OB EAQ Questions
A multiparous client presents to the labor and delivery area in active labor. The initial vaginal examination reveals that the cervix is dilated 4 cm and 100% effaced. Two hours later the client experiences rectal pressure, followed by delivery 5 minutes later. How is this delivery best documented? Precipitous vaginal delivery Prolonged transitional phase Primigravida primary delivery Normal spontaneous vaginal delivery
Precipitous vaginal delivery
After receiving a diagnosis of placenta previa, the client asks the nurse what this means. What is the nurse's best response? "It's premature separation of a normally implanted placenta." "Your placenta isn't implanted securely in place on the uterine wall." "You have premature aging of a placenta that is implanted in your uterine fundus." "The placenta is implanted in the lower uterine segment, and it's covering part or all of the cervical opening."
"The placenta is implanted in the lower uterine segment, and it's covering part or all of the cervical opening."
The nurse discusses fetal weight gain with a pregnant client. When does the fetus generally show a marked increase in size? During the third trimester During the second trimester At the end of the first trimester No difference is observed.
During the third trimester
What does the nurse expect the size of a newborn to be if the mother had inadequately controlled type 1 diabetes during her pregnancy? Average for gestational age, term Small for gestational age, preterm Large for gestational age, postterm Large for gestational age, near term
Large for gestational age, near term
A client who had tocolytic therapy for preterm labor is being discharged. Which instructions should the nurse include in the teaching plan? Restrict fluid intake Limit daily activities Monitor urine for protein Avoid deep-breathing exercises
Limit daily activities
A client at 7 weeks' gestation elects to undergo an induced abortion. After receiving oral mifepristone, she returns to the clinic 2 days later to have misoprostol inserted vaginally. How long after the procedure should the nurse have the client return for a follow-up visit? 4 hours 8 to 24 hours 4 to 8 days 2 weeks
4 to 8 days
A client in her tenth week of pregnancy exhibits presumptive signs of pregnancy. Which clinical findings may the nurse determine upon assessment? Select all that apply. Amenorrhea Breast changes Urinary frequency Abdominal enlargement Positive urine pregnancy test
Amenorrhea Breast changes Urinary frequency
A client in labor is experiencing discomfort because her fetus is in the occiput posterior position. Which nursing action will help relieve this discomfort? Positioning her on the left side Using effleurage on her abdomen Applying pressure against her sacrum Placing her in the semi-Fowler position
Applying pressure against her sacrum
During their initial visit to the prenatal clinic, a couple asks the nurse whether the woman should have an amniocentesis for genetic studies. Which factor indicates that an amniocentesis should be performed? Recent history of drug abuse Family history of genetic abnormalities Maternal age older than 30 years at the time of the first pregnancy Request by client to determine sex of fetus
Family history of genetic abnormalities
A strict vegetarian (vegan) becomes pregnant and asks the nurse whether there is anything special she should do in regard to her diet during pregnancy. What is the most important measure for the nurse to instruct the client to take? Eat at least 40 g/day of protein. Drink at least 1 quart/day of milk. Take a vitamin supplemented with iron every day. Plan to eat from specific groups of vegetable proteins each day.
Plan to eat from specific groups of vegetable proteins each day.
A nurse is assessing a primigravida who was admitted in early labor. She is at 41-weeks' gestation. Her contractions are irregular and her cervix is dilated 3 cm. The fetal head is at station 0 and the fetal heart rate tracing is reactive. How can the nurse help the client facilitate labor? Encourage her to watch television. Take a walk around the unit with her. Ask her to maintain a left-lateral position. Promote the patterned, paced breathing technique.
Take a walk around the unit with her.
A nurse is assessing a client at 16 weeks' gestation. Where does the nurse expect the fundal height to be located? Above the umbilicus At the level of the umbilicus Half the distance to the umbilicus Slightly above the symphysis pubis
Half the distance to the umbilicus
A mother asks the neonatal nurse why her infant must be monitored so closely for hypoglycemia when her type 1 diabetes was in excellent control during the entire pregnancy. How should the nurse best respond? "A newborn's glucose level drops after birth, so we're being especially cautious with your baby because of your diabetes." "A newborn's pancreas produces an increased amount of insulin during the first day of birth, so we're checking to see whether hypoglycemia has occurred." "Babies of mothers with diabetes do not have large stores of glucose at birth, so it's difficult for them to maintain the blood glucose level within an acceptable range." "Babies of mothers with diabetes have a higher-than-average insulin level because of the excess glucose received from the mothers during pregnancy, so the glucose level may drop."
