Question 1

The nurse is obtaining a client's history during an initial prenatal visit.  The client's last menstrual period was from March 1 to March 5.  Unprotected intercourse occurred on March 15.  Slight vaginal spotting was noted on March 23.  The client's menstrual cycles are regular and 28 days long.  Using the Nägele rule, what is the estimated date of birth?

Accepted Answer

Establishing an estimated date of birth (EDB) is important because many decisions and interventions during pregnancy are based on this information (eg, labor induction, diagnosing preterm labor). Methods to determine EDB include the Nägele rule, ultrasound, fundal height measurement, and fetal heart rate auscultation via handheld Doppler monitor (at ~10 weeks gestation). The Nägele rule uses a standard formula based on the last normal menstrual period (LMP) to determine EDB based on a 28-day menstrual cycle: EDB = (LMP − 3 months) + 7 days. days: December 8 First day of LMP: March 1 Subtract 3 months: December 1 Add 7 days: December 8 This client's EDB is December 8 (Option A). (Option B) December 12 was calculated using the last day of the client's menses (March 5). Menses length can vary, so the last day of menses cannot be used to accurately calculate EDB. (Option C) December 22 was calculated based on the likely date of conception (March 15). Because the timing of ovulation varies by client, this is not an accurate method for calculating EDB. (Option D) December 30 was calculated using the client's report of vaginal spotting (March 23). Light vaginal spotting may be noted when the trophoblast implants into the endometrium. Many clients confuse "implantation bleeding" for an unusually light period. Dating a pregnancy from this day is inaccurate. Educational objective: The Nägele rule is a standard formula based on the last normal menstrual period (LMP) that determines the estimated date of birth (EDB) based on a 28-day menstrual cycle: EDB = (LMP − 3 months) + 7 days.

Question 2

The nurse is admitting a client at 41 weeks gestation for induction of labor due to oligohydramnios.  Considering the client's indication for induction, what should the nurse anticipate?

Accepted Answer

11ecbb05_cbef_49b2_b433_7b1fd1ffec06_MD0009_00 Amniotic fluid is produced by the fetal kidney and serves 2 major purposes - to prevent cord compression and promote lung development. Oligohydramnios is a condition characterized by low amniotic fluid volume. This can occur due to fetal kidney anomalies (eg, renal agenesis or urine flow obstruction) or fluid leaking through the vagina (eg, undiagnosed ruptured membranes). Fluid volume also declines gradually after 41 weeks. Small uterine size for gestational age or a fetal outline that is easily palpated through the maternal abdomen should raise suspicion for oligohydramnios. Ultrasound confirms the diagnosis. Major complications of oligohydramnios are: Pulmonary hypoplasia - due to the lack of normal alveolar distension by aspirated amniotic fluid. Therefore, additional neonatal personnel should attend the birth in anticipation of possible resuscitation (Option A). Umbilical cord compression - continuous (not intermittent) fetal monitoring should be applied to monitor for variable decelerations (Option B). (Option C) Operative vaginal birth (ie, use of forceps or vacuum) may be indicated due to prolonged second-stage labor or fetal distress. Oligohydramnios does not increase the likelihood of operative vaginal birth. (Option D) Polyhydramnios (excessive amniotic fluid volume) is a risk factor for postpartum hemorrhage due to overdistension of the uterus. Oligohydramnios is not associated with postpartum hemorrhage. Educational objective: Oligohydramnios increases the risk for umbilical cord compression and pulmonary hypoplasia. Additional neonatal personnel should be present for possible resuscitation and/or evaluation of the newborn. The nurse should anticipate continuous fetal monitoring during labor to monitor for signs of cord compression.

Question 3

A client at 20 weeks gestation reports "running to the bathroom all the time," pain with urination, and foul-smelling urine. Which question is most important for the nurse to ask when assessing the client?

Accepted Answer

11ecbb05_cbee_d481_b433_fbc4cc484fd0_MD0009_00 Urinary tract infections (UTIs) are common during pregnancy due to physiologic renal system changes (eg, ureter dilation, urine stasis). Most UTIs are confined to the lower urinary tract (ie, cystitis, or bladder infection). Symptoms include urinary frequency, dysuria, urgency, foul-smelling urine, and a sensation of bladder fullness. Diagnostic testing includes urinalysis and urine culture. Oral antibiotics are required to appropriately treat cystitis. If cystitis goes unreported or untreated, the infection may ascend to the kidneys and cause pyelonephritis. During pregnancy, pyelonephritis requires IV antibiotics and hospitalization because of the increased risk of preterm labor. Therefore, priority assessment is to rule out indicators of pyelonephritis (eg, flank pain, fever) in clients who report UTI symptoms to ensure appropriate diagnosis and treatment (Option A). flank pain (Option B) Wiping front to back after urination may help prevent Escherichia coli (a common UTI pathogen found in stool) from contaminating the urethra. Reviewing toileting hygiene is important but does not help assess current symptoms. (Option C) Urinary frequency and nocturia are common during pregnancy. However, the nurse should not focus on the normalcy of urinary frequency since the client has reported additional symptoms (eg, dysuria). (Option D) Pregnancy predisposes clients to UTIs. Furthermore, assessing for history of UTI does little to address the client's current symptoms. Educational objective: Urinary tract infections are common during pregnancy. If the client reports signs and symptoms of cystitis, the nurse's priority is to rule out ascending infection (ie, pyelonephritis), which would require hospitalization and IV antibiotics.

