Exam 2 Maternity CH.12-29 Flashcards
Meow
1
Q
How long is an ovum considered fertile?
A
24 hours
2
Q
What kind of fetal anomalies are most often associated with oligohydramnios?
A
Renal
3
Q
A pregnant woman at 25 weeks of gestation dropped a pan, and her baby jumped at the noise (nurse explanation).
A
Babies respond to sound starting at 24 weeks of gestation.
4
Q
At approximately ____ weeks of gestation, lecithin is forming on the alveolar surfaces, the eyelids open, and the fetus measures approximately 27 cm crown to rump and weighs approximately 1110 g. The client is how many weeks of gestation at today’s visit?
A
28 Weeks
5
Q
Which statement regarding the structure and function of the placenta is correct?
A
Secretes both estrogen and progesterone
Human Chorionic gonadotropin (hCG)
Human Chorionic somatomammotropin
6
Q
A woman in labor passes some thick meconium as her amniotic fluid ruptures. The client asks the nurse where the baby makes the meconium. What is the correct response by the nurse?
A
Fetal intestines
7
Q
A woman asks the nurse, “What protects my baby’s umbilical cord from being squashed while the baby’s inside of me?” What is the nurse’s best response?
A
Your baby’s umbilical cord is surrounded by connective tissue called Wharton’s jelly, which prevents compression of the blood vessels.
8
Q
Which structure is responsible for oxygen and carbon dioxide transport to and from the maternal bloodstream?
A
Chorionic villi
9
Q
A woman who is 8 months pregnant asks the nurse, “Does my baby have any antibodies to fight infection?” What is the most appropriate response by the nurse?
A
“Your baby has IgG and IgM.”
10
Q
The measurement of lecithin in relation to sphingomyelin (lecithin/sphingomyelin [L/S] ratio) is used to determine fetal lung maturity. Which ratio reflects fetal maturity of the lungs?
A
2:1
11
Q
A client arrives for her initial prenatal examination. This is her first child. She asks the nurse, “How does my baby get air inside my uterus?” What is the correct response by the nurse?
A
The placenta provides oxygen to the baby and excretes carbon dioxide into your bloodstream.
12
Q
What is the most basic information that a nurse should be able to share with a client who asks about the process of conception?
A
Implantation in the endometrium occurs 6 to 10 days after conception.
13
Q
The maternity nurse is cognizant of what important structure and function of the placenta?
A
As one of its early functions, the placenta acts as an endocrine gland.
14
Q
Which statement regarding the development of the respiratory system is a high priority for the nurse to understand?
A
Maternal hypertension can reduce maternal-placental blood flow, accelerating lung maturity.
15
Q
The various systems and organs of the fetus develop at different stages. Which statement is most accurate?
A
Cardiovascular system is the first organ system to function in the developing human.
16
Q
Which statement concerning neurologic and sensory development in the fetus is correct?
A
Fetuses respond to sound by 24 weeks of gestation and can be soothed by the sound of the mother’s voice.
17
Q
A woman’s cousin gave birth to an infant with a congenital heart anomaly. The woman asks the nurse when such anomalies occur during development. The nurse’s response by the nurse
is most accurate?
A
Defects occur between the third and fifth weeks of development.
18
Q
Which information regarding amniotic fluid is important for the nurse to understand?
A
Amniotic fluid serves as a source of oral fluid and a repository for waste from the fetus.
19
Q
An expectant couple attending childbirth classes have questions regarding multiple births since twins “run in the family.” What information regarding multiple births is important for the nurse to share?
A
Twinning and other multiple births are increasing because of the use of fertility drugs and delayed childbearing.
20
Q
The nurse caring for a pregnant client is evaluating his or her health teaching regarding fetal circulation. Which statement from the client reassures the nurse that his or her teaching has been effective?
A
Optimal fetal circulation is achieved when I am in the side-lying position
21
Q
Some of the embryo’s intestines remain within the umbilical cord during the embryonic period. What is the rationale for this development of the gastrointestinal system?
A
Abdomen is too small to contain all the organs while they are developing.
22
Q
A woman is 15 weeks pregnant with her first baby. She asks how long it will be before she feels the baby move. What is the nurse’s best answer?
A
Within the next month, you should start to feel fluttering sensations.
23
Q
A new mother asks the nurse about the “white substance” covering her infant. How should the nurse explain the purpose of vernix caseosa?
A
Vernix caseosa protects the fetal skin from the amniotic fluid.
24
Q
A woman who is 16 weeks pregnant asks the nurse, “Is it possible to tell by ultrasound if the baby is a boy or girl yet?” What is the best answer?
A
The baby has developed enough to enable us to determine the sex by examining the genitals through an ultrasound scan.
25
Which development related to the integumentary system is correct?
Very fine hairs called lanugo appear at 12 weeks of gestation.
