PrepU Antepartum review if time lots of Q for lecture7

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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 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.

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.

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 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.

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.

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.

When performing a vaginal examination on a pregnant client, the nurse determines that the biparietal diameter of the fetal head has reached the pelvic inlet. Which statement best describes the position of the fetus at this time?

It's engaged. Explanation: The largest part of the fetus's head, the presenting part, is marked by the biparietal diameter. The largest part of the head is accommodated by the largest part of the passage — the pelvic inlet. Engagement refers to entry of the fetus's head or presenting part into the superior pelvic strait, which is marked by the pelvic inlet. When the fetus's head is at the level of the ischial spines, it's at the pelvic outlet. The ischial spines are designated as zero station, not first station. A floating fetus hasn't yet entered the pelvic inlet.

The primary healthcare provider (HCP) orders 1,000 mL of Ringer's Lactate intravenously over an 8-hour period for a 29-year-old primigravid client at 16 weeks' gestation with hyperemesis. The drip factor is 12 gtts/mL. The nurse should administer the IV infusion at how many drops per minute? Record your answer as a whole number.

25 Gtts/min = (12 gtts/1 mL) X (1000 mL/8 hr) X (1 hr/60 min) = 25 gtts/min.

A client with preeclampsia is prescribed magnesium sulfate to prevent seizure activity. The nurse is reviewing the results of the client's serum magnesium level and determines that the client's level is therapeutic based on which result?

6.8 mEq/L (3.4 mmol/L) Explanation: The therapeutic level of magnesium for clients with preeclampsia ranges 4 to 8 mEq/L (2 to 4 mmol/L). A serum magnesium level of 8 to 10 mEq/L (4 to 5 mmol/L) may cause the absence of reflexes in the client. Serum levels of 10 to 12 mEq/L (5 to 6 mmol/L) may cause respiratory depression, and a serum level of magnesium greater than 15 mEq/L (7.5 mmol/L) may result in respiratory paralysis.

A client is at risk for seizures due to pregnancy-induced hypertension. The health care provider orders 4 g magnesium sulfate in 250 ml D5W to be infused at 1 g/hour following a loading dose. What is the flow rate in milliliters per hour? Record your answer using a whole number.

63 Explanation: To solve this, first set up a proportion and then solve for X: 4 g/250 ml = 1 g/X 4X = 250 ml X = 62.5 ml, which rounds to 63 ml/h.

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 Explanation: X = 500mL/20grams x 2grams/hour. X = 50 mL/hour.

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?

7 days after fertilization Explanation: 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, 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.

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.

Which information would be included in the teaching plan about pregnancy-related breast changes for a primigravid client?

Colostrum is usually secreted by about the 16th week of gestation. Explanation: Colostrum is usually secreted by about the 16th week of gestation in preparation for breast-feeding. Growth of the milk ducts is greatest in the last trimester, not in the first 8 weeks of gestation. Enlargement of the breasts is usually caused by estrogen, not progesterone. Darkening of the areola can occur as early as the sixth week of gestation.

A 40-year-old primigravid client with AB-positive blood visits the outpatient clinic for an amniocentesis at 16 weeks' gestation. The nurse determines that the most likely reason for the client's amniocentesis is to determine if the fetus has which problem?

Down syndrome Explanation: Because of the client's age, the amniocentesis is most likely being done to evaluate for Down syndrome (trisomy 21). Women older than 35 years are at higher risk for having a child with Down syndrome. Cri-du-chat syndrome is a genetic disorder involving a short arm on chromosome 5. This disorder is not associated with mothers who are older than 35 years. The client is AB-positive, so the amniocentesis is not being done for ABO incompatibility, in which the mother is type O and the fetus is type A, B, or AB. The amniocentesis is not being done to detect erythroblastosis fetalis because the mother is Rh-positive.

The nurse is providing instruction to a woman who is 18 weeks pregnant. Which findings are expected at this time? Select all that apply.

Fundal height of approximately 18 cm Quickening Explanation: Between 18 and 30 weeks' gestation, fundal height in centimeters is approximately the same as the number of weeks' gestation. In this case, the client is 18 weeks pregnant, so fundal height should measure approximately 18 cm. Quickening, which is typically described as light fluttering and is usually felt between 16 and 22 weeks' gestation, is caused by fetal movement. Insomnia, Braxton-Hicks contractions, and leg cramps are common during the third trimester.

A client at 24 weeks gestation comes to the clinic for a prenatal check-up and informs the nurse that she has been "seeing double." The nurse checks the urine and determines that there is 3+ proteinuria. What does the nurse determine is the potential priority problem?

Gestation hypertension Explanation: A client with gestational hypertension typically presents with headaches, double vision, and sudden weight gain. Additional findings include proteinuria. Clients with gestational diabetes would have elevated glucose levels. The client with hyperemesis gravidarum would present with intractable vomiting and signs of dehydration. Placenta previa is the covering of the cervical os with the placenta and would be demonstrated by painless vaginal bleeding.

The nurse is assessing a pregnant client using Leopold's maneuvers. Which of the following nursing actions are appropriate for this assessment? Select all that apply.

Palpate the client's upper abdomen using both hands Note the shape and consistency of the palpated part The palpated part should be noted for mobility Explanation: Leopold's maneuvers are used to determine the position of the fetus and the presenting part. The client should have her bladder emptied and positioned on her back. The first maneuver is done by palpating the upper abdomen, noting the mobility, shape, and consistency of the palpated part.

