PrepU Antepartum

A woman who has preeclampsia is receiving magnesium sulfate 20 grams per 500 mL of lactated Ringers via infusion pump. The prescribed rate of infusion is 2 grams/hour. How many mL/hour should the nurse set the infusion pump for? Record your answer using a whole number.

50

When working the mother-baby unit which client would the nurse anticipate giving Rho(D) immune globulin (human) to: A) the Rh negative mother with an Rh positive baby. B) the Rh negative baby with an Rh positive mother. C) the Rh positive mother with an Rh negative baby. D) the Rh positive baby with an Rh negative mother.

A) the Rh negative mother with an Rh positive baby. Rho (D) immune globulin (human) is give to an Rh negative mother after the birth of an Rh positive baby to prevent the woman from making antibodies that are sensitized to attack foreign Rh positive blood cells in future pregnancies. Rho D is also given during pregnancy to Rh negative mothers at 28 weeks, with invasive procedures, or after any trauma, such as an automobile accident. Rho (D) is not given to Rh positive mothers and is never given to babies.

At what gestational age should a primigravida expect to start feeling quickening? A) 26 weeks B) 18 to 20 weeks C) 21 to 23 weeks D) 12 weeks

B) 18 to 20 weeks For the client who's pregnant for the first time, quickening occurs around 18 to 20 weeks. Women who have had children will feel quickening earlier, usually around week 16, because they recognize the sensations.

After instructing a primigravid client about the functions of the placenta, the nurse determines that the client needs additional teaching when she says that which hormone is produced by the placenta? A) estrogen B) testosterone C) progesterone D) human chorionic gonadotropin (hCG)

B) testosterone The placenta does not produce testosterone. Human placental lactogen, hCG, estrogen, and progesterone are hormones produced by the placenta during pregnancy. The hormone hCG stimulates the synthesis of estrogen and progesterone early in the pregnancy until the placenta can assume this role. Estrogen results in uterine and breast enlargement. Progesterone aids in maintaining the endometrium, inhibiting uterine contractility, and developing the breasts for lactation. The placenta also produces some nutrients for the embryo and exchanges oxygen, nutrients, and waste products through the chorionic villi.

A client and her spouse, both 25 years old, are having trouble conceiving. Infertility in this couple is defined as: A) the inability to conceive after 6 months of unprotected attempts. B) the inability to conceive after 1 year of unprotected attempts. C) a low sperm count and decreased motility. D) the inability to sustain a pregnancy.

B) the inability to conceive after 1 year of unprotected attempts. The determination of infertility is based on age. In a couple younger than 30 years old, infertility is defined as failure to conceive after 1 year of unprotected intercourse. In a couple age 30 or older, the time period is reduced to 6 months of unprotected intercourse. The inability to sustain a pregnancy doesn't factor into the definition of infertility. A low sperm count and decreased motility may contribute to infertility, but they don't determine infertility.

A 32-year-old multigravida returns to the clinic for a routine prenatal visit at 36 weeks' gestation. The assessments during this visit include: blood pressure 140/90 mm Hg; pulse 80 beats/min; respiratory rate 16 breaths/min. What further information should the nurse obtain to determine if this client is becoming preeclamptic? A) blood glucose level B) headaches C) proteinuria D) peripheral edema

C) proteinuria The two major defining characteristics of preeclampsia are blood pressure elevation of 140/90 mm Hg or greater and proteinuria. Because the client's blood pressure meets the gestational hypertension criteria, the next nursing responsibility is to determine if she has protein in her urine. If she does not, then she may be having transient hypertension. The peripheral edema is within normal limits for someone at this gestational age, particularly because it is in the lower extremities. While, the preeclamptic client may significant edema in the face and hands, edema can be caused by other factors and is not part of the diagnostic criteria. Headaches are significant in pregnancy-induced hypertension but may have other etiologies. The client's blood glucose level has no bearing on a preeclampsia diagnosis.

When auscultating the heart sounds of a client who's 34 weeks pregnant, the nurse detects a systolic ejection murmur. Which action should the nurse take? a) Explain that this finding may indicate a cardiac disorder. b) Contact the client's primary health care provider. c) Consult with a cardiologist. d) Document the finding, which is normal during pregnancy.

D - Document the finding; it is normal during pregnancy During pregnancy, a systolic ejection murmur over the pulmonic area is a common finding. Typically, it results from increases in blood volume and cardiac output, along with changes in heart size and position. Other cardiac rhythm disturbances also may occur during pregnancy and don't require treatment unless the client has concurrent heart disease. The nurse should document the finding and check for the murmur during the next visit. The nurse need not consult a cardiologist or the primary care health provider and shouldn't tell the client that this finding indicates a cardiac disorder.

A 32-year-old female client visits the family planning clinic and requests an intrauterine device for contraception. When assessing the client, a history of which problem would be most important to determine? A) previous liver disease B) coronary artery disease C) thrombophlebitis D) pelvic inflammatory disease

D) pelvic inflammatory disease The nurse should assess the client for a history of pelvic inflammatory disease because intrauterine devices have been associated with an increased risk of pelvic inflammatory disease and perforation of the uterus. A history of thrombophlebitis, liver disease, or cardiovascular disease would be important to assess if the client were to receive oral contraceptives. Thrombophlebitis is a contraindication for oral contraceptives.

A primigravid client visits the clinic at 12 weeks' gestation and tells the nurse that she has a cold and her nose is stuffy. The nurse should instruct the client to treat the nasal stuffiness by using: A) oral decongestants. B) oral antihistamines. C) ice packs to the nasal area. D) saline nose drops.

D) saline nose drops. Saline nose drops are a natural remedy and can alleviate the discomfort. Clients who are pregnant should not take any medications without consulting the health care provider; therefore, oral antihistamines and oral decongestions should be avoided. Ice packs are not helpful in alleviating congestion. Warm moist towels might be helpful.

A client with hyperemesis gravidarum is on a clear liquid diet. The nurse should serve this client: A) milk and ice pops. B) apple juice and oatmeal. C) decaffeinated coffee and scrambled eggs. D) tea and gelatin dessert.

D) tea and gelatin dessert. A clear liquid diet consists of foods that are clear liquids at room temperature or body temperature, such as ice pops, regular or decaffeinated coffee and tea, gelatin desserts, carbonated beverages, and clear juices. Milk, pasteurized eggs, egg substitutes, and oatmeal are part of a full liquid diet.

At an initial prenatal visit the client tells the nurse that her last menstrual period started on April 14th. Using Naegele's rule, the nurse determines the woman's estimated due date is when? A) February 14 B) February 21 C) January 21 D) January 28

C) January 21 Naegele's rule is a mathematical equation that uses a woman's last menstrual period (LMP) to estimate a pregnant client's dues date. The formula is LMP + 7 days ? 3 months. Here the LMP is: April 14th + 7 days = April 21st; April 21st ? 3 months = January 21st. The other options do not fit the formula.

A client, approximately 11 weeks pregnant, and her husband are seen in the antepartal clinic. The client's husband tells the nurse that he has been experiencing nausea and vomiting and fatigue along with his wife. The nurse interprets these findings as suggesting that the client's husband is experiencing which complication? A) Couvade syndrome B) ptyalism C) mittelschmerz D) pica

A) Couvade syndrome Couvade syndrome refers to the situation in which the expectant father experiences some of the discomforts of pregnancy along with the pregnant woman as a means of identifying with the pregnancy. Ptyalism is the term for excessive salivation. Mittelschmerz is the lower abdominal discomfort felt by some women during ovulation. Pica refers to an oral craving for substances such as clay or starch that some pregnant clients experience.

A client who is 24 weeks pregnant has sickle cell anemia. When preparing the care plan, the nurse should identify which factor as a potential trigger for a sickle cell crisis during pregnancy? A) Dehydration B) Sedative use C) Hypertension D) Tachycardia

A) Dehydration Factors that may precipitate a sickle cell crisis during pregnancy include dehydration, infection, stress, trauma, fever, fatigue, and strenuous activity. Sedative use, hypertension, and tachycardia aren't known to precipitate a sickle cell crisis.

A nurse is obtaining a prenatal history from a client who's 8 weeks pregnant. To help determine whether the client is at risk for a TORCH infection, the nurse should ask: A) "Do you have any cats at home?" B) "Have you recently had a rubeola vaccination?" C) "Have you ever had osteomyelitis?" D) "Do you have any birds at home?"

A) "Do you have any cats at home?" TORCH refers to Toxoplasmosis, Other Rubella virus, Cytomegalovirus, and Herpes simplex virus — agents that may infect the fetus or neonate, causing numerous ill effects. Toxoplasmosis is transmitted to humans through contact with the feces of infected cats (which may occur when emptying a litter box), through ingesting raw meat, or through contact with raw meat followed by improper hand washing. Osteomyelitis, a serious bone infection; histoplasmosis, which can be transmitted by birds; and rubeola aren't TORCH infections.

A client has just expelled a hydatidiform mole. She's visibly upset over the loss and wants to know when she can try to become pregnant again. How should the nurse respond? A) "I can see you're upset. Why don't we discuss this with you at a later time when you're feeling better." B) "Pregnancy should be avoided until all of your testing is normal." C) "I can see that you're upset; however, you must wait at least 1 year before becoming pregnant again." D) "Let me check with your physician and get you something that will help you relax."

