NUR 410 Maternity PrepU
Which of the following findings is most worrisome in Melissa, a woman in her 26th week of pregnancy?
Facial edema
Which recommendation would the nurse give to a pregnant client with a sexually transmitted infection who is at risk for transmitting the infection?
Participate in early prenatal care.
The nurse is monitoring a pregnant patient 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 woman with placenta previa is being treated with expectant management. The woman and fetus are stable. The nurse is assessing the woman for possible discharge home. Which statement by the woman would suggest to the nurse that home care might be inappropriate?
"I have a toddler and preschooler at home who need my attention."
Upon entering the room of a client who has had a spontaneous abortion, the nurse observes the client crying. Which response by the nurse would be most appropriate?
"I'm sorry you lost your baby."
A 16-year-old client gave birth to a 12 weeks' gestation fetus last week. The client has come to the office for follow-up and while waiting in an examination room notices that on the schedule is written her name and "follow-up of spontaneous abortion." The client is upset about what is written on the schedule. How can the nurse best explain this terminology?
"Spontaneous abortion is a more specific term used to describe a spontaneous miscarriage, which is a loss of pregnancy before 20 weeks. This term does not imply that you did anything to affect the pregnancy."
A pregnant client at 32 weeks' gestation is treated with magnesium sulfate for seizure management. The nurse assesses which of the following for evidence of magnesium toxicity?
Absence of knee jerk response
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.
A patient in her third trimester comes in for a routine prenatal visit. The nurse places her in a comfortable position and attaches the tocodynamometer and ultrasound monitor to the patient's abdomen. What is the purpose of this test?
Assesses fetal well-being
A nurse is assigned to care for a pregnant client as she undergoes a nonstress test. Place the steps involved in conducting the nonstress test in the correct order from first to last. All options must be used.
Client consumes a meal. Client placed in left lateral recumbent position. External electronic fetal-monitoring device applied. Client is handed an event marker. Fetal monitor strip marked for fetal movement.
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
What special interventions would the nurse implement in a client who is carrying twin fetuses?
Demonstrate to the client how to perform fetal movement counts after 32 weeks.
The nurse should encourage a pregnant client who is taking short-acting insulin for her diabetes to avoid eating after self-administering the insulin.
False
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 alert the RN or health care provider?
Initial BP 100/70 mm Hg; current BP 140/90 mm Hg
The nurse is caring for a pregnant client with fallopian tube rupture. Which intervention is the priority for this client?
Monitor the client's vital signs and bleeding.
A pregnant patient 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 woman who is 8 months' pregnant comes to the clinic with urinary frequency and pain on urination. The client is diagnosed with a urinary tract infection (UTI). Which medication would the nurse anticipate the physician will prescribe?
amoxicillin
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 nurse suspects that a client is developing HELLP syndrome. The nurse notifies the health care provider based on which finding?
elevated liver enzymes
A woman with an incomplete abortion is to receive misoprostol. The woman asks the nurse, "Why am I getting this drug?" The nurse responds to the client, integrating understanding that this drug achieves which effect?
ensures passage of all the products of conception
A nurse is providing care to a client who has been diagnosed with a common benign form of gestational trophoblastic disease. The nurse identifies this as:
hydatidiform mole.
A pregnant client has tested positive for cytomegalovirus. What can this cause in the newborn?
microcephaly
A woman with gestational hypertension develops eclampsia and experiences a seizure. Which intervention would the nurse identify as the priority?
oxygenation
A nurse is assessing the following antenatal clients. Which client is at highest risk for having a multiple gestation?
the 41-year-old client who conceived by in vitro fertilization
A nurse is teaching a prenatal class and is asked the purpose of amniotic fluid. Which statements are correct? Select all that apply
1. Amniotic fluid promotes fetal movement enhancing musculoskeletal development. 2. Sufficient amounts of amniotic fluid cushion the fetus from trauma. 3. Amniotic fluid allows the fetal umbilical cord to be relatively free from compression. 4. Sufficient amounts of amniotic fluid help the fetus maintain a constant body temperature.
