Pregnancy, Labor, Childbirth, Postpartum -At Risk

A client is to undergo amniocentesis at 38 weeks' gestation to determine fetal lung maturity. What lecithin/sphingomyelin ratio (L/S ratio) is adequate for the nurse to conclude that the fetus' lungs are mature enough to sustain extrauterine life? 1. 2:1 2. 1:1 3. 1:4 4. 3:4

1. 2:1 **The lecithin concentration increases abruptly at 35 weeks, reaching a level that is twice the amount of sphingomyelin, which decreases concurrently. At 30 to 32 weeks' gestation, the amounts of lecithin and sphingomyelin are equal, indicating lung immaturity. A ratio of 1:4 does not reflect fetal lung maturity; nor does a ratio of 3:4.

A nurse in the clinic, during a routine prenatal visit, notes bruises on the client's upper arms. When questioned, the client responds that her boyfriend was upset and hit her. What is the priority nursing action? 1. Developing a safety plan with the client 2. Calling the nurse manager to inspect the bruises 3. Informing the client that her pregnancy is in danger 4. Notifying social services to monitor the home situation

1. Developing a safety plan with the client

The nurse is counseling a pregnant client with type 1 diabetes about medication changes as pregnancy progresses. Which medication will be needed in increased dosages during the second half of her pregnancy? 1. Insulin 2. Antihypertensives 3. Pancreatic enzymes 4. Estrogenic hormones

1. Insulin

The family of a pregnant client with myasthenia gravis asks the nurse whether the client will be an invalid. What is the best response by the nurse? 1. "Medications will mask the signs of the disease." 2. "With continuous treatment, the progression of the disease can usually be controlled." 3. "The progression is slow, so people with myasthenia will spend their younger life with few problems." 4. "There will be periods when bedrest will be necessary and times when regular activity will be possible."

3. "The progression is slow, so people with myasthenia will spend their younger life with few problems."

A client with frank vaginal bleeding is admitted to the birthing unit at 30 weeks' gestation. The admission data include blood pressure of 110/70 mm Hg, pulse of 90 beats/min, respiratory rate of 22 breaths/min, fetal heart rate of 132 beats/min. The uterus is nontender, the client is reporting no contractions, and the membranes are intact. In light of this information, what problem does the nurse suspect? 1. Preterm labor 2. Uterine inertia 3. Placenta previa 4. Abruptio placentae

3. Placenta previa **A nontender uterus and bright-red bleeding are classic signs of placenta previa ; as the cervix dilates, the overlying placenta separates from the uterus and begins to bleed.

A pregnant woman at 34 weeks' gestation is being seen at the clinic. The client's blood pressure is 166/100 mm Hg and her urine is +3 for protein. She states that she has a severe headache and occasional blurred vision. Her baseline blood pressure was 100/62 mm Hg. What is the priority nursing action? 1. Arranging transportation to the hospital 2. Obtaining a prescription for an antihypertensive 3. Rechecking the blood pressure within 30 minutes 4. Obtaining a prescription for acetaminophen to relieve the headache

1. Arranging transportation to the hospital

On reporting to the labor and delivery area a primipara indicates to the nurse that her contractions are occurring every 5 minutes. Upon further inquiry the nurse learns that the client has not attended any childbirth classes, and a cervical assessment reveals that she is in labor. When is the best time for the nurse to include education on simple breathing and relaxation techniques? 1. During the latent phase of the first stage of labor 2. During the active phase of the first stage of labor 3. During the active phase of the second stage of labor 4. During the transition phase of the first stage of labor

1. During the latent phase of the first stage of labor

During a prenatal interview at 20 weeks' gestation, the nurse determines that the client has a history of pica. What is the most appropriate nursing action? 1. Seeking a psychological referral for the client 2. Ensuring that the client's diet is nutritionally adequate 3. Informing the client of the danger this poses to her fetus 4. Obtaining a prescription for a multivitamin supplement for the client

2. Ensuring that the client's diet is nutritionally adequate

A client at 36 weeks' gestation is admitted to the high-risk unit because she gained 5 lb in the previous week and there is a pronounced increase in blood pressure. What is the initial intervention in the client's plan of care? 1. Preparing for an imminent cesarean birth 2. Providing a dark, quiet room with minimal stimuli 3. Initiating intravenous furosemide to promote diuresis 4. Administering calcium gluconate to lower the blood pressure

2. Providing a dark, quiet room with minimal stimuli **Increasing cerebral edema may predispose the client to seizures; therefore stimuli of any kind should be minimized.