Question 4

A client at 39 weeks gestation with preeclampsia has a blood pressure of 170/100 mm Hg, 2+ proteinuria, and moderate peripheral edema.  Immediately after hospital admission, she develops seizures and uterine contractions.  Magnesium sulfate is prescribed.  Which finding indicates that the drug has achieved the desired therapeutic effect?

Accepted Answer

Preeclampsia is a systemic disease characterized by hypertension and proteinuria after the 20th gestational week with unknown etiology. Eclampsia is the onset of convulsions or seizures that cannot be attributed to other causes in a woman with preeclampsia. Delivery is the only cure for preeclampsia-eclampsia syndrome. Magnesium sulfate is a central nervous system depressant used to prevent/control seizure activity in preeclampsia/eclampsia clients. During administration, the nurse should assess vital signs, intake and output, and monitor for signs of magnesium toxicity (eg, decreased deep-tendon reflexes, respiratory depression, decreased urine output). A therapeutic magnesium level of 4-7 mEq/L (2.0-3.5 mmol/L) is necessary to prevent seizures in a preeclamptic client. (Option A) Hypertension is a sign of preeclampsia. Hydralazine (Apresoline), methyldopa (Aldomet), or labetalol (Trandate) is used to lower blood pressure (BP) if needed (usually considered when BP is >160/110 mm Hg). (Option C) Proteinuria is a symptom of preeclampsia. Control of hypertension and delivery will reduce the protein level. Magnesium sulfate is not prescribed to decrease proteinuria. (Option D) Tocolytic drugs (eg, terbutaline, magnesium sulfate, indomethacin, nifedipine) are used to suppress uterine contractions in preterm labor, allowing pregnancy to be prolonged for 2-7 days so that corticosteroid administration can improve fetal lung maturity. This client is at term, and there is no need to delay delivery. Educational objective: Magnesium sulfate is prescribed for clients with preeclampsia to prevent seizure activity. A therapeutic magnesium level of 4-7 mEq/L (2.0-3.5 mmol/L) is necessary to prevent seizures in a preeclamptic client.

Question 5

A pregnant client comes in for a routine first prenatal examination.  According to the last menstrual period, the estimated gestational age is 12 weeks.  Where would the nurse expect to palpate the uterine fundus in this client?

Accepted Answer

11ecbb05_cbef_bee3_b433_ff8772b3ae5a_MD0009_00 The enlarging pregnant uterus should be just above the symphysis pubis at approximately 12 weeks gestation (Option D). At 16 weeks gestation, the fundus is roughly halfway between the symphysis pubis and the umbilicus. It reaches the umbilicus at 20-22 weeks gestation and approaches the xiphoid process around 36 weeks gestation. At 38-40 weeks, the fetus engages into the maternal pelvis and the fundal height drops. After 20 weeks gestation, the fundal height, measured in centimeters from the symphysis pubis to the top of the fundus, correlates closely to the weeks of gestation. (Options A, B, and C) At 12 weeks gestation, the uterine fundus should be just above the symphysis pubis. Educational objective: The fundus rises above the symphysis pubis at approximately 12 weeks gestation, reaches the umbilicus at 20-22 weeks gestation, and reaches the xyphoid process at 36 weeks gestation. After 20 weeks gestation, the fundal height in centimeters correlates closely to the weeks of gestation.

Question 6

A client comes to the clinic indicating that a home pregnancy test was positive. The client's last menstrual period was September 7. Today is December 7. Which are true statements for this client? Select all that apply.

Accepted Answer

Naegele's rule, which is the last menstrual period minus 3 months plus 7 days, can be used to calculate a client's expected date of delivery. The accuracy of this method may be influenced by the regularity and length of the client's menstrual cycle. September 7 minus 3 months is June 7, plus 7 days is June 14 (Option A). Detection of a fetal heart rate is possible using a Doppler by 10-12 weeks gestation (Option B). Urinary frequency, a presumptive sign of pregnancy common in the first trimester, occurs primarily due to hormonal changes and anatomical changes in the renal system (Option E). However, clients also reporting dysuria, fever/chills, or back pain should be evaluated for a urinary tract infection. (Option C) Uterine growth is assessed by measuring fundal height using a measuring tape. After 20 weeks gestation, the fundal height measurement in centimeters should correlate closely with the number of weeks pregnant (eg, 24 cm = 24 weeks). The client should empty the bladder before having fundal height measured, as a full bladder can displace the uterus and affect measurement accuracy. (Option D) Quickening, the awareness of fetal movements, occurs around 18-20 weeks gestation in primigravidas and at 14-16 weeks in multigravidas. Educational objective: Naegele's rule for estimating date of delivery is the last menstrual period minus 3 months plus 7 days. Fetal heart rate is detectable by Doppler at 10-12 weeks gestation. Urinary frequency is a presumptive sign of pregnancy in the first trimester.

