Correct answer: D. All of the above

Dairy products, fresh fruit, vegetables, and foods high in protein (like cheese and peanut butter) are excellent choices. Fried foods, such as chicken nuggets and tater tots, and foods such as cheeseburgers and buttered popcorn are high in fat; carbonated drinks such as diet colas, and foods such as pickles and ketchup contain large amounts of sodium. These foods can lead to an increase in ankle edema and promote weight gain from empty calories.

Correct answer: C. "I can meet two goals when I drink milk, lots of iron and meeting my calcium needs at the same time."

Milk contains a large amount of calcium but contains no iron. Coffee, tea, and caffeinated soft drinks inhibit the absorption of iron. The vitamin C found in orange juice enhances the absorption of iron. Cream of wheat (1 cup/10 mg iron) and molasses (1 tbsp/3.0 mg iron) are considered excellent sources of iron as they contain the indicated amounts of iron.

Correct answer: B. Synthesis of proteins, nucleic acids, and fats.

Magnesium aids in the synthesis of protein, nucleic acids, proteins, and fats. It is important for cell growth and neuromuscular function. Magnesium also activates the enzymes for metabolism of protein and energy. Calcium prevents demineralization of the mother’s bones. Vitamin B6 is important for amino acid metabolism. Folic acid assists in the development of neural pathways in the fetus.

Correct answer: D. Calcium.

The diet for Vietnamese clients typically consists of small portions of meat and ample amounts of rice. Fresh milk may not have been readily available in Vietnam, and many Asian clients are lactose intolerant. Therefore, the nurse would need to assess the client’s diet for deficiencies of calcium and possibly iron. Traditionally, Southeast Asian diets have an abundance of dark green leafy vegetables, such as mustard greens and bok choy, which contain adequate amounts of vitamin E and vitamin C. Seafood, which contains iodine, is usually adequate in the diets of Southeast Asian women.

Correct answer: B. "The procedure involves the insertion of a thin catheter into my uterus."

Chorionic villi sampling, which can be performed between 8 and 10 weeks’ gestation, involves the insertion of a thin catheter into the vagina and uterus to obtain a sample of the chorionic cells. It is a useful diagnostic test to determine trisomy 13, translocations, fragile X syndrome, and trisomy 18. Fetoscopy is performed with a small fiberoptic fetoscope inserted through a small incision into the client’s uterus to inspect the fetus for gross abnormalities. There are no food or fluid restrictions necessary before chorionic villi sampling. Ideally, the client should empty the bladder before this procedure. A full bladder would be needed if the client were scheduled to have an ultrasound examination.

Correct answer: B. Normal because multiparous clients can experience quickening between 14 and 20 weeks’ gestation.

Although most multiparous women experience quickening at about 17� weeks’ gestation, some women may perceive it between 14 and 20 weeks’ gestation because they have been pregnant before and know what to expect. Detecting movement early does not suggest a twin pregnancy. If the multiparous client does not experience quickening by 20 weeks’ gestation, further investigation is warranted, because the fetus may have died, the client has a hydatidiform mole, or the pregnancy dating is incorrect. There is no evidence that the client’s expected date of birth is erroneous.

Correct answer: C. ?-fetoprotein (AFP) testing.

AFP testing is usually performed between the 15th and 18th weeks of gestation. Abnormally high levels found in maternal serum may be indicative of neural tube defects such as anencephaly and spina bifida. Low levels may indicate trisomy 21 (Down syndrome). Culdocentesis is used to confirm a tubal pregnancy. Chorionic villus sampling is done as early as 10 weeks’ gestation to detect anomalies. Ultrasound testing may be done in the first trimester to determine fetal viability and in the third trimester to determine pelvic adequacy and fetal or placental position.

Correct answer: C. Empty her bladder.

Leopold’s maneuvers involve abdominal palpation. The client should empty her bladder before the nurse palpates the abdomen. Doing so increases the client’s comfort and makes palpation more accurate. Although breathing deeply may help to relax the client, it has no effect on the accuracy of the results of Leopold’s maneuvers. The client does not need to drink a full glass of water before the examination. The client should be lying in a supine position with the head slightly elevated for greater comfort and with the knees drawn up slightly.

Correct answer: C. Left occipital transverse.

In left occipital transverse lie, the occiput faces the woman’s left hip. In left occipital anterior lie, the occiput faces the left anterior segment of the woman’s pelvis. In right occipital transverse lie, the occiput faces the woman’s right hip. In right occipital anterior lie, the occiput faces the right anterior segment of the woman’s pelvis.

Correct answer: B. "This usually disappears after childbirth."

Discoloration on the face that commonly appears during pregnancy, called chloasma (mask of pregnancy), usually fades postpartum and is of no clinical significance. The client who is bothered by her appearance may be able to decrease its prominence with ordinary makeup. Chloasma is not a sign of skin melanoma. It is not caused by dilated capillaries. Rather, it results from increased secretion of melanocyte-stimulating hormones caused by estrogen and progesterone secretion. No treatment is necessary for this condition.

Correct answer: D. Estimate the fetal growth.

Assessment of fundal height is a gross estimate of fetal growth. By 20 weeks’ gestation, the height of the fundus should be at the level of the umbilicus, after which it should increase 1 cm for each week of gestation until approximately 36 weeks’ gestation. Fundal height that is significantly different from that implied by the estimated gestational age warrants further evaluation (eg, ultrasound examination) because it possibly indicates multiple pregnancy or fetal growth retardation. Fundal height estimation will not determine uterine activity or a need for increased weight gain. Ultrasound examination, not fundal height estimation, will locate the placenta.

Correct answer: C. Possible premature labor.

One of the primary risks of amniocentesis is stimulation of the uterus and subsequent preterm labor. Other risks include hemorrhage from penetration of the placenta, infection of the amniotic fluid, and puncture of the fetus. There is little risk for rupture of the membranes, fetal limb malformations, or fetal organ malformations, if a practitioner skilled in using ultrasound performs the procedure. Fetal limb malformations have been associated with percutaneous umbilical blood sampling.

Correct answer: B. "Taking the trip is okay if you stop every 1 to 2 hours and walk."

The client traveling by automobile should be advised to take intermittent breaks of 10 to 15 minutes, including walking, every 1 to 2 hours to stimulate the circulation, which becomes sluggish during long periods of sitting. Automobile travel is not contraindicated during pregnancy unless the client develops complications. There is no set maximum number of hours allowed. The pregnant client should always wear a seat belt when traveling by automobile. The client should be aware of the nearest health care facility in the city to which she is traveling.

Correct answer: A. Position the left leg at or below the body’s horizontal plane.