"Babies of mothers with diabetes have a higher-than-average insulin level because of the excess glucose received from the mothers during pregnancy, so the glucose level may drop."
External fetal uterine monitoring is started for a client in active labor. A nurse identifies fetal heart rate decelerations in a uniform wave shape that reflects the shape of the contraction. What is the nurse's next action? Notifying the healthcare provider of possible head compression Placing the client in a knee-chest position to avoid cord compression Putting the client in a dorsal recumbent position to prevent compression of the vena cava Continuing to monitor the client for the return of the fetal heart rate to baseline when each contraction ends
Continuing to monitor the client for the return of the fetal heart rate to baseline when each contraction ends
The nurse is caring for a newborn with caput succedaneum. The nurse is able to differentiate caput succedaneum from cephalhematoma because of what characteristic of the scalp edema in caput succedaneum? Becomes ecchymotic Crosses the suture line Increases after several hours Is tender in the surrounding area
Crosses the suture line
A nurse is caring for a preterm neonate with physiologic jaundice who requires phototherapy. What is the physiologic mechanism of this therapy? Stimulates the liver to dispose of the bilirubin Breaks down the bilirubin into a conjugated form Facilitates the excretion of bilirubin by activating vitamin K Dissolves the bilirubin, allowing it to be excreted by the skin
Breaks down the bilirubin into a conjugated form
While caring for a client in labor, the nurse notes that during a contraction there is a 15-beat-per-minute acceleration of the fetal heart rate above the baseline. What is the nurse's most appropriate action at his time? Call the practitioner to prepare for an imminent birth. Turn the mother on her left side to increase venous return. Record the fetal response to contractions and continue to monitor the heart rate. Document the fetal heart rate abnormality and monitor the fetal heart rate continuously.
Record the fetal response to contractions and continue to monitor the heart rate.
At 38 weeks' gestation a client is admitted to the birthing unit in active labor, and an external fetal monitor is applied. Late fetal heart rate decelerations begin to appear when her cervix is dilated 6 cm, and her contractions are occurring every 4 minutes and lasting 45 seconds. What is the likely cause of these late decelerations? Imminent vaginal birth Uteroplacental insufficiency Pattern of nonprogressive labor Reassuring response to contractions
Uteroplacental insufficiency
A nurse is assessing a postpartum client for signs of hemorrhage by evaluating the degree of perineal pad saturation. What other parameter can the nurse use to estimate blood loss in a postpartum client? Odor of the lochia Color of the lochia Presence of small clots on the pad Time elapsed between pad changes
Time elapsed between pad changes
Which pregnant client does the nurse suspect is most likely to have placenta previa? 19 years old, gravida 1, para 0 30 years old, gravida 6, para 5 25 years old, gravida 2, para 1 40 years old, gravida 3, para 2
30 years old, gravida 6, para 5
A client in the prenatal clinic is diagnosed with preeclampsia. Which clinical findings support this diagnosis? Increased blood pressure of 150/100 mm Hg Increased blood pressure that is accompanied by a headache Blood pressure above the baseline that fluctuates with each reading Blood pressure higher than 140 mm Hg systolic accompanied by proteinuria
Blood pressure higher than 140 mm Hg systolic accompanied by proteinuria
Which clinical finding does the nurse expect when assessing a client with abruptio placentae? Flaccid uterus Painless bleeding Boardlike abdomen Bright red bleeding
Boardlike abdomen
A nurse suspects that a newborn has toxoplasmosis, one of the TORCH infections. How and when may it have been transmitted to the newborn? In utero through the placenta In the postpartum period through breast milk During birth through contact with the maternal vagina After the birth through a blood transfusion given to the mother
In utero through the placenta
A woman is admitted to the high-risk unit in preterm labor at 30 weeks' gestation. Which factor does the nurse suspect precipitated this preterm labor? Android pelvis Incompetent cervix First-time pregnancy Antiseizure medication
Incompetent cervix
The nurse instructs a pregnant woman in labor that she must avoid lying on her back. The nurse bases this instruction on the information that the supine position is primarily avoided because it can do what? Prolong the course of labor Cause decreased placental perfusion Lead to transient episodes of hypertension Interfere with free movement of the coccyx
Cause decreased placental perfusion
A client in the birthing suite has spontaneous rupture of the membranes, after which a prolapsed cord is identified. The nurse calls for help and with a sterile gloved hand moves the fetal head off the cord. What should the nurse anticipate? Cesarean birth Prolonged labor Rapidly induced labor Vacuum extraction vaginal birth
Cesarean birth
A woman in labor with her third child is dilated to 7 cm, and the fetal head is at station +1. The client's membranes rupture. What is the nurse's priority intervention? Notify the practitioner. Observe the vaginal opening for a prolapsed cord. Reposition the client on a sterile towel on her left side. Check the fetal heart rate while observing the color of the amniotic fluid.
