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?
D.
Family history, BMI, drug and alcohol abuse
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?
A. Ultrasound examination
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?
A. Doppler blood flow analysis
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?
B. Biophysical profile (BPP)
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?
C. Amniocentesis for fetal lung maturity
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?
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?
B. Ultrasound for fetal anomalies
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?
A. “Your placenta changes as your pregnancy progresses, and it is given a score that indicates how well it is functioning.”
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?
Of these psychosocial factors, which has the least negative effect on the health of the mother and/or fetus?
A. Moderate coffee consumption
Which information should nurses provide to expectant mothers when teaching them how to evaluate daily fetal movement counts (DFMCs)?
C. The fetal alarm signal should go off when fetal movements stop entirely for 12 hours.
In comparing the abdominal and transvaginal methods of ultrasound examination, which information should the nurse provide to the client?
D. The transvaginal examination allows pelvic anatomy to be evaluated in greater detail.
Which clinical finding is a major use of ultrasonography in the first trimester?
B. Presence of maternal abnormalities
Which information is the highest priority for the nurse to comprehend regarding the BPP?
A. BPP is an accurate indicator of impending fetal well-being.
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?
C. Administration of Rho(D) immunoglobulin may be necessary.
Which information is an important consideration when comparing the CST with the NST?
A. The NST has no known contraindications.
The nurse is planning the care for a laboring client with diabetes mellitus. This client is at greater risk for which clinical finding?
Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy. Which statement regarding monitoring techniques is the most accurate?
D. MSAFP is a screening tool only; it identifies candidates for more definitive diagnostic procedures.
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 should not be included in this group?
A pregnant woman’s BPP score is 8. She asks the nurse to explain the results. How should the nurse respond at this time?
A. “The test results are within normal limits.”
Which analysis of maternal serum may predict chromosomal abnormalities in the fetus?
A. Multiple-marker screening
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)?
Which nursing intervention is necessary before a first-trimester transabdominal ultrasound?
B. Instruct the woman to drink 1 to 2 quarts of water.
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?
The indirect Coombs’ test is a screening tool for Rh incompatibility. If the titer is greater than ______, amniocentesis may be a necessary next step.
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
Which assessments are included in the fetal BPP? (Select all that apply.)
A. Fetal movement
b.
Fetal tone
c.
Fetal heart rate
d.
AFI
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
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
A primigravida is being monitored at the prenatal clinic for preeclampsia. Which finding is of greatest concern to the nurse?
C. Dipstick value of 3+ for protein in her urine
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?
C. Hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome
A woman with preeclampsia has a seizure. What is the nurse’s highest priority during a seizure?
D. To stay with the client and call for help
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?
C. To discontinue the magnesium sulfate infusion
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?
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?
C. “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.”
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?
D. Boggy uterus with heavy lochia flow
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’s most appropriate response?
A.
“The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor.”
What nursing diagnosis is the most appropriate for a woman experiencing severe preeclampsia?
A. Risk for injury to mother and fetus, related to central nervous system (CNS) irritability
Which statement best describes chronic hypertension?
D. Chronic hypertension can occur independently of or simultaneously with preeclampsia.
Which intervention is most important when planning care for a client with severe gestational hypertension?
A. Induction of labor is likely, as near term as possible.
What is the primary purpose for magnesium sulfate administration for clients with preeclampsia and eclampsia?
C. To prevent convulsions
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?
C. 19-year-old African American who is pregnant with twins
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?
Which neonatal complications are associated with hypertension in the mother?
A. Intrauterine growth restriction (IUGR) and prematurity
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?
D. More brisk than expected, slightly hyperactive
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?
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?
B. Respiratory rate of 10 breaths per minute
What is the most common medical complication of pregnancy?
Which statement most accurately describes the HELLP syndrome?
C. Characterized by hemolysis, elevated liver enzymes, and low platelets
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
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.
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?
B. The presence of any contractions, rupture of membranes (ROM), or severe perineal pressure should be reported.
A perinatal nurse is giving discharge instructions to a woman, status postsuction, 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?
B. “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.”
The nurse is preparing to administer methotrexate to the client. This hazardous drug is most often used for which obstetric complication?
C. Unruptured ectopic pregnancy
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?