Keeping the involved extremity at or below the body’s horizontal plane will facilitate tissue perfusion and prevent tissue damage. The nurse should avoid placing the affected extremity on a hard surface, such as a firm mattress, to avoid pressure ulcers. In addition, the involved extremity should be free from heavy overlying bed linens. The nurse should handle the involved extremity in a gentle fashion to prevent friction or pressure. Raising the leg would cause occlusion to the iliac artery, which is contrary to the goal to promote arterial circulation.

Correct answer: B. Straighten the knee and flex the toes toward the chin.

Leg cramps are thought to result from excessive amounts of phosphorus absorbed from milk products. Straightening the knee and flexing the toes toward the chin is an effective measure to relieve leg cramps. Also, decreasing milk intake and supplementing with calcium lactate may help to reduce the cramping. Keeping the legs warm and elevating them are good preventive measures. Changing positions frequently aids venous return but is not helpful in relieving leg cramps. Alternately flexing and extending the legs will not help to relieve the leg cramp. Lying prone in the bed is a difficult position for a client at 37 weeks’ gestation to achieve and maintain because of the increase in abdominal size and therefore is not considered helpful.

Correct answer: B. Eat smaller and more frequent meals during the day.

Eating smaller and more frequent meals may help prevent heartburn because acid production is decreased and stomach displacement is reduced. Heartburn can occur at any time during pregnancy. Contributing factors include stress, tension, worry, fatigue, caffeine, and smoking. Certain spicy foods (eg, tacos) may trigger heartburn in the pregnant client. The client should be advised to avoid sodium bicarbonate antacids (eg, Alka-Seltzer), baking soda, Bicitra or sodium citrate, and fatty foods, which are high in sodium and can contribute to fluid retention. Increasing, not decreasing, fluid intake may help to relieve heartburn by diluting gastric juices. Caffeinated products such as coffee or tea can stimulate acid formation in the stomach, further contributing to heartburn.

Correct answer: B. Both of the above

Discharge teaching begins when the client enters the hospital. One of the risk factors for clot formation is a sedentary lifestyle, and the client should engage in daily aerobic activity, such as biking or swimming (non-weight-bearing). The client is also overweight and should plan to control the weight through dietary counseling or attending weight management programs in the community. Strength training is beneficial by increasing strength and lean body mass, but not helpful in preventing vascular disease. Stress management is not a focus based on the client’s needs at this time. It is not necessary to wear special supportive shoes; comfortable shoes for walking are adequate.

Correct answer: A. Determine what is in the fundus.

In the first maneuver, which is done with the nurse facing the client’s head, both hands are used to palpate and determine which fetal body part (eg, the head or buttocks) is in the fundus. This first maneuver helps to determine the presenting part of the fetus. In the second maneuver, also done with the nurse facing the client’s head, the palms of both hands are used to palpate the sides of the uterus and determine the location of the fetal back and spine. In the third maneuver, one hand gently grasps the lower portion of the abdomen just above the symphysis pubis to determine whether the fetal head is at the pelvic inlet. The fourth maneuver, done with the nurse facing the client’s feet, determines the degree of fetal descent and flexion into the pelvis.

Correct answer: C. Increased levels of AFP are associated with neural tube defects.

Increased AFP levels are associated with neural tube defects, such as spina bifida, anencephaly, and encephalocele. Ultrasonography is used to confirm a neural tube defect only when AFP levels are increased. Because AFP levels are usually highest at 15 to 18 weeks’ gestation, this is the optimum time for testing. Performing the test after this time leads to inaccurate results. The client’s blood, not urine, is used for the sample.

Correct answer: C. Pregnant adolescents are at high risk for pregnancy-induced hypertension.

Prenatal care is commonly the most critical factor influencing pregnancy outcome. This is especially true for adolescents, because the most significant medical complication in pregnant adolescents is pregnancy-induced hypertension. Continued prenatal care helps to allow for early detection and prompt intervention should the complication arise. Other risks for adolescents include low-birth-weight infant, preterm labor, iron-deficiency anemia, and cephalopelvic disproportion. Gestational diabetes can occur with any pregnancy regardless of the age of the mother. Generally, all first-time mothers need instruction related to discomforts. Adolescent mothers have better nutrition when they attend group classes and are subject to peer pressure. No evidence demonstrates that most adolescents lack support systems. Fathers may abandon mothers at any time during the pregnancy; other fathers, regardless of age, are supportive throughout the pregnancy

Correct answer: C. Colostrum is usually secreted by about the 16th week of gestation.

Colostrum is usually secreted by about the 16th week of gestation in preparation for breast-feeding. Growth of the milk ducts is greatest in the last trimester, not in the first 8 weeks of gestation. Enlargement of the breasts is usually caused by estrogen, not progesterone. Darkening of the areola can occur as early as the sixth week of gestation.

Correct answer: C. All of the above

Understanding of breast-feeding education is demonstrated by statements involving knowledge of the several positions available for comfortable breast-feeding, oxytocin release from the pituitary leading to a let-down reflex and uterine contractions for involution, and feeding cues helpful in successful breast-feeding (because waiting until the infant is hungry and crying is stressful). Breast size does not ensure successful breast-feeding. Mastitis is an infectious process and is not influenced by latching on. Breast milk needs to be stored in the refrigerator or freezer to decrease the risk of bacterial growth.

Correct answer: D. Cardiac output increases by 25% to 50% during pregnancy.

Understanding of breast-feeding education is demonstrated by statements involving knowledge of the several positions available for comfortable breast-feeding, oxytocin release from the pituitary leading to a let-down reflex and uterine contractions for involution, and feeding cues helpful in successful breast-feeding (because waiting until the infant is hungry and crying is stressful). Breast size does not ensure successful breast-feeding. Mastitis is an infectious process and is not influenced by latching on. Breast milk needs to be stored in the refrigerator or freezer to decrease the risk of bacterial growth.

Correct answer: A. A fetal biophysical profile involves assessments of breathing movements, body movements, tone, amniotic fluid volume, and fetal heart rate reactivity.

The fetal biophysical profile includes fetal breathing movements, fetal body movements, tone, amniotic fluid volume, and fetal heart rate reactivity. A reactive nonstress test is a sign of fetal well-being and does not require further evaluation. A nonreactive nonstress test requires further evaluation. A contraction stress test or oxytocin challenge test should be performed only on women who are at risk for fetal distress during labor. The contraction stress test is rarely performed before 28 weeks’ gestation because of the possibility of initiating labor. Percutaneous umbilical cord sampling requires the insertion of a needle through the abdomen to obtain a fetal blood sample.

