EDAPT: Nursing Care of the
High-Risk Mother
A gravida 2, para 1 (G2P1) at 35 weeks gestation is admitted with preeclampsia. During the
admission evaluation, the nurse notes that deep tendon reflexes are hyperactive, and blood
pressure is 156/ninety four mm Hg. Twenty-4 hours later, the purchaser's reflexes are more
and more hyperactive and her blood strain is 168/112 mm Hg. Which priority movements
must the nurse take?- ANS-Check the protein stage within the urine
Implement seizure precautions
A nurse is worrying for a purchaser identified with gestational diabetes mellitus. Which of the
subsequent, called the diagnostic gold fashionable, allows in confirming gestational
diabetes? - ANS-A three-hour glucose tolerance test (GTT)
A nurse is being concerned for a patron who's receiving intravenous magnesium sulfate to
deal with excessive preeclampsia. Which medication ought to the nurse administer if signs
and symptoms of toxicity are present? - ANS-Calcium gluconate
A nurse is coaching a client who is sixteen weeks gestation about danger symptoms at some
point of pregnancy that have to be stated straight away to the healthcare provider. Which
threat symptoms need to the nurse include within the teaching plan? - ANS-Persistent
vomiting that causes weight loss.
A pregnant patron is susceptible to growing seizures. Click to suggest whether every motion
is appropriate or now not appropriate. - ANS-*Appropriate:*
Maintain low stimulation surroundings
Keep facet rails padded
Have suction and oxygen to be had
Have calcium gluconate available
Ambulation with assistance simplest
Keep the room freed from litter
*Not Appropriate:*
Deny visitation
Use intermittent fetal tracking
A pregnant lady with a regarded vaginal contamination would not be a very good candidate
for which exertions interventions? Select all that practice. - ANS-Internal digital fetal tracking
Frequent vaginal assessments
Artificial rupture of membranes in early labor
A lady with gestational diabetes asks the nurse why she is having extra checking out done to
make sure that her estimated due date (EDD) is correct. Which declaration is the nurse's
satisfactory reaction? - ANS-"The fetus may also grow a chunk larger than traditional
, because of gestational diabetes, and an correct expected due date (EDD) allows us to
reveal your infant's length with regards to the gestational age."
Abruptio placentae is a hardship of being pregnant. What findings ought to the nurse reveal
if this circumstance is gift? Select all that practice.- ANS-Maternal hemorrhage
Misdiagnosed as labor
Fetal distress due to reduced perfusion
After transport, for which virus need to Kim's immunity popularity be checked and, if poor,
vaccination be provided?- ANS-Rubella
After fetal monitoring and assessment, it determines that Amy is not in exertions and the
fetus is well oxygenated. The nurse discusses with Amy approximately the chance signs of
pregnancy that must be stated without delay.
Based on Amy's cutting-edge assessment findings (eleven/19), which findings are
concerning and require further assessment? Select all that practice. - ANS-Absence or
decrease in fetal motion
Vaginal bleeding of any amount
Analyze the assessment findings and indicate whether or not every is related to abruptio
placentae or placenta previa. Select best one solution in every row. - ANS-*Abruptio
Placentae:*
Increased fundal height
Uterine tenderness and pressure
Painful vaginal bleeding
Common reason is preeclampsia
May have hid bleeding
*Placenta Previa:*
Painless vaginal bleeding
Can be diagnosed early in being pregnant and controlled
Often associated with fetal malposition
At which point is the chance for transmission of hepatitis B from mom to fetus highest?-
ANS-During vaginal shipping if the mother is fine for hepatitis B.
Based on Kim being concerned for her little one and now not having obtained the normal
formative years vaccines, Kim is at chance for infection with the aid of which organisms?