26
The pancreas forms in the foregut during the 5th to 8th week of gestation. A client with poorly controlled gestational diabetes asks the nurse what the effects of her condition will be on the fetus. What is the best response by the nurse? Poorly controlled maternal gestational diabetes will:
result in a macrocosmic fetus.
27
Congenital disorders refer to those conditions that are present at birth. These disorders may be inherited and caused by environmental factors or maternal malnutrition. Toxic exposures have the greatest effect on development between 15 and 60 days of gestation. For the nurse to be able to conduct a complete assessment of the newly pregnant client, he or she should be knowledgeable regarding known human teratogens. Which substances might be considered a teratogen?
A. Cytomegalovirus (CMV)
B. Ionizing radiation
D. Carbamazepine
E. Lead
28
Relating to the fetal circulatory system, which special characteristics allow the fetus to obtain sufficient oxygen from the maternal blood?
A. Fetal hemoglobin (Hb) carries 20% to 30% more oxygen than maternal Hb.
C. Hb concentration is 50% higher than that of the mother.
D. Fetal heart rate is 110 to 160 beats per minute.
29
(CH.13) A woman’s obstetric history indicates that she is pregnant for the fourth time, and all of her children from previous pregnancies are living. One was born at 39 weeks of gestation, twins were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system?
4-1-2-0-4
30
Which presumptive sign or symptom of pregnancy would a client experience who is approximately 10 weeks of gestation?
Amenorrhea
31
A client is seen at the clinic at 14 weeks of gestation for a follow-up appointment. At which level does the nurse expect to palpate the fundus?
Slightly above the symphysis pubis
32
The musculoskeletal system adapts to the changes that occur throughout the pregnancy. Which musculoskeletal alteration should the client expect?
She will have increased lordosis.
33
A 31-year-old woman believes that she may be pregnant. She took an over-the-counter (OTC) pregnancy test 1 week ago after missing her period; the test was positive. During her assessment interview, the nurse inquires about the woman’s last menstrual period and asks whether she is taking any medications. The client states that she takes medicine for epilepsy. She has been under considerable stress lately at work and has not been sleeping well. Her physical examination does not indicate that she is pregnant. She has an ultrasound scan, which confirms that she is not pregnant. What is the most likely cause of the false-positive pregnancy test result?
Anticonvulsant medications may cause the false-positive test result.
34
A woman is in her seventh month of pregnancy. She has been complaining of nasal congestion and occasional epistaxis. Which statement best describes why this may be happening to this client?
This respiratory change is normal in pregnancy and is caused by an elevated level of estrogen.
35
The nurse is providing education to a client regarding the normal changes of the breasts during pregnancy. Which statement regarding these changes is correct?
Lactation is inhibited until the estrogen level declines after birth.
36
Which hormone is essential for maintaining pregnancy?
Progesterone
37
Which clinical finding in a primiparous client at 32 weeks of gestation might be an indication of anemia?
Pica (a desire to eat nonfood substances)
38
Why might it be more difficult to diagnose appendicitis during pregnancy?
The appendix is displaced upward and laterally, high and to the right.
39
The nurse is providing health education to a pregnant client regarding the cardiovascular system. Which information is correct and important to share?
Changes in heart size and position and increases in blood volume create auditory changes from 20 weeks of gestation to term.
40
Which statement regarding the probable signs of pregnancy is most accurate?
Observed by the health care provider
41
Which time-based description of a stage of development in pregnancy is correct?
Term—pregnancy from the beginning of 38 weeks of gestation to the end of 42 weeks of gestation
42
Of which physiologic alteration of the uterus during pregnancy is it important for the nurse to alert the patient?
Woman’s increased urinary frequency in the first trimester is the result of exaggerated uterine antireflexion caused by softening.
42
hCG is an important biochemical marker for pregnancy and therefore the basis for many tests. Which statement regarding hCG is true?
Higher-than-normal levels of hCG may indicate an ectopic pregnancy or Down syndrome.
43
What is the correct term used to describe the mucous plug that forms in the endocervical canal?
Operculum
44
Which renal system adaptation is an anticipated anatomic change of pregnancy?
Increased bladder sensitivity and then compression of the bladder by the enlarging uterus result in the urge to urinate even when the bladder is almost empty.
44
Some pregnant clients may complain of changes in their voice and impaired hearing. What should the nurse explain to the client concerning these findings?
Voice changes and impaired hearing are due to the results of congestion and swelling of the upper respiratory tract.
45
A pregnant client tells her nurse that she is worried about the blotchy, brownish coloring over her cheeks, nose, and forehead. The nurse can reassure her that this is a normal condition related to hormonal changes. What is the correct term for this integumentary finding?
Melasma
45
A first-time mother at 18 weeks of gestation is in for her regularly scheduled prenatal visit. The client tells the nurse that she is afraid that she is going into premature labor because she is beginning to have regular contractions. The nurse explains that these are Braxton Hicks contractions. What other information is important for the nurse to share?
Braxton Hicks contractions should be painless.
46
Which gastrointestinal alteration of pregnancy is a normal finding?