Correct answer: D. All of the above

The gestational diabetic needs to maintain blood glucose levels as close to "normal" as the nondiabetic pregnant woman. Walking is an excellent form of exercise for anyone and works well for pregnant diabetics as it burns calories, accelerates the heart rate, and as a result maintains the blood sugar at a lower level. During pregnancy continuously high blood glucose levels measured by a hemoglobin A1C of greater than 6 mg/dL (60 g/L) carry risks for the dyad. The suggested diet for a gestational diabetic is 1,800 to 2,400 cal/day to avoid the body breaking down maternal fat to maintain blood glucose levels. Continuing prenatal vitamins, iron, and folic acid (800 mcg/day) are general nutritional recommendations for pregnancy.

Correct answer: C. Strengthen the perineal muscles.

The purpose of Kegel exercises is to strengthen the perineal muscles in preparation for the labor process. These movements strengthen the pubococcygeal muscle, which surrounds the urinary meatus and vagina. No evidence is available to support the idea that these exercises prevent vulvar edema, alleviate lower back discomfort, or strengthen the abdominal muscles.

Correct answer: D. "It’s not uncommon to have dreams about the baby, particularly in the third trimester."

During the third trimester, it is not uncommon for clients to have dreams or fantasies about the baby. Sometimes the dreams are about infants who are malformed or, in this example, covered with hair. There is no evidence to suggest that the client is trying to cope with becoming a parent. Having dreams about the baby does not mean that labor will begin soon.

Correct answer: D. Practice relaxation techniques before bedtime.

Insomnia in the later part of pregnancy is not uncommon because the client has difficulty getting into a position of comfort. This is further compounded by frequent nocturia. The best suggestion would be to advise the client to practice relaxation techniques before bedtime. The client should avoid caffeine products such as chocolate and coffee before going to bed because caffeine is a stimulant. Alcohol consumption, regardless of the type or amount, should be avoided. Exercise is advised during the day, but it should be avoided before bedtime because exercise can stimulate the client and decrease the client’s ability to fall asleep.

Correct answer: D. "I should sit in a hot tub for 20 minutes to relax after working."

The client needs further instruction when she says it is permissible to sit in a hot tub for 20 minutes to relax after working. Hot tubs and saunas should be avoided, particularly in the first trimester, because their use can lead to maternal hyperthermia, which is associated with fetal anomalies such as central nervous system defects. The client should use nonskid pads in the shower or bath to avoid slipping because the client’s center of gravity has shifted and she may fall. The client should avoid using soap on the nipples to prevent removal of the natural protective oils. Douching is not recommended for pregnant women because it can destroy the normal flora and increase the client’s risk of infection.

Correct answer: A. The father of the baby is irritated that the mother is not like she was before pregnancy.

Pregnancy creates changes in the mother and father. Being considerate, accepting changes, and being supportive of the current situation are considered acceptable responses by the father, rather than feeling irritation about these changes. Expressing concern with the financial changes pregnancy and an expanded family include is normal. The first trimester involves the client and family feeling ambivalent about pregnancy and moving toward acceptance of the changes associated with pregnancy. Maternal acceptance of the pregnancy and a subsequent change in her focus are normal occurrences.

Correct answer: B. The thyroid enlarges with an increase in basal metabolic rate.

Thyroid enlargement and increased basal body metabolism are common occurrences during pregnancy. Human placental lactogen enhances milk production. Estrogen is responsible for hyperpigmentation and vascular skin changes. Progesterone relaxes smooth muscle in the respiratory tract.

Correct answer: A. External genitalia.

Although sex is not easily discerned at 9 to 12 weeks, external genitalia are developed at this period of fetal development. Myelinization of the nerves begins at about 20 weeks’ gestation. Brown fat stores develop at approximately 21 to 24 weeks. Air ducts and alveoli develop later in the gestational period, at approximately 25 to 28 weeks.

Correct answer: C. Monozygotic twins occur by chance regardless of race or heredity.

Monozygotic twinning is independent of race, age, parity, or heredity. Monozygotic twins result from the fertilization of one ovum by two different sperm. Dizygotic twinning occurs with the fertilization of more than one ovum during conception. Dizygotic twins may be of the same sex or different sexes. Dizygotic twinning is correlated with increased parity, becoming pregnant within 1 month after stopping oral contraception, and infertility treatments. A primigravid client is less likely to conceive dizygotic twins.

Correct answer: B. Restarts the metoprolol.

The client is experiencing a rebound tachycardia from abrupt withdrawal of the beta blocker. The beta blocker should be restarted due to the tachycardia, history of hypertension, and the desire to reduce the risk of postoperative myocardial morbidity. The bypass surgery should correct the claudication and need for pentoxifylline. The furosemide and increase in fluids are not indicated since the client’s urine output and blood pressure are satisfactory and there is no indication of bleeding. The potassium should also be assessed prior to starting the furosemide.

Correct answer: D. "The maximum blood loss considered within normal limits is 500 mL."

In a normal birth and for the first 24 hours postpartum, a total blood loss not exceeding 500 mL is considered normal. Blood loss during childbirth is almost always estimated because it provides a valuable indicator for possible hemorrhage. A blood loss of 1,000 mL is considered hemorrhage.

Correct answer: D. "Fetal nutrients are provided by the amniotic fluid."

Although the amniotic fluid promotes normal prenatal development by allowing symmetric development, it does not provide the fetus with nutrients. Rather, nutrients are provided by the placenta. The amniotic fluid does help dilate the cervix once labor begins by pressure and gravity forces. The amniotic fluid helps to protect the fetus from injury by cushioning against impact of the maternal abdomen and allows room and buoyancy for fetal movement. The amniotic fluid and sac keep the fetus at a stable temperature by maintaining a neutral thermal environment

Correct answer: C. Pelvic rocking.

Pelvic rocking helps to relieve backache during pregnancy and early labor by making the spine more flexible. Deep breathing exercises assist with relaxation and pain relief during labor. Tailor sitting and squatting help stretch the perineal muscles in preparation for labor.

Correct answer: D. All of the above

Pain during the first stage of labor is primarily caused by hypoxia of the uterine and cervical muscle cells during contraction, stretching of the lower uterine segment, dilatation of the cervix and perineum, and pressure on adjacent structures. Ambulating will assist in increasing circulation of blood to the area and relaxing the muscles. Slow chest breathing is appropriate during the first stage of labor to promote increased oxygenation as well as relaxation. The woman or her coach can lightly massage the abdomen (effleurage) while using slow chest breathing. Chest breathing and massaging increase oxygenation and relaxation of uterine muscles. Pain medication is not used during the first stage of labor because most medications will slow labor; anesthesia may be considered during the second stage of labor. Sipping ice water, while helpful for maintaining hydration, will not be useful as a pain management strategy.