Check the fetal heart rate while observing the color of the amniotic fluid.
The nurse admits a client with preeclampsia to the high-risk prenatal unit. What is the next nursing action after the vital signs have been obtained? Calling the primary healthcare provider Checking the client's reflexes Determining the client's blood type Administering the prescribed intravenous (IV) normal saline
Checking the client's reflexes
While reviewing the health history of a newborn with suspected jaundice, the nurse recalls that some risk factors place infants at a higher risk for developing jaundice. Which conditions are risk factors for jaundice? Select all that apply. Infection Female sex Prematurity Breast-feeding Formula feeding Maternal diabetes
Infection Prematurity Breast-feeding Maternal diabetes
The nurse is counseling a pregnant client with type 1 diabetes regarding medication changes as pregnancy progresses. Which medication will be needed in increased dosages during the second half of her pregnancy? Insulin Antihypertensives Pancreatic enzymes Estrogenic hormones
Insulin
A pregnant client at 37 weeks' gestation is taught the signs and symptoms that should be reported immediately to the primary care provider. The nurse determines that the client understands the information presented when she states that she will immediately report what? Lower back pain White vaginal discharge Irregular strong contractions Leakage of fluid from the vagina
Leakage of fluid from the vagina
A woman at 40 weeks' gestation is admitted in active labor. When the client reaches 5 centimeters dilation, the woman asks for and receives epidural analgesia. Once the epidural catheter has been inserted, which assessments and interventions should be performed? Select all that apply. Maintaining intravenous fluid administration Having oxygen available in case of hypotension Checking the bladder for distention every 2 hours Positioning the client supine for ease of monitoring Monitoring fetal heart rate and labor progress per hospital protocol Administering an oxytocin infusion to maintain the labor pattern
Maintaining intravenous fluid administration Having oxygen available in case of hypotension Checking the bladder for distention every 2 hours Monitoring fetal heart rate and labor progress per hospital protocol
A client is admitted to the birthing unit in active labor. Which physiologic changes should the nurse anticipate after an amniotomy is performed? Diminished bloody show Increased and more variable fetal heart rate Less discomfort with contractions Progressive dilation and effacement
Progressive dilation and effacement
Using the five-digit system, determine the obstetric history in this situation: The client is 38 weeks into her fourth pregnancy. Her third pregnancy, a twin gestation, ended at 32 weeks with a live birth, her second pregnancy ended at 38 weeks with a live birth, and her first pregnancy ended at 18 weeks. G4, T2, P1, A1, L2 G4, T1, P2, A1, L1 G4, T1, P1, A1, L3 G4, T2, P1, A1, L1
G4, T1, P1, A1, L3 G (gravida) 4. One pregnancy that ended at 38 weeks = T (term) 1. One pregnancy that ended at 32 weeks = P (preterm) 1. One pregnancy that ended at 18 weeks = A (abortion) 1. One set of twins and a singleton = L (living) 3.
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? Taking exogenous insulin stimulates fetal growth. Consuming more calories covers the insulin secreted by the fetus. Extra circulating glucose causes the fetus to acquire fatty deposits. Fetal weight gain increases as a result of the common response of maternal overeating.
Extra circulating glucose causes the fetus to acquire fatty deposits.
What is the desired outcome for the intrapartum client during the third stage of labor? Absence of discomfort Firmly contracted uterine fundus Efficient fetal heart beat-to-beat variability Maternal respiratory rate within the expected range
Firmly contracted uterine fundus
The nurse is caring for a client in active labor at a birthing center. She is 100% effaced, dilated 3 cm, and at +1 station. In which stage of labor is this client? First Latent Second Transitional
First
What nursing action is the priority for a client in the second stage of labor? Check the fetus's position. Administer medication for pain. Promote effective pushing by the client. Explain that breastfeeding can start right after birth.
Promote effective pushing by the client.
What type of lochia should the visiting nurse expect to observe on a client's pad on the fourth day after a vaginal delivery? Scant alba Scant rubra Moderate rubra Moderate serosa
Moderate serosa
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 for what reason? Body metabolism is sluggish in the first trimester. Morning sickness may result in decreased food intake. Fetal requirements of glucose in this period are minimal. Hormones of pregnancy increase the body's need for insulin.
Morning sickness may result in decreased food intake.
