OB nursing concepts

Which statement by the nursing student about the management of reduced cervical competence (premature dilation of the cervix) in a pregnant patient indicates effective learning?

"A prophylactic cerclage is used to constrict the internal os of the cervix." The best treatment option for premature dilation of the cervix is to surgically place a prophylactic cerclage to constrict the internal os of the cervix. It is usually placed at 11 to 15 weeks of gestation. Progesterone supplementation may not be effective in constricting the cervix and surgical intervention may be necessary. An abdominal cerclage is necessary in case of a failed vaginal cerclage and is usually placed at 11 to 13 weeks of gestation in patients by means of a laparotomy. In patients with an extremely short cervix, an abdominal cerclage is used, which is followed by a cesarean birth.

The nursing instructor is teaching a group of student nurses about postpartum depression assessment tools. Which statement by a student nurse needs correction?

"Edinburgh Postnatal Depression Scale (EPDS) is a 35 item Likert response scale." Unlike Postpartum Depression Screening Scale (PDSS), Edinburgh Postnatal Depression Scale (EPDS) is not a 35 item Likert response scale; rather it has 10 statements about common symptoms of depression. A maximum score on EPDS is 30 and a client with a score ≥12 requires treatment for depression. The Postpartum Depression Screening Scale (PDSS) assesses seven dimensions of depression. These seven dimensions include sleeping or eating disturbances, anxiety, emotional liability, mental confusion, loss of self, guilt or shame, and suicidal thoughts

Following a vaginal delivery, the client tells the nurse that she intends to breastfeed her infant but she is very concerned about returning to her prepregnancy weight. Based on this interaction, how would the nurse advise the client? Select all that apply.

"Even though more calories are needed for lactation, typically women who breastfeed lose weight more rapidly than women who bottle feed in the postpartum period" is an accurate statement related to lactation and weight loss. "Weight loss diets are not recommended for women who breastfeed" is an accurate statement relative to women who breastfeed so as to provide adequate nutrient stores and milk production. "If breastfeeding, she should regulate her fluid consumption in response to her thirst level" is an accurate statement that will ensure adequate hydration without overhydration. Weight loss diet plans are not recommended for women who are breastfeeding, because they can lead to depletion of reserves and decreased milk production. Breastfeeding mothers need to increase their caloric intake by 400 to 500 calories per day to ensure provide adequate nutritional stores and milk production.

The nurse is preparing to discharge a 30-year-old woman who has experienced a miscarriage at 10 weeks of gestation. Which statement by the woman indicates a correct understanding of the discharge instructions?

"I should eat foods that are high in iron and protein to help my body heal." A woman who has experienced a miscarriage should be advised to eat foods that are high in iron and protein to help replenish her body after the loss. After a miscarriage a woman may experience mood swings and depression from the reduction of hormones and the grieving process. Sexual intercourse should be avoided for 2 weeks or until the bleeding has stopped, and pregnancy should be avoided for 2 months. The woman should not experience bright red, heavy, profuse bleeding; this should be reported to the health care provider.

What does the nurse instruct a pregnant client who is diabetic to do? Select all that apply.

"Perform exercises with a partner." "Stop exercising if contractions occur." "Exercise at the same time every day." The nurse should instruct the client to exercise with a partner as a safety measure. The client should be instructed to stop exercising immediately if contractions occur. The client should perform exercises, eat meals, and take insulin at the same time every day. It is best to perform exercises after meals, when the blood glucose levels are rising. If contractions occur, the client should drink two to three glasses of water and lie down on her side for an hour. If contractions do not cease, the client should contact the primary health care provider.

Which instruction does the nurse give a postpartum client to prevent infections?

"Wipe from front to back after using the toilet." The nurse instructs the postpartum client to wipe from front to back after using the toilet to prevent the spread of bacteria to the vaginal or perineal area. The nurse should ask the client to clean the perineal area with an antiseptic solution and warm water to prevent infections. The client should change the perineal pad carefully to avoid the spread of bacteria. The nurse instructs the client to use slippers while walking around the hospital to prevent contamination of the linens on returning to bed.

The nurse is caring for a breastfeeding client who smokes. What advice does the nurse give the client to minimize the amount of nicotine in the milk and to improve the let-down reflex?

"You should avoid smoking for 2 hours before feeding the baby." The nurse should advise the client to avoid smoking for 2 hours before breastfeeding the infant. This helps reduce the nicotine content in the milk and improves the let-down reflex. Breast milk enhances immunity and helps in proper growth and development of the newborn. Therefore, the nurse should not advise the client to avoid breastfeeding the infant. Using nicotine patches will not help minimize the amount of nicotine in the milk or improve the let-down reflex. The nurse can advise the client to chew gum after smoking to mask the odor and taste. However, this does not improve the let-down reflex or reduce the nicotine content of the breast milk.

Which test would provide evidence of fetal blood in maternal circulation?

A Kleihauer-Betke test determines the presence of fetal blood in maternal circulation. A positive fern test would indicate the presence of amniotic fluid, noting that membranes had ruptured. A positive Coomb's test would indicate that the mother has Rh antibodies. A negative Coomb's test would indicate no presence of Rh antibodies.

The nurse is working in an obstetric ward. Which client in the ward is at the highest risk of developing hydatidiform mole?

A client with prior molar pregnancy Hydatidiform mole is a benign proliferative growth of the placental trophoblast. In this condition the chorionic villi develop into edematous or avascular transparent vesicles, which hang in a grapelike cluster. A client with prior molar pregnancy is at a higher risk of developing hydatidiform mole. The presence of growing tissue in a molar pregnancy increases the risk of hydatidiform mole. Clients with hypothyroidism, diabetes mellitus, and lupus erythematosus are not at a higher risk of developing hydatidiform mole.

A nurse is caring for a client whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of what?

A fetal heart rate (FHR) of 180 with absence of variability is nonreassuring. The oxytocin should be immediately discontinued and the physician should be notified. Uterine contractions that occur every 8 to 10 minutes do not qualify as hyperstimulation. The oxytocin should be discontinued if uterine hyperstimulation occurs. The client needing to void is not an indication to discontinue the oxytocin induction immediately or to call the physician. Unless a change occurs in the FHR pattern that is nonreassuring or the client experiences uterine hyperstimulation, the oxytocin does not need to be discontinued. The physician should be notified that the client's membranes have ruptured.

Which client situation presents the greatest risk for the occurrence of hypotonic dysfunction during labor?

A multiparous woman at 39 weeks of gestation who is expecting twins. Overdistention of the uterus in a multiple pregnancy is associated with hypotonic dysfunction, because the stretched uterine muscle contracts poorly. A young primigravida usually will have good muscle tone in the uterus. This prevents hypotonic dysfunction. There is no indication that this woman's uterus is overdistended, which is the main cause of hypotonic dysfunction. A primigravida usually will have good uterine muscle tone, and there is no indication of an overdistended uterus.

Which food does the nurse suggest to the postpartum client to increase docosahexaenoic acid (DHA) in breast milk?

A nursing mother needs 200 to 300 mg of DHA so that there is adequate DHA in her breast milk. Therefore, the client can add one or two portions of fish to her diet, because fish contains DHA. Eggs and citrus fruits will not increase DHA in breast milk. However, the client can consume these foods for general health. Sugar can also be used in moderation.

Which infant has a higher possibility of sustaining a birth trauma? An infant who:

A vaginal birth increases the chance of injuries due to the use of forceps or vacuum extraction or from pressure of the fetal skull against the maternal pelvis. An infant with low glucose levels at birth is hypoglycemic. Inborn errors of metabolism refer to an inherited disease and are not a birth trauma. An infant born to a patient with a urinary tract infection has a higher chance of acquiring the infection, but this is not a birth trauma.

Necrotizing enterocolitis (NE) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. What are some generalized signs?

Abdominal distention, temperature instability, and grossly bloody stools. Some generalized signs of NEC include decreased activity, hypotonia, pallor, recurrent apnea and bradycardia, decreased oxygen saturation values, respiratory distress, metabolic acidosis, oliguria, hypotension, decreased perfusion, temperature instability, cyanosis, abdominal distention, residual gastric aspirates, vomiting, grossly bloody stools, abdominal tenderness, and erythema of the abdominal wall.

A client is diagnosed with ectopic pregnancy. Which signs associated with ectopic pregnancy can be found in the client? Select all that apply.

Abdominal pain Delayed menses Abnormal vaginal bleeding Ectopic pregnancy is a condition in which the fertilized ovum is implanted outside the uterine cavity. A client with ectopic pregnancy would have colicky pain due to the stretching of the fallopian tube because of the growth of the embryo. Ectopic pregnancy delays menses and can produce abnormal vaginal bleeding. Mild to moderate dark red or brown intermittent vaginal bleeding is observed in ectopic pregnancy. Ectopic pregnancy may cause tubal rupture and result in internal bleeding. This type of pregnancy affects the heart rate and causes tachycardia. Bradycardia is not observed in ectopic pregnancy. The internal bleeding causes hypotension. Hypertension is not observed in ectopic pregnancy.

A pregnant client is diagnosed with abruptio placentae. What signs and symptoms would the nurse find in the client? Select all that apply.

Abdominal pain Vaginal bleeding Uterine tenderness Premature separation of the placenta from the uterus is called as abruptio placentae. Vaginal bleeding, abdominal pain, and uterine tenderness are signs and symptoms of abruptio placentae. Abruptio placentae does not affect blood glucose level; therefore, it does not cause hypoglycemia. Delayed menses is a sign of an ectopic pregnancy.

A pregnant client with chronic hypertension is at risk for placental abruption. Which symptoms of abruption does the nurse instruct the client to be alert for? Select all that apply.

Abdominal pain Vaginal bleeding Uterine tenderness The nurse instructs the pregnant client to be alert for abdominal pain, vaginal bleeding, and uterine tenderness, because they indicate placental abruption. Weight loss indicates fluid and electrolyte loss, not placental abruption. Shortness of breath indicates inadequate oxygen, which is usually seen in a clientwho is having cardiac arrest.

The nurse is using pain-relief methods based in the gate-control theory of pain while assisting a pregnant client in labor. Which action by the nurse is in accordance with this theory?

According to the gate-control theory of pain, pain sensations travel to the brain along the sensory nerve pathways. However, only a limited number of pain sensations can travel at a time. The use of imagery during labor blocks the capacity of the nerve pathways to transmit the pain. Imagery helps close the hypothetic gate in the spinal cord and prevents pain signals from reaching the brain. Showering is not related to the use of the senses to achieve pain control. The use of opioid analgesic is a pharmacologic measure of relieving pain. The gate-control theory of pain is based on the use of sensory organs to relieve pain and does not depend on the adjustment of environmental factors like lights and noise

The nurse is observing a postpartum client who has been bleeding excessively during the first hour postpartum, saturating multiple pads. Which interventions would the nurse anticipate that the physician would order? Select all that apply.

Administer oxygen via nonrebreather mask at 10 L/minute Insert a secondary intravenous line access

In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate?

Administration of blood. Primary medical management in all cases of DIC involves correction of the underlying cause, volume replacement, blood component therapy, optimization of oxygenation and perfusion status, and continued reassessment of laboratory parameters. Central monitoring would not be ordered initially in a woman with DIC because this can contribute to more areas of bleeding. Management of DIC includes volume replacement, not volume restriction. Steroids are not indicated for the management of DIC.

What intervention does the nurse perform to suppress lactation in a client who had a stillbirth?

Advise the client to wear a breast binder for the first 72 hours after giving birth. Suppression of lactation is recommended in cases of neonatal death. To suppress lactation, the nurse should advise the client to wear a breast binder continuously for the first 72 hours after delivery. Running warm water over the breast stimulates lactation. Mild analgesics can be administered to reduce breast engorgement, but they are not used to suppress lactation. Administration of oral or intravenous fluids may stimulate lactation.

An Apgar score of 10 at 1 minute after birth indicates what?