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
An 18-year-old pregnant client is hospitalized as she recovers from hyperemesis gravidarum. The client reveals she wanted to have an abortion but the cultural background forbids it. She is very unhappy about being pregnant and even expresses a wish for a miscarriage. Which action should the LPN prioritize?
Consult with the RN about offering the client a chance to speak with a psychiatrist.
The health care provider prescribes PGE2 for a woman to help evacuate the uterus following a spontaneous abortion. Which action would be most important for the nurse to do?
Maintain the client supine for 30 minutes after administration.
The obstetric nurse is caring for a pregnant client who has been diagnosed with hydatidiform mole. What assessment should the nurse prioritize?
Vaginal bleeding
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 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+
A novice nurse asks to be assigned to the least complex antepartum client. Which condition would necessitate the least complex care requirements?
gestational hypertension
A patient with diabetes is in the first trimester of pregnancy and is currently having difficulty keeping blood glucose levels within normal limits. The patient explains that she has been "eating for two" so the baby is healthy. How should the nurse respond to the patient?
"Elevated blood glucose levels in the first trimester have been linked to congenital anomalies."
A client in her first trimester arrives at the emergency room with reports of severe cramping and vaginal spotting. On examination, the health care provider informs her that no fetal heart sounds are evident and orders a dilatation and curettage. The client looks frightened and confused and states that she does not believe in abortion. Which statement by the nurse is best?
"Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications."
A pregnant patient with intermittent preterm contractions at 30 weeks has been on weekly home care assessments for 1 month without health care visits to the doctor or any activities outside the home. The nurse has established adequate fetal growth and is aware that contractions have been occurring roughly two times a day. The patient makes little effort to look at the nurse or discuss her plans for the upcoming delivery. The nurse makes which diagnosis of the current needs of this patient?
At risk for depression because of extended activity restriction, as evidenced by affect
A client has been admitted to the hospital with a diagnosis of severe preeclampsia. Which nursing intervention is the priority?
Confine the client to bed rest in a darkened room
A 28-year-old client with a history of endometriosis presents to the emergency department with severe abdominal pain and nausea and vomiting. The client also reports her periods are irregular with the last one being 2 months ago. The nurse prepares to assess for which possible cause for this client's complaints?
Ectopic pregnancy
TORCH is an acronym for maternal infections associated with congenital malformations and disorders. Which of the following disorders does the H represent?
Herpes simplex virus
A student nurse is preparing for a presentation which 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 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.
The nurse is caring for a client who has a multifetal pregnancy. What topic should the nurse prioritize during health education?
Signs of preterm labor
A client is 20 weeks pregnant. At a prenatal visit, the nurse begins the prenatal assessment. Which finding would necessitate calling the primary care provider to assess the client?
The client has pink vaginal discharge and pelvic pressure.
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
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
While assessing a pregnant woman, the nurse suspects that the client may be at risk for hydramnios. Which information would the nurse use to support this suspicion? Select all that apply.
history of diabetes reports of shortness of breath difficulty obtaining fetal heart rate
A client in her fifth month of pregnancy is having a routine clinic visit. The nurse should assess the client for which common second trimester condition?
physiological anemia
A 44-year-old client has lost several pregnancies over the last 10 years. For the past 3 months, she has had fatigue, nausea, and vomiting. She visits the clinic and takes a pregnancy test; the results are positive. Physical examination confirms a uterus enlarged to 13 weeks' gestation; fetal heart tones are heard. Ultrasound reveals that the client is experiencing some bleeding. Considering the client's prenatal history and age, what does the nurse recognize as the greatest risk for the client at this time?
spontaneous abortion (miscarriage)
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?
use of IUD for contraception
A primigravida 21-year-old client at 24 weeks' gestation has a 2-year history of HIV. As the nurse explains the various options for delivery, which factor should the nurse point out will influence the decision for a vaginal birth?
