Exam (elaborations) NURS 125 Maternity Evolve Exam Test Bank

Exam (elaborations) NURS 125 Maternity Evolve Exam Test Bank A nonstress test is performed, and the physician documents “accelerations lasting less than 15 seconds throughout fetal movement.” The nurse interprets these findings as: A. Normal B. Reactive C. Nonreactive Correct D. Inconclusive Rationale: A reactive nonstress test is a normal, or negative, result and indicates a healthy fetus. The result requires two or more fetal heart rate accelerations of at least 15 beats/min lasting at least 15 seconds from the beginning of the acceleration to the end, in association with fetal movement, during a 20­minute period. A nonreactive test is an abnormal test, showing no accelerations or accelerations of less than 15 beats/min or lasting less than 15 seconds during a 40­ minute observation. An inconclusive result is one that cannot be interpreted because of the poor quality of the fetal heart rate recording. Test­Taking Strategy: Use the process of elimination. Eliminate a reactive nonstress test and a normal nonstress test first because they are comparable or alike. To select from the remaining options, note the relationship between “less than 15 seconds” in the question and “nonreactive” in the correct option. If you had difficulty answering this question, review the interpretation of nonstress test results. 2. A nurse caring for a client in labor performs an assessment. The client is having consistent contractions less than 2 minutes apart. The fetal heart rate (FHR) is 170 beats/min, and fetal monitoring indicates a pattern of decreased variability. In light of these findings, the appropriate nursing action is: A. Contacting the physician Correct B. Documenting the findings C. Continuing to monitor the client D. Reassuring the client and her partner that labor is progressing normally Rationale: Signs of potential complications of labor include contractions consistently lasting 90 seconds or longer, contractions consistently occurring 2 minutes or less apart, fetal bradycardia, tachycardia, persistently decreased variability, or an irregular FHR. The normal FHR is 110 to 160 beats/min. Therefore, because the finding is abnormal, the physician must be contacted. Continuing to monitor the client delays necessary intervention. Reassuring the client that labor is progressing normally is incorrect. The nurse would document the data, actions taken, and the client’s response, but, of the options provided, contacting the physician is the most appropriate. Test­Taking Strategy: Use the process of elimination and focus on the data in the question. Eliminate the options that are comparable or alike and indicate that the data in the question are normal findings. Review normal assessment findings during the labor process if you had difficulty with this question. 3. A stillborn infant was delivered a few hours ago. After the birth, the family remains together, holding and touching the baby. Which statement by the nurse is appropriate? A. “I know how you feel.” B. “This must be hard for you.” Correct C. “Now you have an angel in heaven.” D. “You’re young. You can have other children.” Rationale: Therapeutic communication helps the mother, father, and other family members express their feelings and emotions. “This must be hard for you” is a caring and empathetic response, focused on feelings and encouraging communication. The other options are nontherapeutic and may devalue the family members' feelings. Test­Taking Strategy: Use your knowledge of therapeutic communication techniques. The correct option is the only option that is focused on the family members’ feelings. Review therapeutic communication techniques if you had difficulty with this question. 4. A rubella antibody screen is performed in a pregnant client, and the results indicate that the client is not immune to rubella. The nurse tells the client that: A. A rubella vaccine must be administered immediately B. A rubella vaccine must be administered after childbirth Correct C. She will not contract rubella if she is exposed to the disease D. She does not need to be concerned about being exposed to rubella Rationale: A prenatal rubella antibody screen is performed in every pregnant woman to determine whether she is immune to rubella, which can cause serious fetal anomalies. If she is not immune, rubella vaccine is offered after childbirth to keep her from contracting rubella during subsequent pregnancies. The vaccine is a live virus, and defects might occur in the fetus if the vaccine were administered during pregnancy or if the mother were to become pregnant soon after it was administered. Administering a rubella vaccine immediately places the fetus at risk. Telling the client that she does not need to be concerned about being exposed to rubella is incorrect, because the possibility of exposure, which could be harmful to the fetus, does exist. Test­Taking Strategy: Use the process of elimination. Eliminate first the options that are comparable or alike (i.e., the client will not acquire rubella and does not need to be concerned about exposure). To select from the remaining options, recall that rubella vaccine is a live virus; this will direct you to the correct option. Review rubella vaccine and its implications during pregnancy if you had difficulty with this question. 