A) "I can see you're upset. Why don't we discuss this with you at a later time when you're feeling better." Clients who develop a hydatidiform mole must be instructed to wait at least 1 year before attempting another pregnancy, despite testing that shows they have returned to normal. A hydatidiform mole is a precursor to cancer, so the client must be monitored carefully for 1 year by an experienced health care provider. Discussing this situation at a later time or checking with the physician to give the client something to relax does nothing to address the client's immediate concerns. Advising the client to wait until all tests are normal is a vague response and provides the client with little information.

A nurse is caring for a client in the first 4 weeks of pregnancy. The nurse should expect to collect which assessment findings? A) Breast sensitivity B) Uterine enlargement C) Fetal heart tones D) Presence of menses

A) Breast sensitivity Breast sensitivity is the only sign assessed within the first 4 weeks of pregnancy. Amenorrhea, not the presence of menses, is expected during this time. Uterine enlargement and fetal heart tones don't occur until after the first 4 weeks of pregnancy.

A client at 37 weeks gestation is at a prenatal visit and states that she sometimes feels dizzy when lying directly on her back. Which of the following is the nurse's best response? A) "This may be due to the uterus putting pressure on a blood vessel." B) "Do you have a family history of cardiac-related illnesses?" C) "This is most likely due to low hemoglobin." D) "This is a normal occurrence in the third trimester."

A) "This may be due to the uterus putting pressure on a blood vessel." The central nervous system (CNS) functioning and freedom from injury is a priority in maintaining well-being of the maternal-fetal unit. If the mother suffers CNS damage related to hypertension or stroke, oxygenation status is compromised, and the well-being of both mother and infant are at risk. Continuous fetal monitoring is an assessment strategy for the infant only and would be of secondary importance to maternal CNS assessment because maternal oxygenation will dictate fetal oxygenation and well-being. In preeclampsia, frequent assessment of maternal reflexes, clonus, visual disturbances, and headache give clear evidence of the condition of the maternal CNS system. Monitoring the liver studies does give an indication of the status of the maternal system, but the less invasive and highly correlated condition of the maternal CNS system in assessing reflexes, maternal headache, visual disturbances, and clonus is the highest priority. Psychosocial care is a priority and can be accomplished in ways other than having the family remain at the bedside.

Which statement by the nurse would be most appropriate when responding to a primigravid client who asks, "What should I do about this brown discoloration across my nose and cheeks?" A) "This usually disappears after childbirth." B) "The discoloration is due to dilated capillaries." C) "It will fade if you use a prescribed cream." D) "It is a sign of skin melanoma."

A) "This usually disappears after childbirth." Discoloration on the face that commonly appears during pregnancy, called chloasma (mask of pregnancy), usually fades postpartum and is of no clinical significance. The client who is bothered by her appearance may be able to decrease its prominence with ordinary makeup. Chloasma is not a sign of skin melanoma. It is not caused by dilated capillaries. Rather, it results from increased secretion of melanocyte-stimulating hormones caused by estrogen and progesterone secretion. No treatment is necessary for this condition.

A nurse is caring for a 16-year-old pregnant adolescent. The client is taking an iron supplement. What should this client drink to increase the absorption of iron? A) A glass of orange juice. B) A liquid antacid. C) A glass of milk. D) A cup of hot tea.

A) A glass of orange juice. Increasing vitamin C enhances the absorption of iron supplements. Taking an iron supplement with milk, tea, or an antacid reduces the absorption of iron.

A nurse assesses a client for signs and symptoms of ectopic pregnancy. Which assessment finding should the nurse expect? A) Abdominal pain B) Temperature elevation C) Nausea and vomiting D) Vaginal bleeding

A) Abdominal pain Abdominal pain is the most common finding in ectopic pregnancy, occurring in more than 90% of women with this antepartum complication. Temperature elevation, vaginal bleeding, and nausea and vomiting are less commonly associated with ectopic pregnancy.

Where is the best place for a nurse to detect fetal heart sounds for a client in the first trimester of pregnancy? A) Above the symphysis pubis B) At the umbilicus C) Below the symphysis pubis D) Above the umbilicus

A) Above the symphysis pubis In the first trimester, fetal heart sounds are loudest in the area of maximum intensity, just above the client's symphysis pubis at the midline. Fetal heart sounds aren't heard as well below the symphysis pubis, above the umbilicus, or at the umbilicus.

A 16-year-old primigravida at 36 weeks' gestation who has had no prenatal care experienced a seizure at work and is being transported to the hospital by ambulance. What should the nurse do upon the client's arrival? A) Admit the client to a quiet, darkened room. B) Auscultate breath sounds every 4 hours. C) Monitor the vital signs every 4 hours. D) Position the client in a supine position.

A) Admit the client to a quiet, darkened room. Because of her age and report of a seizure, the client is probably experiencing eclampsia, a condition in which convulsions occur in the absence of any underlying cause. Although the actual cause is unknown, adolescents and women older than 35 years are at higher risk. The client's environment should be kept as free of stimuli as possible. Thus, the nurse should admit the client to a quiet, darkened room. Clients experiencing eclampsia should be kept on the left side to promote placental perfusion. In some cases, edema of the lungs develops after seizures and is a sign of cardiovascular failure. Because the client is at risk for pulmonary edema, breath sounds should be monitored every 2 hours. Vital signs should be monitored frequently, at least every hour.

Assessment of a nulligravid client in active labor reveals the following: moderate discomfort; cervix dilated 3 cm, 0 station and completely effaced; and fetal heart rate of 136 bpm. Which should the nurse plan to do next? A) Assist the client with comfort measures and breathing techniques. B) Prepare the client for epidural anesthesia to relieve pain. C) Turn the client from the left side-lying position to the right side-lying position. D) Instruct the client that internal fetal monitoring is necessary.

A) Assist the client with comfort measures and breathing techniques. The client's assessment findings indicate that the client is in the latent phase of the first stage of labor. Therefore, the nurse should plan to assist the client with comfort measures and breathing techniques to relieve discomfort. The client can move around, walk, or ambulate at this phase of labor. If the client chooses to remain in bed, a left side-lying position provides the greatest perfusion. It is too early for the client to have an epidural anesthetic. Epidural anesthesia is usually administered when the cervix is dilated 4 to 5 cm. The fetal heart rate is normal, so internal fetal monitoring is not warranted at this time.

A nurse is developing a teaching plan for a primigravid client who's 2 months pregnant. The nurse should tell the client that she can expect to feel the fetus move at which time? A) Between 18 and 20 weeks' gestation B) Between 21 and 23 weeks' gestation C) Between 10 and 12 weeks' gestation D) Between 24 and 26 weeks' gestation

A) Between 18 and 20 weeks' gestation A primigravid can usually detect fetal movements (quickening) between 18 and 20 weeks' gestation. After 20 weeks, the fetus continues to gain weight steadily, the lungs start to produce surfactant, the brain is grossly formed, and myelination of the spinal cord begins.

A client is in the eighth month of pregnancy. To enhance cardiac output and renal function, the nurse should advise her to use which body position? A) Left lateral B) Right lateral C) Supine D) Semi-Fowler's

A) Left lateral The left lateral position shifts the enlarged uterus away from the vena cava and aorta, enhancing cardiac output, kidney perfusion, and kidney function. The right lateral and semi-Fowler positions don't alleviate pressure of the enlarged uterus on the vena cava. The supine position reduces sodium and water excretion because the enlarged uterus compresses the vena cava and aorta; this decreases cardiac output, leading to decreased renal blood flow, which in turn impairs kidney function.

A nurse is caring for a client with hyperemesis gravidarum who will need close monitoring at home. When should the nurse begin discharge planning? A) On admission to the facility B) When the client's vomiting has stopped C) On the day of discharge D) When the client expresses readiness to learn

A) On admission to the facility Discharge planning should begin when a client is first admitted to the facility. Initially, discharge planning requires collecting information about the client's home environment, support systems, functional abilities, and finances. This information is used to determine what support services will be needed. Waiting until the day of discharge to begin planning is also likely to cause the client to become overwhelmed and anxious. Such factors as when the client stops vomiting and expresses readiness to learn shouldn't influence when the nurse begins discharge planning.

A client treated with terbutaline (Brethine) for premature labor is ready for discharge. Which instruction should the nurse include in the discharge teaching plan? A) Report a heart rate greater than 120 beats/minute to the physician. B) Take terbutaline every 4 hours, during waking hours only. C) Call the physician if the fetus moves 10 times in an hour. D) Increase activity daily if not fatigued.

A) Report a heart rate greater than 120 beats/minute to the physician. Because terbutaline can cause tachycardia, the woman should be taught to monitor her radial pulse and call the physician for a heart rate greater than 120 beats/minute. Terbutaline must be taken every 4 to 6 hours around-the-clock to maintain an effective serum level that will suppress labor. A fetus normally moves 10 to 12 times per hour. The client doesn't need to contact the physician if such movement occurs. The client experiencing premature labor must maintain bed rest at home.

A client who's 12 weeks pregnant is complaining of severe left lower quadrant pain and vaginal spotting. She is admitted for treatment of an ectopic pregnancy. The nurse should give the highest priority to which nursing diagnosis? A) Risk for deficient fluid volume B) Impaired gas exchange C) Acute pain D) Anxiety

A) Risk for deficient fluid volume A ruptured ectopic pregnancy is a medical emergency because of the large quantity of blood that may be lost in the pelvic and abdominal cavities. Shock may develop from blood loss, and large quantities of I.V. fluids are needed to restore intravascular volume until the bleeding is surgically controlled. Although the other nursing diagnoses are relevant for a woman with an ectopic pregnancy, fluid volume loss through hemorrhage is the greatest threat to her physiological integrity and must be stopped. Anxiety may result from such factors as the risk of dying and the fear of future infertility. Pain may be caused by a ruptured or distended fallopian tube or blood in the peritoneal cavity. Impaired gas exchange may result from the loss of oxygen-carrying hemoglobin through blood loss.

