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The client admitted in preterm labor is told that an amniocentesis needs to be performed. The client asks the nurse why this is necessary when the HCP has been performing ultrasounds throughout the pregnancy. Which is an appropriate response by the nurse?
- A. “Your baby is older now, and an amniocentesis provides us with more information on how your baby is doing.”
- B. “An amniocentesis could not be Performed before 32 weeks, so you will be having this test from now until delivery.”
- C. “Your doctor wants to make sure that there are no problems with the baby that an ultrasound might not be able to identify.”
- D. “With your preterm labor your doctor needs to know your baby’s lung maturity; this is best identified by amniocentesis.”
Correct Answer: D
Rationale: The amniocentesis is being performed to determine fetal lung maturity. Once fetal lung maturity is determined, appropriate care can be planned, including administration of betamethasone, administration of tocolytics, or delivery of the baby. While an amniocentesis can provide fetal information that an ultrasound cannot, the rationale for the amniocentesis is to determine lung maturity. Stating additional information is too broad. An amniocentesis can be performed as early as 12 weeks’ gestation, not after 32 weeks. The amniocentesis is not being performed to identify fetal anomalies.
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When up to the bathroom for the first time after a vaginal delivery, the client states, “A friend told me that I’m going to have trouble with urinary incontinence now that I have had a baby.” Which is the best response by the nurse?
- A. “That’s not true. You won’t need to worry about this until menopause.”
- B. “I will teach you how to do Kegel exercises to strengthen your muscles.”
- C. “Wearing a pad similar to a sanitary pad will help contain the incontinence.”
- D. “If this occurs, notify your HCP to have surgery to correct urinary incontinence.”
Correct Answer: B
Rationale: Women of any life stage can experience urinary incontinence. Kegel exercises strengthen muscles surrounding the vagina and urinary meatus, preventing urinary incontinence for many women. To perform Kegel exercise, contract the muscles around the vagina and hold for 10 seconds, then rest for 10 seconds. This should be repeated 30 or more times each day. The nurse should educate the client about ways in which to prevent urinary incontinence, not just offer information about how to manage the condition if it should occur. Surgical repair only occurs in the most extreme circumstances, after less invasive interventions have been unsuccessful.
The laboring client is experiencing dyspnea, diaphoresis, tachycardia, and hypotension while lying on her back. Which intervention should the nurse implement immediately?
- A. Turn the client onto her left side.
- B. Turn the client onto her right side.
- C. Notify the attending obstetrician.
- D. Apply oxygen by nasal cannula.
Correct Answer: A
Rationale: When the laboring client lies flat on her back, the gravid uterus completely occludes the inferior vena cava and laterally displaces the subrenal aorta. This aortocaval compression reduces maternal cardiac output, producing dyspnea, diaphoresis, tachycardia, and hypotension. Other symptoms include air hunger, nausea, and weakness. A left side-lying position decreases aortocaval compression. Lying on the right side increases aortocaval compression. Notifying the obstetrician is not the first intervention. The obstetrician would be notified if symptoms are not relieved by a left side-lying position. Applying oxygen may be needed, but first the client should be placed left side-lying.
The nurse is reviewing the laboratory report from the first prenatal visit of the pregnant client. Which laboratory result should the nurse most definitely discuss with the HCP?
- A. Hemoglobin 11 g/dL; hematocrit 33%
- B. White blood cell (WBC) count: 7000/mm3
- C. Pap smear: human papilloma virus changes
- D. Urine pH: 7.4; specific gravity 1.015
Correct Answer: C
Rationale: A Pap smear with HPV changes reflects an abnormal result. HPV changes are a risk factor for cervical cancer. The nurse should discuss the result with the HCP because it requires further assessment and follow-up. A normal Hgb is 12—15 g/dL; nutritional counseling should be initiated when the Hgb is less than 12 g/dL. An Hct of 33% is also low (normal Hct value = 38% to 47%; this decreases by 4% to 7% in pregnancy), but increasing the Hgb with iron-rich foods should also raise the Hct. A WBC count of 7000/mm3 is within the normal range of 5000 to 12,000/mm3. A urine pH of 7.4 is within the normal range of 4.6 to 8.0; the specific gravity is within the normal range of 1.010 to 1.025.
Which statement by the client indicates a need for additional teaching regarding chlamydial infection?
- A. My sex partner(s) will require treatment as well.
- B. I will have to have a cesarean birth to protect my baby.
- C. The physician will treat the infection with an antibiotic.
- D. My Pap smear results may show abnormal cells.
Correct Answer: B
Rationale: Chlamydia does not typically require a cesarean birth; antibiotics treat the infection, and partners need treatment to prevent reinfection.
Which response by the nurse is correct concerning the legal threshold of viability?
- A. It is usually estimated to be 36 to 40 weeks.
- B. It is usually estimated to be 30 to 35 weeks.
- C. It is usually estimated to be 20 to 24 weeks.
- D. It is usually estimated to be 10 to 15 weeks.
Correct Answer: C
Rationale: The legal threshold of viability is typically 20-24 weeks, when a fetus may survive outside the womb with medical support.