Correct answer: B. "True labor contractions are felt first in the lower back, then the abdomen."

With true labor, the contractions are felt first in the lower back and then the abdomen. They gradually increase in frequency and duration and do not disappear with ambulation, rest, or sleep. In true labor, the cervix dilates and effaces. Walking tends to increase true contractions. False labor contractions disappear with ambulation, rest, or sleep. False labor contractions commonly remain the same in duration and frequency. Clients who are experiencing false labor may have pain, even though the contractions are not very effective.

Correct answer: C. Pelvic tilt exercises.

Pelvic tilt exercises are useful to alleviate backache during pregnancy and labor but are not useful for the pain from contractions. Biofeedback (a conscious effort to control the response to pain), effleurage (light uterine massage), and guided imagery (focusing on a pleasant scene) are appropriate pain relief techniques to practice before labor begins. Various breathing exercises also can help to alleviate the discomfort from contraction pain.

Correct answer: B. Schedule an appointment at the clinic for an examination.

Increased vaginal discharge is normal during pregnancy, but yellow-gray frothy discharge with local itching is associated with infection (e.g., Trichomonas vaginalis). The client’s symptoms must be further assessed by a health professional because the client needs treatment for this condition. T. vaginalis infection is commonly treated with metronidazole (Flagyl). However, this drug is not used in the first trimester. In the first trimester, the typical treatment is topical clotrimazole. Although a yeast infection is associated with vaginal itching, the vaginal discharge is cheese-like. Furthermore, because the client may have a serious vaginal infection, over-the-counter medications are not advised until the client has been evaluated. Douching is not recommended during pregnancy because it would predispose the client to an ascending infection. The client is not exhibiting signs and symptoms of preterm labor, such as contractions or leaking fluid. And although the client’s problems are suggestive of a T. vaginalis infection, which can lead to preterm labor and premature rupture of the membranes, further evaluation is needed to confirm the cause of the infection.

Correct answer: B. Increased risk for urinary tract infections.

During pregnancy, urinary tract infections are more common because of urinary stasis. Clients need instructions about increasing fluid volume intake. Plasma volume increases during pregnancy. The increase in plasma volume is more pronounced and occurs earlier than the increase in red blood cell mass, possibly resulting in physiologic anemia. Peripheral vascular resistance decreases during pregnancy, providing a relatively stable blood pressure. Hemoglobin levels decrease during pregnancy even though there is an increase in blood volume

Correct answer: B. Maternal blood.

For the Rh-negative client who may be pregnant with an Rh-positive fetus, an indirect Coombs test measures antibodies in the maternal blood. Titers should be performed monthly during the first and second trimesters and biweekly during the third trimester and the week before the due date.

Correct answer: A. Class II.

According to both the New York Heart Association and the Canadian Cardiovascular Society, this client would fit under Class II because she is symptomatic with increased activity (dyspnea with exertion). Class II clients have cardiac disease and a slight limitation in physical activity. When physical activity occurs, the client may experience angina, difficulty breathing, palpations, and fatigue. All of the client’s other symptoms are within normal limits.

Correct answer: A. All of the above

The test result indicates that the mother has an active hepatitis infection and is a carrier. Hepatitis B immune globulin at birth provides the infant with passive immunity against hepatitis B and serves as a prophylactic treatment. Additionally, the infant will be started on the vaccine series of three injections. The infant should not be screened or isolated because the infant is already hepatitis B positive. As with all clients, universal precautions should be used and are sufficient to prevent transmission of the virus. Women who are positive for hepatitis B surface antigen are able to breast-feed.

Correct answer: A. "I need to continue taking my asthma medication as prescribed."

Asthma medications and bronchodilators should be continued during pregnancy as prescribed before the pregnancy began. The medications do not cause harm to the mother or fetus. Regular use of asthma medication will usually prevent asthma attacks. Prevention and limitation of an asthma attack is the goal of care for a client who is or is not pregnant and is the appropriate care strategy. During an asthma attack, oxygen needs continue as with any pregnant client but the airways are edematous, decreasing perfusion. Asthma exacerbations during pregnancy may occur as a result of infrequent use of medication rather than as a result of the pregnancy.

Correct answer: B. Refer the client to her health care provider for evaluation and treatment of the pain.

The nurse seeing this client should refer her to a health care provider for further evaluation of the pain. This referral would allow a more definitive diagnosis and medical interventions that may include surgery. Referral would occur because of her high pain rating as well as the other symptoms, which suggest gallbladder disease. During pregnancy, the gallbladder is under the influence of progesterone, which is a smooth muscle relaxant. Because bile does not move through the system as quickly during pregnancy, bile stasis and gallstone formation can occur. Although education should be a continuous strategy, with pain at this level, a brief explanation is most appropriate. Major emphasis should be placed on determining the cause and treating the pain. It is not appropriate for the nurse to diagnose pain at this level as heartburn. Discussing nutritional strategies to prevent heartburn are appropriate during pregnancy, but not in this situation. Tylenol is an acceptable medication to take during pregnancy but should not be used on a regular basis as it can mask other problems.

Correct answer: D. Disseminated intravascular coagulation.

A fetus that has died and is retained in utero places the mother at risk for disseminated intravascular coagulation (DIC) because the clotting factors within the maternal system are consumed when the nonviable fetus is retained. The longer the fetus is retained in utero, the greater the risk of DIC. This client has no risk factors, history, or signs and symptoms that put her at risk for either abruptio placentae or placenta previa, such as sharp pain and "woody," firm consistency of the abdomen (abruption) or painless bright red vaginal bleeding (previa). There is no evidence that she is threatening to abort as she has no cramping or vaginal bleeding.

Correct answer: D. "Chorionic villus sampling can be performed earlier in pregnancy."

Chorionic villus sampling (CVS) can be performed from approximately 8 to 12 weeks’ gestation, while amniocentesis cannot be performed until between 11 weeks’ gestation and the end of the pregnancy. Eleven weeks’ gestation is the earliest possible time within the pregnancy to obtain a sufficient amount of amniotic fluid to sample. Because CVS take a piece of membrane surrounding the infant, this procedure can be completed earlier in the pregnancy. Amniocentesis and chorionic villus sampling identify the genetic makeup of the fetus in its entirety, rather than a portion of it. Laboratory analysis of chorionic villus sampling takes less time to complete. Both procedures place the fetus at risk and postprocedure teaching asks the client to report the same complicating events (bleeding, cramping, fever, and fluid leakage from the vagina).

Correct answer: A. Guilt.

With a spontaneous abortion, many clients and their partners feel an acute sense of loss. Their grieving commonly includes feelings of guilt, which may be expressed as wondering whether the woman could have done something to prevent the loss. Anger, sadness, and disappointment are also common emotions after a pregnancy loss. Ambivalence, anxiety, and fear are not common emotions after a spontaneous abortion.

