Old's Maternal-Newborn Nursing and Women's Health, 11e (Davidson/London/Ladewig)

Chapter 18 Pregnancy at Risk: Gestational Onset

1. A woman is hospitalized with severe preeclampsia. The nurse is meal-planning with the client and encourages a diet that is high in what?
2. Sodium
3. Carbohydrates
4. Protein
5. Fruits

Explanation

1. It is important that the client limit her intake of sodium.
2. While it is important that the client have an adequate intake of carbohydrates, another food group is more important.
3. The client who experiences preeclampsia is losing protein.
4. It is important that the client have adequate intake of fruits, but another food group is more important.

Page Ref: 402

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | AACN Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | NLN Competencies: Relationship-Centered Care: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 4 Describe the maternal and fetal-neonatal risks, clinical manifestations, and nursing care of a pregnant woman with a hypertensive disorder.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. The nurse is assessing a client who has severe preeclampsia. What assessment finding should be reported to the physician?
2. Excretion of less than 300 m g of protein in a 24-hour period
3. Platelet count of less than 150,000/m m3
4. Urine output of 50 m L per hour
5. 12 respirations

Page Ref: 400

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | AACN Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 4 Describe the maternal and fetal-neonatal risks, clinical manifestations, and nursing care of a pregnant woman with a hypertensive disorder.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. A woman is 16 weeks pregnant. She has had cramping, backache, and mild bleeding for the past 3 days. Her physician determines that her cervix is dilated to 2 centimeters, with 10% effacement, but membranes are still intact. She is crying, and says to the nurse, "Is my baby going to be okay?" In addition to acknowledging the client's fear, what should the nurse also say?
2. "Your baby will be fine. We'll start IV, and get this stopped in no time at all."
3. "Your cervix is beginning to dilate. That is a serious sign. We will continue to monitor you and the baby for now."
4. "You are going to miscarry. But you should be relieved because most miscarriages are the result of abnormalities in the fetus."
5. "I really can't say. However, when your physician comes, I'll ask her to talk to you about it."

Page Ref: 388

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: Ⅰ. C. 2. Respect and encourage individual expression of patient values, preferences, and expressed needs. | AACN Essentials Competencies: Ⅸ. 21. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | NLN Competencies: Relationship-Centered Care: Appreciate the patient as a whole person with his or her own life story and ideas of the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 1 Delineate the bleeding problems associated with pregnancy.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. The nurse is supervising care in the emergency department. Which situation most requires an intervention?
2. Moderate vaginal bleeding at 36 weeks' gestation; client has an Ⅳ of lactated Ringer's solution running at 125 m L/hour
3. Spotting of pinkish-brown discharge at 6 weeks' gestation and abdominal cramping; ultrasound scheduled in 1 hour
4. Bright red bleeding with clots at 32 weeks' gestation; pulse = 110, blood pressure 90/50, respirations = 20
5. Dark red bleeding at 30 weeks' gestation with normal vital signs; client reports an absence of fetal movement

Page Ref: 387

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | AACN Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors or actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Contrast the etiology, medical therapy, and nursing interventions for the various bleeding problems associated with pregnancy.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. A client who is 11 weeks pregnant presents to the emergency department with complaints of dizziness, lower abdominal pain, and right shoulder pain. Laboratory tests reveal a beta-hCG at a lower-than-expected level for this gestational age. An adnexal mass is palpable. Ultrasound confirms no intrauterine gestation. The client is crying and asks what is happening. The nurse knows that the most likely diagnosis is an ectopic pregnancy. Which statement should the nurse include?
2. "You're feeling dizzy because the pregnancy is compressing your vena cava."
3. "The pain is due to the baby putting pressure on nerves internally."
4. "The baby is in the fallopian tube; the tube has ruptured and is causing bleeding."
5. "This is a minor problem. The doctor will be right back to explain it to you."

Page Ref: 392

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Contrast the etiology, medical therapy, and nursing interventions for the various bleeding problems associated with pregnancy.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. A woman at 7 weeks' gestation is diagnosed with hyperemesis gravidarum. Which nursing diagnosis would receive priority?
2. Fluid Volume: Deficient
3. Cardiac Output, Decreased
4. Injury, Risk for
5. Nutrition, Imbalanced: Less than Body Requirements

Page Ref: 395

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management, across the health-illness continuum, across the lifespan, and in all healthcare settings. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Diagnosis.

