A nurse in a high-risk prenatal metabolic clinic is caring for a 26-year-old client at 7 weeks’ gestation with a known history of phenylalanine hydroxylase (PAH) deficiency (maternal PKU). The client reports strict adherence to a low-phenylalanine diet prior to pregnancy but states that persistent nausea and vomiting have significantly limited oral intake over the past two weeks. Laboratory results reveal a maternal phenylalanine level of 8.4 mg/dL (recommended pregnancy target

A 31-year-old client, gravida 4 para 2, presents to the labor and delivery triage unit at 33 weeks’ gestation with a sudden episode of bright red vaginal bleeding noted while at rest. She denies abdominal pain, uterine tightening, recent intercourse, or trauma. Vital signs are stable. On abdominal examination, the uterus is soft and non-tender, and fetal monitoring demonstrates a baseline heart rate of 145 beats/min with moderate variability and no decelerations. No digital cervical examination has been performed. Her obstetric history includes one prior cesarean birth, and she reports daily cigarette use.Which clinical finding most strongly supports placenta previa rather than placental abruption in this client?

A nurse in a prenatal endocrine clinic evaluates laboratory results for a 29-year-old client at 9 weeks’ gestation with a known history of Hashimoto’s thyroiditis. Despite adherence to levothyroxine 112 mcg daily, current laboratory findings reveal a TSH of 7.6 mU/L and a free T4 of 0.7 ng/dL. During the assessment, the client reports taking her thyroid medication each morning at the same time as her prenatal vitamin containing iron and calcium. Based on ATA pregnancy guidelines for first-trimester hypothyroidism management, which nursing intervention is most appropriate to optimize this client’s thyroid control?

A labor and delivery nurse is caring for a primigravida at 7 cm dilation who requests pain relief. The health care provider orders nalbuphine hydrochloride (Nubain) 10 mg IV. The nurse reviews the client’s history and evaluates for any contraindications before administration.Which of the following clinical findings would contraindicate the use of opioid agonist-antagonist analgesics during labor?Select all that apply.

A client develops acute postpartum hemorrhage following a vaginal birth with a boggy uterus and continued heavy vaginal bleeding despite fundal massage. The provider prescribes pharmacologic management. Based on the medication guide provided, which prescribed interventions are most appropriate and safest for this client, assuming no additional contraindications are present?(Select all that apply)

A 34-year-old client, gravida 3 para 1, is in active labor at 9 cm dilation with no fetal descent over the past 3.5 hours despite adequate uterine contractions confirmed by intrauterine pressure catheter. Vaginal examination reveals the fetal head at 0 station in a persistent occipitoposterior, deflexed position. Prenatal assessment previously identified an android pelvic configuration. The fetal heart rate tracing remains reassuring.Which clinical findings or risk factors support the diagnosis of cephalopelvic disproportion (CPD) in this client?Select all that apply.

A nurse in a postpartum high-risk obstetric unit is caring for a client with severe preeclampsia receiving intravenous magnesium sulfate at 1.5 g/hr for seizure prophylaxis. The nurse notes progressive lethargy, absent patellar reflexes, and a respiratory rate of 9 breaths/min. Serum magnesium level returns at 10.4 mEq/L. The magnesium infusion is stopped immediately.Based on American College of Obstetricians and Gynecologists Practice Bulletin guidance for magnesium sulfate toxicity, which nursing actions are priority interventions to reverse toxicity and prevent respiratory arrest?Select all that apply.

A nurse notes that new parents are learning to interpret their infant’s cues, reconciling expectations of a “fantasy child” with the real infant, experimenting with new coping strategies, and gradually gaining confidence in caregiving despite periods of disequilibrium, emotional vulnerability, and self-doubt.This process is most accurately identified as which concept?

A labor and delivery nurse is caring for a multiparous client (G3P2) at 6 cm dilation who requests pain relief during active labor. The healthcare provider orders fentanyl 100 mcg IV push for systemic opioid analgesia. The nurse prepares to administer the opioid and provide anticipatory guidance. The client asks how the medication might affect her and her baby. Which of the following statements by the nurse accurately reflect the clinical implications of administering opioid analgesics during labor? (Select all that apply.)

A 31-year-old client, gravida 4 para 1, presents for a prenatal visit at 18 weeks’ gestation. Her obstetric history is significant for a spontaneous preterm birth at 29 weeks in a prior pregnancy. A transvaginal ultrasound performed today demonstrates a cervical length of 21 mm. The provider prescribes daily vaginal progesterone. The client asks why this medication is recommended and what benefits it provides.Which explanation by the nurse most accurately reflects current evidence-based understanding of progesterone therapy for this client?