Correct answer: D. Absence of nausea.

Hydroxyzine has a tranquilizing effect and also decreases nausea and vomiting. It does not decrease fluid retention, reduce pain, decrease uterine cramping, or promote uterine contractility. One of the adverse effects of the medication is sleepiness. Ibuprofen may decrease pain from uterine cramping. Oxytocin may be used to increase uterine contractility.

Correct answer: C. "I’m truly sorry you lost your baby."

The death of a fetus at any time during pregnancy is a tragedy for most parents. After a spontaneous abortion, the client and family members can be expected to suffer from grief for several months or longer. When offering support, a simple statement such as "I’m truly sorry you lost your baby" is most appropriate. Therapeutic communication techniques help the client and family understand the meaning of the loss, move less stressfully through the grief process, and share feelings. Asking the client whether she is experiencing a great deal of uterine pain is inappropriate because this is a "yes-no" question and doesn’t allow the client to express her feelings. Saying that the embryo was defective is inappropriate because this may lead the client to think that she contributed to the fetus’s demise. This is not the appropriate time to discuss embryonic or fetal malformations. However, the nurse should explain to the client that this situation was not her fault. Telling the client that she should get pregnant again as soon as possible is not therapeutic and discounts the feelings of the expectant mother who had already begun to bond with the fetus.

Correct answer: A. Development of Rh-positive antibodies.

Rh sensitization can be prevented by Rho(D) immune globulin, which clears the maternal circulation of Rh-positive cells before sensitization can occur, thereby blocking maternal antibody production to Rh-positive cells. Administration of this drug will not prevent future Rh-positive fetuses, nor will it prevent future abortions. An antibody response will not occur to Rh-negative cells. Rh-negative mothers do not develop sensitivities if the fetus is also Rh negative.

Correct answer: D. Take frequent rest periods with the legs elevated above the hips.

The client with leg varicosities should take frequent rest periods with the legs elevated above the hips to promote venous circulation. The client should avoid constrictive clothing, but support hose that reach above the varicosities may help alleviate the pain. Contracting and relaxing the feet and ankles twice daily is not helpful because it does not promote circulation. Taking a leave of absence from work may not be possible because of economic reasons. The client should try to rest with her legs elevated or walk around for a few minutes every 2 hours while on the job

Correct answer: B. Herpes genitalis.

The client is reporting symptoms typically associated with herpes genitalis. Some women have no symptoms of gonorrhea. Others may experience vaginal itching and a thick, purulent vaginal discharge. C. trachomatis infection in women is commonly asymptomatic, but symptoms may include a yellowish discharge and painful urination. The first symptom of syphilis is a painless chancre.

Correct answer: C. While caring for a 24-year-old primigravid client scheduled for emergency surgery because of a probable ectopic pregnancy, the nurse should:

The client may need surgery to remove a ruptured fallopian tube where the pregnancy has occurred, and the nurse is usually responsible for witnessing the signature on the informed consent. Typically, if bleeding is occurring, it is internal and there is only scant vaginal bleeding with no discoloration. The nurse cannot determine whether the fallopian tube can be salvaged; this can be accomplished only during surgery. If the tube has ruptured, it must be removed. If the tube has not ruptured, a linear salpingostomy may be done to salvage the tube for future pregnancies. With an ectopic pregnancy, although the client is experiencing abdominal pain, she is not having uterine contractions.

Correct answer: C. Multigravida who had a positive oxytocin challenge test.

Late decelerations during an oxytocin challenge test indicate that the infant is not receiving enough oxygen during contractions and is exhibiting signs of utero-placental insufficiency. This client would need further medical intervention. Fetal movement 6 times in 2 hours is adequate in a healthy fetus and a biophysical profile of 9 indicates that the risk of fetal asphyxia is rare. A reactive nonstress test informs the health care provider that the fetus has 2 fetal heart rate accelerations of 15 beats per minute above baseline and lasting for 15 seconds within a 20-minute period, which is a normal result and an indication of fetal well-being.

Correct answer: A. The clinic social worker.

The social worker is available to assist the client in finding services within the community to meet client needs. The charge nurse of the clinic or a primary care provider would be able to refer the client to the social worker. The client’s insurance company deals with payments for health care and would most likely refer the client back to the local setting to find resources for transportation.

Correct answer: D. All of the above

The same safety policies apply to both inpatient and outpatient settings and are adapted to the individual specialty. Handwashing and use of two patient identifiers are standard procedures. Abbreviations that are used for inpatient are also used for outpatient as the same mistakes can occur in either setting with confusion in spelling or interpretation of letters and numbers. Preprocedure verification with name and procedure is used in the operating room, inpatient, and in ambulatory settings regardless of the procedure. It is logical to place clients with obvious communicable diseases by themselves, but nausea and vomiting are a "normal" situation in early pregnancy and not contagious.

Correct answer: C. Lying on the abdomen with toes pointed inward.

To promote comfort when injecting at the ventrogluteal site, the position of choice is with the client lying on the abdomen with toes pointed inward. This positioning promotes muscle relaxation, which decreases the discomfort of making an injection into a tense muscle. Lying on the side with legs extended will not provide the greatest muscle relaxation. Leaning over the edge of a table with the hips flexed and standing upright with the feet apart will increase muscular tension.

Correct answer: A. Proteinuria.

The two major defining characteristics of preeclampsia are blood pressure elevation of 140/90 mm Hg or greater and proteinuria. Because the client’s blood pressure meets the gestational hypertension criteria, the next nursing responsibility is to determine if she has protein in her urine. If she does not, then she may be having transient hypertension. The edema is within normal limits for someone at this gestational age, particularly because it is in the lower extremities. The preeclamptic client will have significant edema in the face and hands. Headaches are significant in pregnancy-induced hypertension but may have other etiologies. The client’s blood glucose level has no bearing on a preeclampsia diagnosis.

Correct answer: C. "If the fetus moves more often than 3 times an hour."

The fetus is considered well if it moves more often than 3 times in 1 hour. Daily fetal movement counting is part of all high-risk assessments and is a noninvasive, inexpensive method of monitoring fetal well-being. The health care provider should be notified if there is a gradual slowing over time of fetal activity, if each day it takes longer for the fetus to move a minimum of 10 times, or if the fetus stops moving for 12 hours or longer.

Correct answer: D. Assess reflexes, clonus, visual disturbances, and headache.

The fetus is considered well if it moves more often than 3 times in 1 hour. Daily fetal movement counting is part of all high-risk assessments and is a noninvasive, inexpensive method of monitoring fetal well-being. The health care provider should be notified if there is a gradual slowing over time of fetal activity, if each day it takes longer for the fetus to move a minimum of 10 times, or if the fetus stops moving for 12 hours or longer.