Learning Outcome: 3 Discuss the medical therapy and nursing care of a woman with hyperemesis gravidarum.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. The prenatal clinic nurse is caring for a client with hyperemesis gravidarum at 14 weeks' gestation. The vital signs are: blood pressure 95/48, pulse 114, respirations 24. Which order should the nurse implement first?
2. Weigh the client.
3. Give 1 liter of lactated Ringer's solution Ⅳ.
4. Administer 30 m L Maalox (magnesium hydroxide) orally.
5. Encourage clear liquids orally.

Page Ref: 395

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce harm to self or others. | AACN Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Teamwork: Function competently within one's own scope of practice as leader or member of the healthcare team, and manage delegation effectively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 3 Discuss the medical therapy and nursing care of a woman with hyperemesis gravidarum.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. A primary herpes simplex infection in the first trimester can increase the risk of which of the following?
2. Spontaneous abortion
3. Preterm labor
4. Intrauterine growth restriction
5. Neonatal infection

Page Ref: 411

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | AACN Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | NLN Competencies: Teamwork: Function competently within one's own scope of practice as leader or member of the healthcare team, and manage delegation effectively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 5 Contrast the effects of various infections on the pregnant woman and her unborn child.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. The nurse is performing a preoperative assessment on a client who is in the second trimester of pregnancy. For which finding(s) should the nurse monitor?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Respiratory infection
2. Fever
3. Urinary tract infection
4. Anemia
5. ABO incompatibility

Page Ref: 417

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and (a) quality and safe patient care, (b) excellence in nursing, and (c) advancement of the profession. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 6 Summarize the risks and implications of surgical procedures performed during pregnancy.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. The community health nurse is teaching a class about causes of traumatic injury leading to pregnancy complications. What statement should the nurse include in the teaching?
2. "Although falls are an uncommon cause of trauma, it is important to know what to do in the case of these incidents."
3. "In early pregnancy, the woman is at a greater risk for injury due to decreased balance and coordination."
4. "The pregnant woman should be given the same care as any person suffering from trauma."
5. "Violence, including domestic violence, is the most common cause of injury for pregnant women, after motor vehicle accidents."

Page Ref: 417

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | NLN Competencies: Context and environment: Read and interpret data; apply health promotion/disease prevention strategies. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 8 Discuss the needs and care of the pregnant woman who suffers from intimate partner violence.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. When blood pressure and other signs indicate that preeclampsia is worsening, hospitalization is necessary to monitor the woman's condition closely. At that time, which of the following should be assessed?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Fetal heart rate
2. Blood pressure
3. Temperature
4. Urine color
5. Pulse and respirations

Page Ref: 400

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. | AACN Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Personal and Professional Development: Identify problems. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 4 Describe the maternal and fetal-neonatal risks, clinical manifestations, and nursing care of a pregnant woman with a hypertensive disorder.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. The community nurse is working with a client at 32 weeks' gestation who has been diagnosed with preeclampsia. Which statement by the client would indicate that additional information is needed?
2. "I should call the doctor if I develop a headache or blurred vision."
3. "Lying on my left side as much as possible is good for the baby."
4. "My urine could become darker and smaller in amount each day."
5. "Pain in the top of my abdomen is a sign my condition is worsening."

Page Ref: 400

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 4 Describe the maternal and fetal-neonatal risks, clinical manifestations, and nursing care of a pregnant woman with a hypertensive disorder.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. Infants of women with preeclampsia during pregnancy tend to be small for gestational age (SGA) because of which condition?
2. Intrauterine growth restriction
3. Oliguria
4. Proteinuria
5. Hypertension

Page Ref: 400

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | NLN Competencies: Personal and Professional Development: Identify problems. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 4 Describe the maternal and fetal-neonatal risks, clinical manifestations, and nursing care of a pregnant woman with a hypertensive disorder.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. A woman is experiencing preterm labor. The client asks why she is on betamethasone. Which is the nurse's best response?
2. "This medication will halt the labor process until the baby is more mature."
3. "This medication will relax the smooth muscles in the infant's lungs so the baby can breathe."
4. "This medication is effective in stimulating lung development in the preterm infant."
5. "This medication is an antibiotic that will treat your urinary tract infection, which caused preterm labor."