5. A nurse caring for a client in the active stage of labor assesses the fetal status and notes a late deceleration on the monitor strip. In light of this finding, which nursing action is the priority? A. Documenting the finding B. Preparing for immediate birth C. Administering oxygen by way of face mask Correct D. Increasing the rate of the oxytocin (Pitocin) infusion Rationale: Late decelerations are a result of uteroplacental insufficiency stemming from decreased blood flow and oxygen transfer to the fetus during uterine contractions. This causes hypoxemia; therefore oxygen is necessary, making the administration of oxygen the correct choice. Late decelerations are considered an ominous sign but do not necessarily require immediate birth of the baby. The oxytocin infusion should be discontinued when a late deceleration is noted. The oxytocin would cause further hypoxemia, because the medication stimulates contractions, leading to increased uteroplacental insufficiency. Although the finding needs to be documented, documentation is not the priority action in this situation. Test­Taking Strategy: Note the strategic word “priority” in the question. Use your knowledge of the ABCs — airway, breathing, and circulation — to answer the question. This will direct you to the correct option, the one that addresses oxygen. Review content on late decelerations if you had difficulty with this question. 6. A nurse provides instructions regarding postpartum exercises to a client who has delivered a newborn vaginally. The nurse tells the client that: A. The exercises should be delayed for 1 month to allow healing B. Performing such exercises in the postpartum period may result in stress urinary incontinence C. Alternating contraction and relaxation of the muscles of the perineal area should be practiced Correct D. Abdominal exercises will be started while the client is in the hospital as a means of evaluating tolerance Rationale: Postpartum exercises may be started soon after birth, although the woman should be encouraged to begin with simple exercises and gradually progress to more strenuous ones. Abdominal exercises are postponed until approximately 4 weeks after a cesarean birth. Kegel exercises (alternated contraction and relaxation of the muscles of the perineal area) are extremely important in strengthening the muscle tone of the perineal area after vaginal birth. Kegel exercises help restore the muscle tone that is often lost as pelvic tissues are stretched and torn during pregnancy and birth. Women who maintain muscle strength may benefit years later, experiencing continued urinary continence. Test­Taking Strategy: Use the process of elimination. Note the relationship between the word “vaginally” in the question and “perineal area” in the correct option. Review the purpose and benefit of Kegel exercises if you had difficulty with this question. 7. A client in the first trimester of pregnancy arrives at the clinic and reports that she has been experiencing vaginal bleeding. Threatened abortion is suspected, and the nurse provides instructions to the client regarding care. Which statement by the client indicates the need for further instruction? A. “I need to stay in bed for the rest of my pregnancy.” Correct B. “I need to avoid having sex until the bleeding has stopped.” C. “I need to watch for stuff that looks like tissue coming from my vagina.” D. “I need to count the number of perineal pads that I use each day and make a note of the amount and color of blood on each pad.” Rationale: Strict bed rest throughout the remainder of the pregnancy is not required. The woman is advised to curtail sexual activities until bleeding has ceased and for 2 weeks after the last evidence of bleeding, as recommended by the physician or nurse­midwife. The woman is instructed to count the perineal pads she uses each day and to note the quantity and color of blood on each pad. The woman should also watch for the evidence of the passage of tissue. Test­Taking Strategy: Use the process of elimination. Note the strategic words “need for further instruction” in the question, which indicate a negative event query and the need to select the incorrect client statement. Noting the words “stay in bed for the rest of my pregnancy” will direct you to this option. Review therapeutic management for threatened abortion if you had difficulty with this question. 