A client is 2 months pregnant. Which factor should the nurse anticipate as most likely to affect her psychosocial transition during pregnancy? A) Support from her partner B) Readiness at home for the baby C) Previous health promotion activities D) The month of her due date

A) Support from her partner Many factors can influence the smoothness of a pregnant client's psychosocial transition. The most important factors are support from her partner, parents, friends, and others; whether the pregnancy was planned or unplanned; and previous childbirth and parenting experiences. Age, socioeconomic status, sexuality concerns, birth stories of family members and friends, and past experiences with health care facilities and professionals may also influence a client's psychosocial transition during pregnancy. The month of her due date and previous health promotion activities don't affect her psychological transition. Readiness for the baby at home usually affects the client during the third trimester, not in the second month.

A client, 30 weeks pregnant, is scheduled for a biophysical profile (BPP) to evaluate the health of her fetus. Her BPP score is 8. What does this score indicate? A) The fetus isn't in distress at this time. B) The client should repeat the test in 24 hours. C) The client should repeat the test in 1 week. D) The fetus should be delivered within 24 hours.

A) The fetus isn't in distress at this time. The BPP evaluates fetal health by assessing five variables: fetal breathing movements, gross body movements, fetal tone, reactive fetal heart rate, and qualitative amniotic fluid volume. A normal response for each variable receives 2 points; an abnormal response receives 0 points. A score between 8 and 10 is considered normal, indicating that the fetus has a low risk of oxygen deprivation and isn't in distress. A fetus with a score of 6 or lower is at risk for asphyxia and premature birth; this score warrants detailed investigation. The BPP may be repeated if the score isn't within normal limits.

A pregnant client arrives in the emergency department and states, "My baby is coming." The nurse sees a portion of the umbilical cord protruding from the vagina. Why should the nurse apply manual pressure to the baby's head? A) To relieve pressure on the umbilical cord B) To rupture the membranes C) To slow the delivery process D) To reinsert the umbilical cord

A) To relieve pressure on the umbilical cord Applying manual pressure to the baby's head by gently pushing up with the fingers relieves pressure on the umbilical cord. This intervention is effective if the cord begins to pulsate. The mother may also be placed in either the knee-chest or Trendelenburg's position to ensure blood flow to the baby. This intervention isn't done to slow the delivery process. A prolapsed cord necessitates emergency cesarean birth. The nurse shouldn't attempt to reinsert the umbilical cord because doing so would further compromise blood flow. At this point, the membranes are probably ruptured already.

During a physical examination, a client who is 32 weeks pregnant becomes pale, dizzy, and light-headed while supine. Which action should the nurse immediately take? A) Turn the client on her left side. B) Listen to fetal heart tones. C) Ask the client to breathe deeply. D) Measure the client's blood pressure.

A) Turn the client on her left side. As the uterus enlarges, pressure on the inferior vena cava increases, compromising venous return and causing blood pressure to drop. This may lead to syncope and accompanying symptoms when the client is supine. Turning the client on her left side relieves pressure on the vena cava, restoring normal venous return and blood pressure. Deep breathing wouldn't relieve this client's symptoms. Listening to fetal heart tones and measuring the client's blood pressure wouldn't provide relevant information nor would they treat the client's symptoms.

A client at 36 weeks' gestation, begins to exhibit signs of labor after an eclamptic seizure. The nurse should assess the client for: A) abruptio placentae B) placenta accreta C) transverse lie D) uterine atony

A) abruptio placentae After an eclamptic seizure, the client is at risk for abruptio placentae due to severe vasoconstriction resulting in hemorrhage into the decidua basalis. Abruptio placentae is manifested by a board-like abdomen and an abnormal fetal heart rate tracing. Transverse lie or shoulder presentation, placenta accreta, and uterine atony are not related to eclampsia. Causes of a transverse lie may include relaxation of the abdominal wall secondary to grand multiparity, preterm fetus, placenta previa, abnormal uterus, contracted pelvis, and excessive amniotic fluid. Placenta accreta, a rare phenomenon, refers to a condition in which the placenta abnormally adheres to the uterine lining. Uterine atony, or relaxed uterus, may occur after childbirth, leading to postpartum hemorrhage.

A pregnant woman states that she frequently ingests laundry starch. The nurse should assess the client for: A) anemia. B) lactose intolerance. C) muscle spasms. D) diabetes mellitus.

A) anemia. All pregnant clients should be screened for pica, or the ingestion of nonfood substances, such as clay, dirt, or laundry starch. Commonly, clients who practice pica are anemic. Muscle spasms are not associated with the ingestion of laundry starch. However, they may be related to seizure disorder or seizure activity or a calcium deficiency. Lactose intolerance is not associated with the ingestion of laundry starch. Lactose intolerance would occur when the client ingests milk or milk products. Diabetes mellitus is not associated with the ingestion of laundry starch. Diabetes mellitus is associated with abnormal glucose levels, excessive thirst, and frequent voiding.

When measuring the fundal height of a primigravid client at 20 weeks' gestation, the nurse will locate the fundal height at which point? A) at about the level of the client's umbilicus B) halfway between the client's symphysis pubis and umbilicus C) near the client's xiphoid process and compressing the diaphragm D) between the client's umbilicus and xiphoid process

A) at about the level of the client's umbilicus Measurement of the client's fundal height is a gross estimate of fetal gestational age. At 20 weeks' gestation, the fundal height should be at about the level of the client's umbilicus. The fundus typically is over the symphysis pubis at 12 weeks. A fundal height measurement between these two areas would suggest a fetus with a gestational age between 12 and 20 weeks. The fundal height increases approximately 1 cm/week after 20 weeks' gestation. The fundus typically reaches the xiphoid process at approximately 36 weeks' gestation. A fundal height between the umbilicus and the xiphoid process would suggest a fetus with a gestational age between 20 and 36 weeks. The fundus then commonly returns to about 4 cm below the xiphoid owing to lightening at 40 weeks. Additionally, pressure on the diaphragm occurs late in pregnancy. Therefore, a fundal height measurement near the xiphoid process with diaphragmatic compression suggests a fetus near the gestational age of 36 weeks or older.

In which maternal locations would the nurse place the ultrasound transducer of the external electronic fetal heart rate monitor if a fetus at 34 weeks' gestation is in the left occipitoanterior (LOA) position? A) below the umbilicus on the left side B) at the level of the umbilicus C) near the symphysis pubis D) two inches (5.1 cm) above the umbilicus

A) below the umbilicus on the left side As the uterus contracts, the abdominal wall rises and, when external monitoring is used, presses against the transducer. This movement is transmitted into an electrical current, which is then recorded. With the fetus in the LOA position, the cardiotransducer should be placed below the umbilicus on the side where the fetal back is located and uterine displacement during contractions is greatest. If the fetal back is near the symphysis pubis, the fetus is presenting as a transverse lie. If the fetus is in a breech position, the fetal back may be at or above the umbilicus.

The primary health care provider (HCP) prescribes intravenous magnesium sulfate for a primigravid client at 38 weeks' gestation diagnosed with severe preeclampsia. Which medication would be most important for the nurse to have readily available? A) calcium gluconate B) phenytoin C) diazepam D) hydralazine

A) calcium gluconate The client receiving magnesium sulfate intravenously is at risk for possible toxicity. The antidote for magnesium sulfate toxicity is calcium gluconate, which should be readily available at the client's bedside. Diazepam is used to treat anxiety, and usually it is not given to pregnant women. Hydralazine would be used to treat hypertension, and phenytoin would be used to treat seizures.

A client wants to avoid methods of birth control that contain estrogen. Which method would be the nurse recommend? A) depot medroxyprogesterone acetate injection B) combined hormonal oral contraceptive C) birth control patch D) etonogestrel/ethinyl estradiol vaginal ring

A) depot medroxyprogesterone acetate injection Birth control methods that contain estrogen increase risk for clotting disorders especially in women over the age of 35 years who smoke or who have had a a previous clotting problem. Depot medroxyprogesterone acetate (DMPA) injections contain progesterone, but no estrogen. Combined hormonal contraceptives, vaginal rings, and the birth control patch all contain estrogen.

Following a positive pregnancy test, a client begins discussing the changes that will occur in the next several months with the nurse. The nurse should include which information about changes the client can anticipate in the first trimester? A) experiencing ambivalence about pregnancy B) enjoying the role of nurturer C) preparing for the reality of parenthood D) differentiating the self from the fetus

A) experiencing ambivalence about pregnancy Many women in their first trimester feel ambivalent about being pregnant because of the significant life changes that occur for most women who have a child. Ambivalence can be expressed as a list of positive and negative consequences of having a child, consideration of financial and social implications, and possible career changes. During the second trimester, the infant becomes a separate individual to the mother. The mother will begin to enjoy the role of nurturer postpartum. During the third trimester, the mother begins to prepare for parenthood and all of the tasks that parenthood includes.

When performing Leopold's maneuvers, which action would the nurse ask the client to perform to ensure optimal comfort and accuracy? A) breathe deeply for 1 minute B) empty her bladder C) lie on her left side D) drink a full glass of water

B) empty her bladder Leopold's maneuvers involve abdominal palpation. The client should empty her bladder before the nurse palpates the abdomen. Doing so increases the client's comfort and makes palpation more accurate. Although breathing deeply may help to relax the client, it has no effect on the accuracy of the results of Leopold's maneuvers. The client does not need to drink a full glass of water before the examination. The client should be lying in a supine position with the head slightly elevated for greater comfort and with the knees drawn up slightly.