Question 7

A 37-weeks-pregnant woman comes to the emergency department with a fractured ankle. Which assessment finding is most concerning and requires the nurse to follow up?

Accepted Answer

Fetal tachycardia is a baseline of >160 beats/min for >10 minutes. Tachycardia needs evaluation and continued surveillance. The most sensitive indicators of fetus health are fetal movement and fetal heart rate. (Option B) This is an expected finding. Monitoring fetal movement/kick counts is a primary method of fetal surveillance. The reassuring finding is when the movement equals or exceeds the established baseline. In general, 4 movements/hour or 10 distinct fetal movements within 2 hours is a reassuring finding. (Option C) Braxton-Hicks contractions are felt mid-pregnancy onward. These painless, occasional physiological contractions are normal. The contractions are a concern if they become regular and persist. (Option D) During pregnancy, hemoglobin can drop to 11 g/dL (110 g/L), a condition known as physiological anemia of pregnancy. Due to the increased oxygen requirements of pregnancy, the red blood cell count increases 30%. However, anemia can result from an increase in the plasma volume that is relatively larger than the increase in red blood cells. This lowered maternal hemoglobin is within the expected range. Educational objective: Sustained fetal tachycardia (>160/min for >10 minutes) is a concerning finding that requires further follow-up.

Question 8

The nurse is preparing to assess a client visiting the women's health clinic. The client's obstetric history is documented as G₅T₁P₂A₁L₂. Which interpretation of this notation is correct?

Accepted Answer

11ecbb05_cbed_74f0_b433_ad1aef8273c9_MD0009_00 The GTPAL system is a shorthand system of documenting a client's obstetric history. This client (G₅T₁P₂A₁L₂) has been pregnant 5 times (G₅); had 1 term birth (T₁), 2 preterm births (P₂), and 1 abortion (A₁); and has 2 currently living children (L₂). The client's term birth is indicated by the T₁ portion of the GTPAL notation (Option A). (Option B) The client had 2 preterm births, indicated by the P₂ portion of the GTPAL notation. (Option C) The client has 2 currently living children, as indicated by the L₂ portion of the GTPAL notation. If a child born full- or preterm is not living (due to stillbirth from 20 wk 0 d and beyond or infant/child death after birth), that birth and subsequent death is counted toward T or P (term or preterm) but is not notated under L (currently living children); T and P record total number of births without regard to current living status. This client has 2 currently living children (L₂), which is 1 less than the client's total notation for term + preterm (T₁ + P₂ = 3). Therefore, the client has experienced the death of 1 child who had been born at 20 wk 0 d gestation or beyond. (Option D) If a client is currently pregnant, the number of pregnancies (gravida) will be greater than the number of births (term, preterm, and abortions combined). This client is a G₅, and T₁ + P₂ + A₁ = 4. Therefore, the client is currently pregnant. Educational objective: The GTPAL system notational components are G - gravida (number of pregnancies, regardless of outcome and including current pregnancies), T - term (37 wk 0 d gestation and beyond), P - preterm (20 wk 0 d through 36 wk 6 d gestation), A - abortions (before 20 wk 0 d gestation; spontaneous or induced), and L - currently living children.

Question 9

The nurse is providing nutrition counseling during a preconception visit to a client who does not eat green vegetables. In addition to a daily prenatal vitamin, which foods can the client add to the daily diet to decrease the risk of neural tube defects? Select all that apply.

Accepted Answer

11ecbb05_cbeb_2afd_b433_4b554f58764c_MD0009_00 Folic acid, or folate, is a water-soluble, B-complex vitamin necessary for red blood cell production. Pregnant women and those attempting pregnancy need a minimum of 400 mcg of folic acid per day to decrease the chance of fetal neural tube defects (eg, spina bifida, anencephaly). Most prenatal vitamins contain 400-800 mcg of folic acid; additional folic acid can come from the diet. Leafy green vegetables are the best dietary sources of folic acid. However, other appropriate food choices include cooked beans, rice, fortified cereals, and peanut butter, which provide at least 40 mcg folic acid per serving (Options A, B, and D). spina bifida (Option C) Sweet potatoes provide vitamin A, vitamin C, and minerals to the diet but no folic acid. (Option E) Raw carrots are a dietary source of vitamin A, vitamin C, and minerals, but not of folic acid. Educational objective: Folic acid is a B-complex vitamin that decreases the risk of fetal neural tube defects. Pregnant women require a minimum of 400 mcg of folic acid daily. Leafy green vegetables supply excellent dietary folic acid; alternate sources include beans, rice, peanut butter, and fortified cereals.

Question 10

Which client in a prenatal clinic should the nurse assess first?