An infant having no difficulty adjusting to extrauterine life but who should be assessed again at 5 minutes after birth. An initial Apgar score of 10 is a good sign of healthy adaptation; it must be repeated at the 5-minute mark. A score of 10 at 1 minute of life indicates excellent transition to extrauterine life; however, the score needs to be repeated at 5 minutes of life. An infant in need of resuscitation has a very low Apgar score. The Apgar scores do not predict neurologic outcome but are useful for describing the newborn's transition to their extrauterine environment.

A macrosomic infant had a difficult birth. The nurse suspects that the baby may have sustained brachial plexus injury. Which assessment findings in the baby should the nurse look for to confirm the injury? Select all that apply.

Arm hanging limply alongside the body Adducted and internally rotated shoulder and arm Extended elbow and pronated forearm. Brachial plexus injury is the commonest birth injury, with macrosomia being the commonest cause. The arm affected with brachial plexus injury may hang limply alongside the shoulder, with the shoulder and arm adducted and internally rotated. The affected infant has the elbow extended and the forearm is pronated. The hand and wrist are usually flexed. A flaccid hand and wrist may indicate an injury in the lower plexus. The grasp reflex is usually present in the brachial plexus injury, whereas it is absent in the lower plexus injury.

After change of shift report, the nurse assumes care of a multiparous client in labor. The woman is complaining of pain that radiates to her abdominal wall, lower back, buttocks, and down her thighs. Before implementing a plan of care, the nurse should understand that this type of pain is called what?

As labor progresses the woman often experiences referred pain. This occurs when pain that originates in the uterus radiates to the abdominal wall, the lumbosacral area of the back, the gluteal area, and thighs. The woman usually has pain only during a contraction and is free from pain between contractions. Visceral pain is that which predominates the first stage of labor. This pain originates from cervical changes, distention of the lower uterine segment, and uterine ischemia. Visceral pain is located over the lower portion of the abdomen. Somatic pain is described as intense, sharp, burning, and well localized. This results from stretching of the perineal tissues and the pelvic floor. This occurs during the second stage of labor. Pain experienced during the third stage of labor or afterward during the early postpartum period is uterine. This pain is very similar to that experienced in the first stage of labor

Which factor is associated with the reduced pain and feelings of euphoria in a pregnant client during labor?

Beta-endorphins are endogenous opioids secreted by the pituitary gland and are associated with feelings of euphoria. An increase in beta-endorphin levels increases the pain threshold so that the client is able to endure acute pain during labor. Hydrotherapy facilitates birth and can reduce labor pains, but is not associated with feelings of euphoria. Distraction techniques help reduce pain as the client focuses on other things apart from the pain. However, they are not associated with euphoria. An increase in catecholamine levels indicates that the client is experiencing more stress.

The nurse advises a postpartum client not to give any water to her 1-month-old infant after breastfeeding. What is the reason for this advice?

Breast milk is the best source of fluid for the infant, because it contains 87% water. Breast milk meets the infant's fluid needs. Neonates have fluid reserves during birth, which get depleted in a few days. Infants do have fluctuations in fluid balance, which are to be monitored regularly by the nurse. Taking additional water decreases the infant's caloric consumption.

As part of the postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman who is 1 day postpartum. What is an expected finding?

Breasts are essentially unchanged for the first 24 hours after birth. Colostrum is present and may leak from the nipples. Leakage of milk occurs after the milk comes in 72 to 96 hours after birth. Engorgement occurs at day 3 or 4 postpartum. A few blisters and a bruise indicate problems with the breastfeeding techniques being used.

The nurse finds the oxygen saturation in an infant to be 90%, when providing maximum hood therapy. What intervention would promote respiratory function in the infant?

CPAP Hood therapy is used to provide oxygen to the infant who has reduced oxygen saturation levels below 92%. If the saturation levels are not maintained after providing hood therapy, the nurse should immediately arrange for continuous positive airway pressure. The pressure enhances oxygen supply to the infant. Antibiotics are prescribed if the infant has sepsis. Hood therapy and nasal canula provide oxygen supply at a steady rate. Nasal canula is not as efficient as that of the hood therapy. Therefore, application of nasal cannula is only useful if the infant needs minimal support. Kangaroo care is skin-to-skin contact between the mother and the infant, and is used to maintain the infant's normal body temperature.

The nurse is caring for a pregnant client who has a history of second trimester loss and preterm birth. After reviewing the ultrasound reports, the nurse finds that the client has a cervix less than 30 mm. What treatment strategy should be included in the treatment plan?

Cerclage . A client who has a history of second trimester loss and preterm delivery has a risk of premature cervical opening called cervical insufficiency. Cerclage insertion decreases preterm birth through a cervical suture placed surgically to tie the cervix and keep it closed. It is not necessary for a client with cervical insufficiency to have a cesarean delivery. If the client has proper treatment with cerclage or progesterone, it is possible for the client to have a vaginal delivery. Corticosteroid therapy is given to the client at risk of having a preterm delivery to accelerate fetal lung maturity. MTX therapy is used to treat ectopic pregnancy.

Upon assessment of a pregnant client, the nurse concludes that the client is less likely to have a preterm delivery. Which client clinical finding led the nurse to conclude this?

Cervical length is more than 30 mm. The cervical length is a good predictor of preterm birth. For childbirth, the cervix needs to prepare itself, in terms of effacement and dilatation. Clients having a cervical length of more than 30 mm would not have preterm labor, even if they have symptoms of preterm labor. A previous cesarean birth may not rule out the risk of preterm delivery. Chronic hypertension and preexisting diabetes mellitus might not increase the risk of preterm labor.

The nurse is caring for a pregnant client who has frequent mood swings and seems to be acting erratically. The nurse finds that the client is addicted to cocaine. Which may be the best method to determine the gestational age of the fetus?

Clients who are addicted to morphine and cocaine may have frequent mood swings and reduced cognition and may therefore not be unable to recall the date of conception. To determine the gestational age of the fetus in such clients, the nurse may need to conduct initial and serial ultrasound studies. A blood test helps confirm the pregnancy; it does not help find the gestational age of the fetus. Clients who have a substance abuse problem have reduced concentration and may not be able to count fetal movements. Furthermore, fetal movements are not felt during early pregnancy, and counting fetal movements does not help find the exact gestational age of the fetus. A client with a substance abuse problem may not be able to remember the exact date of her last menstrual period. Moreover, she may have amenorrhea. Hence, it is not the best way to determine the gestational age in clients who have a substance abuse problem.

A client had a previous cesarean birth. What are the criteria in order to try having a vaginal birth during the second pregnancy? Select all that apply.

Clinically adequate pelvis Previous low transverse incision No history of uterine rupture. A vaginal birth is possible after a previous caesarean delivery if the pelvis is found to be adequate to provide room for childbirth. A previous low transverse incision poses less risk of rupture and a vaginal delivery may be possible. A client with no history of uterine rupture would have less risk of uterine rupture during the vaginal delivery. A history of postpartum hemorrhage may not affect the risk associated with a second vaginal delivery in women with a history of first caesarean delivery. A previous vertical incision on the uterus increases the risk of uterine rupture.

The nurse is preparing to perform a fetal fibronectin test for a pregnant client. Which intervention should the nurse perform to collect the sample for the test?

Collect the vaginal secretions using a swab. The fetal fibronectin test is conducted to assess whether a client is at risk for preterm labor. Fetal fibronectin is a glycoprotein found in the vaginal secretions during early and late pregnancy. In order to conduct the test the nurse should collect the vaginal secretions using a swab and send it for analysis. Urine, blood, and amniotic fluid are not collected for a fetal fibronectin test, because they may not contain adequate glycoprotein levels.

In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes what as the most important factor affecting pregnancy outcome?

Degree of glycemic control during pregnancy Although advanced maternal age may pose some health risks, for the woman with pregestational diabetes the most important factor remains the degree of glycemic control during pregnancy. The number of years since diagnosis is not as relevant to outcomes as the degree of glycemic control. The key to reducing risk in the pregestational diabetic woman is not the amount of insulin required but rather the level of glycemic control. Women with excellent glucose control and no blood vessel disease should have good pregnancy outcomes.

A client reports mild vaginal bleeding, pain, and cramping in her lower abdomen at 6 weeks of gestation. Upon performing a pelvic examination, the nurse finds that the client's cervical os is closed. What is the priority intervention in this condition?

Determine the client's human chorionic gonadotropin and progesterone levels. Mild vaginal bleeding, pain in the lower abdomen, and mild uterine cramps with a closed cervical os are the symptoms of threatened miscarriage. Therefore, the nurse should determine the human chorionic gonadotropin and progesterone levels in the client to find whether the fetus is alive in the uterus. The nurse should administer intravenous fluids if the client has severe bleeding. The nurse should administer methylcarboprost tromethamine (Hemabate) to prevent excessive bleeding after miscarriage. In this case, the client does not have a complete miscarriage or excessive bleeding; therefore, the nurse would not administer this medication to the client. Dilation and curettage is a surgical method to terminate a pregnancy. It is performed on a client with inevitable miscarriage, but not threatened miscarriage.

After reviewing the laboratory reports of a pregnant client with a history of depression, the nurse concludes that the client is at risk of postpartum depression. Which laboratory findings support the nurse's assumptions? Select all that apply.

Diabetes mellitus and thyroid disorders increase the risk of postpartum depression in the client. Therefore, a decrease in the thyroxine levels indicates that the patient has hypothyroidism and an increased risk of postpartum depression. A decrease in estrogen and progesterone levels results in hypogonadism and increases the risk of postpartum depression. Thromboplastin helps in blood clotting, but does not play a role in postpartum depression.

A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes. The nurse caring for this woman understands what?

Dietary management involves distributing nutrient requirements over three meals and two or three snacks. Small frequent meals over a 24-hour period help decrease the risk for hypoglycemia and ketoacidosis. Oral hypoglycemic agents can be harmful to the fetus and less effective than insulin in achieving tight glucose control. In some women gestational diabetes can be controlled with dietary modifications alone. Blood, not urine, glucose levels are monitored several times a day. Urine is tested for ketone content; results should be negative.

While preparing a diet plan for a pregnant client, the nurse includes foods rich in folate, vitamin B2, vitamin B6, and omega-3 fatty acids. Why does the nurse include these dietary supplements in the client's diet?

Dietary supplements play a role in preventing postpartum depression. Folate, vitamin B2, vitaminB6, and omega-3 fatty acids are needed for the synthesis of serotonin and other neurotransmitters. This helps prevent depression. Generalized anxiety disorder is characterized by excessive worrying. This can be prevented by reducing stress and making the client feel comfortable. Uterine hypertrophy is a normal physiologic change that takes place during pregnancy and is not related to diet. Postpartum hemorrhage is characterized by loss of blood. This cannot be prevented by dietary modifications.

During pregnancy, alcohol withdrawal may be treated using:

Disulfiram is contraindicated in pregnancy because it is teratogenic. Corticosteroids are not used to treat alcohol withdrawal. Symptoms that occur during alcohol withdrawal can be managed with short-acting barbiturates or benzodiazepines. Aminophylline is not used to treat alcohol withdrawal.

What are the manifestations associated with hypoglycemia? Select all that apply.

Dizziness Blurred vision Excessive hunger Hypoglycemia refers to decreased blood sugar levels. Decreased availability of glucose impairs brain function, which results in dizziness and blurred vision. Decreased glucose levels stimulate the satiety center of the brain, which results in excessive hunger. Fruity breath and the presence of acetone in urine result from increased ketone levels in the blood. This complication may occur when the blood glucose increases over 300 mg/dl in the non-pregnant client and 200 mg/dl in the pregnant client.

The nurse is assessing a client for gestational diabetes mellitus (GDM) using the oral glucose tolerance test (OGTT). What intervention by the nurse is appropriate while caring for this client?

Draw blood for a fasting blood glucose level just before the test. The nurse must draw blood for a fasting blood glucose level just before the test begins. This is the first sample, after which blood is drawn 1, 2, and 3 hours after providing the glucose load. The nurse must teach the client to eat an unrestricted diet that includes at least 150 g of carbohydrates for at least 3 days before the test. The client must be instructed to avoid caffeine for 12 hours before the test because it increases glucose levels. The client is given a 100 g oral glucose load, and then the client's blood glucose levels are determined every hour for up to 3 hours. The plasma glucose level is obtained after a 50 g oral glucose load in the first step of screening for GDM.