Nausea and vomiting rarely have harmful effects on the fetus and may be beneficial.
47
Pregnancy hormones prepare the vagina for stretching during labor and birth. Which change related to the pelvic viscera should the nurse share with the client?
Increased vascularity of the vagina increases sensitivity and may lead to a high degree of arousal, especially in the second trimester.
48
Numerous changes in the integumentary system occur during pregnancy. Which change persists after birth?
Striae gravidarum
49
What is the correct term for a woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability?
Primipara
50
To reassure and educate their pregnant clients regarding changes in their blood pressure, nurses should be cognizant of what?
Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of a term pregnancy.
51
Which finding in the urinalysis of a pregnant woman is considered a variation of normal?
Glycosuria
52
Cardiac output increases from 30% to 50% by the 32nd week of pregnancy. What is the rationale for this change?
To provide adequate perfusion of the placenta
53
Which statement best describes the rationale for the physiologic anemia that occurs during pregnancy?
Dilution of hemoglobin concentration occurs in pregnancy with physiologic anemia.
54
A patient in her first trimester complains of nausea and vomiting. She asks, “Why does this happen?” What is the nurse’s best response?
Nausea and vomiting may be due to changes in hormones.
55
The diagnosis of pregnancy is based on which positive signs of pregnancy? (Select all that apply.)
A. Identification of fetal heartbeat
C. Visualization of the fetus
D. Verification of fetal movement
56
A woman is in for a routine prenatal checkup. The nurse is assessing her urine for glycosuria and proteinuria. Which findings are considered normal? (Select all that apply.)
A. Dipstick assessment of trace to +1
B. <300 mg/24 hours
E. Albumin < 30 mg/24 hours
57
During pregnancy, many changes occur as a direct result of the presence of the fetus. Which of these adaptations meet this criterion? (Select all that apply.)
C. Quickening
D. Ballottement
E. Lightening
58
Pregnancy is a hypercoagulable state in which women are at a fivefold to sixfold increased risk for thromboembolic disease. The tendency for blood to clot is greater, attributable to an increase in various clotting factors. Which of these come into play during pregnancy? (Select all that apply.)
A. Factor VII
B. Factor VIII
C. Factor IX
E. Fibrinogen
59
(CH.14) Ideally, when should prenatal care begin?
After the first missed menstrual period
60
A woman arrives at the clinic for a pregnancy test. Her last menstrual period (LMP) was February 14, 2015. What is the client’s expected date of birth (EDB)?
November 21, 2015
61
Which women should undergo prenatal testing for the human immunodeficiency virus (HIV)?
All women, regardless of risk factors
62
Which sign or symptom is considered a first-trimester warning sign and should be immediately reported by the pregnant woman to her health care provider?
Vaginal bleeding
63
Which condition is likely to be identified by the quadruple marker screen?
Down syndrome
64
Which client might be well advised to continue condom use during intercourse throughout her pregnancy?
Women at risk for acquiring or transmitting STIs
65
A pregnant woman at 18 weeks of gestation calls the clinic to report that she has been experiencing occasional backaches of mild-to-moderate intensity. Which intervention should the nurse recommend?
Pelvic rock exercises
66
A woman is 3 months pregnant. At her prenatal visit she tells the nurse that she does not know what is happening; one minute she is happy that she is pregnant and the next minute she cries for no reason. Which response by the nurse is most appropriate?
Hormone changes during pregnancy commonly result in mood swings.
67
What is the primary role of the nonpregnant partner during pregnancy?
To support and nurture the pregnant woman
68
During the first trimester, which of the following changes regarding her sexual drive should a client be taught to expect?
Decreased sexual drive, because of nausea and fatigue
69
A 3-year-old girl’s mother is 6 months pregnant. What concern is this child most likely to verbalize?
How will the baby eat?
70
In her work with pregnant women of different cultures, a nurse practitioner has observed various practices that seemed unfamiliar. The nurse practitioner has learned that cultural rituals and practices during pregnancy seem to have one purpose in common. Which
statement bestdescribes that purpose?
To protect the mother and fetus during pregnancy
70
What should the nurse be cognizant of concerning the client’s reordering of personal relationships during pregnancy?
Women usually express two major relationship needs during pregnancy: feeling loved and valued and having the child accepted by the father.
71
A client has arrived for her first prenatal appointment. She asked the nurse to explain exactly how long the pregnancy will be. What is the nurse’s best response?
Normal pregnancy is 10 lunar months.
72
What represents a typical progression through the phases of a woman’s establishing a relationship with the fetus?
I am pregnant”—“I am going to have a baby”—“I am going to be a mother.
73
Who is most likely to experience the phenomenon of someone other than the mother-to-be having pregnancy-like symptoms such as nausea and weight gain?
Expectant father
74
During the initial visit with a client who is beginning prenatal care, which action should be thehighest priority for the nurse?
The nurse should be alert to the appearance of potential parenting problems, such as depression or lack of family support.