Select all that practice. - ANS-Hepatitis A
Hepatitis B
Rubella
Cytomegalovirus
Click to specify the 5 findings that require instantaneous observe-up.Select most effective
one answer for each row. - ANS-*Requires Follow-Up:*
Blood glucose stage one hundred sixty mg/dL
Decreased urine output
High-Risk Mother
A gravida 2, para 1 (G2P1) at 35 weeks gestation is admitted with preeclampsia. During the
admission evaluation, the nurse notes that deep tendon reflexes are hyperactive, and blood
pressure is 156/ninety four mm Hg. Twenty-4 hours later, the purchaser's reflexes are more
and more hyperactive and her blood strain is 168/112 mm Hg. Which priority movements
must the nurse take?- ANS-Check the protein stage within the urine
Implement seizure precautions
A nurse is worrying for a purchaser identified with gestational diabetes mellitus. Which of the
subsequent, called the diagnostic gold fashionable, allows in confirming gestational
diabetes? - ANS-A three-hour glucose tolerance test (GTT)
A nurse is being concerned for a patron who's receiving intravenous magnesium sulfate to
deal with excessive preeclampsia. Which medication ought to the nurse administer if signs
and symptoms of toxicity are present? - ANS-Calcium gluconate
A nurse is coaching a client who is sixteen weeks gestation about danger symptoms at some
point of pregnancy that have to be stated straight away to the healthcare provider. Which
threat symptoms need to the nurse include within the teaching plan? - ANS-Persistent
vomiting that causes weight loss.
A pregnant patron is susceptible to growing seizures. Click to suggest whether every motion
is appropriate or now not appropriate. - ANS-*Appropriate:*
Maintain low stimulation surroundings
Keep facet rails padded
Have suction and oxygen to be had
Have calcium gluconate available
Ambulation with assistance simplest
Keep the room freed from litter
*Not Appropriate:*
Deny visitation
Use intermittent fetal tracking
A pregnant lady with a regarded vaginal contamination would not be a very good candidate
for which exertions interventions? Select all that practice. - ANS-Internal digital fetal tracking
Frequent vaginal assessments
Artificial rupture of membranes in early labor
A lady with gestational diabetes asks the nurse why she is having extra checking out done to
make sure that her estimated due date (EDD) is correct. Which declaration is the nurse's
satisfactory reaction? - ANS-"The fetus may also grow a chunk larger than traditional
, because of gestational diabetes, and an correct expected due date (EDD) allows us to
reveal your infant's length with regards to the gestational age."
Abruptio placentae is a hardship of being pregnant. What findings ought to the nurse reveal
if this circumstance is gift? Select all that practice.- ANS-Maternal hemorrhage
Misdiagnosed as labor
Fetal distress due to reduced perfusion
After transport, for which virus need to Kim's immunity popularity be checked and, if poor,
vaccination be provided?- ANS-Rubella
After fetal monitoring and assessment, it determines that Amy is not in exertions and the
fetus is well oxygenated. The nurse discusses with Amy approximately the chance signs of
pregnancy that must be stated without delay.
Based on Amy's cutting-edge assessment findings (eleven/19), which findings are
concerning and require further assessment? Select all that practice. - ANS-Absence or
decrease in fetal motion
Vaginal bleeding of any amount
Analyze the assessment findings and indicate whether or not every is related to abruptio
placentae or placenta previa. Select best one solution in every row. - ANS-*Abruptio
Placentae:*
Increased fundal height
Uterine tenderness and pressure
Painful vaginal bleeding
Common reason is preeclampsia
May have hid bleeding
*Placenta Previa:*
Painless vaginal bleeding
Can be diagnosed early in being pregnant and controlled
Often associated with fetal malposition
At which point is the chance for transmission of hepatitis B from mom to fetus highest?-
ANS-During vaginal shipping if the mother is fine for hepatitis B.
Based on Kim being concerned for her little one and now not having obtained the normal
formative years vaccines, Kim is at chance for infection with the aid of which organisms?
Select all that practice. - ANS-Hepatitis A
Hepatitis B
Rubella
Cytomegalovirus
Click to specify the 5 findings that require instantaneous observe-up.Select most effective
one answer for each row. - ANS-*Requires Follow-Up:*
Blood glucose stage one hundred sixty mg/dL
Decreased urine output
