109 Midterms Transes
109 Midterms Transes
109 Midterms Transes
Key Facts
NATIONAL HEALTH SITUATION IN THE PHILIPPINES ON
MATERNAL AND CHILD NURSING Every day in 2017, approximately 810 women died from
preventable causes related to pregnancy and childbirth.
The Philippines has made significant investments and
Between 2000 and 2017, the maternal mortality ratio
advances in health in recent years. Rapid economic
(MMR, number of maternal deaths per 100,000 live
growth and strong country capacity have contributed to
births) dropped by about 38% worldwide.
Filipinos living longer and healthier. However, not all the
94% of all maternal deaths occur in low and lower
benefits of this growth have reached the most
middle-income countries.
vulnerable groups, and the health system remains
Young adolescents (ages 10-14) face a higher risk of
fragmented.
complications and death as a result of pregnancy than
Health insurance now covers 92% of the population.
other women.
Maternal and child health services have improved, with
Skilled care before, during and after childbirth can save
more children living beyond infancy, a higher number of
the lives of women and newborns.
women delivering at health facilities and more births
being attended by professional service providers than Causes
ever before.
Access to and provision of preventive, diagnostic and Women die as a result of complications during and following
treatment services for communicable diseases have pregnancy and childbirth. Most of these complications develop
improved, while there are several initiatives to reduce during pregnancy and most are preventable or treatable. Other
illness and death due to noncommunicable diseases complications may exist before pregnancy but are worsened
(NCDs). Despite substantial progress in improving the during pregnancy, especially if not managed as part of the
lives and health of people in the Philippines, woman’s care. The major complications that account for nearly
achievements have not been uniform and challenges 75% of all maternal deaths are (4):
remain.
severe bleeding (mostly bleeding after childbirth)
Deep inequities persist between regions, richand the
poor, and different population groups. Many Filipinos infections (usually after childbirth)
continue to die or suffer from illnesses that have well- high blood pressure during pregnancy (pre-eclampsia
proven, cost-effective interventions, such tuberculosis, and eclampsia)
HIV and dengue, or diseases affecting mothers and complications from delivery
children. Many people lack sufficient knowledge to unsafe abortion.
make informed decisions about their own health. Rapid
The remainder are caused by or associated with infections such as
economic development, urbanization, escalating climate
malaria or related to chronic conditions like cardiac diseases or
change, and widening exposure to diseases and
diabetes.
pathogens in an increasingly global world increase the
risks associated with disasters, environmental threats,
and emerging and re-emerging infections
PHILIPPINES
STATISTICS ON MCN
Chart and table of the Philippines infant mortality rate from 1950
Worldwide to 2021. United Nations projections are also included through the
year 2100
Maternal mortality refers to deaths due to
complications from pregnancy or childbirth. From 2000 The current infant mortality rate for Philippines in 2021
to 2017, the global maternal mortality ratio declined by is 18.392 deaths per 1000 live births, a 2.25% decline
38 per cent – from 342 deaths to 211 deaths per from 2020.
100,000 live births, according to UN inter-agency The infant mortality rate for Philippines in 2020 was
estimates. This translates into an average annual rate of 18.815 deaths per 1000 live births, a 2.2% decline from
reduction of 2.9 per cent. While substantive, this is less 2019.
than half the 6.4 per cent annual rate needed to achieve
Unit 1 - Framework For Maternal And Child Health Nursing Focusing On At-Risk, High Risk And Sick Clients
The infant mortality rate for Philippines in 2019 was - In humans, each cell, with the excemption of the
19.239 deaths per 1000 live births, a 2.16% decline from sperm and ovum, contains 46 chromosomes (44
2018. autosomes and 2 sex chromosomes)
The infant mortality rate for Philippines in 2018 was - Spermatozoa and ova each carry 23 chromosomes
19.663 deaths per 1000 live births, a 3.96% decline from (1/2)
2017. - For each chromosome in the sperm cell, there is a
like chromosome of similar shape and size and
According to UNICEF function in the egg cell (AUTOSOME)
WESTERN VISAYAS
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of being a heterozygous for a trait (brown eyed – • There is usually a history of the disorder in other family
phenotype) that will carry a recessive gene for blue eyes members
(genotype).