75
A pregnant couple has formulated a birth plan and is reviewing it with the nurse at an expectant parent’s class. Which aspect of their birth plan should be considered potentially unrealistic and require further discussion with the nurse?
Regardless of the circumstances, we do not want the fetal monitor used during labor because it will interfere with movement and doing effleurage.
76
During the physical examination of a client beginning prenatal care, which initial action is most important for the nurse to perform?
The client should empty her bladder before the pelvic examination.
77
A woman who is 16 weeks pregnant has come in for a follow-up visit with her significant other. To reassure the client regarding fetal well-being, which is the highest priority action for the nurse to perform?
Offer the woman and her family the opportunity to listen to the fetal heart tones.
78
Dental care during pregnancy is an important component of good prenatal care. Which instruction regarding dental health should the nurse provide?
If dental treatment is necessary, then the woman will be most comfortable with it in the second trimester.
79
What is the primary role of the doula during labor?
Helps the woman perform Lamaze breathing techniques and to provide support to the woman and her partner
80
The client is instructed to place her thumb and forefinger on the areola and gently press inward. What is the purpose of this exercise?
To determine whether the nipple is everted or inverted
81
A client at 34 weeks of gestation seeks guidance from the nurse regarding personal hygiene. Which information should the nurse provide?
Tub bathing is permitted even in late pregnancy unless membranes have ruptured.
82
Many pregnant women have questions regarding work and travel during pregnancy. Which education is a priority for the nurse to provide?
While working or traveling in a car or on an airplane, women should arrange to walk around at least every hour or so.
83
Which statement accurately describes the centering model of care?
Approximately 8 to 12 women are placed in each gestational-age cohort group.
83
A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of the exercise on the fetus. Which guidance should the nurse provide?
You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month.
84
Which sign of a potential complication is the most important for the nurse to share with the client?
Alteration in the pattern of fetal movement
84
A woman who is 14 weeks pregnant tells the nurse that she always had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know if it is safe for her to have a drink with dinner now. Which guidance should the nurse provide?
Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy.
85
Which behavior indicates that a woman is “seeking safe passage” for herself and her infant?
She keeps all prenatal appointments.
86
What type of cultural concern is the most likely deterrent to many women seeking prenatal care?
Modesty
87
The nurse working with pregnant clients must seek to gain understanding of the process
whereby women accept their pregnancy. Which statement regarding this process
is most accurate?
Mood swings are most likely the result of worries about finances and a changed lifestyle, as
well as profound hormonal changes.
88
What is important for the nurse to recognize regarding the new father and his acceptance of
the pregnancy and preparation for childbirth?
The father goes through three phases of acceptance of his own
89
Which consideration is essential for the nurse to understand regarding follow-up prenatal care
visits?
During the abdominal examination, the nurse should be alert for supine hypotension.
90
With regard to medications, herbs, boosters, and other substances normally encountered by
pregnant women, what is important for the nurse to be aware of?
Both prescription and over-the-counter (OTC) drugs that otherwise are harmless can be
made hazardous by metabolic deficiencies of the fetus.
91
Which statement regarding multifetal pregnancy is incorrect?
Twin pregnancies come to term with the same frequency as single pregnancies.
92
While assessing the vital signs of a pregnant woman in her third trimester, the client
complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate?
Have the patient turn to her left side, and then recheck her BP in 5 minutes.
92
Which signs and symptoms should a woman immediately report to her health care
provider?(Select all that apply.)
A. Vaginal bleeding
B. Rupture of membranes
C. Heartburn accompanied by severe headache
93
A woman has just moved to the United States from Mexico. She is 3 months pregnant and has
arrived for her first prenatal visit. During her assessment interview, the nurse learns that the
client has not had any immunizations. Which immunizations should she receive at this point in
her pregnancy? (Select all that apply.)
A. Tetanus
B. Diphtheria
E. Hepatitis B
93
The number of routine laboratory tests during follow-up visits is limited; however, those that
are performed are essential. Which statements regarding group B Streptococcus (GBS) testing
are correct? (Select all that apply.)
B. Performed between 35 and 37 weeks of gestation.
D. Only women planning a vaginal birth should be tested.
E. Women with a history of GBS should be retested.
93
A woman arrives at the clinic seeking confirmation that she is pregnant. The following
information is obtained: She is 24 years old with a body mass index (BMI) of 17.5. She admits to
having used cocaine “several times” during the past year and occasionally drinks alcohol. Her
blood pressure is 108/70 mm Hg. The family history is positive for diabetes mellitus and cancer.
Her sister recently gave birth to an infant with a neural tube defect (NTD). Which characteristics
places this client in a high-risk category?
Family history, BMI, drug and alcohol abuse
94
A 39-year-old primigravida woman believes that she is approximately 8 weeks pregnant,
although she has had irregular menstrual periods all her life. She has a history of smoking
approximately one pack of cigarettes a day; however, she tells the nurse that she is trying to cut
down. Her laboratory data are within normal limits. What diagnostic technique would be useful
at this time?
