Maternity and Women's Health Nursing - Pregnancy, At Risk

Unilateral abdominal pain History of a sexually transmitted infection

A client has a diagnosis of an unruptured tubal pregnancy. Which findings correlate with this diagnosis? (Select all that apply.)

Leg lifts and sit-ups

A woman with an active lifestyle is in her 30th week of pregnancy. Which activity will the nurse discourage?

"It's understandable for you to be worried that you won't be able to carry this pregnancy to term. You've had a difficult time."

At 12 weeks' gestation a client with a history of frequent spontaneous abortions says to the nurse, "Every day I wonder whether I'll be able to have this baby." How should the nurse respond?

Epidural anesthesia with a vacuum extraction birth

At 30 weeks' gestation a client with class II cardiac disease expresses concern about her labor and asks the nurse what to expect. What does the nurse tell the client to expect if cardiac decompensation occurs?

Monitoring for signs of uterine contractions

What is the priority nursing care after an amniocentesis?

Antibiotic

something with cardiac...mitral valve stenosis

Threatened abortion

A client at 12 weeks' gestation arrives in the prenatal clinic complaining of cramping and vaginal spotting. A pelvic examination reveals that the cervix is closed. Which probable diagnosis should the nurse expect?

Evidence of pyelonephritis

A pregnant client with sickle cell anemia visits the clinic each month for a routine examination. What additional observation should be made during every visit?

Dehydration

A pregnant woman who was admitted to the high-risk maternity unit for severe hyperemesis gravidarum is receiving total parenteral nutrition (TPN). Intralipids are not being administered. For what potential complication should the nurse monitor the client?

One who gives birth to an infant weighing 9 lb 8 oz

Which client should a nurse suspect is at increased risk for postpartum hemorrhage?

Maintaining a quiet, darkened environment

What is an important nursing intervention when a client is receiving intravenous (IV) magnesium sulfate for preeclampsia?

Trendelenburg

What is the safest position for a woman in labor when the nurse notes a prolapsed cord?

A sharp, sudden decrease

What should a nurse anticipate about the insulin requirements of a client with diabetes on her first postpartum day?

Nonreassuring fetal signs, indicating prolapse of the cord

A health care provider determines that a fetus is in a breech presentation. For which complication should the nurse monitor the client?

Prolapse of the umbilical cord

A multipara whose membranes have ruptured is admitted in early labor. Assessment reveals a breech presentation, cervical dilation of 3 cm, and fetal station at -2. For what complication should the nurse assess when caring for this client?

Have the mother breastfeed the newborn

A neighbor who is a nurse is called on to assist with an emergency home birth. What should the nurse do to help expel the placenta?

Gravida I who has had an intrauterine fetal death

A nurse is caring for a group of postpartum clients. Which client is at the highest risk for disseminated intravascular coagulation (DIC)?

Type A or B

Laboratory studies reveal that a pregnant client's blood type is O and she is Rh-positive. Problems related to incompatibility may develop in her infant if the infant is:

"The progression is slow, so people with myasthenia will spend their younger life with few problems."

The family of a pregnant client with myasthenia gravis asks the nurse whether the client will be an invalid. What is the best response by the nurse?

Position of the fetus and the placenta

The nurse teaches a client who is to undergo amniocentesis that ultrasonography will be performed just before the procedure to determine the:

Increasing fatigue

Which adaptation does the nurse suspect is the result of early decompensation in a pregnant woman with cardiac problems?

"A beta-adrenergic."

A client at 31 weeks' gestation is admitted in preterm labor. She asks the nurse whether there is any medication that can stop the contractions. What is the nurse's response?

A decrease in frequency and duration of contractions

A client at 32 weeks' gestation is admitted to the prenatal unit in preterm labor. An infusion of magnesium sulfate is started. What physiological response indicates to the nurse that the magnesium sulfate is having a therapeutic effect?

Dyspnea

A client at 36 hours' postpartum is being treated with subcutaneous enoxaparin (Lovenox) for deep vein thrombosis of the left calf. Which client adaptation is of most concern to the nurse who is monitoring the client?

