercourse for which time frame before the analysis?
2 to 4 days
The nurse is caring for a pregnant woman determined to be at high risk for gestational diabetes. The nurse prepares to rescreen this client at which time frame?
24 to 28 weeks
A client in her first trimester is concerned about how weight gain will affect her appearance and questions the nurse concerning dietary restrictions. How much weight gain should the nurse point out will be safe for this client with a low BMI?
28 to 40 pounds (13 to 18 kilograms)
You care for a woman in a prenatal clinic who thinks she might be pregnant. Which of the following assessments is a probable sign of pregnancy?
A positive pregnancy test
A nurse in the maternity triage unit is caring for a client with a suspected ectopic pregnancy. Which nursing intervention should the nurse perform first?
Assess the client's vital signs.
The nurse is comforting and listening to a young couple who just suffered a spontaneous abortion (miscarriage). When asked why this happened, which reason should the nurse share as a common cause?
Chromosomal abnormality
A nurse is developing a plan of care with a client and significant other; both have been diagnosed as being sterile. Which outcome should receive priority in the plan?
Clients state they are taking steps to remain close in light of stress.
A couple is being assessed for infertility. The male partner is required to collect a semen sample for analysis. What instruction should the nurse give him?
Deliver sample for analysis within 1 to 2 hours after ejaculation.
The nurse discovers a soft systolic murmur when auscultating the heart of a client at 32 weeks' gestation. Which action would be most appropriate?
Document this and continue to monitor the murmur at future visits.
The nurse cares for a pregnant client at the first prenatal visit and reviews expected changes that will occur during pregnancy. Which information will the nurse include in the education?
During pregnancy blood volume can increase by at least 40%.
A pregnant client at 34 weeks' gestation reports a burning sensation in the lower esophagus. What action would the nurse recommend to increase her comfort? Select all that apply.
Eat five to six small meals per day. Do not eat fried, fatty foods. Do not lie down immediately after eating.
A nurse is visiting with a couple who has recently completed subfertility assessments and are awaiting the results. Throughout the conversation the wife intermittently begins to cry. What would be the most appropriate nursing diagnosis for this couple?
Fear related to possible outcome of subfertility studies
The nurse is appraising the laboratory results of a pregnant client who is in her second trimester and notes the following: thyroid stimulating hormone (TSH) slightly elevated, glucose in the urine, complete blood count (CBC) low normal, and normal electrolytes. The nurse prioritizes further testing to rule out which condition?
Gestational diabetes
A pregnant mother may experience constipation and the increased pressure in the veins below the uterus can lead to development of what problem?
Hemorrhoids
Which STI could be transmitted perinatally?
Herpes simplex
A newborn's cord begins to bleed 1 day following birth. What measures would the nurse take to address this problem?
Inspect the clamp to insure that it is tightly closed and applied correctly.
Management of primary dysmenorrhea often requires a multifaceted approach. The nurse who provides care for a patient with this condition should be aware that the optimal pharmacologic therapy for pain relief is
Nonsteroidal antiinflammatory drugs (NSAIDs)
A pregnant woman at 38 weeks' gestation is receiving care for preeclampsia and suddenly complains of sharp abdominal pain. Which action should the nurse prioritize if the nurse notes a firm, distended, and painful abdomen and dark red vaginal bleeding?
Obtain a full set of vital signs.
A woman just delivered a healthy term newborn. Upon assessing the umbilical cord, the nurse would identify which of the following as normal? Select all that apply.
One vein Two arteries
After a regular prenatal visit, a pregnant client asks the nurse to describe the differences between placental abruption (abruptio placentae) and placenta previa. Which statement will the nurse include in the teaching?
Placenta previa is an abnormally implanted placenta that is too close to the cervix.
The nurse is conducting an assessment of a pregnant client at a routine second trimester prenatal visit. Which lower extremity assessment should the nurse prioritize?
Presence of varicosities
A man needs to bring a semen specimen in for analysis. Which instruction would the nurse give him?
Protect it against chilling.
The following hourly assessments are obtained by the nurse on a client with preeclampsia receiving magnesium sulfate: 97.3oF (36.2oC), HR 88, RR 12 breaths/min, BP 148/110 mm Hg. What other priority physical assessments by the nurse should be implemented to assess for potential toxicity?
Reflexes
A nurse is caring for a client who is 8 months pregnant. Which instruction is the nurse most likely to give her?
