Chapter 5

What are the "Danger Signs in Pregnancy" that we as the nurse should instruct women to report promptly during pregnancy?

-gush fluid from vagina -vaginal bleeding -abdominal pain -abnormal "kick count" -persistent vomiting -epigastric pain -edema of face/hands -severe persistent headache -Blurred vision/dizziness -chills with fever greater than 38.0 -painful urination, reduce urine output. Nurse should teach women to report any danger signs that occur during pregnancy.

What is the best description of erythroblastosis fetalis of the fetus and newborn?

An immune reaction by the mother's blood against the Rh factor on the fetus' red blood cells Erythroblastosis fetalis (hemolytic disease) of the fetus and newborn is caused by an immune reaction by the mother's blood against the blood group factor on the fetus' red blood cells.REF: p. 101

A patient reports difficulty breathing at 35 weeks of gestation. On ultrasound, the length of the umbilical cord is 36 cm, there is polyhydramnios, and an increased uterine size. Which complication do these findings put the fetus at risk for?

Anatomical abnormality. pg 86

A pregnant patient with anemia has been prescribed an iron supplement. The nurse determines that the patient is also using antacids for heartburn and advises the patient to discontinue this practice. Which rationale supports this instruction to the patient?

Antacids impairs the absorption of iron. pg.107

An obstetrical patient with preexisting diabetes mellitus is preparing to deliver a term neonate. The nurse would prepare for which potential neonatal complication?

Birth injury pg. 103

The nurse is caring for a patient who is being treated with magnesium sulfate therapy to manage pregnancy-induced hypertension. The nurse observes respiratory depression and loss of deep tendon reflexes. Which intravenous medication does the nurse expect the primary health care provider to prescribe?

Calcium gluconate pg. 100

Which are symptoms of withdrawal syndrome in heroin addicted woman?

Diarrhea & Rhinorrhea pg 115

The nurse is caring for a patient with severe pregnancy-induced hypertension who is being with intravenous magnesium sulfate. The patient has absence of deep tendon reflexes, blood pressure is 150/100 mm of Hg, respiratory rate is 10 BPM, and urine output is 10 mL/hour. Which is the PRIORITY nursing interventions in this situation?

Discontinue the magnesium sulfate infusion. pg 100

The health care provider suspects abruptio placentae in a patient who is 36 weeks pregnant. The nurse finds that the patient is bleeding from the mouth and nose. The nurse is concerned about which complication of abruptio placentae?

Disseminate intravascular coagulation pg. 96-97

What are the effects rubella can have on the developing fetus?

Effects on fetus can be destructive. Early pregnancy can disrupt formation of major body systems. Acquired later more likely to damage organs that are already formed. Microcephalic (small head). Intellectual impairment, congenital cataracts, deafness, IUGR, cardiac defects.

A patient is 28 weeks pregnant and has pregnancy-induced hypertension. Which symptom would indicate that her condition is worsening?

Epigastric pain Epigastric pain is a sign of worsening preeclampsia. Blood pressure of 138/90 mm Hg, dependent edema, and feelings of lethargy are not signs that preeclampsia is worsening.REF: p. 99

What are the effects of high risk pregnancy on the family?

Family may have to assume role of pregnant women at home if in bed rest or hospital stay in addition to their own role. Caregiver for young children. Sitter for children if extended family lives far away when needed. Financial difficulties if income stops for woman.

when hypertension develops as complication during pregnancy, it is known as __________________ ____________________. Also known as pregnancy induced hypertension (PIH). What are the cardinal or classic symptoms of this disorder? Name the two stages of this disorder? This disorder progresses to the next stage when __________ occur. The cause of GH is unknown, but _____ is it cure.

First blank- gestational hypertension second blank-eclampsia third blank-birth

An obese women is high risk for developing these complications during pregnancy?

Gestational diabetes mellitus, hypertension, cardiac problems, preeclampsia, and respiratory problems.

A patient reports profuse vaginal bleeding an persistent nausea and vomiting at 15 weeks of gestation. Diagnostic testing reveals a distinctive "snowstorm pattern" on ultrasound and a hematocrit value of 10%. Which complication is the patient at risk for?