During a health-teaching session, a pregnant client asks the nurse how soon the fertilized ovum becomes implanted in the endometrium. Which answer should the nurse supply? A) 14 days after fertilization B) 7 days after fertilization C) 28 days after fertilization D) 21 days after fertilization

B) 7 days after fertilization Implantation occurs at the end of the first week after fertilization, when the blastocyst attaches to the endometrium. During the second week (14 days after implantation), implantation progresses and two germ layers, cavities, and cell layers develop. During the third week of development (21 days after implantation), the embryonic disk evolves into three layers, and three new structures — the primitive streak, notochord, and allantois — form. Early during the fourth week (28 days after implantation), cellular differentiation and organization occur.

A client has a cerclage placed at 16 weeks' gestation. She has had no contractions and her cervix is dilated 2 cm. The nurse is preparing the client for discharge. Which statement by the client should indicate to the nurse that the client needs further instruction? A) "I can have nothing in my vagina until I am at term." B) "I can have sex again in about 2 weeks." C) "I will need more frequent prenatal visits." D) "I should call if I am leaking fluid or have bleeding or contractions."

B) "I can have sex again in about 2 weeks." Intercourse commonly stimulates uterine contractions. The prostaglandins found in semen can also initiate contractions. After placement of a cerclage for advanced dilation and contractions, the client is considered at high risk for preterm birth and should be seen by her health care provider (HCP) more frequently. The client should call the HCP immediately if she sees signs of complications, such as leaking fluid (rupture of membranes), vaginal bleeding, and contractions (particularly with a cerclage in place). Anything in the vagina may initiate contractions and the labor process.

A nurse is caring for a client in her 34th week of pregnancy who wears an external monitor. Which statement by the client indicates an understanding of the nurse's teaching? A) "I know that the external monitor increases my risk of a uterine infection." B) "I can lie in any comfortable position, but I should stay off my back." C) "You won't need to come in and check on me while I'm wearing this monitor." D) "I'll need to lie perfectly still."

B) "I can lie in any comfortable position, but I should stay off my back." The client demonstrates understanding of the nurse's teaching when she states that she should stay off her back. A woman with an external monitor should lie in the position that is most comfortable to her, but the supine position should be discouraged. It isn't necessary for the client to lie perfectly still. A woman should be encouraged to change her position as often as necessary; however, the monitor may need to be repositioned after a position change. The nurse still needs to frequently assess and provide emotional support to a woman in labor who's wearing an external monitor. Because an external monitor isn't invasive and is worn around the abdomen, it doesn't increase the risk of uterine infection.

During a routine prenatal visit, a pregnant client reports constipation, and the nurse teaches her how to relieve it. Which statement indicates the client's understanding of the nurse's instructions? A) "I'll limit fluid intake to four 8-oz (240 mL) glasses." B) "I'll increase my intake of unrefined grains." C) "I'll decrease my intake of green, leafy vegetables." D) "I'll take iron supplements regularly."

B) "I'll increase my intake of unrefined grains." To increase peristalsis and relieve constipation, the client should increase her intake of high-fiber foods (such as green, leafy vegetables; unrefined grains; and fruits) and fluids. The use of iron supplements can cause — rather than relieve — constipation.

During a routine clinic visit, a 25-year-old multigravid client who initiated prenatal care at 10 weeks' gestation and is now in her third trimester states, "I've been having strange dreams about the baby. Last week I dreamed he was covered with hair." The nurse should tell the mother: A) "Dreams about the baby late in pregnancy usually mean that labor is about to begin soon." B) "It is not uncommon to have dreams about the baby, particularly in the third trimester." C) "Commonly when a mother has these dreams, she is trying to cope with becoming a parent." D) "Dreams like the ones that you describe are very unusual. Please tell me more about them."

B) "It is not uncommon to have dreams about the baby, particularly in the third trimester." During the third trimester, it is not uncommon for clients to have dreams or fantasies about the baby. Sometimes the dreams are about infants who are malformed or, in this example, covered with hair. There is no evidence to suggest that the client is trying to cope with becoming a parent. Having dreams about the baby does not mean that labor will begin soon.

A client who's 4 weeks pregnant comes to the clinic for her first prenatal visit. When obtaining her health history, the nurse explores her use of drugs, alcohol, and cigarettes. Which client outcome identifies a safe level of alcohol intake for this client? A) "The client consumes 2 to 6 oz (60 to 180 mL) of alcohol daily, depending on body weight." B) "The client consumes no alcohol." C) "The client consumes no more than 2 oz (60 mL) of alcohol daily." D) "The client consumes no more than 4 oz (120 mL) of alcohol daily."

B) "The client consumes no alcohol." A safe level of alcohol intake during pregnancy hasn't been established. Therefore, authorities recommend that pregnant women abstain from alcohol entirely. Excessive alcohol intake has serious harmful effects on the fetus, especially between the 16th and 18th weeks of pregnancy. Affected neonates exhibit fetal alcohol syndrome, which includes microcephaly, growth restriction, short palpebral fissures, and maxillary hypoplasia. Alcohol intake may also affect the client's nutrition and may predispose her to complications in early pregnancy.

Using Nägele's rule for a client whose last normal menstrual period began on May 10, the nurse determines that the client's estimated date of childbirth is what date? A) January 17 B) February 13 C) February 17 D) January 13

C) February 17 When using Nägele's rule to determine the estimated date of childbirth, the nurse would count back 3 calendar months from the first day of the last menstrual period and add 7 days. This means the client's estimated date is February 17.

On her second visit to the prenatal facility, a client states, "I guess I really am pregnant. I've missed two periods now." Based on this statement, the nurse determines that the client has accomplished which psychological task of pregnancy? A) Identifying the fetus as a separate being B) Accepting the biological fact of pregnancy C) Preparing to relinquish the neonate through labor D) Assuming caretaking responsibility for the neonate

B) Accepting the biological fact of pregnancy The first maternal psychological task of pregnancy is to accept the pregnancy as a biological fact. If the client doesn't accept that she's pregnant, she's unlikely to seek prenatal care. Identifying the fetus as a separate being usually occurs after the client feels fetal movements. Assuming caretaking responsibility for the neonate should occur during the postpartum period. Preparing to relinquish the neonate through labor normally occurs during the third trimester.

A nurse is assessing a client who is 6 weeks pregnant. Which findings best support a suspicion of ectopic pregnancy? A) Amenorrhea, sudden weight gain, and audible fetal heart tones above the symphysis pubis B) Amenorrhea and adnexal fullness and tenderness C) Grapefruit-size uterine enlargement and vaginal spotting D) Nausea, vomiting, and slight uterine enlargement

B) Amenorrhea and adnexal fullness and tenderness Signs and symptoms of ectopic pregnancy include amenorrhea and adnexal fullness and tenderness. Nausea, vomiting, and vaginal spotting may occur in ectopic pregnancy, but the uterus doesn't enlarge because it remains empty. Weight gain may accompany ectopic pregnancy; however, fetal heart tones aren't audible above the symphysis pubis in clients with this disorder.

A charge nurse is completing client assignments for the nursing staff on the pediatric unit. Which client would the nurse refrain from assigning to a pregnant staff member? A) A 2-year-old with Kawasaki's disease. B) An 8-year-old with Rubella. C) A 3-month-old with Roseola. D) A 6-year-old with ringworm.

B) An 8-year-old with Rubella. Rubella (German measles) has a teratogenic effect on the fetus. An infected child must be isolated from pregnant women. Ringworm is caused by a fungal infection on the skin. Standard hand hygiene is necessary. Kawasaki's disease is an autoimmune disease in which blood vessels become inflamed. Roseola is a virus transferred by oral secretions.

When planning a class for primigravid clients about the common physiologic changes of pregnancy, which information should the nurse include in the teaching plan? A) The anterior pituitary gland secretes oxytocin late in pregnancy. B) Cardiac output increases by 25% to 50% during pregnancy. C) The temperature decreases slightly early in pregnancy. D) The circulating fibrinogen level decreases as much as 50% during pregnancy.

B) Cardiac output increases by 25% to 50% during pregnancy. During pregnancy, the circulatory system undergoes tremendous changes. Cardiac output increases by 25% to 50%, and circulatory blood volume increases by about 30%. The client may experience transient hypotension and dizziness with sudden position changes. Early in pregnancy there is a slight increase in the temperature, and clients may attribute this to a sinus infection or a cold. The client may feel warm, but this sensation is transient. The level of circulating fibrinogen increases as much as 50% during pregnancy, probably because of increased estrogen. Any calf tenderness should be reported, because it may indicate a clot. Late in pregnancy, the posterior pituitary gland secretes oxytocin. The client may experience painful Braxton Hicks contractions or early labor symptoms.

A primigravid client at 16 weeks' gestation visits the clinic for a routine examination. The client tells the nurse that she knows someone whose baby was born with congenital toxoplasmosis. What should the nurse instruct the client to do to prevent transmission of the toxoplasmosis protozoan? A) Consider a course of prophylactic penicillin as prevention. B) Cook all meats, such as beef and pork, thoroughly. C) Avoid contact with anyone diagnosed with this disease. D) Plan to be vaccinated for this condition at the next visit.