8. A nurse is assessing the respiratory rate of a newborn. Which finding would the nurse document as normal? A. 20 breaths/min B. 25 breaths/min C. 50 breaths/min Correct D. 70 breaths/min Rationale: The normal respiratory rate for a newborn infant is 30 to 60 breaths/min. All of the other options are outside the normal range. Test­Taking Strategy: Knowledge regarding the normal respiratory rate of a newborn is required to answer this question. If you are unfamiliar with the normal ranges for newborn vital signs, review this content. 9. A nurse notes that the laboratory report of a pregnant client with suspected HIV infection indicates leukopenia, thrombocytopenia, anemia, and an increased erythrocyte sedimentation rate. Which laboratory test that would further confirm the presence of HIV does the nurse anticipate that the physician will prescribe? A. Platelet count B. Angiotensin level C. Glomerular filtration rate D. T­lymphocyte determination Correct Rationale: HIV has a strong affinity for surface marker proteins on lymphocytes. This affinity of HIV for T­lymphocytes leads to significant cell destruction. Angiotensin is produced in the kidney and plays a role in blood pressure control. Glomerular filtration rate is an indicator of kidney function. The platelet count is important and may be used as an indicator of the effects of HIV, but the platelet count (thrombocytopenia) has already been addressed in the question. Test­Taking Strategy: Use the process of elimination, focusing on the subject, the presence of HIV. Eliminate the platelet count, because this has already been addressed in the question (thrombocytopenia). Next eliminate the options that are comparable or alike in that they are related to kidney function. If you had difficulty with this question, review the clinical manifestations and pathology of HIV infection. 10. A nurse palpates the anterior fontanel of a neonate and notes that it feels soft. This nurse interprets this assessment data as: A. A normal finding Correct B. Indicative of dehydration C. Indicative of increased intracranial pressure D. Indicative of decreased intracranial pressure Rationale: The anterior fontanel, which is diamond shaped, is located on the top of the head. It measures 1 to 4 cm but varies because of molding and individual differences. It normally closes by 12 to 18 months of age. It may be described as soft, which is normal, or full and bulging, which may be indicative of increased intracranial pressure. Conversely, a depressed fontanel could mean that the neonate is dehydrated. Test­Taking Strategy: Use the process of elimination, noting the strategic words “feels soft” in the question. Remember that the anterior fontanel is soft in the neonate. If you had difficulty answering this question, review normal assessment findings in the neonate. 11. A nurse provides information about the treatment for hypoglycemia to a client with gestational diabetes who will be taking insulin. The nurse tells the client that if signs and symptoms of hypoglycemia occur, she must immediately: A. Lie down B. Contact the physician Incorrect C. Drink 8 oz of diet soda D. Check her blood glucose level Correct Rationale: If signs and symptoms of hypoglycemia occur, the client should immediately check the blood glucose level. The results will determine the required treatment. If the blood glucose is less than 60 mg/dL, the client should immediately eat or drink something that contains 10 to 15 g of simple carbohydrate. Examples include a half cup (4 oz) of unsweetened fruit juice, a half cup (4 oz) of regular (not diet) soda, 5 or 6 LifeSavers candies, 1 tablespoon of honey or corn (Karo) syrup; 1 cup (8 oz) of milk; or 2 or 3 glucose tablets. The blood glucose is tested again 15 minutes after intake of the carbohydrate. If the glucose level is still below 60 mg/dL, the client should eat or drink another 10 to 15 g of simple carbohydrate. The blood glucose is tested once again 15 minutes after intake of the carbohydrate, and the physician is notified immediately if it is still below 60 mg/dL, because further intervention is necessary. Lying down will not increase the blood glucose level and will delay necessary intervention. Test­Taking Strategy: Use the process of elimination and note the strategic word “immediately.” Remember that if hypoglycemia is suspected, a blood glucose test is needed to confirm its occurrence and then treatment measures must be taken immediately. Review the treatment measures for hypoglycemia if you had difficulty with this question. 