OB Exam 1

After an uneventful pregnancy a client at term arrives at the birthing unit. The nurse determines that her contractions are 10 minutes apart and that her cervix is dilated 2 cm. What stage of labor should the nurse document in the client's medical record? 1 Second stage 2 Latent first stage 3 Active first stage 4 Transition stage

2 Latent first stage Regular contractions occurring 10 minutes apart with a cervix dilated 2 cm indicate that the client is in the latent phase of the first stage of labor. The second stage of labor begins with full dilation and ends with expulsion of the fetus. Contractions occur more regularly and more frequently and the cervix is more dilated in the active stage of labor. Contractions are intense and occur every 1 to 2 minutes in the transition phase of the first stage of labor.

The nurse providing newborn stabilization must be aware that the primary side effect of maternal narcotic analgesia in the newborn is: a. respiratory depression. b. bradycardia. c. tachypnea. d. acrocyanosis.

a. respiratory depression.

Excessive blood loss after childbirth can have several causes; the most common is: Select one: a. vaginal or vulvar hematomas. b. retained placental fragments. c. failure of the uterine muscle to contract firmly. d. unrepaired lacerations of the vagina or cervix.

c. failure of the uterine muscle to contract firmly.

A woman gave birth to a 7-lb, 6-ounce infant girl 1 hour ago. The birth was vaginal, and the estimated blood loss (EBL) was approximately 1500 mL. When assessing the woman's vital signs, the nurse would be concerned to see: Select one: a. temperature 36.8° C, heart rate 60, respirations 18, BP 140/90. b. temperature 37.4° C, heart rate 88, respirations 36, BP 126/68. c. temperature 37.9° C, heart rate 120, respirations 20, blood pressure (BP) 90/50. d. temperature 38° C, heart rate 80, respirations 16, BP 110/80.

c. temperature 37.9° C, heart rate 120, respirations 20, blood pressure (BP) 90/50.

As relates to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that: a. if the patient develops pulmonary edema while receiving tocolytics, intravenous (IV) fluids should be given. b. there are no important maternal (as opposed to fetal) contraindications. c. the drugs can be given efficaciously up to the designated beginning of term at 37 weeks. d. its most important function is to afford the opportunity to administer antenatal glucocorticoids.

d. its most important function is to afford the opportunity to administer antenatal glucocorticoids.

A placenta previa in which the placental edge just reaches the internal os is more commonly known as: a. total. b. complete. c. partial. d. marginal.

d. marginal.

A nurse teaches a pregnant woman about the need to increase her intake of complete proteins. Which foods identified by the client indicate that the teaching is effective? Select all that apply. 1 Nuts 2 Milk 3 Eggs 4 Bread 5 Beans 6 Cheese

2 Milk 3 Eggs 6 Cheese

Prepidil (prostaglandin gel) has been ordered for a pregnant woman at 43 weeks of gestation. The nurse recognizes that this medication will be administered to: a. ripen the cervix in preparation for labor induction. b. increase amniotic fluid volume. c. stimulate the amniotic membranes to rupture. d. enhance uteroplacental perfusion in an aging placenta.

a. ripen the cervix in preparation for labor induction.

The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is: a. cramping. b. intense abdominal pain. c. uterine activity. d. bleeding.

b. intense abdominal pain.

With regard to a pregnant woman's anxiety and pain experience, nurses should be aware that: a. women who have had a painful labor will have learned from the experience and have less anxiety the second time because of increased familiarity. b. even mild anxiety must be treated. c. severe anxiety increases tension, which increases pain, which in turn increases fear and anxiety, and so on. d. anxiety may increase the perception of pain, but it does not affect the mechanism of labor.

c. severe anxiety increases tension, which increases pain, which in turn increases fear and anxiety, and so on.

A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to: a. reduce maternal and fetal tachycardia associated with ritodrine administration. b. maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy. c. stimulate fetal surfactant production. d. suppress uterine contractions.

c. stimulate fetal surfactant production.

A pregnant woman's diet may not meet her need for folates. A good source of this nutrient is: a. chicken. b. potatoes. c. cheese. d. green leafy vegetables.

d. green leafy vegetables.

A maternal indication for the use of forceps is: a. a history of rapid deliveries. b. failure to progress past 0 station. c. a wide pelvic outlet. d. maternal exhaustion.

d. maternal exhaustion.

A woman in labor hears the primary healthcare provider tell the nurse that the fetal lie is longitudinal. The mother asks the nurse what this means in relation to her labor and birth of the baby. How should the nurse respond? 1 "A vaginal birth is possible." 2 "We're anticipating a cesarean delivery." 3 "It has no relevance to the labor and birth." 4 "Labor probably will be long, and you might have back pain."

1 "A vaginal birth is possible."

A client is admitted to the birthing unit because fluid is leaking from her vagina. She is unsure whether her "bag of water" has broken. What should the nurse do to help determine whether the fluid is amniotic fluid? 1 Test the fluid with Nitrazine paper. 2 Inspect the fluid for its characteristics. 3 Assess the fluid for the presence of protein. 4 Send the fluid to the laboratory for analysis.

1 Test the fluid with Nitrazine paper. Amniotic fluid is slightly alkaline, and urine is acidic; when moistened with amniotic fluid, Nitrazine will turn dark blue, indicating an alkaline substance.

A maternal indication for the use of forceps is: a. maternal exhaustion. b. a wide pelvic outlet. c. a history of rapid deliveries. d. failure to progress past 0 station.

a. maternal exhaustion.

A woman gave birth to a healthy infant boy 5 days ago. What type of lochia would the nurse expect to find when assessing this woman? Select one: a. Lochia sangra b. Lochia serosa c. Lochia alba d. Lochia rubra

b. Lochia serosa

Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother? a. Hypoinsulinemia b. Hypobilirubinemia c. Hypoglycemia d. Hypercalcemia

c. Hypoglycemia

Which minerals and vitamins usually are recommended to supplement a pregnant woman's diet? a. Calcium and zinc b. Fat-soluble vitamins A and D c. Iron and folate d. Water-soluble vitamins C and B6

c. Iron and folate

In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, what finding would alert the nurse to possible side effects? a. Deep tendon reflexes 2+ and no clonus b. Respiratory rate of 16 breaths/min c. Serum magnesium level of 10 mg/dL d. Urine output of 160 mL in 4 hours

c. Serum magnesium level of 10 mg/dL

Which finding 12 hours after birth requires further assessment? Select one: a. The fundus is palpable at the level of the umbilicus. b. The fundus is palpable one fingerbreadth below the umbilicus. c. The fundus is palpable two fingerbreadths above the umbilicus. d. The fundus is palpable two fingerbreadths below the umbilicus.

c. The fundus is palpable two fingerbreadths above the umbilicus.

Postpartal overdistention of the bladder and urinary retention can lead to which complications? Select one: a. Urinary tract infection and uterine rupture b. Fever and increased blood pressure c. After birth hemorrhage and eclampsia d. After birth hemorrhage and urinary tract infection

d. After birth hemorrhage and urinary tract infection

Which condition would not be classified as a bleeding disorder in late pregnancy? a. Abruptio placentae b. Cord insertion c. Placenta previa d. Spontaneous abortion

d. Spontaneous abortion

When nurses help their expectant mothers assess the daily fetal movement counts, they should be aware that: a. "Kick counts" should be taken every half hour and averaged every 6 hours, with every other 6-hour stretch off". b. Obese mothers familiar with their bodies can assess fetal movement as well as average-size women. c. Alcohol or cigarette smoke can irritate the fetus into greater activity. d. The fetal alarm signal should go off when fetal movements stop entirely for 12 hours.

d. The fetal alarm signal should go off when fetal movements stop entirely for 12 hours.

