MATERNITY

A client at 35 weeks' gestation is admitted to the L&D unit for severe pre-eclampsia. She is started on IV magnesium sulfate for seizure prophylaxis. Which of the following signs indicate that the client has developed magnesium sulfate toxicity? SATA 1. 0/4 patellar reflex 2. Blood pressure of 156/84 3. Client voiding 600 mL in 8 hours 4. respirations of 10/min 5. Serum magnesium level of 8.0 mEq/L

ANSWER: - 0/4 patellar reflex, - respirations of 10/min - Serum magnesium level of 8.0 RATIONALE: Therapeutic levels of magnesium is 4-7 mEq/L. Calcium gluconate should be administered as an antidote. - Normal findings of DTR is +2 - Urine output of less than 30 mL/hr is a sign of magnesium toxicity

A client indicates the desire to become pregnant. Which of the following are important preconception education topics for the nurse to provide? SATA 1. Aim for BMI of 18.5-24.9 2. Avoid alcohol consumption and tobacco products 3. Ensure daily intake of 400 mcg of folic acid 4. Obtain testing for rubella immunity 5. Schedule dental wellness appointment

ANSWER: - All of them are correct RATIONALE: - Preconception counseling assesses for pregnancy risk factors and implements appropriate interventions to promote a healthy pregnancy. - Folic acid supplements 3 months before pregnancy are recommended to reduce the incidence of neural tube defects since it develops around week 3 - It is good to check Rubella since you cant have live vaccines during pregnancy. - Regular dental visits are important to avoid periodontal disease

The nurse is preparing to discharge a client following a first trimester miscarriage. Which of the following statements should the nurse include in discharge teaching for the client and partner? SATA - Attending a support group with other people who had a pregnancy loss can be helpful - genetic counseling is recommended for couples after their first miscarriage - one of the most important things you can do right now is communicate with your partner - The grieving period only lasts about 6 months following a miscarriage - Trying to conceive again can help you cope by giving you something to look forward to

ANSWER: - Attending a support group with other people who had a pregnancy loss can helpful - One of the most important things you can do right now is communicate with your partner RATIONALE: A spontaneous abortion is an unintentional pregnancy loss before 20 weeks gestation. - Genetic counseling is more appropriate for clients who experienced 2-3 miscarriages consecutively

Which mean should the nurse recommend for a pregnant client at 13 weeks gestation? 1. Baked chicken, turnip greens, peanut butter cookie and grape juice 2. Baked swordfish, fries, baked apples, and fat-free milk 3. Chilled ham and cheese sandwich, broccoli, orange slices, and water 4. Fried liver and onions, pasteurized cheese, fresh fruit, and water

ANSWER: - Baked chicken, turnip greens, peanut butter cookie, and grape juice RATIONALE: Foods containing folic acid, protein, whole grains, iron, and omega 3 fatty acids are especially important. Clients should avoid unpasteurized milk products, unwashed fruits and vegetables, deli meat and hot dogs and raw fish/meat. They should also avoid the intake of fish high in mercury like shark, swordfish, king mackerel, tilefish. Liver has high amounts of vitamin A which can be teratogenic.

A nurse is admitting a client at 42 weeks gestation to the labor and delivery unit for induction of labor. What is a predicator of a successful induction? 1. Bishop score of 10 2. Firm and posterior cervix 3. History of precipitous labor 4. Reactive nonstress test

ANSWER: - Bishop score of 10 RATIONALE: - We would want a soft, anterior, 3-4 cm dilation, 60-70% effacement and -1-0 station

A pregnant client arrives in the L&D unit with mild contractions and brisk, painless vaginal bleeding. The client received no prenatal care and reports being "about 7-8 months." Which actions should the nurse anticipate? SATA 1. Blood draw for type and screen 2. Electronic fetal monitoring 3. Initiation of 2 large bore IV catheters 4. Pad counts to assess bleeding 5. Vaginal examination for cervical dilation

