97.
4. For the Rh-negative client who may be pregnant with an Rh-positive fetus, an indirect Coombs test measures antibodies in the maternal blood. Titers should be performed monthly during the fi rst and second trimesters and biweekly during the third trimester and the week before the due date.CN: Health promotion and maintenance;
CL: Apply
98.
2. According to the New York Heart Associa- tion Cardiac Disease classifi cation, this client would fi t under Class II because she is symptomatic with increased activity (dyspnea with exertion). The New York Heart Association Cardiac Disease Clas- sifi cation identifi es Class II clients as having cardiac disease and a slight limitation in physical activ- ity. When physical activity occurs, the client may experience angina, diffi culty breathing, palpations, and fatigue. All of the client’s other symptoms are within normal limits.CN: Management of care; CL: Analyze
99.
1, 2, 5. The test result indicates that the mother has an active hepatitis infection and is a car- rier. Hepatitis B immune globulin at birth provides the infant with passive immunity against hepatitis B and serves as a prophylactic treatment. Addi- tionally, the infant will be started on the vaccine series of three injections. The infant should not be screened or isolated because the infant is already hepatitis B positive. As with all clients, universal precautions should be used and are suffi cient to prevent transmission of the virus. Women who are positive for hepatitis B surface antigen are able to breast-feed.CN: Management of care; CL: Create
100.
4. Asthma medications and bronchodila- tors should be continued during pregnancy as prescribed before the pregnancy began. The medi- cations do not cause harm to the mother or fetus.Regular use of asthma medication will usually pre- vent asthma attacks. Prevention and limitation of an asthma attack is the goal of care for a client who is or is not pregnant and is the appropriate care strategy. During an asthma attack, oxygen needs continue as with any pregnant client but the air- ways are edematous, decreasing perfusion. Asthma exacerbations during pregnancy may occur as a result of infrequent use of medication rather than as a result of the pregnancy.
CN: Pharmacological and parenteral therapies; CL: Evaluate
101.
2. The nurse seeing this client should refer her to a health care provider for further evalua- tion of the pain. This referral would allow a more defi nitive diagnosis and medical interventions that may include surgery. Referral would occur because of her high pain rating as well as the other symp- toms, which suggest gallbladder disease. During pregnancy, the gallbladder is under the infl uence of progesterone, which is a smooth muscle relaxant.Because bile does not move through the system as quickly during pregnancy, bile stasis and gallstone formation can occur. Although education should be a continuous strategy, with pain at this level, a brief explanation is most appropriate. Major em- phasis should be placed on determining the cause and treating the pain. It is not appropriate for the nurse to diagnose pain at this level as heartburn.
Discussing nutritional strategies to prevent heart- burn are appropriate during pregnancy, but not in this situation. Tylenol is an acceptable medication to take during pregnancy but should not be used on a regular basis as it can mask other problems.
CN: Management of care; CL: Synthesize
102.
3. A fetus that has died and is retained in utero places the mother at risk for disseminated intravascular coagulation (DIC) because the clotting factors within the maternal system are consumed when the nonviable fetus is retained. The longer the fetus is retained in utero, the greater the risk of DIC.This client has no risk factors, history, or signs and symptoms that put her at risk for either abruptio placentae or placenta previa, such as sharp pain and
“woody,” fi rm consistency of the abdomen (abrup- tion) or painless bright red vaginal bleeding (previa).
There is no evidence that she is threatening to abort as she has no complaints of cramping or vaginal bleeding.
CN: Management of care; CL: Analyze
103.
2. Chorionic villus sampling (CVS) can be performed from approximately 8 to 12 weeks’ gesta- tion, while amniocentesis cannot be performed until between 11 weeks’ gestation and the end of the pregnancy. Eleven weeks’ gestation is the earliest possible time within the pregnancy to obtain a suf- fi cient amount of amniotic fl uid to sample. Because CVS take a piece of membrane surrounding the infant, this procedure can be completed earlier in the pregnancy. Amniocentesis and chorionic villus sampling identify the genetic makeup of the fetus in its entirety, rather than a portion of it. Laboratory analysis of chorionic villus sampling takes less time to complete. Both procedures place the fetus at risk and postprocedure teaching asks the client to report the same complicating events (bleeding, cramping, fever, and fl uid leakage from the vagina).CN: Management of care; CL: Evaluate
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104.