The nurse caring for the after birth woman understands that breast engorgement is caused by: Select one: a. hyperplasia of mammary tissue. b. accumulation of milk in the lactiferous ducts and glands. c. overproduction of colostrum. d. congestion of veins and lymphatics.

d. congestion of veins and lymphatics.

The first and most important nursing intervention when a nurse observes profuse after birth bleeding is to: Select one: a. call the woman's primary health care provider. b. assess maternal blood pressure and pulse for signs of hypovolemic shock. c. administer the standing order for an oxytocic. d. palpate the uterus and massage it if it is boggy.

d. palpate the uterus and massage it if it is boggy.

A woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability is called a: a. primigravida. b. multipara. c. nulligravida. d. primipara.

d. primipara.

During the assessment of a client in labor, the cervix is determined to be dilated 4 cm. What stage of labor does the nurse record? 1 First 2 Second 3 Prodromal 4 Transitional

1 First The first stage of labor is from zero cervical dilation to full cervical dilation (10 cm). The second stage is from full cervical dilation to delivery. The prodromal stage is before cervical dilation begins. The transitional phase is the first stage of labor, from 8 cm of dilation to 10 cm of dilation.

A primigravida is admitted to the birthing suite at term with contractions occurring every 5 to 8 minutes and a bloody show present. She and her partner attended childbirth preparation classes. Vaginal examination reveals that the cervix is dilated 3 cm and 75% effaced. The fetus is at +1 station in occiput anterior position, and the membranes are intact. The client is cheerful and relaxed and asks the nurse whether it is all right for her to walk around. In light of the nurse's observations regarding the contractions and the client's knowledge of the physiology and mechanism of labor, how should the nurse respond? 1 "I can't make a decision on that; I'll have to ask your primary healthcare provider." 2 "Please stay in bed; walking could interfere with effective uterine contractions." 3 "It's all right for you to walk as long as you feel comfortable and your membranes are intact." 4 "You may sit in a chair, because your contractions cannot be timed when you walk and I won't be able to listen to the baby's heart."

3 "It's all right for you to walk as long as you feel comfortable and your membranes are intact." Contractions become stronger and more regular when the woman is standing; also, as the woman walks, the diameter of the pelvic inlet increases, allowing easier entrance of the head into the pelvis.

The nurse is caring for a client who is in the first stage of labor. The fetal heart rate monitor displays an irregular baseline that was in the 150s and is now in the 130s with variability. What is the priority nursing intervention? 1 Administering oxygen 2 Notifying the primary healthcare provider 3 Changing the client's position 4 Continuing to monitor the client

4 Continuing to monitor the client This is an expected occurrence caused by the interplay of the sympathetic and parasympathetic nervous systems

A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests: Select one: a. uterine atony. b. infection of the uterus. c. perineal hematoma. d. lacerations of the genital tract.

d. lacerations of the genital tract.

A primigravida is admitted to the birthing unit in early labor. A pelvic examination reveals that her cervix is 100% effaced and dilated 3 cm. The fetal head is at +1 station. In which area of the client's pelvis is the fetal occiput? 1 Not yet engaged 2 Below the ischial spines 3 Entering the pelvic inlet 4 Visible at the vaginal opening

2 Below the ischial spines A station of +1 indicates that the fetal head is 1 cm below the ischial spines. The head is now past the points of engagement, the ischial spines. When the head is entering the pelvic inlet, it is said to be at 0 station. The head must be at +3 to +4 station to be visible at the vaginal opening.

The nurse caring for the after birth woman understands that breast engorgement is caused by: Select one: a. overproduction of colostrum. b. congestion of veins and lymphatics. c. hyperplasia of mammary tissue. d. accumulation of milk in the lactiferous ducts.

b. congestion of veins and lymphatics.

A woman is experiencing back labor and complains of intense pain in her lower back. An effective relief measure would be to use: a. conscious relaxation or guided imagery. b. counterpressure against the sacrum. c. effleurage. d. pant-blow (breaths and puffs) breathing techniques.

b. counterpressure against the sacrum.

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? 1 Usually fluctuate in length 2 Continuous, without relaxation 3 Related to time of membrane rupture 4 Accompanied by progressive cervical dilation

4 Accompanied by progressive cervical dilation Progressive cervical dilation is the only positive sign of true labor; the cervix dilates in response to regular, coordinated uterine contractions. The contractions of true labor increase in length and intensity.

A 42-year-old client undergoes amniocentesis during the 16th week of gestation because of concern about Down syndrome. Which additional information about the fetus will examination of the amniotic fluid reveal at this time? 1 Lung maturity 2 Type 1 diabetes 3 Cardiac anomaly 4 Neural tube defect

4 Neural tube defect

A 25-year-old gravida 2, para 2-0-0-2 gave birth 4 hours ago to a 9-lb, 7-ounce boy after augmentation of labor with Pitocin. She puts on her call light and asks for her nurse right away, stating, "I'm bleeding a lot." The most likely cause of after birth hemorrhage in this woman is: Select one: a. uterine atony. b. unrepaired vaginal lacerations. c. retained placental fragments. d. puerperal infection.

a. uterine atony.

With regard to the care management of preterm labor, nurses should be aware that: a. all women must be considered at risk for preterm labor and prediction is so hit-and-miss, teaching pregnant women the symptoms probably causes more harm through false alarms. b. preterm labor is likely to be the start of an extended labor, a woman with symptoms can wait several hours before contacting the primary caregiver. c. the diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change. d. Braxton Hicks contractions often signal the onset of preterm labor.

c. the diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change.

A pregnant client with severe preeclampsia is receiving an infusion of magnesium sulfate. What does the nurse identify as the main reason that this medication is administered? 1 It acts as a diuretic. 2 It has a sedative effect. 3 It acts as an anticonvulsant. 4 It has an antihypertensive effect.

3 It acts as an anticonvulsant.

A primigravida who is at 40 weeks' gestation arrives at the birthing center with abdominal cramping and a bloody show. Her membranes ruptured 30 minutes before arrival. A vaginal examination reveals 1 cm of dilation and the presenting part at -1 station. After obtaining the fetal heart rate and maternal vital signs, what should the nurse's priority intervention be? 1 Teach the client how to push with each contraction. 2 Encourage the client to perform patterned, paced breathing. 3 Provide the client with comfort measures used for women in labor. 4 Prepare to have the client's blood typed and crossmatched in the event of the need for a transfusion.

3 Provide the client with comfort measures used for women in labor. The client is experiencing the expected discomforts of labor; the nurse should initiate measures that will promote relaxation. The client is in early first-stage labor; pushing commences during the second stage. Patterned, paced breathing should be used in the transition phase, not the early phase of the first stage of labor

Approximately 10% to 15% of all clinically recognized pregnancies end in miscarriage. Which is the most common cause of spontaneous abortion? a. Chromosomal abnormalities b. Infections c. Immunologic factors d. Endocrine imbalance

a. Chromosomal abnormalities

A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse? a. A dipstick value of 3+ for protein in her urine. b. Blood pressure (BP) increase to 138/86 mm Hg. c. Weight gain of 0.5 kg during the past 2 weeks. d. Pitting pedal edema at the end of the day.

a. A dipstick value of 3+ for protein in her urine.

The nurse is assessing a client with worsening preeclampsia. What is the most significant clinical manifestation of severe preeclampsia? 1 Polyuria 2 Vaginal spotting 3 Proteinuria of 3+ 4 Blood pressure of 130/80 mm Hg

3 Proteinuria of 3+ As preeclampsia worsens, blood pressure and edema increase and degenerative changes of the kidney cause increasing proteinuria (3+). With worsening preeclampsia, oliguria, not polyuria, is expected.