The nurse is caring for a pregnant client with gestational diabetes. What does the nurse teach the client about diet during pregnancy?

Eat three meals a day with two or three snacks. The nurse should teach the client to distribute her daily required calories into three meals with two or three snacks. In order to prevent hypoglycemia, the client should eat meals on time and never skip meals. The client should consume a bedtime snack of at least 25 g of complex carbohydrate with some protein or fat to prevent hypoglycemia and starvation ketosis during the night. The nurse should teach the client to avoid the use of sweeteners that are nonnutritive and foods high in refined sugar. The client should eat foods that are high in dietary fiber.

With regard to systemic analgesics administered during labor, nurses should be aware of what?

Effects on the fetus and newborn can include decreased alertness and delayed sucking. Effects depend on the specific drug given, the dosage, and the timing. Systemic analgesics cross the fetal blood-brain barrier more readily than the maternal blood-brain barrier. IV administration is preferred over IM administration because the drug acts faster and more predictably. PCAs result in decreased use of an analgesic.

The nurse is caring for a postpartum client with an active gonorrhea infection. Which medication may be helpful in preventing ophthalmia neonatorum in the newborn?

Erythromycin ointment. Ophthalmia neonatorum is a major eye complication associated with gonorrhea. It should be treated within an hour of birth using erythromycin ointment. Penicillin is used to treat syphilis in neonates. Ceftriaxone is used to prevent systemic infection in infants with gonococcal eye infections. Silver nitrate is used as prophylactic therapy to prevent gonococcal conjunctivitis.

Which of the following findings would cause a concern for the nurse who is monitoring a postpartum patient who had a spontaneous vaginal delivery (SVD) of a 10-pound baby boy?

Even though the fundus is firm and midline, the fact that spurts of blood are evident on fundal massage may indicate that a tear is present. Further investigation is required, because this is considered to be nonlochial bleeding.

With regard to the condition and reconditioning of the urinary system after childbirth, nurses should be aware of what?

Excess fluid loss can occur through perspiration and urinary output, as well as through other means. Kidney function usually returns to normal in about a month. Diastasis recti abdominis is the separation of muscles in the abdominal wall; it has no effect on the voiding reflex. Bladder tone usually is restored 5 to 7 days after childbirth.

A pregnant client is extremely anxious during the labor process. Which condition does the nurse assess in the client that may occur due to anxiety?

Excessive anxiety in the client increases catecholamine levels during labor, which increase the stimuli to the brain from the pelvis. This process decreases blood flow and magnifies pain perception. The client becomes more anxious and the effectiveness of uterine contractions decreases, ultimately slowing the progress of labor. A heightened sense of anxiety and fear also increases muscle tension, thereby increasing discomfort.

If a pregnant client suspects signs and symptoms of preterm labor, which conditions would lead the client to go to hospital immediately? Select all that apply.

Fluid leakage from vagina Presence of vaginal bleeding Contractions every 10 minutes Fluid leakage from the vagina indicates rupture of the amniotic membranes. The client should seek immediate medical attention, because ruptured amniotic membranes can compromise fetal health. Presence of vaginal bleeding may indicate onset of labor or placental hemorrhage, which may compromise fetal perfusion. Therefore the client should go to the hospital immediately. Uterine contractions (UCs) after every 10 minutes indicate active labor and the client should go to the hospital immediately. Nausea and vomiting and upper back pain do not indicate labor. The client need not seek immediate medical attention for these conditions.

The nurse observes golden yellow stains on the skin of a just-born postterm neonate. The nurse also observes that the neonate has difficulty breathing due to reduced respiratory efforts and decreased muscle tone. What intervention would help promote normal breathing pattern in the neonate?

Give oxygen therapy. Clinical manifestations such as golden yellow stains on the neonate's skin, respiratory depression, and reduced muscular tone indicate meconium aspiration syndrome (MAS) in a just-born postterm neonate. MAS is usually found in postterm neonates, and results in a reduced supply of oxygen, which causes respiratory depression (RD) and pulmonary hypertension. The PHP administers oxygen to maintain oxygen levels and blood pressure. Incubator support is given to maintain the neonate's body temperature and is unrelated to MAS. Administering sucrose solution treats hypoglycemia, and it is unrelated to MAS. A gastrostomy feeding tube may be used when the neonate has gastric anomalies; it is not used for MAS.

The nurse observes that an infant exhibits grunting and nasal flaring. The infant also has a low respiratory rate. What intervention should the nurse follow to prevent aspiration of mucus in the infant?

Grunting, nasal flaring, and low respiratory rate indicate an ineffective respiratory pattern related to pulmonary activity in the infant. Therefore, the nurse has to place the infant in the prone or supine position without hyperextending the infant's neck. This helps the infant breathe more comfortably. The Trendelenburg position is avoided to prevent increased intracranial pressure and reduction of lung capacity. Exposure to cool air and drafts is avoided to prevent predisposition of the infant to heat loss. TPN is administered as prescribed to provide the infant with adequate nutrition and fluid intake

The nurse is caring for a postpartum client with acute psychosis who is prescribed haloperidol (Haldol). Which factor does the nurse monitor to ensure the client's safety?

Haloperidol (Haldol) is an antipsychotic drug. Antipsychotic drugs are associated with tachycardia, urinary retention, weight gain, and agranulocytosis. Agranulocytosis is characterized by a decrease in white blood cell count. Therefore, the nurse should monitor the client's white blood cell count to ensure safety and to prevent adverse effects of the medication.

Upon reviewing the ultrasonography reports of a pregnant client, the nurse finds that the placenta is at a distance of 2.5 cm from the internal cervical os. What complication is likely if the client has a vaginal delivery?

Hemorrhage A placenta implanted in the lower uterine segment 2.5 cm from the internal cervical os indicates that the client has marginal placenta previa. In placenta previa, disruption of placental blood vessels occurs with stretching and thinning of the lower uterine segment, which results in bleeding. Therefore, the major maternal complication associated with placenta previa is hemorrhage. Hyperthyroidism is one of the serious complications of hydatidiform mole. Thrombocytopenia and hypofibrinogenemia are complications of abruptio placentae.

Which condition does the nurse expect to find in a neonate born to a client with insulin-dependent diabetes?

High blood glucose levels in a client impair the renal functioning and decreases reabsorption of magnesium. Therefore, the newborn of a client with insulin-dependent diabetes may have hypomagnesemia. An increase in maternal blood glucose levels will not cause fluid overload and hypervolemia in the newborn. High maternal blood glucose levels may decrease serum calcium levels and result in hypocalcemia, but not hypercalcemia. Maternal diabetes increases the bilirubin levels in the fetus and causes hyperbilirubinemia, but not hypobilirubinemia.

Which statement is most likely to be associated with a breech presentation?

High rate of neuromuscular disorders Fetuses with neuromuscular disorders have a higher rate of breech presentation, perhaps because they are less capable of movement within the uterus. Breech is the most common malpresentation, affecting 3% to 4% of all labors. Descent is often slow because the breech is not as good a dilating wedge as is the fetal head. Diagnosis is made by abdominal palpation and vaginal examination. It is confirmed by ultrasound.

The nurse is informing a diabetic pregnant client about the dietary changes, need for exercise and possible risks to the fetus. Which fetal risks does the nurse need to inform the client about? Select all that apply.

Hypoglycemia Respiratory distress syndrome. Hypoglycemia is seen in infants of diabetic women at birth, because the infant's glucose supply is removed abruptly at the time of birth. Fetal macrosomia (not microsomia) is seen in some infants born to diabetic women due to maternal hyperlipidemia and increased lipid transfer to the fetus. Hyperinsulinemia and hyperglycemia reduce fetal surfactant synthesis and cause respiratory distress syndrome in the infant of a diabetic woman. Galactosemia is an autosomal recessive disorder that results from various gene mutations. Phenylketonuria is an inborn error of metabolism.

The nurse is caring for a neonate with intrauterine growth restriction (IUGR). The nurse observes that the neonate is restless, lethargic, and hypothermic. What immediate intervention does the nurse provide to ensure the neonate's safety?

IUGR causes restricted growth patterns in the neonate, resulting in complications like hypoglycemia and polycythemia. Reduced body temperature (hypothermia) is characteristic of hypoglycemia. Restlessness and lethargy are other symptoms that indicate hypoglycemia. The nurse should immediately assess the blood sugar levels, and administer dextrose the blood sugar is found to be less. Water feeding is avoided in neonates, as it may cause water intoxication. Ventilator support is provided in the case of neonatal respiratory depression. Immediate formula feed or mother's milk should be encouraged for neonates with hypoglycemia.

On interacting with a lactating client, the nurse finds that the patient consumes alcohol. Which advice should the nurse give in order to prevent potential risks to the infant?

If a breastfeeding mother consumes alcohol, she is advised to avoid breastfeeding for at least 2 hours after consuming alcohol. This will avoid potential risks to the infant. Consuming grape juice is beneficial during breastfeeding, but it does not reduce risks in the infant. Pumping and discarding the first 10 drops of milk is not sufficient to remove alcohol. Breast milk is nutritionally superior to cow's milk. Therefore, the nurse should advise the patient to feed the infant breast milk rather than cow's milk.

With regard to injuries to the infant's plexus during labor and birth, what should nurses be aware of?

If the ganglia are disconnected completely from the spinal cord, the damage is permanent. Erb palsy is damage to the upper plexus and is less serious than brachial palsy. Parents of children with brachial palsy are taught to avoid picking up the child under the axillae or by pulling on the arms. Breastfeeding is not contraindicated, but both mother and infant will need help from the nurse at the start.

The nurse is assessing a breast-fed newborn 1 hour after birth. The nurse identified that the glucose levels are less than 25 mg/dl and immediately reports it to the primary health care provider (PHP). What medication administration does the nurse expect the PHP to advise?

If the glucose levels are less than 25 mg/dl in the first 4 hours, or less than 35 mg/dl in the first 4 to 24 hours, it indicates hypoglycemia. All infants at risk of hypoglycemia should be fed within the first hour, with glucose testing performed 30 minutes after breastfeeding. If the glucose levels remain low despite feeding, IV dextrose is prescribed to the newborn. Cow's milk is generally not preferred for infants, because it may cause infections. Administration of infant formula is recommended in infants with hypocalcemia. IV saline infusion is not beneficial to hypoglycemic infants, because a saline infusion consists of plain salts and does not increase the glucose levels in the body.

Preterm infants are more likely to become septic due to what fact?

IgG levels are directly proportional to gestational age and reflect immature immune function. IgG and IgA levels are not adequate at birth and require time to become optimal. IgG levels are decreased in preterm infants. Serum complement levels are decreased at birth in preterm infants

The nurse is caring for a postpartum client who is Muslim. Which cultural practice does the nurse observe in the client?

In Muslim culture, before initiating the first feeding, a small piece of softened date is rubbed on the newborn's palate. Cultures in southern Asia, the Pacific Islands, and parts of sub-Saharan African often feed newborns honey or clarified butter before the initiation of breastfeeding. Mexican women feed infants both commercial formula and breast milk in order to provide the infant with the benefits of breastfeeding as well as additional vitamins from formula.

The nurse is assessing a neonate during the first hour of birth. Which signs of birth trauma does the nurse relate to a breech presentation?

In a breech presentation, the neonate is likely to have bruising and swelling over the buttocks or genitalia. If the neonate is born with a face presentation, there will be marked bruising over the entire face. The skin over the entire head may be ecchymotic and covered with petechiae if the neonate had a tight nuchal cord. A forceps injury will produce a linear mark across both sides of the face in the shape of the blades of the forceps.

Which of the following changes are consistent with metabolic function during the postpartum period? Select all that apply.