Misoprostol (Cytotec) Oxytocin (Pitocin) Dinoprostone (Prepidil)

A client at 39 weeks' gestation is admitted for induction of labor. Knowing that several medications are used to induce labor, a nurse identifies those that may be prescribed. (Select all that apply.)

Preparing for a cesarean birth

A client is admitted in active labor at 39 weeks' gestation. During the initial examination the nurse identifies multiple red blister-like lesions on the edges of the client's vaginal orifice. Once the nurse has spoken to the practitioner and receive prescriptions, the priority nursing action is:

Fundal height

A client is admitted to the birthing unit with uterine tenderness and minimal dark-red vaginal bleeding. She has a marginal abruptio placentae. The priority evaluation includes fetal status, vital signs, skin color, and urine output. What additional information is essential?

Restricting visitors Maintaining a quiet environment

What are the primary nursing interventions when a client is receiving an infusion of magnesium sulfate for severe preeclampsia? (Select all that apply.)

Discuss why bedrest is necessary

A client is found to have preeclampsia, and bedrest at home is prescribed. It is doubtful that this client will be able to comply because she has two preschool children. What should be included in the plan of care that may help the client follow the prescribed regimen?

Decreased frequency and duration of contractions

A client arrives at the clinic in preterm labor, and terbutaline (Brethine) is prescribed. For what therapeutic effect should the nurse monitor the client?

Syncope on exertion

A client at 28 weeks' gestation with previously diagnosed mitral valve stenosis is being evaluated in the clinic. Which sign or symptom indicates that the client is experiencing cardiac difficulties?

122/86 mm Hg

A 16-year-old primigravida at 36 weeks' gestation visits the prenatal clinic for a routine examination. Her blood pressure is significantly increased, and there is 1+ proteinuria. The client's blood pressure had been averaging 92/70 mm Hg during her previous prenatal visits. What is the lowest blood pressure that should cause the nurse to become concerned?

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

A 24-year-old client who has had type 1 diabetes for 6 years is concerned about how her pregnancy will affect her diet and insulin needs. How should the nurse respond?

2:1 The lecithin concentration increases abruptly at 35 weeks, reaching a level that is twice the amount of sphingomyelin, which decreases concurrently. At 30 to 32 weeks' gestation, the amounts of lecithin and sphingomyelin are equal, indicating lung immaturity. A ratio of 1:4 does not reflect fetal lung maturity; nor does a ratio of 3:4.

A client is to undergo amniocentesis at 38 weeks' gestation to determine fetal lung maturity. What lecithin/sphingomyelin ratio (L/S ratio) is adequate for the nurse to conclude that the fetus' lungs are mature enough to sustain extrauterine life?

Monitoring the client for signs of electrolyte imbalances

A client who is in the first trimester is being discharged after a week of hospitalization for hyperemesis gravidarum. She is to be maintained at home with rehydration infusion therapy. What is the priority nursing activity for the home health nurse?

The probability of tonic-clonic seizures is reduced.

A nurse places a newly admitted client with worsening preeclampsia in a private room. Why is it important for this client to be in a nonstimulating environment?

Low-lying

The practitioner diagnoses placenta previa. What does this indicate to the nurse about the condition of the placenta?

Respiratory rate The increased respiratory rate is one sign of cardiac decompensation ; cardiac output and blood volume peak during the second trimester, and signs and symptoms of cardiac disease become prominent at this time. Oliguria (not increased urine output), accompanied by edema of the face, legs, and fingers, is a sign of cardiac complications. The client's blood pressure is within the expected range for a pregnant woman. Diaphragmatic tenderness is a vague symptom that is not related to heart disease.

While a client at 30 weeks' gestation is being examined in the prenatal clinic, the nurse identifies a respiratory rate of 26/min, blood pressure of 100/60, and diaphragmatic tenderness, and the client reports increased urinary output. Which finding indicates that the client may be experiencing a complication?

Encouraging the client to verbalize her feelings about the loss

A 28-year-old woman is recovering from her third consecutive spontaneous abortion in 2 years. What is the most therapeutic nursing intervention for this client at her follow-up appointment?