Ultrasound examination
95
The nurse sees a woman for the first time when she is 30 weeks pregnant. The client has
smoked throughout the pregnancy, and fundal height measurements now are suggestive of
intrauterine growth restriction (IUGR) in the fetus. In addition to ultrasound to measure fetal
size, what is another tool useful in confirming the diagnosis?
Doppler blood flow analysis
95
A 41-week pregnant multigravida arrives at the labor and delivery unit after a NST indicated
that her fetus could be experiencing some difficulties in utero. Which diagnostic tool yields more
detailed information about the condition of the fetus?
Biophysical profile (BPP)
96
At 35 weeks of pregnancy, a woman experiences preterm labor. Although tocolytic
medications are administered and she is placed on bed rest, she continues to experience regular
uterine contractions and her cervix is beginning to dilate and efface. What is an important test for
fetal well-being at this time?
Amniocentesis for fetal lung maturity
97
A 30-year-old gravida 3, para 2-0-0-2 is at 18 weeks of gestation. Which screening test should
the nurse recommend be ordered for this client?
MSAFP screening
98
An MSAFP screening indicates an elevated level of alpha-fetoprotein. The test is repeated, and
again the level is reported as higher than normal. What is the next step in the assessment
sequence to determine the well-being of the fetus?
Ultrasound for fetal anomalies
99
A client asks her nurse, “My doctor told me that he is concerned with the grade of my placenta
because I am overdue. What does that mean?” What is the nurse’s best response?
Your placenta changes as your pregnancy progresses, and it is given a score that indicates
how well it is functioning.
100
A woman is undergoing a nipple-stimulated CST. She is having contractions that occur every 3
minutes. The fetal heart rate (FHR) has a baseline heart rate of approximately 120 beats per
minute without any decelerations. What is the correct interpretation of this test?
Negative
100
Of these psychosocial factors, which has the least negative effect on the health of the mother
and/or fetus?
Moderate coffee consumption
100
Which information should nurses provide to expectant mothers when teaching them how to
evaluate daily fetal movement counts (DFMCs)?
The fetal alarm signal should go off when fetal movements stop entirely for 12 hours.
101
In comparing the abdominal and transvaginal methods of ultrasound examination, which
information should the nurse provide to the client?
The transvaginal examination allows pelvic anatomy to be evaluated in greater detail.
102
Which clinical finding is a major use of ultrasonography in the first trimester?
Presence of maternal abnormalities
103
Which information is the highest priority for the nurse to comprehend regarding the BPP?
BPP is an accurate indicator of impending fetal well-being.
103
A client in the third trimester has just undergone an amniocentesis to determine fetal lung
maturity. Which statement regarding this testing is important for the nurse in formulating a care
plan?
Administration of Rho(D) immunoglobulin may be necessary.
104
Which information is an important consideration when comparing the CST with the NST?
The NST has no known contraindications.
105
The nurse is planning the care for a laboring client with diabetes mellitus. This client is at
greater risk for which clinical finding?
Polyhydramnios
106
Nurses should be aware of the strengths and limitations of various biochemical assessments
during pregnancy. Which statement regarding monitoring techniques is the most accurate?
MSAFP is a screening tool only; it identifies candidates for more definitive diagnostic
procedures.
107
In the past, factors to determine whether a woman was likely to develop a high-risk
pregnancy were primarily evaluated from a medical point of view. A broader, more
comprehensive approach to high-risk pregnancy has been adopted today. Four categories have
now been established, based on the threats to the health of the woman and the outcome of
pregnancy. Which category shouldnot be included in this group?
Geographic
108
A pregnant woman’s BPP score is 8. She asks the nurse to explain the results. How should the
nurse respond at this time?
The test results are within normal limits.
109
Which analysis of maternal serum may predict chromosomal abnormalities in the fetus?
Multiple-marker screening
110
While working with the pregnant client in her first trimester, what information does the nurse
provide regarding when CVS can be performed (in weeks of gestation)?
10
111
Which nursing intervention is necessary before a first-trimester transabdominal ultrasound?
Instruct the woman to drink 1 to 2 quarts of water.
112
How does the nurse document a NST during which two or more FHR accelerations of 15
beats per minute or more occur with fetal movement in a 20-minute period?
Reactive
113
he indirect Coombs’ test is a screening tool for Rh incompatibility. If the titer is greater than
______, amniocentesis may be a necessary next step.
1:8
114
IUGR is associated with which pregnancy-related risk factors? (Select all that apply.)
A. Poor nutrition
B. Maternal collagen disease
C. Gestational hypertension
E. Smoking
114
Which assessments are included in the fetal BPP? (Select all that apply.)
A. Fetal movement
B. Fetal tone
C. Fetal heart rate
D. Placental grade
115
Transvaginal ultrasonography is often performed during the first trimester. While preparing a
6-week gestational client for this procedure, she expresses concerns over the necessity for this
test. The nurse should explain that this diagnostic test may be indicated for which
situations?(Select all that apply.)
