Rationale: In early pregnancy, amniocentesis can be used to identify chromosomal and neural tube defects and to determine the sex of the fetus. It can also be used to evaluate fetal lung maturity during the last trimester of pregnancy. A blood test performed between 24 and 28 weeks’ gestation is used to screen for gestational diabetes. Ultrasound is used to identify polyhydramnios; amniocentesis can be used to treat polyhydramnios by removing excess fluid.
2.Answer: a, b, d
Rationale: A BPP is an ultrasound assessment of fetal well-being that includes the following components: nonstress test, fetal tone, fetal breathing, fetal motion,and volume of amniotic fluid. It’s used to confirm the health of the fetus or identify abnormalities. Crownrump length is used to assess gestational age during the first trimester. Biparietal diameter and femur length are also used to assess gestational age and are done in the second and third trimesters
3.Answer: d
Rationale: Hyperemesis gravidarum is severe nausea and vomiting that persists after the first trimester. If untreated,it can lead to weight loss, starvation, dehydration,fluid and electrolyte imbalances, and acid-base disturbances.The client may report thirst, hiccups, oliguria,vertigo, and headache. A rapid pulse and elevated or subnormal temperature can also occur. Signs and symptoms of irondeficiency anemia include fatigue,pallor, and exercise intolerance. Placenta previa causes painless, bright red, vaginal bleeding after 20 weeks of pregnancy. Pregnancy-induced hypertension usually develops after 20 weeks of pregnancy; the client reports sudden weight gain and presents with hypertension.
4.Answer: c
Rationale: The weight of the pregnant uterus is sufficiently heavy to compress the vena cava, which could impair blood flow to the uterus, possibly decreasing oxygen to the fetus. The client may experience supine hypotension syndrome (faintness, diaphoresis, and hypotension) from the pressure on the inferior vena cava. The sidelying position puts the weight of the fetus on the bed, not on the woman.The side-lying position hasn’t been shown to prevent fetal anomalies, nor does it facilitate bladder emptying or digestion.
5.Answer: a
Rationale: The fetal heart rate monitoring strip shows late decelerations, which indicate uteroplacental circulatory insufficiency and can lead to fetal hypoxia and acidosis if the underlying cause isn’t corrected. The client should be turned onto her left side to increase placental perfusion and decrease contraction frequency.In addition, the I.V. fluid rate may be increased and oxygen administered. The right lateral, supine, and prone positions don’t increase placental perfusion.
6.Answer: b, c, e
Rationale: The nurse can expect that terbutaline, a beta-2 agonist that relaxes smooth muscle, will be administered to halt contractions; that betamethasone, a corticosteroid, will be administered to decrease the risk of respiratory distress to the neonate if preterm delivery occurs; and that I.V. fluids will be given to expand the intravascular volume and decrease contractions if dehydration is the cause. Folic acid is a mineral recommended throughout pregnancy (especially in the first trimester) to decrease the risk of neural tube defects. RhoGam is given to Rh-negative clients who have been, or may have been, exposed to Rhpositive fetal blood. Nalbuphine is an opioid analgesic used during labor and delivery.
7.Answer: b
Rationale: The monitoring strip from this client’s chart shows early decelerations. These can result from head compression during normal labor and don’t indicate fetal distress. The nurse should reassure the client and continue to monitor the fetal heart rate. The other
nursing interventions aren’t appropriate.
8.Answer: b, d
Rationale: In the third stage of labor, the client focuses on the neonate’s condition. Before the placenta is expelled, she may also state that she is experiencing discomfort from uterine contractions. Excitement and apprehension are characteristic of the first stage of labor. Exhaustion is common in the second stage of
labor.
9.Answer: c
Rationale: This fetal monitoring strip illustrates a late
deceleration. The decrease in fetal heart rate begins after the peak of the contraction and doesn’t return to baseline until the contraction is over. Late decelerations are associated with uteroplacental insufficiency, shock, or fetal metabolic acidosis. Cephalopelvic disproportion may cause early, not late, decelerations early
in labor. Oligohydramnios (less than normal amount
of amniotic fluid) may be associated with variable decelerations.
Hydramnios (excessive amniotic fluid) may be associated with uterine rupture.
10.Answer: b
Rationale: The taking-in phase is normally the first postpartum phase. During this phase, the mother feels overwhelmed by the responsibilities of newborn care and is still fatigued from delivery. Taking hold is the
next phase, when the client has rested and can learn mothering skills with confidence. Letting go is the final stage, when the client adapts to parenthood, her new role as a caregiver, and her new baby as a separate entity. Holding out isn’t a valid phase.
11.Answer: c, e
Rationale: A postpartum client should be suspected of psychosis if she exhibits delusions or hallucinations,generally starting within 4 weeks postpartum. Typically,the woman has a past history of a psychiatric disorder and treatment. A history of bipolar disorder is an important
risk factor. The disorder occurs in less then 1% of postpartum mothers. It’s considered a medical emergency. Suicide and infanticide are common.
12.Answer: a
Rationale: Blood loss from the uterus that exceeds 500 ml in a 24-hour period is considered postpartum hemorrhage. If uterine atony is the cause, the uterus feels soft and relaxed. A full bladder can prevent the uterus from contracting completely, increasing the risk of hemorrhage. Puerperal infection is an infection of
the uterus and structures above; its characteristic sign is fever. Two major types of deep vein thrombosis occur in the postpartum period: pelvic and femoral. Each has different signs and symptoms, but both occur later in the postpartum period (femoral, after 10 days postpartum;pelvic, after 14 days). Mastitis is an inflammation of the mammary glands that disrupts normal lactation and usually develops 1 to 4 weeks postpartum.
13.Answer: d
Rationale: For the first 3 days after birth, the discharge
is called lochia rubra. It consists almost entirely of blood, with only small particles of decidua and mucus.Lochia alba is a creamy white or colorless discharge that occurs 10 to 14 days postpartum. Lochia
serosa is a pink or brownish discharge that occurs 4 to 14 days postpartum. The term lochia alone isn’t a correct description of the discharge.
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