Increased basal metabolic rate (BMR) in the immediate postpartum period Decrease in estrogen and cortisol levels. BMR remains elevated for the first two weeks after birth and then returns to prepregnancy levels. Decreases in hormones such as estrogen and cortisol are seen during the postpartum period. Blood sugar levels typically decrease in the postpartum period as a result of the reversal of diabetogenic effects of pregnancy. A decrease in the insulinase enzyme occurs postpartum. Thyroid hormones gradually decrease to prepregnant levels in the 4 weeks following delivery.

The primary health care provider prescribes magnesium sulfate (Epsom salts) for a client to prevent preterm labor. Following administration, the nurse observes that the client has a respiratory rate of 10 breaths/minute and deep tendon reflexes. Based on these findings, what interventions would help to prevent complications in the client?

Infuse 500 mg of calcium chloride intravenously for 30 minutes. Magnesium sulfate is a tocolytic that is administered to the patient at 24 to 32 weeks of gestation to prevent the risk of preterm birth. A respiratory rate of 10 breaths/minute (below 12 breaths/minute) and deep tendon reflexes are intolerable adverse effects of the drug. Therefore, 500 mg of calcium chloride is infused intravenously for 30 minutes to reverse the magnesium sulfate (Epsom salt) toxicity. Nifedipine (Adalat) is a calcium channel blocker that should not be administered concurrently with magnesium sulfate (Epsom salt), because it results in skeletal muscle blockade. Propranolol (Inderal) is used to reverse the intolerable cardiovascular effects of terbutaline (Brethine). Dexamethasone (Decadron) is an antenatal glucocorticoid that is used to prevent the risk of respiratory distress syndrome in the fetus.

A pregnant client with pregestational insulin-dependent diabetes is going for a week's vacation to another state. What should the nurse ask the client to carry with her in order to prevent complications? Select all that apply.

Insulin vials Glucose tablets Blood glucose meter A client with pregestational diabetes should be very careful and should be prepared to tackle any complications associated with high or low blood sugar levels. The nurse should ask the client to carry the routine insulin medications. Hormonal effects of pregnancy can also cause hypoglycemia, which can be normalized by taking glucose tablets. The client should be able to find out her blood sugar levels any time. Therefore, the nurse should ask the client to take a glucometer for routine monitoring of blood sugar levels. Antibiotics should be taken only if the client has an infection. Antihypertensives would be required if the client has high blood pressure.

The nurse is caring for a 32-year-old pregnant client who had an onset of labor at 40 weeks' gestation. Following the labor, the nurse finds that the newborn has a low birth weight (LBW). What explanation will the nurse give to the client as to the etiology of the newborn's LBW?

Intrauterine growth restriction (IUGR). The low birth weight of the newborn is due to IUGR, a condition of inadequate fetal growth. It may be caused due to various conditions, such as gestational hypertension that interferes with uteroplacental perfusion. Interference with uteroplacental perfusion limits the flow of nutrients into the fetus and causes the low birth weight. The onset of labor is at 40 weeks' gestation. Therefore, it is not a preterm labor. The client's age is normal for pregnancy. Therefore, the client's age is not a reason for the low birth weight of the child. Infants born to clients with diabetes would have a high birth weight, not a low one.

Of what should a nurse providing care to a woman in labor be aware regarding cesarean birth?

Is performed primarily for the benefit of the fetu The most common indications for cesarean birth are dangers to the fetus related to labor and birth complications. Cesarean births are increasing in the United States. Wealthier women who have health insurance and who give birth in a private hospital are more likely to experience cesarean birth. A woman's right to elect cesarean surgery is in dispute, as is her right to refuse it if in doing so she endangers the fetus. Legal issues are not absolutely clear.

With regard to the use of tocolytic therapy to suppress uterine activity, nurses should be aware of what?

Its most important function is to afford the opportunity to administer antenatal glucocorticoids. Buying time for antenatal glucocorticoids to accelerate fetal lung development might be the best reason to use tocolytics. Once the pregnancy has reached 34 weeks, the risks of tocolytic therapy outweigh the benefits. There are important maternal contraindications to tocolytic therapy. Tocolytic-induced edema can be caused by IV fluids.

A pregnant woman has contacted the nurse about severe nausea and vomiting. What is the priority assessment in evaluating a pregnant woman with severe nausea and vomiting?

Ketonuria Determination of ketonuria would be a critical assessment that would lead toward determination of hyperemesis. A pregnant client with severe nausea and vomiting may have hyperemesis gravidarum and, as such, requires critical monitoring to determine the nature of the problem. A FBS, although informative would not be the priority assessment at this time. Although a bilirubin level would be needed, it would not be the priority assessment. A WBC count would indicate the possibility of an infectious source but it would not be a priority assessment in terms of the client's presentation.

Which test is used to determine the presence of fetal-to-maternal bleeding in a pregnant patient?

Kleihauer-Betke (KB) test The KB test is used to determine the presence of fetal-to-maternal bleeding or transplacental hemorrhage. The D-dimer test is used to diagnose blood disorders, such as disseminated intravascular coagulation (DIC). The NST and BPP tests are used to determine fetal surveillance.

The nurse is assessing a postpartum client 5 days after delivery. The client's partner tells the nurse that the client does not eat properly, starts crying suddenly for no reason, and has difficulty sleeping. What does the nurse infer from these symptoms?

Loss of appetite, insomnia, and crying suddenly for no reason indicate that the client is experiencing postpartum blues. These symptoms diminish in few days or a week. The symptoms of anxiety are abdominal pain, restlessness, muscle tension, and irritability. The client with postpartum psychosis has suicidal intention and hallucinations. If the client experiences the symptoms of postpartum blues for more than 2 weeks, it indicates that the client has postpartum depression.

The ultrasound report of a 12-week pregnant woman shows snowstorm pattern. Upon further examination, the nurse finds elevated human chorionic gonadotropin (hCG) levels and dark brown vaginal discharge. What complication does the nurse expect in the client?

MOLAR pregnancy . Snowstorm pattern in the ultrasound, elevated hCG, and dark brown vaginal discharge indicate that the client has a hydatidiform mole. The risk of hemorrhage is predominant in a client with placenta previa. The blood pressure of the client is not affected by the hydatidiform mole. Therefore, the client would not be at a risk of hypertension. a hydatidiform mole does not alter the blood glucose levels. Therefore, the client would not necessarily have hyperglycemia.

The nurse examines a woman 1 hour after birth. The woman's fundus is boggy, midline, and 1 cm below the umbilicus. Her lochial flow is profuse, with two plum-sized clots. What is the nurse's initial action?

Massage her fundus. A boggy or soft fundus indicates that uterine atony is present. This is confirmed by the profuse lochia and passage of clots. The first action is to massage the fundus until firm. There is no indication of a distended bladder; thus having the woman urinate will not alleviate the problem. The physician can be called after massaging the fundus, especially if the fundus does not become or remain firm with massage. Methylergonovine can be administered after massaging the fundus, especially if the fundus does not become or remain firm with massage.

The nurse is assessing a pregnant client at 16 weeks of gestation. Which diagnostic test should the nurse say is used to identify neural tube defects in the fetus?

Measurement of maternal serum alpha-fetoprotein is performed between 16 and 18 weeks of gestation to determine the risk of neural tube defects. The fetus is at increased risk for neural tube defects such as spina bifida, anencephaly, and microcephaly. Fetal echocardiography is performed between 20 and 22 weeks of gestation to detect cardiac anomalies. Glycosylated hemoglobin is measured to assess glycemic control over the previous 4 to 6 weeks. The nonstress test (NST) is performed between 28 and 32 weeks of gestation in clients with vascular disease or poor glucose control. The NST is used to evaluate fetal well-being.

Nurses must be cognizant of the growing problem of methamphetamine use during pregnancy. When caring for a woman who uses methamphetamines, it is important for the nurse to be aware of which factor related to the abuse of this substance?

Methamphetamine users are extremely psychologically addicted. Typically these women display poor control over their behavior and a low threshold for pain. This substance is relatively inexpensive and easy to obtain. Methamphetamines are vasoconstrictors. The rate of relapse for methamphetamine users is very high.

The nurse is teaching a client diagnosed with phenylketonuria (PKU) about foods to be avoided in the daily diet. Which foods can have an adverse effect on the mother and fetus? Select all that apply.

Milk Eggs Nuts A client diagnosed with PKU must avoid milk, eggs, and nuts in her diet before conception and throughout the pregnancy. The client must have a modified diet that excludes all high-protein foods. The client lacks the enzyme phenylalanine hydrolase; this lack impairs her body's ability to metabolize the amino acid phenylalanine, found in all protein foods. Most fruits and vegetables contain very little or no proteins; the client may include these in her diet.

Which physiologic change causes a postpartum increase in circulating blood volume?

Mobilization of extravascular fluid Three physiologic changes occur postpartum to protect the client by increasing circulating blood volume during puerperium. Mobilization of extravascular fluid to intravascular space increases the circulating blood volume postpartum. The placenta, which has the capability to release vasodilation-stimulating hormones, acts as an endocrine organ during pregnancy. In postpartum clients the stimulus for vasodilation is removed. Reduction in plasma volume results because of diuresis during immediate puerperium. This does not account for the increase in circulating blood volume. Postpartum hormonal changes result in reduced kidney function, which includes decreased water reabsorption, resulting in diuresis. Hence, this does not cause an increase in circulating blood volume.

A client with postpartum depression has been prescribed a monoamine oxidase inhibitor (MAOI). On assessing the client's dietary habits, the nurse finds that the client eats preserved meats and liver frequently. Which complications could these dietary choices pose to the client? Select all that apply.

Monoamine oxidase inhibitors (MAOIs) interact with food substances that contain tyramine, such as preserved meat and chicken or beef liver. This may result in hypertensive crisis, which is characterized by stiff neck, flushing, and chest pain. Back pain and abdominal pain are not associated with hypertensive crisis. They are symptoms of generalized anxiety disorder

The nurse is caring for an infant who is suspected to have neonatal sepsis. Which risk factor would the nurse expect to observe?

Multiple gestation and low birth weight. Neonatal risk factors include multiple gestation and low birth weight. LGA and infant of a diabetic mother are not neonatal risk factors. SGA and intrauterine growth restriction are not neonatal risk factors for this infant. Singleton and female are not neonatal risk factors.

A nurse providing care to preterm infants should understand that nasogastric and orogastric tubes are used to assist in what?

Nasogastric and orogastric tubes are used in gavage feeding, providing breast milk or formula directly to an infant unable to nipple feed. Nasogastric and orogastric tubes are not used in order to help maintain body temperature. This infant should be placed on a warmer. Nasogastric and orogastric tubes cannot provide O2 and ventilation. Supplemental oxygen, continuous positive airway pressure (CPAP), and a ventilator are used for O2 and ventilation. Surfactants are not replaced by using nasogastric or orogastric tubes.

A pregnant client experienced preterm labor at 30 weeks gestation. Upon assessing the client the nurse finds that the newborn is at risk of having cerebral palsy. Which medication administration should the nurse perform to prevent cerebral palsy in the newborn?

Newborns who are born before 32 weeks' gestation may be at risk of cerebral palsy. Administering magnesium sulfate to the client can prevent this risk, because it would delay delivery. Calcium gluconate is administered when the preterm child has magnesium toxicity. This intervention would not help to prevent cerebral palsy. Also, the newborn would not have a fully developed respiratory system. Therefore, administering glucocorticoids to the pregnant client would help to prevent risk of respiratory depression in the baby. However, it does not help in preventing cerebral palsy. Administering antibiotics during labor would help prevent neonatal group B streptococci infection.

In the current practice of childbirth preparation, emphasis is placed on what?

No specific method, but a variety of techniques. Encouraging expectant parents to attend class is most important, because preparation increases a woman's confidence and thus her ability to cope with labor and birth. Gaining in popularity are Birthing from Within and Hypnobirthing. Historically the Dick-Read is a popular childbirth method still in use. The goal is to encourage new parents to attend any one of the acceptable childbirth education programs. The Lamaze method is less focused on a "method" approach and more concerned with psychologic preparation for labor. Attendance at any available class should be encouraged. Bradley as well as other methods encourage women to choose the techniques that work best for them. Women are assisted to develop their own birth philosophy and then choose from a variety of skills to help cope with the labor process.