12. A nurse is providing nutritional counseling to pregnant client with a history of cardiac disease. What does the nurse advise the client to eat? A. Water and pretzels B. Low­fat cheese omelet C. Nachos and fried chicken D. Apple and whole­grain toast Correct Rationale: The pregnant woman needs a well­balanced diet high in iron and protein and adequate in calories for weight gain. Iron supplements that are taken during pregnancy tend to cause constipation. Constipation causes the client to strain during defecation, inadvertently performing the Valsalva maneuver, which causes blood to rush to the heart and overload the cardiac system. The pregnant woman, then, should increase her intake of fluids and fiber. An unlimited intake of sodium (pretzels, cheese, nachos) could cause overload of the circulating blood volume and contribute to the cardiac condition. Test­Taking Strategy: Use the process of elimination and note that the client has a history of cardiac disease. Recalling the concepts of care of the client with cardiac disease and noting that the question involves a client who is pregnant will direct you to the correct option. Review dietary requirements and examples of foods containing those requirements for a cardiac client who is pregnant if you had difficulty with this question. 13. A neonate is irritable, cries incessantly, and has a temperature of 99.4° F. The neonate is also tachypneic, diaphoretic, feeding poorly, and hyperactive in response to environmental stimuli. The nurse determines that these signs and symptoms are consistent with: A. Sepsis B. Hypercalcemia Incorrect C. Intraventricular hemorrhage D. Neonatal abstinence syndrome Correct Rationale: Neonatal abstinence syndrome is the term given to the group of signs and symptoms associated with drug withdrawal in the neonate. Drug withdrawal causes a hyperactive response in the infant because of the increased central nervous system (CNS) stimulation. This hyperactive response and the signs and symptoms of drug withdrawal seem to be most apparent around 1 week of age. Sepsis, hypercalcemia, and intraventricular hemorrhage cause symptoms of CNS depression. Test­Taking Strategy: Use the process of elimination, focusing on the data in the question. Note the strategic word “hyperactive,” which indicates CNS stimulation and should direct you to the correct option. If you had difficulty with this question, review the signs and symptoms of drug withdrawal in the neonate. 14. A nurse is assisting a physician in performing a physical examination of a client who has just been told that she is pregnant. The physician tells the nurse that the Goodell sign is present. The nurse understands that this sign is indicative of: A. The presence of fetal movement B. A high risk for spontaneous abortion C. An increase in vascularity and hyptertrophy of the cervix Correct D. The presence of human chorionic gonadotropin (hCG) in the urine Incorrect Rationale: In the early weeks of pregnancy, the cervix becomes more vascular and slightly hypertrophic; this is referred to as the Goodell sign. The edematous appearance of the cervix will be noted during pelvic examination by the examiner. hCG is noted in maternal urine in a urine pregnancy test. The Goodell sign does not indicate the presence of fetal movement or a risk for spontaneous abortion. Test­Taking Strategy: Knowledge regarding the Goodell sign is required to answer this question. It is necessary to know that the sign consists of increased vascularity and hypertrophy of the cervix. If you had difficulty with this question, review the changes in the cervix that occur during pregnancy. 15. A nurse is monitoring a client in labor for signs of intrauterine infection. Which sign, indicative of infection, would prompt the nurse to contact the healthcare provider? A. Maternal fatigue B. Clear amniotic fluid C. Strong­smelling amniotic fluid Correct D. A fetal heart rate of 140 beats/min Rationale: Signs associated with intrauterine infection includes fetal tachycardia (rising baseline or faster than 160 beats/min, a maternal fever (38° C or 100.4° F), foul or strong­smelling amniotic fluid, or cloudy or yellow amniotic fluid. The normal fetal heart rate is 110 to 160 beats/min. Clear amniotic fluid is normal. Maternal fatigue normally occurs during labor. Test­Taking Strategy: Focus on the subject of the question, a sign of intrauterine infection. Eliminate the options that are comparable or alike in that they are normal expectations during labor. Review the signs of intrauterine infection if you had difficulty with this question. 