A. Multifetal gestation
B. Obesity
C. Fetal abnormalities
E. Ectopic pregnancy
115
A primigravida is being monitored at the prenatal clinic for preeclampsia. Which finding is
of greatest concern to the nurse?
Dipstick value of 3+ for protein in her urine
116
Cell-free deoxyribonucleic acid (DNA) screening is a new method of noninvasive prenatal
testing (NIPT) that has recently become available in the clinical setting. This technology can
provide a definitive diagnosis of which findings? (Select all that apply.)
A. Fetal Rh status
B. Fetal gender
D. Paternally transmitted gene disorder
E. Trisomy 21
117
The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the
oxytocin (Pitocin) infusion, the nurse reviews the woman’s latest laboratory test findings, which
reveal a platelet count of 90,000 mm3, an elevated aspartate aminotransaminase (AST) level, and
a falling hematocrit. The laboratory results are indicative of which condition?
Hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome
118
A woman with preeclampsia has a seizure. What is the nurse’s highest priority during a
seizure?
To stay with the client and call for help
119
A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and
birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes,
dark red vaginal bleeding, and a tense, painful abdomen. Which clinical change does the nurse
anticipate?
Abruptio placentae
120
The client is being induced in response to worsening preeclampsia. She is also receiving
magnesium sulfate. It appears that her labor has not become active, despite several hours of
oxytocin administration. She asks the nurse, “Why is this taking so long?” What is the
nurse’smost appropriate response?
The magnesium is relaxing your uterus and competing with the oxytocin. It may increase
the duration of your labor
120
A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe
preeclampsia for 24 hours. On assessment, the nurse finds the following vital signs: temperature
37.3° C, pulse rate 88 beats per minute, respiratory rate 10 breaths per minute, BP 148/90 mm
Hg, absent deep tendon reflexes (DTRs), and no ankle clonus. The client complains, “I’m so
thirsty and warm.” What is the nurse’s immediate action?
To discontinue the magnesium sulfate infusion
121
A woman with worsening preeclampsia is admitted to the hospital’s labor and birth unit. The
physician explains the plan of care for severe preeclampsia, including the induction of labor, to
the woman and her husband. Which statement by the husband leads the nurse to believe that the
couple needs further information?
Since we will be here for a while, I will call my mother so she can bring the two boys—2
years and 4 years of age—to visit their mother.”
122
The client has been on magnesium sulfate for 20 hours for the treatment of preeclampsia. She
just delivered a viable infant girl 30 minutes ago. What uterine findings does the nurse expect to
observe or assess in this client?
Boggy uterus with heavy lochia flow
123
What nursing diagnosis is the most appropriate for a woman experiencing severe
preeclampsia?
Risk for injury to mother and fetus, related to central nervous system (CNS) irritability
124
Which statement best describes chronic hypertension?
Chronic hypertension can occur independently of or simultaneously with preeclampsia.
125
Which neonatal complications are associated with hypertension in the mother?
Intrauterine growth restriction (IUGR) and prematurity
125
Which intervention is most important when planning care for a client with severe gestational
hypertension?
Induction of labor is likely, as near term as possible.
125
Women with mild gestational hypertension and mild preeclampsia can be safely managed at
home with frequent maternal and fetal evaluation. Complete or partial bed rest is still frequently
ordered by some providers. Which complication is rarely the result of prolonged bed rest?
Fluid retention
125
What is the primary purpose for magnesium sulfate administration for clients with
preeclampsia and eclampsia?
To prevent convulsions
125
The American College of Obstetricians and Gynecologists (ACOG) has developed a
comprehensive list of risk factors associated with the development of preeclampsia. Which client
exhibits the greatest number of these risk factors?
19-year-old African American who is pregnant with twins
125
Which statement most accurately describes the HELLP syndrome?
Characterized by hemolysis, elevated liver enzymes, and low platelets
125
A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous
infusion for 8 hours. The nurse assesses the client and documents the following findings:
temperature of 37.1° C, pulse rate of 96 beats per minute, respiratory rate of 24 breaths per
minute, BP of 155/112 mm Hg, 3+ DTRs, and no ankle clonus. The nurse calls the provider with
an update. The nurse should anticipate an order for which medication?
Hydralazine
125
The nurse has evaluated a client with preeclampsia by assessing DTRs. The result is a grade
of 3+. Which DTR response most accurately describes this score?
More brisk than expected, slightly hyperactive
126
The client being cared for has severe preeclampsia and is receiving a magnesium sulfate
infusion. Which new finding would give the nurse cause for concern?
Respiratory rate of 10 breaths per minute
126
What is the most common medical complication of pregnancy?
Hypertension
127
Which adverse prenatal outcomes are associated with the HELLP syndrome? (Select all that
apply.)