The fetal fibronectin test of a pregnant client is positive, and her cervical length is found to be 32 mm. What will the nurse interpret from these observations regarding the client's pregnancy status?

Normal gestation labor The cervical length and fibronectin test help to identify the risk of preterm delivery in the client. If the cervical length of the client is greater than 30 mm, the client would not have preterm labor, irrespective of having the symptoms of preterm labor. Because the cervical length of the patient is 32 mm, the client may have normal gestational labor. Cervical length and the fibronectin test do not indicate whether the client would have a miscarriage. If the cervical length is less than 30 mm, the client may have indicated or spontaneous preterm labor.

After reviewing the blood glucose levels of a client, the nurse finds that the client is hypoglycemic and gives three glucose tablets to the client. After 15 minutes, the nurse finds that the client is still hypoglycemic, and again administers three glucose tablets. What should the nurse do next, if the client's blood glucose is 60 mg/dl after 15 minutes?

Notify the primary health care provider. The hypoglycemic client's blood sugar level has not risen after giving three glucose tablets twice over an interval of 15 minutes each. In this situation, the nurse should notify the primary health care provider so that emergency intervention can be provided. Administering three more glucose tablets would not be of use, because this intervention had not been useful to improve the client's blood sugar level previously. An intravenous push of 50% dextrose should be done if the hypoglycemic client has become unconscious. In this case, arterial blood gas analysis would not be helpful in finding out the cause of persistent low blood sugar

What nursing intervention is important to implement when caring for a substance-abusing client?

Nurses must understand that substance abuse is an illness and that the client deserves to be treated with patience, kindness, consistency, and firmness when necessary. The most important nursing intervention to implement when caring for a substance-abuse client is that nurses must understand that substance abuse is an illness and that the client deserves to be treated with patience, kindness, consistency, and firmness when necessary. The interventions that nurses must confront the substance-abuse client and force him or her into treatment; nurses should try to understand that substance abusers are just like any other client and should be treated the same; and nurses should get a nurse who is recovering from substance abuse to care for the substance-abuse client are not appropriate interventions to implement.

Which is a priority nursing intervention when providing care for a high risk infant?

Nursing interventions should be implemented in a way that facilitates the conservation of energy in a high risk infant. The infant can then use this energy for growth and development. To prevent stress the nurse avoids touching the infant often. Enteral feeding may be contraindicated in some infants to prevent complications. Breastfeeding may not be possible in infants with respiratory distress syndrome and therefore parenteral nutrition may be required.

For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse?

One fetal movement noted in 1 hour of assessment by the mother. Self-care in a postterm pregnancy should include performing daily fetal kick counts three times per day. The mother should feel four fetal movements per hour. If fewer than four movements have been felt by the mother, she should count for 1 more hour. Fewer than four movements in that hour warrants evaluation. A fetal heart rate of 120 beats/min is a normal finding at 42 weeks of gestation. Cervical dilation of 2 cm with 50% effacement is a normal finding in a woman at 42 weeks of gestation. A score of 8 on the BPP is a normal finding in a pregnancy at 42 weeks.

The nurse is preparing a client for abortion. Which medicine is administered to the client after the evacuation of the uterus to prevent hemorrhage?

Oxytocin (Pitocin). Oxytocin (Pitocin) is administered to the client to prevent hemorrhage after evacuation of the uterus. It prevents hemorrhage by causing contractions of the uterus. Misoprostol (Cytotec) is used to complete a missed miscarriage within 7 days. It helps by expelling the products of conception from the uterus. Vitamin K (Aqua-Mephyton) is used for the treatment of disseminated intravascular coagulation (DIC). Magnesium sulfate (Sulfamag) is used for tocolysis to suppress uterine contractions.

A newborn's heart rate is 80 beats per minute. The nurse learns that during labor, the amniotic fluid was meconium stained. What further assistance should the nurse provide to the newborn?

Oxytocin may cause uterine tachysystole, which may lead to meconium-stained amniotic fluid. Meconium contains waste products of the fetus. Meconium-stained amniotic fluid increases the risk of fetal meconium aspiration. Therefore, the newborn should be provided endotracheal suction to help remove the meconium aspirated into the lungs. The newborn's heart rate of 80 beats per minute indicates reduced heart rate that should be managed by providing ventilation support to the newborn. A large-bore suction catheter and bulb syringe are used to remove meconium ingested by the baby if the heart rate of the newborn is more than 100 beats per minute. The nurse should remove the ingested meconium first. Incubating the newborn and providing backrubs would not help to remove the meconium. A sucrose solution of 5 mg is administered to newborns with hypoglycemia. Sucrose solution is unrelated to meconium aspiration.

What are the complications parvovirus B19 can cause during pregnancy? Select all that apply.

Parvovirus B19, also known as slapped cheek illness, is an infection that can result in miscarriage, fetal demise, hydrops fetalis, fetal anemia (not fetal polycythemia), intrauterine growth restriction (IUGR), and stillbirth (not live birth).

The nurse is assessing a pregnant client at 6 weeks of gestation. Upon reviewing the client's medical history, the nurse finds that the client had undergone a large cone biopsy. Which treatment strategy does the nurse expect to be most beneficial to prevent miscarriage in the client?

Performing abdominal cerclage at 11 weeks of gestation A client who has undergone a large cone biopsy may be at risk of miscarriage due to the presence of an extremely short cervix. Therefore, the primary health care provider would perform an abdominal cerclage at 11 or 13 weeks of gestation in order to prevent the opening of the cervical os. Misoprostol (Cytotec) is a prostaglandin analogue that induces miscarriage. Therefore, misoprostol (Cytotec) does not help to prevent miscarriage in the patient. Ergonovine (Methergine) causes uterine contractions and helps prevent excessive bleeding, but it does not prevent miscarriage. A rescue cerclage cannot be performed in a client who has undergone a large cone biopsy, because the client has a short cervix.

A client reports painless, bright-red vaginal bleeding during the second trimester of pregnancy. Upon assessment, the nurse finds that the client's urine output has decreased, the fundal height has increased, and the uterus is nontender with normal tone. What does the nurse interpret from these findings?

Placenta previa Placenta previa is an obstetric complication in which the placenta is implanted partially or completely in the lower uterine segment (near to or covering the cervix). Painless, bright-red vaginal bleeding takes place during the second trimester. Decreased urine output, greater-than-expected fundal height, and a nontender uterus with normal tone are signs of placenta previa. In ectopic pregnancy the fertilized ovum is implanted outside the uterine cavity. Hydatidiform mole is a benign proliferative growth of the placental trophoblast in which the chorionic villi develop into cystic vesicles that hang in a grapelike cluster. Decreased urine output is a complication seen in clients with diffused intravascular coagulopathy (DIC).

A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of what condition?

Placental abruption Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption). Women with hypertension are at increased risk for an abruption. Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture presents as hypotonic uterine activity, signs of hypovolemia, and in many cases the absence of pain. Placenta previa presents with bright red, painless vaginal bleeding.

The nurse is caring for a postpartum client who gave birth to a full-term infant. After delivery, the nurse places the newborn on the client's chest. What is the reason for such an intervention?

Placing the newborn on the patient's chest during the first hour establishes skin-to-skin contact. This intervention helps foster milk production and initiate breastfeeding. The mother does not recognize the infant's hunger cues simply because the infant is on her chest. Rooming-in helps the patient initiate breastfeeding and recognize the newborn's hunger cues. Pulmonary development in a full-term newborn occurred in the mother's womb itself, not after birth. Symptoms like anxiety and restlessness are common in every postpartum client. Placing the infant on the client's chest facilitates bonding between the client and the infant but may not reduce the client's anxiety and restlessness.

The nurse is caring for a client who is 35 weeks pregnant, and reports moderate vaginal bleeding. The ultrasonographic reports indicate abruptio placentae. Which immediate interventions should the nurse provide?

Prepare the client for delivery. The nurse should immediately prepare the client for delivery because the client is near the end of gestation and has moderate bleeding. The client's hemoglobin and hematocrit values should be determined to monitor the bleeding. However, this intervention can be performed after the client is admitted for delivery. The nurse should assess the blood and fluid volume by inserting a catheter during delivery to determine if blood transfusion is necessary. Oxygen therapy may be given if the client has difficulty in breathing.

Which of the following increase the risk of preterm infants developing hematologic problems? Select all that apply.

Prolonged PT time Decreased red blood cell survival time Decrease in erythropoiesis Prolonged PT reflects an increased tendency to bleed in preterm infants. Decrease in red blood cell survival time is seen in preterm infants. Decreased functional ability of erythropoietin following birth is seen in preterm infants limiting red blood cell synthesis. One sees an increase in the size of red blood cells in preterm infants; this affects the survival time of the red blood cells. One sees increased capillary fragility in preterm infants.

The nurse is caring for a client with insulin-dependent diabetes mellitus in the first trimester of pregnancy. The client feels dizzy and lethargic and her blood glucose level is 50 mg/dl. What should the nurse do first in this situation?

Provide the client a dose of glucose gel or a few glucose tablets. Symptoms such as dizziness and lethargy, as well as a blood glucose level of 50mg/dl, indicate that the client may have hypoglycemia or be in insulin shock. Pregnant client with insulin-dependent diabetes mellitus are extremely prone to hypoglycemia during the first trimester, because estrogen and progesterone stimulate the release of insulin. In this situation, the nurse should give the client fast glucose in the form of a gel or tablets to quickly stabilize the client . If the client is hypoglycemic, the nurse should not ask the dietician to prescribe a completely sugar-free diet. The signs and symptoms of the client do not indicate that the client may have retinopathy and nephropathy. The progesterone and estrogen levels are high in a pregnant client In this situation, it is not important to assess the levels of these hormones.

The nurse is assessing a client with hyperemesis gravidarum during the early stages of pregnancy. Which nonpharmacologic measure is appropriate to alleviate the discomforts associated with nausea and vomiting?

Providing environment that is free from odors. The client must be allowed to rest in an environment that is free from odors. This helps to alleviate the discomforts associated with hyperemesis gravidarum. Most clients find exposure to cooking odors nauseating; it is better to have other family members cook for the client. It is important for the client to have limited periods of visitation and receive adequate rest, because sleep disturbances accompany hyperemesis. The client is able to tolerate dry, cold foods better than warm, soupy foods.

The nurse is assessing a postpartum client 6 hours after delivery. The nurse finds that the client's body temperature is 100.3° F. What should the nurse do in this situation?

Recheck the temperature again 24 hours after delivery. It is natural for a client's body temperature to be slightly elevated for 24 hours following delivery. In this situation, the nurse should check the client's temperature 24 hours postdelivery to see if it has stabilized. The client does not have a fever so does not need to be given a cold compress. The client's urine sample needs to be cultured only if the client is suspected to have urinary tract infection. Based on this information, the nurse cannot conclude that the client has a urinary tract infection. Ice packs can be applied to reduce breast tenderness and discomfort after delivery, but this intervention is not used to bring down the client's body temperature.

A pregnant client is on tocolytic therapy with magnesium sulfate. Under which client circumstance would the nurse suggest discontinuing the therapy?

Respiratory rate is 10 breaths per minute. Magnesium sulfate is used as a tocolytic. However, it can cause severe adverse effects. Therefore the nurse should closely monitor the client. A respiratory rate of 10 breaths per minute indicates that the client has respiratory depression, which is an adverse effect of magnesium sulfate. Therefore the nurse should stop administration of the drug. A blood pressure of 120/80 mm Hg is normal and does not require discontinuation of magnesium sulfate. Urine output of 40 ml per hour indicates normal urine output; hence, the nurse need not discontinue the therapy. The therapeutic serum magnesium level should be 5 mEq/L to exert its action. Therefore if the serum magnesium level is 5 mEq/L, the nurse need not discontinue the therapy, because it would not cause toxic effects.

