Mod 8 ATI notes

high-risk pregnancy

A pregnancy in which risk factors or complications place the pregnant client and/or fetus at risk for poor outcomes.

biophysical factors

The physical and biological needs of the human body.

psychosocial factors

A person's psychological and/or social well-being can be affected by psychosocial circumstances. These elements might include social factors such as peer relationships, family circumstances, work or school colleagues, or traumatic experiences. Psychological factors may include self-esteem, emotional intelligence and temperament, and coping skills.

sociodemographic factors

Gender, age, education level, occupation, marital status, number of people living in the home as a whole, and living circumstances.

environmental factors

A person's exposure to chemicals or industrial waste where they live or work, such as lifestyle choices (such as smoking or a poor diet) that can raise a person's risk of disease, or stressful conditions (such as racism).

A nurse is caring for a client who is experiencing a high-risk pregnancy. Which of the following is a biophysical factor that can cause a high-risk pregnancy?

Genetics

Nutritional status

Obstetrical disorders

trisomy 21 (Down syndrome)

A genetic condition resulting in an extra chromosome 21 in some or all of the body’s cells. It is characterized by modest to severe delays in learning, development, and growth.

trisomy 18 (Edwards syndrome)

A hereditary condition characterized by low birth weight and a few aberrant traits. It is brought on by having an extra copy of chromosome 18 in some or all of the body's cells.

food insecurity

Having inconsistent access to food.

A nurse is caring for a client who was obese prior to conception. For which of the following complications is this client at risk?

Gestational diabetes

Preeclampsia

Preterm birth

Fetal demise

Spontaneous abortion

hyperglycemia

Elevated blood glucose.

macrosomia

A fetus or newborn who is larger than average (4,000 to 4,500 g [9 to 10 lb]).

cesarean birth

Birth of a neonate during a surgery in which the client’s abdomen is cut to allow for birth; sometimes referred to as surgical birth.

stillbirth

When a fetus dies inside the uterus after 20 weeks of gestation

hypoglycemia

Decreased blood glucose.

polyhydramnios

Excessive amount of amniotic fluid surrounding the fetus in pregnancy.

neonate

Infant less than 1 month old; also called a newborn.

A nurse is caring for a pregnant client who has gestational diabetes and has had a cesarean birth. What process could cause this newborn to have hypoglycemia following birth? 

The nurse should identify that the newborn is at risk for increased insulin production and fetal hypoglycemia

eclampsia

Seizure activity stemming from the most severe form of pregnancy hypertension.

uteroplacental insufficiency

A syndrome in which the placental vascular remodeling fails, impairing placentation and causing acidosis and fetal hypoxia.

fetal growth restriction

Fetal weight less than the 10th percentile, as estimated via ultrasound.

A nurse is caring for a pregnant client who has preeclampsia. Which of the following is this client at risk for? 

Fetal hypoxia  

Seizures

Fetal demise

A nurse is caring for a pregnant client who has a seizure disorder and is taking phenytoin. Which of the following is this client at risk for?

Decreased vitamin D absorption

chorioamnionitis

An infection within the amniotic sac.

endometritis

An infection in the lining of the uterus.

placental abruption

Occurs when the placenta detaches from the uterine wall.

myxedema

An extreme form of hypothyroidism.

Which of the following medical conditions can place a pregnant client at risk?

Hyperglycemia

Hypertension

Sexually transmitted infections (STIs)

Thyroid dysfunction

Asthma

uterine fibroids

Benign tumors inside the uterus.

placenta previa

Occurs when the placenta is covering the cervical os, either partially or completely.

postpartum hemorrhage

Cumulative blood loss greater than 1,000 mL with manifestations of hypovolemia within 24 hr of birth, regardless of the route of birth.​​​​​​​

myomectomy

Surgical removal of fibroids.

uterine rupture

A full tear in the uterus' three layers. It most frequently takes place during a trial of labor that follows a previous surgical birth.

hysterectomy

Surgical removal of all or part of the uterus.

cerebral palsy

A disorder affecting movement and coordination as a result of brain damage at or prior to birth.

Which of the following fetal complications is associated with multifetal pregnancy?

Cerebral palsy

Preeclampsia

Gestational diabetes

Low birth weight

sudden unexpected infant death (SUID)

The unexpected death of an infant under the age of 1 year. Prior to investigation, there may not be a known cause of death.

fetal alcohol spectrum disorders (FASDs)

A spectrum of manifestations, which includes medical issues, behavioral issues, and learning difficulties, that can affect a person who was exposed to alcohol before birth.

A nurse is performing a health interview on a client who is newly confirmed pregnant. The client reports current use of smoking, alcohol, and cocaine use. Which of the following factors increase the client’s risk of fetal demise? 