One minute after birth a nurse notes that a newborn is crying, has a heart rate of 140 beats/min, is acrocyanotic, resists the suction catheter, and keeps the arms extended. What Apgar score should the nurse assign to the newborn? Record your answer using a whole number. ______
The Apgar score is 8. A perfect score is 10; 1 point is deducted for lessened muscle tone (the baby's arms do not flex) and 1 point for acrocyanosis, which is manifested by bluish hands and feet.
A nurse teaches the warning signs that should be reported throughout pregnancy. Which statement by the client indicates an understanding of the prenatal instructions? "I'll call the clinic if I have abdominal pain." "Mild, irregular contractions mean that my labor is starting." "I need to call the clinic if my ankles start to swell at night." "A whitish vaginal discharge means that I'm getting an infection."
"I'll call the clinic if I have abdominal pain."
A 24-year-old client who has had type 1 diabetes for 6 years is concerned about how her pregnancy will affect both diet and insulin needs. How should the nurse respond? "Insulin needs will decrease; the excess glucose will be used for fetal growth." "Diet and insulin needs won't change, and maternal and fetal needs will be met." "Protein needs will increase, and adjustments to insulin dosage will be necessary." "Insulin dosage and dietary needs will be adjusted in accordance with the results of blood glucose monitoring."
"Insulin dosage and dietary needs will be adjusted in accordance with the results of blood glucose monitoring."
A pregnant client is asking the nurse when she will gain the greatest amount of weight during the pregnancy. At which time during prenatal development should the nurse tell the client to expect the greatest fetal and maternal weight gain? Third trimester Second trimester First 8 weeks Implantation period
Third trimester
A primigravida client with type 1 diabetes is attending 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? Tenth and twelfth weeks of gestation Eighteenth and twenty-second weeks of gestation Twenty-fourth and twenty-eighth weeks of gestation Thirty-sixth and fortieth weeks of gestation
Twenty-fourth and twenty-eighth weeks of gestation
A woman who is admitted to the labor suite has herpes simplex virus type 2 (HSV-2) with active lesions in the perineal area. What should the nurse's plan of care include? Withholding oral fluid intake Discussing the need for formula feeding Obtaining permission for a paracervical block Applying moist compresses to the perineal area
Withholding oral fluid intake: Withholding oral intake of fluids is part of the preparation for a cesarean birth. This client has active herpes, which can be transmitted to the infant during a vaginal birth. A client with herpes may breast-feed. A paracervical block is not used for a planned cesarean birth. Herpes lesions should be kept as dry as possible.
Which statement made by a pregnant client to a nurse indicates that the client does not understand the teaching regarding fetal growth and development? "The baby is smaller if the mother smokes." "The baby gets food from the amniotic fluid." "The baby's oxygen is provided by the mother." "The baby's umbilical cord has two arteries and one vein."
"The baby gets food from the amniotic fluid."
The nurse is caring for a client in preterm labor who reports that she fell down the stairs. Bruises are apparent on the left part of the client's lower abdomen, the back of each shoulder, and on both wrists. After instituting electronic fetal monitoring, starting tocolytic therapy, and examining the monitor strips, what action should the nurse take next? Ambulating the client to promote circulation Inserting two small-bore intravenous catheters Determining whether the client feels safe at home Ensuring that the client has her glasses to ambulate
Determining whether the client feels safe at home
What is the priority nursing care immediately after an amniocentesis? Giving perineal care after the procedure Encouraging lots of fluids every hour Changing the abdominal dressing Monitoring for signs of uterine contractions
Monitoring for signs of uterine contractions
At a client's first prenatal visit, the nurse-midwife performs a pelvic examination. The nurse states that the client's cervix is bluish purple, which is known as the Chadwick sign. The client becomes concerned and asks whether something is wrong. What does the nurse respond with about this expected finding? "It helps confirm your pregnancy." "It is not unusual, even in women who are not pregnant." "It occurs because the blood is trapped by the pregnant uterus." "It is caused by increased blood flow to the uterus during pregnancy."
"It is caused by increased blood flow to the uterus during pregnancy."
A nurse genetic counselor is working with a couple, each of whom is a carrier of an autosomal-recessive disorder. Which statement indicates that the couple has understood the teaching about this disorder? "Most of our children will have the disorder." "None of our children will have the disorder." "There is a 1-in-4 chance of having a child with the disorder." "There is a 1-in-2 chance of having a child with the disorder."
"There is a 1-in-4 chance of having a child with the disorder."