A pregnant woman at 14 weeks of gestation is admitted to the hospital with a diagnosis of hyperemesis gravidarum. What is the primary goal of her treatment at this time?

Reverse fluid, electrolyte, and acid-base imbalances Fluid, electrolyte, and acid-base imbalances present the greatest immediate danger to the well-being of the mother and fetus and should be corrected as soon as possible. Resting the GI tract is a component of treatment; however, it is not an immediate goal for this client. Discussing her feelings is also a component of treatment but not an immediate goal at this time. The ability to retain oral fluid and foods is a longer-term goal of treatment for this condition.

The nurse is assessing a client at 30 weeks of pregnancy with poorly controlled pregestational diabetes. The client has come for the antenatal visit on a Monday. When should the nurse ask the client to come next?

Same week on a Thursday. An antepartum client with pregestational diabetes requires more frequent antenatal visits. A client with poorly controlled diabetes who is in the third trimester of pregnancy should visit the clinic twice a week. If the client visited the clinic on a Monday, the nurse should instruct the client to come for the next visit on the same week on a Thursday. A client who is in the first and second trimester of pregnancy can come once in a week or two weeks. Because this client is in the third trimester and has poorly controlled diabetes, the nurse should not ask the client to come on next week on Monday, Thursday, or the week after next on Monday.

The nurse is preparing a diet plan for a Korean postpartum patient. What food should the nurse include in the client's diet plan to possibly increase the production of breast milk?

Seaweed soup is preferred by Korean clients after delivery to increase milk production. Some cultures believe that clarified butter will clear out meconium. Corn syrup solids are added to infant formula to increase carbohydrate levels. Hmong patients prefer boiled chicken as part of their diet in the first month after birth. Test-Taking Tip: Watch for grammatical inconsistencies. If one or more of the options is not grammatically consistent with the stem, the alert test taker can identify it as a probable incorrect option. When the stem is in the form of an incomplete sentence, each option should complete the sentence in a grammatically correct way.

Which antidepressant medication cannot be given with dextromethorphan?

Sertraline (Zoloft) is a selective serotonin reuptake inhibitor (SSRI) that reduces symptoms of depression. SSRIs interact with dextromethorphan (Benylin), trigger serotonin syndrome, and cause hyperreflexia, shivering, and diarrhea in clients. In order to prevent serotonin syndrome, the nurse advises the client to avoid taking cough preparations that contain dextromethorphan (Benylin). Phenelzine (Nardil) is a monoamine oxidase inhibitor (MAOI). It does not interact with dextromethorphan (Benylin). Nortriptyline (Pamelor) and clomipramine (Anafranil) are tricyclic antidepressants. They are relatively safer than SSRIs and do not interact with dextromethorphan (Benylin).

After placing an infant in the radiant warmer bed, the nurse observes that the infant has cyanosis, bradycardia, and 90% oxygen saturation. What immediate care should the nurse provide?

Signs such as cyanosis, bradycardia and low oxygen saturation indicate that the infant is hypoxic. Therefore, the nurse should provide hood therapy to supply oxygen to the infant. The nurse should avoid providing rapid heat when the infant is hypoxic, and, instead, should provide oxygen supply to maintain oxygen saturation levels (greater than 92%). Dextrose should be administered if the infant has reduced glucose levels (less than 40 mg/dl). Antibiotics are prescribed when the infant has unregulated respiratory depression and it is suspected that sepsis might develop.

What does the nurse teach a group of expectant mothers about slow-paced breathing?

Slow-paced breathing is performed at approximately half the patient's normal breathing rate. It is initiated in the first stage of labor when the patient can no longer walk or talk through contractions. Patterned-pace breathing, not slow-paced breathing, is performed during the onset of the second stage of labor. Modified-paced breathing requires the patient to remain alert and concentrate more fully on breathing.

The nurse finds that the blood pH of a pregnant client who is diabetic is 6.5. What should the nurse administer to normalize the client's blood pH?

Sodium bicarbonate solution A blood pH of 6.5 indicates that the client has acidosis. In order to revert this state, the nurse should administer an alkaline solution, such as sodium bicarbonate solution. Dextrose and normal saline solution are neither acidic nor alkaline. These solutions would not help to normalize the blood pH. Sodium citrate solution would increase acidity and would worsen the client's condition.

The 5 A's Screening Intervention tool is based on client response. What is it used to help?

The 5 A's Screening Intervention tool is based on client response and is used to implement smoking cessation only, not to help a person quit alcohol, methamphetamines, or heroin.

The nurse assesses a postpartum client who is breastfeeding her infant. The client states that she does not consume eggs or meat. The nurse is aware that the infant may have which deficiency?

The client does not consume eggs and meat, which are rich sources of vitamin B12. Therefore, the infant should receive supplemental vitamin B12 from birth to decrease the risk associated with vitamin B12 deficiency. Vitamin D is absent in human milk. It is produced in the infants when they are exposed to sunlight. Vitamin E deficiency is not observed in clients who do not consume eggs and meat. Deficiency of vitamin K may occur in the infant if the client does not consume green leafy vegetables.

The nurse advises a postpartum client to avoid direct breastfeeding. What could be the reason for this suggestion?

The client has herpes simplex lesions on her breasts. The client with herpes simplex lesions should avoid direct breastfeeding of the newborn. The herpes simplex virus spreads through oral contact and is most contagious when lesions are present. Thalassemia is an inherited condition that affects the baby's ability to produce healthy hemoglobin. Thalassemia does not affect breastfeeding. Mothers of preterm infants are encouraged to breastfeed their babies. A client with acute H1N1 infection is temporarily isolated from the newborn to reduce the risk of transferring the virus from the client to the newborn.

The nurse is caring for a client who reports abdominal pain and abnormal vaginal bleeding after the menstrual cycle. The nurse tells the client, "You should not consume foods rich in folic acid, and you should stay indoors." What is the reason for these instructions?

The client is taking methotrexate (MTX). Abdominal pain and abnormal vaginal bleeding after the menstrual cycle indicate that the client has ectopic pregnancy. MTX therapy is used in the treatment of ectopic pregnancy. Folic-rich, gas-forming foods and sun exposure decreas the effectiveness of MTX. These factors do not affect the effectiveness of oxytocin (Pitocin), misoprostol (Cytotec), and ergonovine (Methergine). Hence, the client does not need to avoid folic-rich, gas-forming foods, or sun exposure, while taking oxytocin (Pitocin), misoprostol (Cytotec), and ergonovine (Methergine).

The nurse is assessing a preterm baby and observes dark red skin color with harlequin signs on the skin. What does the nurse infer from these findings? The baby has what?

The dark red color skin of the newborn with harlequin signs indicates polycythemia. Polycythemia is common in preterm infants due to the presence of fetal red blood cells (RBCs). The presence of hypotension in the infant is indicated by grey coloration of the skin. Presence of hyperthermia in a newborn is indicated by blue coloration (cyanosis) of the skin. Neurologic disorders are associated with cyanosis, but not with polycythemia.

The anesthesia care provider accidentally causes dural puncture while administering an epidural block to a pregnant client in labor. On assessment, the primary health care provider prescribes an autologous epidural blood patch for the client. Which condition in the client indicates a need for this order?

The dural puncture may cause postdural puncture headache (PDPH), or spinal headache. The use of an autologous epidural blood patch helps constrict the cerebral blood vessels and relieve the spinal headache. Fetal hypoxia is a side effect of opioids and occurs due to a decrease in maternal heart and respiratory rates and blood pressure. Hypotension may occur as a side effect of spinal anesthesia. The leakage of cerebrospinal fluid may be a side effect of the blood patch.

Which factor increases the risk of complications for infants of diabetic mothers?

The duration and severity of maternal disease is a significant factor in increasing the risk for complications in infants of diabetic mothers. Glycemic control would be a positive factor indicating that blood glucose levels were maintained within normal range. Hemoglobin A1c level of 7 is within normal range. Decreased hemoglobin A1c levels indicate adequate glycemic control in the periconception period.

What assessment finding does the nurse expect to find in a postpartum patient 12 hours after childbirth?

The fundus is approximately 1 cm above the umbilicus. The fundus can rise to approximately 1 cm above the umbilicus within 12 hours after childbirth. By the sixth postpartum day the fundus is normally located halfway between the umbilicus and the symphysis pubis. At the end of the third stage of labor, the uterus is in the midline, approximately 2 cm below the level of the umbilicus with the fundus resting on the sacral promontory. The uterus is about the same size as it was at 20 weeks' gestation at 24 hours post-birth, not 12 hours after birth.

The nurse observes pinpoint hemorrhagic spots on the face and trunk of an infant after a forceps delivery. These hemorrhagic spots disappear within 2 days. What does the nurse infer from this observation?

The infant has benign hemorrhagic areas. Pinpoint hemorrhages such as ecchymoses and petechiae are observed on the neonate's body when instrumentation (forceps or a vacuum cup) is used to assist with delivery of the infant. The disappearance of the pinpoint hemorrhages within 2 days indicates that they are benign, or harmless. Cephalhematoma is caused by the pressure applied when the fetal head is pushed through the dilated cervix. Ecchymoses and petechiae are unrelated to cephalhematoma. Scleral hemorrhage results from the rupture of capillaries due to increased intracranial pressure. Scleral hemorrhage is unassociated with ecchymoses and petechiae. Ecchymoses or petechiae that persist for more than 2 days indicate a serious disorder such as thrombocytopenic purpura.

The nurse finds that an infant has tremors and decreased serum calcium levels. Which finding from the child's medical history may be responsible for these symptoms?

The infant's mother feeds unmodified cow's milk to the infant. Cow's milk is rich in calcium. However, unmodified cow's milk has a low calcium to phosphorus ratio and results in decreased calcium absorption. It causes hypocalcemia and tremors in the infant. Therefore, the nurse should check whether the infant's mother is feeding the infant unmodified cow's milk. Fluoride supplements cause spotting of the permanent teeth (fluorosis). If the infant's mother underwent bariatric surgery, then the risk of vitamin B12 deficiency is increased in the infant. Because infants have immature kidneys, concentrated formula may impede the filtration ability of the infant's kidneys.

The most commonly used antidepressant in pregnancy

The most commonly used antidepressant drugs are often divided into four groups: TCAs, MAOIs, SSRIs, and SNRIs.

Diabetes in pregnancy puts the fetus at risk in several ways. Of what should the nurse be aware regarding this?

The most important cause of perinatal loss in diabetic pregnancy is congenital malformations. congenital malformations account for 30% to 50% of perinatal deaths. Even with good control, sudden and unexplained stillbirth remains a major concern. Infants of diabetic mothers are at increased risk for respiratory distress syndrome. The transition to extrauterine life often is marked by hypoglycemia and other metabolic abnormalities.

The nurse is assessing the body temperature of a neonate born 8 hours ago by placing the neonate on the mother's abdomen. The nurse finds that the neonate's body temperature is decreasing gradually. Based on these findings, the nurse concludes the mother's record to be normal. Which maternal condition is responsible for the neonate's decreasing body temperature?

The mother has been administered magnesium sulfate. The nurse places the neonate on the mother's abdomen to maintain thermoregulation. If the mother has been administered magnesium sulfate, the newborn may develop vasoconstriction. This reduces the newborn's ability to conserve heat. Though the birth was through cesarean section, the newborn's temperature should stabilize within 9 hours after the birth in extrauterine life. Neither gestational hyperglycemia nor Ringer's lactate solution would prevent thermoregulation between the neonate and the mother.

The nurse is teaching care guidelines to a postpartum client who is addicted to cocaine. Which action followed by the client reduces hyperactivity in the newborn?

The newborn that is exposed to cocaine has irritability, hyperactivity, inability to interact, and gaze aversion. Therefore, the client should use vertical rocking techniques to prevent overstimulation and hyperactivity in the newborn. Cocaine is also found in breast milk. Therefore, feeding breast milk to the newborn can worsen the symptoms of neonatal abstinence syndrome. The client should avoid maintaining eye contact while feeding or talking with the newborn because it causes overstimulation. The client should hold the infant firmly and close to the body to prevent self-stimulation.