ANSWER: - Blood draw for type and screen - Electronic fetal monitoring - Initiation of 2 large bore IV catheters RATIONALE: Placenta previa is an abnormal implantation of the placenta resulting in partial or complete covering of the cervical os. There is usually painless bleeding. - The IV bores are necessary in case fluid resuscitation is needed and administration of blood products - Clients with placenta previa are on pelvic rest (no intercourse and nothing in vagina including examination)

The nurse is caring for a client at 30 weeks gestation who is hospitalized for preeclampsia. After reviewing the client's chart and performing an initial assessment, the nurse notes several abnormal findings. WHich finding should the nurse discuss with the heath care provider immediately? 1. Dark red vaginal bleeding 2. Edema of the hands and face 3. Elevated liver enzymes 4. Urine output of 150 mL in 4 hours

ANSWER: - Dark red vaginal bleeding RATIONALE: Placental abruption is a potential complication of preeclampsia related to hypertensuoon that can be life threatening to the mother or fetus. It causes premature detachment of the placenta from the uterine wall, resulting in bleeding from uterine blood vessels. Common manifestations include abdominal pain, dark red vaginal bleeding, a rigid uterus, abnormal fetal heart rate and uterine tachysystole. This is priority because the client may need C-section.

A nurse is participating in an obstetrical emergency simulation in which the health care provider announces shoulder dystocia. Which of the following interventions should the assisting nurse implement? SATA 1. Assist maternal pushing efforts by applying fundal pressure during each contraction 2. Document the time the fetal head was born 3. Flex the clients legs back against the abdomen and apply downward pressure above the symphysis pubis 4. Prepare for forceps-assisted birth 5. Request additional assistance from other nurses immediately

ANSWER: - Document the time the fetal head was born - Flex the client's legs back against the abdomen and apply downward pressure above the symphysis pubis - Request additional assistance from other nurses immediately RATIONALE: McRoberts Maneuver is when the flexed onto abdomen causes rotation of pelvis, alignment of sacrum and opening of the birth canal. Apply suprapubic pressure. - The nurse should be documenting the exact time of events and verbalizing how much time has passed, perform maneuvers to relieve should impaction and requesting additional help

The nurse receives report for a client at 36 weeks gestation who is being transferred to the unit for labor induction from a rural health care facility with an intrauterine fetal demise of unknown duration. Which intervention is MOST important when receiving care of the client? 1. Apply toco and evaluate current contraction pattern 2. Ask the client about the family's desire for speaking with a chaplain 3. Draw coagulation tests, fibrinogen, and CBC with platelets 4. Initiate oxytocin prescription to begin induction of labor

ANSWER: - Draw coag tests, fibrinogen, and CBC with platelets RATIONALE: - Clients with placental abruption and fetal demise are at risk for disseminated intravascular coagulation (DIC). Thromboplastin from the dead fetus activates the clotting cascade and consumption of clotting gactors and platelets leads to life threatening external and internal bleeding.

A client at 38 weeks gestation is in latent labor with ruptured membranes and is receiving oxytocin infusion for labor augmentation. The client is requesting IV pain medication. When administering an IV narcotic during labor, which nursing action is appropriate? 1. Discontinue the oxytocin infusion prior to giving the medication 2. Give the medication slowly during the peak of the next contraction 3. Hold until the contractions are occurring at least every 4 minutes for an hour 4. Withdraw 5 mL of lactated ringer from the IV tubing to dilute the medication

ANSWER: - Give the medication slowly during the peak of the next contraction RATIONALE: - Administration of IV narcotics during the peak of contractions can help decrease sedation of the fetus and subsequent newborn respiratory depression.

The nurse assesses a client at term gestation who reports having contractions for the last 2 hours. The client states, "I'm not sure, but I think my water broke." The nurse performs a nitrazine pH test, which turns blue. When documenting the results of the test, which client statement is most concerning to the nurse? 1. I did have sex with my partner 1 hour before coming in today 2. I have noticed constant wetness in my panties since I thought my water broke 3. It is difficult for me to tell if my water broke or if I just peed on myself a little bit 4. With my last 3 pregnancies, my water never broke on its own

ANSWER: - I did have sex with my partner 1 hour before coming in today RATIONALE: pH 5-6 means that the membranes are still intact. pH 6.5-7.5 means membranes probably ruptured. However, the presence of blood or semen can cause a false positive since they are alkaline.

