Uworld MATERNITY

MATERNITY A A A The nurse reviews laboratory test results for a pregnant client at 32 weeks gestation. What is the nurse's best action based on these results? Click on the exhibit button for additional information. Laboratory results Hemoglobin 11.4 g/dL (114 g/L) Hematocrit 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.