Example:
• If the father is heterozygous (has one dominant and one
recessive gene), a child born to this couple has equal • HUNTINGTON DISEASE
chance to have brown eyes or blue eyes – A progressive neurologic disorder that usually
• Suppose the mother is heterozygous, and the father is manifests symptoms between 35 and 45 years
homozygous dominant, the chances are equal that their of age and is characterized by loss of motor
child will be homozygous dominant like the father or control and intellectual deterioration.
heterozygous like the mother. All the children’s – Analyzing a specific gene in chromosome 4
phenotype will be brown eyes
– No cure
• Suppose both parents are heterogenous:
• FACIOSCAPULOHUMERAL muscular dystrophy
There is a 25% chance of their child to being
homozygous recessive (appearing blue eyed), 50% – A disorder that result to muscle weakness
chance of being heterozygous (appearing brown eyed)
and 25% homozygous dominant (appearing brown eyed)
INHERITANCE OF DISEASE
– More than 3,000 ADD are known only a few • OSTEOGENESIS IMPERFECTA
are commonly seen.
– A disorder in which bones are exceedingly
– Most of them cause structural defects. brittle
Rule (ADD)
Karyotyping.
For karyotyping, a sample of peripheral venous blood or
a scraping of cells from the buccal membrane is taken.
Cells are allowed to grow until they reach metaphase,
the most easily observed phase. Cells are then stained,
placed under a microscope, and photographed.
Chromosomes are identified according to size, shape,
AUTOSOMAL RECESSIVE DISORDERS and stain; cut from the photograph, and arranged.
– Biochemical or enzymatic
– Do not occur unless 2 genes for a disease are
Maternal Serum Screening.
present (homozygous recessive pattern)
Alpha-fetoprotein (AFP) is a glycoprotein produced by
– Examples: Cystic fibrosis, adrenogenital
the fetal liver that reaches a peak in maternal serum
syndrome, albinism, Tay-sachs disease,
between the 13th and 32nd week of pregnancy. The
galactosemia, phenylketonuria, limb-girdle
level is elevated with fetal spinal cord disease (more
muscular dystrophy and RH factor
than twice the value of the mean for that gestational
incompatibility.
age) and is decreased in a fetal chromosomal disorder
GENOGRAM such as trisomy 21.
• Both parents are disease free but both are heterozygous Chorionic Villi Sampling.
in genotype. CVS is a diagnostic technique that involves the retrieval
and analysis of chorionic villi from the growing placenta
• The sex of the affected individual is unimportant
for chromosome or DNA analysis. The test is highly
• The family history for the disorder is negative accurate and yields no more false-positive results than
does amniocentesis.
• A known common ancestor between the parents
sometimes exist. Amniocentesis.
Amniocentesis is the withdrawal of amniotic fluid
through the abdominal wall for analysis at the 14th to
SCREENING AND DIAGNOSTIC TESTING 16th week of pregnancy. Because amniotic fluid has
reached about 200 mL at this point, enough fluid can be
Pre-pregnancy: withdrawn for karyotyping of skin cells found in the fluid
as well as an analysis of AFP or acetylcholinesterase. If
DNA analysis or karyotyping of both parents and an
no acetylcholinesterase, a breakdown product of blood,
already affected child (provides a picture of the family’s
is found in the specimen, it confirms that an elevated
genetic pattern and can be used for prediction in future
AFP level is not a false-positive reading caused by blood
children)
in the fluid.
GENETIC DISORDER SCREENING AND DIAGNOSTIC TEST
Percutaneous Umbilical Blood Sampling. PUBS, or
cordocentesis
is the removal of blood from the fetal umbilical cord at
about 17 weeks using an amniocentesis technique. This
allows analysis of blood components as well as more
rapid karyotyping than is possible when only skin cells
are removed.
Fetal Imaging.
