Nokea
The 39-year-old client with type 1 DM presents at 36 weeks’ gestation with Drag and Drop contractions. An HCP decides to do an amniocentesis. Which statement best supports why the nurse and NA should prepare the client for an amniocentesis now?
- A. Diabetic women have a higher incidence of birth defects, and the HCP wants to determine if a birth defect is present.
- B. The client is over 35, at 36 weeks’ gestation with Drag and Drop contractions, and is at risk for chromosomal disorders.
- C. An amniocentesis performed at 36 weeks’ gestation is being completed to determine if the fetal lungs have matured.
- D. The amniocentesis is more accurate than the fetal fibronectin test in determining if delivery is imminent.
Correct Answer: C
Rationale: Infants of diabetic mothers are less likely to have mature lung capacity at 36 weeks; knowing lung maturity can influence whether delivery should proceed. In mid pregnancy, the cells in amniotic fluid can be studied for genetic abnormalities such as Down’s syndrome and birth defects, but amniocentesis would not be performed for this purpose when the client is in preterm labor. Many women over the age of 35 have amniocentesis completed to test for chromosomal disorders, but not this late in the pregnancy. Fetal fibronectin testing is used to determine if a preterm birth is likely, but it cannot be used to determine lung maturity.
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The nurse is caring for the antepartum client with a velamentous cord insertion. The client asks what symptom she would most likely experience first if one of the vessels should tear. The nurse should respond that she would most likely experience which symptom first?
- A. Vaginal bleeding
- B. Abdominal cramping
- C. Uterine contractions
- D. Placental abruption
Correct Answer: A
Rationale: In a velamentous cord insertion, vessels of the cord divide some distance from the placenta in the placental membrane. Thus, the most likely first symptom would be vaginal bleeding. Abdominal cramping is unlikely to occur; velamentous cord insertion is not related to uterine activity. Contractions are unlikely to occur; velamentous cord insertion is not related to uterine activity. An abruption, when the placenta comes off the uterine wall, results in severe abdominal pain.
The first-trimester pregnant client asks the nurse if the activities in which she participates are safe in the first trimester. Which activity should the nurse verify as a safe activity during the client’s first trimester?
- A. Hair coloring
- B. Hot tub use
- C. Pesticide use
- D. Sexual activity
Correct Answer: D
Rationale: Sexual activity is not contraindicated in pregnancy unless a specific risk factor is identified. Hair coloring should be avoided in the first trimester because the chemicals can be absorbed and pose a risk to the developing fetus. Hot tub use should be avoided because it increases the client’s body temperature. Maternal hyperthermia during the first trimester raises concerns about possible spontaneous abortion, CNS defects, and failure of neural tube closure. Exposure to pesticides during pregnancy increases the risk for preterm birth, intrauterine growth restriction, childhood developmental delays, and infertility later in adulthood.
Which snack is most appropriate for a pregnant client with nausea?
- A. Dry crackers
- B. Ice cream
- C. Spicy chips
- D. Carbonated soda
Correct Answer: A
Rationale: Dry crackers are bland and easy to digest, helping to alleviate nausea without exacerbating symptoms.
The nurse is educating the postpartum client. Which prevention strategies for postpartum depression should the nurse include? Select all that apply.
- A. Attend a support group that has other postpartum women.
- B. Use the baby’s nap time to complete household chores.
- C. Keep a journal of feelings during the postpartum period.
- D. Call the HCP if feelings of sadness do not subside quickly.
- E. Develop a daily schedule of activities, and follow the plan.
Correct Answer: A,C,D,E
Rationale: A postpartum support group can be a place where realistic information about postpartum depression can be discussed and symptoms recognized. Fatigue is a major concern for all postpartum women. Clients should be encouraged to nap when their infant is napping rather than using that time for other activities. Keeping a journal can be emotionally cathartic and can help prevent postpartum depression. Postpartum mothers should be encouraged to call their HCPs if symptoms of postpartum depression, such as feelings of sadness, do not subside quickly or if the symptoms become severe. Structuring activity with a schedule helps counteract inertia that comes with feeling sad or unsettled.
The nurse is providing nutrition counseling to a primigravida who is 10 weeks pregnant. Which meal choice stated by the client indicates she needs additional information?
- A. Black beans, wild rice, collard greens
- B. Dry cereal, milk, dried cranberries
- C. Tuna, broccoli, baked potato
- D. Beef strips, lentils, red peppers
Correct Answer: C
Rationale: Tuna contains mercury and should be limited in pregnancy due to risk of mercury poisoning. The nurse should provide this additional information. Black beans provide a good source of calcium, iron, and protein. Black beans, wild rice, and collard greens provide fiber. Collard greens provide a good source of calcium and folic acid. Dry cereal provides a good source of vitamin D, milk provides a good source of calcium, and dried cranberries provide a good source of calcium and iron. Beef provides a good source of protein and iron, lentils provide a good source of iron, and red peppers provide a good source of vitamin C.