The nurse provides discharge instructions to a client at 14 weeks gestation who has received a prophylactic cervical cerclage. Which client statement indicates an understanding of teaching? 1. I need to be on bed rest for the duration of my pregnancy 2. I will notify my health care provider if I start having low back aches 3. Pelvic pressure is to be expected after cervical cerclage 4. The cerclage will be removed once my baby is at 28 weeks

ANSWER: - I will notify my health care provider if I start having low back aches RATIONALE: - Placement usually occurs at 12-14 weeks for clients with a history of cervical insufficiency or up to 23 weeks gestation id signs of cervical insufficiency. Discharge instructions include activity restriction and recognition of signs of preterm labor (low back aches, contractions, pelvic pressure and rupture of membranes.

A nurse is caring for a client at 12 weeks gestation who is admitted for hyperemesis gravidarum. Which clinical manifestation should the nurse expect? 1. Abdominal pain and low grade fever 2. Blood pressure greater or equal to 140/90 3. High urine protein level 4. Moderate to high urine ketones

ANSWER: - Moderate to high urine ketones RATIONALE: Clinical features is weight loss, poor skin tugor, dry mucous membranes, hypotension, tachycardia. Lab abnormalities are hypokalemia/hyponatremia, ketonuria, increased urine specific gravity, hemoconcentration, and metabolic alkalosis. Ketones are a by-product of the fat breakdown that occurs in starvation states.

A client in active labor who received an epidural 20 minutes ago reports feeling nauseated and lightheaded. Which action should the nurse perform FIRST? 1. Administer IV Odanestron 2. Apply oxygen via face mask 3. Obtain blood pressure 4. Perform vaginal examination

ANSWER: - Obtain blood pressure RATIONALE: - An epidural inhibits the SNS. SNS can cause peripheral vasodilation which may produce significant hypotension. The nurse should determine the cause before performing interventions. If it's from hypotension then the nurse should administer an IV fluid bolus.

The nurse is caring for a client in the first trimester during an initial prenatal clinic visit. Based on the information provided by the client, which factor places the client at an increased risk for preterm labor? 1. Age 25 2. Periodontal disease 3. Vegetarian diet 4. White ethnicity

ANSWER: - Periodontal disease RATIONALE: Infection (periodontal disease or UTI) are strongly associated with preterm labor particularly when untreated. Infection causes the release of prostaglandins which are uterotonic and contribute to cervical softening. - Non-hispanic black women have the highest rates of preterm labor and birth.

The nurse is counseling a pregnant client who is HIV positive. Which information is appropriate to discuss? 1. Infant should be exclusively breastfed for 6 months to receive maternal antibodies 2. Infant will not require treatment for HIV after birth 3. Prescribed antiretroviral therapy should be continued during pregnancy 4. Tdap vaccine should be avoided until after birth

ANSWER: - Prescribed antiretroviral therapy should be continued during pregnancy RATIONALE: Perinatal transmission of HIV can occur from mother to baby anytime during the antepartum, intrapartum, and postpartum periods. Maternal antiretroviral therapy is imperative during pregnancy to decrease viral load and decrease risk of transmission. - HIV can be transmitted through breast milk - Infants born to HIV+ clients should receive therapy at birth and for at least 4-6 weeks after birth to reduce the chance of developing HIV. Infants are tested at birth and at age 1 and 4 months.

The nurse is caring for a client with Gestational diabetes during the second stage of labor. After birth of the head, the nurse notes retraction of the fetal head against the maternal perineum. Which action should the nurse anticipate? 1. Administering a tocolytic 2. Initiating fundal pressure during a contraction 3. Obtaining the vacuum extractor 4. Pressing downward on the symphysis pubis

ANSWER: - Pressing downward on the symphysis pubis RATIONALE: - This is an indication of should dystocia. The is more common with macrosomia which can occur from gestational diabetes. Primary nurse interventions is to do the McRoberts maneuver and apply suprapubic pressure

A laboring client, gravida 3 para 2, is admitted to the labor unit reporting severe perineal pressure and urgently requesting pain relief. The client's cervix is 10 cm dilated and 100% effaced, with the fetal head at 0 station. Which pain management technique is most appropriate for the client's report of perineal pressure? 1. Epidural anesthesia 2. Hydrotherapy 3. IV Narcotics 4. Pudendal nerve block

ANSWER: - Pudendal nerve block RATIONALE: A pudendal nerve block infiltrates local anesthesia (lidocaine) into the areas surrounding the pudendal nerves. This medication poses the least amount of risks to the mother and baby.