Magnetic resonance imaging (MRI) and ultrasound are
diagnostic tools used to assess a fetus for general size
and structural disorders of the internal organs, spine,
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• Any woman older than 35 years of age and any man ECTOPIC PREGNANCY
older than 55 years of age. - Any gestation located outside the uterine cavity
• Couples of ethnic background in which specific illnesses - The zygote implants in an abnormal location
are known to occur. outside the uterus (extrauterine pregnancy is 2nd
leading cause of bleeding in early pregnancy)
LEGAL AND ETHICAL ASPECTS OF GENETIC SCREENING AND
COUNSELING
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Tubal (ampulla)
Ovarian (mgt; cystectomy or oophorectomy)
Cervical (due to IVF or embryo transfer
o Painless vaginal bleeding
o Distended thin-walled cervix
o Dilated external os
o Seldom goes beyond 20w gestation - Ultrasound (reveals presence of gestational sac
Abdominal outside the uterine cavity)
Broad Ligaments - Colpotomy (direct visualization of the oviducts and
Tubo-uterine ovaries) is atype of incision made in the back wall
Tubo-abdominal of the vagina. During a tubal ligation, the doctor
can use a colpotomy also vaginotomy as one of the
Tubo-ovarian
ways to reach your fallopian tubes *…+
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Management
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Unit 1 - Framework For Maternal And Child Health Nursing Focusing On At-Risk, High Risk And Sick Clients
- Molar pregnancy occurs when the placenta Gestational Trophoblastic tumors (persistent
develops into an abnormal mass of cysts rather trophoblastic proliferation after H-mole) they are 3
than becoming a viable pregnancy kinds
- Molar pregnancy is a type of gestational o Choriocarcinoma
trophoblastic disease (gtd) Most severe malignant complication
- In a complete molar pregnancy, there’s no embryo that involve the transformation of
or normal placental tissue chorion into cancer cells that evades
- In partial molar pregnancy, there’s an abnormal and erode blood vessels and uterine
embryo and possibly some normal placental tissue. muscles. This leads to sloughing and
This embryo begins to develop but is malformed necrosis of the endometrium,
and can’t survive bleeding and infection. The cancer
cells can spread to the other parts of
Symptoms the body via the blood and lymph.
- Rapid growth of the uterus (out of proportion to Invasive Mole
the actual AOG) o The mole is locally invasive and is
- Uterus bigger than dates (though many can be the characterized by excessive formation of
same size or even smaller) trophoblastic villi that penetrates the
- Persistent nausea and vomiting (due to elevated myometrium. Develops during the first
HCG levels) 6months after H-mole.
- Bleeding or spotting in the first or second trimester
(spotting or heavy, intermittent or continuous, Placental Site Trophoblastic Tumor
usually light) – common sign o Composed of cytotrophoblastic cells arising
- No fetal heart tones or fetal movement from the site of the placenta
- Pelvic pressure o These cells produce both prolactin and HCG
- Hypertension may become a problem in the second o Main symptom is bleeding
trimester (signs of preeclampsia bfore 24 weeks: o May follow an abortion, normal pregnancy
HPN, edema, and proteinuria) and H-Mole
- SOB (late, life threatening indication of an o Major protein secreted is HPL
embolism) o Management of all Trophoblastic Tumor is
- Enlarged, tender ovaries (ovarian cysts) HYSTERECTOMY
- Passage of “grape-like” vesicles with bleeding (4th
month)
- UTZ reveal a mass of fluid-filled vesicles instead of INCOMPETENT CERVIX
developing fetus
Mechanical defect of the cervix wherein there occurs
Management painless cervical dilation in the 2nd trimester or early in
the 3rd trimester, followed by a prolapse and ballooning
- Dilatation and curettage (D&C) to remove the
of the membranes in the vagina, then rupture of
mole. If woman is >40 years old, hysterectomy is
membranes, expulsion of fetus
done since she has a higher chance of developing
This abnormality, which may be congenital or acquired,
choriocarcinoma
is the most common cause of habitual abortion
- Methotrexate (for 1yr to prevent the development
of malignant or cancer cells in the uterus
o Other anticancer drugs used: Actinomycin
D, vinblastine
- The woman is monitored for HCG level for 1yr. HCG
should be negative for 2-6weeks after removal of
mole
o HCG level is monitored every 2weeks
until normal ---then monthly for
6months---then every 2months for
another 6 months
o When HCG level is normal, it is monitored
monthly for 6months and then every
2months until 2 years. Signs and Symptoms