A nurse assesses the frequency of a client's contractions by timing them from the beginning of a contraction until when? 1 The uterus starts to relax 2 The end of a second contraction 3 The uterus has relaxed completely 4 The beginning of the next contraction

4 The beginning of the next contraction

Which documentation on a woman's chart on after birth day 14 indicates a normal involution process? Select one: a. Fundus below the symphysis and not palpable b. Episiotomy slightly red and puffy c. Moderate bright red lochial flow d. Breasts firm and tender

a. Fundus below the symphysis and not palpable

A pregnant woman's amniotic membranes rupture. Prolapsed umbilical cord is suspected. What intervention would be the top priority? a. Placing the woman in the knee-chest position. b. Covering the cord in sterile gauze soaked in saline. c. Preparing the woman for a cesarean birth. d. Starting oxygen by face mask.

a. Placing the woman in the knee-chest position.

A woman gave birth 48 hours ago to a healthy infant girl. She has decided to bottle-feed. During your assessment you notice that both of her breasts are swollen, warm, and tender on palpation. The woman should be advised that this condition can best be treated by: Select one: a. wearing a loose-fitting bra to prevent nipple irritation. b. expressing small amounts of milk from the breasts to relieve pressure. c. running warm water on her breasts during a shower. d. applying ice to the breasts for comfort.

d. applying ice to the breasts for comfort.

A woman visits the prenatal clinic because an over-the-counter pregnancy test has rendered a positive result. After the initial examination verifies the pregnancy, the nurse explains some of the metabolic changes that occur during the first trimester of pregnancy. What should the nurse include? Select all that apply. 1 Sleep needs increase 2 Urinary frequency 3 Body temperature decreases 4 Calcium requirements remain the same 5 The need for carbohydrates decreases

1 Sleep needs increase 2 Urinary frequency 4 Calcium requirements remain the same

A primigravida in her seventh week of gestation asks the nurse when she can expect to feel her baby move. The nurse replies that quickening usually occurs in which week? 1 24th week 2 20th week 3 16th week 4 12th week

2 20th week

A woman at 10 weeks of gestation who is seen in the prenatal clinic with presumptive signs and symptoms of pregnancy likely will have: a. positive pregnancy test. b. Chadwick's sign. c. amenorrhea. d. Hegar's sign.

c. amenorrhea.

The nurse is explaining insulin needs to a client with gestational diabetes who is in her second trimester of pregnancy. Which information should the nurse give to this client? 1 Insulin needs will increase during the second trimester. 2 Insulin needs will decrease during the second trimester. 3 Insulin needs will not change during the second trimester. 4 Insulin will be switched to an oral antidiabetic medication during the second trimester.

1 Insulin needs will increase during the second trimester.

While caring for a client during labor, what does the nurse remember about the second stage of labor? 1 It ends at the time of birth. 2 It ends as the placenta is expelled. = 3 It begins with the transition phase of labor. 4 It begins with the onset of strong contractions.

1 It ends at the time of birth.

A client with a diagnosis of severe preeclampsia is admitted to the hospital from the emergency department. Which precaution should the nurse institute? 1 Padding the side rails on the bed 2 Placing the call button next to the client 3 Having oxygen and a facemask available 4 Assigning a nursing assistant to stay with the client

1 Padding the side rails on the bed seizure precautions

A primary healthcare provider suspects ectopic pregnancy in an adolescent and conducts further evaluation. Which signs and symptoms have led the provider to suspect ectopic pregnancy? Select all that apply. 1 Hypotension 2 Abdominal pain 3 Vaginal bleeding 4 Cervical abnormalities 5 Maternal systemic illness

1 Hypotension 2 Abdominal pain 3 Vaginal bleeding An adolescent girl with hypotension and abdominal pain may have an ectopic pregnancy that has ruptured, and emergency surgery may be indicated after prompt evaluation. When an adolescent girl experiences vaginal bleeding and abdominal pain, ectopic pregnancy must be ruled out. Cervical abnormalities and systemic maternal illness may lead to spontaneous abortion, but they do not signal ectopic pregnancy.

The nurse is caring for a client who has just had an amniotomy performed by the primary healthcare provider. The fetal heart rate immediately decreases from 140 to 80 beats/min. What is the priority nursing action? 1 Inspecting the vagina 2 Administering oxygen 3 Increasing the intravenous fluids 4 Placing the client in the knee-chest position

1 Inspecting the vagina Follow the nursing process and begin with an assessment to determine possible cause for the deceleration

The nurse discusses the recommended weight gain during pregnancy with a newly pregnant client who is 5 ft 3 in (160 centimeters) tall and weighs 130 lb (57 kilograms). The nurse explains that with the recommended weight gain, at term the client should weigh how much? 1 155 lb (70 kg) 2 140 lb (63.5 kg) 3 135 lb (61 kg) 4 130 lb (57 kg)

1 155 lb (70 kg) A weight of 155 lb (70 kg) would put the client within the recommended weight gain of at least 25 lb (11 kg) for a woman who was of average weight for her height before pregnancy.

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. 1 Amenorrhea 2 Breast changes 3 Urinary frequency 4 Abdominal enlargement 5 Positive urine pregnancy test

1 Amenorrhea 2 Breast changes 3 Urinary frequency The key to answering this question is understanding the difference between presumptive versus probable signs of pregnancy. Presumptive signs of pregnancy are less specific subjective changes that are reported by the client during an assessment interview. Probable signs of pregnancy are more objective changes that can be measured in the reproductive organs during a physical assessment.

A client at 40 weeks' gestation is admitted to the birthing unit, and an amniotomy is performed to facilitate labor. Once the nurse determines that the umbilical cord has not prolapsed, what is her next action? 1 Assessing the fetal heart rate 2 Obtaining the maternal vital signs 3 Turning the client on her left side 4 Monitoring the frequency of contractions

1 Assessing the fetal heart rate Once cord prolapse and consequent cord compression have been ruled out, it is imperative to evaluate the effect of the amniotomy on the fetus.

The electronic fetal monitor displays contractions every 2 minutes and lasting 95 seconds. What is the nurse's highest priority intervention at this time? 1 Stop the oxytocin (Pitocin) infusion. 2 Administer oxygen at 8 to 10 L/min. 3 Increase the main line fluid delivery rate to 150 mL/hr. 4 Prepare the client for insertion of an intrauterine pressure catheter.

1 Stop the oxytocin (Pitocin) infusion. The contraction pattern indicates hyperstimulation of the uterus. Stopping the oxytocin infusion permits relaxation of the uterus and perfusion of the placenta.

A woman at 40 weeks' gestation is having contractions. Wondering whether she is in true labor, she asks, "How will you know if I'm really in labor?" Which information should the nurse provide to the client at this time? 1 The cervix dilates and becomes effaced in true labor. 2 Bloody show is the first sign of true labor. 3 The membranes rupture at the beginning of true labor. 4 Fetal movements lessen and become weaker in true labor.

1 The cervix dilates and becomes effaced in true labor. The major difference between true and false labor is that true labor can be confirmed by the presence of dilation and effacement of the cervix.

What is the optimal nursing action for a client in active labor whose cervix is dilated 4 cm and 100% effaced with the fetal head at 0 station? 1 Document the fetal heart rate every 5 minutes. 2 Call the anesthesia department to alert the staff there of an imminent birth. 3 Assist the client's coach in helping her with the use of breathing techniques. 4 Suggest that the client accept the as-needed (PRN) medication for pain that has been prescribed.

3 Assist the client's coach in helping her with the use of breathing techniques. The client is in the early part of the first stage of labor, and it is important to help the partner with the role of coach. It is not necessary to check the fetal heart rate every 5 minutes until the second stage of labor.