Rest on the left side for at least 1 hour in the morning and afternoon.
Why is fertility testing initiated with sperm analysis of the male partner?
Sperm analysis is one of the easiest tests to complete.
A couple consults with the nurse regarding their infertility issues. The female says "I don't know what I have done so bad that God would punish me like this." What would be the most appropriate nursing diagnosis for this couple?
Spiritual distress related to inability to conceive
The nurse is monitoring a pregnant client who is receiving intravenous magnesium sulfate for eclampsia. During the last assessment, the nurse was unable to elicit a patellar reflex. What should the nurse do?
Stop the current infusion.
A couple comes in and tells the nurse that they have been trying diligently to conceive for the last 3 months and are subfertile. What should the nurse explain to the couple about the definition of subfertility?
Subfertility is said to exist when a pregnancy has not occurred after at least 1 year of engaging in unprotected sex.
The fetus receives blood flow from the mother via the placenta and umbilical cord. What is the route of fetal circulation through the umbilical cord?
The one umbilical vein carries oxygen rich blood to the fetus from the placenta
A young woman presents at the emergency department reporting lower abdominal cramping and spotting at 12 weeks' gestation. The primary care provider performs a pelvic examination and finds that the cervix is closed. What does the care provider suspect is the cause of the cramps and spotting?
Threatened abortion
During an examination, a client at 32 weeks' gestation becomes dizzy, lightheaded, and pale while supine. What should the nurse do first?
Turn the client on her left side.
The nurse is instructing a client with dysmenorrhea on how to manage her symptoms. Which suggestions should the nurse include in the teaching plan? Select all that apply.
Use heating pads or take warm baths. Increase water consumption. Increase exercise and physical activity.
When a nurse is counseling a woman for primary dysmenorrhea, which non-pharmacologic intervention might be recommended?
Using a heating pad on the abdomen to relieve cramping
A nurse is caring for a client who has had an intrauterine fetal death with prolonged retention of the fetus. For which signs and symptoms should the nurse watch to assess for an increased risk of disseminated intravascular coagulation? Select all that apply.
acute renal failure tachycardia bleeding gums (petechiae, ecchymosis, and uncontrolled bleeding during birth.)
15. A woman tells the nurse that she is quite sure she is pregnant. The nurse recognizes which as a positive sign of pregnancy?
d. Fetal heartbeat
A nurse assesses a primigravida client in the eighth week of gestation. The client reports nausea and vomiting in the mornings. The client tells the nurse, "I'm not able to keep liquids down and I'm eating like a bird." The client also expresses concerns about hormonal changes and how the pregnancy will affect her physical appearance. Which client problem should the nurse assess first?
deficient fluid volume
The nurse is describing pregnancy danger signs to a pregnant woman who is in her first trimester. Which danger sign might occur at this point in her pregnancy
excessive vomiting
Which of the following findings is most worrisome in Melissa, a woman in her 26th week of pregnancy?
facial edema
Which definition best explains the term "subfertility/infertility"?
failure to achieve pregnancy after 1 year of unprotected intercourse
A client is admitted with a diagnosis of ruptured ectopic pregnancy. For what should the nurse anticipate preparing the client?
immediate surgery
The nurse is examining a woman who came to the clinic because she thinks she is pregnant. Which data collected by the nurse are presumptive signs of her pregnancy? Select all that apply.
morning sickness amenorrhea breast changes
The nurse is assessing a pregnant woman. What assessment would suggest that the client's heart has been pushed upward and to the left by pregnancy?
murmurs
Which symptom may indicate a complication (not a common discomfort) in the second or third trimester of pregnancy?
pain underneath the ribs on the right side (PRECLAMPSIA)
The nursing student doing a rotation in obstetrics is talking to her preceptor about dystocia. She asks what is meant by the term "expulsive forces," better known as the "powers." The preceptor correctly tells her that the "powers" include which factors? Select all that apply.
presentation position fetal development
A client presents to the emergency department reporting regular uterine contractions. Examination reveals that her cervix is beginning to efface. The client is in her 36th week of gestation. The nurse interprets the findings as suggesting which condition is occurring?
preterm labor
A woman who is 30 weeks of gestation arrives at the hospital with bleeding. Which differential diagnosis would not be applicable for this client?
spontaneous abortion
A pregnant woman has arrived to the office reporting vaginal bleeding. Which finding during the assessment would lead the nurse to suspect an inevitable spontaneous abortion (miscarriage)?
strong abdominal cramping
A clinic nurse is interviewing a young client during a subfertility work up. When the client asks the nurse what causes infertility, the nurse informs the client that the problem can rest with the man, the woman, or both. What does the nurse tell the client are common problem areas related to the woman? Select all that apply.
tubal transport ovulation impaired implantation
A pregnant woman at term is in the obstetrics unit for induction in the morning. Her membranes rupture, and the external fetal monitor shows deep variable decelerations. The nurse should immediately check the client for:
umbilical cord prolapse.