What should the nurse instruct the parents about traveling with the infant in a car?

The nurse must instruct the parents about travelling with a federally approved rear-facing car seat in the rear of the car. The infant must be correctly secured in the car seat. The infant must be placed at 45-degree angle in the car seat to prevent slumping, which can lead to airway obstruction. The infant must travel in a rear-facing car seat until the age of 2. A car safety seat that faces the rear protects the weak neck and heavy head of the infant. The infant must never be placed in the front seat of cars with front air bags because the car seat is close to the dashboard. Serious injury can occur in the event of an accident.

The nurse is teaching the parents of an infant about prevention and care of diaper rash. Which intervention is appropriate when caring for an infant with diaper rashes?

The nurse must teach the parents to check the diaper often and change it as soon as the infant voids or stools to prevent discomfort and infection. The diaper area may be cleaned with baby wipes that are not scented and do not contain alcohol. Parents should avoid the use of baby powder, because it irritates the infant's lungs. The buttocks may be exposed to air to help dry up diaper rash by decreasing proliferation of bacteria. Warm water and mild soap with neutral pH may be used to clean the diaper area, especially after the infant has passed urine or stool.

The nurse observes that a breastfeeding client is experiencing postpartum fatigue (PPF). Which intervention may help reduce fatigue in this client?

The nurse should suggest fewer visitors in the hospital so that the client gets enough rest, but should encourage visitors to help the new mother with housework and meals when she returns home. Postponing hospital discharge will not ensure that the client will get enough rest. The nurse does not encourage the client to avoid ambulation, because it may increase the risk for venous thromboembolism. The side-lying position for breastfeeding may promote rest and reduce postpartum fatigue (PPF), but it is not recommended because of the risk of sudden infant death syndrome (SIDS) in newborns.

The nurse is providing discharge teaching to a nonlactating client who has breast engorgement. What should the nurse suggest that the client do in order to reduce tissue swelling and suppress milk production?

The nurse should suggest that the client apply cabbage leaves on her breasts between feedings, because the photochemical present in cabbage leaves reduces tissue swelling and suppresses milk flow. Hydrogel pads reduce inflammation and provide comfort. They do not suppress milk flow. Taking warm showers stimulate milk flow. They do not reduce tissue swelling. Breast shells prevent irritation, but do not suppress milk production.

A pregnant client is diagnosed with succenturiate placenta. What should the nurse understand about the client's condition?

The placenta is divided into more lobes, rather than a single lobe. When the placenta is divided into two or more lobes, rather than as a single mass, it is called a succenturiate placenta. Premature separation of the placenta from the uterus is called abruptio placentae. A placenta implanted in the lower uterine segment is known as placenta previa. Benign proliferative growth of the placental trophoblast is known as molar pregnancy.

The nurse is assessing a pregnant client who takes nifedipine (Adalat). What instruction does the nurse provide to ensure the client's safety?

The potent vasodilator effect of nifedipine (Adalat) causes variations in the blood pressure of a pregnant client. So, the nurse advises the client to consume adequate fluids to maintain blood pressure. Nifedipine (Adalat) is best tolerated when taken with food. Hence, the nurse does not ask the client to take the medication on empty stomach. Clients on glucocorticoids are advised to avoid carbohydrate-rich foods, because glucocorticoids increase glucose levels in the body, and are unrelated to nifedipine (Adalat). Nifedipine (Adalat) is taken orally and does not require medical supervision to administer it.

The primary healthcare provider instructs the nurse to give a hepatitis B (HepB) vaccine to a newborn. How should the nurse administer the vaccine? Select all that apply.

The preferred injection site for a newborn is the vastuslateralis muscle in the thigh at a 90-degree angle. This is the best choice because this muscle has an adequate amount of muscle mass and fat. Administration of the hepatitis B (HepB) vaccine through the deltoid muscle is not recommended in infants, because this muscle has an inadequate amount of muscle for intramuscular (IM) administration. The dorsogluteal muscle is very small, poorly developed, and dangerously close to the sciatic nerve, which occupies a proportionately larger area in infants than in older children. Therefore it is not recommended as an injection site in newborns. The administration of the hepatitis B (HepB) vaccine is done by inserting the needle at a 90-degree angle, not at a 60-degree angle.

The nurse is caring for an addicted mother who gave birth 24 hours ago. The mother is on methadone for her addiction. What therapy would be used for neonatal withdrawal?

The therapy used for methadone withdrawal is similar to the therapy for heroin withdrawal. Buprenorphine, a partial agonist-partial antagonist synthetic opioid with a long duration of action, has gained acceptance and FDA licensing for treating opioid addiction. Antabuse is used in the treatment of alcohol. Methadone and phenobarbital are used in the treatment of heroin addiction

The nurse is conducting a pelvic examination of a postpartum client in the sixth week following delivery. The nurse finds that the client has a palpable uterus and an infection due to retention of placental fragments. Which condition is likely to be found in the client?

The uterus should not be palpable after 2 weeks following delivery and will return to its prepregnant location by 6 weeks after childbirth. A palpable uterus 6 weeks after delivery indicates subinvolution. The failure of the uterus to return to its prepregnant state is known as subinvolution. Subinvolution may occur due to retention of placental fragments after labor

With regard to what might be called the tactile approaches to comfort management, nurses should be aware that:

The woman and her partner should experiment with massage before labor to see what might work best. Heat and cold may be applied in an alternating fashion for greater effect. Unlike acupressure, acupuncture, which involves the insertion of thin needles, should be done only by a certified therapist. Therapeutic touch is a laying-on of hands technique that claims to redirect energy fields in the body.

A laboring woman becomes anxious during the transition phase of the first stage of labor and develops a rapid and deep respiratory pattern. She complains of feeling dizzy and light-headed. What should the nurse's immediate response be?

The woman is exhibiting signs of hyperventilation. This leads to a decreased carbon dioxide level and respiratory alkalosis. Rebreathing her air would increase the carbon dioxide level. Telling her to breathe more slowly does not ensure a change in respirations. Turning her on her side will not solve this problem. Administration of a sedative could lead to neonatal depression because this woman, being in the transition phase, is near the birth process. The side-lying position is appropriate for supine hypotension.

What does the nurse teach a couple expecting their first child about the use of therapeutic touch (TT) to relieve pain during labor?

Therapeutic touch (TT) uses the concept of energy fields within the body, called prana. Specially trained persons lay hands on to redirect energy fields associated with pain. According to this concept, prana are thought to be deficient in some people who are in pain. Counterpressure is steady pressure applied by a support person to both hips to cope with the sensation of internal pressure. Hand and foot massage is found to be especially relaxing in advanced labor when hyperesthesia limits the patient's tolerance for touch on other parts of the body.

The nurse is caring for a neonate. The neonate is showing signs of sepsis. Which would the neonate exhibit? Select all that apply.

Thrombocytopenia and neutropenia Hyperglycemia and metabolic acidosis Feeding intolerance and abdominal distention

After discharge from the hospital, the nurse frequently visits a client who has postpartum depression and also interacts with the client frequently over the telephone. What is the reason behind this intervention?

To determine the need for further care and treatment. After discharging a client with postpartum depression, the nurse should frequently contact the client and interact with her over the telephone, or visit the client's home. It helps the nurse evaluate the client's feelings and perception. Frequently contacting the client helps the nurse determine whether the client requires further care and treatment. The nurse does not assess the client's home environment after discharge; this should be done during the course of the therapy. To prevent loneliness and boredom, the nurse should suggest recreational activities and support groups to the client. To develop a therapeutic relationship with the client, the nurse should be nonjudgmental and follow therapeutic communication methods. Developing a therapeutic relationship with the client is not the main objective of frequent home visits and follow-up care.

The nurse uses microbore tubing while providing continuous gavage feeding to an infant. What is the reason for this intervention?

To prevent calorie loss from the milk. When breast milk is infused through a gavage feeding tube, the cream of the milk may adhere to the tube walls and the baby may not receive sufficient calories from the breast milk. This problem can be prevented by using microbore tubing. The tubing prevents the separation of cream from the milk, thereby preventing the loss of calories. Choking is observed when the infant is overfed and is unrelated to microbore tubing. Mucus aspiration is performed using a bulb syringe, not by using microbore tubing. Gastric hemorrhage is observed in infants with congenital anomalies. Microbore tubing does not prevent gastric hemorrhage.

The nurse is assessing the newborn of a client who is addicted to amphetamine (Adderall). The nurse finds that the newborn has tachypnea, shrill cry, irritability, and seizures. Which interventions does the nurse expect to be beneficial to alleviate the newborn's symptoms? Select all that apply. Administering phenobarbital (Luminal) Wrapping the infant snugly and holding tight

Trachyphea seizures and a shrill cry are the symptoms of neonatal abstinence syndrome. It is most commonly found in newborns of clients who are addicted to psychoactive drugs, such as amphetamine (Adderall). Phenobarbital (Luminal) is an anticonvulsant medication that helps to treat seizures. Therefore, the nurse should administer phenobarbital (Luminal) to alleviate the newborn's symptoms. The nurse should wrap the infant snugly and hold tightly to reduce self-stimulation behavior and protect the skin from abrasions. Neonatal abstinence syndrome is not associated with hyperbilirubinemia. Therefore, the nurse would not monitor serum bilirubin levels. Miconazole (Monistat) is an antifungal medication that helps to treat fungal infection, but not neonatal abstinence syndrome.Expressed milk enhances immunity and prevents risk of infection, but does not reduce symptoms of neonatal abstinence syndrome.

The nurse is assessing a postpartum client who is on tranylcypromine (Parnate) therapy. Upon reviewing the client's dietary habits, the nurse discovers that the client consumes cheese, chicken, and smoked fish regularly. Which complications does the nurse expect to find in the client? Select all that apply.

Tranylcypromine (Parnate) is a monoamine oxidase inhibitor (MAOI). Foods that are rich in tyramine, such as cheese, chicken, and smoked fish, interact with MAOIs and cause hypertensive crisis, resulting in retroorbital pain and occipital headache. Shivering and hyperreflexia are symptoms of serotonin syndrome, which is caused by selective serotonin reuptake inhibitors (SSRIs), but not MAOIs. MAOIs are antidepressant medications that treat depression, but do not cause depression in clients.

Which statement provides helpful and accurate nursing advice concerning bathing the newborn? Select all that apply.

Tub baths may be given before the infant's umbilical cord falls off and the umbilicus is healed. Powders are not recommended because the infant can inhale powder. Tub baths may be given as soon as an infant's temperature has stabilized. Powder is not recommended because of the risk of inhalation. If a parent chooses to use baby powder, it should never be sprinkled directly onto the baby's skin. The parent can apply a small amount of powder to his or her own hand and then apply to the infant. Newborns do not need a bath every day, even if the parents enjoy it. The diaper area and creases under the arms and neck need more attention. Unscented mild soap is appropriate to use to wash the infant. Do not bathe immediately after a feeding period because the increased handling may cause regurgitation.

Perineal care is an important infection control measure. When evaluating a postpartum woman's perineal care technique, the nurse would recognize that the patient understands this properly if she does what? Select all that apply.

Uses soap and warm water to wash the vulva and perineum Washes from symphysis pubis back to the episiotomy Changes her perineal pad every 2 to 3 hours

Which description of postpartum restoration or healing times is accurate?

Vaginal rugae are never again as prominent as in a nulliparous woman. Localized dryness may occur until ovarian function resumes. The cervix regains its form within days; the cervical os may take longer. Most episiotomies take 2 to 3 weeks to heal. Hemorrhoids can take 6 weeks to decrease in size.

The nurse auscultates a neonate in resting position and hears a murmur. What further assessments should the nurse make to know if the infant has any cardiac defects?

When murmurs are heard, the nurse should check the neonates' BP from all four extremities to rule out congenital heart diseases. Circumference of the head is measured to detect head-related complications, such as microcephaly and hydrocephaly. However, it is unrelated to congenital heart disease. Assessing the body movements would correlate more with the muscular activity of the neonate, but not the cardiac activity.