B) Cook all meats, such as beef and pork, thoroughly. Toxoplasmosis is a protozoal infection caused by Toxoplasma gondii, which is transmitted through ingestion of raw or undercooked meat, through contact with infected cat feces, or across the placental barrier from the mother to the fetus. The mother should be instructed to cook all meats thoroughly, avoid touching the mucous membranes when handling raw meat, thoroughly clean all kitchen surfaces that have come in contact with raw meat, avoid uncooked eggs, and avoid contact with cat litter boxes and cat feces. The disease is not spread by contact with an infected person. Although prophylactic penicillin may be used for pregnant clients who test positive for group B streptococcus, penicillin is not used to treat toxoplasmosis. Toxoplasmosis may be treated with a combination of pyrimethamine and sulfadiazine, accompanied by folic acid to reduce the toxicity of the other two drugs. However, controversy exists about whether to treat the mother. There is no vaccine for toxoplasmosis. Although a vaccine exists for rubella, this is given within 72 hours postpartum if the client is not immune.

A client who's 19 weeks pregnant comes to the clinic for a routine prenatal visit. In addition to checking the client's fundal height, weight, and blood pressure, what should the nurse assess for at each prenatal visit? A) Hemoglobin alterations B) Edema C) Rh factor changes D) Pelvic adequacy

B) Edema At each prenatal visit, the nurse should assess the client for edema because edema, increased blood pressure, and proteinuria are cardinal signs of gestational hypertension. Pelvic measurements and Rh typing are determined at the first visit only because they don't change. The nurse should monitor the hemoglobin level on the client's first visit, at 24 to 28 weeks' gestation, and at 36 weeks' gestation.

During a prenatal visit, a health care provider decides to admit a client to the hospital. Based on the nurse's progress note, which complication of pregnancy would the health care provider suspect? Progress Note - 2/2/15 @ 1100 - 30-year-old female admitted with nausea and vomiting. Client is 16 weeks pregnant and reports of thirst and vertigo. BP 120/70 mm Hg, RR 20, P 104, Temp 100F (37.8C). Client has had nothing to eat or drink for 24 hours. -------------------------S. Thomas, RN A) Placenta previa. B) Hyperemesis gravidarum. C) Iron-deficiency anemia. D) Pregnancy-induced hypertension.

B) Hyperemesis gravidarum. Hyperemesis gravidarum is severe nausea and vomiting that persists after the first trimester. If untreated, it can lead to weight loss, starvation, dehydration, fluid and electrolyte imbalances, and acid-base disturbances. The client may report thirst, hiccups, oliguria, vertigo, and headache. A rapid pulse and elevated or subnormal temperature can also occur. Signs and symptoms of iron-deficiency anemia include fatigue, pallor, and exercise intolerance. Placenta previa causes painless, bright red, vaginal bleeding after 20 weeks of pregnancy. Pregnancy-induced hypertension usually develops after 20 weeks of pregnancy; the client reports sudden weight gain and presents with hypertension.

A primigravid client with class II heart disease who is visiting the clinic at 8 weeks' gestation tells the nurse that she has been maintaining a low-sodium, 1,800-calorie diet. Which instruction should the nurse give the client? A) Take iron supplements with milk to enhance absorption. B) Increase caloric intake to 2,200 calories daily to promote fetal growth. C) Avoid folic acid supplements to prevent megaloblastic anemia. D) Severely restrict sodium intake throughout the pregnancy.

B) Increase caloric intake to 2,200 calories daily to promote fetal growth. The client can continue a low-sodium diet but should increase the caloric intake to 2,200 calories daily to provide adequate nutrients to support fetal growth and development. Folic acid supplements, a standard component of care, are used to prevent folic acid deficiency, which is associated with megaloblastic anemia during pregnancy. Severe restriction of sodium intake is not recommended because sodium is necessary to maintain fluid volume. Iron supplements should be taken with acidic foods and fluids (e.g., citrus juices) for maximum absorption. Milk decreases the absorption of iron.

A nurse is preparing to auscultate fetal heart tones in a pregnant client. Abdominal palpation reveals a hard, round mass under the left side of the rib cage; a softer, round mass just above the symphysis pubis; small, irregular shapes in the right side of the abdomen; and a long, firm mass on the left side of the abdomen. Based on these findings, what is the best place to auscultate fetal heart tones? A) Left lower abdominal quadrant B) Left upper abdominal quadrant C) Right lower abdominal quadrant D) Right upper abdominal quadrant

B) Left upper abdominal quadrant In this client, abdominal palpation reveals that the fetus is lying in a breech position with its back facing the client's left side. Because fetal heart tones are best heard through the fetus's back, the nurse should place the fetoscope or ultrasound stethoscope in the left upper abdominal quadrant for auscultation. Although placement in other locations might allow auscultation of fetal heart tones, the tones would be less clear.

A nurse is developing a care plan for a client in her 34th week of gestation who's experiencing premature labor. What nonpharmacologic intervention should the plan include to halt premature labor? A) Serving a nutritious diet B) Promoting adequate hydration C) Performing nipple stimulation D) Encouraging ambulation

B) Promoting adequate hydration Providing adequate hydration to the woman in premature labor may help halt contractions. The client should be placed on bed rest so that the fetus exerts less pressure on the cervix. A nutritious diet is important in pregnancy, but it won't halt premature labor. Nipple stimulation activates the release of oxytocin, which promotes uterine contractions.

When developing the plan of care for a multigravid client with class III heart disease, which of the following areas should the nurse expect to assess frequently? A) Dehydration. B) Tachycardia. C) Nausea and vomiting. D) Iron-deficiency anemia.

B) Tachycardia. Assessing for signs and symptoms associated with cardiac decompensation is the priority. Class III heart disease during pregnancy has a 25% to 50% mortality. These clients are markedly compromised, with marked limitation of physical activity. They frequently experience fatigue, palpitations, dyspnea, or anginal pain. A pulse rate greater than 100 bpm or a respiratory rate greater than 25 breaths/minute may indicate cardiac decompensation that could result in cardiac arrest. Additional symptoms include dyspnea, peripheral edema, orthopnea, tachypnea, rales, and hemoptysis.

During a nonstress test (NST), a nurse notes three fetal heart rate (FHR) increases of 20 beats/minute, each lasting 20 seconds. These increases occur only with fetal movement. What does this finding suggest? A) The fetus is nonreactive and hypoxic. B) The fetus is not in distress at this time. C) The client should undergo an oxytocin challenge test. D) The test is inconclusive and must be repeated.

B) The fetus is not in distress at this time. In an NST, reactive (favorable) results include two to three FHR increases of 15 beats/minute or more, each lasting 15 seconds or more and occurring with fetal movement. An oxytocin challenge test is performed to stimulate uterine contractions and evaluate the FHR. If results are inconclusive, a nipple stimulation contraction test may be ordered. A nonreactive result occurs when the FHR doesn't rise 15 beats/minute or more over the specified time; a nonreactive result may indicate fetal hypoxia.

The nurse is admitting a primigravid client at 37 weeks' gestation who has been diagnosed with preeclampsia to the labor and birth area. Which client care rooms is most appropriate for this client? A) a brightly lit private room at the end of the hall from the nurses' station B) a darkened private room as close to the nurses' station as possible C) a private room with many windows that is near the operating room D) a semiprivate room midway down the hall from the nurses' station

B) a darkened private room as close to the nurses' station as possible A primigravid client diagnosed with preeclampsia has the potential for developing seizures (eclampsia). This client should be in a room with the least amount of stimulation possible to reduce the risk of seizures and as close to the nurses' station as possible in case the client requires immediate assistance. Bright lighting and sunshine can be a stimulant, possibly increasing the risk of seizures, as can being in a semiprivate room with roommate, visitors, conversation, and noise.

A client is admitted to the facility with a suspected ectopic pregnancy. When reviewing the client's health history for risk factors for this abnormal condition, the nurse expects to find: A) grand multiparity (five or more births). B) a history of pelvic inflammatory disease. C) use of an intrauterine device for 1 year. D) use of a hormonal contraceptive for 5 years.

B) a history of pelvic inflammatory disease. Pelvic inflammatory disease with accompanying salpingitis is commonly implicated in cases of tubal obstruction, the primary cause of ectopic pregnancy. Ectopic pregnancy isn't associated with grand multiparity or hormonal contraceptive use. Ectopic pregnancy is associated with use of an intrauterine device for 2 years or more.

A 24-year-old client admitted to the hospital is suspected of having an ectopic pregnancy. On admission, which factor would be most important to assess? A) sexual practices B) date of last menstrual period C) type of oral contraceptives D) use of a diaphragm

B) date of last menstrual period Although it may be important to obtain information from a client with suspected ectopic pregnancy concerning when she last had intercourse, whether she is taking birth control pills, and whether she has been pregnant previously, it is most important to determine the date of her last menstrual period and if she has experienced amenorrhea. Such information helps establish an accurate diagnosis. Usually the client with an ectopic pregnancy suspects or knows that she is pregnant, having missed one or two menstrual periods. However, if the client's menstrual cycle is irregular, she may be unaware that she is pregnant.

A 36-year-old multigravid client is admitted to the hospital with possible ruptured ectopic pregnancy. When obtaining the client's history, which finding would be most important to identify as a predisposing factor? A) urinary tract infection B) episodes of pelvic inflammatory disease C) marijuana use during pregnancy D) use of estrogen-progestin contraceptives

B) episodes of pelvic inflammatory disease Anything that causes a narrowing or constriction in the fallopian tubes so that a fertilized ovum cannot be properly transported to the uterus for implantation predisposes an ectopic pregnancy. Pelvic inflammatory disease is the most common cause of constricted or narrow tubes. Developmental defects are other possible causes. Ectopic pregnancy is not related to urinary tract infections. Use of marijuana during pregnancy is not associated with ectopic pregnancy, but its use can result in cognitive reduction if the mother's use during pregnancy is extensive. Progestin-only contraceptives and intrauterine devices have been associated with ectopic pregnancy.

