COMPLICATIONS OF PREGNANCY

A 16-years old unmarried client visits the prenatal clinic at 32 weeks gestation. The client is 5 feet, 2 inches tall and weighed 120 pounds before the pregnancy, the client now weighs 140 pounds. She has been receiving care at the clinic and is being carefully monitored for early signs of pregnancy-induced hypertension (PIH)


1. The nurse assess the client for possible risk factors for PIH, which of the following will be most important for the nurse to assess ?
a.Proteinuria
b.Small for gestation age fetus
c.ABO incompability
d.Fluid intact.

(the correct answer is a, The most important assessment is checking the urine for protein. Proteinuria, even in the absence of an elevated blood pressure, is indicative of PIH. PIH occurs more often in primigravidas , adolescents, woman of lower socioeconomic status, primigravidas older then 35 years, woman with family histories of PIH and woman with additional complication such as multiple gestation, diabetic mellitus, Rh incompatibility and hydatidiform mole)

2. The client's base line blood pressure at her initial visit at 12 weeks gestation was 110/70 mm hg, during an assessment at 32 weeks gestation, which of the following data indicate mild PIH ?
a.blood pressure 160/110mm hg on two separate occasions
b.proteinuria more than 5 g in 24 hours
c.elevated serum creatinine
d.swelling of fingers and ankles

(the correct answer is d,Generalized edema with swelling of the face, hands,fingers and ankles, often occurs with mild PIH. Blood pressure of 160 mm kg systolic and 100 mm hg diastolic, proteinuria and oliguria less then 400 ml with in 24 hour) are sign of severe PIH)

3. A Priority nursing diagnosis for this client is
a.Non compliance related to poor nutrition and luck of exercise during pregnancy.
b.Fluid volume deficit related to fluid shift from intravascular to extravascular space.
c.High risk to injury related to cerebral vasospasm.
d.High risk for injury to fetus related to altered sensorium of mother.

(the correct answer is b, based on information provided, the most appropriate nursing diagnosis is Fluid Volume Deficit related to fluid shift from intravascular to extravascular space. The potential for these diagnosis exists, however particularly if the client indicates a knowledge deficit or if her condition deteriorates)

4. The nurse assess the client of additional  symptoms of PIH. Which of the following symptoms would further confirm the diagnosis of PIH ?
a.Mild headache after reading.
b.history of tract urinary infection.
c.Frequent voiding in large amount.
d.Mild edema in hands and face.

(the correct answer is d, the diagnosis of mild PIH is further confirmed if the client of exhibits mild edema in the hands and face. Mild headache after reading,history of a urinary tract infection and voiding frequently in large amount are not related to PIH)

5. The nurses plan to instruct the client in care while the client is at home. Which of the following is an appropriate goal for the client? The client will
a.return to the prenatal clinic in two weeks.
b.exhibit decreased edema after one week of a low protein, law salt diet
c.rest on the left side during the day,with bath room privileges
d.immediately report adverse reactions from oral calcium carbonate medication.

(the correct answer is c, The client with mild PIH is often treated at home. Restricting activities is of primary importance and bed rest for most of the day is recommended. The left lateral recumbent position is recommended to decrease pressure on the vena cava, which increases venous return,circulatory volume and renal and placental perfusion)

6. The nurse teach the client abut how PIH affects the growing fetus. The nurse realize that the client needs further instruction when she says that PIH can lead
a.anenchepaly
b.low birth weigh infan
c.fetal hydrop
d.intrauterine growth retardation

(the correct answer is a, congenital anomalies such as anencephaly are not associated with hypertensive disease. Such condition as stillbirth, prematurity, intrauterine growth retardation and fetal hydrops are associated with PIH )


A 21 year-old primigravida  is diagnosed with mild PIH at 36 weeks gestation. She is being treated at home and has a home care nurse visit twice weekly.