History of smoking

History of alcohol use

History of cocaine use

A nurse is caring for a pregnant client who has perinatal anxiety. Which of the following are manifestations of perinatal anxiety?

Panic attack

Feelings of doom 

Excessive worry

preterm premature rupture of membranes (PPROM)

The rupture of the amniotic membranes before term or 37 weeks of gestation.

Apgar score

Evaluation of neonate’s overall condition at birth by a registered nurse or provider. Scoring is based on the following parameters: activity, pulse, grimace, appearance, and respiration. The test is usually performed twice (at 1 min and 5 min of life).

A nurse is caring for an adolescent client who is pregnant. Which of the following is a risk factor for adolescent pregnancy?

Lack of parental support

Poverty

Substance abuse

multiparous

Two or more viable pregnancies defined as lasting at least 20 weeks.

gestational hypertension

Systolic blood pressure reading of 140 mm Hg or higher and/or diastolic blood pressure of 90 mm Hg or higher on at least two occasions, 4 hr apart, after 20 weeks of gestation, in clients who previously presented with expected blood pressure readings, with blood pressure readings returning to expected values during the postpartum period.

nulliparous

A client who has never given birth.

primiparous

A client experiencing a first pregnancy that has reached at least 20 weeks gestation.

A nurse is caring for a 38-year-old client who is pregnant and has preeclampsia. Which of the following disorders is this client at increased risk for in the future?

Cardiovascular disease

Effect of Lead Exposure on the Growing Fetus

• Small for gestational age

• Low birth weight

• Preterm birth

• Damage to renal system and other organs

• Neurocognitive impairment

• Behavioral impairment 

• Increased risk for ADHD

• Fetal malformation

• Encephalopathy

• Impaired motor control

anecdotal findings

Data that is gathered through observation and report of experiences rather than through experimental studies. ​​​​​​​

A nurse is caring for a pregnant client who has been found to have an elevated serum lead level. Which of the following sources reported by the client should the nurse suspect as the likely cause of lead exposure?

Lives within 1 mile of an airport

Toxoplasmosis

protozoal infection that can result from having contact with feline feces in either litter boxes or contaminated soil, eating unwashed or unpeeled and uncooked fruits or vegetables, handling raw meat without washing hands, or eating undercooked meat from infected animals.

A nurse is teaching a pregnant client about safe food choices during pregnancy. Which of the following foods should the nurse include in the teaching?

Grilled salmon

cervical insufficiency

Dilatation of the cervix without labor, resulting in loss of the pregnancy.

A nurse is evaluating a new client at their first prenatal visit. Which of the following factors is a possible risk factor for a high-risk pregnancy?

The client is employed as an x-ray technician.

The client has two outdoor cats and enjoys vegetables from the garden in the yard.

A nurse is caring for a client who is newly pregnant and has chronic hypertension and asthma. Which of the following statements should the nurse make when discussing this pregnancy and prenatal testing?

“Because you have chronic hypertension and asthma, we will monitor you closely and perform prenatal testing regularly to identify any problems early.”   

chronic hypertension

Hypertension diagnosed prior to pregnancy or a systolic blood pressure of 140 mm Hg or higher and/or a diastolic blood pressure of 90 mm Hg or higher on at least two occasions, 4 hr apart, before 20 weeks of gestation.

HELLP syndrome

H (hemolysis, the rupture of red blood cells), EL (elevated liver enzymes), and LP (low platelet count); a life-threatening complication often associated with preeclampsia.​​​​​​​

During each routine prenatal visit, clients should expect to have which of the following tests performed?

Blood pressure measurement

acute kidney injury (AKI)

An episode of renal injury or failure with a rapid onset.

cholestasis

Sluggish or poor flow of bile through the biliary system.

biophysical profile (BPP)

An ultrasound assessment, lasting a maximum of 30 min, that assesses fetal well-being and is paired with a fetal heart rate tracing.

A nurse is caring for a pregnant client who is suspected of having cholestasis of pregnancy. Which of the following lab studies should the nurse anticipate the provider prescribing?

Chemistry panel

Liver function studies

Bile acid levels

oligohydramnios

Less-than-typical amount of amniotic fluid surrounding the fetus in pregnancy.

intrahepatic cholestasis

A disease that hinders the liver cells' ability to excrete bile.

A nurse is teaching a nursing student about risk factors for fetal demise. Which of the following risk factors should the nurse include in the teaching?

Oligohydramnios   

Intrahepatic cholestasis

Previous fetal demise

quickening

Early fetal movements, typically felt between 16 to 20 weeks of gestation, that are often described as fluttering, small muscle spasms, gas bubbles, flickering, tapping, or pulsations.

nonstress test (NST)

A noninvasive test used during the third trimester of pregnancy to assess fetal well-being.

ultrasound

A diagnostic test that uses high-frequency sound waves to create a picture of the fetus, placenta, and cord. Also referred to as a sonogram.