"It's when the fetus is expelled but other parts of the pregnancy remain in the uterus."

After an incomplete abortion, a client tells a nurse that although her health care provider explained what an incomplete abortion was, she did not understand. What is the best response by the nurse?

Irritability and muscle tremors

What signs and symptoms of withdrawal does the nurse identify in a postpartum client with a history of opioid abuse?

Preterm labor Multiple gestation Chromosomal anomalies Bleeding in the first trimester

Women who become pregnant for the first time at a later reproductive age (35 years or older) are at risk for what complications? (Select all that apply.)

Heparin (Hep-Lock) Enoxaparin (Lovenox)

A nurse is caring for a pregnant client with thrombophlebitis. Which anticoagulant medication may be prescribed? (Select all that apply.)

Sudden onset of knifelike pain in one of the lower quadrants

What clinical manifestation requires immediate intervention in a woman with a probable ruptured tubal pregnancy?

Diminished cardiac output

What is a nurse's most important concern when caring for a client with a ruptured tubal pregnancy?

Suddenly decrease

A nurse is caring for a client with type 1 diabetes on her first postpartum day. When planning care for this client, what changes in the client's insulin requirements does the nurse expect?

Compensates for a rapid turnover of red blood cells

A nurse is teaching a pregnant client with sickle cell anemia about the importance of taking supplemental folic acid. Folic acid is important for this client because it:

Amino acids PKU is an inborn error of metabolism involving an inability to metabolize phenylalanine, an essential amino acid. Lactose, glucose, and fatty acids are all metabolized by people with PKU.

A nurse provides a list of foods for a breastfeeding client with phenylketonuria (PKU) to avoid. Which nutrient is included on the list?

Extra circulating glucose causes the fetus to acquire fatty deposits.

A nurse teaching a prenatal class is asked why infants of diabetic mothers are larger than those born to women who do not have diabetes. On what information about pregnant women with diabetes should the nurse base the response?

8.2

A practitioner prescribes penicillin G benzathine suspension (Bicillin L-A) 2.45 million units for a client with a sexually transmitted infection (STI). The medication is available in a multidose vial of 10 mL in which 1 mL = 300,000 units. How many milliliters should the nurse administer? Record your answer using one decimal place. ____ mL.

The fetus may be compromised in utero.

A client's membranes rupture spontaneously during the latent phase of the first stage of labor, and the fluid is greenish brown. What does the nurse conclude?

Fetal well-being

A nonstress test is scheduled for a client with preeclampsia. During the nonstress test the nurse concludes that if nonperiodic accelerations of the fetal heart rate occur with fetal movement, this probably indicates:

Developing a safety plan with the client

A nurse in the clinic, during a routine prenatal visit, notes bruises on the client's upper arms. When questioned, the client responds that her boyfriend was upset and hit her. What is the priority nursing action?

Hypotonia

A nurse is caring for a client who is receiving IV magnesium sulfate for preeclampsia. At 37 weeks' gestation she gives birth to an infant weighing 4 lb. What clinical finding in the newborn may indicate magnesium sulfate toxicity?

Absence of the knee-jerk reflex Respiratory rate of 11 breaths/min

A nurse is caring for a client with severe preeclampsia who is receiving magnesium sulfate. What side effects indicate that the serum magnesium level may be excessive? (Select all that apply.)

Ectopic pregnancy

A client who has missed two menstrual periods arrives at the prenatal clinic with vaginal bleeding and one-sided lower quadrant pain. What condition does the nurse suspect?

Placenta previa

A client with frank vaginal bleeding is admitted to the birthing unit at 30 weeks' gestation. The admission data include blood pressure of 110/70 mm Hg, pulse of 90 beats/min, respiratory rate of 22 breaths/min, fetal heart rate of 132 beats/min. The uterus is nontender, the client is reporting no contractions, and the membranes are intact. In light of this information, what problem does the nurse suspect?

Side-lying

A client with mild preeclampsia is being treated on an outpatient basis. Three days of bedrest is prescribed. What position should the nurse encourage the client to maintain while in bed?

Maintenance dosages of cardiac medications will probably be increased

What should the nurse explain to a newly pregnant client with cardiac disease?