Accepted Answer

11ecbb05_cbf0_a944_b433_4d4c3f2cea13_MD0009_00 Gestational hypertension is new-onset high blood pressure (≥140/90 mm Hg) that occurs after 20 weeks gestation without proteinuria. The development of proteinuria with hypertension indicates preeclampsia, which may manifest with symptoms such as headache, visual disturbances, and facial swelling. This client is exhibiting symptoms of preeclampsia and should be assessed first (Option C). Complications of preeclampsia may include thrombocytopenia, liver dysfunction, and renal insufficiency. Clients with preeclampsia must be monitored closely for sudden worsening, which can lead to serious complications, including eclampsia and/or HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets). (Option A) Backache and pelvic pressure are common discomforts of pregnancy. The enlarging uterus stretches the supporting ligaments and may cause increased backache. Fluid retention from increasing blood volume causes pelvic congestion, which may be reported as pelvic pressure. (Option B) Earache and sinus congestion are common discomforts during pregnancy that result from increased blood volume and fluid retention. This client should be assessed to rule out sinus and/or ear infection, but this is not the highest priority. (Option D) The increase in estrogen and progesterone during pregnancy often results in leukorrhea, a mucoid, white vaginal discharge. Pressure on the bladder from the fetal head during the third trimester may cause diminished bladder capacity and urinary frequency without dysuria. These are common and expected findings. Educational objective: The nurse should assess the client with symptoms of potentially serious complications first before assessing the remaining clients. Signs of hypertensive disorders during pregnancy may include headache and facial edema.

Question 11

The initial prenatal laboratory screening results of a client at 12 weeks gestation indicate a rubella titer status of nonimmune.  What will the nurse anticipate as the plan of care for this client?

Accepted Answer

In a pregnant client, a serum sample is collected at the first prenatal visit to determine immunity to the rubella virus. A positive immune response indicates immunity to the rubella virus, attributed to either past infection or vaccination. A negative, or nonimmune, response indicates that the client is susceptible to rubella disease and requires vaccination. An equivocal response indicates partial immunity to rubella and is treated clinically the same as nonimmune status. Measles-mumps-rubella (MMR) is a live attenuated vaccine. Live vaccines are contraindicated in pregnancy due to the theoretical risk of contracting the disease from the vaccine. Maternal rubella infection can be teratogenic for the fetus. The fetal effects of congenital rubella syndrome include congenital cataracts, deafness, heart defects (patent ductus arteriosus), and cerebral palsy. The best time to administer an MMR vaccine to a nonimmune client is in the postpartum period just prior to discharge (Option B). The MMR vaccine can safely be administered to breastfeeding clients. (Options A and C) MMR vaccine is contraindicated in pregnancy. Also, pregnancy should be avoided for at least 1-3 months after the immunization is given. (Option D) This client is rubella nonimmune and is susceptible to rubella if exposed. The vaccine should be offered in the postpartum period. Educational objective: The measles-mumps-rubella vaccine is a live attenuated vaccine and is contraindicated in pregnancy due to the risk of teratogenic effects to the fetus. Clients who are nonimmune to rubella should receive the vaccine in the postpartum period. Pregnancy should be avoided for at least 1-3 months after immunization.

Question 12

The nurse is caring for a client in the first trimester during an initial prenatal clinic visit.  Based on the information provided by the client, which factor places the client at an increased risk for preterm labor?

Accepted Answer

Preterm birth is defined as birth before 37 weeks and 0 days gestation. Infection (eg, periodontal disease, urinary tract infection) is strongly associated with preterm labor, particularly when untreated (Option B). Infection causes release of inflammatory mediators such as prostaglandins, which are uterotonic (ie, promote contractions) and contribute to cervical softening. Some risk factors for preterm birth may be modifiable with lifestyle changes and early treatment. Risk factors should be addressed at the initial and each subsequent prenatal visit to allow for early identification and management. Some risk factors for preterm birth include: History of spontaneous preterm birth in a previous pregnancy (single largest independent risk factor) Previous cervical surgery, such as a cone biopsy (weakens cervical support) Tobacco and/or illicit drug use (Option A) Maternal ages <17 and >35 are associated with increased risk for preterm birth. Maternal age of 25 is not a risk factor. (Option C) Maternal undernutrition can increase the risk for preterm birth and low infant birth weight. However, a balanced vegetarian diet with adequate pregnancy weight gain does not increase preterm birth risk. (Option D) Non-Hispanic black women have the highest rates of preterm labor and birth. Non-Hispanic white ethnicity is not a risk factor for preterm birth. Educational objective: Infection (eg, periodontal disease, urinary tract infection) places pregnant clients at increased risk for preterm labor and birth. Other risk factors include history of preterm birth, previous cervical surgery, tobacco/illicit drug use, and maternal age <17 or >35.

Question 13

A client indicates the desire to become pregnant. Which of the following are important preconception education topics for the nurse to provide? Select all that apply.