After instructing a primigravid client at 38 weeks' gestation about how preeclampsia can affect the client and the growing fetus, the nurse realizes that the client needs additional instruction when she says that preeclampsia can lead to which problem?

hydrocephalic infant Explanation: Congenital anomalies such as hydrocephalus are not associated with preeclampsia. Conditions such as stillbirth, prematurity, abruptio placentae, intrauterine growth restriction, and poor placental perfusion are associated with preeclampsia. Abruptio placentae occurs because of severe vasoconstriction. Intrauterine growth restriction is possible owing to poor placental perfusion. Poor placental perfusion results from increased vasoconstriction.

A nurse is providing care for a pregnant client. The client asks the nurse how she can best deal with her fatigue. The nurse should instruct her to:

try to get more rest by going to bed earlier. Explanation: The client should listen to the body's way of telling her that she needs more rest and try going to bed earlier. Sleeping pills shouldn't be consumed prenatally because they can harm the fetus. Vitamins won't take away fatigue. False reassurance is inappropriate and doesn't help the client deal with fatigue now.

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:

"Do you have any cats at home?" Explanation: 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.

After explaining to a multigravid client at 36 weeks' gestation who is diagnosed with severe hydramnios about the possible complications of this condition, which client statement indicates the need for further instruction?

"I can continue to work at my job at the automobile factory until labor starts." Explanation: The client needs further instructions when she says, "I can continue to work at my job at the automobile factory until labor starts." The goal is to avoid preterm labor. Because the client is experiencing severe hydramnios, she will most likely be maintained on bed rest to increase uteroplacental circulation and reduce pressure on the cervix. Hydramnios has been associated with increased weight gain caused by increased amniotic fluid volume. Hydramnios has been associated with gastrointestinal disorders in the fetus, such as tracheoesophageal fistula with stenosis or intestinal obstruction. The client should continue to eat high-fiber foods and should avoid straining, which could lead to ruptured membranes. Stool softeners may also be prescribed. The client should report any symptoms of fluid rupture or labor.

An obese 36-year-old multigravid client at 12 weeks' gestation has a history of chronic hypertension. She was treated with methyldopa before becoming pregnant. When counseling the client about diet during pregnancy, the nurse realizes that the client needs additional instruction when she makes which statement?

"I need to reduce my caloric intake to 1,200 calories a day." Explanation: Pregnancy is not the time for clients to begin a diet. Clients with chronic hypertension need to consume adequate calories to support fetal growth and development. They also need an adequate protein intake. Meat and beans are good sources of protein. Most pregnant women report that eating more frequent, smaller meals decreases heartburn resulting from the reflux of acidic secretions into the lower esophagus. Pregnant women need adequate hydration (fluids) and fiber to prevent constipation.

After instruction of a primigravid client at 8 weeks' gestation about measures to overcome early morning nausea and vomiting, which client statement indicates the need for additional teaching?

"I will eat two large meals daily with frequent protein snacks." Explanation: The client needs further instructions when she says she should eat two meals a day with frequent protein snacks to decrease nausea and vomiting. The client should eat more frequent, smaller meals, with frequent carbohydrate snacks to decrease nausea and vomiting. Eating dry crackers or toast before arising, consuming fluids separately from meals, and avoiding greasy or spicy foods may also help to decrease nausea and vomiting.

After reinforcing the danger signs to report with a gravida 2 client at 32 weeks' gestation with an elevated blood pressure, which client statements would demonstrate her understanding of when to call the primary health care provider's (HCP's) office? Select all that apply.

"If I see any bleeding, even if I have no pain." "If I have a pounding headache that will not go away." "If the baby seems to be more active than usual." Explanation: Vaginal bleeding with or without pain could signify placenta previa or abruptio placentae. Continuous or pounding headache could indicate an elevated blood pressure, and change in the strength or frequency of fetal movements could indicate that the fetus is in distress. Orthostatic hypotension can occur during pregnancy and can be alleviated by rising slowly. Leg veins may increase in size due to additional pressure from the increasing uterine size, while leg cramps may also occur and can commonly be decreased with calcium supplements.

A nurse is caring for a client who is anxious to know her baby's due date. The nurse instructs the client on how to determine the baby's due date according to Nägele's rule. The client is correct to state which of the following when discussing the use of the rule. Select all that apply.

"Nägele's rule provides a good approximation of the due date." "I will add seven days to the first day of my last menstrual period and count back 3 months." "Nägele's rule may be used in conjunction with other assessment findings." Explanation: Nägele's rule is one method of determining the estimated due date. When using Nägele's rule, add 7 days to the first day of the last menstrual period, and count back 3 months. Nägele's rule may be used with other assessment findings, especially in situations when the last menstrual period is in question. Nägele's rule does not use dates of intercourse nor adding 9 months to the last menstrual period to determine the due date.

A nurse determines that a client is in false labor. After obtaining discharge orders, the nurse provides discharge teaching to the client. Which instruction is most appropriate at this time?

"Return to the facility if fever occurs." Explanation: The nurse should instruct a client in false labor to return to the health care facility if she develops signs or symptoms of infection, such as a fever; if her membranes rupture; if vaginal bleeding occurs; or if her contractions become more intense. The nurse should suggest warm milk or herbal tea, which promote relaxation and rest, instead of coffee or caffeinated tea. Taking a warm tub bath or shower — not applying cold compresses — helps relieve discomfort. A semi-upright position with pillows placed under the client's knees promotes rest.

A primiparous client at 10 weeks' gestation questions the nurse about the need for an ultrasound. She states, "I feel fine, so why should I have the test?" The nurse should incorporate which statements as the underlying reason for performing the ultrasound now? Select all that apply.