16. A nurse is assessing the uterine fundus of a client who has just delivered a baby and notes that the fundus is boggy. The nurse massages the fundus, and then presses to expel clots from the uterus. To prevent uterine inversion during this procedure, the nurse: A. Has the client void before the uterine assessment B. Tells the woman to bear down during fundal message C. Simultaneously provides pressure over the lower uterine segment Correct D. Asks the client to take slow, deep breaths during fundal assessment Rationale: After massaging a boggy fundus until it is firm, the nurse presses the fundus to expel clots from the uterus. The nurse must also keep one hand pressed firmly just above the symphysis (over the lower uterine segment) the entire time. Removing the clots allows the uterus to contract properly. Providing pressure over the lower uterine segment prevents uterine inversion. Having the client void before uterine assessment will not prevent uterine inversion. Telling the woman to bear down while the nurse performs fundal message and asking the client to take slow, deep breaths during fundal assessment also will not prevent uterine inversion. Test­Taking Strategy: Use the process of elimination, focusing on the subject, prevention of uterine inversion. Visualizing each of the actions in the options and relating the action to the subject of the question will direct you to the correct option. Review fundal assessment and massage if you had difficulty with this question. 17. A nurse assists a pregnant client who is in the second trimester into lithotomy position on the examining table in the obstetrician’s office. The client suddenly becomes dizzy, lightheaded, nauseated, and pale. The nurse immediately: A. Positions the client on her side Correct B. Calls the physician to see the client C. Places a cool washcloth on the client’s forehead D. Checks the client’s blood pressure, pulse, and respirations Rationale: Supine hypotension may occur during the second and third trimesters when a woman is placed in the lithotomy position, in which the weight of the abdominal contents may compress the vena cava and aorta, causing a drop in blood pressure and a feeling of faintness. Other signs and symptoms include pallor, dizziness, breathlessness, tachycardia, nausea, clammy (damp, cool) skin, and sweating. The nurse would immediately position the woman on her side. Placing a cool washcloth on the client’s forehead or checking the client’s vital signs will not eliminate this problem. The physician must be contacted if the symptoms do not subside, but this would not be the immediate action. Test­Taking Strategy: Use the process of elimination and note the strategic word “immediately.” Focusing on the data in the question and determining that the client is experiencing supine hypotension will direct you to the correct option. Review the manifestations of supine hypotension and the interventions for treating this occurrence if you had difficulty with this question. 18. A nurse is monitoring a newborn who has been admitted to the nursery. The nurse notes that the anterior fontanel measures 4 cm across and bulges when the infant is at rest. In light of this observation, what is the appropriate nursing action? A. Notifying the physician Correct B. Documenting the finding C. Assessing the infant’s blood pressure D. Reassessing the fontanel in 30 minutes Rationale: The anterior fontanel, which is diamond shaped, is located on the top of the head. It should be flat and soft. It measures 1 to 4 cm, varying as a result of molding and individual differences. It normally closes by 12 to 18 months of age. Although the anterior fontanel may bulge slightly when the infant cries, bulging at rest may indicate increased intracranial pressure. If this is suspected, the physician is notified. The other options would delay necessary treatment. Test­Taking Strategy: Use the process of elimination and note the strategic words “bulges when the infant is at rest.” Recalling that the fontanel should be soft and flat will direct you to the correct option. Review normal newborn assessment findings if you had difficulty with this question. 19. A nurse midwife performs an assessment of a pregnant client and documents the station of the fetal head as it is reflected in the figure below. The nurse reviews the assessment findings and determines that the fetal presenting part is: A. At +1 station B. At –1 station C. At zero station Correct D. Stationed at the bottom of the coccyx Rationale: Station is the relationship of the presenting part to an imaginary line drawn between the ischial spines. It is measured in centimeters and is noted as a negative number above the line, a positive number below the line, and zero at the line. Test­Taking Strategy: Knowing that station is measured in centimeters, with the ischial spines as a reference point, will assist you in answering this question. Focus on the figure and note that the fetal head is at zero station. Review station if you had difficulty with this question. 