The nurse is collecting a neonate's blood sample by the heelstick method. What safety measure will the nurse follow to prevent necrotizing osteochondritis in the neonate?

When performing the heelstick method, the nurse punctures the heel of a neonate at a depth of 2.4 mm to prevent necrotizing osteochondritis. The nurse should apply warm pressure before performing the puncture, not cold pressure. The nurse would make an imaginary line before puncturing the heel of a newborn, but the line is not on the hip. The nurse would not repeat the test on the other side to prevent necrotizing osteochondritis, but, rather, will perform the test accurately the first time.

The insulin dose of a client in the second trimester of pregnancy has been increased. When does the nurse expect the client's prepregnant dose of insulin to be recommended again?

When the client weans the baby from breastfeeding. Pregnancy hormones cause increased glucose tolerance and decreased sensitivity to insulin. This results in an increased need of insulin to obtain glycemic control. In this case, the client's glucose metabolism would reach its prepregnant state only when the client stops breastfeeding the baby. During lactation, the maternal glucose is utilized and, therefore, the client would require a low dose of insulin. When the client delivers the baby, the insulin-glucose levels do not return to their nonpregnant state immediately. Therefore, the client still has to continue with the recommended high insulin dose for some time. During the third trimester, the diabetogenic effect of hormones is excessive, and maternal insulin requirements may double.

With regard to dysfunctional labor, nurses should be aware of what?

Women experiencing precipitous labor have a labor that lasts less than 3 hours. Precipitous labor lasts less than 3 hours. Short women who are more than 30 pounds overweight are more at risk for dysfunctional labor. Hypotonic uterine dysfunction, in which the contractions become weaker, is more common. Abnormal labor patterns are more common in older women.

What discharge instructions are given to the parents of an infant with facial paralysis?

administer eyedrops daily . In an infant with facial paralysis, sometimes the eyelid on the affected side does not close completely. Hence the nurse instructs the parents to instill eye drops in the eyes daily to prevent drying of the conjunctiva, sclera, and cornea. The parent can breastfeed the child with assistance to help the infant grasp and compress the areolar area. Range-of-motion exercises are not necessary in facial palsy; they are necessary for an infant with brachial palsy. It is not necessary to place an infant with facial palsy on the affected side; however, in an infant with phrenic nerve palsy, placing on the affected side will facilitate maximum expansion of the uninvolved lung.

The nurse correctly explains to the nursing student that the majority of ectopic pregnancies are located where?

ampulla. The majority of ectopic pregnancies, approximately 80 percent, are located in the ampulla, or the largest portion of the tube. A pregnancy within the uterus would be considered a normal pregnancy. Implantation of the pregnancy at the cervical os would be a significant abnormality.

What is the pathologic change associated with diabetic ketoacidosis?

celular dehydration. Diabetic ketoacidosis is characterized by an increase in blood sugar and ketone levels. This causes osmotic diuresis, which ultimately results in cellular dehydration. There is loss of electrolytes in ketoacidosis. Ketone bodies in the blood would result in decreased blood pH, which is referred to as metabolic acidosis. In this condition, the kidneys excrete large amounts of fluid, which results in a decrease in blood volume.

What are the clinical manifestations of the infection caused by Toxoplasma gondii? Select all that apply.

chorioretinitis hydrocephalus cerebral calcifications Chorioretinitis, hydrocephalus, and cerebral calcifications are the three detectable clinical signs of the infection caused by Toxoplasma gondii. Polyhydramnios is not associated with Toxoplasma gondii infection. Toxoplasma gondii infection does not cause respiratory distress.

A mother expresses fear about changing her infant's diaper after he is circumcised. What does the woman need to be taught to take care of the infant when she gets home?

cleanse the penis gently with water and put petroleum jelly around the glans after each diaper change. Cleansing the penis gently with water and putting petroleum jelly around the glans after each diaper change is appropriate when caring for an infant who has had a circumcision. With each diaper change, the penis should be washed off with warm water to remove any urine or feces. If bleeding occurs, the nurse should apply gentle pressure to the site of the bleeding with a sterile gauze square. Yellow exudate covers the glans penis in 24 hours after the circumcision. This is part of normal healing and not an infective process. The exudate should not be removed

In which pregnant client does the nurse identify the need to screen for undiagnosed homozygous maternal phenylketonuria (PKU)?

client who has given birth to a microcephalic infant. A client who has previously had a microcephalic infant must be screened for undiagnosed homozygous maternal PKU in the first prenatal visit. Toxic accumulation of phenylalanine in the blood due to a lack of the enzyme phenylalanine hydrolase interferes with brain development. The client who had a previous macrosomic fetus must be screened for hyperglycemia. A client with a macrosomic fetus may have obstructed labor. Placental insufficiency may lead to stillbirth. The client who had placental insufficiency in a previous pregnancy need not be screened for PKU.

Which drug prevents the risk of cerebral palsy in the fetus?

epson salts .Magnesium sulfate. Magnesium sulfate (Epsom salts) is a tocolytic agent used for preventing or reducing the risk of cerebral palsy in the fetus if preterm birth appears inevitable. Nifedipine (Adalat) is a calcium channel blocker used in the tocolytic therapy for preterm labor. Propranolol (Inderal) is used to reverse the intolerable cardiovascular effects of terbutaline (Brethine). Dexamethasone (Decadron) is an antenatal glucocorticoid that is used to prevent the risk of respiratory distress syndrome in the fetus.

Why are monoamine oxidase inhibitors (MAOIs) contraindicated in pregnant clients?

fetal growth restriction. MAOIs cause gestational hypertension and fetal vasoconstriction, resulting in fetal growth restriction. MAOIs do not block dopamine receptors and do not result in extrapyramidal side effects in the client like clomipramine (Anafranil) would. Unlike selective serotonin reuptake inhibitors (SSRIs), MAOIs do not inhibit the synthesis of P-450 isoenzymes in the client or fetus. MAOIs do not decrease insulin production, nor do they increase the risk of gestational diabetes.

A pregnant client has painful lower abdominal cramps and a mucoid vaginal discharge. Upon further examination, the nurse concludes that the client may have a low risk of having a preterm delivery. What finding led the nurse to this conclusion?

he client has a cervical length of 40 mm. Painful, lower abdominal cramps and a mucoid vaginal discharge are symptoms of preterm labor. The cervical length is a good predictor of preterm birth. Women whose cervical length is greater than 30 mm are unlikely to experience premature birth, even if they have symptoms of preterm labor. The cervix needs to prepare itself for childbirth in terms of effacement and dilatation. A previous cesarean birth does not indicate that the woman will likely not have a preterm delivery. Preexisting diabetes and chronic hypertension are preterm birth risk factors.

A woman diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At the present time she is at the greatest risk for what?

hemorrhage Hemorrhage is the most immediate risk because the lower uterine segment has limited ability to contract to reduce blood loss. Infection is a risk because of the location of the placental attachment site; however, it is not a priority concern at this time. Placenta previa poses no greater risk for urinary retention than with a normally implanted placenta. There is no greater risk for thrombophlebitis than with a normally implanted placenta.

The blood glucose level of a pregnant client is 325 mg/dl. Which test should be performed on the patient to assess the risk of maternal or intrauterine fetal death?

ketones in the urine. Diabetic ketoacidosis is a potentially fatal complication of diabetes that can lead to fetal death. This complication may occur if the client's blood glucose levels rise above 200mg/dl. Diabetic ketoacidosis can be confirmed by assessing the presence of ketones in the urine. The client's blood glucose level is 325 mg/dl and, hence, the patient has poorly controlled diabetes. Therefore, the nurse need not assess the urine glucose levels. Arterial blood gases and abdominal ultrasound are not useful for diagnosis of intrauterine fetal death.

Which drug is used for treating a client with severe postpartum bleeding?

oxytocin Oxytocin (Pitocin) is a synthetic hormone used to induce labor and to control severe postpartum bleeding by making the uterus contract. Nifedipine (Adalat) is a calcium channel blocker that is used intocolytic therapy for preterm labor. Propranolol (Inderal) is used to reverse intolerable cardiovascular effects of terbutaline (Brethine). Metronidazole (Flagyl) is a broad-spectrum antibiotic that is used to treat chorioamnionitis after cesarean birth.

The nurse observes that the perineal pad used by a postpartum client is saturated within 15 minutes, and there is blood pooling under the client's buttocks. What action does the nurse take?

perform fundal massage. If the perineal pad is saturated in 15 minutes, and there is blood pooling under the client's buttocks, it indicates excessive blood loss. The nurse should perform fundal massage, because it could lessen the bleeding. Changing the pad every 10 minutes will not help prevent blood loss. The client's blood pressure may not fluctuate until she has lost 30% to 40% of her blood volume. Therefore, the nurse needs to assess other factors like respiration, pulse, skin condition, urinary output, and level of consciousness to understand the risk of hypovolemic shock due to blood loss. The nurse should report the bleeding to the primary health care provider immediately, but should provide a fundal massage first.

The nurse is assessing a postpartum client 12 hours after delivery. The nurse finds that the client's breasts are soft, the uterus is at the level of umbilicus, and deep tendon reflexes are 4+. The client also has dark red rubra. For what condition should the nurse assess based on these findings?

preeclampsia reflexes +4 clonus Preeclampsia is a pregnancy disorder that is associated with high blood pressure. An increase in blood pressure can cause the client to have high muscle contraction and deep tendon reflexes of 4+, so the nurse should assess further for preeclampsia. A client with infection may have high white blood cell count and foul smelling lochia. Presence of dark red rubra is a normal finding. Engorgement is associated with firmness, heat, and pain in the breast. Presence of a soft breast does not indicate that the client has engorgement. The presence of the uterus at the level of the umbilicus during the first 24 hours after the delivery is a normal finding. It does not indicate that the client has uterine atony

The nurse administers magnesium sulfate (Epsom salts) to stop labor in a pregnant client. Which symptoms should the nurse monitor to ensure the client's safety?

respiratory rate Magnesium sulfate (Epsom salts) is administered to a pregnant client to stop labor. Magnesium sulfate (Epsom salts) causes respiratory depression as a toxic effect. Therefore, the nurse should monitor the respiratory rate of the client. Swollen legs or edema is acommon observation during labor, which is caused by increased abdominal contents. Edema is unrelated to magnesium sulfate. Magnesium sulfate (Epsom salts) does not alter a client's eating habits. Maternal chills are observed in clients with membrane rupture and are unrelated to magnesium sulfate (Epsom salts). Test-Taking Tip: Pace yourself while taking a quiz or exam. Read the entire question and all answer choices before answering the question. Do not assume that you know what the question is asking without reading it entirely.

A woman presents to the emergency department complaining of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary health care provider finds that the cervix is closed. The anticipated plan of care for this woman is based on a probable diagnosis of which type of spontaneous abortion?

threatened. A woman with a threatened abortion presents with spotting, mild cramps, and no cervical dilation. A woman with an incomplete abortion presents with heavy bleeding, mild to severe cramping, and cervical dilation. An inevitable abortion presents with the same symptomatology as an incomplete abortion: heavy bleeding, mild to severe cramping, and cervical dilation. A woman with a septic abortion presents with malodorous bleeding and typically a dilated cervix.

The nurse is caring for an infant who has congenital toxoplasmosis. The nurse finds a folic acid supplement in the infant's prescription. What is the reason for folic acid supplementation in an infant?

to prevent anemia. Infants with congenital toxoplasmosis may have severe anemia. Therefore, folic acid supplements are prescribed to prevent anemia due to congenital toxoplasmosis. Leukemia is a cancerous condition in which the white blood cell (WBC) count increases due to the overfunctioning of bone marrow. Congenital toxoplasmosis and folic acid supplements are unrelated to leukemia. Hemophilia is excessive bleeding due to defective clotting factors. Administering folic acid supplements does not prevent hemophilia. Congenital toxoplasmosis, a protozoan infection, can be treated with antibiotics, but not with folic acid. Folic acid supplements are administered to prevent anemia, one of the risks of congenital toxoplasmosis.