UWorld Maternity Nursing
Maternity Nursing
Antepartum
34 Week Gestation Client With Constipation
Test Id: 51538826
Question Id: 31554 (729561)
1 of 20
A A A
A client at 34 weeks gestation has constipation. The client has been taking
325 mg ferrous sulfate tid for anemia since the last appointment 4 weeks
ago. Which instructions should the nurse recommend for this client? Select
all that apply.
Unordered Options Ordered Response
1. Decrease total daily dairy intake
2. Increase intake of fruits and vegetables
3. Moderate-intensity regular exercise
4. One cup of hot coffee each morning
5. One laxative twice daily for a week
You answered this question incorrectly. Correct answer is: 2,3
Time Spent: 93 Seconds
40% of people answered this question correctly.
Last Updated: 8/19/2015
Explanation
Constipation is a common complication of pregnancy due to an increase in
the hormone progesterone, which causes the smooth muscles of the
gastrointestinal tract
,UWorld Maternity Nursing
to relax. This leads to constipation from slowing of stool movement. Ferrous sulfate
(iron) may also cause constipation.
Interventions to prevent and treat constipation include:
1. High-fiber diet – increase fruits and vegetables and add breakfast
cereals and whole-grain bread; prunes also help constipation
2. Increased fluid intake – drink at least 10-12 cups of fluid daily. In
combination with a high-fiber diet, fluids help the most to treat
constipation.
3. Regular exercise – moderate-intensity exercise (eg, walking,
swimming, aerobics) is recommended throughout pregnancy
4. Bulk-forming fiber supplements – bulk-forming agents such as psyllium
(eg, Metamucil), methylcellulose (eg, Citrucel), and wheat dextran (eg,
Benefiber) are natural synthetic fiber products. These agents absorb
water and create bulk to the stool. They have very few adverse
effects.
(Option 1) Dairy is a great source of calcium, which is essential for fetal
bone development.
(Option 4) Coffee may contain caffeine and should be avoided during
pregnancy. Coffee can also lead to heartburn.
(Option 5) Laxatives are not recommended during pregnancy due to the
risk of dehydration and electrolyte imbalance. Dehydration can lead to
preterm labor. The client should contact the health care provider (HCP)
regarding any over-the-counter drugs, including stool softeners and
laxatives.
Educational objective:
Constipation in pregnancy may be caused by increased progesterone levels
and from ferrous sulfate. It is best treated with 10-12 cups of fluid daily, a
high-fiber diet, and regular exercise. Clients should not take laxatives
without first discussing these with the primary HCP.
Antepartum
Pre-Eclampsia/Eclampsia
Test Id: 51538826
Question Id: 30515 (729561)
,UWorld Maternity Nursing
2 of 20
A A A
A 28-year-old client is admitted to the labor and delivery unit for severe
preeclampsia. She is started on IV magnesium sulfate infusion. Which signs
indicate that the client has developed magnesium sulfate toxicity? Select all
that apply.
Unordered Options Ordered Response
1. 0/4 patellar reflex
2. Blood pressure is 156/84 mm Hg
3. Client voided 600 mL in 8 hours
4. Respirations are 10/min
5. Serum magnesium level is 6 mg/dL
You answered this question incorrectly. Correct answer is: 1,4
Time Spent: 105 Seconds
12% of people answered this question correctly.
Last Updated: 1/12/2016
Explanation
Although the normal blood level of magnesium is 1.5-2.5 mEq/L, a
therapeutic magnesium level of 5-8 mg/dL is necessary to prevent seizures in
a preeclamptic client (Option 5). Magnesium that exceeds the therapeutic
level causes toxicity by acting as a central nervous system depressant and
by blocking neuromuscular transmission.
Loss of deep-tendon reflexes (DTRs) is the earliest sign of magnesium sulfate
toxicity (9.6-12 mg/dL). If not recognized at this level, clients progress to
respiratory depression (12-18 mg/dL), followed by cardiac arrest (24-30
mg/dL). Urine output is
, UWorld Maternity Nursing
also reduced. The treatment for magnesium sulfate toxicity is immediate
discontinuation of the infusion. Administration of calcium gluconate
(antidote) is recommended only for cardiorespiratory compromise (not for
loss of DTRs).
(Option 1) DTRs are scored on a scale of 0-4; normal findings are 2+. DTRs
should be assessed every 2 hours during magnesium administration.
Decreased reflexes could be a sign of pending respiratory depression.
(Option 2) Hypertension is a sign of preeclampsia. Hydralazine (Apresoline),
methyldopa (Aldomet), or labetalol (beta blockers) is used to lower blood
pressure if needed (usually considered when >160/110 mm Hg).
(Option 3) Urine output below the obligatory amount of 30 mL/hr is a sign of
magnesium toxicity. The client can always void more and would be
expected to do so with additional fluid administration.
(Option 4) Respiratory depression (rate <12/min) is an assessment finding
indicating magnesium toxicity. Assessments (including vital signs) should
initially be performed every 5-15 minutes during the loading dose and then
every 30-60 minutes until the client stabilizes.
Educational objective:
The therapeutic level of magnesium for preeclampsia-eclampsia treatment
is 5-8 mg/dL. Signs of magnesium toxicity are decreased/loss of DTRs,
respiratory depression (<12/min), decreased urine output (<30 mL/hr), and
cardiac arrest if these are not recognized. Calcium gluconate (antidote)
should be readily available for cardiorespiratory compromise.