Accepted Answer

NCLEX® CHANGE AS OF 2017 - Please note that select-all-that-apply (SATA) questions on NCLEX can now include any number of correct responses. Only ONE option or up to ALL options may be correct. UWorld questions now reflect this change. Visit NCSBN® NCLEX FAQs for more information. Preconception counseling assesses for pregnancy risk factors and implements appropriate interventions to promote a healthy pregnancy. Some behaviors the client may begin independently include eating a nutritious diet; exercising; abstaining from alcohol, tobacco, and illicit drugs; and taking folic acid supplements. Obesity (BMI >30 kg/m²) during pregnancy is associated with an increased risk for fetal/maternal complications (eg, gestational diabetes, hypertension, cesarean birth). Achieving a normal BMI (18.5-24.9 kg/m²) is optimal (Option A). No amount of alcohol is considered safe in pregnancy; complete abstinence from alcohol is recommended to avoid fetal alcohol syndrome. Smoking cessation is encouraged due to its association with fetal growth restriction; illicit drugs may also cause fetal harm (Option B). fetal alcohol syndrome Folic acid supplementation of at least 400 mcg per day for 3 months before pregnancy is recommended to reduce the incidence of neural tube defects (Option C). Neural tube development begins around the third week following conception, before a woman may realize that she is pregnant. Finally, clients should visit their health care provider to discuss pregnancy's effect on certain health conditions (eg, asthma, diabetes) and check rubella immunity (Option D). Rubella vaccination should be given if the client is nonimmune, and pregnancy should be avoided for at least 4 weeks after vaccination. Regular visits with a dentist can help prevent periodontal disease, which is associated with poor pregnancy outcomes (eg, preterm birth, low birth weight) (Option E). Educational objective: Preconception care improves pregnancy outcomes and includes folic acid supplementation; regular dental care; updated vaccinations; avoidance of alcohol, smoking, and illicit drugs; and achieving a normal weight.

Question 14

Which meal should the nurse recommend for a pregnant client at 13 weeks gestation?

Accepted Answer

During pregnancy, it is important for the client to consume a balanced diet with appropriate nutrients, vitamins, and minerals. Foods containing folic acid, protein, whole grains, iron, and omega-3 fatty acids are especially important. Due to the risk for bacterial contamination (eg, Listeria, toxoplasmosis), pregnant clients should avoid consuming unpasteurized milk products, unwashed fruits and vegetables, deli meat and hot dogs (unless heated until steaming hot), and raw fish/meat. They should also avoid intake of fish high in mercury (eg, shark, swordfish, king mackerel, tilefish). (Option B) This meal contains swordfish, which is high in mercury and should be avoided during pregnancy. (Option C) This meal contains cold deli meat, which should be avoided during pregnancy due to the risk of listeriosis from Listeria monocytogenes. (Option D) Liver should be avoided during pregnancy due to high amounts of vitamin A. Although liver is a good source of iron, the excessively high amounts of vitamin A can be teratogenic. Educational objective: An appropriate diet is essential to meet the needs of the pregnant client and growing fetus. Pregnant clients should avoid deli meats and hot dogs (unless steaming hot), liver, unpasteurized milk products, unwashed fruits and vegetables, raw fish, and fish high in mercury.

Question 15

A client at 38 weeks gestation is brought to the emergency department after a motor vehicle crash. She reports severe, continuous abdominal pain. The nurse notes frequent uterine contractions and mild, dark vaginal bleeding. What actions should the nurse take? Select all that apply.

Accepted Answer

11ecbb05_cbea_67ab_b433_99f696059499_MD0009_00 Placental abruption occurs when the placenta separates prematurely from the uterine wall, causing hemorrhage beneath the placenta. Abruptions are classified as partial, complete, or marginal and may be overt (visible vaginal bleeding) or concealed (bleeding behind placenta). Risk factors include abdominal trauma, hypertension, cocaine use, history of previous abruption, and preterm premature rupture of membranes. hemorrhage Symptoms and their severity depend on extent of abruption and include abdominal and/or back pain, uterine contractions, uterine rigidity, and dark red vaginal bleeding. Tachysystole (ie, excessive uterine contractions), with or without fetal distress, is often present, and continuous fetal monitoring is necessary (Option B). A type and crossmatch should be drawn as treatment may include blood transfusion (Option D). In severe cases, emergent cesarean birth is indicated (Option A). Although blood loss is maternal, the loss of functional placental surface area can result in decreased placental perfusion, impaired fetal oxygenation, and fetal death. Tachysystole (ie, excessive uterine contractions) (Option C) Maternal vital signs should be assessed frequently for signs of shock (eg, tachycardia, hypotension) as client condition can decline rapidly. In this acute scenario, assessment of vital signs every 4 hours is not sufficient. (Option E) Abruption may require rapid volume replacement with IV fluid and blood products, requiring large-bore IV access. Peripheral IV access with a 16- or 18-gauge catheter should be initiated. Educational objective: Placental abruption usually presents with abdominal pain and dark red vaginal bleeding. The main concerns are maternal blood loss resulting in hypotension and shock and fetal compromise. Maternal stabilization and expedited birth are indicated.