"The test helps us view the gross anatomy of the fetus." "We need to determine gestational age." Explanation: Although ultrasounds are not considered part of routine care, the ultrasound is able to confirm the pregnancy, identify the major anatomic features of the fetus and possible abnormalities, and determine the gestational age by measuring crown-to-rump length of the embryo during the first trimester. At this time, the ultrasound cannot confirm that the fetus is viable. The ultrasound will provide information about fetal position; however, this information would be more important later in the pregnancy, not during the first trimester. The ultrasound would provide no information about nutrient supply for the fetus.

A client who's 4 months pregnant asks the nurse how much and what type of exercise she should get during pregnancy. How should the nurse counsel her?

"Walk briskly for 10 to 15 minutes daily, and gradually increase this time." Explanation: Taking brisk walks is one of the easiest ways to exercise during pregnancy. The client should begin by walking slowly for 10 to 15 minutes per day and increase gradually to a comfortable speed and a duration of 30 to 45 minutes per day. The pregnant client should avoid high-intensity aerobics because these greatly increase oxygen consumption; pregnancy itself not only increases oxygen consumption but reduces oxygen reserve. Starting from the fourth month of pregnancy, the client should avoid back-lying exercises because in this position the enlarged uterus may reduce blood flow through the vena cava. The client should avoid exercises that raise the heart rate over 140 beats/minute because the cardiovascular system already is stressed by increased blood volume during pregnancy.

A client is at her ideal weight when she conceives. During a prenatal visit 2 months later, she asks the nurse how much weight she should gain during pregnancy. What is the nurse's best response?

"You should gain 25 to 35 lb." Explanation: For a client entering pregnancy in her ideal weight range, a gain of 25 to 35 lb (11.4 to 15.9 kg) is adequate to meet her needs and the needs of her fetus. Weight gain below the recommended range predisposes the client to complications during pregnancy, labor, and birth.

When the nurse instructs a pregnant client with a history of varicose veins about strategies to promote comfort, which client statement indicates that the teaching has been successful? A) "Lying down with my feet elevated should help." B) "Restricting milk intake may provide some relief." C) "Wearing knee-high stockings is better than pantyhose." D) "Support hose can be put on just before bedtime."

A) "Lying down with my feet elevated should help." The enlarging uterus exerts pressure on blood vessels carrying blood to and from the lower part of the body, especially the extremities, predisposing the client to varicosities. Prevention and management of varicosities includes lying down with feet elevated several times a day to promote venous return and avoiding anything that constricts the legs or thighs, such as round garters or knee-high hose. Supportive hose or elastic stockings may be helpful but should be applied as soon as the client awakens in the morning. Restriction of milk intake has no effect on varicosities. Knee-high stockings could cause constriction and should be avoided.

A primigravid client in a preparation for parenting class asks how much blood is lost during an uncomplicated vaginal birth. The nurse should tell the woman: A) "The maximum blood loss considered within normal limits is 500 ml." B) "The minimum blood loss considered within normal limits is 1,000 ml." C) "Blood loss during childbirth is rarely estimated unless there is a hemorrhage." D) "It would be very unusual if you lost more than 100 ml of blood during the birth."

A) "The maximum blood loss considered within normal limits is 500 ml." In a normal birth and for the first 24 hours postpartum, a total blood loss not exceeding 500 mL is considered normal. Blood loss during childbirth is almost always estimated because it provides a valuable indicator for possible hemorrhage. A blood loss of 1,000 mL is considered hemorrhage.

A nulligravid client with gestational diabetes tells the nurse that she had a reactive nonstress test 3 days ago and asks, "What does that mean?" The nurse explains that a reactive nonstress test indicates which of the following about the fetus? A) Fetal well-being at this point in the pregnancy. B) Evidence of some compromise that will require birth soon. C) Evidence of late decelerations occurring during the test. D) No accelerations demonstrated within a 20-minute period.

A) Fetal well-being at this point in the pregnancy. A reactive nonstress test is a positive sign indicating that the fetus is doing well at this point in the pregnancy. For a nonstress test to be a reactive test, at least two accelerations (15 beats or more) of the fetal heart rate lasting at least 15 seconds must occur after movement. If the fetus were compromised, the nonstress test would demonstrate no accelerations in fetal heart rate; a contraction stress test would show fetal heart rate decelerations during simulated labor. Late decelerations are associated with a positive or abnormal contraction stress test. No accelerations in a 20-minute period during a nonstress test may mean that the fetus is sleeping; however, this is interpreted as a nonreactive nonstress test.

A nurse is completing a prenatal assessment on a woman who is 28 weeks pregnant with gestational hypertension. Which findings should be reported to the primary care provider? Select all that apply. A) dull headache B) 1+ urine protein C) fundal height of 28 centimeters D) blurred vision E) edematous feet

A) dull headache B) 1+ urine protein D) blurred vision The nurse must be alert for any signs and symptoms of superimposed preeclampsia in women with gestational hypertension. Dull headache, blurred vision, protein in urine are all classic signs of preeclampsia in pregnancy and must be reported to the primary care provider immediately. Edema in lower extremities is not a sign of preeclampsia in pregnancy as it is seen in uncomplicated pregnancy. Fundal height of 28 centimeters is an expected finding.

A primigravid client at 8 weeks' gestation tells the nurse that since having had sexual relations with a new partner 2 weeks ago, she has noticed flu-like symptoms, enlarged lymph nodes, and clusters of vesicles on her vagina. The nurse refers the client to a primary health care provider because the nurse suspects which sexually transmitted infection? A) herpes genitalis B) syphilis C) gonorrhea D) Chlamydia trachomatis infection

A) herpes genitalis The client is reporting symptoms typically associated with herpes genitalis. Some women have no symptoms of gonorrhea. Others may experience vaginal itching and a thick, purulent vaginal discharge. C. trachomatis infection in women is commonly asymptomatic, but symptoms may include a yellowish discharge and painful urination. The first symptom of syphilis is a painless chancre.