A pregnant client with diabetes mellitus is at risk for having a large-for-gestational-age neonate because: A) excess sugar causes reduced placental functioning. B) insulin acts as a growth hormone on the fetus. C) excess insulin reduces placental functioning. D) the mother follows a high-calorie diet.

B) insulin acts as a growth hormone on the fetus. Insulin acts as a growth hormone on the fetus. Therefore, pregnant clients with diabetes must maintain good glucose control. Large babies are prone to complications and may have to be delivered by cesarean birth. Neither excess sugar nor excess insulin reduces placental functioning. A high-calorie diet helps control the mother's disease and doesn't contribute to neonatal size.

A client at 28 weeks' gestation is complaining of contractions. Following admission and hydration, the physician writes an order for the nurse to give 12 mg of betamethasone I.M. This medication is given to: A) slow contractions. B) promote fetal lung maturity. C) prevent infection. D) enhance fetal growth.

B) promote fetal lung maturity. Betamethasone is given to promote fetal lung maturity by enhancing the production of surface-active lipoproteins. The drug has no effect on contractions, fetal growth, or infection.

A woman who's 10 weeks pregnant tells the nurse that she's worried about her fatigue and frequent urination. The nurse should: A) tell her that she may be excessively worried. B) recognize these as normal early pregnancy signs and symptoms. C) question her further about these signs and symptoms. D) tell her that she'll need blood work and urinalysis.

B) recognize these as normal early pregnancy signs and symptoms. Fatigue and frequent urination are early signs and symptoms of pregnancy that may continue through the first trimester. Questioning the client about the signs and symptoms is helpful to complete the assessment but won't reassure her. Prenatal blood work and urinalysis is routine for this situation but doesn't address the client's concerns. Telling her that she may be excessively worried isn't therapeutic.

A pregnant client asks the nurse whether she can take castor oil for her constipation. How should the nurse respond? A) "No, it can promote sodium retention." B) "No, it can lead to increased absorption of fat-soluble vitamins." C) "No, it can initiate premature uterine contractions." D) "Yes, it produces no adverse effects."

C) "No, it can initiate premature uterine contractions." Castor oil can initiate premature uterine contractions and other adverse effects in pregnant women. Castor oil doesn't promote sodium retention and isn't known to increase absorption of fat-soluble vitamins.

After instructing a pregnant client about third trimester edema, the nurse determines that the client needs further instruction when the client makes which statement? A) "Swelling of my feet and ankles is normal." B) "I will continue to drink six to eight glasses of water a day." C) "Swelling in my hands and face is to be expected." D) "I need to avoid standing in one place for too long."

C) "Swelling in my hands and face is to be expected." If the client experiences swelling in the face or hands or has any visual disturbances, she needs to report these symptoms promptly because they may indicate pregnancy-induced hypertension. Swelling of the feet and ankles is a common discomfort of pregnancy. The client should continue to drink six to eight glasses of a noncaffeinated beverage or water daily to prevent dehydration. The client should elevate her feet whenever possible and avoid prolonged standing or sitting to promote adequate venous return.

During a prenatal visit, a nurse measures a client's fundal height at 19 cm. This measurement indicates that the fetus has reached approximately which gestational age? A) 28 weeks B) 12 weeks C) 19 weeks D) 24 weeks

C) 19 weeks The fundal height measurement in centimeters equals the approximate gestational age in weeks, until week 32. Thus, fundal height at 12 weeks is 12 cm; at 24 weeks, 24 cm; and at 28 weeks, 28 cm.

When teaching a primigravid client at 24 weeks' gestation about the diagnostic tests to determine fetal well-being, which information should the nurse include? A) Contraction stress testing, performed on most pregnant women, can be initiated as early as 16 weeks' gestation. B) A reactive nonstress test is an ominous sign and requires further evaluation with fetal echocardiography. C) A fetal biophysical profile involves assessments of breathing movements, body movements, tone, amniotic fluid volume, and fetal heart rate reactivity. D) Percutaneous umbilical blood sampling uses a needle inserted through the vagina to obtain a sample.

C) A fetal biophysical profile involves assessments of breathing movements, body movements, tone, amniotic fluid volume, and fetal heart rate reactivity. The fetal biophysical profile includes fetal breathing movements, fetal body movements, tone, amniotic fluid volume, and fetal heart rate reactivity. A reactive nonstress test is a sign of fetal well-being and does not require further evaluation. A nonreactive nonstress test requires further evaluation. A contraction stress test or oxytocin challenge test should be performed only on women who are at risk for fetal distress during labor. The contraction stress test is rarely performed before 28 weeks' gestation because of the possibility of initiating labor. Percutaneous umbilical cord sampling requires the insertion of a needle through the abdomen to obtain a fetal blood sample.

A pregnant client comes to the facility for her first prenatal visit. When providing teaching, the nurse should be sure to cover which topic? A) Signs and symptoms of pregnancy B) Labor techniques C) Danger signs during pregnancy D) Tests to evaluate for high-risk pregnancy

C) Danger signs during pregnancy No matter how far the client's pregnancy has progressed by the time of her first prenatal visit, the nurse should teach about danger signs during pregnancy so the client can identify and report them early, helping to avoid complications. The nurse should discuss other topics just before they're expected to occur. For example, the nurse should teach about labor techniques near the end of pregnancy; signs and symptoms of pregnancy, shortly before they're anticipated, based on the number of weeks' gestation; and any tests, a few weeks before they're scheduled.

A client who's 2 months pregnant complains of urinary frequency and says she gets up several times at night to go to the bathroom. She denies other urinary symptoms. How should the nurse intervene? A) Refer the client to a urologist for further investigation. B) Explain that urinary frequency isn't a sign of urinary tract infection (UTI). C) Explain that urinary frequency is expected during the first trimester. D) Advise the client to decrease her daily fluid intake.

C) Explain that urinary frequency is expected during the first trimester. Urinary frequency is expected during the first trimester as the growing uterus exerts pressure on the client's bladder. Although the client should increase fluid intake during pregnancy, she should avoid drinking fluids after 6 p.m. to reduce the need to get up at night. Because urinary frequency is a normal discomfort of pregnancy and the client has no other signs or symptoms of UTI, referral to a urologist is unnecessary. Urinary frequency, dysuria, and voiding of small amounts of urine indicate UTI.

Which intervention listed in the care plan for a client with an ectopic pregnancy requires revision? A) Providing emotional support and assessing per vaginal loss B) Managing pain and providing emotional support C) Providing for dietary needs and nursing in a dark quiet room D) Assessing vital signs and managing pain

C) Providing for dietary needs and nursing in a dark quiet room Providing for the client's dietary needs is not appropriate because the client should not eat or drink anything pending surgery. Nursing the client in a dark quiet room is not appropriate for a client with ectopic pregnancy. Assessing vital signs for indicators of potential shock, managing pain, assessing per vaginal loss, and providing emotional support are essential nursing interventions in caring for a client with an ectopic pregnancy.

A woman at 22 weeks' gestation has right upper quadrant pain radiating to her back. She rates the pain as 9 on a scale of 1 to 10 and says that it has occurred 2 times in the last week for about 4 hours at a time. She does not associate the pain with food. Which nursing measure is the highest priority for this client? A) Support the client's use of acetaminophen to relieve pain. B) Educate the client concerning changes occurring in the gallbladder as a result of pregnancy. C) Refer the client to her health care provider for evaluation and treatment of the pain. D) Discuss nutritional strategies to decrease the possibility of heartburn.

C) Refer the client to her health care provider for evaluation and treatment of the pain. The nurse seeing this client should refer her to a health care provider for further evaluation of the pain. This referral would allow a more definitive diagnosis and medical interventions that may include surgery. Referral would occur because of her high pain rating as well as the other symptoms, which suggest gallbladder disease. During pregnancy, the gallbladder is under the influence of progesterone, which is a smooth muscle relaxant. Because bile does not move through the system as quickly during pregnancy, bile stasis and gallstone formation can occur. Although education should be a continuous strategy, with pain at this level, a brief explanation is most appropriate. Major emphasis should be placed on determining the cause and treating the pain. It is not appropriate for the nurse to diagnose pain at this level as heartburn. Discussing nutritional strategies to prevent heartburn are appropriate during pregnancy, but not in this situation. Acetaminophen is an acceptable medication to take during pregnancy but should not be used on a regular basis as it can mask other problems.

A client who's 7 months pregnant reports severe leg cramps at night. Which nursing action would be most effective in helping the client cope with these cramps? A) Suggesting that she walk for 1 hour twice per day B) Advising her to take over-the-counter calcium supplements twice per day C) Teaching her to dorsiflex her foot during the cramp D) Instructing her to increase milk and cheese intake to 8 to 10 servings per day

C) Teaching her to dorsiflex her foot during the cramp Common during late pregnancy, leg cramps cause shortening of the gastrocnemius muscle in the calf. Dorsiflexing or standing on the affected leg extends that muscle and relieves the cramp. Although moderate exercise promotes circulation, walking 2 hours daily during the third trimester is excessive. Excessive calcium intake may cause hypercalcemia, promoting leg cramps; the physician must evaluate the client's need for calcium supplements. If the client eats a well-balanced diet, calcium supplements and additional servings of high-calcium foods may be unnecessary.