20. A client is admitted to the hospital for an emergency cesarean delivery. Contractions are occurring every 15 minutes, the client has a temperature of 100° F, and the client reports that she last ate 2 hours ago. The client also states that “everything happened so fast" and that she has had no preparation for the cesarean delivery. Which of the following actions should the nurse take first? A. Continuing to time the contractions B. Beginning teaching about the cesarean delivery C. Reporting the time of last food intake to the physician Correct D. Giving acetaminophen (Tylenol) to lower the client’s temperature Rationale: The nurse should report the time of last food intake to the physician. General anesthesia may be used for an emergency cesarean delivery. Gastric contents are very acidic and can produce chemical pneumonitis if aspirated. Continued monitoring and client instruction are correct nursing actions but are of lesser priority than reporting the time of last oral intake. Giving acetaminophen (Tylenol) is incorrect because it requires a physician’s prescription. Test­Taking Strategy: Note the strategic word “first” and use your knowledge of the ABCs — airway, breathing, and circulation — to find the correct option, which pertains to breathing (maintaining an open airway). Review client preparation for an emergency cesarean delivery if you had difficulty with this question. 21. A nurse is monitoring a client who was given an epidural opioid for a cesarean birth. The nurse notes that the client’s oxygen saturation on pulse oximetry is 92%. The nurse first: A. Contacts the physician B. Documents the findings C. Instructs the client to take several deep breaths Correct D. Administers 100% oxygen by way of face mask Rationale: If the client has been given an epidural opioid, the nurse should monitor the client’s respiratory status closely. If the oxygen saturation falls below 95%, the nurse instructs the client to take several deep breaths to increase the level. Although the finding would be documented, action is required to increase the oxygen saturation level. It is not necessary to contact the physician. If the deep breaths fail to increase the oxygen saturation level, the physician is notified and may prescribe oxygen. Test­Taking Strategy: Use the process of elimination and focus on the data in the question. Noting the oxygen saturation level will assist you in eliminating this option. Noting the strategic word “first” will direct you to the correct option. Review care of the client after a cesarean birth if you had difficulty with this question. 22. A nurse is monitoring a client in the third trimester of pregnancy who has a diagnosis of severe preeclampsia. Which finding would prompt the nurse to contact the physician? A. Complaint of feeling hot B. Enlargement of the breasts C. Diaphoresis and tachycardia Correct D. Periods of fetal movement followed by quiet periods Rationale: Disseminated intravascular coagulation (DIC) is a complication of preeclampsia. Physical examination reveals unusual bleeding, spontaneous bleeding from the woman’s gums or nose, or the presence of petechiae around a blood pressure cuff placed on the woman’s arm. Excessive bleeding may occur from a site of slight trauma such as a venipuncture site, an intramuscular or subcutaneous injection site, a nick sustained during shaving of the perineum or abdomen, or injury inflicted during insertion of a urinary catheter. Tachycardia and diaphoresis indicate impending shock as a result of blood loss. Breast enlargement, fetal movement with rest periods, and complaints of feeling hot are all normal occurrences in the last trimester of pregnancy. Test­Taking Strategy: Use the process of elimination. Eliminate the options that are comparable or alike in that they are normal occurrences in pregnancy. Review the complications associated with severe preeclampsia if you had difficulty with this question. 