- A nurse is caring for a client who is prescribed Rho immune globulin standard dose IM (Rhogam). The nurse should understand the action of this medication as which of the following?
Rhogam prevents the formation of Rh antibodies in mothers who are Rh negative - Fetal movement that is noted by the mother is a very important assessment factor to determine fetal well- being. If the nurse is to ask the client if she has “felt her baby move”, when is the best time for a primigravid client to note the first fetal activity?
18 – 20 weeks. - The nurse is palpating the uterus of a client who is 20 weeks pregnant to measure fundal height. Identify where the nurse will find the uterine fundus?
At or near the umbilicus - A woman asks the nurse: “What protects my baby’s umbilical cord from being pinched while the baby’s inside”. The nurse’s best response is?
“Your baby’s umbilical cord is surrounded by connective tissue called Wharton’s Jelly, which prevents compression of the blood vessels and ensures continued nourishment and oxygen to your baby.” - A 20 year -old client calls the clinic to report that she has found a lump in her breast. The nurse’s best response to her is which of the following?
“Many women have benign lumps and bumps in their breasts. However to make sure that it is benign, you should come in for an examination by your physician”
Activity is an important component of prenatal teaching. Activity that is considered safe for a client that states she does not participate in any activity or exercise program at this time would be?
Walking
During her annual gynecologic check up a 17 year-old woman states that recently she has been experiencing cramping and pain during her menstrual periods. The nurse would document this complaint as?
Dysmenorrhea
Prenatal testing is done to identify health issues that may interfere with the developing fetus. Within the first trimester what lab tests are normally obtained? (select all that apply)
Blood type and Rh factor
Complete blood count (CBC)
HIV
The normal parameter of Fetal heart tones is 110 – 160 and can be heard by a doppler as early as?
10-12 weeks gestation
A common discomfort of pregnancy can be managed by changing nutritional intake and some OTC medications. In reviewing information with the patient after her first prenatal visit the nurse is confident that this woman understand the management of constipation when she makes which of the following statements?
“In addition to increasing my dietary fiber, I can use fiber supplements, drink more water and increase my activity if I have no restrictions”
At 32 weeks of pregnancy a woman experiences preterm labor. Although tocolytics are administered and she is placed on bed rest, she continues to experience regular contractions and her cervix is beginning to dilate and efface. What additional medication should be considered to assist the development of the fetus?
Betamethasone
A 30 week gestational age pregnant client presents to the labor suite with complaints of contractions and pressure. What medications can the nurse expect the provider to order for administration? (select all that apply)
Magnesium sulfate
Terbutaline (Brethine)
Betamethasone
Hormonal shifts in pregnancy and the physiological changes that occur affect every body system. As the nurse, which of the following symptoms or presentation would you consider abnormal?
Headaches occurring in the third trimester
A women with the diagnosis of hyperemesis gravidarum requires hospitalization. In addition to her need to be hospitalized what else is significant?
She has vomiting severe and persistent enough to cause weight loss, dehydration and electrolyte imbalance.
A woman is 39 weeks gestation with severe abdominal pain that remains constant is being admitted to the labor and delivery unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes, has dark red vaginal bleeding and a tense rigid abdomen. What should the nurse suspect at this time?
Placenta abruption
Magnesium sulfate is given to a pregnant client with pre-eclampsia and eclampsia for which of the following reasons?
Prevent and treat seizures
A nurse is caring for a client who has a possible ectopic pregnancy at 8 weeks gestation. Which of the following manifestations should the nurse expect to identify as consistent with this diagnosis?
Unilateral abdominal pain
A woman who is 32 weeks pregnant is informed by the nurse that a danger sign of pregnancy could be which of the following?
changes in the pattern of fetal activity
A nurse instructs a 20 year old female college student about oral contraceptives. After the teaching session, the nurse confirms that the client understands the information when she makes which of the following statements?
Oral contraceptives should be taken the same time each day.
A 34 week pregnant woman is experiencing preterm labor. The nurse will provide the following interventions for her client? (select all that apply)
Obtain a urine specimen
Place on a fetal monitor
IV therapy of Lactated Ringers with a 500 ml bolus of fluid
A client with a gestational age of 32 weeks arrives at the clinic for a routine prenatal visit. In identifying fetal well-being, the nurse knows she must measure fundal height, fetal heart tones and fetal movement. The nurse finds the fundal height to be 28 cm and fetal heart tones at 115 bpm, and mother relates that fetal movement has slowed. What may the nurse conclude with this finding?
Possible IUGR and the nurse should identify risk factors and notify the physician.
A client who is 32 weeks pregnant is being monitored in the Antepartum unit for pregnancy induced hypertension (gestational hypertension). She suddenly complains of continuous abdominal pain and vaginal bleeding. Which of the following nursing interventions should be included in the care of this client? (select all that apply)
Evaluate fetal heart tones
Evaluate vital signs
Monitor the amount of vaginal bleeding
The clinic nurse reviews the complete blood count results of a 30-year-old woman who is now 33 weeks’ gestation. The patient’s hemoglobin value is 11.2 g/dL and her hematocrit is 38%. How does the clinic nurse interpret these findings?
normal pregnancy values for the third trimester.