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? 1 Contractions that occur every 3 minutes and lasting 60 seconds 2 Elevation of blood pressure from 110/70 to 135/85 mm Hg during the last 30 minutes 3 Rupture of membranes with amniotic fluid that contains threads of blood and mucus 4 Several late fetal heart rate decelerations that return to baseline after the contraction is over

4 Several late fetal heart rate decelerations that return to baseline after the contraction is over Late decelerations suggest uteroplacental insufficiency, which is an indication that the oxytocin infusion should be stopped.

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? 1 The caloric content will result in too great a weight gain. 2 The ingredients in soft drinks and candy can be teratogenic in early pregnancy. 3 The salt in this diet will contribute to the development of gestational hypertension. 4 The nutritional composition of the diet places her at risk for a low-birth-weight infant.

4 The nutritional composition of the diet places her at risk for a low-birth-weight infant.

An abortion in which the fetus dies but is retained within the uterus is called a(n): a. threatened abortion. b. incomplete abortion. c. missed abortion. d. inevitable abortion.

c. missed abortion.

Which instruction should be included in the discharge teaching plan to assist the patient in recognizing early signs of complications? Select one: a. Notify the physician of any increase in the amount of lochia or a return to bright red bleeding. b. Palpate the fundus daily to ensure that it is soft. c. Report any decrease in the amount of brownish red lochia. d. The passage of clots as large as an orange can be expected.

a. Notify the physician of any increase in the amount of lochia or a return to bright red bleeding.

A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to: a. stimulate fetal surfactant production. b. reduce maternal and fetal tachycardia associated with ritodrine administration. c. suppress uterine contractions. d. maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy.

a. stimulate fetal surfactant production.

With shortened hospital stays, new mothers are often discharged before they begin to experience symptoms of the baby blues or after birth depression. As part of the discharge teaching, the nurse can prepare the mother for this adjustment to her new role by instructing her regarding self-care activities to help prevent after birth depression. The most accurate statement as related to these activities is to: Select one: a. keep feelings of sadness and adjustment to your new role to yourself. b. be certain that you are the only caregiver for your baby to facilitate infant attachment. c. realize that this is a common occurrence that affects many women. d. stay home and avoid outside activities to ensure adequate rest.

c. realize that this is a common occurrence that affects many women.

A 24-year-old client is admitted at 40 weeks' gestation. The cervix is dilated 5 cm and is 100% effaced, and the presenting part is at station 0. The nurse assesses that the fetal heart tones are just above the umbilicus. Which fetal presentation does the nurse document? 1 Face 2 Brow 3 Breech 4 Shoulder

3 Breech

The nurse observes a laboring client's amniotic fluid and decides that it is the expected color and consistency. Which finding supports this conclusion? 1 Clear, dark amber colored, and containing shreds of mucus 2 Straw-colored, clear, and containing little white specks 3 Milky, greenish yellow, and containing shreds of mucus 4 Greenish yellow, cloudy, and containing little white specks

2 Straw-colored, clear, and containing little white specks Dark amber-colored fluid suggests the presence of bilirubin, an ominous sign. Greenish-yellow fluid may indicate the presence of meconium and suggests fetal compromise. Cloudy fluid suggests the presence of purulent material.

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? 1 Imminent vaginal birth 2 Uteroplacental insufficiency 3 Pattern of nonprogressive labor 4 Reassuring response to contractions

2 Uteroplacental insufficiency

The four essential components of labor are passenger, powers, passageway, and position. Passageway refers to the bony pelvis. Which type of pelvis is considered the most favorable for a vaginal delivery? 1 Android 2 Anthropoid 3 Gynecoid 4 Platypelloid

3 Gynecoid

A after birth woman overhears the nurse tell the obstetrics clinician that she has a positive Homans' sign and asks what it means. The nurse's best response is: Select one: a. "You have pitting edema in your ankles." b. "You have deep tendon reflexes rated 2+." c. "You have calf pain when the nurse flexes your foot." d. "You have a 'fleshy' odor to your vaginal drainage."

c. "You have calf pain when the nurse flexes your foot."

The priority nursing intervention after an amniotomy should be to: a. estimate the amount of amniotic fluid. b. assess the fetal heart rate. c. assess the color of the amniotic fluid. d. change the patient's gown.

b. assess the fetal heart rate.

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. The nurse's first action is to: Select one: a. begin an intravenous (IV) infusion of Ringer's lactate solution. b. massage the woman's fundus. c. assess the woman's vital signs. d. call the woman's primary health care provider.

b. massage the woman's fundus.

The priority nursing care associated with an oxytocin (Pitocin) infusion is: a. evaluating cervical dilation. b. monitoring uterine response. c. measuring urinary output. d. increasing infusion rate every 30 minutes.

b. monitoring uterine response.

The priority nursing care associated with an oxytocin (Pitocin) infusion is: a. measuring urinary output. b. monitoring uterine response. c. increasing infusion rate every 30 minutes. d. evaluating cervical dilation.

b. monitoring uterine response.

It is important for the nurse to develop a realistic birth plan with the pregnant woman in her care. The nurse can explain that a major advantage of nonpharmacologic pain management is: a. the woman remains fully alert at all times. b. no side effects or risks to the fetus are involved. c. greater and more complete pain relief is possible. d. a more rapid labor is likely.

b. no side effects or risks to the fetus are involved.

A woman with preeclampsia has a seizure. The nurse's primary duty during the seizure is to: a. insert an oral airway. b. stay with the patient and call for help. c. administer oxygen by mask. d. suction the mouth to prevent aspiration.

b. stay with the patient and call for help.

A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to: a. reduce maternal and fetal tachycardia associated with ritodrine administration. b. stimulate fetal surfactant production. c. suppress uterine contractions. d. maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy.

b. stimulate fetal surfactant production

A woman who is 14 weeks pregnant tells the nurse that she always had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know if it is safe for her to have a drink with dinner now. The nurse would tell her: a. "One drink every night is too much. One drink three times a week should be fine." b. "Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy." c. "Since you're in your second trimester, you can drink as much as you like." d. "Since you're in your second trimester, there's no problem with having one drink with dinner."

b. "Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy."

The nurse is assessing a pregnant client with type 1 diabetes about her understanding regarding changing insulin needs during pregnancy. The nurse determines that further teaching is needed if the client makes which statement? a. My insulin levels should return to pre-pregnant levels within 7-10 days if I bottle feed. b. I will need to increase my insulin during the first 3 months of pregnancy. c. Episodes of hypoglycemia are more likely to occur in the first 3 months of pregnancy d. My insulin will likely need to be increased during the second and third trimesters

b. I will need to increase my insulin during the first 3 months of pregnancy.

A woman is at 14 weeks of gestation. The nurse would expect to palpate the fundus at which level? a. Slightly above the umbilicus b. Not palpable above the symphysis at this time c. Slightly above the symphysis pubis d. At the level of the umbilicus

c. Slightly above the symphysis pubis

The perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the woman is experiencing profuse bleeding. The most likely etiology for the bleeding is: Select one: a. vaginal hematoma. b. vaginal laceration. c. uterine inversion. d. uterine atony.

d. uterine atony.

The laboratory blood tests of a client at 10 weeks' gestation reveal that she has anemia. The client refuses iron supplements. The nurse teaches her that the best source of iron is liver. What other foods does the nurse encourage the client to eat? Select all that apply. 1 Dark leafy green vegetables 2 Legumes 3 Dried fruits 4 Broiled halibut 5 Ground beef patty

1 Dark leafy green vegetables 2 Legumes 3 Dried fruits 5 Ground beef patty Excellent food sources of iron include liver, meats, whole grain or enriched breads, dark green leafy vegetables, legumes, and dried fruits. Halibut is a good source of protein, not iron.