Hydatidiform mole pg. 94

Which topic would be the focus when discussing complications of pregnancy with a patient who is 8 weeks gestation?

Hyperemesis gravidarum pg. 88

What are the predisposing factors for abruptio placentae? (Select all that apply.)

Hypertension Poor nutrition Folate deficiency Cigarette smoking Folate deficiency, hypertension, abdominal trauma, poor nutrition, and cigarette smoking are all predisposing factors to abruptio placentae.REF: p. 96

A pregnant patient with abruptio placentae consumes cocaine. Which complication of abruptio placentae is likely in this patient?

Impaired blood clotting pg. 95

The nurse is reviewing the chart of a patient and learns that some products of conception have been expelled, but some remain in the uterus. Which type of abortion has the patient experienced?

Incomplete pg. 89

During a prenatal checkup a patient reports dry mouth, scant urine, and persistent nausea and vomiting. Which findings does the nurse expect in the patients laboratory reports?

Increased serum hematocrit levels. pg. 88

Which postpartum complications are associated with placenta previa?

Infection Hemorrhage Fetal anemia pg. 96

The nurse is caring for a neonate with macrosomia and finds that the mother has gestational diabetes. Which complications does the nurse expect in the neonate?

Jaundice Hypoglycemia Polycythemia Hypocalcemia pg. 103

Which condition manifest in a pregnant patient has severe nausea, vomiting, dry mouth, and decreased skin elsticity?

Ketonuria pg. 88

_______________ is an anticonvulsant administered to prevent administered to prevent seizures. Identify specific nursing actions taken when a pregnant women is receiving this drug?

Magnesium sulfate Nursing actions: assist prenatal care 2) helping cope with therapy 3) care for women/ help administer drugs.

What is an ecotopic pregnancy? What are the manifestations? How is the recommended treatment?

Occurs when the fertilized ovum is implanted outside the uterine cavity. Manifestations: Women has history missed periods. Complains lower abdominal pain has light bleeding tube ruptures may have sudden severe lower abdominal pain vaginal bleeding signs hypovolemic shock. Vaginal bleeding may be minimal because most blood is lost into the abdomen rather than externally through the vagina. Shoulder pain is symptom that often accompanies bleeding into the abdomen. -Treatment 1) medical therapy with methotrexate if tube is ruptured. 2) Surgery to remove products of conception from tube if damage is minimal. Severe damage removal of entire tube and sometimes uterus.

At what point does preeclampsia become eclampsia?

One or more generalized tonic-clonic seizures Progression to eclampsia occurs when the woman has one or more generalized tonic-clonic seizures.REF: p. 97

Which characteristic distinguishes preeclampsia from eclampsia?

One or more generalized tonic-clonic seizures. pg. 99

A pregnant patient reports nausea, vomiting, and significant weight loss. The nurse also finds that the patient has high serum hematocrit levels with dry mucous membranes. Which treatment will be beneficial?

Oral or intravenous fluid pg 88

Which intervention is provided during labor to a patient with sickle cell disease to prevent sickle cell crises?

Oxygen therapy pg. 108

The blood pressure of a postpartum patient is 160/110 mm Hg. Which complications would the nurse monitor for in this patient?

Renal failure Pulmonary edema pg. 101

The nurse is providing prenatal care to a patient with preeclampsia. The health care provider has prescribed magnesium sulfate. Which complication is the provider attempting to avoid by prescribing this medication?

Seizure. pg. 100

Which symptoms should be reported to the obstetrician during any pregnancy?

Sudden gush of fluid Blurred vision Vaginal bleeding pg. 88

The nurse instructs a patient with placenta previa to keep a pillow under one hip while resting on the bed. Which complication is the nurse attempting to prevent in the patient?

Supine hypotension pg. 96

What does the acronym TORCH stand for?