Prevent injury

A client with severe preeclampsia in the high-risk unit is receiving an infusion of magnesium sulfate. If eclampsia were to occur, what action would the nurse take first?

Central nervous system depressant that blocks neuromuscular transmissions

A client with severe preeclampsia is receiving an IV infusion of magnesium sulfate. The nurse remembers that magnesium sulfate is a:

6th

A primigravida is admitted to the emergency department with a sharp, shooting pain in the lower abdomen and vaginal spotting. A ruptured tubal pregnancy is diagnosed. During what week of gestation does this condition most commonly occur?

Pulmonary edema has developed.

While auscultating the lungs of a client admitted with severe preeclampsia, the nurse identifies crackles. What inference does the nurse make when considering the presence of crackles in the lungs?

Morning sickness may lead to decreased food intake.

A client at 6 weeks' gestation who has type 1 diabetes is attending the prenatal clinic for the first time. The nurse explains that during the first trimester insulin requirements may decrease because:

Shock

A client being prepared for surgery because of a ruptured tubal pregnancy complains of feeling lightheaded. Her pulse is rapid, and her color is pale. What condition does the nurse anticipate as a common complication of a ruptured tubal pregnancy?

Active genital herpes

A client in labor at 39 weeks' gestation is told by the health care provider that she will need a cesarean birth. The nurse reviews the client's prenatal history. What preexisting condition is the most likely reason for the cesarean birth?

Prolapsed cord

A client in labor is admitted with a suspected breech presentation. For what occurrence should the nurse be prepared?

Lie on the side with the head raised on a small pillow. Bedrest keeps the pressure of the fetal head off the cervix. The side-lying position keeps the gravid uterus from impeding blood flow through major vessels, thus maintaining uterine perfusion. The Trendelenburg position is used when the cord is prolapsed or the client is in shock. Sitting up in bed increases pressure on the cervix and could lead to further dilation. Assuming the knee-chest position at regular intervals throughout the day may help relieve pressure of the fetus on the cervix, but it will not enhance uterine perfusion.

A pregnant client with a history of preterm labor is at home on bedrest. What instructions should a teaching plan for this client include?

24th and 28th weeks of gestation

A primigravida with type 1 diabetes is having her first prenatal visit. While discussing changes in insulin needs during pregnancy and after birth, the nurse explains that in light of the client's blood glucose readings she should expect to increase her insulin dosage. Between which weeks of gestation is this expected to occur?

Painless vaginal bleeding

A sonogram performed on a client in the third trimester demonstrates a low-lying placenta. The nurse should teach the client that she is at risk for:

Call for assistance and don sterile gloves Insert two fingers into the vagina and exert upward pressure against the fetal presenting part Put a rolled towel under one hip and place in the modified Sims position Administer oxygen to the mother and monitor fetal heart tones

After a client's membranes rupture spontaneously, the nurse sees the umbilical cord protruding from the vagina. Place the nursing interventions in order of priority.

Taking-in By discussing the experience, the client is bringing it into reality; this is characteristic of the taking-in phase . The client is not ready to assume the tasks of the letting-go phase until completing the tasks of the taking-in and taking-hold phases. The taking-hold phase is marked by an increased desire to resume independence; this statement reveals that the client is not ready for this phase. The working-through phase is not a separate phase of adjustment to parenthood; it is not relevant.

After an unexpected emergency cesarean birth the client tells the nurse, "I failed natural childbirth." Which postpartum phase of adjustment does this statement most closely typify

Reducing her blood pressure

An 18-year-old primigravida at 36 weeks' gestation is admitted with a diagnosis of mild preeclampsia. What is the nurse's most important goal for this client?

Ensuring that the client's diet is nutritionally adequate

During a prenatal interview at 20 weeks' gestation, the nurse determines that the client has a history of pica. What is the most appropriate nursing action?

Iron Folic acid

On her first visit to the prenatal clinic a client with rheumatic heart disease asks the nurse whether she has special nutritional needs. What supplements in addition to the regular pregnancy diet and prenatal vitamin and minerals will she need? (Select all that apply.)