MATERNITY
A A A
The nurse reviews laboratory test results for a pregnant client at 32 weeks gestation. What
is the nurse's best action based on these results? Click on the exhibit button for additional
information.
Laboratory results
Hemoglobin 11.4 g/dL (114 g/L)
Hematocrit 34% (0.34)
Red ...
MATERNITY
A A A
The nurse reviews laboratory test results for a pregnant client at 32 weeks gestation. What
is the nurse's best action based on these results? Click on the exhibit button for additional
information.
Laboratory results
Hemoglobin 11.4 g/dL (114 g/L)
Hematocrit 34% (0.34)
Red blood cells 5.3 x 106/mm3 (5.3 x 1012/L)
White blood cells 14,000/mm³ (14.0 x 109/L)
Platelets 230,000/mm3 (230 x 109/L)
1. Complete the client assessment and documentation [56%]
2. Draw another sample for repeat complete blood count [7%]
3. Prepare for transfusion of packed red blood cells [9%]
4. Request a prescription for iron supplementation [26%]
EXPLANATION:
Pregnant women experience a 40%-45% increase in total blood volume during pregnancy
to meet the increased oxygen demand and nutritional needs of the growing fetus and
maternal tissues. Because the increase in plasma volume is greater than the increase in red
,blood cells, a hemodiluted state called physiologic anemia of pregnancy occurs, and is
reflected in lower hemoglobin and hematocrit values. It is also normal for the white blood
cell count to increase during pregnancy; counts can be as high as 15,000/mm3 (15.0 x
109/L).
These laboratory results are within the normal ranges for a pregnant client in the third
trimester, and no intervention is required (Options 1 and 2).
(Option 3) A blood transfusion should not be considered in pregnancy unless severe
anemia (hemoglobin <7.0 g/dL [<70 g/L]) is suspected.
(Option 4) Iron is frequently prescribed for pregnant women to prevent or treat iron
deficiency anemia (hemoglobin ≤11 g/dL [110 g/L] and hematocrit ≤33% [0.33]).
However, this pregnant client's laboratory results are within normal ranges, and iron
supplementation is not necessary.
Educational objective:
Pregnant women experience an increase in total blood volume to meet the increased
oxygen demand and nutritional needs of the growing fetus and maternal tissues. The
increase in plasma volume is greater than the increase in red blood cells, creating a
hemodiluted state termed physiologic anemia of pregnancy, which is reflected in decreased
hemoglobin (>11.0 g/dL [>110 g/L]) and hematocrit (>33% [0.33]) values.
A A A
The nurse is preparing a nutritional teaching plan for a client planning to become pregnant.
Which foods would best prevent neural tube defects?
1. Calcium-rich snacks [7%]
2. Fortified cereals [68%]
3. Organ meats [16%]
4. Wild salmon [7%]
Explanation:
Women who are planning on becoming pregnant should consume 400-800 mcg of folic acid
daily. Food options that are rich in folic acid include fortified grain products (eg, cereals,
bread, pasta) and green, leafy vegetables (Option 2). Inadequate maternal intake of folic
acid during the critical first 8 weeks after conception (often before a woman knows she is
pregnant) increases the risk of fetal neural tube defects (NTDs), which inhibit proper
development of the brain and spinal cord. Common NTDs are spina bifida and anencephaly
(lack of cerebral hemispheres and overlying skull).
(Option 1) Adequate calcium intake is especially important during the last trimester for
mineralization of fetal bones and teeth, but it does not prevent NTDs.
,(Option 3) Organ meats (eg, liver) may contain moderately high levels of folate but are
consumed more for their high iron content, which can promote red blood cell formation
and prevent maternal anemia.
(Option 4) A prenatal diet rich in omega-3 fatty acids is important for fetal neurologic
function and is linked to a lower risk of preterm birth. Dietary sources include wild salmon,
anchovies, flaxseed, and walnuts.
Educational objective:
Women who are planning to become pregnant should consume 400-800 mcg of folic acid
daily to prevent neural tube defects (eg, spina bifida, anencephaly). Food options that are
rich in folic acid include fortified grain products (eg, cereals, bread, pasta) and green, leafy
vegetables.
A A A
A pregnant client at 30 weeks gestation comes to the prenatal clinic. Which vaccines may
be administered safely at this prenatal visit? Select all that apply.
1. Influenza injection
2. Influenza nasal spray
3. Measles, mumps, and rubella
4. Tetanus, diphtheria, and pertussis
5. Varicella
Explanation:
Health promotion during pregnancy includes the administration or avoidance of certain
vaccines to decrease risks to mother and fetus. Pregnant women have suppressed immune
systems and are at increased risk for illness and subsequent complications. Some viruses
(eg, rubella, varicella) can cause severe birth defects if contracted during pregnancy.
Inactivated vaccines contain a "killed" version of the virus and pose no risk of causing
illness from the vaccine. Some vaccines contain weakened (ie, attenuated) live virus and
pose a slight theoretical risk of contracting the illness from the vaccine. For this reason,
women should not receive live virus vaccines during pregnancy or become pregnant within
4 weeks of receiving such a vaccine.
The tetanus, diphtheria, and pertussis (Tdap) vaccine is recommended for all pregnant
women between the beginning of the 27th and the end of the 36th week of gestation as it
provides the newborn with passive immunity against pertussis (whooping cough) (Option
4).
, During influenza season (October-March), it is safe and recommended for pregnant women
to receive the injectable inactivated influenza vaccine regardless of trimester (Option 1).
(Options 2, 3, and 5) The influenza nasal spray; measles, mumps, and rubella (MMR)
vaccine; and varicella vaccine contain live viruses and are contraindicated in pregnancy.
Educational objective:
Inactivated vaccines (eg, inactivated influenza; tetanus, diphtheria, and pertussis) may be
given during pregnancy to protect pregnant clients from illness and provide the fetus with
passive immunity. Live virus vaccines are contraindicated in pregnancy.
A A A
A client at 39 weeks gestation with preeclampsia has a blood pressure of 170/100 mm Hg,
2+ proteinuria, and moderate peripheral edema. Immediately after hospital admission, she
develops seizures and uterine contractions. Magnesium sulfate is prescribed. Which
finding indicates that the drug has achieved the desired therapeutic effect?
1. Blood pressure <130/80 mm Hg [24%]
2. Seizure activity stops [55%]
3. Urine has 1+ protein [1%]
4. Uterine contractions stop [18%]
Explanation:
Preeclampsia is a systemic disease characterized by hypertension and proteinuria after the
20th gestational week with unknown etiology. Eclampsia is the onset of convulsions or
seizures that cannot be attributed to other causes in a woman with preeclampsia. Delivery
is the only cure for preeclampsia-eclampsia syndrome.
Magnesium sulfate is a central nervous system depressant used to prevent/control seizure
activity in preeclampsia/eclampsia clients. During administration, the nurse should assess
vital signs, intake and output, and monitor for signs of magnesium toxicity (eg, decreased
deep-tendon reflexes, respiratory depression, decreased urine output). A therapeutic
magnesium level of 4-7 mEq/L (2.0-3.5 mmol/L) is necessary to prevent seizures in a
preeclamptic client.
(Option 1) Hypertension is a sign of preeclampsia. Hydralazine (Apresoline), methyldopa
(Aldomet), or labetalol (Trandate) is used to lower blood pressure (BP) if needed (usually
considered when BP is >160/110 mm Hg).
(Option 3) Proteinuria is a symptom of preeclampsia. Control of hypertension and delivery
will reduce the protein level. Magnesium sulfate is not prescribed to decrease proteinuria.
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