A nurse assesses a client for signs and symptoms of ectopic pregnancy. Which assessment finding should the nurse expect?

Abdominal pain Explanation: 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.

Admit the client to a quiet, darkened room. Explanation: 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.

During a nonstress test (NST), the electronic tracing displays a relatively flat line for fetal movement, making it difficult to evaluate the fetal heart rate (FHR). To mark the strip, a nurse should instruct the client to push the control button at which time?

At the beginning of each fetal movement Explanation: An NST assesses the FHR during fetal movement. In a healthy fetus, the FHR accelerates with each movement. By pushing the control button when a fetal movement starts, the client marks the strip to allow easy correlation of fetal movement with the FHR. The FHR is assessed during uterine contractions in the oxytocin contraction test, not the NST. Pushing the control button after every three fetal movements or at the end of fetal movement wouldn't allow accurate comparison of fetal movement and FHR changes.

A pregnant client is seeking information from the nurse about a home birth with registered midwives. Which of the following statements lets the nurse know that the client has considered the risks and benefits of using a midwife? Select all that apply. A) "I am safer having a home birth with a physician." B) "I understand the complications that could occur in a home birth setting." C) "I will look for an obstetrician because it's hard to find a general practitioner who provides maternity services." D) "I will develop a list of questions to use in interviewing potential midwives." E) "I realize that I may need to be transferred to a hospital if complications develop."

B) "I understand the complications that could occur in a home birth setting." C) "I will look for an obstetrician because it's hard to find a general practitioner who provides maternity services." E) "I realize that I may need to be transferred to a hospital if complications develop." Developing a list of questions, understanding the complications that could occur with a home birth, and realizing that a transfer to a hospital might be necessary all demonstrate that the client has researched a home birth and is aware of the positive and negative factors that could occur. These choices show that the client is approaching the situation in a realistic and educated manner. Looking for an obstetrician and stating that a home birth is safer with a physician are not appropriate answers.

After teaching a primigravid client at 24 weeks' gestation, who has received permission from the primary care provider to make a 6-hour automobile trip to visit her parents, about precautions to take during the trip, which client statement indicates the need for further teaching? A) "I will be sure to wear the car seat belt while traveling." B) "I will sleep for 1 hour at the halfway point of the trip." C) "I will drink plenty of fluids to avoid dehydration." D) "I will take frequent rest breaks every 2 hours."

B) "I will sleep for 1 hour at the halfway point of the trip." Taking a 1-hour nap at the halfway point of the trip is not necessary. However, taking frequent rest breaks (e.g., every 2 hours) is advisable. Drinking plenty of fluids is recommended to promote adequate hydration and prevent dehydration. The client should be encouraged to take frequent rest breaks and stretch her muscles by walking approximately every 2 hours to increase circulation to the lower extremities and prevent venous stasis. Wearing the seat belt is a recommended safety measure for all people, including pregnant women.

A primigravida, currently about 8 weeks pregnant, and her husband ask when they should begin the preparation for childbirth classes that discuss maternal nutrition during pregnancy. Which time would be most appropriate for the nurse to suggest that they begin the classes? A) after scheduling a visit with the dietitian B) now during the first trimester of pregnancy C) as soon as the client experiences lightening D) toward the end of the second trimester

B) now during the first trimester of pregnancy Early pregnancy classes, which typically focus on maternal nutrition, minor discomforts of pregnancy, and newborn nutrition, are appropriate for clients seeking early obstetric care. Typically, couples begin attending these classes during the first trimester. This allows the woman to incorporate proper nutritional guidelines into her diet. The couple then has ample time to decide the method of choice for feeding the newborn. Most clients make the decision to breastfeed or bottle-feed by the sixth month of pregnancy. Lightening occurs about 1 to 2 weeks before the beginning of labor. The couple should have attended childbirth classes before this time. Although clients often have a visit with a dietitian early in pregnancy, they need not wait for this to occur before participating in childbirth classes. Toward the end of the second trimester or the beginning of the third trimester, couples are usually psychologically ready for the pregnancy to end and are ready for classes dealing with labor and birth, newborn care, and postpartum care.

After instructing a primigravid client about desired weight gain during pregnancy, the nurse determines that the teaching has been successful when the client states which statement? A) "A total weight gain of approximately 20 lb (9 kg) is recommended." B) "A weight gain of about 12 lb (5.5 kg) every trimester is recommended." C) "Although it varies, a gain of 25 to 35 lb (11.4 to 14.5 kg) is about average." D) "A weight gain of 6.6 lb (3 kg) in the second and third trimesters is considered normal."

C) "Although it varies, a gain of 25 to 35 lb (11.4 to 14.5 kg) is about average." The National Academy of Sciences Institute of Medicine and Health Canada recommend that women gain 25 to 35 lb (11.5 to 14.5 kg) during pregnancy. The pattern of weight gain is as important as the total amount of weight gained. Underweight women and women carrying twins should have a greater weight gain. Typically, women should gain 3.5 lb (1.6 kg) during the first trimester and then 1 lb (0.45 kg)/week during the remainder of the pregnancy (24 weeks) for a total of about 27 to 28 lb (12.2 to 12.7 kg). A weight gain of only 6.6 lb (3 kg) in the second and third trimesters is not normal because the client should be gaining about 1 lb (0.45 kg)/week, or 12 lb (5.4 kg) during the second and third trimesters. Gaining 12 lb (5.4 kg) during each trimester would total 36 lb (16.2 kg), which is slightly more than the recommended weight gain. In addition, nausea and vomiting during the first trimester can contribute to a lack of appetite and smaller weight gain during this trimester.

