ematocrit 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. (Option 4) Tocolytic drugs (eg, terbutaline, magnesium sulfate, indomethacin, nifedipine) are used to suppress uterine contractions in preterm labor, allowing pregnancy to be prolonged for 2-7 days so that corticosteroid administration can improve fetal lung maturity. This client is at term, and there is no need to delay delivery. Educational objective: Magnesium sulfate is prescribed for clients with preeclampsia to prevent seizure activity. A therapeutic magnesium level of 4-7 mEq/L (2.0-3.5 mmol/L) is necessary to prevent seizures in a preeclamptic client. A A A A nurse is admitting a client at 42 weeks gestation to the labor and delivery unit for induction of labor. What is a predictor of a successful induction? 1. Bishop score of 10 [54%] 2. Firm and posterior cervix [11%] 3. History of precipitous labor [5%] 4. Reactive nonstress test [28%] Explanation: The Bishop score is a system for the assessment and rating of cervical favorability and readiness for induction of labor. The cervix is scored (0-3) on consistency, position, dilation, effacement, and station of the fetal presenting part. A higher Bishop score indicates an increased likelihood of successful induction that results in vaginal birth. For nulliparous women, a score ≥8 usually indicates that induction will be successful (Option 1). (Option 2) A cervix that is firm and posterior is associated with a low Bishop score, which reflects a low likelihood of successful labor induction. (Option 3) A history of precipitous labor (3 hours from onset of contractions to birth) may indicate that the client will again experience precipitous labor once labor is established. However, such a history is not an independent predictor of successful induction. (Option 4) A reactive nonstress test indicates that the fetus is well oxygenated and establishes fetal well-being. It does not provide information about the likely success or failure of labor induction. Educational objective: The Bishop score is a system for the assessment and rating of cervical favorability and readiness for induction of labor. A score 8 in nulliparous women is associated with successful induction and subsequent vaginal birth.