A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods. (Natural family planning, FAM’s) What is the nurse’s most appropriate response?
“They can be effective for many couples, but they require motivation.”
The student nurse is learning that is is recommended to screen for domestic violence in the first prenatal visit for all clients. The instructor has explained how to communicate and ask questions that are personal, so which question would be the best stated for the student nurse to ask?
“This is something that we ask everyone. Do you feel safe in your current living environment and relationships?”
The prenatal clinic nurse meets with a 30-year-old woman who is experiencing her first pregnancy. The patient’s quadruple marker screen result is positive or abnormal at 17 weeks of gestation and her provider recommends an amniocentesis. The nurse explains that the patient needs a referral to one of the following.
Genetics counselor/specialist.
Management of primary dysmenorrhea often requires a multifaceted approach. What is the optimal pharmacological therapy for pain relief when caring for a client with this condition?
Non-steroidal anti- inflammatory drugs (NSAIDS)
Screening at 24 weeks gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. What does the nurse identify as the greatest risk for the fetus?
Macrosomia
The nurse caring for a pregnant client knows that her health teaching regarding fetal circulation has been effective when the client reports that she has been sleeping in what position?
In a side-lying position
A woman is at 14 weeks gestation. The nurse would expect to palpate the fundus at which level?
Slightly above the symphysis pubis
Which of the following signs and symptoms should a woman report immediately to her health care provider? Choose all that apply:
Rupture of membranes
Vaginal bleeding
Headaches that do not respond to usual therapy.
A woman’s obstetrical history indicates that she is pregnant for the 4th 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
Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester?
Increased pulse rate
A woman arrives at the clinic for a pregnancy test. The first day of her last menstrual period (LMP) was February 14. Her expected date of birth (EDB) would be?
November 21
A pregnant client at 32 weeks gestation has mild pre-eclampsia. She is discharged home with instructions to remain on bedrest. She should also be instructed to call her provider if she experiences which of the following symptoms? (select all that apply)
Blurred vision
Headache not relieved with over the counter medication
Epigastric pain
Intrauterine growth restriction is the result of poor placental perfusion. What pregnancy risk factors may contribute to intrauterine growth restriction? (select all that apply)
Drug abuse
Hypertension
Smoking
A 25-year-old single female comes to the gynecologist’s office for a follow-up visit related to her abnormal Papanicolaou (Pap) smear. The test revealed that the client has human papillomavirus (HPV). The client asks, “What is that? Can you get rid of it?” What is your best response?
“HPV stands for ‘human papillomavirus.’ It is a sexually transmitted infection (STI) that may lead to cervical cancer.”
The amniotic fluid has many functions and we know that amniotic fluid is necessary for fetal well- being. Please select the purpose of the fluid for fetal well -being. Select all that apply.
permits free movement of the baby
cushioning of the baby from minor trauma
temperature control
A pregnant woman experiencing nausea and vomiting. What action can she take?
eat small, frequent meals (every 2 to 3 hours)
A nurse in a prenatal clinic is caring for a client who is in the first trimester of pregnancy. The client’s health record includes this data: G3, T1, P0, A1, L1. How should the nurse interpret this information? (select all that apply)
Client has had two prior pregnancies
Client has one living child
Client has delivered one newborn at term
A nurse in a clinic is teaching a client of childbearing age about recommended folic acid supplements. Which of the following defects can occur in the fetus or neonate as a result of folic acid deficiency?
Neural tube defects
A nurse is caring for a client who is receiving IV magnesium sulfate. Which of the following medications should the nurse anticipate administering if magnesium sulfate toxicity is suspected?
Calcium gluconate
Nurse is instructing a client who is taking an oral contraceptive about danger signs to report to her provider. The nurse determines the client understands the teaching when the client states the need to report which of the following?
Shortness of breath
A client in the prenatal clinic is complaining of episodes of dizziness when sitting up after lying supine for some time. Which response by the nurse explains this change during pregnancy?
“This is due to the weight of the uterus on the vena cava.”
A nurse is reviewing a prescription for ferrous sulfate (iron supplementation) with a client who is at 12 weeks gestation. Which of the following statements by the client indicates understanding of the teaching?
“I plan to drink more orange juice while taking this pill.”
As a nurse working in a prenatal clinic it is important to obtain both maternal and fetal assessments. While obtaining fetal assessments, which of the following should the nurse complete for fetal well-being?
Fetal heart tones, Fetal movement, and Fundal height
A nurse is caring for a client who is at 36 weeks of gestation and who has a suspected placenta previa. Which of the following findings support this diagnosis?
Painless red vaginal bleeding
A nurse is completing a health history for a client who is at 6 weeks of gestation. The client informs the nurse that she smokes one pack of cigarettes per day. The nurse should advise the client that smoking places the client’s newborn at risk for which of the following complications?
Intrauterine growth restriction
A nurse is admitting a client who has severe preeclampsia at 35 weeks of gestation and is reviewing the provider’s orders. Which of the following orders requires clarification?
Ambulate twice daily.
A student nurse asks the faculty about the importance of preconception counseling. Which response by the faculty is best?
“It is the best time to find any conditions that could have a negative effect on a pregnancy.”