Correct answer: A. Adolescent age group.

Clients with increased risk for preeclampsia include primigravid clients younger than 20 years or older than 40 years, clients with five or more pregnancies, women of color, women with multifetal pregnancies, women with diabetes or heart disease, and women with hydramnios. A total weight gain of 20 lb (9.1 kg) at 32 weeks’ gestation with a 1-lb (0.45-kg) weight gain in the last 2 weeks is within normal limits. Short stature is not associated with the development of preeclampsia. A trace amount of protein in the urine is common during pregnancy. However, protein amounts of 1+ or more may be a symptom of pregnancy-induced hypertension.

Correct answer: A. Hydrocephalic infant.

Congenital anomalies such as hydrocephalus are not associated with preeclampsia. Conditions such as stillbirth, prematurity, abruptio placentae, intrauterine growth retardation, and poor placental perfusion are associated with preeclampsia. Abruptio placentae occurs because of severe vasoconstriction. Intrauterine growth retardation is possible owing to poor placental perfusion. Poor placental perfusion results from increased vasoconstriction.

Correct answer: A. 1-hour period each day.

Numerous methods have been proposed to record the maternal perceptions of fetal movement or "kick counts." A commonly used method is the Cardiff count-to-10 method. The client begins counting fetal movements at a specified time (eg, 8:00 am) and notes the time when the 10th movement is felt. If the client does not feel at least 6 movements in a 1-hour period, she should notify the health care provider. The fetus typically moves an average of 1 to 2 times every 10 minutes or 10 to 12 times per hour. A 30- or 45-minute period is not enough time to evaluate fetal movement accurately. The client should monitor fetal movements more frequently than 1 time per week. One hour of monitoring each day is adequate.

Correct answer: D. Regular diet.

For clients with mild preeclampsia, a regular diet with ample protein and calories is recommended. If the client experiences constipation, she should increase the fiber in her diet, such as by eating raw fruits and vegetables, and increase fluid intake. A high-residue diet is not a nutritional need in preeclampsia. Sodium and fluid intake should not be restricted or increased. A high-protein diet is unnecessary.

Correct answer: D. Blurred vision.

Severe headache, visual disturbances such as blurred vision, and epigastric pain are associated with the development of severe preeclampsia and possibly eclampsia. These danger signs and symptoms must be reported immediately. Severe headache and visual disturbances are related to severe vasoconstriction and a severe increase in blood pressure. Epigastric pain is related to hepatic dysfunction. Ankle edema is common during the third trimester. However, facial edema is associated with increased fluid retention and the progression from mild to severe preeclampsia. Increased energy levels are not associated with a progression of the client’s preeclampsia or the development of complications. In fact, some women report an "energy spurt" before the onset of labor. Mild backache is a common discomfort of pregnancy, unrelated to a progression of the client’s preeclampsia. It also may be associated with bed rest when the mattress is not firm. Some multiparous women have reported a mild backache as a sign of impending labor.

Correct answer: A. "I think the doctor should see you today. Can you come to the clinic this morning?"

A client with preeclampsia and a continuous headache for 2 days should be seen by a health care provider immediately. Continuous headache, drowsiness, and mental confusion indicate poor cerebral perfusion and are symptoms of severe preeclampsia. Immediate care is recommended because these symptoms may lead to eclampsia or seizures if left untreated. Advising the client to take two acetaminophen tablets would be inappropriate and may lead to further complications if the client is not evaluated and treated. Although the application of cool compresses may ease the pain temporarily, this would delay treatment. Aspirin with codeine may temporarily relieve the client’s headache. However, this delays immediate treatment, which is crucial. Additionally, pregnant women are advised not to take aspirin at this time because it may cause clotting problems in the neonate. Codeine generally is not prescribed.

Correct answer: C. Padding for the side rails.

The client with severe preeclampsia may develop eclampsia, which is characterized by seizures. The client needs a darkened, quiet room and side rails with thick padding. This helps decrease the potential for injury should a seizure occur. Airways, a suction machine, and oxygen also should be available. If the client is to undergo induction of labor, oxytocin infusion solution can be obtained at a later time. Tongue blades are not necessary. However, the emergency cart should be placed nearby in case the client experiences a seizure. The ultrasound machine may be used at a later point to provide information about the fetus. In many hospitals, the client with severe preeclampsia is admitted to the labor area, where she and the fetus can be closely monitored. The safety of the client and her fetus is the priority.

Correct answer: B. Calcium gluconate.

The client receiving magnesium sulfate intravenously is at risk for possible toxicity. The antidote for magnesium sulfate toxicity is calcium gluconate, which should be readily available at the client’s bedside. Diazepam (Valium), used to treat anxiety, usually is not given to pregnant women. Hydralazine (Apresoline) would be used to treat hypertension, and phenytoin (Dilantin) would be used to treat seizures.

Correct answer: A. Decreased deep tendon reflexes.

Typical signs of hypermagnesemia include decreased deep tendon reflexes, sweating or a flushing of the skin, oliguria, decreased respirations, and lethargy progressing to coma as the toxicity increases. The nurse should check the client’s patellar, biceps, and radial reflexes regularly during magnesium sulfate therapy. Cool skin temperature may result from peripheral vasodilation, but the opposite-flushing and sweating-are usually seen. A rapid pulse rate commonly occurs in hypomagnesemia. Tingling in the toes may suggest hypocalcemia, not hypermagnesemia.

Correct answer: D. All of the above

Headaches could be a sign of preeclampsia/eclampsia in pregnancy. The client should be assessed for headache, vision changes, epigastric pain, hyper reflexes, and the presence of clonus. Her fetus should be assessed using a nonstress test. An ultrasound done in this pregnancy does not give information to assess the presence of preeclampsia/eclampsia.

Correct answer: B. Absence of any seizure activity during the first 48 hours.

The highest priority for a client with severe preeclampsia is to prevent seizures, thereby minimizing the possibility of adverse effects on the mother and fetus, and then to facilitate safe childbirth. Efforts to decrease edema, reduce blood pressure, increase urine output, limit kidney damage, and maintain sedation are desirable but are not as important as preventing seizures. It would take several days or weeks for the edema to be decreased. Sedation and decreased reflex excitability can occur with the administration of intravenous magnesium sulfate, which peaks in 30 minutes, much sooner than 48 hours.

