A nurse is caring for a client at 35 weeks of gestation who has preeclampsia with severe features and is scheduled for an immediate induction of labor after the manifestations worsened. The client is upset because the provider has disregarded their birth plan. Which of the following considerations should the nurse implement for the client?

Antenatal steroid administration

Expectant management protocols

Method of birth

Shared decision-making

Answer and Explanation

The Correct Answer is D

A. Antenatal steroid administration: Antenatal steroids (e.g., betamethasone) are used to enhance fetal lung maturity in preterm pregnancies (<34 weeks). At 35 weeks, steroids are generally not indicated.

B. Expectant management protocols: Expectant management (delaying delivery with close monitoring) is considered in mild preeclampsia but is not appropriate in severe preeclampsia due to the risk of maternal and fetal complications.

C. Method of birth: The method of birth (vaginal vs. C-section) is determined based on maternal and fetal conditions. While important, it is not the key consideration in addressing the client's concern about their birth plan.

D. Shared decision-making: Shared decision-making ensures that the client feels heard and involved in their care plan, even in urgent situations. The nurse should acknowledge the client's concerns, explain the rationale for induction, and explore possible accommodations for their birth plan.

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Correct Answer is D

Explanation

A. "It is useful for estimating fetal age." While ultrasound can estimate fetal age, the primary purpose before amniocentesis is to guide needle placement.

B. "This will determine if there is more than one fetus." Although ultrasound can detect multiple pregnancies, this is not its main function before amniocentesis.

C. "This is a screening tool for spina bifida." Ultrasound can assist in detecting neural tube defects, but amniocentesis is primarily used for genetic testing.

D. "It assists in identifying the location of the placenta and fetus."Ultrasound helps determine the safest location for needle insertion to avoid injuring the fetus or placenta.

A. Urinary output 40 mL in 2 hr B. Fetal heart rate 158/min C. Reflexes +2 D. Respirations 16/min

Correct Answer is A

Explanation

A. Urinary output 40 mL in 2 hr: Oliguria (urine output < 30 mL/hr) is a sign of magnesium toxicity, which can lead to respiratory depression, loss of reflexes, and cardiac arrest. The kidneys excrete magnesium, and impaired renal function increases toxicity risk. This finding requires immediate action.

B. Fetal heart rate 158/min: A fetal heart rate of 158 bpm is within the normal range (110-160 bpm) and is not a priority concern.

C. Reflexes +2: A +2 reflex response is normal. In magnesium toxicity, reflexes become diminished or absent (+1 or 0), indicating neuromuscular depression.

D. Respirations 16/min: While respiratory depression is a concern with magnesium sulfate, a respiratory rate of 16 breaths/min is within normal limits (12-20 bpm) and does not require immediate intervention. However, monitoring is still necessary.

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Naxlex Comprehensive Predictor Exams

A nurse in a provider's office is caring for a client who is at 36 weeks of gestation and scheduled for an amniocentesis. The client asks why she is having an ultrasound prior to the procedure. Which of the following is an appropriate response by the nurse?

Correct Answer is D

Explanation

A nurse is assessing a client who is receiving magnesium sulfate as a treatment for preeclampsia. Which of the following clinical findings is the nurse's priority?

Correct Answer is A

Explanation

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A nurse receives a report about a client who is in labor and is having contractions 3 min apart. Which of the following patterns should the nurse expect on the fetal monitoring tracing?

What is considered a reactive nonstress test (NST)?

Which of the following is a sign that childbirth labor is likely to begin?

A nurse is admitting a client who has severe preeclampsia at 35 weeks of gestation and is reviewing the provider's orders. Which of the following orders requires clarification?

A nurse is caring for an adolescent client who is gravida 1 and para 0. The client was admitted to the hospital at 38 weeks of gestation with a diagnosis of preeclampsia. Which of the following findings should the nurse identify as inconsistent with preeclampsia?

A nurse is caring for a client who has preeclampsia and is being treated with magnesium sulfate IV. The client's respiratory rate is 10/min and deep-tendon reflexes are absent. Which of the following actions should the nurse take?

The nurse in a health care clinic is instructing a pregnant client how to perform "kick counts." Which statement by the client indicates a need for further instruction?