Ms. N is a 20-year-old gravida 1, para 0 (G1P0) woman who begins her prenatal care today at 24 weeks’ gestation. She say

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Ms. N is a 20-year-old gravida 1, para 0 (G1P0) woman who begins
her prenatal care today at 24 weeks’ gestation. She says that she
didn’t know she was pregnant until now. Her prepregnancy body mass
index was 23. She has gained 30 lb so far. She admits that she eats
poorly and smokes a half-pack of cigarettes daily, but claims to
use no other substances. She lives with her boyfriend and has no
immediate family in the area. She reports no significant medical,
surgical, or family history. You are the RN taking her history and
drawing samples for laboratory work today on this first prenatal
visit.
1. What
would be your priority topics in client teaching today? (Select
all that apply.)
1. Smoking cessation
methods
2. Recommendation of a flu
shot (if flu season)
3. Danger signs during
pregnancy
4. Basics of nutrition
5. Pain relief options in
labor and birth
Qtn 2. Ms. N returns for her
second prenatal appointment 1 week later. You review her laboratory
results with her and note the following abnormal findings: 1-hour
glucose tolerance test, 190 mg/dL; Pap smear results, low-grade
squamous intraepithelial lesion (LSIL) with high-risk human
papillomavirus (HPV) present; chlamydia test, positive for the
organism. The physician has written orders for a 3-hour glucose
tolerance test and a colposcopy, and has provided a prescription
for azithromycin (Zithromax) 1 g by mouth. Ms. N has increased her
smoking to 1 pack/day because of stress.
What would be accurate and priority
information to give Ms. N about the positive chlamydia test
result?
1. By taking the
medication now and having her partner treated, she can help avoid
complications in the pregnancy.
2. The medication for
chlamydia infection is not safe in pregnancy, and she should use
condoms until she can be treated postpartum.
3. Chlamydia infection
cannot really be cured and may recur despite treatment.
4. Chlamydia infection
does no harm to the baby during the pregnancy or at delivery, but
treatment is recommended to avoid pelvic inflammatory disease in
the woman.
Qtn 3.
What else would be a priority given the scenario described
earlier?
1. Instruct Ms. N not to
fast for the 3-hour glucose tolerance test because it is not safe
to do so in pregnancy.
2. Refer Ms. N to a social
worker because her increased stress can be a risk factor for
preterm birth.
3. Instruct Ms. N that HPV
infection can be effectively treated with colposcopy.
4. Instruct Ms. N that, if
HPV is present at the time of labor, a cesarean section will be
needed.
Qtn 4 The nurse receives report at the
beginning of the shift about a client with an intrauterine fetal
demise. On assessment of the client, the nurse expects to note
which finding?
1 Intractable vomiting and
dehydration
2 Elevated blood pressure,
proteinuria, and edema
3 Uterine size greater than expected
for gestational age
4 Regression of pregnancy symptoms and
absence of fetal heart tones
Qtn 5. Ms. N arrives at the
hospital at 38 weeks’ gestation in active labor. Her membranes are
intact. Her contractions are every 3 minutes. Her mother is at the
bedside assisting her with breathing and relaxation. A vaginal
examination reveals that the cervix is 5 cm dilated and 100%
effaced, with the fetal head at −1 station. Her vital sign values
are as follows:
Blood pressure
140/90 mm Hg
Heart rate
88 beats/min
Respiratory rate
24 breaths/min
Temperature
98.6° F (37° C)
The fetal heart rate is 140
beats/min. There is average variability. Accelerations are present
and no decelerations are noted.
Based on Ms. N’s vital sign
measurements, what are the priority questions that the RN should
ask? (Select all that apply.)
1.
Is she having headaches?
2.
Is she having pain with urination?
3.
Is she having epigastric pain?
4.
Is she experiencing visual changes?
5.
Has her water broken?