Nokea
A pregnant woman undergoes a triple/quadruple screen at 16 to 18 weeks' gestation. What would the nurse suspect if the woman's alpha-fetoprotein (AFP) level is decreased?
- A. Sickle-cell anemia
- B. Cardiac defects
- C. Down syndrome
- D. Respiratory disorders
Correct Answer: C
Rationale: Low AFP suggests Down syndrome, often with altered hCG and estriol. Sickle-cell anemia uses other tests, cardiac defects may raise AFP, and respiratory issues don't typically affect AFP levels.
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A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. Which finding would the nurse interpret as indicating a therapeutic level of medication?
- A. Difficulty in arousing
- B. Deep tendon reflexes 2+
- C. Urinary output of 30 mL per hour
- D. Respiratory rate of 10 breaths/minute
Correct Answer: B
Rationale: Deep tendon reflexes at 2+ indicate a therapeutic magnesium level, preventing seizures without toxicity. Difficulty arousing, low urinary output (below 40 mL/hr), or respiratory rate of 10 suggest toxicity, requiring intervention.
A pregnant client in her second trimester has a hemoglobin level of 11 g/dL. The nurse interprets this as indicating:
- A. Hemoconcentration by hypertension
- B. A multiple gestation pregnancy
- C. Greater-than-expected weight gain
- D. Iron-deficiency anemia
Correct Answer: D
Rationale: A hemoglobin of 11 g/dL is low for the second trimester (10.5-14 g/dL), suggesting iron-deficiency anemia, especially with symptoms like fatigue. Hemoconcentration raises hemoglobin, multiple gestation lowers it slightly, and weight gain is unrelated.
A woman with a history of systemic lupus erythematosus comes to the clinic for evaluation. The woman tells the nurse that she and her partner would like to have a baby but that they are afraid her lupus will be a problem. Which response would be most appropriate for the nurse to make?
- A. Be sure that your lupus is stable or in remission for 6 months before getting pregnant.
- B. It's probably not a good idea for you to get pregnant since you have lupus.
- C. Your lupus will not have any effect on your pregnancy whatsoever.
- D. When you get pregnant we'll have to add quite a few medications to your normal treatment plan.
Correct Answer: A
Rationale: Stable lupus for 6 months before pregnancy reduces risks like flares or miscarriage. Discouraging pregnancy is insensitive, claiming no effect is false, and adding many medications is inaccurate without specifics.
A client with hyperemesis gravidarum is admitted to the facility after being cared for at home without success. What would the nurse expect to include in the client's plan of care?
- A. clear liquid diet
- B. administration of diethylstilbestrol
- C. total parenteral nutrition
- D. nothing by mouth
Correct Answer: C
Rationale: Hyperemesis gravidarum causes severe vomiting, risking dehydration and malnutrition. Total parenteral nutrition delivers complete nutrients intravenously, addressing these risks when oral intake fails. Clear liquids or nothing by mouth worsen malnutrition, and diethylstilbestrol, a discontinued drug, is irrelevant.
A 22-year-old homeless woman arrives at a walk-in clinic seeking pregnancy confirmation. The nurse notes on assessment a 12-week gestational uterus, a BP of 110/70, a BMI of 17.5. The client admits to using cocaine a few times. She has been pregnant before and indicates she 'loses them early.' What characteristics place the client in the high-risk pregnancy category? Select all that apply.
- A. Homelessness
- B. Age
- C. BP 110/70
- D. BMI 17.5
- E. Prenatal care
- F. Prenatal history
Correct Answer: A,D,E,F
Rationale: Homelessness increases risks via poor nutrition and stress; BMI 17.5 indicates malnutrition; lack of prenatal care raises complication risks; prior losses suggest underlying issues. Age (22) is optimal, and BP 110/70 is normal, not risks.