A 27-year-old primigravid client with insulin-dependent diabetes at 34 weeks' gestation undergoes a nonstress test, the results of which are documented as reactive. What should the nurse tell the client that the test results indicate? A) The nonstress test should be repeated. B) Chorionic villus sampling is necessary. C) There is evidence of fetal well-being. D) A contraction stress test is necessary.

C) There is evidence of fetal well-being. The nonstress test is considered reactive when two or more fetal heart rate accelerations of at least 15 bpm occur (from a baseline fetal heart rate of 120 to 160 bpm), along with fetal movement, during a 10- to 20-minute period. A reactive nonstress test indicates fetal heart rate accelerations and well-being. There is no indication for further evaluation (such as a contraction stress test). However, contraction stress tests are commonly scheduled for pregnant clients with insulin-dependent diabetes in the latter part of pregnancy and are repeated periodically until birth. Chorionic villus sampling is usually performed early in the pregnancy to detect fetal abnormalities.

A client who is 18 weeks pregnant is losing weight. She tells a nurse that she's out of work and, after paying bills, has no money to buy healthy food. The nurse should offer the client information about: A) Women in Distress. B) Healthy Mothers, Healthy Babies. C) Women, Infants, and Children (WIC). D) Medicaid.

C) Women, Infants, and Children (WIC). WIC is an organization that assists women and infants who are at nutritional risk. The client may be able to obtain nutritional foods through this program. Women in Distress is an organization that provides shelter and services to women who are victims of domestic violence. Medicaid provides financial assistance to eligible low-income families. Healthy Mothers, Healthy Babies offers case managers to help pregnant women access community services.

A 29-year-old multigravida at 37 weeks' gestation is being treated for severe preeclampsia and has magnesium sulfate infusing at 3 g/h. To maintain safety for this client, the priority intervention is to: A) maintain continuous fetal monitoring. B) monitor maternal liver studies every 4 hours. C) assess reflexes, clonus, visual disturbances, and headache. D) encourage family members to remain at bedside.

C) assess reflexes, clonus, visual disturbances, and headache. The central nervous system (CNS) functioning and freedom from injury is a priority in maintaining well-being of the maternal-fetal unit. If the mother suffers CNS damage related to hypertension or stroke, oxygenation status is compromised, and the well-being of both mother and infant are at risk. Continuous fetal monitoring is an assessment strategy for the infant only and would be of secondary importance to maternal CNS assessment because maternal oxygenation will dictate fetal oxygenation and well-being. In preeclampsia, frequent assessment of maternal reflexes, clonus, visual disturbances, and headache give clear evidence of the condition of the maternal CNS system. Monitoring the liver studies does give an indication of the status of the maternal system, but the less invasive and highly correlated condition of the maternal CNS system in assessing reflexes, maternal headache, visual disturbances, and clonus is the highest priority. Psychosocial care is a priority and can be accomplished in ways other than having the family remain at the bedside.

A client, 38 weeks pregnant, arrives in the emergency department complaining of contractions. To help confirm that she's in true labor, the nurse should assess for: A) increased fetal movement. B) irregular contractions. C) changes in cervical effacement and dilation after 1 to 2 hours. D) contractions that feel like pressure in the abdomen and groin.

C) changes in cervical effacement and dilation after 1 to 2 hours. True labor is characterized by progressive cervical effacement and dilation after 1 to 2 hours, regular contractions, discomfort that moves from the back to the front of the abdomen and, possibly, bloody show. False labor causes irregular contractions that are felt primarily in the abdomen and groin and commonly decrease with walking, increased fetal movement, and lack of change in cervical effacement or dilation even after 1 or 2 hours.

A client who's 12 weeks pregnant attends a class on fetal development as part of a childbirth education program. The nurse anticipates that at 16 weeks' gestation, the client's fetus will: A) have open nostrils. B) be able to suck and swallow. C) have audible heart sounds. D) open the eyes.

C) have audible heart sounds. Fetal heart tones are usually audible using Doppler ultrasound around 12 weeks' gestation. The fetus can suck and swallow at about 20 weeks' gestation. The eyes are open at approximately 28 weeks' gestation. The nostrils are open at about 21 to 28 weeks' gestation.

A new nurse is asked to start an I.V. on an antepartum client. The new nurse has performed the procedure only once and isn't familiar with the I.V. pumps used in this facility. The new nurse should: A) attempt the procedure without assistance. B) tell the client that she isn't experienced enough to start the I.V. C) review the unit's procedure manual. D) ask another new nurse to assist her.

C) review the unit's procedure manual. A nurse should always refer to a policy and procedure manual for instructions on correctly performing a procedure. Asking another new nurse for assistance or attempting to perform an unfamiliar procedure without the necessary information makes the new nurse liable for errors that occur. A nurse who tells a client that she isn't experienced decreases that client's confidence in the nurse's credibility.

A newly pregnant woman tells the nurse that she hasn't been taking her prenatal vitamins because they make her nauseated. In addition to telling the client how important taking the vitamins are, the nurse should advise her to: A) take the vitamin with orange juice for better absorption. B) switch brands. C) take the vitamin on a full stomach. D) take the vitamin first thing in the morning.

C) take the vitamin on a full stomach. Prenatal vitamins commonly cause nausea and taking them on a full stomach may curb this adverse effect. Switching brands may not be helpful and may be more costly. Orange juice tends to make pregnant women nauseated. The vitamins may be taken at night, rather than in the morning, to reduce nausea.

A primigravid client at 32 weeks' gestation with ruptured membranes is prescribed to receive betamethasone 12 mg intramuscularly for two doses 24 hours apart. When teaching the client about the medication, what should the nurse include as the purpose of this drug? A) to improve the fetal heart rate pattern B) to reduce contraction frequency C) to accelerate fetal lung maturity D) to prevent potential infection

C) to accelerate fetal lung maturity Corticosteroids, such as betamethasone, are prescribed for clients who are preterm to accelerate fetal lung maturity and reduce the incidence and severity of respiratory distress syndrome. Infection would be treated with antibiotics. Tocolytic therapy is used to reduce contractions. The nurse should monitor the fetal heart rate pattern, but betamethasone will not improve the fetal heart rate.

A multigravid client visits the clinic because she suspects that she is pregnant but is unable to tell the nurse when her last menstrual period began. The client has a history of preterm birth. The nurse instructs the client that the gestational age of the fetus can be estimated by which procedure? A) amniocentesis B) percutaneous umbilical blood sampling C) ultrasonography D) alpha-fetoprotein level

C) ultrasonography An ultrasound can provide a fairly accurate estimate of the fetal gestational age through various measurements of fetal landmarks. Amniocentesis is appropriate for determining genetic deviations and fetal lung maturity (lecithin-to-sphingomyelin ratio). Percutaneous umbilical blood sampling is used to detect genetically transmitted (inherited) blood disorders, acidosis, or infection. Alpha-fetoprotein levels are performed between the 15th and 20th weeks of gestation to determine if neural tube defects are present.

Which client statement indicates a need for additional teaching about self-care during pregnancy? A) "I should avoid douching even if my vaginal secretions increase." B) "I should use nonskid pads when I take a shower or bath." C) "I should avoid using soap on my nipples to prevent drying." D) "I should sit in a hot tub for 20 minutes to relax after working."

D) "I should sit in a hot tub for 20 minutes to relax after working." The client needs further instruction when she says it is permissible to sit in a hot tub for 20 minutes to relax after working. Hot tubs and saunas should be avoided, particularly in the first trimester, because their use can lead to maternal hyperthermia, which is associated with fetal anomalies such as central nervous system defects. The client should use nonskid pads in the shower or bath to avoid slipping because the client's center of gravity has shifted and she may fall. The client should avoid using soap on the nipples to prevent removal of the natural protective oils. Douching is not recommended for pregnant women because it can destroy the normal flora and increase the client's risk of infection.

A nurse is providing care for a pregnant 16-year-old. The client says that she is concerned she may gain too much weight and wants to start dieting. The nurse should respond by saying: A) "Let's explore your feelings further." B) "The prenatal vitamins should ensure the baby gets all the necessary nutrients." C) "Now isn't a good time to begin dieting because you are eating for two." D) "Nutrition is important because depriving your baby of nutrients can cause developmental and growth problems."

D) "Nutrition is important because depriving your baby of nutrients can cause developmental and growth problems." Depriving the developing fetus of nutrients can cause serious problems and the nurse should discuss this issue with the client. The client isn't eating for two; this belief is a misconception. Exploring feelings helps the client understand her concerns, but the nurse also needs to make the client aware of the risks at this time. The vitamins are supplements and don't contain everything a mother or developing fetus needs; they work in conjunction with a balanced diet.

A pregnant client at about 29 weeks' gestation asks the nurse "What can I do about this dark brown line running down my stomach?" When teaching the client about this brown line, the nurse should tell the client: A) "This is a normal finding known as Chadwick's sign." B) "These are stretch marks that will turn a silvery color after birth." C) "This is a mask of pregnancy that will remain dark after birth." D) "This is a linea nigra that will fade after the baby is born."

D) "This is a linea nigra that will fade after the baby is born." This dark brown line is a darkened pigmentation termed linea nigra. The pigmentation will fade after birth. Chadwick's sign is a bluish hue of the cervix and vagina. It is considered a normal pregnancy finding. The mask of pregnancy, called chloasma, appears as darkened areas of pigmentation on the cheeks and across the nose. It usually lightens and disappears after pregnancy. Stretch marks are reddish or purplish in color and result from the skin stretching due to the growing fetus. After birth, the marks typically become silvery white in appearance.