A nurse is caring for a pregnant client admitted with mild preeclampsia. Which assessment finding should the nurse prioritize?
urine output of less than 15 ml/hr
A nurse has completed an assessment of a male client for subfertility. Which finding will the nurse interpret as increasing the client's risk for experiencing a limited sperm count?
useing a hot tub and sauna 4 to 5 times a week
The nurse is teaching a prenatal class on potential problems during pregnancy to a group of expectant parents. The risk factors for placental abruption (abruptio placentae) are discussed. Which comment validates accurate learning by the parents?
"Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain."
A client is admitted to the unit in preterm labor. In preparing the client for tocolytic drug therapy, the nurse anticipates that the client's pregnancy may be prolonged for how long when this therapy is used?
2 to 7 days
A nurse is conducting an assessment on a female client being seen for infertility issues. Which assessment data leads the nurse to believe that anovulation is occurring? Select all that apply.
BMI 14.6 (ideal 18.5-24.9) No fluctuation on BBT graph
A pregnant client in her third trimester, lying supine on the examination table, suddenly grows very short of breath and dizzy. Concerned, she asks the nurse what is happening. Which response should the nurse prioritize?
Blood is trapped in the vena cava in a supine position.
A nurse is assessing a pregnant client. The nurse understands that hormonal changes occur during pregnancy. Which hormones would the nurse most likely identify as being inhibited during the pregnancy?
FSH and LH
The nurse is assessing a young couple who desire to get pregnant. The 38-year-old husband and 29-year-old wife report they had used oral contraceptive pills (OCPs); however, they have now been trying unsuccessfully to conceive over the past 4 months. What is the best response for the nurse to make?
Increase intercourse frequency to four times a week around the time of ovulation.
The nurse is caring for a pregnant client with severe preeclampsia. Which nursing intervention should a nurse perform to institute and maintain seizure precautions in this client?
Keep the suction equipment readily available.
A woman who had preterm labor and preterm PROM successfully halted has reached week 36 of pregnancy and is doing well on home care. Which of the following nursing diagnoses should the nurse prioritize for this client?
Risk for fetal infection related to early rupture of membranes
The nurse should carefully screen a client who insists on using only oral contraceptive pills (OCPs) for which contraindication?
deep vein thrombosis
A nurse is assessing a pregnant client for the possibility of preexisting conditions that could lead to complications during pregnancy. The nurse suspects that the woman is at risk for hydramnios based on which preexisting condition?
diabetes
Preterm prelabor rupture of membranes (PPROM) can be a serious complication of labor. What is the most common cause of preterm PROM?
infection
A nurse is caring for a client at 30 weeks' gestation who had preterm premature rupture of membranes (PROM) 25 hours ago. The client has a temperature of 102°F (38.9°C) and a foul-smelling odor from the vagina. Which medication order should the nurse question?
magnesium sulfate 2 g IV/hr
Which medication will the nurse anticipate the health care provider will prescribe as treatment for an unruptured ectopic pregnancy?
methotrexate
The nurse is planning care for several pregnant clients. Which client is at the highest risk for nutritional deficiency while pregnant?
woman with a 1-year-old infant
A pregnant women calls the clinic to report a small amount of painless vaginal bleeding. What response by the nurse is best?
"Please come in now for an evaluation by your health care provider."
A 40-year-old client is a high profile local politician and exercises on a daily basis. She states to the clinic nurse "We stopped using birth control 7 months ago and I still have not gotten pregnant. Should we be worried?" What is the nurse's best response?
"You should tell the health care provider today during the visit."
A nurse is providing information regarding ovulation to a couple who want to have a baby. Which fact should the nurse tell the clients?
At ovulation, a mature follicle ruptures, releasing an ovum.