Which client is at increased risk for postpartum hemorrhage? One who breast-feeds in the birthing room One who receives a pudendal block for the birth One whose third stage lasts less than 10 minutes One who gives birth to an infant weighing 9 lb 8 oz (4366 g)
One who gives birth to an infant weighing 9 lb 8 oz (4366 g)
A client with a diagnosis of severe preeclampsia is admitted to the hospital from the emergency department. Which precaution should the nurse institute? Padding the side rails on the bed Placing the call button next to the client Having oxygen and a facemask available Assigning a nursing assistant to stay with the client
Padding the side rails on the bed
A client with preeclampsia has a prescription for a magnesium sulfate infusion to be initiated. The nurse assesses the client's status to obtain baseline information. Which assessments are necessary? Select all that apply. Patellar reflex Output of urine Respiratory rate Body temperature Urine specific gravity
Patellar reflex Output of urine Respiratory rate
The nurse is instructing a primigravid client how to identify the onset of labor. Which clinical indicator of labor would necessitate the client to call her healthcare provider? Bloody show and back pressure occurring with no contractions Irregular contractions coming 10 minutes apart Rupture of membranes or contractions 5 minutes apart Contractions 12 minutes apart and lasting about 30 seconds
Rupture of membranes or contractions 5 minutes apart
A pregnant client has a history of multiple preterm births followed by neonatal deaths. Which is the most significant impending sign of danger that the client must be taught to report? Leg cramps Pelvic pressure Nausea after 11 am No fetal movement at 12 weeks
Pelvic pressure Pelvic pressure or a feeling that the fetus is pushing down is one symptom of preterm labor and should be taught to the client so she may seek care immediately.
A nurse is caring for a client with type 1 diabetes on her first postpartum day. While planning care for this client, what changes in insulin requirements does the nurse anticipate? Slowly decrease Quickly increase Suddenly decrease Usually remain unchanged
Suddenly decrease
A nurse assesses the frequency of a client's contractions by timing them from the beginning of a contraction until when? The uterus starts to relax The end of a second contraction The uterus has relaxed completely The beginning of the next contraction
The beginning of the next contraction
A pregnant client's blood test reveals an increased alpha-fetoprotein (AFP) level. Which condition does the nurse suspect that this result indicates? Cystic fibrosis Phenylketonuria Down syndrome Neural tube defect
Neural tube defect
The nurse is assessing the rate of involution of a client's uterus on the second postpartum day. Where does the nurse expect the fundus to be located? At the level of the umbilicus One fingerbreadth above the umbilicus Above and to the right of the umbilicus One or two fingerbreadths below the umbilicus
One or two fingerbreadths below the umbilicus
A client's membranes rupture, and the nurse immediately detects the presence of a prolapsed umbilical cord. The nurse alerts another nurse, who calls the primary healthcare provider. Place the following nursing interventions in the order in which they should be performed. Checking the fetal heart rate Administering oxygen by facemask Moving the presenting part off the cord Placing the client in the Trendelenburg position
The priority nursing intervention is to maintain perfusion to the cord by removing the presenting part that is compressing it. The Trendelenburg position will help keep the presenting part off the cord. Oxygen should be administered to the mother to promote optimal oxygenation to the mother and fetus. Evaluating the response to the interventions includes checking the fetal heart rate.
During her first visit to the prenatal clinic a client tells the nurse that she has a cat and is responsible for changing the cat's litter box. The client asks whether doing this will be harmful to her or the fetus. How should the nurse reply? "Cat litter is not harmful during pregnancy." "Exposure to cat litter for short periods of time is not harmful." "There are several factors that determine a person's response to the toxins in cat litter." "Fetal abnormalities are associated with exposure to cat litter, even after minimal contact."
"There are several factors that determine a person's response to the toxins in cat litter."
A client in labor is admitted to the birthing room. The nurse's assessment reveals that the fetus is at -1 station. Where is the presenting part? 1 cm above the ischial spines 1 cm below the ischial spines Visible at the vaginal opening At the level of the ischial spines
1 cm above the ischial spines
When does a nurse caring for a client with eclampsia determine that the risk for another seizure has decreased? After birth occurs After labor begins 48 hours postpartum 24 hours postpartum
48 hours postpartum
Five minutes after birth, a newborn is pale; has irregular, slow respirations; has a heart rate of 120 beats/min; displays minimal flexion of the extremities; and has minimal reflex responses. What is this newborn's Apgar score? Record your answer using a whole number. _____
5
At 39 weeks' gestation a client asks the nurse about the difference between true and false labor. Which information regarding true labor contractions should the nurse include in a response to the client's question? Usually fluctuate in length Continuous, without relaxation Related to time of membrane rupture Accompanied by progressive cervical dilation
Accompanied by progressive cervical dilation
A nurse in the newborn nursery is monitoring an infant for jaundice related to ABO incompatibility. What blood type does the mother usually have to cause this incompatibility? A B O AB
O Mothers with type O blood have anti-A and anti-B antibodies that are transferred across the placenta. This is the most common incompatibility, because the mother is type O in 20% of all pregnancies. Blood types A, B, and AB usually do not present this problem.
