Nokea
Which screening is recommended for a client over 35 years old?
- A. Amniocentesis for genetic disorders
- B. Blood type screening
- C. Urine culture
- D. Basic ultrasound
Correct Answer: A
Rationale: Amniocentesis is recommended for women over 35 to screen for genetic disorders due to increased risk with advanced maternal age.
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The client at 32 weeks’ gestation presents to a hospital with a severe headache. Her admission BP is 184/104 mm Hg. Based on the assessment and findings of the serum laboratory report, which most severe complication warrants the nurse’s further assessment?
- A. Renal failure
- B. Liver failure
- C. Preeclampsia
- D. HELLP syndrome
Correct Answer: D
Rationale: It is most important for the nurse to further assess for HELLP syndrome, a variation of pregnancy-induced hypertension characterized by hemolysis (elevated bilirubin), elevated liver enzymes, and low platelets. The laboratory results do not show the serum creatinine level, so no inferences can be made about renal failure. Although liver enzymes are elevated, HELLP syndrome is a more severe complication associated with pregnancy. Preeclampsia commonly coexists with HELLP syndrome; however, these laboratory findings show worsening symptoms that are associated with HELLP syndrome.
The nurse is providing nutrition counseling to the client during her first prenatal clinical visit. Which statement, if made by the client, indicates that the client has an understanding of some of the nutritional requirements during pregnancy?
- A. “I can eat cheese as an alternative to milk, as I don’t care for milk.”
- B. “I should be eating more at each meal because I’m eating for two.”
- C. “I will need to limit my calories because I am already overweight.”
- D. “I should limit myself to eating only three healthy meals per day.”
Correct Answer: A
Rationale: Cheese is a milk product and is an alternative to milk. This statement indicates understanding of nutritional requirements regarding milk and milk products. Caloric intake needs to increase by 300 kcal per day during pregnancy to meet increased metabolic needs. However, “I’m eating for two” is a common misconception and leads to caloric intake greater than necessary. Caloric intake needs to increase by 300 kcal per day and should not be limited during pregnancy. Nutritional snacks throughout the day can provide for steady blood glucose levels and decrease the nausea associated with pregnancy. A limit of only three meals per day may not provide the client with enough calories to meet increased metabolic needs or may cause the client to eat more at each meal and increase nausea and bloating.
Where can the nurse expect to palpate the fundus at this time?
- A. Just above the symphysis pubis
- B. Just below the xiphoid process
- C. Near the level of the umbilicus
- D. Just below the symphysis pubis
Correct Answer: C
Rationale: At 20 weeks' gestation, the fundus is typically palpated near the level of the umbilicus, reflecting uterine growth.
The nurse is caring for the client who has been in the second stage of labor for the last 12 hours. The nurse should monitor for which cardiovascular change that occurs during this stage of labor?
- A. An increase in maternal heart rate
- B. A decrease in the cardiac output
- C. An increase in the white blood cell (WBC) count
- D. A decreased intravascular volume during contractions
Correct Answer: A
Rationale: Maternal HR is normally increased due to pain resulting from increased catecholamine secretion, fear, anxiety, and increased blood volume. When the laboring client holds her breath and pushes against a closed glottis, intrathoracic pressure rises. Blood in the lungs is forced into the left atrium, leading to a transient increase (not decrease) in cardiac output. Although the WBCS increase to 25,000/mm3 to 30,000/mm3 during labor and early postpartum as a physiological response to stress, this is not a cardiovascular change. During the second stage of labor, the maternal intravascular volume is increased (not decreased) by 300 to 500 mL of blood from the contracting uterus.
Which position should the nurse recommend for early labor?
- A. Lying flat on the back
- B. Walking or standing
- C. Sitting upright
- D. Kneeling on all fours
Correct Answer: B
Rationale: Walking or standing in early labor promotes progress and comfort, unlike lying flat, which may slow labor.