- Chest x-ray every 3months for 6months (lungs are
First sign is painless vaginal bleeding accompanied by
common site of metastasis of choriocarcinoma)
cervical dilation
- The woman is advised not to get pregnant for one
Rupture of membranes and passage of amniotic fluid
year (contraceptive methods should NOT BE PILLS -
follows cervical dilation and then loss of the products of
-- contains estrogen which promotes regrowth of
conception
chorionic villi)
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Cervical cerclage or suturing of the cervix between 14 Is the abnormal implantation of placenta near or over
and 16 weeks gestation to prevent cervical dilatation the internal os
o Prerequisite Is the most common bleeding disorder of the third
Cervix not dilated beyond 3cm trimester
Intact membranes
No vaginal bleeding and uterine Types of Placenta Previa
cramping
Low lying placenta
o Types of Cervical Cerclage
Marginal placenta
Shirodkar suture – permanent
Partial placenta
suture which is left in place for
Complete placenta
subsequent pregnancies, fetus is
delivered by CS Causes
Mc Donald Suture – temporary
suture remove starting 38-39 weeks Multiparity
gestation, fetus is delivered vaginally Multiple pregnancy
Advance Maternal Age (over 35 years old)
Smoking
Previous CS and abortion
Condition that make implantation in the upper fundal
portion of the uterus undesirable: previous molar
pregnancy
Abnormal placenta:
Management
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Unit 1 - Framework For Maternal And Child Health Nursing Focusing On At-Risk, High Risk And Sick Clients
Complications
Vaginal Bleeding
o Dark red vaginal bleeding is the usual
manifestation in the covert type
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Cardiovascular system includes: heart, arteries, arterioles, Reducing Risk for Cardiovascular Diseases
capillaries, venules, veins
Avoid tobacco
The Heart Cut back on saturated fat and cholesterol
Maintain a healthy weight
- Muscular, four chambered pump
Modify dietary habits
- Contracts 100,00 times per day
Exercise regularly
- Two upper chambers: atria
Control diabetes
- Two lower chambers: ventricles
Control blood pressure
- Tricuspid, pulmonary, mitral and aortic valves
o Systolic – upper
o Diastolic – lower
Manage stress
Heredity
Age
Gender
Race
Heart
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amounts of water resulting in the woman excreting - Infants of mothers with GDM are vulnerable to several
large amounts of urine chemical imbalances such as:
4. Polydipsia- excretion of large amounts of fluid in the o Low calcium
body leads to dehydration. Excessive thirst is an o Low Magnesium
important symptom of dehydration
5. Weight loss – since glucose cannot be utilized as a Major Problem of Gestational Diabetes
source of energy, the body uses its protein and fats 1. Macrosomia – refers to a baby that is considerably
stores in the muscles and adipose tissue resulting to larger than normal
weight loss 2. Birth Injury
6. Ketoacidosis – breakdown of protein and fats result to 3. Hypoglycemia – refers to low blood sugar in the baby
excessive formation of ketone bodies that the body immediately after birth
cannot excrete right away causing them to accumulate 4. Respiratory distress (difficulty of breathing)
What is Gestational Diabetes
Obesity
Age over 25 years old
Hx of large baby (over 10lbs or more)
Hx of unexplained fetal or perinatal loss
Hx of congenital anomalies in previous pregnancies
Fx Hx of diabetes (one close relative or 2 distant
relatives)
Member of a population with a high risk of diabetes
(native American, Hispanic, Asian)
Effects of Diabetes
1. Mother
Increased tendency to preeclampsia, UTI and
candidiasis
Higher incidence of dystocia because of large
infants
Increased risk for postpartum haemorrhage
due to over distention of the uterus
Hydramnios
Maternal Mortality
Diabetic retinopathy
Diabetic Nephropathy
Preterm Delivery
2. Infant
Macrosomia
Hydramnios
Prematurity
IUGR
Hypoglecemia and hypocalcemia
Predisposition to DM later in life as the
disease is hereditary
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d. Glucosuria
e. Strong family history of diabetes
2. Low Risk – screen at 24 to 28 weeks
a. Age <25 years
b. Normal weight before pregnancy
c. Ethnicity with low prevalence
d. No known first degree relatives with diabetes
e. No history of abnormal glucose tolerance
f. No history of poor obstetric outcome
1. Glycosylated haemoglobin
Provides information about blood glucose
level during the previous 3 months
Because glucose in the bloodstream attaches
to some of the haemoglobin and stay attached
during the 120-day lifespan of the RBC
REMEMBER!
