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Complications of Pregnancy
■ The Pregnant Client with Preeclampsia or Eclampsia
■ The Pregnant Client with a Chronic Hypertensive Disorder
■ The Pregnant Client with Third-Trimester Bleeding
■ The Pregnant Client with Preterm Labor
■ The Pregnant Client with Premature Rupture of the Membranes
■ The Pregnant Client with Diabetes Mellitus
■ The Pregnant Client with Heart Disease
■ The Client with an Ectopic Pregnancy
■ The Pregnant Client with Hyperemesis Gravidarum
■ The Client with a Hydatidiform Mole
■ The Pregnant Client with Miscellaneous Complications
■ Managing Care Quality and Safety
■ Answers, Rationales, and Test Taking Strategies
2
The Pregnant Client with
5.
At 32 weeks’ gestation, a 15-year-old primigravid client who is 5 feet, 2 inches tall has gained a total of 20 lb, with a 1-lb gain in the last 2 weeks. Urinalysis reveals negative glucose and a trace of protein. The nurse should advise the client that which of the following factors increases her risk for preeclampsia?■ 1. Total weight gain.
■ 2. Short stature.
■ 3. Adolescent age group.
■ 4. Proteinuria.
6.
A primigravid client’s baseline blood pres- sure at her initial visit at 12 weeks’ gestation was 110/70 mm Hg. During an assessment at 38 weeks’gestation, which of the following data would indi- cate mild preeclampsia?
■ 1. Blood pressure of 160/110 mm Hg on two separate occasions.
■ 2. Proteinuria, more than 5 g in 24 hours.
■ 3. Serum creatinine concentration of 1.4 mL/dL.
■ 4. Weight gain of 2 lb in the last week.
7.
A 16-year-old client at 34 weeks’ gestation, who is being monitored at home with home nurs- ing visits, is diagnosed with mild preeclampsia and has gained 2 lb in the past week. Her current blood pressure is 144/92 mm Hg. Which assessment fi nd- ing would require further action by the home health nurse?■ 1. Occasional headache.
■ 2. Frequent voiding in large amounts.
■ 3. 1 + pedal edema.
■ 4. 3 + protein on urine dipstick.
8.
When developing the teaching plan for a primigravid client at 30 weeks’ gestation diagnosed with mild preeclampsia who is being treated at home, which of the following would the nurse iden- tify as the most appropriate client-centered goal?■ 1. Return visit to the prenatal clinic in approxi- mately 4 weeks.
■ 2. Decreased edema after 1 week of a low- protein, low-fi ber diet.
■ 3. Bed rest on the left side during the day, with bathroom privileges.
■ 4. Immediate reporting of adverse reactions to magnesium sulfate therapy.
9.
After instructing a primigravid client at 38 weeks’ gestation about how preeclampsia can affect the client and the growing fetus, the nurse realizes that the client needs additional instruction when she says that preeclampsia can lead to which of the following?■ 1. Hydrocephalic infant.
■ 2. Abruptio placentae.
■ 3. Intrauterine growth retardation.
■ 4. Poor placental perfusion.
10.
After instructing a multigravid client diagnosed with mild preeclampsia how to keep a record of fetal movement patterns at home, the nurse determines that the teaching has been effec- tive when the client says that she will count the number of times the baby moves during which of the following time spans?■ 1. 30-minute period three times a day.
■ 2. 45-minute period after lunch each day.
■ 3. 1-hour period each day.
■ 4. 12-hour period each week.
11.
When teaching a multigravid client diag- nosed with mild preeclampsia about nutritional needs, which of the following types of diet should the nurse discuss?■ 1. High-residue diet.
■ 2. Low-sodium diet.
■ 3. Regular diet.
■ 4. High-protein diet.
12.
A 17-year-old client at 33 weeks’ gestation diagnosed with mild preeclampsia is prescribed bed rest at home. The nurse instructs the client to contact the health care provider immediately if she experiences which of the following?■ 1. Blurred vision.
■ 2. Ankle edema.
■ 3. Increased energy levels.
■ 4. Mild backache.
13.
One week after her prenatal visit, a primi- gravid client at 38 weeks’ gestation diagnosed with mild pre-eclampsia calls the clinic nurse complain- ing of a continuous headache for the past 2 days accompanied by nausea. The client does not want to take aspirin. The nurse should tell the client:■ 1. “Take two acetaminophen tablets. They aren’t as likely to upset your stomach.”
■ 2. “I think the doctor should see you today. Can you come to the clinic this morning?”
■ 3. “You need to lie down and rest. Have you tried placing a cool compress over your head?”
■ 4. “I’ll ask the doctor to call in a prescription for aspirin with codeine. What’s your pharmacy’s number?”
14.
When assessing a 16-year-old primigravid client at 37 weeks’ gestation diagnosed with severe preeclampsia, which of the following indicates the client needs continued management for the preec- lampsia?■ 1. Blood pressure of 138/94 mm Hg.
■ 2. Severe blurring of vision.
■ 3. Less than 2 g of protein in a 24-hour sample.
■ 4. Weight gain of 0.5 lb in 1 week.
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15.
When preparing the room for admission of a multigravid client at 36 weeks’ gestation diagnosed with severe preeclampsia, which of the following should the nurse obtain?■ 1. Oxytocin infusion solution.