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? 1 First 2 Latent 3 Second 4 Transitional

1 First The client is in the first stage of labor because she is fully effaced but not yet completely dilated. The first stage lasts from the onset of contractions until full cervical effacement and dilation. The second stage of labor lasts from complete dilation to birth. Latent and transition are phases and not stages of labor. Latent is the first phase of the first and second stages of labor. Transition is the last of three phases occurring in the first stage of labor.

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? 1 Body metabolism is sluggish in the first trimester. 2 Morning sickness may result in decreased food intake. 3 Fetal requirements of glucose in this period are minimal. 4 Hormones of pregnancy increase the body's need for insulin.

2 Morning sickness may result in decreased food intake. Morning sickness, a common occurrence during pregnancy, contributes to decreased food intake; the insulin dosage must be reduced to prevent hypoglycemia. The body's metabolism increases during pregnancy, because the needs of the fetus, as well as those of the mother, must be met. Rapid organogenesis requires large amounts of glucose. During the first trimester the blood glucose level is reduced and glycemic control is enhanced; glycemic control is more difficult to maintain later in the pregnancy.

A pregnant client is making her first antepartum visit. She has a 2-year-old son born at 40 weeks, a 5-year-old daughter born at 38 weeks, and 7-year-old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. How does the nurse, using the GTPAL format, document the client's obstetric history? 1 G4 T3 P2 A1 L4 2 G5 T2 P2 A1 L4 3 G5 T2 P1 A1 L4 4 G4 T3 P1 A1 L4

3 G5 T2 P1 A1 L4 The acronym GTPAL represents gravidity, term births, preterm births, abortions, and living children; G5 T2 P1 A1 L4 indicates that the client has had five pregnancies (twins count as one pregnancy and the current pregnancy counts as one); two term births; one preterm birth (the twins); one abortion; and four living children.

A few hours after being admitted to the hospital with a diagnosis of inevitable abortion, a client at 16 weeks' gestation begins to experience a bearing-down sensation and suddenly expels the products of conception in the bed. What should the nurse do first? 1 Notify the primary healthcare provider 2 Administer the prescribed sedative 3 Take the client to the operating room 4 Check the client's fundus for firmness

4 Check the client's fundus for firmness After a spontaneous abortion the uterine fundus should be palpated for firmness, which indicates effective uterine tone. If the uterus is not firm or appears to be hypotonic, hemorrhage may occur; a soft or boggy uterus also may indicate retained placental tissue. The nurse would notify the primary healthcare provider if necessary after checking for fundal firmness.

What should the plan of care for a client with a tentative diagnosis of partial abruptio placentae include? 1 Bed rest with sedation 2 Trendelenburg position and hydration 3 Preparation for emergency cesarean birth 4 External fetal monitoring and oxygenation

4 External fetal monitoring and oxygenation Fetal monitoring and oxygen administration should be instituted to protect the fetus. Some placental separation has occurred, and it may progress further. Sedation is contraindicated; it may further stress an already compromised fetus. The Trendelenburg position may shift the heavy uterus against the diaphragm and lead to compromised maternal respiratory function, further depriving the fetus of oxygen. Hydration is not a priority at this time. Further assessment of fetal status and progression of abruption placentae is needed before a cesarean birth is considered.

A client exhibits oligohydramnios at 36 weeks' gestation. What newborn complication should the nurse anticipate? 1 Spina bifida 2 Imperforate anus 3 Tracheoesophageal fistula 4 Intrauterine growth restriction (IUGR)

4 Intrauterine growth restriction (IUGR) Oligohydramnios is associated with IUGR; risk factors for IUGR include inadequate maternal nutrition and other high-risk conditions such as diabetes and preeclampsia.

In planning for home care of a woman with preterm labor, which concern must the nurse address? a. Restricted activity and medications will be necessary to prevent recurrence of preterm labor. b. Nursing assessments will be different from those done in the hospital setting. c. Prolonged bed rest may cause negative physiologic effects. d. Home health care providers will be necessary.

c. Prolonged bed rest may cause negative physiologic effects.

A client who is at risk for seizures as a result of severe preeclampsia is receiving an intravenous infusion of magnesium sulfate. What findings cause the nurse to determine that the client is showing signs of magnesium sulfate toxicity? Select all that apply. 1 Proteinuria 2 Epigastric pain 3 Respirations of 10 breaths/min 4 Loss of patellar reflexes 5 Urine output of 40 mL/hr

3 Respirations of 10 breaths/min 4 Loss of patellar reflexes

Which symptom is considered a warning sign and should be reported immediately by the pregnant woman to her health care provider? a. Nausea with occasional vomiting b. Urinary frequency c. Fatigue d. Vaginal bleeding

d. Vaginal bleeding

While caring for the patient who requires an induction of labor, the nurse should be cognizant that: a. oxytocin is less expensive than prostaglandins and more effective but creates greater health risks. b. ripening the cervix usually results in a decreased success rate for induction. c. amniotomy can be used to make the cervix more favorable for labor. d. labor sometimes can be induced with balloon catheters or laminaria tents.

d. labor sometimes can be induced with balloon catheters or laminaria tents.

With regard to a pregnant woman's anxiety and pain experience, nurses should be aware that: a. even mild anxiety must be treated. b. women who have had a painful labor will have learned from the experience and have less anxiety the second time because of increased familiarity. c. anxiety may increase the perception of pain, but it does not affect the mechanism of labor. d. severe anxiety increases tension, which increases pain, which in turn increases fear and anxiety, and so on.

d. severe anxiety increases tension, which increases pain, which in turn increases fear and anxiety, and so on.

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. 1 Headache 2 Constipation 3 Abdominal pain 4 Vaginal bleeding 5 Visual disturbances

1 Headache 3 Abdominal pain 5 Visual disturbances Headache in severe preeclampsia is related to cerebral edema. Abdominal pain in severe preeclampsia is related to decreased circulating blood volume and generalized edema. Visual disturbances in severe preeclampsia are related to retinal edema. Constipation and vaginal bleeding are not related to preeclampsia.

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? 1 Infection 2 Hemodilution 3 Nutritional deficits 4 Concealed bleeding

2 Hemodilution The increase in circulating blood volume during pregnancy is reflected in lower hemoglobin and hematocrit readings (physiological anemia of pregnancy)

A client in labor is admitted to the birthing unit 20 hours after her membranes have ruptured. Which complication should the nurse anticipate when assessing the character of the client's amniotic fluid? 1 Cord prolapse 2 Placenta previa 3 Maternal sepsis 4 Abruptio placentae

3 Maternal sepsis Prolonged rupture of membranes of more than 18 hours increases the risk of maternal and newborn sepsis.

A client who is at 38 weeks' gestation is admitted to the birthing unit because her membranes ruptured 24 hours ago and contractions have started. The fetus is in a breech presentation. The nurse observes that the amniotic fluid is green. What does the nurse conclude from these findings? 1 The fetus has a neural tube defect 2 Fetal well-being is compromised 3 Intrauterine infection has developed 4 Meconium is being expelled with contractions

4 Meconium is being expelled with contractions In a breech presentation, the pressure of the contractions on the fetus's lower abdomen causes meconium to be expelled into the amniotic fluid with each contraction.

A laboring woman received an opioid agonist (meperidine) intravenously 90 minutes before she gave birth. Which medication should be available to reduce the postnatal effects of Demerol on the neonate? a. Nalbuphine (Nubain) b. Naloxone (Narcan) c. Fentanyl (Sublimaze) d. Promethazine (Phenergan)

b. Naloxone (Narcan)

A pregnant woman's amniotic membranes rupture. Prolapsed umbilical cord is suspected. What intervention would be the top priority? a. Starting oxygen by face mask. b. Placing the woman in the knee-chest position. c. Covering the cord in sterile gauze soaked in saline. d. Preparing the woman for a cesarean birth.

b. Placing the woman in the knee-chest position.