A client who tells the nurse that she would like to use the basal body temperature method for family planning receives instructions about the method. Which client statement indicates to the nurse that the teaching has been successful? A) "Taking my temperature in the evening just after dinner or before I go to bed is best." B) "When my temperature remains elevated for 7 days, ovulation has occurred." C) "It is important to take my temperature at about the same time every morning before arising." D) "Because this method is not very effective, I should use other forms of contraception too."

C) "It is important to take my temperature at about the same time every morning before arising." The client using the basal body temperature method should take her temperature for 5 minutes at the same time every morning on awakening, before arising or starting any activity. Doing so prevents other factors, such as eating or moving, from possibly influencing body temperature. The temperature reading should be recorded on a graph. In some women, a slight drop in body temperature occurs just before ovulation. However, a woman cannot determine exactly when ovulation occurs until it has actually happened. Typically, ovulation occurs when the slight drop in body temperature is followed by temperature rise. This temperature rise is maintained for the remainder of the menstrual cycle. Taking the basal body temperature at times other than on awakening, such as before bedtime, may result in inaccurate readings because the client's temperature may be affected by numerous factors, causing fluctuations. Basal body temperature can be an effective fertility management method if the client is motivated and able to perform the procedure correctly. Unfortunately it is one of the least reliable methods. Generally clients who choose this method do not wish to use other chemical or barrier methods for a variety of reasons.

A multigravid client at 38 weeks' gestation is scheduled to undergo a contraction stress test. What should the nurse include in the explanation as the purpose of this test? A) evaluation of fetal lung maturity B) determination of the fetal biophysical profile C) assessment of fetal ability to tolerate labor D) determination of fetal response during movements

C) assessment of fetal ability to tolerate labor The purpose of a contraction stress test is to determine fetal response during labor. If late decelerations are noted with the contractions, the test is considered positive or abnormal. Fetal lung maturity is evaluated through amniocentesis to obtain the lecithin-sphingomyelin ratio. The nonstress test is part of the biophysical profile. Determining fetal response during movements is evaluated as part of the nonstress test.

During a childbirth preparation class, a primigravid client at 36 weeks' gestation tells the nurse, "My lower back has really been bothering me lately." Which exercise suggested would be most helpful? A) deep breathing B) squatting C) pelvic rocking D) tailor sitting

C) pelvic rocking Pelvic rocking helps to relieve backache during pregnancy and early labor by making the spine more flexible. Deep breathing exercises assist with relaxation and pain relief during labor. Tailor sitting and squatting help stretch the perineal muscles in preparation for labor.

The nurse is performing Leopold's maneuvers on a woman who is in her eighth month of pregnancy. The nurse is palpating the uterus as shown above. Which maneuver is the nurse performing? A) second maneuver B) first maneuver C) third maneuver D) fourth maneuver

C) third maneuver The third maneuver is used to identify the presenting part. This maneuver is used to identify the part of the fetus that lies over the inlet to the pelvis. While facing the client, the nurse places the tips of the first three fingers on the side of the woman's abdomen above the symphysis pubis and palpates deeply around the presenting part to identify its contour and size. The first maneuver involves using the tips of the fingers of both hands to palpate the uterine fundus. The second maneuver identifies the back of the fetus, and the fourth maneuver identifies the cephalic prominence.

A 26-year-old primigravida visiting the prenatal clinic for her regular visit at 34 weeks' gestation tells the nurse that she takes mineral oil for occasional constipation. What should the nurse should instruct the client to do? A) Avoid mineral oil because it can lead to vitamin C deficiency in pregnant clients. B) Use the mineral oil regularly on a weekly basis to prevent constipation. C) Take the mineral oil with fruit juice to increase the action of the mineral oil. D) Avoid mineral oil because it interferes with the absorption of fat-soluble vitamins.

D) Avoid mineral oil because it interferes with the absorption of fat-soluble vitamins. Mineral oil is a harsh laxative that is contraindicated during pregnancy because it interferes with absorption of the fat-soluble vitamins A, D, E, and K from the intestinal tract. Dietary measures, exercise, and increased fluid and fiber intake are better choices to prevent constipation. If necessary, a stool softener or mild laxative may be prescribed. Use of fruit juice is recommended for the client receiving iron supplementation to enhance its absorption. Mineral oil does not lead to vitamin C deficiency in pregnant clients. Mineral oil use is contraindicated during pregnancy and therefore should not be used. Increased fluids, fiber, and exercise are better choices to suggest for relief of constipation.

A multipara at 16 weeks' gestation is diagnosed as having a fetus with probable anencephaly. The client is a devout Baptist and has decided to continue the pregnancy and donate the neonatal organs after the death of the neonate. The nurse should: A) contact the client's minister to discuss the client's options related to the pregnancy. B) advise the client that the prolonged neonatal death will be very painful for her. C) ask the client if her family agrees with her decision. D) explore the nurse's own feelings about the issues of anencephaly and organ donation.

D) explore the nurse's own feelings about the issues of anencephaly and organ donation. Anencephaly is a neural tube defect that is not compatible with life, although some of these infants live for several days before death occurs. When the client has decided to continue the pregnancy and donate the neonatal organs after the death of the neonate, the nurse should remain nonjudgmental. The nurse should explore his or her feelings about the issue of anencephaly and organ donation. The nurse should not make judgments about the client's position, nor should the nurse try to persuade the client to terminate the pregnancy. Contacting the client's minister to explore the client's options is not appropriate. As a devout Baptist, the client probably has already discussed the matter with her minister. Telling the client that the neonatal death will be prolonged and painful to her is not helpful. Death may occur very soon after birth. Asking the client about her family's opinion does not help the support the client's decision.

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.