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Intrapartum Management:
Absolute requirements:
o Dextrose containing IV fluid
o Insulin
Hourly glucose monitoring
Continuous fetal heart rate monitoring
Continuous tocodynametry
Manage labor as normal
Fetal Assessment:
o AFP
o Fetal activity Monitoring
Fetal Alcohol Syndrome 4 Major Criteria:
o NST
o Biophysical profile 1. Characteristic facial abnormalities
o Ultrasound 2. Brain structural neauro, functional deficits (lack of
coordination and poor fine motor skills)
3. Growth deficiencies (low birth weights)
SUBSTANCE ABUSE 4. Maternal alcohol use during pregnancy
Small eyes
Inability to meet help An exceptionally thinner upper lip
Major role obligations A short, upturned nose
Increase in legal problem Smooth skin surface between the nose and upper lip
Risk-Taking behaviour:
o Being firm is one thing but “laying down the
law” in a moralistic way can close of lines
o Failing to set expectations – teens who know
their parents disapprove of drug use are less
likely to use and vice versa. Dr. Lee says it’s
best to let kids know how a parent feel about
drugs before they hit their teenage years
o Assuming experimentation is no big deal –
experimentation doesn’t necessarily lead to
addiction, and some parents figure that
there’s nothing especially worrysome about a
Pathophysiology
child trying drugs or alcohol. Infact, even
dabbling in substance abuse can cause big – Cocaine is a small enough molecule to pass across the
problems, such as car accidents, sexual assault placental barrier into the bloodstream of the fetus
and serious overdoses. It’s not a normal rite of – The skin of the fetus is able to absorb the chemical
passage directly from the amniotic fluid until the 24th week of
Exposure to hazardous situations because of an pregnancy. Cocaine can also show up in breast milk and
Addicting Substance affect the nursing baby
Marijuana
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Diagnosis
module 1: quiz 1
Submissions
HIV and Pregnancy
- Perinatal transmission
Here are your latest answers:
- Transmitted between mother & child during pregnancy,
childbirth & breastfeeding Question 1
A disorder resulting from a 5: missing portion of
Factors which increase the risk of transmission
Chromosome abnormal cat-like cry.
Smoking
Substance abuse
Response: Cri-du-chat
Vit A deficiency
Correct answer: Cri-du-chat
Malnutritions
STD Score: 1 out of 1 Yes
Clinical stage of HIV
Labor Question 2
Breastfeeding
When do most patients tend to develop
Therapeutic Management gestational diabetes during pregnancy?
Response: Usually during the 2-3 trimester of
pregnancy
Correct answer: Usually during the 2-3 trimester
of pregnancy
Score: 1 out of 1 Yes
Question 3
The human cells contains 46 chromosomes:
_____ are autosomes
Response: 44
Correct answer: 44
Score: 1 out of 1 Yes
Question 4
Which of the following nursing interventions is
appropriate for a nursing diagnosis of Excessive
Fluid Volume related to compromised regulatory
systems?