The nurse is performing a physical assessment of a pregnant woman. Which factor in the client's history increases the risk for abruptio placentae? Hydramnios Hypertension Cardiac disease Diabetes mellitus
Hypertension
A couple in their late 30s, expecting their first child, plan to have an amniocentesis. The couple is anxious to have the testing completed as soon as possible. The nurse explains that the test will be scheduled at what time? When quickening is felt During the last trimester At the tenth week of gestation After the fourteenth week of pregnancy
After the fourteenth week of pregnancy: n the fourteenth week, amniotic fluid is present, and small amounts may be withdrawn for testing. Amniocentesis may be performed before quickening is established; a nullipara may not feel quickening until the eighteenth week or later. Although amniocentesis may be performed any time after the fourteenth week, it should be done as early as possible after the fourteenth week. Older couples have a higher risk of having a fetus with chromosomal anomalies, and the earlier amniocentesis will aid the parents in decision-making. There is insufficient amniotic fluid present at 10 weeks for amniocentesis, although chorionic villi sampling can be done by the tenth week.
While reviewing laboratory results of clients seen at the maternity clinic, the nurse notes that one client's maternal serum alpha-fetoprotein level is lower than expected. What does the nurse recognizes that this may be associated with? Fetal demise Down syndrome Neural tube defects Esophageal obstruction
Down syndrome
A client at 30-weeks' gestation is admitted to the hospital with a diagnosis of low-lying placenta previa with slight vaginal bleeding. The client is stabilized and bleeding ceases. What is the nurse's primary focus when providing discharge teaching about care at home for this client? Stay on strict bed rest and use a bedpan. Maintain a calm and quiet environment. Check fetal status with a stethoscope daily. Avoid anything that may stimulate the cervix or uterus.
Avoid anything that may stimulate the cervix or uterus.
The nurse is caring for a postpartum client who has experienced an abruptio placentae. Which assessment indicates that disseminated intravascular coagulation (DIC) is occurring? Boggy uterus Hypovolemic shock Multiple vaginal clots Bleeding at the venipuncture site
Bleeding at the venipuncture site
A nurse is teaching a prenatal class regarding the physiologic alterations that occur during the second trimester of pregnancy. What cardiovascular changes should the nurse include? Select all that apply. Cardiac output increases. Blood pressure decreases. The heart is displaced upward. The blood plasma volume peaks. The hematocrit level is lowered.
Cardiac output increases. Blood pressure decreases. The heart is displaced upward.
A client has delivered her infant via cesarean birth. What is the most important nursing intervention to prevent thromboembolism on the client's first postpartum day? Providing oxygen therapy Administering pain medication Encouraging frequent ambulation Recommending an increase in oral fluids
Encouraging frequent ambulation
A nurse in the high-risk prenatal unit admits a client at 35 weeks' gestation with a diagnosis of complete placenta previa. What is the most appropriate nursing intervention at this time? Applying a pad to the perineal area Having oxygen available at the bedside Allowing bathroom privileges with assistance Educating the client regarding the intensive care nursery
Having oxygen available at the bedside
A client is admitted to the birthing suite with a blood pressure of 150/90 mm Hg, 3+ proteinuria, and edema of the hands and face. A diagnosis of severe preeclampsia is made. What other clinical findings support this diagnosis? Select all that apply. Headache Constipation Abdominal pain Vaginal bleeding Visual disturbances
Headache Abdominal pain Visual disturbances
During the fourth stage of labor, the assessment of a primipara who has had a vaginal birth reveals a moderate to large amount of lochia rubra, a firm fundus that is at the umbilicus and deviated to the right, and pain that she rates as a 3 on a scale of 1 to 10. What is the priority nursing action? Massaging the fundus Helping the client void Increasing the rate of the oxytocin infusion Administering the prescribed pain medication
Helping the client void A fundus that is deviated to the right during the fourth stage of labor commonly is caused by a distended bladder; if the bladder remains distended, involution will be inhibited, resulting in a boggy uterus that is prone to hemorrhage. The fundus is firm and does not need to be massaged; there is also thus no need to increase the rate of the oxytocin infusion. Because the client's pain is minimal, the priority is emptying the bladder to prevent hemorrhage.