What should be included in the plan of care for a client with class I cardiac disease during the last weeks of pregnancy? 1. Administering penicillin, promoting periods of rest, and daily testing of urine for protein 2. Maintaining bedrest, administering oxygen and penicillin, and monitoring for cardiac decompensation 3. Instituting seizure precautions and instructing the client to report dyspnea, coughing, palpitations, and increased fatigue 4. Advising the client to limit stress, promoting rest after meals, and educating the client about the analgesia and anesthesia used during labor

4. Advising the client to limit stress, promoting rest after meals, and educating the client about the analgesia and anesthesia used during labor

A nurse is counseling a pregnant woman with type 1 diabetes. What is the most important nursing consideration in the planning of care for this client? 1. Higher risk for fetal mortality 2. Possible need for cesarean birth 3. Expectation of lowered insulin needs 4. Requirement of intensive prenatal care

4. Requirement of intensive prenatal care

A nurse is caring for a pregnant client with thrombophlebitis. Which anticoagulant medication may be prescribed? (Select all that apply.) 1. Heparin (Hep-Lock) 2. Clopidogrel (Plavix) 3. Warfarin (Coumadin) 4. Enoxaparin (Lovenox) 5. Acetylsalicylic acid (Acuprin)

1. Heparin (Hep-Lock) 4. Enoxaparin (Lovenox) **Heparin (Hep-Lock) may be used during pregnancy because it does not cross the placental barrier and will not cause hemorrhage in the fetus. Enoxaparin (Lovenox) does not cross the placental barrier; its classification for pregnancy is B.

At 37 weeks' gestation a client's membranes spontaneously rupture but she does not have contractions. What action is most important in the nursing plan of care for this client? 1. Monitoring for the presence of fever 2. Monitoring for signs of preeclampsia 3. Monitoring for heavy vaginal bleeding 4. Making preparations for fetal scalp pH sampling

1. Monitoring for the presence of fever

A client at 24 weeks' gestation arrives at the clinic for a routine examination. She tells the nurse, "I feel puffy all over." In light of this statement, what is most important? 1. Obtaining her blood pressure 2. Determining how much salt she uses 3. Asking the extent of her daily fluid intake 4. Reviewing her history for total weight gain

1. Obtaining her blood pressure

A client with severe preeclampsia in the high-risk unit is receiving an infusion of magnesium sulfate. If eclampsia were to occur, what action would the nurse take first? 1. Prevent injury 2. Assess fetal heart tones 3. Maintain an open airway 4. Increase the infusion rate

1. Prevent injury

A 16-year-old primigravida at 32 weeks' gestation is admitted to the high-risk unit. Her blood pressure is 170/110 mm Hg and she has 4+ proteinuria. She gained 50 lb during the pregnancy, and her face and extremities are edematous. What complication, which occurs in the latter part of pregnancy, does the nurse identify? 1. Eclampsia 2. Severe preeclampsia 3. Chronic hypertension 4. Gestational hypertension

2. Severe preeclampsia **With severe preeclampsia, arteriolar spasms cause hypertension and decreased arterial perfusion of the kidneys, which in turn cause an alteration in the glomeruli, resulting in oliguria and proteinuria, as well as retention of sodium and water, resulting in edema.

A health care provider determines that a fetus is in a breech presentation. For which complication should the nurse monitor the client? 1. Rapid dilation of the cervix, indicating precipitate labor 2. Stronger contractions, indicating progression of the labor 3. Nonreassuring fetal signs, indicating prolapse of the cord 4. Cessation of contractions, indicating primary uterine inertia

3. Nonreassuring fetal signs, indicating prolapse of the cord

A nurse is assessing a postpartum client for signs of an impending hemorrhage resulting from laceration of the cervix. Besides monitoring the client for a firm uterus, what other assessment is important? 1. Slowed pulse rate 2. Increased blood pressure 3. Persistent muscular twitching 4. Continuous trickling of blood

4. Continuous trickling of blood

A client is admitted to the birthing unit with uterine tenderness and minimal dark-red vaginal bleeding. She has a marginal abruptio placentae. The priority evaluation includes fetal status, vital signs, skin color, and urine output. What additional information is essential? 1. Fundal height 2. Obstetric history 3. Time of the last meal 4. Family history of bleeding disorders

1. Fundal height **It is vital that a baseline measurement be obtained, because increasing fundal height is a sign of concealed hemorrhage.

A pregnant woman who is in the third trimester arrives in the emergency department with vaginal bleeding. She states that she snorted cocaine approximately 2 hours ago. Which complication does the nurse suspect as the cause of the bleeding? 1. Placenta previa 2. tubal pregnancy 3. Abruptio placentae 4. Spontaneous abortion

3. Abruptio placentae

A nurse is planning for the discharge of a crack-addicted 17-year-old mother and her newborn. What is the most appropriate referral to meet the mother's and infant's needs? 1. Legal aid 2. Family court 3. Foster parent care 4. Home health nurse

4. Home health nurse

A nurse is caring for a client who has severe preeclampsia. For which characteristic of eclampsia should the nurse monitor the client? 1. Seizures 2. Anasarca 3. Excessive weight gain 4. Increased blood pressure

1. Seizures

After an unexpected emergency cesarean birth the client tells the nurse, "I failed natural childbirth." Which postpartum phase of adjustment does this statement most closely typify? 1. Taking-in 2. Letting-go 3. Taking-hold 4. Working-through

1. Taking-in **By discussing the experience, the client is bringing it into reality; this is characteristic of the taking-in phase .