Response: Monitor intake and output every hour
and record
Correct answer: Monitor intake and output every
hour and record
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- Can take many years to develop - Administration of Rh (Anti-D) globulin (Rhogam) within
- Eventually kills or impairs more and more cells in the the 1st 72 hours after delivery to woman who
immune system and body loses ability to fight off o Have delivered Rh positive babies
common infections such as: diarrhea or colds o Have had untypable pregnancies such as:
- Can die from diseases that are usually not dangerous for ectopic pregnancies, still birth,
people with healthy immune system o …
- If the fetus in subsequent pregnancies is RH+, the HEMATOLOGIC DISORDERS AMND PREGNANCY
antibodies is already present in the maternal blood 1. A woman with Iron deficiency anemia
stream will attack and destroy the fetal RBC resulting to - Most common anemia of pregnancy
fetal anemia - Condition in which you you do not have enough healthy
- The breakdown of RBC also cause the formation of red blood cells to carry adequate O2 to your body
bilirubin, the build-up of which can lead to jaundice and tissues
possible brain damage. - Low numbers ot properly functioning RBC in the body
- WHO and American College of Obstetricians and
*baby is exposed to bili light
Gynecologists define anemia in pregnancy as:
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Easy fatigability
Sensitivity to cold 2. Anemia from Acute Blood Loss
Proneness to infection Caused by several bleeding disorders/complications of
Dizziness pregnancy. These include: ECTOPIC PREGNANCY,
ABORTION, PLACENTA PREVIA, H-MOLE AND
Laboratory Findings ABRUPTIO PLACENTA
Erythrocyte hypochromia – means that the RBC have *Pregnant woman to undergo CS - required to have onhand
less color than normal when examined under a bag of blood
microscope. This usually occurs when there is not
enough of the pigment that carries oxygen Management
(haemoglobin) in the RBC
If the HGB level is more than 7g/dl, iron replacement
Microcytosis – condition defined as a mean corpuscular
therapy until 3mos after anemia has been corrected
volume less than 80um3 (80fL) in adults. The most
For massive haemorrhage: blood transfusion of whole
common causes of microcytosis are iron deficiency
blood, packed RBC, and plasma expanders to restore
anemia and thalassemia trait
normal blood volume.
Low serum ferritin levels (ferritin is a protein that
contains iron and is the primary form of iron stored *if packed RBC is not available – plasma expanders can be use but
inside of cells. Normal ferritin levels range from 12-300 is only temporary. After a few days packed rbc should still be
nanograms per millilitre of blood (ng/ml) for males and transfused
12-150 ng/ml for females
Elevated serum iron bindings capacity (blood test to see 3. Effects of FAD on Pregnancy
if you have too much or too little iron in your blood…\
No sustainable bone marrow Abortion
Abruption placenta
Management Neural tube defects
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Food sources of Folate Sickling of RBC – when they sickle, they break down
prematurely which can lead to anemua
Leafy, dark green vegetables Anemia can cause shortness of breath, fatigue, and
Dried beans and peas delayed growth and development in children
Citrus fruits and juices and most berries Rapid breakdown of RBC may also cause yellowing of
Fortified breakfast cereals the eyes and skin, which are signs of jaundice
Enriched grain products
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Predisposing Factors
1. Cardiovascular changes
Decrease cardiac output
Hemoconcentration (increased concentration of cells
and solids in the blood usually resulting from loss of
fluid to the tissues)
Failure of blood volume to expand to normotensive
women
Thrombocytopenia (condition…)
Increased levels of clotting factors (prolonged thrombin
time)
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Question 4
A client is being admitted to the antepartum unit for
hypovolemia secondary to hyperemesis gravidarum. Which
of the following factors predisposes a client to the
development of this?
Response: Gestational trophoblastic disease
Correct answer: Gestational trophoblastic disease
Score: 1 out of 1 Yes
Question 5
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During a home visit to a teenage client at 34-weeks’ A woman has been diagnosed as having pregnancy-induced
gestation diagnosed with mild preeclampsia, assessment hypertension. Which of the following is the most typical
reveals that the client has gained 2 lbs in the past week and symptom of this?
her current BP is 140/90. Which of the following assessment
findings would provide further evidence to support the client’s Response: Protein in urine
diagnosis?
Correct answer: Protein in urine
Response: mild edema in hands and face
Score: 1 out of 1 Yes
Correct answer: mild edema in hands and face
Question 12
Score: 1 out of 1 Yes In Hyperemesis Gravidarum, there is severe nausea and
vomiting. What would be the implication of this?
Question 6
The physician orders IV magnesium sulfate for a Response: increased HCG level
primigravida client with severe preeclampsia. Which of the
Correct answer: increased HCG level
following medications would the nurse has readily available
at the client’s bedside? Score: 1 out of 1 Yes
Response: Calcium gluconate
Question 13
Correct answer: Calcium gluconate The nurse can anticipate to a reasonable degree of certainty
that microorganisms most likely responsible for cystitis/UTI
Score: 1 out of 1 Yes is:
Question 11
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