A woman's pregnancy has been uneventful, and she has gained 25 lb (11.3 kg). At term her hemoglobin level is 10.6 g/dL (106 mmol/L) and her hematocrit is 31%. What is the physiologic reason for these hemoglobin and hematocrit levels? Infection Hemodilution Nutritional deficits Concealed bleeding
Hemodilution
The nurse is caring for a client who is admitted to the birthing unit with a diagnosis of abruptio placentae. Which complication associated with a placental abruption should the nurse carefully monitor this client for? Cerebral hemorrhage Pulmonary edema Impending seizures Hypovolemic shock
Hypovolemic shock
The nurse is caring for a pregnant client with type 1 diabetes. Which complication is the result of type 1 diabetes? Increased risk of hypertensive states Abnormal placental implantation Excessive weight gain because of increased appetite Decreased amount of amniotic fluid as the pregnancy progresses
Increased risk of hypertensive states
A grand multipara at 34 weeks' gestation is brought to the emergency department because of vaginal bleeding. The nurse suspects that the client has a placenta previa. Which characteristic typical of placenta previa supports the nurse's conclusion? Painful vaginal bleeding in the first trimester Painful vaginal bleeding in the third trimester Painless vaginal bleeding in the first trimester Painless vaginal bleeding in the third trimester
Painless vaginal bleeding in the third trimester
The nurse is counseling a client who is experiencing preterm contractions in the thirty-fifth week of gestation and whose cervix is dilated 2 cm. What should the nurse teach this client regarding sexual intercourse at this time? It should be limited to once a week It is prohibited because it may stimulate labor It should be restricted to the side-lying position It is permitted as long as penile penetration is shallow
It is prohibited because it may stimulate labor
A pregnant client with type 1 diabetes is visiting the prenatal clinic for the first time. The client is at risk for serious complications. What is the most important goal during pregnancy to decrease risk of complications? Monitor and control blood glucose levels. Limit pregnancy weight gain to an average of 25 pounds. Preplan for a cesarean section. Show up for all perinatal office visits.
Monitor and control blood glucose levels.
When reviewing the history of a client admitted in preterm labor during her thirtieth week of gestation, the nurse suspects a risk factor associated with this client's preterm labor. Which risk factor does the nurse suspect? Primigravida Android-shaped pelvis Anticonvulsant medication therapy Multiple urinary tract infections
Multiple urinary tract infections
The nurse is caring for the newborn of a mother with diabetes. For which signs of hypoglycemia should the nurse assess the newborn? Select all that apply. Pallor Irritability Hypotonia Ineffective sucking Excessive birth weight
Pallor Irritability Hypotonia Ineffective sucking
A client who is in preterm labor at 34 weeks' gestation is receiving intravenous tocolytic therapy. The frequency of her contractions increases to every 10 minutes, and her cervix dilates to 4 cm. The infusion is discontinued. Toward what outcome should the priority nursing care be directed at this time? Reduction of anxiety associated with preterm labor Promotion of maternal and fetal well-being during labor Supportive communication with the client and her partner Helping the family cope with the impending preterm birth
Promotion of maternal and fetal well-being during labor
What is the priority nursing intervention for a client with severe preeclampsia? Isolating her in a dark room Maintaining her in a supine position Encouraging her to drink clear fluids Protecting her against extraneous stimuli
Protecting her against extraneous stimuli
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? Seizure activity is imminent. Pulmonary edema has developed. Bronchial constriction was precipitated by the stress of pregnancy. Impaired diaphragmatic function was caused by the enlarged uterus.
Pulmonary edema has developed.
The nurse is admitting a client in active labor. When the fetal monitor is applied to the client's abdomen, it records late decelerations. What should the nurse do first? Notify the practitioner. Elevate the head of the bed. Reposition her on her left side. Administer oxygen by way of face mask.