For what complication should the nurse specifically monitor a grand multipara who has just given birth? 1. Uterine atony 2. Bladder distention 3. Profuse diaphoresis 4. Hypertensive episodes

1. Uterine atony **Grand multiparas have diminished uterine muscle tone as a result of the repeated distentions of pregnancy; consequently, the uterine muscles may not contract effectively during the fourth stage of labor.

At 30 weeks' gestation a client with class II cardiac disease expresses concern about her labor and asks the nurse what to expect. What does the nurse tell the client to expect if cardiac decompensation occurs? 1. Elective cesarean birth 2. Artificial rupture of the membranes 3. Induction of labor with an oxytocin infusion 4. Epidural anesthesia with a vacuum extraction birth

4. Epidural anesthesia with a vacuum extraction birth

Which client should a nurse suspect is at increased risk for postpartum hemorrhage? 1. One who breastfeeds in the birthing room 2. One who receives a pudendal block for the birth 3. One whose third stage lasts less than 10 minutes 4. One who gives birth to an infant weighing 9 lb 8 oz

4. One who gives birth to an infant weighing 9 lb 8 oz

On her first visit to the prenatal clinic a client with rheumatic heart disease asks the nurse whether she has special nutritional needs. What supplements in addition to the regular pregnancy diet and prenatal vitamin and minerals will she need? (Select all that apply.) 1.Iron 2. Calcium 3. Folic acid 4. Vitamin C 5. Vitamin B12

1.Iron 3. Folic acid **Because pregnant women with heart disease are more likely to have anemia, there may be an additional need for iron and also for folic acid.

The nurse is caring for a group of postpartum clients. Which one should the nurse monitor most closely? 1. A primipara who had an 8-lb newborn 2. A grand multipara who just had her sixth child 3. A primipara who received 50 mcg of IV fentanyl during her labor 4. A multipara whose placenta was expelled 15 minutes after the birth

2. A grand multipara who just had her sixth child **A grand multipara is a woman who has had at least 6 births . Multiparity contributes to an increased incidence of uterine atony because the uterine muscle may not contract effectively, leading to postpartum hemorrhage

A client at 9 weeks' gestation asks the nurse in the prenatal clinic whether she may have chorionic villi sampling (CVS) performed during this visit. What should the nurse keep in mind as the optimal time for CVS while formulating a response? 1. At 8 weeks but no later than 10 weeks 2. At 10 weeks but no later than 12 weeks 3. At 12 weeks but no later than 14 weeks 4. At 14 weeks but no later than 16 weeks

2. At 10 weeks but no later than 12 weeks

A client at 39 weeks' gestation arrives in the birthing suite reporting that she is having regular contractions. A vaginal examination reveals that the presentation is a double-footling breech. The practitioner decides to proceed to a cesarean birth under regional anesthesia. What is an important intervention to help prevent postoperative maternal complications? 1. Providing scrupulous skin care 2. Maintaining adequate hydration 3. Monitoring the vital signs frequently 4. Teaching how to use an incentive spirometer

2. Maintaining adequate hydration

A client in labor is admitted with a suspected breech presentation. For what occurrence should the nurse be prepared? 1. Uterine inertia 2. Prolapsed cord 3. Imminent birth 4. Precipitate labor

2. Prolapsed cord

While auscultating the lungs of a client admitted with severe preeclampsia, the nurse identifies crackles. What inference does the nurse make when considering the presence of crackles in the lungs? 1. Seizure activity is imminent. 2. Pulmonary edema has developed. 3. Bronchial constriction was precipitated by the stress of pregnancy. 4. Impaired diaphragmatic function was caused by the enlarged uterus.

2. Pulmonary edema has developed.

When working with a client who has spontaneously aborted a pregnancy, it is important for the nurse to first deal with his or her own feelings about abortion, death, and loss so that he or she may : 1. Maintain control of the situation 2. Share personal grief with the clients 3. Allow the clients to express their grief 4. Teach the clients how to cope effectively

3. Allow the clients to express their grief **The nurse can be more sensitive to the needs of the client by addressing personal emotions first. Control is not, and should not be, the goal of the nurse. The client's feelings, not the nurse's, should be the focus. A time of crisis is not the time to teach; the client is not ready to learn.