Correct answer: B. All of the above

The use of magnesium sulfate as an anticonvulsant acts to depress the central nervous system by blocking peripheral neuromuscular transmissions and decreasing the amount of acetylcholine liberated. While being used, the temperature and pulse of the client should remain within normal limits. The respiratory rate needs to be greater than 12 respirations per minute (RPM). Rates at 12 RPM or lower are associated with respiratory depression and are seen with magnesium toxicity. Renal compromise is identified with a urinary output of less than 30 mL/hour. A fetal heart rate that is maintained within the 112 to 160 range is desired without later or variable decelerations. Deep tendon reflexes should not be diminished or exaggerated. The therapeutic magnesium sulfate level of 5 to 8 mg/dL (2.5 to 4 mmol/L) is to be maintained.

Correct answer: A. Respiratory rate of 12 breaths/min.

A respiratory rate of 12 breaths/min suggests potential respiratory depression, an adverse effect of magnesium sulfate therapy. The medication must be stopped and the primary health care provider should be notified immediately. A patellar reflex of +2 is normal. Absence of a patellar reflex suggests magnesium toxicity. A blood pressure reading of 160/88 mm Hg would be a common finding in a client with severe preeclampsia. Urinary output exceeding intake is not likely in a client receiving intravenous magnesium sulfate. Oliguria is more common.

Correct answer: A. Call for immediate assistance.

If a client begins to have a seizure, the first action by the nurse is to remain with the client and call for immediate assistance. The nurse needs to have some assistance in managing this client. After the seizure, the client needs intensive monitoring. An airway can be inserted, if appropriate, after the seizure ends. Noting the time the seizure begins and ends and turning the client to her left side should be done after assistance is obtained.

Correct answer: D. Tachycardia.

One of the most common adverse effects of the drug hydralazine (Apresoline) is tachycardia. Therefore, the nurse should assess the client’s heart rate and pulse. Hydralazine acts to lower blood pressure by peripheral dilation without interfering with placental circulation. Bradypnea and polyuria are usually not associated with hydralazine use. Dysphagia is not a typical adverse effect of hydralazine.

Correct answer: B. 4+.

These findings would be documented as 4+. 1+ indicates a diminished response; 2+ indicates a normal response; 3+ indicates a response that is brisker than average but not abnormal. Mild clonus is said to be present when there are two movements.

Correct answer: A. Epigastric pain.

Epigastric pain or acute right upper quadrant pain is associated with the development of eclampsia and an impending seizure; this is thought to be related to liver ischemia. Decreased contraction intensity is unrelated to the severity of the preeclampsia. Typically, the client’s temperature increases because of increased cerebral pressure. A decrease in temperature is unrelated to an impending seizure. Hyporeflexia is not associated with an impending seizure. Typically, the client would exhibit hyperreflexia.

Correct answer: D. Uterine contractions.

After an eclamptic seizure, the client commonly falls into a deep sleep or coma. The nurse must continually monitor the client for signs of impending labor, because the client will not be able to verbalize that contractions are occurring. Oliguria is more common than polyuria after an eclamptic seizure. Facial flushing is not common unless it is caused by a reaction to a medication. Typically, the client remains hypertensive unless medications such as magnesium sulfate are administered.

Correct answer: C. Abruptio placentae.

After an eclamptic seizure, the client is at risk for abruptio placentae due to severe vasoconstriction resulting in hemorrhage into the decidua basalis. Abruptio placentae is manifested by a board-like abdomen and an abnormal fetal heart rate tracing. Transverse lie or shoulder presentation, placenta accreta, and uterine atony are not related to eclampsia. Causes of a transverse lie may include relaxation of the abdominal wall secondary to grand multiparity, preterm fetus, placenta previa, abnormal uterus, contracted pelvis, and excessive amniotic fluid. Placenta accreta, a rare phenomenon, refers to a condition in which the placenta abnormally adheres to the uterine lining. Uterine atony, or relaxed uterus, may occur after childbirth, leading to postpartum hemorrhage.

Correct answer: A. Lactate dehydrogenase (LDH) greater than 200 U/L (3.34 ?kat/L).

The normal value of LDH in a nonpregnant person is 45 to 90 U/L (0.75 to 1.5 ?kat/L). LDH elevations indicate tissue destruction that can occur with HELLP syndrome. This platelet range is in the normal range and remains unchanged during pregnancy. Uric acid in a nonpregnant woman is 2 to 6.6 mg/dL (119 to 393 ?mol/L). AST normal range is 4 to 20 U/L (0.07 to 0.33 ?kat/L).

Correct answer: D. "I need to reduce my caloric intake to 1,200 cal/day."

Pregnancy is not the time for clients to begin a diet. Clients with chronic hypertension need to consume adequate calories to support fetal growth and development. They also need an adequate protein intake. Meat and beans are good sources of protein. Most pregnant women report that eating more frequent, smaller meals decreases heartburn resulting from the reflux of acidic secretions into the lower esophagus. Pregnant women need adequate hydration (fluids) and fiber to prevent constipation.

Correct answer: A. "I need close monitoring because I may have a small-for-gestational-age infant."

Women with chronic hypertension during pregnancy are at risk for complications such as preeclampsia (about 25%), abruptio placentae, and intrauterine growth retardation, resulting in a small-for-gestational-age infant. There is no association between chronic hypertension and hyperthyroidism. Pregnant women with chronic hypertension are not at an increased risk for hydramnios (polyhydramnios), an abnormally large amount of amniotic fluid. Clients with diabetes and multiple gestations are at risk for this condition. Placenta accreta, a rare placental abnormality, refers to a condition in which the placenta abnormally adheres to the uterine lining. It is not associated with chronic hypertension.

Correct answer: A. All of the above

Vaginal bleeding with or without pain could signify placenta previa or abruptio placentae. Continuous or pounding headache could indicate an elevated blood pressure, and change in the strength or frequency of fetal movements could indicate that the fetus is in distress. Orthostatic hypotension can occur during pregnancy and can be alleviated by rising slowly. Leg veins may increase in size due to additional pressure from the increasing uterine size, while leg cramps may also occur and can commonly be decreased with calcium supplements.

Correct answer: B. Applying external fetal monitor and complete physical assessment.

Bright red vaginal bleeding without contractions could indicate a placenta previa. A sterile vaginal exam should never be done on a woman with a known or suspected placenta previa. Applying the external fetal monitor will allow the nurse to assess fetal status. A complete physical assessment of the patient is indicated. A fundal height is used to monitor fetal growth during pregnancy but does not provide information related to vaginal bleeding.

Correct answer: A. Ask client time of last oral intake and prepare to start an IV.