B. Transvaginal ultrasound for placental location
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?
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?
C.,Cullen sign associated with a ruptured ectopic pregnancy
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?
D. If a miscarriage occurs before the 12th week of
pregnancy, then it may be observed only as moderate discomfort and blood loss.
A woman who is 30 weeks of gestation arrives at the hospital with bleeding. Which differential diagnosis would not be applicable for this client?
With regard to hemorrhagic complications that may occur during pregnancy, what information is most accurate?
A. An incompetent cervix is usually not diagnosed until the woman has lost one or two pregnancies.
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?
Which laboratory marker is indicative of DIC?
B. Presence of fibrin split products
When is a prophylactic cerclage for an incompetent cervix usually placed (in weeks of gestation)?
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?
In caring for the woman with DIC, which order should the nurse anticipate?
A. Administration of blood
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?
In contrast to placenta previa, what is the most prevalent clinical manifestation of abruptio placentae?
B. Intense abdominal pain
Which maternal condition always necessitates delivery by cesarean birth?
B. Complete placenta previa
What is the correct definition of a spontaneous termination of a pregnancy (abortion)?
A. Pregnancy is less than 20 weeks.
What is the correct terminology for an abortion in which the fetus dies but is retained within the uterus?
What condition indicates concealed hemorrhage when the client experiences abruptio placentae?
C. Hard, boardlike abdomen
What is the highest priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy?
A. Assessing FHR and maternal vital signs
Which order should the nurse expect for a client admitted with a threatened abortion?
Which finding on a prenatal visit at 10 weeks of gestation might suggest a hydatidiform mole?
C. Fundal height measurement of 18 cm
A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Which information assists the nurse in developing the plan of care?
D. Hemorrhage is the primary concern.
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.)
A. Iron supplementation
C. Referral to a support group, if necessary
E. Emphasizing the need for rest
Approximately 10% to 15% of all clinically recognized pregnancies end in miscarriage. What are possible causes of early miscarriage? (Select all that apply.)
A. Chromosomal abnormalities
C. Endocrine imbalance
d.
Systemic disorders
e.
Varicella
The reported incidence of ectopic pregnancy has steadily risen over the past 2 decades. Causes include the increase in sexually transmitted infections (STIs) accompanied by tubal infection and damage. The popularity of contraceptive devices such as the IUD has also increased the risk for ectopic pregnancy. The nurse suspects that a client has early signs of ectopic pregnancy. The nurse should be observing the client for which signs or symptoms? (Select all that apply.)
A. Pelvic pain
b.
Abdominal pain
D. Vaginal spotting or light bleeding
e.
Missed period
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?
B. Congenital anomalies in the fetus
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?
C. “Diet and insulin needs change during pregnancy.”
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?
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?
B. Imbalanced nutrition: less than body requirements
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?
B. The fetus may develop neurologic problems.
The nurse who is caring for a woman hospitalized for hyperemesis gravidarum would expect the initial treatment to involve what?
B. Intravenous (IV) therapy to correct fluid and electrolyte imbalances
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?
B. Type 2 diabetes often goes undiagnosed.
A number of metabolic changes occur throughout pregnancy. Which physiologic adaptation of pregnancy will influence the nurse’s plan of care?
C. During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus.
Which statement concerning the complication of maternal diabetes is the most accurate?
A. Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy.
Which statement regarding the laboratory test for glycosylated hemoglobin Alc is correct?
C. This laboratory test measures the levels of hemoglobin Alc, which should remain at less than 7%.
A new mother with a thyroid disorder has come for a lactation follow-up appointment. Which thyroid disorder is a contraindication for breastfeeding?
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?
B. Deficient knowledge, related to diabetic pregnancy management
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?
D. 50 mg/dl just after waking up from a nap. This is too low; maybe eat a snack before going to sleep.
Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother?
Which preexisting factor is known to increase the risk of GDM?
C. Previous birth of large infant
Which physiologic alteration of pregnancy most significantly affects glucose metabolism?
D. Placental hormones are antagonistic to insulin, thus resulting in insulin resistance.
To manage her diabetes appropriately and to ensure a good fetal outcome, how would the pregnant woman with diabetes alter her diet?
C. Eat her meals and snacks on a fixed schedule.
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.)
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
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