4. Additional teaching is needed when the parent says that adolescents are at greater risk for congenital anomalies. Although adolescents are at greater risk for denial of the pregnancy, lack of pre- natal care, low-birth-weight infant, cephalopelvic disproportion, anemia, and nutritional defi cits and have a higher maternal mortality rate, studies reveal that congenital anomalies are not more common in adolescent pregnancies.CN: Health promotion and maintenance;
CL: Evaluate
105.
4. With a spontaneous abortion, many clients and their partners feel an acute sense of loss. Their grieving commonly includes feelings of guilt, which may be expressed as wondering whether the woman could have done something to prevent the loss.Anger, sadness, and disappointment are also com- mon emotions after a pregnancy loss. Ambivalence, anxiety, and fear are not common emotions after a spontaneous abortion.
CN: Psychosocial adaptation;
CL: Analysis
106.
1. Hydroxyzine (Vistaril) has a tranquilizing effect and also decreases nausea and vomiting. It does not decrease fl uid retention, reduce pain, de- crease uterine cramping, or promote uterine contrac- tility. One of the adverse effects of the medication is sleepiness. Ibuprofen may decrease pain from uterine cramping. Oxytocin may be used to increase uterine contractility.CN: Pharmacological and parenteral therapies; CL: Evaluate
107.
3. The death of a fetus at any time during preg- nancy is a tragedy for most parents. After a spontane- ous abortion, the client and family members can be expected to suffer from grief for several months or longer. When offering support, a simple statement such as “I’m truly sorry you lost your baby” is most appropriate. Therapeutic communication techniques help the client and family understand the meaning of the loss, move less stressfully through the grief pro- cess, and share feelings. Asking the client whether she is experiencing a great deal of uterine pain is inappro- priate because this is a “yes-no” question and doesn’t allow the client to express her feelings. Saying that the embryo was defective is inappropriate because this may lead the client to think that she contributed to the fetus’s demise. This is not the appropriate time to dis- cuss embryonic or fetal malformations. However, the nurse should explain to the client that this situation was not her fault. Telling the client that she should get pregnant again as soon as possible is not therapeutic and discounts the feelings of the expectant mother who had already begun to bond with the fetus.CN: Psychosocial adaptation; CL: Apply
108.
4. Rh sensitization can be prevented by Rho(D) immune globulin, which clears the maternal circulation of Rh-positive cells before sensitiza- tion can occur, thereby blocking maternal antibody production to Rh-positive cells. Administration of this drug will not prevent future Rh-positive fetuses, nor will it prevent future abortions. An antibody response will not occur to Rh-negative cells. Rh- negative mothers do not develop sensitivities if the fetus is also Rh negative.CN: Pharmacological and parenteral therapies; CL: Apply
109.
2. The client with leg varicosities should take frequent rest periods with the legs elevated above the hips to promote venous circulation. The client should avoid constrictive clothing, but support hose that reach above the varicosities may help allevi- ate the pain. Contracting and relaxing the feet and ankles twice daily is not helpful because it does not promote circulation. Taking a leave of absence from work may not be possible because of economic reasons. The client should try to rest with her legs elevated or walk around for a few minutes every 2 hours while on the job.CN: Reduction of risk potential;
CL: Synthesis
110.
1. Cryotherapy, electrocautery, or laser therapy may be used to remove the genital warts.Podophyllin solution should not be used to decrease their size while the client is pregnant, because fetal malformations may result. A 25% trichloroacetic acid solution can decrease the size of the warts, but because this disease is caused by a virus, the disor- der may recur. Condylomata acuminata has been as- sociated with cervical cancer, and the client should have semiannual or annual Pap smears to detect cervical dysplasia.
CN: Pharmacological and parenteral therapies; CL: Create
111.
4. The client is reporting symptoms typically associated with herpes genitalis. Some women have no symptoms of gonorrhea. Others may experience vaginal itching and a thick, purulent vaginal dis- charge. C. trachomatis infection in women is com- monly asymptomatic, but symptoms may include a yellowish discharge and painful urination. The fi rst symptom of syphilis is a painless chancre.CN: Physiological adaptation; CL: Apply
112.
