Card Set Information

2013-11-22 23:32:29
Nursing Childbearing

high risk pregnancy I
Show Answers:

  1. Your client is 18 weeks gestation and her blood 
    pressure is 145/95 and 150/94.  
    Blood pressures were taken at two different 
    times during the prenatal visit.  Her urine 
    protein is negative, reflexes are +1 on 
    all four extremities, and no excessive 
    weight gain has occurred. What hypertensive
     disorder of pregnancy do you anticipate 
    this client has?
    Student’s Answer:  Chronic (pre-existing) Hypertension is correct.    Key point:  Client is less than 20 weeks gestation.
  2. Your client is 38 weeks gestation and her 
    blood pressure is 145/95 and 150/94. 
     Blood pressures were taken at two different 
    times during the prenatal visit.  Her urine 
    protein is negative, reflexes are +1 on all 
    four extremities, and no excessive weight 
    gain has occurred. What hypertensive 
    disorder of pregnancy do you anticipate this
     client has? 
    • Student’s answer:  Gestational Hypertension is
    •  correct Key point:  Client is over 20 wks 
    • gestation and only cardiovascular system is 
    • affected. 
  3. Your client is 28 weeks gestation and her blood
     pressure is 145/95 and 150/94.  Blood 
    pressures were taken at two different times 
    during the prenatal visit.  Her urine protein is 
    +1, reflexes are +3 on all four extremities,
     and weight gain was 3 pounds in one week.
     What hypertensive disorder of pregnancy 
    do you anticipate this client has? 
    • Student’s answer:  Pre-eclampsia (mild) , exhibiting glomerular 
    • damage.   Key points:  Client is over 29 wks 
    • gestation, systems affected are:  cardiovascular
    •  (incr. B/P, weight gain), 
    • Renal (+1 protein in urine or proteinuria), 
    • and central nervous  system (+3 reflexes).
  4. Your client is 32 weeks gestation and as you 
    walk into the room she is in the bed and having
     a seizure.  You notice she is breathing .  What
     is the first thing you should do?   What 
    hypertensive disorder does this client have? 
    Student’s answer:  Eclampsia is correct.  Stay with patient and call for help. Key points:  Patient is having seizure. Since you can see she is breathing you do not need to put on oxygen mask but you should turn head to the side or turn patient on her side if possible and monitor.
  5. Your client was admitted today with pre-eclampsia and is being treated with Magnesium 
    Sulfate that is infusing at 2 grams / hour.  
    What is the goal in administering magnesium
     sulfate to the patient? 
    Student’s answer:  It's a CNS depressant-prevents and controls convulsions.  It decreases CNS irritability. Also it relaxes smooth muscle including the uterus so it may be used as tocolytic in preterm labor patients.
  6. Identify two nursing diagnoses appropriate for
     a client with pre-elcampsia. 
    Student’s answer:   Deficient fluid volume related to fluid shift from intra to extravascular space secondary to vasospasm Risk for injury (Fetus) related to uteroplacental insufficiency secondary to vasospam Altered tissue perfusion
  7. Your client is 32 weeks gestation and was 
    admitted today for pre-eclampsia and
     is being treated with Magnesium sulfate that
     is infusing at 2 grams / hour.  Her admission
     labs are as follows:
     RBC:   3.83 M/mm3 (Low)  HCT:  33% (Low)  Hb: 11.6 g/kL  (Low) BUN: 7 mg/dL  (normal)  Platelets: 79 K/mm3 (Low)   Bun/creatinine:  11.7 ratio          
     ALT:  366 U/L  (Increased)  AST: 270 U/L  (Increased)  Based on these
     lab values, what condition does this client 
    appear to be developing? 
    Student’s answer:  HELLP Syndrome  
  8. Your client is admitted for pre-eclampsia 
    and is being treated with Magnesium Sulfate 
    that is infusing at 2 grams/hour.  What needs
     to be included as part of your hourly
    Student’s answer:  Maternal VS and Fetal HR, Reflexes, edema, somatic symptoms [HA, blurred vision, scotoma, epigastric pain in liver area], lungs, I&O, weight (please read this information in textbook and lecture notes. Watch for signs of Magnesium sulfate toxicity
  9. Your client is 32 weeks gestation and was 
    admitted today for pre-clampsia and
     is being treated with Magnesium sulfate that