What instruction should a nurse offer to a pregnant client or a client who wishes to become pregnant to help her avoid exposure to teratogenic substances?
Avoid medications.
A woman in her third trimester is suffering from heartburn. What should the nurse advise her to do?
Eat small meals frequently rather than large meals.
A couple, both age 22, want to know what they can do to improve the chances of conceiving. What should the nurse respond to this couple?
Have sex every other day.
A 32-year-old gravida 3 para 2 at 36 weeks' gestation comes to the obstetric department reporting abdominal pain. Her blood pressure is 164/90 mm Hg, her pulse is 100 beats per minute, and her respirations are 24 per minute. She is restless and slightly diaphoretic with a small amount of dark red vaginal bleeding. What assessment should the nurse make next?
Palpate the fundus and check fetal heart rate.
A nurse is caring for a client in her second trimester of pregnancy. During a regular follow-up visit, the client reports varicosities of the legs. Which instruction should the nurse provide to help the client alleviate varicosities of the legs?
Refrain from crossing legs when sitting for long periods.
A 31-year-old client at 28 weeks' gestation reports frequent low back pain and ankle edema by the end of the day. Which suggestion should the nurse prioritize for this client?
Rest when possible with feet elevated at or above the heart.
The nurse is assessing a 37-year-old woman who has presented in active labor and notes the client has an increased risk for placental abruption (abruptio placentae). Which assessment finding should the nurse prioritize?
Sharp fundal pain and discomfort between contractions
A client recovering from a surgical pregnancy termination returns for a postprocedure examination. The client tells the nurse that she is relieved that the procedure is over but that she is feeling sad. What should the nurse do to assist the client at this time?
Suggest the client talk with a counselor.
A pregnant woman with diabetes at 10 weeks' gestation has a glycosylated hemoglobin (HbA1c) level of 13%. At this time the nurse should be most concerned about which possible fetal outcome?
congenital anomalies
A 38-year-old client presents to the clinic desiring to get pregnant. She reports she had a tubal ligation in her early 20s after two babies and a divorce. After learning that the client recently underwent a reversal of the tubal ligation, the nurse will warn the client of which potential risk?
ectopic pregnancy
Which assessment finding will alert the nurse to be on the lookout for possible placental abruption (abruptio placentae) during labor?
gestational hypertension
A woman at 8 weeks' gestation is admitted for ectopic pregnancy. She is asking why this has occurred. The nurse knows that which factor is a known risk factor for ectopic pregnancy?
history of endometriosis
A clinic nurse explains to a client who is undergoing an infertility workup that the patency of her fallopian tubes will be checked. Which test is currently used to do this?
hysterosalpingography
The nurse is identifying nursing diagnoses for a client with gestational hypertension. Which diagnosis would be the most appropriate for this client?
ineffective tissue perfusion related to vasoconstriction of blood vessels
The nurse is caring for a client with preeclampsia and understands the need to auscultate this client's lung sounds every 2 hours to detect which condition?
pulmonary edema
A woman has presented to the emergency department with symptoms that suggest an ectopic pregnancy. Which finding would lead the nurse to suspect that the fallopian tube has ruptured?
referred shoulder pain
During the development of the fetus, its chorionic villi eventually meet with an area of uterine tissue to form the placenta. Which of the following statements accurately describes a function of the placenta? Select all answers that apply.
• It slows the maternal immune response .• It produces hormones that help maintain the pregnancy. • It carries waste away for excretion by the mother.
A couple in their early 30s is concerned because they have been trying to get pregnant for 4 months without success. The woman says that she had been on oral contraceptives before they began trying. Which of the following should the nurse say to the couple?
"Oral contraceptives may delay conception for a few months. Give it another 6 to 8 months."
During pregnancy a woman's blood volume increases to accommodate the growing fetus to the point that vital signs may remain within normal range without showing signs of shock until the woman has lost what percentage of her blood volume?
40%
A student nurse is preparing for a presentation that will illustrate the various physiologic changes in the woman's body during pregnancy. Which cardiovascular changes up through the 26th week should the student point out?