Reposition her on her left side. Late decelerations may indicate impaired placental profusion. Turning the client on her left side relieves pressure on the vena cava and aorta, improving circulation to the placenta. Calling the practitioner is premature. The nurse should notify the practitioner if late decelerations continue after nursing interventions are implemented. Elevating the head of the bed will increase pressure on the vena cava and aorta, further reducing placental perfusion. Oxygen may be administered if placing the client on her left side does not resolve the late deceleration
A client at 42 weeks' gestation is scheduled for induction of labor. The nurse begins the induction with a piggyback infusion of 15 units of oxytocin. Which clinical finding requires the nurse to discontinue the oxytocin infusion? Contractions that occur every 3 minutes and lasting 60 seconds Elevation of blood pressure from 110/70 to 135/85 mm Hg during the last 30 minutes Rupture of membranes with amniotic fluid that contains threads of blood and mucus Several late fetal heart rate decelerations that return to baseline after the contraction is over
Several late fetal heart rate decelerations that return to baseline after the contraction is over
A pregnant client with diabetes is referred to the dietitian in the prenatal clinic for nutritional assessment and counseling. What should the nurse emphasize when reinforcing the client's dietary program? The need to increase high-quality protein and decrease fats The need to increase carbohydrates to meet energy demands and prevent ketosis The need to eat a low-calorie diet that maintains the current insulin coverage and helps prevent hyperglycemia The need to eat a pregnancy diet that meets increased dietary needs and to adjust the insulin dosage as necessary
The need to eat a pregnancy diet that meets increased dietary needs and to adjust the insulin dosage as necessary
Intravenous magnesium sulfate therapy is instituted for a client with severe preeclampsia who has a blood pressure of 170/110 mm Hg, a pulse of 108 beats/min, and a respiratory rate of 24 breaths/min. Eight hours later her blood pressure is 150/110 mm Hg, the pulse is 98 beats/min, the respiratory rate is 10 breaths/min, and the knee-jerk reflex is absent. What should the nurse do next? Stop the infusion of magnesium sulfate and notify the primary healthcare provider. Administer calcium gluconate, because it is an antidote to magnesium sulfate. Continue the magnesium sulfate infusion, because the blood pressure is still high. Check vital signs and reflexes in 1 hour and then discontinue the infusion if necessary.
Stop the infusion of magnesium sulfate and notify the primary healthcare provider.
An adolescent at 10 weeks' gestation visits the prenatal clinic for the first time. The nutrition interview indicates that her dietary intake consists mainly of soft drinks, candy, French fries, and potato chips. Why does the nurse consider this diet inadequate? The caloric content will result in too great a weight gain. The ingredients in soft drinks and candy can be teratogenic in early pregnancy. The salt in this diet will contribute to the development of gestational hypertension. The nutritional composition of the diet places her at risk for a low-birth-weight infant.
The nutritional composition of the diet places her at risk for a low-birth-weight infant.
The nurse is reevaluating a newborn who had an axillary temperature of 97° F (36.1° C) and was placed skin to skin with the mother. The newborn's axillary temperature is still 97° F (36.1° C) after 1 hour of skin-to-skin contact. Which intervention should the nurse implement next? Placing the newborn under a radiant warmer in the nursery Checking the newborn for a wet diaper and then continue the skin-to-skin contact Leaving the newborn in skin-to-skin contact and rechecking the temperature in 1 hour Double-wrapping the newborn in warm blankets and returning the newborn to a crib by the mother's bedside
Placing the newborn under a radiant warmer in the nursery
A 37-year-old client with hypertension, type 1 diabetes and good glycemic control is pregnant for the third time. Her first child is 4 years old, and her second pregnancy resulted in a stillbirth. She is seen in the antepartum testing unit for a nonstress test (NST) at 33 weeks' gestation. What are the primary risk factors in the client's history that indicate the need for a nonstress test? Select all that apply. Age older than 35 years The risk for placenta previa The risk for placental insufficiency A history of stillbirth from her last pregnancy Maternal history of hypertension
The risk for placental insufficiency A history of stillbirth from her last pregnancy Maternal history of hypertension
A client at 7 weeks' gestation tells the nurse in the prenatal clinic that she is sick every morning with nausea and vomiting and adds that she does not think she can tolerate it throughout her pregnancy. The nurse assures her that this is a common occurrence in early pregnancy and will probably disappear by the end of which month? Fifth month Third month Fourth month Second month
Third month
When discussing dietary needs during pregnancy, a client tells the nurse that milk causes her to be constipated at times. What should the nurse teach the client? Substitute a variety of cheeses for the milk. Replace fat-free or low-fat milk for whole milk. Increase intake of prenatal supplements and omit the milk. Treat constipation when it occurs and continue drinking milk.
Treat constipation when it occurs and continue drinking milk.
The nurse is assessing her assignment of four postpartum clients. Which conditions increase the risk for postpartum hemorrhage? Select all that apply. Twin birth Overdistended bladder Hypertonic uterine dystocia Retained placental fragments Mild gestational hypertension
Twin birth Overdistended bladder Retained placental fragments
All women of childbearing age are advised to include at least 400 mcg of folic acid in the daily diet to decrease the risk of neural tube defects in pregnancy. What should the nurse recommend to meet the recommendation? Select all that apply. Vitamin A Vitamin B6 Vitamin B9 Vitamin B12 Legumes, dark-green leafy vegetables, and citrus fruits Eggs, meat, and poultry
Vitamin B9 Legumes, dark-green leafy vegetables, and citrus fruits