When assessing a pregnant client with diabetes mellitus, the nurse stays alert for signs and symptoms of a vaginal or urinary tract infection (UTI). Which laboratory value makes this client more susceptible to such infections? A) Hemoglobin A1C of 6.8% B) Potassuim level of 3.0 mEq/L (3.0 mmol/L) C) Blood glucose level of 60 mg/dL (3.3mmol/L) D) +3 urine glucose

D) +3 urine glucose Glycosuria, evidenced by a +3 urine glucose level, predisposes the pregnant diabetic client to vaginal infections (especially Candida vaginitis) and UTIs, because the hormonal changes of pregnancy affect vaginal pH and the bladder. Electrolyte imbalances, such as a potassium level of 3.0 mEq/L and hypoglycemia, evidenced by a blood glucose level of 60 mg/dl (3.3 mmol/L), aren't associated with vaginal infections or UTIs. Hemoglobin A1C of 6.8% is within normal range for a client with diabetes and doesn't increase the client's risk for infection.

Which medication is considered safe during pregnancy? A) Aspirin B) Magnesium hydroxide C) Oral antidiabetic agents D) Insulin

D) Insulin Insulin is a required hormone for any client with diabetes mellitus, including the pregnant client. Aspirin, magnesium hydroxide, and oral antidiabetic agents aren't recommended for use during pregnancy because these agents may cause fetal harm.

Which instruction should a nurse include in a home-safety teaching plan for a pregnant client? A) Avoid having area rugs around your house. B) It's OK to wear high heels. C) It's OK to clean your cat's litter box. D) Place a nonskid mat on the floor of the tub or shower.

D) Place a nonskid mat on the floor of the tub or shower. Using a mat for the floor of the shower or tub will prevent slipping. The client shouldn't clean the cat's litter box because doing so puts her at risk for toxoplasmosis. Wearing high heels may make the client lose balance and fall. The client doesn't need to completely avoid having area rugs around her house. Nonslip rugs can be used to prevent tripping or falling.

During the first trimester, a nurse evaluates a pregnant client for factors that suggest that she might abuse a child. Which parental characteristic is of most concern to the nurse? A) The client did not graduate from high school. B) The client is carrying twins. C) The client eats fast food every day. D) The client states she is stupid and ugly.

D) The client states she is stupid and ugly. Typically, the abusive parent has low self-esteem, which may be evident by self-deprecating statements, and many unmet needs. Lack of nurturing experience and inadequate knowledge of childhood growth and development may also contribute to the potential for child abuse. A low educational level, multiple gestations, and poor diet aren't direct risk factors for committing child abuse.

Which outcome would the nurse identify as the priority to achieve when developing the plan of care for a primigravid client at 38 weeks' gestation who is hospitalized with severe preeclampsia and receiving intravenous magnesium sulfate? A) decreased generalized edema within 8 hours B) decreased urinary output during the first 24 hours C) sedation and decreased reflex excitability within 48 hours D) absence of any seizure activity during the first 48 hours

D) absence of any seizure activity during the first 48 hours The highest priority for a client with severe preeclampsia is to prevent seizures, thereby minimizing the possibility of adverse effects on the mother and fetus, and then to facilitate safe childbirth. Efforts to decrease edema, reduce blood pressure, increase urine output, limit kidney damage, and maintain sedation are desirable but are not as important as preventing seizures. It would take several days or weeks for the edema to be decreased. Sedation and decreased reflex excitability can occur with the administration of intravenous magnesium sulfate, which peaks in 30 minutes, much sooner than 48 hours.

A primigravid client visits the clinic for a routine examination at 35 weeks' gestation. The client's blood pressure is near the baseline of 120/74 mm Hg with no proteinuria or evidence of facial edema. The client asks the nurse, "What should I take if I get an occasional headache after looking at my computer at work all day?" The nurse instructs the client that she can occasionally take which over-the-counter medication? A) naproxen B) aspirin C) ibuprofen D) acetaminophen

D) acetaminophen The nurse should instruct the client that symptoms from an occasional headache due to eye strain or continuous work at a computer can be relieved by acetaminophen. Although this drug causes prostaglandin inhibition, this effect is rapidly reversed and cleared with no apparent harmful effects in pregnancy. If the headaches become more frequent or severe, the client should be instructed to contact her health care provider (HCP) immediately. Aspirin should be avoided during pregnancy because it inhibits prostaglandin synthesis. It also decreases uterine contractility and may delay the onset of labor or prolong pregnancy and labor. Aspirin decreases platelet aggregation, possibly increasing the risk of bleeding. Ibuprofen and naproxen can lead to premature closure of the fetal ductus arteriosus and decreased amniotic fluid with prolonged use. They may also prolong pregnancy or labor because of their antiprostaglandin effects.

A client who is 32 weeks pregnant presents to the emergency department with bright red bleeding and no abdominal pain. A nurse should: A) assess the client's blood pressure. B) perform a pelvic examination. C) order a stat hemoglobin and hematocrit. D) assess the fetal heart rate.

D) assess the fetal heart rate. The nurse should assess the fetal heart rate for distress or viability. She shouldn't attempt to perform a pelvic examination because of the possibility of placenta previa, which presents as bright red bleeding without abdominal pain. The nurse should assess the client's blood pressure after attempting to hear fetal heart tones. Ordering a hemoglobin and hematocrit is a physician intervention, not a nursing intervention.

A client is in the last trimester of pregnancy. The nurse should instruct her to notify her primary health care provider immediately if she notices: A) dyspnea on exertion. B) increased vaginal mucus. C) hemorrhoids. D) blurred vision.

D) blurred vision. Blurred vision or other visual disturbances, excessive weight gain, edema, and increased blood pressure may signal severe preeclampsia. This condition may lead to eclampsia, which has potentially serious consequences for the client and fetus. Although hemorrhoids may be a problem during pregnancy, they don't require immediate attention. Increased vaginal mucus and dyspnea on exertion are expected as pregnancy progresses.

A client's membranes rupture during the 36th week of pregnancy. Eighteen hours later, the nurse measures the client's temperature at 101.8° F (38.8° C). After initiating ordered antibiotic therapy, the nurse should prepare the client for: A) amniocentesis. B) tocolytic therapy. C) sonography. D) delivery.

D) delivery. After rupture of the membranes in a client who has a fever or other signs or symptoms of infection, the fetus must be delivered promptly. Data obtained by amniocentesis or sonography wouldn't change the decision to deliver the fetus. Tocolytic drugs are used to arrest preterm labor.

During a prenatal visit, a pregnant client with cardiac disease and slight functional limitations reports increased fatigue. To help combat this problem, the nurse should advise her to: A) eat three well-balanced meals per day. B) exercise 1 hour before each meal. C) take a vitamin and mineral supplement. D) divide daily food intake into five or six meals.

D) divide daily food intake into five or six meals. To combat fatigue, the nurse should advise the client to divide her daily food intake into five or six meals eaten throughout the day to minimize the energy expenditure associated with consuming three larger meals. Exercising before meals would increase fatigue, interfering with the client's nutritional intake. Vitamin and mineral supplements are appropriate for anyone, not specifically pregnant clients, and have little effect on fatigue.

A client makes a routine visit to the prenatal clinic. Although she's 14 weeks pregnant, the size of her uterus approximates an 18- to 20-week pregnancy. The physician diagnoses gestational trophoblastic disease and orders ultrasonography. The nurse expects ultrasonography to reveal: A) an empty gestational sac. B) a severely malformed fetus. C) an extrauterine pregnancy. D) grapelike clusters.

D) grapelike clusters. In a client with gestational trophoblastic disease, an ultrasound performed after the third month shows grapelike clusters of transparent vesicles rather than a fetus. The vesicles contain a clear fluid and may involve all or part of the decidual lining of the uterus. Usually no embryo (and therefore no fetus) is present because it has been absorbed. Because there is no fetus, there can be no extrauterine pregnancy. An extrauterine pregnancy occurs with an ectopic pregnancy.

When teaching a group of pregnant adolescents about reproduction and conception, the nurse is correct when stating that fertilization occurs: A) near the fimbriated end. B) in the uterus. C) when the ovum is released. D) in the first third of the fallopian tube.

D) in the first third of the fallopian tube. Fertilization occurs in the first third of the fallopian tube. After ovulation, an ovum is released by the ovary into the abdominopelvic cavity. It enters the fallopian tube at the fimbriated end and moves through the tube on the way to the uterus. Sperm cells "swim up" the tube and meet the ovum in the first third of the fallopian tube. The fertilized ovum then travels to the uterus and implants. Nurses must know where fertilization occurs because of the risk of an ectopic pregnancy.

A 25-year-old client tells the nurse that she would like to become pregnant, but she has been diagnosed with blocked fallopian tubes due to pelvic inflammatory disease. When helping the client explore infertility treatment options, what is most appropriate for this client? A) zygote intrafallopian transfer (ZIFT) B) gamete intrafallopian transfer (GIFT) C) menotropin therapy D) in vitro fertilization (IVF)

D) in vitro fertilization (IVF) Because this client's tubes are blocked, IVF would be the most appropriate. After ova are removed surgically from the client and fertilized outside the uterus, the fertilized ova are introduced vaginally through a special tube through the cervix to the uterus for implantation, completely bypassing the fallopian tubes. Gamete intrafallopian transfer, the transfer of ova into a patent fallopian tube for fertilization, would be inappropriate for client with blocked fallopian tubes. Zygote intrafallopian transfer involves oocyte retrieval then fertilization. After fertilization, the fertilized eggs are transferred into the client's fallopian tubes. This is not an option for a client who has blocked tubes. Menotropin therapy would be appropriate if the client was experiencing ovarian dysfunction.