Increased pulse rate and decreased blood pressure
A young woman is having trouble conceiving and has come to the office for fertility testing. She states that she has irregular and unpredictable menstrual cycles. On blood testing, it is found that her ovaries are producing excess testosterone, which is lowering her follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels. Which of the following is the most likely cause of her subfertility?
anovulation
A 19-year-old woman presents to the emergency department in the late stages of active labor. Assessment reveals she received no prenatal care. As part of her examination, a rapid HIV screen indicates she is HIV positive. To reduce the perinatal transmission to her infant, which intravenous medication would the nurse anticipate administering?
antiretroviral
A nurse suspects that a client may be developing disseminated intravascular coagulation. The woman has a history of placental abruption (abruptio placentae) during birth. Which finding would help to support the nurse's suspicion?
appearance of petechiae (petechiae, ecchymoses)
The time in a woman's life when she loses the capability to reproduce is called menopause. Menopause does not occur all at once, but over a period of time that differs from woman to woman. There is, however, an average age when menopause occurs. What is this average age?
between 47 and 55 years
A woman at 9 weeks' gestation was unable to control the nausea and vomiting of hyperemesis gravidarum through conservative measures at home. With nausea and vomiting becoming severe, the woman was omitted to the obstetrical unit. Which action should the nurse prioritize?
establish IV for rehydration
The nurse is describing pregnancy danger signs to a pregnant woman who is in her first trimester. Which danger sign might occur at this point in her pregnancy?
excessive vomiting
A nurse is monitoring a client with PROM who is in labor and observes meconium in the amniotic fluid. What does the observation of meconium indicate?
fetal distress related to hypoxia
A nurse is listening to a client's heart and determines that there is a change since the last normal prenatal visit. The client has no history of heart disease, so which of the following should the nurse expect has developed?
functional murmur
After teaching a class of newly pregnant women about the many changes the female body undergoes during pregnancy, the nurse determines that the teaching was successful when the class identifies which hormones as being secreted by the placenta? Select all that apply.
hCG2 relaxin estrogen
A nurse is reviewing an article about preterm premature rupture of membranes. Which factors would the nurse expect to find placing a woman at high risk for this condition? Select all that apply.
low socioeconomic status smoking urinary tract infection (low socioeconomic status, multiple gestation, low body mass index, tobacco use, preterm labor history, placenta previa, placental abruption (abruptio placentae), urinary tract infection, vaginal bleeding at any time in pregnancy, cerclage, and amniocentesis.)
A nurse is reviewing the medical record of a pregnant client. The physical exam reveals that the placenta is implanted near the internal os but does not reach it. The nurse interprets this as which condition?
low-lying placenta
A nurse is conducting a review course on tocolytic therapy for perinatal nurses. After teaching the group, the nurse determines that the teaching was successful when they identify which drugs as being used for tocolysis? Select all that apply.
nifedipine magnesium sulfate indomethacin
During a routine prenatal visit, a client is found to have 1+ proteinuria and a blood pressure rise to 140/90 mm Hg with mild facial edema. The nurse recognizes that the client has which condition?
preeclampsia without severe features
A client at 7 months' gestation presents to the emergency department with reports of a large gush and continuous leaking of fluid from her vagina. She does have some slight pelvic pressure but denies any contractions. This client is showing clinical signs of which of the following?
premature rupture of membranes
A woman at 35 weeks' gestation with severe polyhydramnios is admitted to the hospital. The nurse recognizes that which concern is greatest regarding this client?
preterm rupture of membranes followed by preterm birth
A couple informs the nurse that they have not been able to conceive for the last year. During assessment, the nurse learns that the couple has a 3-year-old daughter and 7-year-old son. They report having had no problems getting pregnant the other times. Which type of fertility is this couple exhibiting?
secondary subfertility
A client in her third trimester reports sleeping poorly: sleeping on her back results in lightheadedness and dizziness and lying on her side results in no sleep. Which suggestion for sleeping should the nurse prioritize for this client?
with a pillow under her right hip
The nurse is caring for a client after experiencing a placental abruption (abruptio placentae). Which finding is the priority to report to the health care provider?
45 ml urine output in 2 hours
A woman is receiving magnesium sulfate as part of her treatment for severe preeclampsia. The nurse is monitoring the woman's serum magnesium levels. The nurse determines that the drug is at a therapeutic level based on which result?
6.1 mEq/L
A pregnant woman has been admitted to the hospital due to preeclampsia with severe features. Which measure will be important for the nurse to include in the care plan?
Institute and maintain seizure precautions.