Question 16

A client at 35 weeks gestation is admitted to the labor and delivery unit for severe pre-eclampsia. She is started on IV magnesium sulfate for seizure prophylaxis. Which of the following signs indicate that the client has developed magnesium sulfate toxicity? Select all that apply.

Accepted Answer

11ecbb05_cbec_ffbf_b433_4d3115460cb6_MD0009_00 IV magnesium sulfate is administered for seizure (eclampsia) prophylaxis in pregnant clients with pre-eclampsia. A loading dose of 4-6 g of magnesium sulfate, followed by a maintenance dose of 1-2 g/hr, helps achieve therapeutic magnesium levels of 4-7 mEq/L (2.0-3.5 mmol/L). Magnesium toxicity may occur when magnesium levels are >7 mEq/L (3.5 mmol/L), which causes central nervous system depression and blocks neuromuscular transmission (Option E). Absent or decreased deep tendon reflexes (DTRs) are the earliest sign of magnesium toxicity. DTRs, scored on a scale of 0 to 4+, should be frequently assessed during magnesium sulfate infusion; normal findings are 2+ (Option A). If toxicity is not recognized early (eg, decreasing DTRs), clients can progress to respiratory depression (<12 breaths/min), followed by cardiac arrest (Option D). Administration of calcium gluconate (antidote) is recommended in the event of cardiorespiratory compromise. (Option B) Hypertension is a sign of pre-eclampsia, not of magnesium toxicity. Hydralazine (Apresoline) and/or labetalol are used to lower blood pressure if needed (ie, when >160/110 mm Hg). (Option C) Urine output <30 mL/hr is a sign that magnesium toxicity may be likely, as magnesium is excreted through the urine. Educational objective: The therapeutic level of magnesium for pre-eclampsia/eclampsia treatment is 4-7 mEq/L (2.0-3.5 mmol/L). Signs of magnesium toxicity may be noted with serum levels >7 mEq/L (3.5 mmol/L) and include absent or decreased deep tendon reflexes, respiratory depression, and cardiac arrest. Calcium gluconate (antidote) should be readily available in the event of cardiorespiratory compromise.

Question 17

The nurse is teaching a client, gravida 1 para 0, at 8 weeks gestation about expected weight gain during pregnancy. The client's prepregnancy BMI is 21 kg/m². Which statement by the client indicates an appropriate understanding about weight gain?

Accepted Answer

11ecbb05_cbeb_c73e_b433_7902a00e37dc_MD0009_00 Appropriate weight gain during pregnancy decreases risks to the client and fetus. Expected weight gain is determined by prepregnancy BMI. Underweight clients need to gain more weight (1 lb [0.5 kg] per week) during the second and third trimesters of pregnancy than obese clients (0.5 lb [0.2 kg] per week). However, weight gain in the first trimester should be 1.1-4.4 lb (0.5-2.0 kg), regardless of BMI. With a prepregnancy BMI of 21 kg/m², this client has an appropriate weight and should gain 25-35 lb (11.3-15.9 kg) over the course of the pregnancy (Option B). ² (Option A) Weight gain during the first trimester should be approximately 1.1-4.4 lb (0.5-2.0 kg). A 10 lb (4.5 kg) weight gain during the first three months of pregnancy would be excessive for any client. (Option C) A client of appropriate weight should gain approximately 1 lb (0.5 kg) per week during the second and third trimesters of pregnancy. A weight gain of only 0.5 lb (0.2 kg) per week is recommended for obese clients. (Option D) A weight gain of <20 lb (9.1 kg) during pregnancy is inadequate for a client of appropriate weight. Restricting weight gain increases the fetus' risk for low birth weight (<5.5 lb [2500 g]) and preterm birth. Educational objective: Appropriate weight gain during pregnancy decreases risks to the client and fetus. Weight gain in the first trimester should be 1.1-4.4 lb (0.5-2.0 kg), regardless of BMI. The optimal total weight gain during pregnancy is determined by the client's prepregnancy BMI.

Question 18

A pregnant client at 39 weeks gestation is brought to the emergency department in stable condition following a motor vehicle collision. The client, who is secured supine on a backboard, suddenly becomes pale with a blood pressure of 88/50 mm Hg. Which action should the nurse take first?

Accepted Answer

11ecbb05_cbe9_cb6a_b433_5959a1942483_MD0009_00 During stabilization of a pregnant client after trauma (eg, motor vehicle collision, fall), uterine displacement is the first step to address supine hypotension (due to aortocaval compression and decreased venous return to the heart) and promote blood circulation to the fetus. The client should be tilted laterally while strapped on the backboard to promote venous return and protect the client from further potential spinal injury (Option D). Manifestations of aortocaval compression (eg, hypotension, pallor, dizziness) may mimic those of other complications of trauma. It is therefore critical to reassess blood pressure after uterine displacement to identify persistent hypotension, which may indicate hemorrhage caused by trauma (eg, placental abruption). (Option A) An IV fluid bolus of isotonic fluids (eg, lactated Ringer solution) to correct hypotension is appropriate if position changes do not relieve symptoms or hemorrhage is suspected. Client positioning should be considered first. (Option B) Assessing medical and obstetric history is important when planning care for a pregnant client, but immediate physical needs are the priority. (Option C) The nurse should first reposition the client to address a potential cause of hypotension (aortocaval compression), which can affect blood flow to the fetus, and then initiate fetal monitoring. Educational objective: During stabilization of a pregnant client after trauma, uterine displacement is the first step to prevent/correct supine hypotension and promote blood circulation to the fetus. A lateral tilt of the backboard can correct aortocaval compression while protecting the client from further spinal injury.

