Nokea
The nurse is contacting a client at 28 weeks gestation to review laboratory results and schedule a follow-up prenatal visit. Laboratory Results Laboratory Test and Reference Range 12 Weeks Gestation 26 Weeks Gestation 28 Weeks Gestation
WBC (prostent) 5,000-1多份 (5.0-15.0 × 10°/L) 8,900/mm3 (8.9 × 10°/L) 16,500 /mm° (16.5 × 10%/L)
Hemoglobin (pregnant) 11-16 g/dL (110-160 g/L) 13 g/dL (130 g/L) 10.8 g/dL (108 g/L) Hematocrit (pregnant) 33%-47% (0.33-0.47) 39% (0.39) 32% (0.32)
Chlamydia Negative Positive Negative Hemoglobin A1c 4.0%-5.9% 5.1%
1-hour oral glucose challenge test <140 mg/dL (7.8 mmol/L) 175 mg/dL (9.7 mmol/L)
3-hour oral glucose tolerance test Fasting: <110 mg/dL (6.1 mmol/L) 1 hour: <180 mg/dL (10.0 mmol/L) 2 hour: <140 mg/dL (7.8 mmol/L 3 hour: <70-115 mg/dL (<6.4 mmol/L) Fasting: 115 mg/dL (6.4 mmol/L) 1 hour: 205 mg/dL (11.4 mmol/L) 2 hour: 162 mg/dL (9.0 mg/dL) 3 hour: 135 mg/dL (7.5 mg/dL)
The nurse should be most concerned about the client's. and anticipate the client's need for
- A. Glucosuria
- B. Contractions
- C. Blood pressure
- D. Blood glucose levels
- E. Insulin
- F. A urine culture
- G. Antihypertensives
Correct Answer: D,E
Rationale: Blood glucose levels are critical in gestational diabetes, requiring insulin to manage hyperglycemia.
You may also like to solve these questions
The nurse is assisting the registered nurse with caring for a client who is at 36 weeks gestation. History and Physical Vital Signs
General - Client is gravida 2 para 1 at 36 weeks gestation; reports a throbbing headache rated as / on a scale of 0-10, blurred vision, and epigastric pain; client states that she took 1000 mg of acetaminophen 2 hours ago with no relief, medical history includes seasonal allergies and exercise-induced asthma
Neurological -Patellar deep tendon reflexes 2+ bilaterally, clonus absent
Cardiovascular -Heart tones normal; facial edema noted; +2 pitting edema in bilateral upper extremities; +3 pitting edema in bilateral lower extremities
Gastrointestinal -Client reports fetal movement, no contractions noted; soft uterine resting tone on palpation
Genitourinary -Cervical examination: 1 cm dilated, 0% effaced, -3 fetal station, cephalic fetal presentation, amniotic membranes intact; cesarean birth 5 years ago at 40 weeks gestation for breech fetal presentation, resulting in delivery of healthy newborn
Which of the following findings are clinical manifestations of preeclampsia? Select all that apply.
- A. Epigastric pain
- B. Facial edema
- C. High blood pressure
- D. Proteinuria
- E. Throbing headache
- F. Visual disturbances
Correct Answer: A,B,C,D,E,F
Rationale: Preeclampsia manifests with epigastric pain , edema , hypertension , proteinuria , headaches , and visual disturbances .
Emergency Department
0800: A 43-year-old client comes to the emergency department due to lower
back pain and bilateral leg weakness. The client reports that the
weakness began 3 days ago in the feet and has gradually worsened.
The client sought treatment today after becoming "so weak that I fell
while walking" and noticing new hand weakness and difficulty
swallowing. Back pain radiates down both legs and is rated as 5 on a
scale of 0-10. The client recently recovered from an illness with flu-like
symptoms. The client reports a history of hypertension and takes no
medications. Assessment of the lower extremities reveals muscle
strength of 2/5 and decreased sensation to pinprick. Achilles tendon
and patellar reflexes are decreased.
1000:
The client reports difficulty raising the arms and inability to squeeze the
fingers. The client reports chest tightness and difficulty breathing.