A nurse is assessing a pregnant woman with gestational hypertension. Which finding would lead the nurse to suspect that the client has developed severe preeclampsia?
hyperreflexia
A nurse is teaching a group of clients experiencing secondary subfertility. Which of the following would the nurse include as things that can negatively affect spermatogenesis? Select all that apply.
increased scrotal heat trauma to the testes drug use excessive alcohol use x-ray exposure
At her 16-week checkup, a client's blood pressure is slightly decreased from her prepregnancy level. The nurse evaluates this change based on which statements concerning blood pressure during pregnancy?
A decrease in blood pressure in the second trimester may occur because of placental growth.
The nurse is caring for a client who has remained in stable condition at 37 weeks' gestation. The client's condition suddenly changes. Which assessment change should the nurse prioritize?
Vaginal bleeding and no pain
A primigravida at 28 weeks' gestation comes to the clinic for a checkup. She tells the nurse that her mother gave birth to both of her children prematurely, and she is afraid that the same will happen to her. Which risk factors associated with preterm birth would the nurse discuss with the client? Select all that apply.
history of previous preterm birth uterine or cervical abnormalities current multiple gestation pregnancy
During a routine antepartal visit, a pregnant woman says, "I've noticed my gums bleeding a bit since I've become pregnant. Is this normal?" The nurse bases the response on the understanding of which effect of pregnancy?
influence of estrogen and blood vessel proliferation
Disseminated intravascular coagulation is a life-threatening condition that the nurse recognizes can occur as a complication secondary to which primary conditions? Select all that apply.
septicemia severe preeclampsia placental abruption (abruptio placentae) (placental abruption, anaphylactoid syndrome of pregnancy, intrauterine fetal death with prolonged retention of the fetus, acute fatty liver of pregnancy, severe preeclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count), septicemia, and postpartum hemorrhage.)
The nurse recognizes that documenting accurate blood pressures is vital in the diagnosing of preeclampsia, severe preeclampsia and eclampsia. The nurse suspects preeclampsia based on which finding?
BP of 140/90 mm Hg last week and at current visit after 20 weeks' gestation
The nursing instructor is teaching a class on the menstrual cycle. The instructor determines the class is successful when the class correctly chooses which hormone that is responsible for initating ovulation?
luteinizing hormone
A nurse is preparing a nursing care plan for a client who is admitted at 22 weeks' gestation with advanced cervical dilation (dilatation) to 5 cm, cervical insufficiency, and a visible amniotic sac at the cervical opening. Which primary goal should the nurse prioritize at this point?
Bed rest to maintain pregnancy as long as possible
Assessment reveals that a male client is experiencing a decrease in the amount of semen produced during ejaculation. The nurse suspects that which male reproductive structure may be involved?
ejaculatory ducts
A woman at 10 weeks' gestation comes to the clinic for an evaluation. Which assessment finding should the nurse prioritize?
fundal height measurement of 18 cm
A woman having contractions comes to the emergency department. She tells the nurse that she is at 34 weeks' gestation. The nurse examines her and finds that she is already effaced and dilated 2 cm. What is this woman demonstrating?
preterm labor
A woman is being closely monitored and treated for severe preeclampsia with magnesium sulfate. Which finding would alert the nurse to the development of magnesium toxicity in this client?
diminished reflexes
During a prenatal appointment, a client at the end of the first trimester states she ingests laundry starch because of a craving. What action will the nurse take?
Consult with the health care provider to suggest a hemoglobin assessment be done.
A woman who is 37 weeks pregnant reports feeling dizzy when lying on her back. What does the nurse explain as the most likely cause of this symptom?
Supine hypotension syndrome
A(n) ________ is released from the ovary in the event known as ovulation.
secondary oocyte
A client is scheduling a date for an intrauterine insemination after 18 months of being unable to conceive with her spouse. The nurse evaluates that the client understands the procedure when the client notes which action(s) as important in preparing for this procedure? Select all that apply.
assessing cervical mucus recording basal body temperature (BBT) using an ovulation predictor kit
A 25-year-old client at 22 weeks' gestation is noted to have proteinuria and dependent edema on her routine prenatal visit. Which additional assessment should the nurse prioritize and convey to the RN or health care provider?
initial BP 100/70 mm Hg; current BP 140/90 mm Hg
A primary care provider prescribes intravenous tocolytic therapy for a woman in preterm labor. Which agent would the nurse expect to administer?
magnesium sulfate