A client at 39 weeks gestation with preeclampsia has a blood pressure of 170/100, 2+ proteinuria, and moderate peripheral edema. Immediately after hospital admission, she develops seizures and uterine contractions. Mag sulfate is prescribed. Which finding indicates that the drug has achieved the desired therapeutic effect? 1. Blood pressure < 130/80 2. Seizure activity stops 3. urine has 1+ protein 4. Uterine contractions stop

ANSWER: - Seizure activity stops RATIONALE: - Hydralazine or labetalol is administered to lower blood pressure

The graduate nurse is caring for a client at 20 weeks gestation with secondary syphilis. The client reports an allergic reaction to penicillin as a child but does not know what kind of reaction occurred. When discussing the client's potential treatment plan with the precepting nurse, which statement by the GN indicates an appropriate understanding? 1. Doxycyline is an acceptable alternative to penicillin for treatment f syphilis during pregnancy 2. The client will require penicillin desensitization to receive appropriate treatment 3. The newborn can be treated after birth if antepartum treatment is contraindicated 4. Treatment is only effective if provided during the primary stage of syphilis

ANSWER: - The client will require penicillin desensitization to receive appropriate treatment RATIONALE: Syphilis can cross the placenta and has tertogenic effects on fetal development. - The only adequate prenatal treatment is IM penicillin injection - Doxycycline is an alternative but not in pregnancy. It can impair fetal bone mineralization and discolor permanent teeth

When triaging 4 pregnant clients in the obstetric clinic, the nurse should alert the health care provider to see which client first? 1. first trimester client reporting frequent nausea and vomiting 2. Second trimester client with dysuria and urinary frequency 3. Second trimester client with obesity reporting decrease in fetal movement 4. Third trimester client with right upper quadrant pain and nausea

ANSWER: - Third trimester client with right upper quadrant pain and nausea RATIONALE: Right upper quadrant or epigastric pain can an indicator of HELLP syndrome (Severe form of preeclampsia). HELLP stands for hemolysis, elevated liver enzymes, and low platelet count. Clients may have RUQ pain, nausea, vomiting, and malaise

A client at 39 weeks gestation is brought to the ED in stable condition following a motor vehicle accident. The client, who is secured spine on a backboard, suddenly becomes pale with a blood pressure of 88/50. Which action should the nurse take FIRST? 1. Administer normal saline fluid bolus 2. Ask about any prenatal complications 3. Initiate fetal heart rate monitoring 4. Tilt the backboard to one side

ANSWER: - Tilt the backboard to one side RATIONALE: To stabilize uterine displacement, you should address supine hypotension and promote blood circulation to the fetus. The client should be turned laterally on the left side.

The graduate nurse is assisting the nurse preceptor to provide education to a client diagnosed with molar pregnancy. Which statement by the GN requires the precepting nurse to intervene.? 1. A uterine evacuation procedure is the typical treatment for removing the abnormal tissue 2. We can provide you with resources for coping with perinatal loss if needed 3. You may start trying to conceive again as soon as you and your partner feel ready 4. You will need Rh immune globulin following a molar pregnancy because you have a Rh negative blood type

ANSWER: - You may start trying to conceive again as soon as you and your partner feel ready RATIONALE: - The growing tissue may be benign at first but can become cancerous. The Hcg levels continue to rise even after evacuation which can mean it has metastasized. It's important to not get pregnant so that the levels can be accurately assessed. Weekly monitoring is required at first and then continued monitoring 6-12 months after.