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding indicates that preterm labor is occurring? a. Fetal fibronectin is present in vaginal secretions. b. The cervix is effacing and dilated to 2 cm. c. Irregular, mild uterine contractions are occurring every 12 to 15 minutes. d. Estriol is not found in maternal saliva.

b. The cervix is effacing and dilated to 2 cm.

Spontaneous termination of a pregnancy is considered to be an abortion if: a. the products of conception are passed intact. b. the pregnancy is less than 20 weeks. c. the fetus weighs less than 1000 g. d. no evidence exists of intrauterine infection.

b. the pregnancy is less than 20 weeks

As relates to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that: a. there are no important maternal (as opposed to fetal) contraindications. b. if the patient develops pulmonary edema while receiving tocolytics, intravenous (IV) fluids should be given. c. its most important function is to afford the opportunity to administer antenatal glucocorticoids. d. the drugs can be given efficaciously up to the designated beginning of term at 37 weeks.

c. its most important function is to afford the opportunity to administer antenatal glucocorticoids.

The nurse providing newborn stabilization must be aware that the primary side effect of maternal narcotic analgesia in the newborn is: a. tachypnea. b. acrocyanosis. c. respiratory depression. d. bradycardia.

c. respiratory depression.

With regard to the after birth uterus, nurses should be aware that: Select one: a. after 2 weeks after birth it weighs 100 g. b. it returns to its original (prepregnancy) size by 6 weeks after birth. c. after 2 weeks after birth it should not be palpable abdominally. d. at the end of the third stage of labor it weighs approximately 500 g.

c. after 2 weeks after birth it should not be palpable abdominally.

A woman is experiencing back labor and complains of intense pain in her lower back. An effective relief measure would be to use: a. conscious relaxation or guided imagery. b. pant-blow (breaths and puffs) breathing techniques. c. counterpressure against the sacrum. d. effleurage.

c. counterpressure against the sacrum.

With regard to the care management of preterm labor, nurses should be aware that: a. all women must be considered at risk for preterm labor and prediction is so hit-and-miss, teaching pregnant women the symptoms probably causes more harm through false alarms. b. preterm labor is likely to be the start of an extended labor, a woman with symptoms can wait several hours before contacting the primary caregiver. c. the diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change. d. Braxton Hicks contractions often signal the onset of preterm labor.

c. the diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change.

A laboring woman received an opioid agonist (meperidine) intravenously 90 minutes before she gave birth. Which medication should be available to reduce the postnatal effects of Demerol on the neonate? a. Fentanyl (Sublimaze) b. Promethazine (Phenergan) c. Nalbuphine (Nubain) d. Naloxone (Narcan)

d. Naloxone (Narcan)

A woman gave birth to an infant boy 10 hours ago. Where would the nurse expect to locate this woman's fundus? Select one: a. Midway between the umbilicus and the symphysis pubis b. Nonpalpable abdominally c. Two centimeters below the umbilicus d. One centimeter above the umbilicus

d. One centimeter above the umbilicus

A woman gave birth vaginally to a 9-lb, 12-ounce girl yesterday. Her primary health care provider has written orders for perineal ice packs, use of a sitz bath tid, and a stool softener. What information is most closely correlated with these orders? Select one: a. The woman received epidural anesthesia. b. The woman had a vacuum-assisted birth. c. The woman is a gravida 2, para 2. d. The woman has an episiotomy.

d. The woman has an episiotomy.

A woman in labor has just received an epidural block. The most important nursing intervention is to: a. monitor the maternal pulse for possible bradycardia. b. monitor the fetus for possible tachycardia. c. limit parenteral fluids. d. monitor the maternal blood pressure for possible hypotension.

d. monitor the maternal blood pressure for possible hypotension.

Which nursing intervention is specific to clients in active labor who present with a history of cardiac disease? 1 Encouraging frequent voiding 2 Checking the blood pressure hourly 3 Auscultating the lungs for crackles every 30 minutes 4 Helping turn the client from side to side at 15-minute intervals

3 Auscultating the lungs for crackles every 30 minutes Clients with cardiac problems are prone to heart failure during active labor; crackles indicate the presence of pulmonary edema

Which clinical finding does the nurse expect when assessing a client with abruptio placentae? 1 Flaccid uterus 2 Painless bleeding 3 Boardlike abdomen 4 Bright red bleeding

3 Boardlike abdomen Extravasation of blood at the placental separation site into the myometrium causes a tetanic boardlike uterus. The uterus is rigid because it is filled with blood and clots.

Women with hyperemesis gravidarum: a. are a majority because 80% of all pregnant women suffer from it at some time. b. often inspire similar, milder symptoms in their male partners and mothers. c. have vomiting severe and persistent enough to cause weight loss, dehydration, and electrolyte imbalance. d. need intravenous (IV) fluid and nutrition for most of their pregnancy.

c. have vomiting severe and persistent enough to cause weight loss, dehydration, and electrolyte imbalance.

What is an important nursing intervention when a client is receiving intravenous (IV) magnesium sulfate for preeclampsia? 1 Limiting IV fluid intake 2 Preparing for a possible precipitous birth 3 Maintaining a quiet, darkened environment 4 Obtaining magnesium gluconate as an antagonist

3 Maintaining a quiet, darkened environment Calcium gluconate is the antagonist for mag sulfate toxicity not mag gluconate. Infusions are not limited. Reducing environmental stimuli is essential for limiting or preventing seizures.

At a routine monthly visit, while assessing a client who is in her 26th week of gestation, the nurse identifies the presence of striae gravidarum. The nurse describes this condition to the client as what? 1 Brownish blotches on the face 2 Purplish discoloration of the cervix 3 Reddish streaks on the abdomen and breasts 4 A black line running between the umbilicus and mons veneris

3 Reddish streaks on the abdomen and breasts Reddish streaks on the abdomen and breasts are striae gravidarum; they occur as a result of stretching of the breast and abdominal skin. These are known as "stretch marks." Chloasma refers to the condition where brownish blotches develop on the face. Purplish discoloration of the cervix is Chadwick sign. A black line running between the umbilicus and mons veneris is the linea nigra.

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? 1 Tenth and twelfth weeks of gestation 2 Eighteenth and twenty-second weeks of gestation 3 Twenty-fourth and twenty-eighth weeks of gestation 4 Thirty-sixth and fortieth weeks of gestation

3 Twenty-fourth and twenty-eighth weeks of gestation At the end of the second trimester and the beginning of the third trimester, insulin needs increase because of an increase in maternal resistance to insulin.

A first-time mother at 18 weeks of gestation comes for her regularly scheduled prenatal visit. The patient tells the nurse that she is afraid that she is going into premature labor because she is beginning to have regular contractions. The nurse explains that this is the Braxton Hicks sign and teaches the patient that this type of contraction: a. causes cervical dilation. b. impedes oxygen flow to the fetus. c. is painless. d. increases with walking.

c. is painless.

The priority nursing care associated with an oxytocin (Pitocin) infusion is: a. measuring urinary output. b. evaluating cervical dilation. c. monitoring uterine response. d. increasing infusion rate every 30 minutes.

c. monitoring uterine response.

The nurse is assessing a client with a tentative diagnosis of hydatidiform mole. Which clinical finding should the nurse anticipate? 1 Hypotension 2 Decreased fetal heart rate 3 Unusual uterine enlargement 4 Painless, heavy vaginal bleeding

3 Unusual uterine enlargement The proliferation of trophoblastic tissue filled with fluid causes the uterus to enlarge more quickly than if a fetus were in the uterus. Hypertension, not hypotension, often occurs with a molar pregnancy. There is no fetus within a hydatidiform mole. There may be slight painless vaginal bleeding.