1030:
The client is breathless while speaking. Respirations are shallow and
labored. The client is diaphoretic. The skin is pale and cool. No
audible wheezing or stridor is present.
Which action by the nurse is appropriate?
- A. Perform oral suctioning
- B. Prepare the client for intubation
- C. Reposition the client and encourage deep breathing
- D. Request a prescription for an albuterol nebulizer treatment
Correct Answer: B
Rationale: Shallow, labored breathing and chest tightness indicate impending respiratory failure, requiring preparation for intubation.
The newborn nurse is attending births in the labor and delivery unit.
Nurses' Notes
Labor and Delivery Unit
0000: A 39-year-old client, gravida 4 para 3, at 38 weeks gestation arrives at the labor and delivery unit reporting contractions every 2-3 min. During this pregnancy, the client was diagnosed with gestational diabetes mellitus and prescribed insulin, but she reports not taking the insulin. The client reports cigarette smoking (3-5 cigarettes/day) but denies alcohol or recreational drug use. The client received treatment for bacterial vaginosis during the second trimester. The client has gained 55 lb (25 kg) during the pregnancy. Group B Streptococcus result is negative.
Which of the following complications is the newborn at increased risk for based on the maternal hist Select all that apply.
- A. Brachial plexus injury
- B. Cephalohematoma
- C. Hypoglycemia
- D. Neonatal sepsis
- E. Polycythemia
Correct Answer: A,C,E
Rationale: Gestational diabetes and smoking increase risks for brachial plexus injury , hypoglycemia , and polycythemia .
Click to highlight below the findings indicating that the client is improving.
- A. Abdominal dressing removed. Wound is clean, dry, and intact with no bleeding or foul-smelling drainage.
- B. Fundus is firm, midline, and at the umbilicus. Urine output was $500 \mathrm{~mL}$ over the past 4 hours.
- C. Client states that she is too tired and sore to ambulate in room with nursing assistance.
- D. Client states that she cannot properly latch the newborn during breastfeeding.
- E. Tolerating oral labetalol; systolic BP has been 110-130 mm Hg and diastolic BP has been 70-80 mm Hg over the past 12 hours.
- F. Client reports no headaches and remains free of seizures.
Correct Answer: A,B,E,F
Rationale: Clean wound , normal fundus and urine output , stable blood pressure , and absence of headaches/seizures indicate improvement.
The newborn nurse is attending births in the labor and delivery unit.
Nurses' Notes
Labor and Delivery Unit
0000: A 39-year-old client, gravida 4 para 3, at 38 weeks gestation arrives at the labor and delivery unit reporting contractions every 2-3 min. During this pregnancy, the client was diagnosed with gestational diabetes mellitus and prescribed insulin, but she reports not taking the insulin. The client reports cigarette smoking (3-5 cigarettes/day) but denies alcohol or recreational drug use. The client received treatment for bacterial vaginosis during the second trimester. The client has gained 55 lb (25 kg) during the pregnancy. Group B Streptococcus result is negative. 1400: The newborn is delivered via forceps-assisted vaginal birth at
1400. The newborn was immediately placed in skin-to-skin contact with the mother, dried, and stimulated. Apgar scores are 7 at 1 minute and 9 at 5 minutes
1405: Newborn vital signs are T 97.3 F (36.3 C), P 156, and RR 52.
1415: Newborn weight is obtained. The newborn is 9 lb 15 oz (4500 g). The maternal client is assisted to latch the newborn onto the breast.
1430: Slight bruising to the scalp is noted where forceps were applied. Newborn vital signs are T 97.2 F (36.2 C), P 160, RR 55, and SpO 95% on room air.
Which of the following interventions should the nurse anticipate when caring for this newborn? Select all that apply.
- A. Administer oral glucose water with each feeding
- B. Allow skin-to-skin contact with the mother when possible
- C. Check the newborn's blood glucose levels
- D. Initiate newborn feeding within the first hour after birth
- E. Monitor the newborn's respiratory rate frequently
- F. Wrap the newborn in warm blankets to alleviate tremors
Correct Answer: B,C,D,E,F
Rationale: Skin-to-skin contact , glucose checks , early feeding , respiratory monitoring , and warming prevent hypoglycemia and respiratory issues.