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Archer Maternal & Newborn Health Exam
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Archer Maternal & Newborn Health Exam Archer Maternal & Newborn Health Exam Archer Maternal & Newborn Health Exam
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Archer Maternal & Newborn Health ExamA nurse in a gynecology clinic is assessing a first-time client (G1P0) who is eight weeks pregnant. Which
assessment finding would alert the nurse of a high-risk pregnancy?
A. The client reports nausea and vomiting four to five mornings per week.
B. The client expresses her ambivalence toward the pregnancy to the nurse.
C. The client reports intermittent constipation since learning she was pregnant.
D. The client reports intermittent vaginal spotting and abdominal cramping. - CORRECT ANS Explanation
Choice D is correct. The first sign of threatened abortion is vaginal bleeding, which is relatively common
during early pregnancy. Approximately 25% of pregnant women experience "spotting" or bleeding in
early pregnancy, and up to 50% of these pregnancies end in spontaneous abortion. Vaginal bleeding,
which may be brief or last for weeks, may be accompanied by uterine cramping, persistent backache, or
feelings of pelvic pressure. These added symptoms are more likely to be associated with loss of
pregnancy.
Choice A is incorrect. Nausea and vomiting are a result of fluctuating hormone levels during pregnancy.
Unless nausea and vomiting cause severe dehydration and electrolyte loss, the pregnancy is not
considered in jeopardy.
Choice B is incorrect. Ambivalence is a normal emotional response to pregnancy, especially in early
pregnancy, when the mother realizes a separate individual is growing inside her. The mother may have
various feelings, including excitement, anxiety, apprehension, trepidation, worry, fear, eagerness, and
anticipation. Moreover, various factors pertaining to the relationship with the father of the child may
influence the client's emotional response to the pregnancy.
Choice C is incorrect. Increased progesterone level is associated with the relaxation of smooth muscles,
resulting in stasis of urine and increasing the risk for urinary tract infections and constipation.
Learning Objective
Correlate vaginal spotting and abdominal cramping in the early stages of pregnancy as the first signs of a
threatened abortion, rendering the client a high-risk pregnancy.
,Additional Info
Women should be advised to notify their health care provider (HCP) if brownish or red vaginal bleeding
is noted.
Bleeding during the first half of pregnancy should be considered a threatened abortion.
The nurse should
The nurse is caring for a client at 32 gestational weeks. Which laboratory data should be reported to the
primary healthcare provider (PHCP)? Select all that apply.
A. Hemoglobin 11.5 g/dL
B. Platelets 90,000 mm3
C. Fasting blood glucose 254 mg/dL
D. White blood cell 9,500 mm3
E. Creatinine 3.9 mg/dL - CORRECT ANS Explanation
Choices B, C, and E are correct. These laboratory values are abnormal and require follow-up. A platelet
count of fewer than 150,000 mm3 is concerning for thrombocytopenia and suggests severe
preeclampsia. The blood glucose is significantly elevated as the normal fasting blood glucose is 70-100
mg/dL. This client has clinical hyperglycemia and requires follow-up. Finally, the creatinine is quite
elevated, suggesting acute kidney injury. This, combined with a low platelet count, is more convincing of
severe preeclampsia.
Choices A and D are incorrect. These findings are within normal limits. For a client who is pregnant, the
normal hemoglobin level may decrease to 11.5 g/dL without any intervention. Finally, this white blood
cell count is normal (the normal range is 5000 - 10000 mm3).
Additional Info
The following are the clinical criteria for severe preeclampsia
,If one or more of the following criteria are present:
1. Blood pressure of ≥160 mm Hg systolic or ≥110 mm Hg diastolic or higher on two occasions at least 6
hr apart while the patient is on bed rest
2. Oliguria of <500 mL in 24 hr
3. Cerebral or visual disturbances
4. Pulmonary edema or cyanosis
5. Epigastric or right upper quadrant pain
6. Impaired liver function as indicated by abnormally elevated blood concentrations of liver enzymes
(to twice normal concentration), severe persistent right upper quadrant or epigastric pain unresponsive
to medication and not accounted for by alternative diagnoses, or both
7. Thrombocytopenia
8. Renal insufficiency
Last Updated - 03, Nov 2022
Which of the following obstetrical procedures can be used to assist the head of the fetus during vaginal
delivery?
Select all that apply.
A. Amniotomy
B. Forceps assisted delivery
C. External version
D. Vacuum assisted delivery - CORRECT ANS Explanation
Choices B and D are correct. Forceps are tools used to help pull on the head of the baby to assist with
the delivery. Vacuum-assisted delivery is a method where suction is applied to the head of the baby and
pulled while the mother pushes. This helps to deliver the head of the infant.
Choice A is incorrect. An amniotomy is the use of a hook or finger to break the amniotic sac. This helps
to induce labor but does not assist in the delivery of the head of the fetus.
, Choice C is incorrect. The external version is a technique used when the baby is not in an appropriate
position for vaginal delivery. The external cephalic version is used to turn a fetus from a breech position
or side-lying (transverse) position into a more favorable head-down (vertex) position to help prepare the
baby for a vaginal delivery. The external version is typically done before the labor begins, often around
37 weeks. Occasionally, it is done during labor but before the membranes have ruptured. If the amniotic
sac has ruptured or if there is not enough amniotic fluid around the fetus (oligohydramnios), external
version must not be done as it may end up injuring the fetus. External version does not directly assist in
the delivery of the head of the fetus.
NCSBN Client Need: Topic: Physiological Integrity Subtopic: Risk potential reduction
Last Updated - 19, Dec 2021
The nurse is assessing a client with preeclampsia. Which clinical findings should the nurse anticipate?
Select all that apply.
A. Hyperreflexia
B. Headache
C. Uncontrolled vomiting
D. Epigastric pain
E. Glycosuria
Submit Answer - CORRECT ANS Explanation
Choices A, B, and D are correct. Hyperreflexia, headache, and epigastric pain are typical symptoms of
preeclampsia. Preeclampsia is a pregnancy complication characterized by high blood pressure and signs
of damage to another organ system, most often the liver and kidneys. Hyperreflexia is a common finding
and may occur with ankle clonus. These findings arise because of neuromuscular irritability. Other
findings associated with preeclampsia include hypertension, facial swelling, and proteinuria.
Choice C is incorrect. Uncontrolled vomiting is the defining characteristic of hyperemesis gravidarum.
Glycosuria is not specific to preeclampsia. This finding could be expected or concerning for diabetes
mellitus. Proteinuria would be found in preeclampsia.
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