A client at 36 weeks' gestation with type 1 diabetes is scheduled for a contraction stress test. After explaining the purpose of the test, the nurse determines that the client understands the instruction when she states that the test is done to detect which problem? A) amniotic fluid volume B) kidney anomalies C) cardiac anomalies D) uteroplacental sufficiency

D) uteroplacental sufficiency The contraction stress test, commonly performed on high-risk clients, such as those with type 1 (insulin-dependent) diabetes, evaluates uteroplacental sufficiency by subjecting the fetus to uterine contractions, during which fetal heart rate is monitored for changes. During contractions, the vessels supplying the placenta are compressed, causing a temporary reduction in oxygenation. A fetus with adequate oxygen reserve can tolerate the transient oxygen reductions, evidenced by the fetal heart rate remaining within normal limits. An ultrasound, not a contraction stress test, would be performed to detect cardiac or kidney anomalies. An amniotic fluid index (AFI) via ultrasound, not a contraction stress test, would be performed to determine amniotic fluid volume. The contraction stress test, commonly performed on high-risk clients, such as those with type 1 (insulin-dependent) diabetes, evaluates uteroplacental sufficiency by subjecting the fetus to uterine contractions, during which fetal heart rate is monitored for changes. During contractions, the vessels supplying the placenta are compressed, causing a temporary reduction in oxygenation. A fetus with adequate oxygen reserve can tolerate the transient oxygen reductions, evidenced by the fetal heart rate remaining within normal limits. An ultrasound, not a contraction stress test, would be performed to detect cardiac or kidney anomalies. An amniotic fluid index (AFI) via ultrasound, not a contraction stress test, would be performed to determine amniotic fluid volume.

During a visit to the clinic, a pregnant 25-year-old woman who began prenatal care at 10 weeks' gestation and is now in her third trimester reports frequent constipation. Which suggestion by the nurse would be most helpful?

Eat at least four pieces of fruit daily. Explanation: Dietary measures such as increasing dietary intake of bulk and roughage (e.g., eating at least four pieces of fruit each day) help to relieve constipation and should be suggested initially. Other nonpharmacologic measures include drinking a glass of hot fluid in the morning, increasing fluid intake, and exercising regularly. It is best not to suggest laxatives or suppositories because a client may become dependent on them. Additionally, the client should avoid taking any medication unless directed to do so by the primary care provider. If the constipation is unrelieved by other nonpharmacologic measures, the primary care provider may prescribe glycerin suppositories. Avoiding highly seasoned foods would have no effect on constipation. However, if the client was experiencing heartburn, this might be an appropriate suggestion. Laxatives, even mild over-the-counter ones, should be used only when diet, fluid intake, and exercise do not relieve the problem and after consultation with the nurse or primary care provider.

Which statement about a fetal biophysical profile would be incorporated into the teaching plan for a primigravid client with insulin-dependent diabetes?

It is noninvasive using real-time ultrasound. Explanation: The fetal biophysical profile, a noninvasive test using real-time ultrasound, assesses five parameters: fetal heart rate reactivity, fetal breathing movements, gross fetal body movements, fetal tone, and amniotic fluid volume. Fetal heart rate reactivity is determined by a nonstress test; the other four parameters are determined by ultrasound scanning. The results are available as soon as the test is completed and interpreted. The lecithin-sphingomyelin ratio is used to determine fetal lung maturity. Although the fetal biophysical profile is useful in predicting which fetuses may be at greater risk for compromise, there is no correlation with the newborn's Apgar score. The biophysical score is sometimes referred to as the fetal Apgar score. A score of 8 to 10 indicates fetal well-being. Use of an ultrasound requires the mother to have a full bladder.

Refer the client to her health care provider for evaluation and treatment of the pain. Explanation: 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 is diagnosed with oligohydramnios during a clinic visit. Before the client gives birth, the nurse should notify the nurses working in the nursery about the diagnosis so they are aware of which complication that's commonly associated with oligohydramnios?

Renal malformations. Explanation: Oligohydramnios is commonly associated with renal malformations in the neonate. These malformations include renal aplasia, dysplastic kidneys, and obstructive lesions of the lower urinary tract. Hypospadias, an abnormal congenital opening of the male urethra on the underside of the penis, isn't associated with oligohydramnios. Talipes equinovarus, commonly known as clubfoot, isn't associated with oligohydramnios. Babinski's reflex, dorsiflexion of the great toe when the sole of the foot is stimulated, is a normal reflex in neonates.

A client is in the 38th week of her first pregnancy. She calls the prenatal facility to report occasional tightening sensations in the lower abdomen and pressure on the bladder from the fetus, which she says seems lower than usual. The nurse should take which action?

Review premonitory signs of labor with the client. Explanation: Because the client is describing two premonitory signs of labor, Braxton Hicks contractions and tightening, the nurse should review these normal signs and reassure the client. An NST, used to assess fetal well-being, would be inappropriate unless the client reported changes in fetal activity. Urinalysis wouldn't be indicated unless the client reported symptoms of bladder inflammation, such as dysuria or urinary frequency or urgency. Because the client's findings are normal, she need not see the physician other than at her regular weekly appointment.

A client who is 10 weeks pregnant develops spotting; however, the cervix remains closed. The nurse should suspect which of the following?

Threatened abortion Explanation: Spotting in the first trimester may indicate that the pregnancy is in jeopardy. Bed rest and avoidance of physical and emotional stress are recommended. Abortion is usually inevitable if the bleeding is accompanied by pain with dilation and effacement of the cervix. An inevitable abortion is associated with cervical dilation. An ectopic pregnancy is in the fallopian tubes, and a false positive pregnancy could reflect a missed abortion.