     is infusing at 2 grams/hour.  Every hour you 
    perform a pre-eclampsia assessment 
    (vital signs, reflexes, asking client about 
    epigastric pain, headache, and visual 
    .  What is the first clinical sign that would 
    present if she is developing magnesium 
    sulfate toxicity?  What would you do if
     toxicity develops? 
    Student’s answer:   Absent or decreased deep tendon reflexes (DTR) is first clinical sign of toxicity.   Treatment is Turn off Magnesium sulfate and administer Calcium gluconate (usually a standing order).
  10.  What is the oral glucose tolerance test
    that is used to screen clients for gestational 
    diabetes and when is this test performed? 
    Student’s answer:  1 hour 50 gram oral glucose tolerance test ( OGTT). Performed at 24-28 weeks gestation.
  11. What is the oral glucose tolerance test (OGTT)
     that is used to diagnose clients for gestational
     Student’s answer:   3 hour diagnostic test. Key point:  Please make sure you know this is a 3 hour, 100 gram OGTT.   
  12. What is the test that is performed on pregnant
     women with pre-existing diabetes at 
    their first prenatal visit to determine how well 
    their diabetes has been controlled? 
    Student’s answer:  Glycosylated Hb A1C  
  13. A client’s fasting blood sugars should be below
     95 mg/dL but also above _______? 
    Student’s answer:  70 mg/dL   
  14. Postprandial blood sugars should be below:
    Student’s answer:  120 mg/dL  
  15. Identify two nursing diagnoses appropriate 
    for a client with gestational diabetes.
    Student’s Answer:   Risk for fetal injury Risk for infection Altered nutrition: < body requirements
  16. Two clients are on the labor and delivery unit.
     Neither client is in active labor.   Client A is
     29 weeks gestation Client B is 39 weeks 
    gestation.   Which client has Premature 
    rupture of membranes (PROM), and which 
    client has Preterm premature rupture of
     membranes (PPROM)?
    • Student’s answer:   Client A (29 wks) has PPROM       Client B (39 wks) has PROM
    • Key point:  In both situations, the woman's 
    • membranes ruptured at least one hour
    •  before she began contracting 
    • (Onset of labor). 
  17. Identify two nursing diagnoses appropriate 
    for a client with preterm premature rupture 
    of membranes (PPROM)? 
    • Student’s answer: Risk for infection r/t PPROM: provide pericare, limit number of exams
    • Risk for fetal injury due to cord prolapse: would result in emergency C/D
  18. Identify some early signs of a developing 
    infection in a client with premature rupture of
    • Student’s answer:  Odorous vaginal discharge, Fever
    • Key point:  One of the first clinical signs of developing infections is fetal tachycardia
  19. What is the rationale for administering 
    Betamethasone to a client with preterm 
    Student’s answer:   Stimulates fetal lung maturity (promotes surfactant production) and decreases risk of intraventricular hemorrhaging in the newborn.
  20.  Identify any contraindications to 
    administering Betamethasone to a preterm
     labor patient.
    Student’s answer:  inability to delay birth, adequate L/S ratio (fetal lungs mature), maternal bleeding, maternal infection, gestational age >34 weeks.  
  21. List test that can be performed on a preterm
     labor client to determine her risk for 
    delivering soon and the need for
     administering tocolytics: 
    Students’ answer:  Fetal fibronectin (fFN),
     salivary Estriol levels, Endocervical 
    length (measured during ultrasound).  
    Students’ answer:  Fetal fibronectin (fFN), salivary Estriol levels, Endocervical length (measured during ultrasound). 
  22. How common is late-term labor and
    what do you do for that?  
    Late-term labor would be labor post-dates (>42 weeks gestation) and there would be no change in the plan of care but we would watch for uteroplacental insufficiency (fetal distress/late decels) occurring because placenta is "old" and can have calcificiations. 
  23. Identify contraindications to admistering tocolytics to a preterm labor client
    intrauterine fetal demise(IUDF), fetus is full term, lethal fetal anomaly (anencephaly), severe preeclampsia, eclampsia, active vaginal bleeding, chorioamnionitis, acute fetal distress, cervix over 4 cm, chronic IUGR