1. The client may need surgery to remove a ruptured fallopian tube where the pregnancy has oc- curred, and the nurse is usually responsible for wit- nessing the signature on the informed consent. Typi- cally, if bleeding is occurring, it is internal and there is only scant vaginal bleeding with no discoloration.Billings_Part 2_Chap 1_Test 1.indd 59
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116.
4. An antenatal client at 16 weeks’ gestation who has occasional sharp pain on her left side radi- ating from her symphysis to her fundus.
1. A primigravid client at 10 weeks’ gestation complaining of not feeling well with nausea and vomiting, urinary frequency, and fatigue.
2. A multiparous client at 32 weeks’ gestation ask- ing for assistance with fi nding a new physician.
3. A single mother at 4 months postpartum fearful of shaking her baby when he cries.
The fi rst client to be seen should be the postpartum mother who is fearful of shaking her infant. Postpar- tum depression is a disorder that may occur during the fi rst year postpartum but peaks at 4 weeks post- partum, prior to menses, or upon weaning. As a single mother, this client may not have support, a large factor putting women at risk. Other factors accentuat- ing risk include prior depressive or bipolar illness and self-dissatisfaction. Second, the nurse should see the 16-week antenatal client, who is likely experienc- ing round ligament syndrome. At this point in the pregnancy, the uterus is stretching into the abdomen causing this type of pain. The pain is on the wrong side to be attributed to appendicitis or gallbladder dis- ease. Nursing interventions to ease the pain include a heating pad or bringing the legs toward the abdo- men. The nurse should next see the primigravid client complaining of not feeling well because she is exhibit- ing signs and symptoms of discomfort experienced by most women in the fi rst trimester. The multiparous client at 32 weeks’ gestation is the lowest priority as she is physically well, while the other clients have physical and psychological problems. In most emer- gency department situations, she may not be seen by medical or nursing staff but would be given the names of health care providers in the reception area.
CN: Management of care; CL: Synthesize
117.
3. The social worker is available to assist the client in fi nding services within the community to meet client needs. This individual is able to provide the names of pharmacies within the community that offer generic substitutes or others that utilize the client’s insurance plan. The charge nurse of the unit would be able to refer the client to the social worker.The hospital fi nance offi ce does not handle this type of situation and would refer the client back to the unit. The client’s insurance company deals with payments for health care and would refer the client back to the local setting.
CN: Management of care; CL: Apply The nurse cannot determine whether the fallopian
tube can be salvaged; this can be accomplished only during surgery. If the tube has ruptured, it must be removed. If the tube has not ruptured, a linear salpingostomy may be done to salvage the tube for future pregnancies. With an ectopic pregnancy, although the client is experiencing abdominal pain, she is not having uterine contractions.
CN: Physiological adaptation;
CL: Synthesize
113.
1. The optical density of the amniotic fl uid is evaluated for bilirubin level with a spectrophotom- eter. The higher the optical density, the more biliru- bin is present in the fl uid, indicating that fetal red blood cells are being destroyed. From these fi ndings, the severity of the disease can be estimated. Because light destroys bilirubin, specimens should be kept in a dark container until the analysis is complete.A clear, green, or amber container would allow light to enter, thus destroying bilirubin.
CN: Reduction of risk potential;
CL: Apply
Managing Care Quality and Safety
114.
2. Late decelerations during an oxytocin chal- lenge test indicate that the infant is not receiving enough oxygen during contractions and is exhib- iting signs of utero-placental insuffi ciency. This client would need further medical intervention.Fetal movement 6 times in 2 hours is adequate in a healthy fetus and a biophysical profi le of 9 indicates that the risk of fetal asphyxia is rare. A reactive non- stress test informs the health care provider that the fetus has 2 fetal heart rate accelerations of 15 beats per minute above baseline and lasting for 15 sec- onds within a 20-minute period, which is a reassur- ing result and an indication of fetal well-being.
CN: Management of care; CL: Evaluate
115.
1. Folic acid supplementation is recommend- ed to prevent neural tube defects and anemia in pregnancy. Defi ciencies increase the risk of hem- orrhage during delivery as well as infection. The recommended dose prior to pregnancy is 400 mcg/day; while breast-feeding and during pregnancy, the recommended dosage is 500 to 600 mcg/day. Blood glucose levels are not regulated by the intake of folic acid. Vitamin C potentiates the absorption of iron and is also associated with blood clotting or colla- gen formation.
CN: Reduction of risk potential;
CL: Apply
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61
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