Page Ref: 402

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 4 Describe the maternal and fetal-neonatal risks, clinical manifestations, and nursing care of a pregnant woman with a hypertensive disorder.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. A clinic nurse is planning when to administer R h immune globulin (R h o G A M) to an R h-negative pregnant client. When should the first dose of R h o G A M be administered?
2. After the birth of the infant
3. 1 month postpartum
4. During labor
5. At 28 weeks' gestation

Page Ref: 421

Cognitive Level: Remembering

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | NLN Competencies: Teamwork: Function competently within one's own scope of practice as leader or member of the healthcare team, and manage delegation effectively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 9 Explain the cause and prevention of hemolytic disease of the fetus and newborn (HDFN) secondary to R h incompatibility.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. Whether sensitization is the result of a blood transfusion or maternal-fetal hemorrhage for any reason, what test can be performed to determine the amount of R h(D) positive blood present in the maternal circulation, and to calculate the amount of R h immune globulin needed?
2. Indirect Coombs' test
3. Non-stress test
4. Kleihauer-Betke or rosette test
5. Direct Coombs' test

Page Ref: 422

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and (a) quality and safe patient care, (b) excellence in nursing, and (c) advancement of the profession. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 9 Explain the cause and prevention of hemolytic disease of the fetus and newborn (HDFN) secondary to R h incompatibility.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. The client with blood type A, R h-negative, delivered yesterday. Her infant is blood type AB, R h-positive. Which statement indicates that teaching has been effective?
2. "I need to get R h o G A M so I don't have problems with my next pregnancy."
3. "Because my baby is R h-positive, I don't need R h o G A M."
4. "If my baby had the same blood type I do, it might cause complications."
5. "Before my next pregnancy, I will need to have a R h o G A M shot."

Page Ref: 420

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 9 Explain the cause and prevention of hemolytic disease of the fetus and newborn (HDFN) secondary to R h incompatibility.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. Which maternal-child client should the nurse see first?
2. Blood type O, R h-negative
3. Indirect Coombs' test negative
4. Direct Coombs' test positive
5. Blood type B, R h-positive

Page Ref: 421

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | AACN Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | NLN Competencies: Teamwork: Function competently within one's own scope of practice as leader or member of the healthcare team, and manage delegation effectively. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 9 Explain the cause and prevention of hemolytic disease of the fetus and newborn (HDFN) secondary to R h incompatibility.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. A client is concerned because she has been told that her blood type and her baby's are incompatible. What is the nurse's best response?
2. "This is called ABO incompatibility. It is somewhat common but rarely causes significant hemolysis, a breakdown of red blood cells."
3. "This is a serious condition, and additional blood studies are currently in process to determine whether you need a medication to prevent it from occurring with a future pregnancy."
4. "This is a condition caused by a blood incompatibility between you and your husband, but does not affect the baby."
5. "This type of condition is very common, and the baby can receive a medication to prevent jaundice from occurring."

Page Ref: 425

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 10 Compare R h incompatibility to ABO incompatibility with regard to occurrence, treatment, and implications for the fetus/newborn.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. If the woman is R h negative and not sensitized, she is given R h immune globulin to prevent what?
2. The potential for hemorrhage
3. Hyperhomocysteinemia
4. Antibody formation
5. Tubal pregnancy

Page Ref: 420

Cognitive Level: Remembering

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and (a) quality and safe patient care, (b) excellence in nursing, and (c) advancement of the profession. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 10 Compare R h incompatibility to ABO incompatibility with regard to occurrence, treatment, and implications for the fetus/newborn.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. The client presents to the clinic for an initial prenatal examination. She asks the nurse whether there might be a problem for her baby because she has type B R h-positive blood and her husband has type O R h-negative blood, or because her sister's baby had ABO incompatibility. What is the nurse's best answer?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. "Your baby would be at risk for R h problems if your husband were R h-negative."
2. "R h problems only occur when the mother is R h-negative and the father is not."
3. "ABO incompatibility occurs only after the baby is born."
4. "We don't know for sure, but we can test for ABO incompatibility."
5. "Your husband's being type B puts you at risk for ABO incompatibility."

Page Ref: 425

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 10 Compare R h incompatibility to ABO incompatibility with regard to occurrence, treatment, and implications for the fetus/newborn.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. A woman has a hydatidiform mole (molar pregnancy) evacuated, and is prepared for discharge. The nurse should make certain that the client understands that what is essential?
2. That she not become pregnant until after the follow-up program is completed
3. That she receive R h o G A M with her next pregnancy and birth
4. That she has her blood pressure checked weekly for the next 30 days
5. That she seek genetic counseling with her partner before the next pregnancy

Page Ref: 393

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 1 Delineate the bleeding problems associated with pregnancy.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. A client at 10 weeks' gestation has developed cholecystitis. If surgery is required, what is the safest time during pregnancy?
2. Immediately, before the fetus gets any bigger
3. Early in the second trimester
4. As close to term as possible
5. The risks are too high to do it anytime in pregnancy