Doppler velocimetry

A type of ultrasound used to evaluate blood supply to the umbilical cord or placenta.

chorionicity

The count of placentas noted during a multifetal pregnancy.

amnionicity

The count of amniotic sacs noted during a multifetal pregnancy.

chorionic villus sampling (CVS)

Removal of a small section of the placenta for genetic testing.

amniocentesis

A diagnostic test performed during pregnancy that involves withdrawing amniotic fluid from the amniotic sac to detect chromosomal anomalies or to measure fetal lung maturity.

prelabor rupture of membranes (PROM)

The rupture of amniotic membranes between weeks 37 and 40 in a term pregnancy, before labor starts; sometimes referred to as premature rupture of membranes. ​​​​​​​

twin-to-twin transfusion syndrome

Twin gestations that share a single placenta but two amniotic sacs and in which one twin has oligohydramnios while the other twin has polyhydramnios.

malpresentation

When the fetus is not head-down in the birth canal.

Which of the following maternal conditions contributes to oligohydramnios?

Preeclampsia

Diabetes

Hypertension

Placental insufficiency

Premature rupture of membranes (PROM)

prelabor rupture of membranes (PROM)

The rupture of amniotic membranes between weeks 37 and 40 in a term pregnancy, before labor starts; sometimes referred to as premature rupture of membranes. 

preterm prelabor rupture of membranes (PPROM)

The rupture of the amniotic membranes before term or 37 weeks of gestation. ROM may or may not be associated with preterm labor. 

neonatal respiratory distress syndrome (RDS)

Neonate who lacks adequate surfactant production, causing respiratory distress. Commonly seen in preterm infants.

fetal lung hypoplasia

Inadequate lung development that may have an impact on a child's overall development. It usually results in the fetus having significant respiratory insufficiency and can either be primary (idiopathic) or due to other congenital anomalies.

intraventricular hemorrhage (IVH)

Bleeding inside or around the ventricles in the brain that contain the cerebrospinal fluid.

ferning

A fern-like pattern when examined under a microscope, such as with dried amniotic fluid.

A nurse is caring for a pregnant client at 35 weeks of gestation whose membranes have ruptured. Which of the following should the nurse suspect as contributing to the rupture of membranes?

Client pregnant with twins 

Decreased copper level

Amniotic fluid infection

Uterine contractions       

A client in their first trimester has been instructed to count fetal kicks by their provider.

The nurse should tell the client to

count the times the fetus moves or kicks in 1 hour

or

calculate how long it takes the fetus to move or kick 10 times

At 34 weeks of gestation, Isabel was diagnosed with oligohydramnios. The nurse has just reviewed how to perform fetal kick counts with her. Which of the following statements by the Isabel indicates understanding?

“I will perform kick counts daily for at least 1 hour.”

A clinic nurse is teaching a student nurse about decreased fetal movement. Which of the following conditions and complications can contribute to this condition?

Maternal hypertension

Renal disease

Oligohydramnios

Postterm pregnancy

Advanced ultrasound

Used to target suspected problems of pregnancy by using sophisticated equipment

Doppler ultrasound

Used to measure slight variations in the frequency of ultrasound waves when they encounter moving objects, such as blood cells

3D ultrasound

Generates three-dimensional images of the fetus

4D or dynamic 3D ultrasound

Uses scanners to view the fetus’s face and fetal movements prior to birth

Fetal echocardiogram

Uses ultrasound to evaluate the anatomy and function of the fetal heart to identify congenital heart defects

A nurse is caring for a pregnant client whose fetus is suspected of having a congenital heart defect. Which of the following tests should the nurse anticipate the provider will prescribe for this client? 

Fetal echocardiogram   

nonviable

Unable to survive.

A nurse is reviewing the electronic medical record of a client who is Rh negative and is scheduled for an amniocentesis that day. Which of the following findings should the nurse identify as a contraindication to the procedure?

The client reports taking aspirin yesterday.

aneuploidy

An imbalanced chromosomal complement caused by one or more extra or missing chromosomes.

alpha-fetoprotein (AFP)

A blood test performed during pregnancy to identify the fetus’s risk of birth defects.

spina bifida

A disorder that occurs along the spine if the neural tube does not fully close.

A nurse is teaching a pregnant client about the alpha-fetoprotein test (AFP). Which of the following statements should the nurse include in the teaching?

“Because you have diabetes, an AFP is recommended to screen for genetic problems.”

“Because you are over age 35, an AFP is recommended to screen for genetic problems.”

“Given your family history of birth defects, an AFP is recommended to screen for genetic problems.”