A. Placental abruption
C. Renal failure
E. Maternal and fetal death
128
One of the most important components of the physical assessment of the pregnant client is the
determination of BP. Consistency in measurement techniques must be maintained to ensure that
the nuances in the variations of the BP readings are not the result of provider error. Which
techniques are important in obtaining accurate BP readings? (Select all that apply.)
A. The client should be seated.
B. The client’s arm should be placed at the level of the heart.
E. The same arm should be used for every reading.
129
A pregnant woman is being discharged from the hospital after the placement of a cervical
cerclage because of a history of recurrent pregnancy loss, secondary to an incompetent cervix.
Which information regarding postprocedural care should the nurse emphasize in the discharge
teaching?
The presence of any contractions, rupture of membranes (ROM), or severe perineal pressure
should be reported.
130
A perinatal nurse is giving discharge instructions to a woman, status post suction, and curettage
secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for
the next 12 months. What is the best response by the nurse?
The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed
only by measuring the same hormone that your body produces during pregnancy. If you
were to get pregnant, then it would make the diagnosis of this cancer more difficult.
131
The nurse is preparing to administer methotrexate to the client. This hazardous drug
is most often used for which obstetric complication?
Unruptured ectopic pregnancy
132
A 26-year-old pregnant woman, gravida 2, para 1-0-0-1, is 28 weeks pregnant when she
experiences bright red, painless vaginal bleeding. On her arrival at the hospital, which diagnostic
procedure will the client most likely have performed?
Transvaginal ultrasound for placental location
133
A woman arrives for evaluation of signs and symptoms that include a missed period, adnexal
fullness, tenderness, and dark red vaginal bleeding. On examination, the nurse notices an
ecchymotic blueness around the woman’s umbilicus. What does this finding indicate?
Cullen sign associated with a ruptured ectopic pregnancy
134
A laboring woman with no known risk factors suddenly experiences spontaneous ROM. The
fluid consists of bright red blood. Her contractions are consistent with her current stage of labor.
No change in uterine resting tone has occurred. The fetal heart rate (FHR) begins to decline
rapidly after the ROM. The nurse should suspect the possibility of what condition?
Vasa previa
135
The nurse who elects to practice in the area of women’s health must have a thorough
understanding of miscarriage. Which statement regarding this condition is most accurate?
If a miscarriage occurs before the 12th week of pregnancy, then it may be observed only as
moderate discomfort and blood loss.
136
A woman who is 30 weeks of gestation arrives at the hospital with bleeding. Which differential
diagnosis would not be applicable for this client?
Spontaneous abortion
137
With regard to hemorrhagic complications that may occur during pregnancy, what information
is most accurate?
An incompetent cervix is usually not diagnosed until the woman has lost one or two
pregnancies.
138
The management of the pregnant client who has experienced a pregnancy loss depends on the
type of miscarriage and the signs and symptoms. While planning care for a client who desires
outpatient management after a first-trimester loss, what would the nurse expect the plan to
include?
Misoprostol
139
Which laboratory marker is indicative of DIC?
Presence of fibrin split products
140
When is a prophylactic cerclage for an incompetent cervix usually placed (in weeks of
gestation)?
12 to 14
141
In caring for the woman with DIC, which order should the nurse anticipate?
Administration of blood
141
A woman arrives at the emergency department with complaints of bleeding and cramping.
The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary care provider finds that the cervix is closed. The anticipated
plan of care for this woman would be based on a probable diagnosis of which type of
spontaneous abortion?
Threatened
141
In caring for an immediate postpartum client, the nurse notes petechiae and oozing from her
intravenous (IV) site. The client would be closely monitored for which clotting disorder?
DIC
142
In contrast to placenta previa, what is the most prevalent clinical manifestation of abruptio
placentae?
Intense abdominal pain
143
Which maternal condition always necessitates delivery by cesarean birth?
Complete placenta previa
144
What is the correct definition of a spontaneous termination of a pregnancy (abortion)?
Pregnancy is less than 20 weeks.
145
What is the correct terminology for an abortion in which the fetus dies but is retained within
the uterus?
Missed abortion
146
What condition indicates concealed hemorrhage when the client experiences abruptio
placentae?
Hard, boardlike abdomen
147
What is the highest priority nursing intervention when admitting a pregnant woman who has
experienced a bleeding episode in late pregnancy?
Assessing FHR and maternal vital signs
148
Which order should the nurse expect for a client admitted with a threatened abortion?
Bed rest
148
A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Which
information assists the nurse in developing the plan of care?
Hemorrhage is the primary concern.
149
Which finding on a prenatal visit at 10 weeks of gestation might suggest a hydatidiform
mole?
Fundal height measurement of 18 cm
150
. A client who has undergone a D&C for early pregnancy loss is likely to be discharged the
same day. The nurse must ensure that her vital signs are stable, that bleeding has been controlled,
and that the woman has adequately recovered from the administration of anesthesia. To promote
an optimal recovery, what information should discharge teaching include? (Select all that apply.)