Question 19

A pregnant client at 30 weeks gestation comes to the prenatal clinic. Which vaccines may be administered safely at this prenatal visit? Select all that apply.

Accepted Answer

Health promotion during pregnancy includes the administration or avoidance of certain vaccines to decrease risks to mother and fetus. Pregnant women have suppressed immune systems and are at increased risk for illness and subsequent complications. Some viruses (eg, rubella, varicella) can cause severe birth defects if contracted during pregnancy. Inactivated vaccines contain a "killed" version of the virus and pose no risk of causing illness from the vaccine. Some vaccines contain weakened (ie, attenuated) live virus and pose a slight theoretical risk of contracting the illness from the vaccine. For this reason, women should not receive live virus vaccines during pregnancy or become pregnant within 4 weeks of receiving such a vaccine. The tetanus, diphtheria, and pertussis (Tdap) vaccine is recommended for all pregnant women between the beginning of the 27th and the end of the 36th week of gestation as it provides the newborn with passive immunity against pertussis (whooping cough) (Option D). During influenza season (October-March), it is safe and recommended for pregnant women to receive the injectable inactivated influenza vaccine regardless of trimester (Option A). (Options B, C, and E) The influenza nasal spray; measles, mumps, and rubella (MMR) vaccine; and varicella vaccine contain live viruses and are contraindicated in pregnancy. Educational objective: Inactivated vaccines (eg, inactivated influenza; tetanus, diphtheria, and pertussis) may be given during pregnancy to protect pregnant clients from illness and provide the fetus with passive immunity. Live virus vaccines are contraindicated in pregnancy.

Question 20

A client with diabetes visits the clinic reporting breast tenderness, vaginal discharge, and urinary frequency. Which action is most important for the nurse to perform?

Accepted Answer

11ecbb05_cbea_dcdc_b433_4de3d41b7f59_MD0009_00 Subjective (presumptive) signs of pregnancy are self-reported by a client. This client's symptoms could originate from pathologic causes (eg, urinary tract infection [UTI], sexually transmitted infection), but collectively these symptoms may be indicative of early pregnancy. Any client with possible signs/symptoms of early pregnancy should be asked about menstrual history (Option C). (Option A) Regular breast self-exams are an important part of breast self-awareness and may alert the client to early pathologic breast changes. However, breast tenderness is a common sign of early pregnancy, which should be ruled out first. (Option B) Leukorrhea (ie, whitish, mucoid vaginal discharge) increases during pregnancy in response to rising hormone levels. The client should be questioned about color, odor, and consistency of discharge to rule out infection, but this response from the nurse does not address the larger picture. (Option D) Increased urinary frequency may result from hyperglycemia, and clients with diabetes are at increased risk for infections (eg, UTI, yeast infection). Reviewing home blood sugar logs would help the nurse assess the client's level of glycemic control over time but would not address the complete picture of the client's acute symptoms. Educational objective: Subjective (self-reported) signs of pregnancy may include leukorrhea, breast tenderness, and urinary frequency. Any client with possible signs/symptoms of early pregnancy should be asked about menstrual history.

Exam 6: Maternal & Newborn Health

The nurse is admitting a client at 41 weeks gestation for induction of labor due to oligohydramnios. Considering the client's indication for induction, what should the nurse anticipate?

A client at 20 weeks gestation reports "running to the bathroom all the time," pain with urination, and foul-smelling urine. Which question is most important for the nurse to ask when assessing the client?

A pregnant client comes in for a routine first prenatal examination. According to the last menstrual period, the estimated gestational age is 12 weeks. Where would the nurse expect to palpate the uterine fundus in this client?

A client comes to the clinic indicating that a home pregnancy test was positive. The client's last menstrual period was September 7. Today is December 7. Which are true statements for this client? Select all that apply.

A 37-weeks-pregnant woman comes to the emergency department with a fractured ankle. Which assessment finding is most concerning and requires the nurse to follow up?

The nurse is preparing to assess a client visiting the women's health clinic. The client's obstetric history is documented as G₅T₁P₂A₁L₂. Which interpretation of this notation is correct?

The nurse is providing nutrition counseling during a preconception visit to a client who does not eat green vegetables. In addition to a daily prenatal vitamin, which foods can the client add to the daily diet to decrease the risk of neural tube defects? Select all that apply.

Which client in a prenatal clinic should the nurse assess first?

The initial prenatal laboratory screening results of a client at 12 weeks gestation indicate a rubella titer status of nonimmune. What will the nurse anticipate as the plan of care for this client?