7. The nurse instruct the client to keep a record of fetal movement patterns at home. The nurse determines that the instructions are effective when the client says that she will count the number of times the baby moves during a
a.30 minute period three times a day.
b.45 minute period after lunch each day.
c.12 hour period each day.
d.24 hour period each week.

(the correct answer is c, Numerous methods have been propose to record the maternal perceptions of fetal movement. A commonly used method is the Cardiff count to 10 method. The client begins counting fetal movements at a specific time (eg, 8 am) and notes the time when the tenth movement is felt. if 10 movements are not felt in a 12 hours period, the client should notify the health care provider. Another method involve monitoring the fetal movements over one hour, the client should  report if fewer the three movements are felt)

8. The nurse plans to instructs the client about nutritional needs of the client with mild PIH. The teaching plan includes instructing the client about eating a
a.high residue diet
b.low sodium diet
c.regular diet
d.high protein diet

(the correct answer is c, the client should be placed on a regular diet with no caloric modifications. The client should be though to avoid using salt while cooking, but the client does not need a law salt diet. It is preferable to eat raw fruits and vegetables when possible )

9. The nurses discusses  various theories about the cause of PIH. After giving the instruction,the nurse determines that the client needs further instruction when she says that PIH may be caused by
a. iron deficiency anemia
b. an as yet to be identified toxin
c. impaired vascular invasion of the uterine lining
d. an autoimmune response

(the correct answer is a, Although the exact cause of PIH is not yes known, several theories have been proposed . These include an as yet to be define toxin, impaired vascular invasion of the uterine lining and an autoimmune response. Iron deficiency can lead to anemia but this has not been linked to PIH)

10. The client stat that she frequently ingests laundry starch. The nurse should assess the client for symptoms of
a. muscle spasm
b. lactose intolerance
c. diabetes mellitus
d. anemia

(the correct answer is d, All pregnant clients should be screened  for pica,or the ingestion of non food substance such as clay ,dirt or laundry starch. Screening the client for anemia is important because  client who practice pica commonly anemic. Muscle spasm,lactose intolerance and diabetes mellitus are not usually associated with eating starch)

11. The client tells the nurse that she does not like milk. The nurse should instruct the  client that an 8 ounce glass of milk is equal to
a. 2 tablespoons of Parmesan cheese
b. 1/2 cup of a milkshake.
c. 1 1/2 to 2 slices of presliced American cheese.
d. 1/2 cup of cottage cheese.

(the correct answer is c, an 8 ounce glass of milk is equivalent of 1 1/2 to 2 slices of presliced  American cheese)

12. The client tells the nurse that she eats fruits and vegetables  but is not very fond of them. The nurse should instruct the client that one serving of vegetable is equivalent to
a. one fourth of a cantaloupe
b. 3 ounces of vegetable juice cocktail
c. 3 tomatoes
d. 1 raw apricot

(the correct answer is a, one serving of vegetable or fruit is equivalent to one fourth of a cantaloupe. The client would need 6 ounces of a vegetable juice cocktail , two tomatoes or two apricots to have one serving)


A 26 Years Old primigravida visits the prenatal clinic for her regular visits at 34 weeks gestation. she diagnosis with mild PIH.

13. The client tells the nurse she takes mineral oil for occasional constipation, the nurse should instruct the client to
a. take the mineral oil with fruit juice to increase the action of the mineral oil
b. avoid mineral oil because it interferes with the absorption of fat soluble vitamins
c. avoid mineral oil because it can lead to Vitamin C deficiency in pregnant client
d. use the mineral oil only once a week to prevent constipation

(the correct answer is b, The client should be advised to avoid taking mineral oil because it will interferes with absorption of fat-soluble vitamin from the intestinal tract. Harsh lax actives are contraindicated. If dietary measures and increase fluid intact do not prevent constipation and a mild laxative is indicated, the client should contact the physician or other health care provider. A stool softener or a mild laxative,such as milk of magnesia,may be prescribed. Mineral oil does not lead to vitamin C deficiency  in a pregnant client)