At her first prenatal clinic visit a primigravida has blood drawn for a rubella antibody screening test, and the results are positive. Which intervention is important when the nurse discusses this finding with the client? 1 Asking her whether she has ever had German measles and when she had the disease 2 Arranging for her to receive the rubella booster vaccine after the birth 3 Planning for her to receive the rubella booster vaccine at her next visit 4 Informing her that the result was expected and that treatment will not be needed

1 Asking her whether she has ever had German measles and when she had the disease The positive result indicates that the client has had rubella or was vaccinated. The nurse should determine whether she has had the disease, because it is important to know whether it was before or after she became pregnant; if she had rubella at the start of her pregnancy, the fetus is at risk.

How does the nurse determine when true labor and not false labor is present? 1 Cervical dilation is evident. 2 Contractions stop when the client walks around. 3 The client's contractions progress only when she is in a side-lying position. 4 Contractions occur immediately after the membranes rupture.

1 Cervical dilation is evident.

A client who is visiting the prenatal clinic for the first time has a serology test for toxoplasmosis. What information about the client's activities in the history indicates to the nurse that there is a need for this test? 1 The client cares for a neighbor's cat 2 The client works as a dog trainer 3 The client uses chemical cleaners 4 The client consumes raw vegetables

1 The client cares for a neighbor's cat Toxoplasmosis is caused by a protozoal parasite; cats acquire the organism by ingesting infected mice or birds, and the cysts are found in their feces. Caring for or working with cats, not dogs, poses a potential problem with toxoplasmosis. Chemical cleaners may be teratogenic, but they do not cause toxoplasmosis.

Laboratory studies reveal that a pregnant client's blood type is O, and she is Rh positive. The client asks whether her newborn will have a problem with blood incompatibility. Before responding, the nurse must remember that fetal problems may develop in what circumstance? 1 The fetus has type A or B blood. 2 The fetus is born preterm. 3 The fetus has type O, Rh positive blood. 4 The mother has diabetes.

1 The fetus has type A or B blood. ABO incompatibility may develop even in a firstborn infant. The mother has antibodies against antigens of the A and B blood cells. These antibodies, which are transferred across the placenta, produce hemolysis of fetal red blood cells. If the fetus is type A, B, or AB, incompatibility may occur.

A nurse caring for a pregnant client at 28 weeks' gestation and her partner suspects intimate partner violence. Which assessments support this suspicion? Select all that apply. 1 The woman has injuries to the breasts and abdomen. 2 The partner refuses to come into the examination room. 3 The partner answers questions that are asked of the woman. 4 The woman has visited the clinic several times in the last month. 5 The partner is excessively attentive while the health history is being taken.

1 The woman has injuries to the breasts and abdomen. 3 The partner answers questions that are asked of the woman. 4 The woman has visited the clinic several times in the last month.

A client tells the nurse that the first day of her last menstrual period was July 22. What is the estimated date of birth (EDB)? 1 May 7 2 April 29 3 April 22 4 March 6

2 April 29 EDB = last menstrual period + 1 year - 3 months + 7 days.

After the removal of a hydatidiform mole, the nurse assesses the client's laboratory data during a follow-up visit. The nurse notes that a prolonged increase of the serum human chorionic gonadotropin (hCG) level is a danger sign. Which condition is this client at increased risk of developing? 1 Uterine rupture 2 Choriocarcinoma 3 Hyperemesis gravidarum 4 Disseminated intravascular coagulation (DIC)

2 Choriocarcinoma

A 40-year-old primigravida is scheduled to have her first abdominal ultrasound. What should the nurse's instructions include? 1 Postpone breakfast until after the test. 2 Drink water until bladder is full. 3 Empty the bladder immediately before the test. 4 Insert a suppository after arising on the day of the test.

2 Drink water until bladder is full. A full bladder raises the uterus above the pelvis, providing better visualization of its contents.

While conducting prenatal teaching, the nurse should explain to clients that there is an increase in vaginal secretions during pregnancy called leukorrhea. What causes this increase? 1 Decreased metabolic rate 2 Increased production of estrogen 3 Secretion from the Bartholin glands 4 Supply of sodium chloride to the vaginal cells

2 Increased production of estrogen Increased estrogen production during pregnancy causes hyperplasia of the vaginal mucosa, which leads to increased production of mucus by the endocervical glands. The mucus contains exfoliated epithelial cells.

A nurse is discussing diet with a pregnant client who is 5 feet 4 inches tall (163 cm) and whose pre-pregnancy weight was 120 lb (54 kg). What should the nurse include about the changes in calories and nutrients, compared with the pre-pregnancy diet, during the second trimester? 1 Decreasing daily fat consumption by 220 calories 2 Increasing total daily caloric intake by 340 calories 3 Increasing total daily caloric intake by 460 calories 4 Decreasing daily carbohydrate consumption by 130 calories

2 Increasing total daily caloric intake by 340 calories A daily increase of 340 calories is recommended for adult women during the second trimester of pregnancy.

The primary healthcare provider diagnoses placenta previa in a primiparous client. What does this indicate to the nurse regarding the condition of the placenta? 1 Infarcted 2 Low-lying 3 Immaturely developed 4 Separating prematurely

2 Low-lying Implantation should occur in the upper third of the uterus; a low-lying placenta is termed placenta previa. Placenta previa indicates where the placenta is implanted and has no relationship to placental aging.

A client with severe preeclampsia is receiving magnesium sulfate therapy. What is the priority nursing assessment as the nurse monitors this client's response to therapy? 1 Urine output 2 Respiratory rate 3 Deep tendon reflexes 4 Level of consciousness

2 Respiratory rate Respiratory depression occurs with toxic levels of magnesium sulfate; calcium gluconate should be readily available to counteract toxicity. Although the other assessments (urine output, deep tendon reflexes, and level of consciousness) are important, none is the priority.

A pregnant client has class II cardiac disease. To best plan the client's care, what does the nurse anticipate for the client? 1 May participate in as much activity as she desires 2 Should be hospitalized if there is evidence of cardiac decompensation 3 Will have to maintain bed rest for most of the day throughout her pregnancy 4 May have to consider a therapeutic abortion if there is evidence of cardiac decompensation

2 Should be hospitalized if there is evidence of cardiac decompensation Clients with cardiac disease should be taught the signs and symptoms of cardiac decompensation; if they occur, the client should stop the activity that precipitated them and notify the primary healthcare provider. Participating in as much activity as she desires is acceptable behavior for a client with class I cardiac disease. Maintaining bed rest is the treatment for a client with class III cardiac disease. Considering a therapeutic abortion is the recommendation for a client with class IV cardiac disease.

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? 1 Fifth month 2 Third month 3 Fourth month 4 Second month

2 Third month Morning sickness rarely persists beyond the first trimester.

Which statements by a client with hyperemesis gravidarum would confirm that the client requires further teaching? Select all that apply. 1 "I'll start drinking protein shakes." 2 "I'll start drinking plenty of fluids." 3 "I'll start limiting my carbohydrates." 4 "I'll lie down for at least 2 hours after I eat." 5 "I'll be sure to schedule rest periods throughout the day so I won't get tired."

3 "I'll start limiting my carbohydrates." 4 "I'll lie down for at least 2 hours after I eat." During pregnancy the cardiac sphincter may relax, which allows food to come back up into esophagus when supine. Not lying down for up to 2 hours after eating should provide time for digestion so that food is not regurgitated. The client should not decrease carbohydrate intake.