■ 2. Disposable tongue blades.
■ 3. Portable ultrasound machine.
■ 4. Padding for the side rails.
16.
The physician orders intravenous magnesium sulfate for a primigravid client at 38 weeks’ gesta- tion diagnosed with severe preeclampsia. Which of the following medications should the nurse have readily available at the client’s bedside?■ 1. Diazepam (Valium).
■ 2. Hydralazine (Apresoline).
■ 3. Calcium gluconate.
■ 4. Phenytoin (Dilantin).
17.
For the client who is receiving intravenous magnesium sulfate for severe preeclampsia, which of the following assessment fi ndings would alert the nurse to suspect hypermagnesemia?■ 1. Decreased deep tendon refl exes.
■ 2. Cool skin temperature.
■ 3. Rapid pulse rate.
■ 4. Tingling in the toes.
18.
A 28-year-old multigravida at 37 weeks’gestation arrives at the emergency department with a blood pressure of 160/104 mm Hg and +3 refl exes without clonus. The client is diagnosed with severe preeclampsia. The nurse collaborates with the health care provider to develop a plan of care that care will fi rst include:
■ 1. Administration of glucocorticoids (Betame- thasone).
■ 2. Vaginal or cesarean delivery of the fetus.
■ 3. Prevention of seizures with phenytoin (Dilantin).
■ 4. Reduction of fl uid retention with thiazides.
19.
Which of the following would the nurse identify as the priority to achieve when develop- ing the plan of care for a primigravid client at 38 weeks’ gestation who is hospitalized with severe preeclampsia and receiving intravenous magnesium sulfate?■ 1. Decreased generalized edema within 8 hours.
■ 2. Decreased urinary output during the fi rst 24 hours.
■ 3. Sedation and decreased refl ex excitability within 48 hours.
■ 4. Absence of any seizure activity during the fi rst 48 hours.
20.
The nurse is administering intravenous magnesium sulfate as ordered for a client at 34 weeks’ gestation with severe preeclampsia.Which of the following are desired outcomes of this therapy? Select all that apply.
■ 1. T 98, P 72, R 14.
■ 2. Urinary output <30 mL/hr.
■ 3. HR 120 BPM.
■ 4. Fetal heart rate with late decelerations.
■ 5. BP of <140/90.
■ 6. DTR’s 2+.
■ 7. Magnesium level= 5.6 mg/dL.
■ 8. Clonus = 2+.
21.
Soon after admission of a primigravid client at 38 weeks’ gestation with severe preeclampsia, the physician orders a continuous intravenous infu- sion of 5% dextrose in Ringer’s solution and 4 g of magnesium sulfate. While the medication is being administered, which of the following assessment fi ndings should the nurse report immediately?■ 1. Respiratory rate of 12 breaths/minute.
■ 2. Patellar refl ex of +2.
■ 3. Blood pressure of 160/88 mm Hg.
■ 4. Urinary output exceeding intake.
22.
As the nurse enters the room of a newly admitted primigravid client diagnosed with severe preeclampsia, the client begins to experience a seizure. Which of the following should the nurse do fi rst?■ 1. Insert an airway to improve oxygenation.
■ 2. Note the time when the seizure begins and ends.
■ 3. Call for immediate assistance.
■ 4. Turn the client to her left side.
23.
After administering hydralazine (Apresoline) 5 mg intravenously as ordered for a primigravid cli- ent with severe preeclampsia at 39 weeks’ gestation, the nurse should assess the client for:■ 1. Tachycardia.
■ 2. Bradypnea.
■ 3. Polyuria.
■ 4. Dysphagia.
24.
A primigravid client with severe preeclamp- sia exhibits hyperactive, very brisk patellar refl exes with two beats of ankle clonus present. The nurse documents the patellar refl exes as which of the following?■ 1. 1+.
■ 2. 2+.
■ 3. 3+.
■ 4. 4+.
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25.
A 16-year-old unmarried primigravid client at 37 weeks’ gestation with severe preeclampsia is in early active labor. Her mother is at the bed- side. The client’s blood pressure is 164/110 mm Hg.Which of the following would alert the nurse that the client may be about to experience a seizure?
■ 1. Decreased contraction intensity.
■ 2. Decreased temperature.
■ 3. Epigastric pain.
■ 4. Hyporefl exia.
26.
Fifteen minutes after a client experiences an eclamptic seizure, the nurse should assess the client for which of the following?■ 1. Polyuria.
■ 2. Facial fl ushing.
■ 3. Hypotension.
■ 4. Uterine contractions.
27.
A client at 36 weeks’ gestation with eclamp- sia begins to exhibit signs of labor after an eclamptic seizure. The nurse should assess the client for:■ 1. Abruptio placentae.
■ 2. Transverse lie.
■ 3. Placenta accreta.
■ 4. Uterine atony.
28.
The nurse is reviewing the chart of a multi- gravid client at 39 weeks’ gestation with suspected HELLP syndrome. The nurse should notify the health care provider about which of the following test results?■ 1. Platelets 200,000 mm3.
■ 2. Lactate dehydrogenase (LDH) > 200 units/L.
■ 3. Uric acid 3 mg/dL.
■ 4. Aspartate aminotransferase (AST) 15 units/L.