The nurse is caring for a client in the first trimester during an initial prenatal clinic visit. Based on the information provided by the client, which factor places the client at an increased risk for preterm labor?

A client indicates the desire to become pregnant. Which of the following are important preconception education topics for the nurse to provide? Select all that apply.

Which meal should the nurse recommend for a pregnant client at 13 weeks gestation?

A client at 38 weeks gestation is brought to the emergency department after a motor vehicle crash. She reports severe, continuous abdominal pain. The nurse notes frequent uterine contractions and mild, dark vaginal bleeding. What actions should the nurse take? Select all that apply.

A client at 35 weeks gestation is admitted to the labor and delivery unit for severe pre-eclampsia. She is started on IV magnesium sulfate for seizure prophylaxis. Which of the following signs indicate that the client has developed magnesium sulfate toxicity? Select all that apply.

The nurse is teaching a client, gravida 1 para 0, at 8 weeks gestation about expected weight gain during pregnancy. The client's prepregnancy BMI is 21 kg/m². Which statement by the client indicates an appropriate understanding about weight gain?

A pregnant client at 39 weeks gestation is brought to the emergency department in stable condition following a motor vehicle collision. The client, who is secured supine on a backboard, suddenly becomes pale with a blood pressure of 88/50 mm Hg. Which action should the nurse take first?

A pregnant client at 30 weeks gestation comes to the prenatal clinic. Which vaccines may be administered safely at this prenatal visit? Select all that apply.

A client with diabetes visits the clinic reporting breast tenderness, vaginal discharge, and urinary frequency. Which action is most important for the nurse to perform?

Exam 6: Maternal & Newborn Health

The nurse is admitting a client at 41 weeks gestation for induction of labor due to oligohydramnios. Considering the client's indication for induction, what should the nurse anticipate?

A client at 20 weeks gestation reports "running to the bathroom all the time," pain with urination, and foul-smelling urine. Which question is most important for the nurse to ask when assessing the client?

A pregnant client comes in for a routine first prenatal examination. According to the last menstrual period, the estimated gestational age is 12 weeks. Where would the nurse expect to palpate the uterine fundus in this client?

A client comes to the clinic indicating that a home pregnancy test was positive. The client's last menstrual period was September 7. Today is December 7. Which are true statements for this client? Select all that apply.

A 37-weeks-pregnant woman comes to the emergency department with a fractured ankle. Which assessment finding is most concerning and requires the nurse to follow up?

The nurse is preparing to assess a client visiting the women's health clinic. The client's obstetric history is documented as G5T1P2A1L2. Which interpretation of this notation is correct?

The nurse is providing nutrition counseling during a preconception visit to a client who does not eat green vegetables. In addition to a daily prenatal vitamin, which foods can the client add to the daily diet to decrease the risk of neural tube defects? Select all that apply.

Which client in a prenatal clinic should the nurse assess first?

The initial prenatal laboratory screening results of a client at 12 weeks gestation indicate a rubella titer status of nonimmune. What will the nurse anticipate as the plan of care for this client?

The nurse is caring for a client in the first trimester during an initial prenatal clinic visit. Based on the information provided by the client, which factor places the client at an increased risk for preterm labor?

A client indicates the desire to become pregnant. Which of the following are important preconception education topics for the nurse to provide? Select all that apply.

Which meal should the nurse recommend for a pregnant client at 13 weeks gestation?

A client at 38 weeks gestation is brought to the emergency department after a motor vehicle crash. She reports severe, continuous abdominal pain. The nurse notes frequent uterine contractions and mild, dark vaginal bleeding. What actions should the nurse take? Select all that apply.

A client at 35 weeks gestation is admitted to the labor and delivery unit for severe pre-eclampsia. She is started on IV magnesium sulfate for seizure prophylaxis. Which of the following signs indicate that the client has developed magnesium sulfate toxicity? Select all that apply.

The nurse is teaching a client, gravida 1 para 0, at 8 weeks gestation about expected weight gain during pregnancy. The client's prepregnancy BMI is 21 kg/m2. Which statement by the client indicates an appropriate understanding about weight gain?

A pregnant client at 39 weeks gestation is brought to the emergency department in stable condition following a motor vehicle collision. The client, who is secured supine on a backboard, suddenly becomes pale with a blood pressure of 88/50 mm Hg. Which action should the nurse take first?

A pregnant client at 30 weeks gestation comes to the prenatal clinic. Which vaccines may be administered safely at this prenatal visit? Select all that apply.

A client with diabetes visits the clinic reporting breast tenderness, vaginal discharge, and urinary frequency. Which action is most important for the nurse to perform?

The nurse is preparing to assess a client visiting the women's health clinic. The client's obstetric history is documented as G₅T₁P₂A₁L₂. Which interpretation of this notation is correct?

The nurse is teaching a client, gravida 1 para 0, at 8 weeks gestation about expected weight gain during pregnancy. The client's prepregnancy BMI is 21 kg/m². Which statement by the client indicates an appropriate understanding about weight gain?