The viral load
A nurse is interviewing a pregnant woman who has come to the clinic for her first prenatal visit. During the interview, the client tells the nurse that she works in a day care center with 2- and 3-year olds. Based on the client's history, the nurse would be alert for the development of which condition?
cytomegalovirus
A client who is HIV-positive is in her second trimester and remains asymptomatic. She voices concern about her newborn's risk for the infection. Which statement by the nurse would be most appropriate?
"Antiretroviral medications are available to help reduce the risk of transmission."
A woman of 16 weeks' gestation telephones the nurse because she has passed some "berry-like" blood clots and now has continued dark brown vaginal bleeding. Which action would the nurse instruct the woman to do?
"Come to the health facility with any vaginal material passed."
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 client with preeclampsia is receiving magnesium sulfate to suppress or control seizures. Which nursing intervention should a nurse perform to determine the effectiveness of therapy?
Assess deep tendon reflexes.
A woman with a positive history of genital herpes is in active labor. Assessment reveals vesicles in the perineum area, membranes are ruptured, dilated 5 cm, and effaced 70%. The nurse should prepare the client for which type of birth?
Cesarean
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
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.
When assessing a pregnant client for possible gestational hypertension, which factors would lead the nurse to suspect that the client is at increased risk? Select all that apply.
Preexisting hypertension Primiparas, particularly obese clients History of antiphospholipid syndrome
A client at 27 weeks' gestation is admitted to the obstetric unit after reporting headaches and edema of her hands. Review of the prenatal notes reveals blood pressure consistently above 136/90 mm Hg. The nurse anticipates the health care provider will prescribe magnesium sulfate to accomplish which primary goal?
Prevent maternal seizures
A patient having an examination to check the placement of an intrauterine device (IUD) is diagnosed as being pregnant. For which action should the nurse prepare the patient at this time?
Removal of the IUD
A nurse is caring for a pregnant client whose fetus has been diagnosed with macrosomia. When reviewing the client's history, which information would the nurse expect to find?
gestational diabetes
A client has come to the office for a prenatal visit during her 24th week of gestation. On examination, it is noted that her blood pressure has increased to 146/94 mm Hg. Her urine is negative for proteinuria. Blood pressure assessment at 20 weeks' gestation was 142/92 mm Hg and urine was negative for protein. Blood pressure readings at previous visits ranged from 120/76 mm Hg to 126/80 mm Hg. The nurse suspects which condition?
gestational hypertension
A pregnant woman has just found out that she is having twin girls. She asks the nurse the difference between fraternal and identical twins. The nurse explains that with one set of twins there is fertilization of two ova, and with the other set one fertilized ovum splits. What type of twins result from the split ovum?
identical
The nurse is preparing the plan of care for a woman hospitalized for hyperemesis gravidarum. Which interventions would the nurse most likely include? Select all that apply.
obtaining baseline blood electrolyte levels administering antiemetic agents maintaining NPO status for the first day or two monitoring intake and output
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 woman with preterm labor is receiving magnesium sulfate. Which finding would require the nurse to intervene immediately?
1+ deep tendon reflexes
A nurse is preparing a nursing care plan for a client who is admitted at 22 weeks' gestation with advanced cervical 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
A woman in her 20s has experienced a 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 spontaneous miscarriage in the first trimester is related to which factor?
Chromosomal defects in the fetus
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
A female patient is complaining of vaginal spotting and sharp colicky pain. She informs the nurse that her period is 2 weeks late. The patient should be investigated for which of the following?
Ectopic pregnancy
The nurse is preparing a postpartum nursing care plan for a single HIV-positive primigravida client. The nurse should prioritize in the plan how to acquire which resource?
Formula
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 client at 37 weeks' gestation presents to the emergency department with a BP 150/108 mm Hg, 1+ pedal edema, 1+ proteinuria, and normal deep tendon reflexes. Which assessment should the nurse prioritize as the client is administered magnesium sulfate IV?
Respiratory rate
A nurse is conducting a presentation for a group of pregnant women about conditions that can occur during pregnancy and that place the woman at high-risk. When discussing blood incompatibilities, which measure would the nurse explain as most effective in preventing isoimmunization during pregnancy?
Rho(D) immune globulin administration to Rh-negative women