A client has an episiotomy to widen her birth canal. Birth extends the incision into the anal sphincter. This complication is called:

a third-degree laceration. Explanation: Birth may extend an episiotomy incision to the anal sphincter (a third-degree laceration) or the anal canal (a fourth-degree laceration). A first-degree laceration involves the fourchette, perineal skin, and vaginal mucous membranes. A second-degree laceration extends to the fasciae and muscle of the perineal body.

A client at 36 weeks' gestation, begins to exhibit signs of labor after an eclamptic seizure. The nurse should assess the client for:

abruptio placentae Explanation: 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 client is scheduled for amniocentesis. When preparing her for the procedure, the nurse should:

ask the client to void. Explanation: To prepare a client for amniocentesis, the nurse should ask her to empty her bladder to reduce the risk of bladder perforation. Before transabdominal ultrasound, the nurse may instruct the client to drink 1 L of fluid to fill the bladder (unless ultrasound is done before amniocentesis to locate the placenta). I.V. anesthesia isn't given for amniocentesis. The client should be supine during the procedure; afterward, she should be placed on her left side to avoid supine hypotension, promote venous return, and ensure adequate cardiac output.

A client who is 32 weeks pregnant presents to the emergency department with bright red bleeding and no abdominal pain. A nurse should:

assess the fetal heart rate. Explanation: 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.

How does the nurse identify the type of presentation shown in the figure?

complete breech Explanation: For a complete breech, the buttocks present, the feet and legs are flexed on the thighs, and the thighs are flexed on the abdomen. For a frank breech, the buttocks present with the hips flexed and the legs extended against the abdomen and chest. This is the most common type of breech presentation. For a compound breech, the buttocks present together with another part, such as a hand. This is a rare occurrence. For an incomplete breech, one or both feet or the knees extend below the buttocks. This can also be termed a single footling or double footling breech.

On arrival at the emergency department, a client tells the nurse that she suspects that she may be pregnant but has been having a small amount of bleeding and has severe pain in the lower abdomen. The client's blood pressure is 70/50 mm Hg, and her pulse rate is 120 bpm. The nurse notifies the primary health care provider (HCP) immediately because of the possibility of:

ectopic pregnancy. Explanation: The client's signs and symptoms indicate a probable ectopic pregnancy, which can be confirmed by ultrasound examination or by culdocentesis. The HCP is notified immediately because hypovolemic shock may develop without external bleeding. Once the fallopian tube ruptures, blood will enter the pelvic cavity, resulting in shock. Abruptio placentae would be manifested by a board-like uterus in the third trimester. Gestational trophoblastic disease would be suspected if the client exhibited no fetal heart rate and symptoms of pregnancy-induced hypertension before 20 weeks' gestation. A client with a complete abortion would exhibit a normal pulse and blood pressure with scant vaginal bleeding.

explore the nurse's own feelings about the issues of anencephaly and organ donation. Explanation: Anencephaly is a neural tube defect that is not compatible with life, although some of these infants live for several days before death occurs. When the client has decided to continue the pregnancy and donate the neonatal organs after the death of the neonate, the nurse should remain nonjudgmental. The nurse should explore his or her feelings about the issue of anencephaly and organ donation. The nurse should not make judgments about the client's position, nor should the nurse try to persuade the client to terminate the pregnancy. Contacting the client's minister to explore the client's options is not appropriate. As a devout Baptist, the client probably has already discussed the matter with her minister. Telling the client that the neonatal death will be prolonged and painful to her is not helpful. Death may occur very soon after birth. Asking the client about her family's opinion does not help the support the client's decision.

When caring for a multigravid client admitted to the hospital with vaginal bleeding at 38 weeks' gestation, which therapeutic agent would the nurse anticipate administering intravenously if the client develops disseminated intravascular coagulation (DIC)?

fresh frozen platelets Explanation: Treatment of DIC includes treating the causative factor, replacing maternal coagulation factors, and supporting physiologic functions. Intravenous infusions of whole blood, fresh-frozen plasma, or platelets are used to replace depleted maternal coagulation factors. Although Ringer's lactate solution and 5% dextrose solution may be used as intravenous fluid replacement, the client needs blood component therapy. Therefore, normal saline must be used. Intravenous heparin, not warfarin may be administered to halt the clotting cascade.

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:

grapelike clusters. Explanation: 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.

The nurse is working in an ambulatory obstetrics setting. What are emphasized client safety procedures for this setting? Select all that apply.

handwashing or antiseptic use when entering and leaving a room use of two client identifiers when initiating contact with a client conduct preprocedure verification asking for client name and procedure to be performed Explanation: The same safety policies apply to both inpatient and outpatient settings and are adapted to the individual specialty. Handwashing and use of two client identifiers are standard procedures. Abbreviations that are used for inpatient are also used for outpatient as the same mistakes can occur in either setting with confusion in spelling or interpretation of letters and numbers. Preprocedure verification with name and procedure is used in the operating room, inpatient, and in ambulatory settings regardless of the procedure. It is logical to place clients with obvious communicable diseases by themselves, but nausea and vomiting are a "normal" situation in early pregnancy and not contagious.

The primary care provider prescribes 5% dextrose in Ringer's solution and magnesium sulfate intravenously for an adolescent client with preeclampsia. Before administering the magnesium sulfate, what is the most important assessment the nurse should make?

maternal respiratory rate Explanation: Magnesium sulfate is a central nervous system depressant used as an anticonvulsant for severe preeclampsia. It may depress respirations to a dangerously low and even life-threatening level. Therefore, the nurse must assess the client's respiratory rate before administering the drug. If the client's respiratory rate is below 12 breaths/minute, the primary care provider should be notified and the drug should be withheld. Although fetal heart rate variability is an important assessment, it is not the priority assessment in this situation. Fetal heart rate variability would be a priority assessment if the umbilical cord becomes compressed. Although maternal urinary output is an important assessment, it is not the priority assessment in this situation. Assessing maternal urinary output would be a priority after administering magnesium sulfate. Although fetal position, determined by Leopold's maneuvers, is an important assessment, it is not the priority assessment in this situation.