A pregnant client in the first trimester tells the clinic nurse she will be traveling to an area with a known Zika virus outbreak and expresses concern regarding disease transmission. Which statement by the nurse is most appropriate? 1. If you experience Zika symptoms, notify your health care provider 2. Take precautions against mosquito bites throughout your trip 3. You are not far enough along for the Zika virus to affect your baby 4. You should consider postponing your trip until after you have the baby

ANSWER: - You should consider postponing your trip until after you have the baby RATIONALE: Zika virus is transmitted via mosquitoes, sexual contact, and infected bodily fluids. Zika causes viral symptoms (low grade fever, arthralgias - painful joints). It can cause microcephaly, developmental dysfunction and encephalitis in babies born to Zika infected women. - Mosquitoes are not the only mode of transmission

The nurse is reinforcing instructions to a client at 34 weeks gestation who is preparing to travel by airplane. Which of the following instructions are appropriate? SATA 1. Avoid getting up during the flight unless you need the restroom 2. carry a copy of your most up to ate prenatal record 3. increase fluid intake before and during the flight 4. secure the lap belt below the abdomen and across your hips when seated 5. wear compression hose and loose-fitting clothing

ANSWER: - carry a copy of your most up to date prenatal record increase fluid intake before and during the flight secure the lab belt below the abdomen and across your hips when seated wear compression hose and loose-fitting clothing RATIONALE: Domestic air travel is usually allowed for healthy clients under 36 weeks gestation. An updated card is important if emergency care is necessary. Travel to a zika or malaria prevalent area should be avoided as well as remote areas with poor medical attention - Increased fluid intake can help prevent dehydration and thrombus formation

A nurse on the antepartum unit is caring for a pregnant client at 30 weeks gestation who was admitted with reports of vaginal bleeding. A diagnosis of placenta previa was confirmed by ultrasound. What should the nurse tell the client to anticipate? SATA 1. Additional ultrasound around 36 weeks gestation 2. Clearance for sexual activity if bleeding stops 3. Discharge home if bleeding stops and fetal status is reassuring 4. Scheduled c-section birth before onset of labor 5. weekly vaginal examinations to assess for cervical change

ANSWER: -Additional ultrasound around 36 weeks gestation - Discharge home if bleeding stops and fetal status is reassuring - Scheduled c-section birth before onset of labor RATIONALE: Placenta Previa is when the placenta has implanted over or near the cervix. Cervical dilation or effacement can cause massive blood loss and maternal/fetal compromise. Because of this c-section is planned after 36 weeks and before onset of labor. Since this condition can resolve on it's own an ultrasound id necessary after 36 weeks. If bleeding reoccurs then the client should be closely monitored and return for immediate care. Clients should be on pelvic rest so examinations, douching, and intercourse are contraindicated.

A client with diabetes visits the clinic reporting breast tenderness, vaginal discharge, and urinary frequency. Which action is MOST important for the nurse to perform? 1. ask if the client performs breast self exams 2. Ask the client about characteristics of vaginal discharge 3. Assess the date of the client's last menstrual period 4. Review the client's home blood sugar logs

ANSWER: - Assess the date of the client's last menstrual period RATIONALE: All other answers do not address the bigger picture but instead address a single detail in the report

Which client in the prenatal clinic should the nurse assess FIRST? 1. Client at 11 weeks gestation with backache and pelvic pressure? 2. Client at 16 weeks gestation with earache and sinus congestion 3. Client at 27 weeks gestation with headache and facial edema 4. Client at 37 weeks gestation with white vaginal discharge and urinary frequency

ANSWER: - Client at 27 weeks gestation with headache and facial edema RATIONALE: Gestational hypertension is new-onset high blood pressure greater than 140/90 that occurs after 20 weeks gestation. The development of proteinuria with hypertension is preeclampsia. It presents itself with headache, blurred vision, and facial swelling. - Backache and pelvic pressure are common discomforts - Earache and sinus congestion are common from increased blood volume and fluid retention. The client should be assessed for infection but isn't priority. - Urinary frequency is expected

The nurse is performing assessments of several clients during routine prenatal visits. Which client should the nurse discuss with the health care provider first? 1. Client at 30 weeks gestation with darkened patches of skin on the face 2. Client at 32 weeks gestation with painless, flesh colored bumps on the perianal area 3. Client at 34 weeks gestation with intense itching on the hands and feet that worsens at night but no rash 4. Client at 38 weeks gestation with stretch marks on the abdomen that have become reddened and pruritic