T- Toxoplasmosis O- other (usually hepatitis) R- Rubella (german measels) C- Cytomegalovirus H- Herpes Simplex

The student nurse is caring for a a patient who had spontaneous abortion at 17 weeks gestation. The nurse allows the patient's family to visit and waits quietly with the them in the patient's room to provide support. The nurse also provides mementos of the fetus and says to the patient. "You're young and you can always have more children." Which action of the student nurse needs correction?

Talking about having more children. pg. 91-92

A patient who has undergone curettage during delivery is 2 weeks postpartum and reporting fever and brownish vaginal discharge. Temperature is 38 C. Which actions of the patient could have caused these symptoms?

Tampon use Resumption of sexual activity pg. 91

The nurse is caring for a pregnant patient who is used an intrauterine devices for contraception. On reviewing the medical history, the nurse finds that the patient has failed tubal ligation. Which further complication does the nurse infer from these findings?

The patient may have an ectopic pregnancy. pg. 93

What are the best practices for communicating with the pregnant "battered" patient?

Therapeutic nonjudgmental communication, take private area, determine whether there are fetus that increase risk for severe injury homicide drug use by abuser, guns in house, previous use of weapons, violent behavior by abuser outside of home. Whether children are being hurt viral abused does not discover woman reported abuse or intends to leave, referral to shelter and other services they wish to leave abuser, child abuse must be reported to authorities.

The nurse is caring for a patient with hyperemesis gravidarum. The primary health care provider prescribes intravenous dextrose to treat the dehydration. Which medication would the nurse administer first before giving intravenous dextrose?

Thiamine pg. 88

A patient reports vaginal bleeding, muscle cramps, and backache at 16 weeks of gestation. Pelvic examination reveals that the cervix is closed. Which type of abortion would the nurse expect in this patient?

Threatened pg. 89-91

Which symptoms are consistent with neonatal abstinence syndrome?

Tremors high pitched cry disrupted sleep wake cycles pg 115

Which tests are useful in the diagnosis of pulmonary tuberculosis in a pregnant patient?

Tuberculin skin test Serum QuantiFERON-TB (QFT-G) Test pg. 112

Which diagnostic test are performed to confirm ectopic pregnancy?

Ultrasound Laparoscopy Culdocentesis pg. 93

The nurse is caring for a patients in the 20th week of gestation who did not take folic acid supplements in the first trimester of pregnancy. Which diagnostic test would be indicated in this case to identify fetal abnormalities?

Ultrasound examination pg. 105

A Patient reports having missed her last menstrual cycle and wonders about the possibility of pregnancy. Which diagnostic test would help the nurse to confirm a pregnancy?

Ultrasound examination pg. 85

Which signs and symptoms are seen in a pregnant patient with cystitis?

Urgency of urination Slightly elevate temperature pg. 112

Which finding would the nurse observe in a patient in second trimester of pregnancy diagnosed with abruptio placentae?

Uterine tenderness pg . 95

A patient who is at 36 weeks of gestation and diagnosed with placenta previa reports mild uterine contraction. Which clinical manifestations does the nurse assess for in this patient?

Vaginal bleeding pg. 95-96

incomplete abortion

bleeding, cramping, dilation of cervix, passage of tissue

threatened abortion

cramping and backache with light spotting; cervix is closed and no tissue is passed

missed abortion

fetus dies in utero but is not expelled; uterine growth stops; sepsis can occur

What is a hydatidiform mole?

gestational trophoblastic also known as molar pregnancy occurs when the chorionic villi (fingerlike structures that form the placenta) increase abnormally and develop vesicles that resemble tiny grapes. signs/symptoms -bleeding -rapid uterine growth -failure detect heart activity

Inevitable abortion

increased bleeding, cramping; cervix dilates

elective abortion

intentional termination of pregnancy for reasons unrelated to health

therapeutic abortion

intentional termination of pregnancy to preserve the health of the mother

What are the four anemia significant during pregnancy?

iron deficiency, Folic acid deficiency, sickle cell anemia, Thalassemia

What is hyperemesis gravidarum? What are s/s? How is it treated?

is persistent nausea and vomiting of pregnancy and often interferes with nutrition and fluid balance. -Treated with correct dehydration and electrolyte and acid base imbalances with oral or intravenous fluids. Antimeat drugs prescribed and tpn.