Page Ref: 417

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: Ⅴ. B. Demonstrate effective strategies to reduce risk of harm to self or others. | AACN Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 6 Summarize the risks and implications of surgical procedures performed during pregnancy.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. The nurse is presenting a class to newly pregnant families. What form of trauma will the nurse describe as the leading cause of fetal and maternal death?
2. Falls
3. Domestic violence
4. Gun accidents
5. Motor vehicle accidents

Page Ref: 417

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | AACN Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 7 Relate the impact of major trauma during pregnancy to the nursing care of the woman and her fetus.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. During a prenatal exam, a client describes several psychosomatic symptoms and has several vague complaints. What could these behaviors indicate?
2. Abuse
3. Mental illness
4. Depression
5. Nothing, they are normal

Page Ref: 419

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Abuse/Neglect

Standards: QSEN Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | AACN Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 8 Discuss the needs and care of the pregnant woman who suffers from intimate partner violence.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. The nurse is caring for a client at 35 weeks' gestation who has been critically injured in a shooting. Which statement by the paramedics bringing the woman to the hospital would cause the greatest concern?
2. "Blood pressure 110/68, pulse 90."
3. "Entrance wound present below the umbilicus."
4. "Client is positioned in a left lateral tilt."
5. "Clear fluid is leaking from the vagina."

Page Ref: 418

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | AACN Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 7 Relate the impact of major trauma during pregnancy to the nursing care of the woman and her fetus.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. The client at 34 weeks' gestation has been stabbed in the low abdomen by her boyfriend. She is brought to the emergency department for treatment. Which statements indicate that the client understands the treatment being administered?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. "The baby needs to be monitored to check the heart rate."
2. "My bowel has probably been lacerated by the knife."
3. "I might need an ultrasound to look at the baby."
4. "The catheter in my bladder will prevent urinary complications."
5. "The Ⅳ in my arm will replace the amniotic fluid if it is leaking."

Page Ref: 418

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 7 Relate the impact of major trauma during pregnancy to the nursing care of the woman and her fetus.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. The nurse prepares teaching material for a patient who is experiencing a spontaneous abortion. Based upon the material selected, which type of abortion is the patient experiencing?

1. Threatened
2. Imminent
3. Incomplete
4. Complete

Page Ref: 389

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Planning: Teaching/Learning.

Learning Outcome: 2 Contrast the etiology, medical therapy, and nursing interventions for the various bleeding problems associated with pregnancy.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. The maternity nurse is preparing material for a staff development seminar on ectopic pregnancy. When using the diagram below, which area should the nurse identify as being the most common location for the implantation of an ectopic pregnancy?

1. A
2. B
3. C
4. D

Page Ref: 391

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: QSEN Competencies: Ⅱ. B. 9. Communicate with team members, adapting own style of communicating to needs of the team and situation. | AACN Essentials Competencies: Ⅵ. 2. Use inter- and intraprofessional communication and collaborative skills to deliver evidence-based, patient-centered care. | NLN Competencies: Teamwork: Practice; choose communication styles that diminish risks associated with authority gradients among team members to accomplish care, assert one's own views, and minimize risks associated with handoffs among providers and across transitions in care. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 2 Contrast the etiology, medical therapy, and nursing interventions for the various bleeding problems associated with pregnancy.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. A female patient seeks medical attention for vaginal discharge that at times is bright red but is mostly dark brown in color. When preparing materials to share with this patient, why should the nurse include this diagram?

1. It shows the size of the uterus.
2. It explains the location of the cervix.
3. It portrays the vessels within the uterus.
4. It demonstrates the location of the uterus.

Page Ref: 393

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Planning: Teaching/Learning.

Learning Outcome: 2 Contrast the etiology, medical therapy, and nursing interventions for the various bleeding problems associated with pregnancy.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. A pregnant patient weighing 165 lb is diagnosed with preeclampsia and is prescribed to ingest 1.5 g/kg/day of protein. How many grams of protein should the nurse instruct the patient to ingest?

Page Ref: 405

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 4 Describe the maternal and fetal-neonatal risks, clinical manifestations, and nursing care of a pregnant woman with a hypertensive disorder.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.

1. A patient in the first trimester of pregnancy recently emigrated from a foreign country and is diagnosed with rubella. What can occur to the developing fetus because of this infection?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Congenital cataracts
2. Sensorineural deafness
3. Ophthalmia neonatorum
4. Congenital heart defects
5. Intrauterine growth restriction

Page Ref: 410

Cognitive Level: Analyzing

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: QSEN Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Assessment: Nursing Process.

Learning Outcome: 5 Contrast the effects of various infections on the pregnant woman and her unborn child.

MNL LO: Demonstrate use of the nursing process in the care of a pregnant woman with a gestational risk.