A nurse in the birthing unit is admitting a client whose membranes ruptured at home. How does the nurse know whether the client is in true labor? 1 Contractions occur every 10 minutes with no change in frequency over 2 hours, and the cervix is closed. 2 Contractions are not evident; the cervix is dilated 3 cm and 50% effaced, and there is no change after 4 hours of staying out of bed. 3 Contractions occur every 5 to 10 minutes, the cervix is dilated 2 cm and 75% effaced, and dilation has increased to 3 cm in 2 hours. 4 Contractions are irregular, occurring every 10 to 15 minutes, the cervix is dilated one fingertip and is 50% effaced, and there is no change with 4 hours of bed rest.

3 Contractions occur every 5 to 10 minutes, the cervix is dilated 2 cm and 75% effaced, and dilation has increased to 3 cm in 2 hours.

After an incomplete abortion, a client tells the nurse that although her primary healthcare provider explained what an incomplete abortion was, she did not understand. What is the best response by the nurse? 1 "I don't think you should focus on this anymore." 2 "It's when the fetus dies but is retained in the uterus for at least 2 months." 3 "It's when the fetus is expelled but other parts of the pregnancy remain in the uterus." 4 "I think it's best for you to ask your primary healthcare provider for the answer to that question."

3 "It's when the fetus is expelled but other parts of the pregnancy remain in the uterus." A correct and simple definition answers the question and fulfills the client's need to know. Telling the client not to focus on the topic any more denies the client's right to know. The definition of a missed abortion is when the fetus dies but is retained in the uterus for at least 2 months.

A nurse is assessing a client at 16 weeks' gestation. Where does the nurse expect the fundal height to be located? 1 Above the umbilicus 2 At the level of the umbilicus 3 Half the distance to the umbilicus 4 Slightly above the symphysis pubis

3 Half the distance to the umbilicus

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? 1 "Insulin needs will decrease; the excess glucose will be used for fetal growth." 2 "Diet and insulin needs won't change, and maternal and fetal needs will be met." 3 "Protein needs will increase, and adjustments to insulin dosage will be necessary." 4 "Insulin dosage and dietary needs will be adjusted in accordance with the results of blood glucose monitoring."

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

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? 1 "It helps confirm your pregnancy." 2 "It is not unusual, even in women who are not pregnant." 3 "It occurs because the blood is trapped by the pregnant uterus." 4 "It is caused by increased blood flow to the uterus during pregnancy."

4 "It is caused by increased blood flow to the uterus during pregnancy." Stating that the Chadwick sign is caused by increased blood flow to the uterus during pregnancy underscores the normalcy of Chadwick sign and provides a simple explanation of the cause; women often need reassurance that the physical changes associated with pregnancy are expected. Stating that the Chadwick sign helps confirm pregnancy answers part of the question, but fails to explain why it occurs.

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? 1 Painful vaginal bleeding in the first trimester 2 Painful vaginal bleeding in the third trimester 3 Painless vaginal bleeding in the first trimester 4 Painless vaginal bleeding in the third trimester

4 Painless vaginal bleeding in the third trimester Placenta previa is typically associated with painless uterine bleeding in the latter half of pregnancy

A client who is at 12 weeks' gestation tells the nurse at the prenatal clinic that she is experiencing severe nausea and frequent vomiting. The nurse suspects that the client has hyperemesis gravidarum. Which factor is frequently associated with this disorder? A. History of cholecystitis B. Large amount of amniotic fluid C. High level of chorionic gonadotropin D. Decreased secretion of hydrochloric acid

C. High level of chorionic gonadotropin A high level of chorionic gonadotropin is frequently associated with severe vomiting during pregnancy and may result in hyperemesis gravidarum. A high level may also occur in the presence of a hydatidiform mole or multiple pregnancy.

Nurses should know some basic definitions concerning preterm birth, preterm labor, and low birth weight. For instance: a. the terms preterm birth and low birth weight can be used interchangeably. b. low birth weight is anything below 3.7 lbs. c. preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy. d. in the United States early in this century, preterm birth accounted for 18% to 20% of all births.

c. preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy.

A woman is experiencing back labor and complains of intense pain in her lower back. An effective relief measure would be to use: a. counterpressure against the sacrum. b. pant-blow (breaths and puffs) breathing techniques. c. conscious relaxation or guided imagery. d. effleurage.

a. counterpressure against the sacrum.

As relates to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that: a. its most important function is to afford the opportunity to administer antenatal glucocorticoids. b. if the patient develops pulmonary edema while receiving tocolytics, intravenous (IV) fluids should be given. c. there are no important maternal (as opposed to fetal) contraindications. d. the drugs can be given efficaciously up to the designated beginning of term at 37 weeks.

a. its most important function is to afford the opportunity to administer antenatal glucocorticoids.

It is important for the nurse to develop a realistic birth plan with the pregnant woman in her care. The nurse can explain that a major advantage of nonpharmacologic pain management is: a. no side effects or risks to the fetus are involved. b. a more rapid labor is likely. c. greater and more complete pain relief is possible. d. the woman remains fully alert at all times.

a. no side effects or risks to the fetus are involved.

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding indicates that preterm labor is occurring? a. Irregular, mild uterine contractions are occurring every 12 to 15 minutes. b. The cervix is effacing and dilated to 2 cm. c. Estriol is not found in maternal saliva. d. Fetal fibronectin is present in vaginal secretions.

b. The cervix is effacing and dilated to 2 cm.

Methotrexate is recommended as part of the treatment plan for which obstetric complication? a. Complete hydatidiform mole b. Unruptured ectopic pregnancy c. Abruptio placentae d. Missed abortion

b. Unruptured ectopic pregnancy

Physiologic anemia often occurs during pregnancy as a result of: a. the fetus establishing iron stores. b. dilution of hemoglobin concentration. c. inadequate intake of iron. d. decreased production of erythrocytes.

b. dilution of hemoglobin concentration.

While caring for the patient who requires an induction of labor, the nurse should be cognizant that: a. ripening the cervix usually results in a decreased success rate for induction. b. labor sometimes can be induced with balloon catheters or laminaria tents. c. amniotomy can be used to make the cervix more favorable for labor. d. oxytocin is less expensive than prostaglandins and more effective but creates greater health risks.

b. labor sometimes can be induced with balloon catheters or laminaria tents.

In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes that the most important factor affecting pregnancy outcome is the: a. mother's age. b. amount of insulin required prenatally. c. degree of glycemic control during pregnancy. d. number of years since diabetes was diagnosed.

c. degree of glycemic control during pregnancy.

Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for: a. preterm birth. b. congenital anomalies of the central nervous system. c. low birth weight. d. macrosomia.

d. macrosomia.

The nurse practicing in a labor setting knows that the woman most at risk for uterine rupture is: a. a gravida 4 who has had all cesarean births. b. a gravida 3 who has had two low-segment transverse cesarean births. c. a gravida 2 who had a low-segment vertical incision for delivery of a 10-lb infant. d. a gravida 5 who had two vaginal births and two cesarean births.

a. a gravida 4 who has had all cesarean births.

Prenatal testing for human immunodeficiency virus (HIV) is recommended for: a. all women, regardless of risk factors. b. a woman who has had a sexually transmitted infection. c. a woman who has had more than one sexual partner. d. a woman who is monogamous with her partner.

a. all women, regardless of risk factors.

The priority nursing intervention after an amniotomy should be to: a. assess the fetal heart rate. b. change the patient's gown. c. estimate the amount of amniotic fluid. d. assess the color of the amniotic fluid.

a. assess the fetal heart rate.

With regard to a pregnant woman's anxiety and pain experience, nurses should be aware that: a. even mild anxiety must be treated. b. women who have had a painful labor will have learned from the experience and have less anxiety the second time because of increased familiarity. c. anxiety may increase the perception of pain, but it does not affect the mechanism of labor. d. severe anxiety increases tension, which increases pain, which in turn increases fear and anxiety, and so on.

d. severe anxiety increases tension, which increases pain, which in turn increases fear and anxiety, and so on.