The health care provider (HCP) prescribes a maternal blood test for alpha fetoprotein for a nulligravid client at 16 weeks' gestation. When developing the teaching plan, the nurse bases the explanations on the understanding that this test is used to detect which condition?

neural tube defects Explanation: A blood test for alpha fetoprotein is recommended at 15 to 20 weeks' gestation to screen for certain chromosomal abnormalities and neural tube defects such as spina bifida. Chorionic villi sampling is used to detect chromosomal anomalies. Amniotic fluid amino acid determination is used to detect inborn errors of metabolism such as phenylketonuria. An amniocentesis is used to determine the lecithin-sphingomyelin ratio for fetal lung maturity, indicated by a ratio of 2:1, or chromosomal abnormalities. Rh incompatibilities are predicted with blood type testing measured with antigen tests.

A 30-year-old multigravid client has missed three periods and now visits the prenatal clinic because she assumes she is pregnant. She is experiencing enlargement of her abdomen, a positive pregnancy test, and changes in the pigmentation on her face and abdomen. These assessment findings reflect this woman is experiencing a cluster of which signs of pregnancy?

probable Explanation: The plan of care should reflect that this woman is experiencing probable signs of pregnancy. She may be pregnant, but the signs and symptoms may have another etiology. An enlarging abdomen and a positive pregnancy test may also be caused by tumors, hydatidiform mole, or other disease processes as well as pregnancy. Changes in the pigmentation of the face may also be caused by oral contraceptive use. Positive signs of pregnancy are considered diagnostic and include evident fetal heartbeat, fetal movement felt by a trained examiner, and visualization of the fetus with ultrasound confirmation. Presumptive signs are subjective and can have another etiology. These signs and symptoms include lack of menses, nausea, vomiting, fatigue, urinary frequency, and breast changes. The word "diagnostic" is not used to describe the condition of pregnancy.

A client at 15 weeks' gestation presents at the obstetrical triage unit with dark brown vaginal bleeding and continuous nausea and vomiting. Her blood pressure is 142/98 mm Hg and fundal height is 19 cm. Which prescription is most important for the nurse to request from the primary care provider?

stat ultrasound Explanation: The nurse should prepare the client for an ultrasound to determine the cause of the symptoms. Elevated blood pressure at this point in the pregnancy could indicate chronic hypertension as well as hydatidiform mole. The fundal height of 19 cm is higher than is typically found at 15 weeks' gestation and is indicative of a molar pregnancy (hydatidiform mole). The dark brown vaginal bleeding in isolation could indicate an abortion but when placed in context of the other symptoms is likely related to a hydatidiform mole. The continuous nausea and vomiting is abnormal at this point in the pregnancy and can be a result of the high levels of progesterone from a molar pregnancy. There is no fetus involved; the blood pressure elevation and the continuous nausea and vomiting will resolve with evacuation of the mole, negating the need for magnesium sulfate therapy and placing the client on NPO status. Transferring the client to the antenatal unit is premature before a diagnosis has been made.

A cerclage procedure is performed on a client at 20 weeks' gestation who is diagnosed with cervical incompetence. When preparing the discharge teaching plan, the nurse should expect to instruct the client to monitor herself for which problem?

symptoms of infection Explanation: Placement of a cerclage or purse string suture may be used to maintain cervical closure for women with cervical incompetence. Because of the risk of maternal infection, the client should be taught to contact the health care provider if she experiences pain, fever, or changes in the vaginal discharge. Braxton Hicks contractions are normal during pregnancy and nonthreatening to the fetus. Nausea and vomiting usually are not associated with cerclage. Transient hypotension usually is not associated with cerclage.

A primigravid client at 26 weeks' gestation visits the clinic and tells the nurse that her lower back aches when she arrives home from work. The nurse should suggest that the client perform which exercise?

tailor sitting Explanation: Tailor sitting, also referred to as cobbler's or butterfly pose, is an excellent exercise that helps to strengthen the client's back muscles and also prepares the client for the process of labor. The client should be encouraged to rest periodically during the day and avoid standing or sitting in one position for a long time. Leg lifts are helpful for leg aches. Shoulder circling exercises are helpful for neck and upper backaches. Squatting is not helpful for alleviating lower backaches.

Following an eclamptic seizure, the nurse should assess the client for which complication?

uterine contractions Explanation: After an eclamptic seizure, the client commonly falls into a deep sleep or coma. The nurse must continually monitor the client for signs of impending labor because the client will not be able to verbalize that contractions are occurring. Oliguria is more common than polyuria after an eclamptic seizure. Facial flushing is not common unless it is caused by a reaction to a medication. Typically, the client remains hypertensive unless medications such as magnesium sulfate are administered.

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.

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 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.

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 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 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 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.

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.

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.

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.

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 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.

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.

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.

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.

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 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.

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.

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.

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 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 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.

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.

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 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 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.

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.

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.

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.

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.

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 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 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.

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 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, 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 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.

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 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.

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.

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 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.

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 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 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 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 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 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.

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.

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 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 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.

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.

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 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.

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.

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.

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 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.

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.

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.

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.

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 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 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.

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 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.

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 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 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.

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 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.

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.

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.

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.

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 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 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 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 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.

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.

PrepU Antepartum review if time lots of Q for lecture7

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