23. A nurse is monitoring a pregnant client with sepsis for signs of disseminated intravascular coagulopathy (DIC). Which of the following laboratory findings causes the nurse to suspect DIC? A. Increased platelet count B. Increased fibrinogen level C. Shortened prothrombin time D. Increased fibrin degradation products Correct Rationale: DIC is a state of diffuse clotting in which clotting factors are consumed, leading to widespread bleeding. Petechiae, oozing from injection sites, and hematuria are indicative of DIC. Platelets are decreased because they are consumed by the process; coagulation studies show no clot formation (and therefore prolonged times); and fibrin plugs may clog the microvasculature diffusely rather than in an isolated area. Fibrinogen and platelets are decreased, prothrombin and activated partial thromboplastin times are prolonged, and fibrin degradation products are increased. Test­Taking Strategy: Use the process of elimination. Recalling the pathophysiology of DIC will direct you to the correct option. Review laboratory findings in DIC if you had difficulty with this question. 24. A nurse is caring for a client experiencing hypotonic labor contractions. The client is discouraged by the lack of progress with labor but refuses an amniotomy or oxytocin (Pitocin) stimulation. The nurse determines that the client’s behavior may be a result of: A. Concern about her own and the baby’s well­being Correct B. The high level of pain caused by these contractions C. Inability to rest between the frequent contractions D. The normal lack of control clients feel during the transition phase of labor Rationale: Clients have concerns when labor does not proceed as expected and often are worried about the effects of treatments and invasive procedures on themselves and on the fetus. Hypotonic contractions generally occur during the active phase of labor, after a normal latent phase. These contractions are typically of poor intensity and infrequent; they are not painful but cause a very slow progression of labor. Therefore the high level of pain, inability to rest between contractions, and normal lack of control felt during the transition phase of labor are all incorrect. Test­Taking Strategy: Use the process of elimination, focusing on the subject, hypotonic labor contractions. Thinking about the pathophysiology of hypotonic labor will direct you to the correct option. Also, noting that the client is refusing treatments will assist you in answering correctly. Review the characteristics of hypotonic labor contractions and the psychosocial reactions associated with this disorder if you had difficulty with this question. 25. A woman with severe preeclampsia delivers a healthy newborn infant and continues to receive magnesium sulfate therapy in the postpartum period. Twenty­four hours after delivery, the client begins passing more than 100 mL of urine every hour. The nurse recognizes this volume of urine output as an indication of: A. Imminent seizures B. Hyperkalemia C. High­output renal failure D. Diminished edema and vasoconstriction in the brain and kidneys Correct Rationale: In this client, diuresis is a positive sign, indicating that edema and vasoconstriction in the brain and kidneys have decreased. Diuresis also reflects increased tissue perfusion in the kidneys. Clients with severe preeclampsia are not considered out of danger until birth and diuresis have taken place. Diuresis is not an indication of impending seizures. Although renal failure is a complication of severe preeclampsia, it is not the high­output type of failure. Potassium is lost through the urine; therefore hyperkalemia is not associated with diuresis. Test­Taking Strategy: Use the process of elimination. Recalling that oliguria is associated with severe preeclampsia will help you determine that diuresis in this scenario is associated with an improvement in preeclampsia. This will direct you to the correct option. If you had difficulty with this question, review the expected responses to treatment of severe preeclampsia. 26. A pregnant woman reports to the clinic complaining of loss of appetite, weight loss, and fatigue, and tuberculosis is suspected. A sputum culture reveals Mycobacterium tuberculosis. The nurse, providing instructions to the mother regarding therapeutic management of the disease, tells the mother that: A. The infant must be isolated from the mother after birth B. Maternal medication will not be started until the baby is born C. The infant will require medication therapy immediately after birth D. The mother may need to take isoniazid (INH), pyrazinamide, and rifampin (Rifadin) for a total of 9 months Correct Rationale: More than one medication may be used to prevent the growth of resistant organisms in the pregnant woman with tuberculosis. Treatment must be continued for a prolonged period. The preferred treatment for the pregnant woman is isoniazid plus rifampin for a total of 9 months. Ethambutol is added initially if drug resistance is suspected. Pyridoxine (vitamin B6 ) is often adm