A pregnant client with a history of preterm labor is at home on bedrest. What instructions should a teaching plan for this client include? 1. Place blocks under the foot of the bed. 2. Sit upright with several pillows behind the back. 3. Lie on the side with the head raised on a small pillow. 4. Assume the knee-chest position at regular intervals throughout the day.

3. Lie on the side with the head raised on a small pillow.

An 18-year-old primigravida at 36 weeks' gestation is admitted with a diagnosis of mild preeclampsia. What is the nurse's most important goal for this client? 1. Easing her anxiety 2. Limiting the bleeding 3. Reducing her blood pressure 4. Decreasing the circulating blood volume

3. Reducing her blood pressure

A nurse is caring for a client at 42 weeks' gestation who is having a contraction stress test (CST). What does a positive result indicate? 1. The placenta has stopped growing. 2. The fetal lungs have not yet matured. 3. The function of the placenta has diminished. 4. The amniotic fluid is stained with meconium

3. The function of the placenta has diminished. **During a CST uterine blood flow to the placenta decreases. When a decrease is too great, fetal hypoxia and late decelerations occur, reflecting diminished placental function.

A nurse places a newly admitted client with worsening preeclampsia in a private room. Why is it important for this client to be in a nonstimulating environment? 1. The number of respirations is increased. 2. The severity of frontal headaches is decreased. 3. The probability of tonic-clonic seizures is reduced. 4. The duration of action of hypotensive medications is prolonged.

3. The probability of tonic-clonic seizures is reduced.

What should a nurse anticipate about the insulin requirements of a client with diabetes on her first postpartum day? 1. No change 2. A rapid increase 3. A slow, steady decrease 4. A sharp, sudden decrease

4. A sharp, sudden decrease **Insulin requirements may fall suddenly during the first 24 to 48 postpartum hours because the endocrine changes of pregnancy are reversed.

A nurse is teaching a pregnant client with sickle cell anemia about the importance of taking supplemental folic acid. Folic acid is important for this client because it: 1. Lessens sickling of RBCs 2. Prevents vaso-occlusive crises 3. Decreases cellular oxygen need 4. Compensates for a rapid turnover of red blood cells

4. Compensates for a rapid turnover of red blood cells

A client arrives at the clinic in preterm labor, and terbutaline (Brethine) is prescribed. For what therapeutic effect should the nurse monitor the client? 1. Increased blood pressure and pulse 2. Reduction of pain in the perineal area 3. Gradual cervical dilation as labor progresses 4. Decreased frequency and duration of contractions

4. Decreased frequency and duration of contractions **Terbutaline sulfate (Brethine) is a β-mimetic that acts on the smooth muscles of the uterus to reduce contractility, which in turn inhibits dilation and the frequency and duration of contractions.

A client at term is admitted in active labor. She has tested positive for HIV. Which intervention in the standard orders should the nurse question as a risk to the fetus? 1. Sonogram 2. Nonstress test 3. Sterile vaginal examination 4. Internal fetal scalp electrode

4. Internal fetal scalp electrode **The electrode used for internal fetal monitoring pierces the fetal scalp; fetal exposure to maternal blood increases the risk of the fetus' contracting HIV.

A client is admitted to the high-risk prenatal unit with the diagnosis of placenta previa. What should the nurse instruct the client to do? 1. Breathe deeply to ensure that the fetus gets oxygen 2. Keep movement to a minimum to diminish bleeding 3. Remain on her back to minimize pressure on the cervix 4. Lie on her side to avoid putting pressure on the vena cava

4. Lie on her side to avoid putting pressure on the vena cava

In her 37th week of gestation, a client with type 1 diabetes has amniocentesis to determine fetal lung maturity. The lecithin/sphingomyelin ratio is 2:1, phosphatidylglycerol is present, and creatinine is 2 mg/dL. What conclusion should the nurse draw from this information? 1. A cesarean birth will be scheduled. 2. A birth must take place immediately. 3. The fetus need not be monitored any longer. 4. The newborn should be free from respiratory problems.

4. The newborn should be free from respiratory problems.

A client at 12 weeks' gestation arrives in the prenatal clinic complaining of cramping and vaginal spotting. A pelvic examination reveals that the cervix is closed. Which probable diagnosis should the nurse expect? 1. Missed abortion 2. Inevitable abortion 3. Incomplete abortion 4. Threatened abortion

4. Threatened abortion **Because the cervix is closed, it is considered a threatened abortion. The lifeless products of conception are retained in a missed abortion.

A practitioner prescribes penicillin G benzathine suspension (Bicillin L-A) 2.45 million units for a client with a sexually transmitted infection (STI). The medication is available in a multidose vial of 10 mL in which 1 mL = 300,000 units. How many milliliters should the nurse administer? Record your answer using one decimal place. ____ mL.

Use ratio and proportion: 2, 450,000 units : 300,000 units = x mL : 1 mL 300,000x = 2,450,000 x = 8.2 mL