ANSWER: - Client at 34 weeks gestation with intense itching on the hands and feet that worsens at night but no rash RATIONALE: Intense itching is a manifestation of a liver disorder exclusive to pregnancy. This condition increases the risk of fetal demise and requires priority assessment. - Chloasma is a hormonally stimulated increase in pigmentation over the bridge of the nose and cheeks that usually appears in the 2nd trimester. It is benign and fades postpartum

The clinic nurse is collecting data on a pregnant client in the first trimester. Which finding is most concerning and warrants PRIORITY intervention? 1. Client has not been taking prenatal vitamins 2. Client is taking lisinopril to control hypertension 3. Client reports a whitish vaginal discharge 4. Client reports mild cramping pain in the lower abdomen

ANSWER: - Client is taking lisinopril to control hypertension RATIONALE: ACE inhibitors (-pril) and angiotensin ll receptor blockers (-sartan) should be avoided during all stages of pregnancy. They are teratogenic leading to fetal renal and cardiac abnormalities. - Prenatal vitamins are good for iron and folic acid but not priority

The nurse is providing education to several first-trimester pregnant clients. Which client requires PRIORITY anticipatory teaching? 1. Client who gardens and eats homegrown vegetables 2. Client who has gained 4 pounds from prepregnancy weight 3. Client who has noticed thin, milky white vaginal discharge 4. Client who practice yoga and swims in a pool 3 times a week

ANSWER: - Client who gardens and eats homegrown vegetables RATIONALE: Toxoplasmosis is a parasitic infection caused by toxoplasma gondii which can be due to infected cat feces or uncooked meat and soil-contaminated fruits/vegetables

The nurse is preparing a nutritional teaching plan for a client planning to become pregnant. Which foods would BEST prevent neural tube defects? 1. Calcium-rich snacks 2. Fortified cereals 3. Organ meats 4. Wild salmon

ANSWER: - Fortified cereals RATIONALE: Women who are planning to become pregnant should consume 400-800 mcg of folic cid daily. Food options rich in folic acid include fortified grain products and green, leafy vegetables. Folic acid is crucial in the first 8 weeks. - calcium rich foods is mostly important during the last trimester for mineralization of fetal bones and teeth - Organ meats may contain moderately high levels of folate but are consumed for their iron content which can promote red blood cell formation - Omega-3 rich foods are important for neurologic function

A nurse is caring for a pregnant client at 27 weeks gestation after a motor vehicle collision with side airbag deployment. The client's blood type is o negative. Which laboratory test should the nurse anticipate? 1. Group B strep culture 2. Indirect Coombs test 3. Rubella immunity titer 4. Serum alpha-fetoprotein

ANSWER: - Indirect Coombs test RATIONALE: During pregnancy the fetus and the mother have different blood supply mechanisms. However the disruption of this process like delivery or trauma can result in fetomaternal hemorrhage. If the mother is Rh- (O negative) and the baby is Rh positive then the mother will develop antibodies to this. The antibodies will cross the placenta causing the hemolysis to the fetuses RBCs. A Coombs test is used to determine Rh sensitization. - RhoGAM is administered to all Rh negative clients at 28 weeks gestation and within 72 hours postpartum and after trauma. - Strep B test is done at 35-37 weeks - Rubella immunity is tested in first trimester is immediately administered after birth - Serum alpha-fetoprotein is a blood test to screen for fetal neural tube defects

At 20 weeks gestation a client states that she started consuming an increased amount of cornstarch about 3 weeks ago. Based on this assessment, the nurse should anticipate that the health care provider will order which lab test? 1. Hgb and hematocrit 2. Human chorionic gonadotropin level 3. Serum folate level 4. WBC

Pica is an abnormal, compulsive craving for and consumption of substances including ice, cornstarch, chalk, clay, dirt, and paper. Pica is often accompanied by anemia due to insufficient nutritional intake. 2. Is the hormone detected in urine or serum pregnancy test to determine if a client is pregnant.