Bright red vaginal bleeding without contractions could indicate a placenta previa. A sterile vaginal exam should never be done on a woman with a known or suspected placenta previa. Because the woman is currently bleeding and the fetal heart rate is showing decelerations, the woman would need fluid replacement and a possible emergent cesarean birth. The woman may also need fluid volume replacement. The nurse can prepare for this by asking last oral intake obtaining IV access. The client should be placed in a lateral position to enhance uteroplacental blood flow and given oxygen. The nurse should notify the primary health care provider as soon as possible, but the hands and knees position is indicated only if the client is experiencing back labor or umbilical cord prolapse. Leopold’s maneuver is done to determine fetal position in utero and would have already been done prior to placing the fetal heart rate monitor.

Correct answer: A. Urinary output of 25 mL in the past hour.

Urinary output of less than 30 mL/h indicates renal compromise and would be the most important assessment finding to report to the health care provider. The APTT is within normal limits and the hemoglobin is lower than values for an adult female but within normal limits for a pregnant female. Although the platelet level is slightly low and may impact blood clotting, when compared to renal failure, it is less important.

Correct answer: B. History of cocaine use.

Although the exact cause of abruptio placentae is unknown, possible contributing factors include excessive intrauterine pressure caused by hydramnios or multiple pregnancy, cocaine use, cigarette smoking, alcohol ingestion, trauma, increased maternal age and parity, and amniotomy. A history of hypertension is associated with an increased risk of abruptio placentae. A previous low transverse cesarean section and a history of one induced abortion are associated with increased risk of placenta previa, not abruptio placentae.

Correct answer: B. Painless vaginal bleeding.

The most common assessment finding associated with placenta previa is painless vaginal bleeding. With placenta previa, the placenta is abnormally implanted, covering a portion or all of the cervical os. Uterine tetany, intermittent pain with spotting, and dull lower back pain are not associated with placenta previa. Uterine tetany is associated with oxytocin administration. Intermittent pain with spotting commonly is associated with a spontaneous abortion. Dull lower back pain is commonly associated with poor maternal posture or a urinary tract infection with renal involvement.

Correct answer: A. Validate client information and the blood product with another nurse.

When administering blood replacement therapy, extreme caution is needed. Before administering any blood product, the nurse should validate the client information and the blood product with another nurse to prevent administration of the wrong blood transfusion. Although baseline vital signs are necessary, she should initiate the infusion of blood slowly for the first 10 to 15 minutes. Then, if there is no evidence of a reaction, she should adjust the rate of infusion to ensure that the blood product is infused over 2 to 4 hours. The nurse can ask the client if she has ever had a reaction to a blood product, but a general question about allergies may not elicit the most complete response about any reactions to blood product administration. Blood transfusions are typically given with intravenous normal saline solution, not dextrose solutions.

Correct answer: B. The client’s feeling of grief is a normal reaction.

Feelings of loss, grief, and guilt are normal after a cesarean birth, particularly if it was not planned. The nurse should support the client, listen with empathy, and allow the client time to grieve. The likelihood of the client experiencing postpartum blues is not known, and no evidence is presented. Although maternal-infant bonding may be delayed owing to neonatal complications or maternal pain and subsequent medications, it should not be difficult. Although the nurse is aware that this type of birth was necessary to save the client’s life, using this as the basis for the response does not acknowledge the mother’s feelings.

Correct answer: B. Insert a large-gauge intravenous catheter.

Abruptio placentae is a medical emergency because the degree of hypovolemic shock may be out of proportion to visible blood loss. On admission, the nurse should plan to first insert a large-gauge intravenous catheter for fluid replacement and oxygen by mask to decrease fetal anoxia. Vaginal examination usually is not performed on pregnant clients who are experiencing third-trimester bleeding due to abruptio placentae because it can result in damage to the placenta and further fetal anoxia. The client’s history can be obtained once the client has been admitted and the intravenous line has been started. The goal is birth of the fetus, usually by emergency cesarean section. The nurse should also plan to monitor the client’s vital signs and the fetal heart rate. Ultrasound is of limited use in the diagnosis of abruptio placentae.

Correct answer: A. The client will not develop preterm labor.

The absence of fetal fibronectin in a vaginal swab between 22 and 37 weeks’ gestation indicates there is less than 1% risk of developing preterm labor in the next week. Fetal fibronectin is an extra cellular protein normally found in fetal membranes and deciduas and has no correlation with preeclampsia, fetal lung maturation, or gestational diabetes.

Correct answer: B. "Changing to filter cigarettes is helpful."

Smoking in any form is contraindicated in pregnancy, regardless of the type of filtering system used. Smoking is a major risk factor for preterm labor and decreased fetal weight. Dehydration is a risk factor for preterm labor as is prolonged standing and remaining in one position. Infection is thought to be a primary cause of preterm labor and the client would need to avoid contracting any type of infection. While taking trips, frequent emptying of the bladder prevents infection and ambulates the woman.

Correct answer: D. Below the umbilicus on the left side.

As the uterus contracts, the abdominal wall rises and, when external monitoring is used, presses against the transducer. This movement is transmitted into an electrical current, which is then recorded. With the fetus in the LOA position, the cardiotransducer should be placed below the umbilicus on the side where the fetal back is located and uterine displacement during contractions is greatest. If the fetal back is near the symphysis pubis, the fetus is presenting as a transverse lie. If the fetus is in a breech position, the fetal back may be at or above the umbilicus.

Correct answer: D. To enhance fetal lung maturity.

Betamethasone therapy is indicated when the fetal lungs are immature. The fetus must be between 28 and 34 weeks’ gestation and birth must be delayed for 24 to 48 hours for the drug to achieve a therapeutic effect. Antibiotics would be used to treat chorioamnionitis. Betamethasone is not an antagonist for tocolytic therapy. It increases, not decreases, the production of neonatal surfactant.

Correct answer: C. Pulmonary.

The shake test helps determine the maturity of the fetal pulmonary system. The test is based on the fact that surfactant foams when mixed with ethanol. The more stable the foam, the more mature the fetal pulmonary system. Although the shake test is inexpensive and provides rapid results, problems have been noted with its reliability. Therefore, the lecithin-sphingomyelin ratio is usually determined in conjunction with the shake test.

Correct answer: D. Vaginal culture for Neisseria gonorrhoeae.

Because an intrauterine infection may occur when membranes have ruptured, vaginal cultures for N. gonorrhoeae, group B streptococcus, and chlamydia are usually taken. Prophylactic antibiotics may be prescribed to reduce the risk of infection in the newborn. Frequent vaginal examinations should be avoided because they can further increase the client’s risk for infection. Intravenous oxytocin to initiate labor may be used if an infection occurs. Bed rest can sometimes prolong the pregnancy and prevent a preterm birth. A sonogram may be used to validate rupture of the membranes with an amniotic fluid index. However, it is not needed if the primary health care provider has confirmed the rupture.