Antepartum
Pre-Eclampsia/Eclampsia
Test Id: 51538826
Question Id: 30616 (729561)
3 of 20
Maternity Nursing
Antepartum
34 Week Gestation Client With Constipation
Test Id: 51538826
Question Id: 31554 (729561)
1 of 20
A A A
A client at 34 weeks gestation has constipation. The client has been taking
325 mg ferrous sulfate tid for anemia since the last appointment 4 weeks
ago. Which instructions should the nurse recommend for this client? Select
all that apply.
Unordered Options Ordered Response
1. Decrease total daily dairy intake
2. Increase intake of fruits and vegetables
3. Moderate-intensity regular exercise
4. One cup of hot coffee each morning
5. One laxative twice daily for a week
You answered this question incorrectly. Correct answer is: 2,3
Time Spent: 93 Seconds
40% of people answered this question correctly.
Last Updated: 8/19/2015
Explanation
Constipation is a common complication of pregnancy due to an increase in
the hormone progesterone, which causes the smooth muscles of the
gastrointestinal tract
,UWorld Maternity Nursing
to relax. This leads to constipation from slowing of stool movement. Ferrous sulfate
(iron) may also cause constipation.
Interventions to prevent and treat constipation include:
1. High-fiber diet – increase fruits and vegetables and add breakfast
cereals and whole-grain bread; prunes also help constipation
2. Increased fluid intake – drink at least 10-12 cups of fluid daily. In
combination with a high-fiber diet, fluids help the most to treat
constipation.
3. Regular exercise – moderate-intensity exercise (eg, walking,
swimming, aerobics) is recommended throughout pregnancy
4. Bulk-forming fiber supplements – bulk-forming agents such as psyllium
(eg, Metamucil), methylcellulose (eg, Citrucel), and wheat dextran (eg,
Benefiber) are natural synthetic fiber products. These agents absorb
water and create bulk to the stool. They have very few adverse
effects.
(Option 1) Dairy is a great source of calcium, which is essential for fetal
bone development.
(Option 4) Coffee may contain caffeine and should be avoided during
pregnancy. Coffee can also lead to heartburn.
(Option 5) Laxatives are not recommended during pregnancy due to the
risk of dehydration and electrolyte imbalance. Dehydration can lead to
preterm labor. The client should contact the health care provider (HCP)
regarding any over-the-counter drugs, including stool softeners and
laxatives.
Educational objective:
Constipation in pregnancy may be caused by increased progesterone levels
and from ferrous sulfate. It is best treated with 10-12 cups of fluid daily, a
high-fiber diet, and regular exercise. Clients should not take laxatives
without first discussing these with the primary HCP.
Antepartum
Pre-Eclampsia/Eclampsia
Test Id: 51538826
Question Id: 30515 (729561)
,UWorld Maternity Nursing
2 of 20
A A A
A 28-year-old client is admitted to the labor and delivery unit for severe
preeclampsia. She is started on IV magnesium sulfate infusion. Which signs
indicate that the client has developed magnesium sulfate toxicity? Select all
that apply.
Unordered Options Ordered Response
1. 0/4 patellar reflex
2. Blood pressure is 156/84 mm Hg
3. Client voided 600 mL in 8 hours
4. Respirations are 10/min
5. Serum magnesium level is 6 mg/dL
You answered this question incorrectly. Correct answer is: 1,4
Time Spent: 105 Seconds
12% of people answered this question correctly.
Last Updated: 1/12/2016
Explanation
Although the normal blood level of magnesium is 1.5-2.5 mEq/L, a
therapeutic magnesium level of 5-8 mg/dL is necessary to prevent seizures in
a preeclamptic client (Option 5). Magnesium that exceeds the therapeutic
level causes toxicity by acting as a central nervous system depressant and
by blocking neuromuscular transmission.
Loss of deep-tendon reflexes (DTRs) is the earliest sign of magnesium sulfate
toxicity (9.6-12 mg/dL). If not recognized at this level, clients progress to
respiratory depression (12-18 mg/dL), followed by cardiac arrest (24-30
mg/dL). Urine output is
, UWorld Maternity Nursing
also reduced. The treatment for magnesium sulfate toxicity is immediate
discontinuation of the infusion. Administration of calcium gluconate
(antidote) is recommended only for cardiorespiratory compromise (not for
loss of DTRs).
(Option 1) DTRs are scored on a scale of 0-4; normal findings are 2+. DTRs
should be assessed every 2 hours during magnesium administration.
Decreased reflexes could be a sign of pending respiratory depression.
(Option 2) Hypertension is a sign of preeclampsia. Hydralazine (Apresoline),
methyldopa (Aldomet), or labetalol (beta blockers) is used to lower blood
pressure if needed (usually considered when >160/110 mm Hg).
(Option 3) Urine output below the obligatory amount of 30 mL/hr is a sign of
magnesium toxicity. The client can always void more and would be
expected to do so with additional fluid administration.
(Option 4) Respiratory depression (rate <12/min) is an assessment finding
indicating magnesium toxicity. Assessments (including vital signs) should
initially be performed every 5-15 minutes during the loading dose and then
every 30-60 minutes until the client stabilizes.
Educational objective:
The therapeutic level of magnesium for preeclampsia-eclampsia treatment
is 5-8 mg/dL. Signs of magnesium toxicity are decreased/loss of DTRs,
respiratory depression (<12/min), decreased urine output (<30 mL/hr), and
cardiac arrest if these are not recognized. Calcium gluconate (antidote)
should be readily available for cardiorespiratory compromise.
Antepartum
Pre-Eclampsia/Eclampsia
Test Id: 51538826
Question Id: 30616 (729561)
3 of 20