Iron supplementation
Referral to a support group, if necessary
Emphasizing the need for rest
150
During a prenatal visit, the nurse is explaining dietary management to a woman with
pregestational diabetes. Which statement by the client reassures the nurse that teaching has been
effective?
“Diet and insulin needs change during pregnancy.”
150
Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes
mellitus (GDM). In planning her care, the nurse and the client mutually agree that an expected
outcome is to prevent injury to the fetus as a result of GDM. This fetus is at the greatest risk for
which condition?
Macrosomia
151
Preconception counseling is critical in the safe management of diabetic pregnancies. Which
complication is commonly associated with poor glycemic control before and during early
pregnancy?
Congenital anomalies in the fetus
151
Approximately 10% to 15% of all clinically recognized pregnancies end in miscarriage. What
are possible causes of early miscarriage? (Select all that apply.)
Chromosomal abnormalities
Endocrine imbalance
Systemic disorders
Varicella
152
A 26-year-old primigravida has come to the clinic for her regular prenatal visit at 12 weeks.
She appears thin and somewhat nervous. She reports that she eats a well-balanced diet, although
her weight is 5 pounds less than it was at her last visit. The results of laboratory studies confirm
that she has a hyperthyroid condition. Based on the available data, the nurse formulates a plan of
care. Which nursing diagnosis is most appropriate for the client at this time?
Imbalanced nutrition: less than body requirements
153
A client with maternal phenylketonuria (PKU) has come to the obstetrical clinic to begin
prenatal care. Why would this preexisting condition result in the need for closer monitoring
during pregnancy?
The fetus may develop neurologic problems.
154
The nurse who is caring for a woman hospitalized for hyperemesis gravidarum would expect
the initial treatment to involve what?
Intravenous (IV) therapy to correct fluid and electrolyte imbalances
155
In terms of the incidence and classification of diabetes, which information should the nurse
keep in mind when evaluating clients during their ongoing prenatal appointments?
Type 2 diabetes often goes undiagnosed.
156
A number of metabolic changes occur throughout pregnancy. Which physiologic adaptation of
pregnancy will influence the nurse’s plan of care?
During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures
an abundant supply of glucose for the fetus.
157
Which statement concerning the complication of maternal diabetes is the most accurate?
Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy.
158
Which statement regarding the laboratory test for glycosylated hemoglobin Alc is correct?
This laboratory test measures the levels of hemoglobin Alc, which should remain at less
than 7%.
159
A new mother with a thyroid disorder has come for a lactation follow-up appointment. Which
thyroid disorder is a contraindication for breastfeeding?
PKU
159
An 18-year-old client who has reached 16 weeks of gestation was recently diagnosed with
pregestational diabetes. She attends her centering appointment accompanied by one of her
girlfriends. This young woman appears more concerned about how her pregnancy will affect her
social life than her recent diagnosis of diabetes. A number of nursing diagnoses are applicable to
assist in planning adequate care. What is the most appropriate diagnosis at this time?
Deficient knowledge, related to diabetic pregnancy management
160
A woman with gestational diabetes has had little or no experience reading and interpreting
glucose levels. The client shows the nurse her readings for the past few days. Which reading
signals the nurse that the client may require an adjustment of insulin or carbohydrates?
50 mg/dl just after waking up from a nap. This is too low; maybe eat a snack before going
to sleep.
161
Which physiologic alteration of pregnancy most significantly affects glucose metabolism?
Placental hormones are antagonistic to insulin, thus resulting in insulin resistance.
161
Which major neonatal complication is carefully monitored after the birth of the infant of a
diabetic mother?
Hypoglycemia
162
To manage her diabetes appropriately and to ensure a good fetal outcome, how would the
pregnant woman with diabetes alter her diet?
Eat her meals and snacks on a fixed schedule.
162
Which preexisting factor is known to increase the risk of GDM?
Previous birth of large infant
163
. A serious but uncommon complication of undiagnosed or partially treated hyperthyroidism is a
thyroid storm, which may occur in response to stress such as infection, birth, or surgery. What
are the signs and symptoms of this emergency disorder? (Select all that apply.)
Fever
Restlessness
164
Hypothyroidism occurs in 2 to 3 pregnancies per 1000. Because severe hypothyroidism is
associated with infertility and miscarriage, it is not often seen in pregnancy. Regardless of this
fact, the nurse should be aware of the characteristic symptoms of hypothyroidism. Which do they
include? (Select all that apply.)
c. Lethargy
d. Decrease in exercise capacity
e. Cold intolerance
165
Diabetes refers to a group of metabolic diseases characterized by hyperglycemia resulting from
defects in insulin action, insulin secretion, or both. Over time, diabetes causes significant changes in the microvascular and macrovascular circulations. What do these complications
include? (Select all that apply.)
a. Atherosclerosis
b. Retinopathy
d. Nephropathy
e. Neuropathy
166
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