complete abortion

passage of all products of conception, cervix closes, bleeding stops

Which symptoms should be reported to the obstetrician during the pregnancy? (Select all that apply.)

sudden gush of fluid Blurred vision Vaginal bleeding A sudden gush of fluid could indicate rupture of membranes. Blurry vision could indicate preeclampsia. Vaginal bleeding could indicate abruption or tearing of the placenta. Vomiting and frequent urination are not rare occurrences during pregnancy. pg. 88

The first sign of fluid retention in the pregnant woman diagnosed with gestational hypertension is

sudden, excessive weight gain. Sudden, excessive weight gain is the first sign of fluid retention. Visible edema follows the weight gain.REF: p. 98|100

spontaneous abortion

the (unintended) loss of the products of conception before 20 weeks of gestation miscarriage.

Placenta previa

the abnormal implantation in the lower uterine segment.

recurrent abortion

two or more consecutive spontaneous abortions (habitual abortion), usually caused by incompetent cervix or progesterone levels inadequate to maintain pregnancy

A nursing instructor is teaching student nurse about pregnancy related complications. The instructor asks, " How is hyperemesis gravidarum different from normal morning sickness in pregnant patients?" Which response given by student nurse indicates effective learning?

"Dehydration is severe with hyperemesis gravidarum as compared to morning sickness" pg. 88

The nurse is caring for a patient who has undergone an abortion at 28 weeks of gestation. Which dose of Rho (D) immune globulin does the health care provider prescribe for this patient?

300 mcg of RhoGAM if the patient is Rh-negative. pg. 90

incompetent cervix

A mechanical defect in the cervix, making it unable to remain closed throughout pregnancy and resulting in spontaneous abortion

Which description of blood incompatibility between fetus and mother is accurate?

An immune reaction by the mother's blood against the blood group factor on the fetus's red blood cells. pg. 101

Which food is contraindicated in a pregnant patient with iron deficiency?

Bran pg. 107

Which symptoms can be observed in a pregnant patient with pyelonephritis?

Chills High fever flank tenderness pg 112

Compare cystitis & pyelonephritis

Cystitis: is a bladder infection with signs and symptoms of burning with urination, increased frequency urgency of urination, normal or slightly elevated temperature. If not treated can cause pyelonephritis. Pyelonephritis: is a kidney infection with sign and symptoms of high fever, chills, flank pain or tenderness, nausea and vomiting. Treated with multiple antibiotics initially administered intravenously.

A patient who is pregnant is a victim of bioterrorism is diagnosed with pneumonic plague. Which precautions should be required of the patient to prevent the transmission of pneumonic plague?

Droplet precautions pg. 113

A pregnant patient with a history or bariatric surgery is experiencing nausea, vomiting, cramping, and diarrhea. Which condition is associated with these findings?

Dumping syndrome pg. 108

Which term describes a pregnancy occurring outside of the uterus?

Ectopic Pregnancy pg. 93

When a pregnancy occurs outside the uterine cavity, it is referred to as a(n)

Ectopic pregnancy is the term for when the pregnancy occurs outside the uterus. p. 93

In a pregnant patient with gestational hypertension, which findings are associate with the development of preeclampsia?

Elevate levels of creatine Voiding large volumes of urine Decreased count of thrombocytes pg-97-98

The nurse instructs a pregnant patient to consume liquids between meals. Which patient outcome is the nurse addressing?

Elimination of gastric distention. pg. 88

A patient at 28 weeks of gestation has pregnancy induced hypertension. Preeclampsia is diagnosed. Which symptom would indicate that her condition is worsening?

Epigastric pain pg. 99

The nurse is caring for a patient at 14 weeks of gestation. On ultrasound, the uterus is equal to that of patients who are in their 20th week of gestation. An alpha-fetoprotein test is requested. Which fetal complication is associated with these findings?

Gestational trophoblastic disease pg.86

Describe the treatment for a family with Rh incompatibility?

Give Rh(D) immune globulin (RhoGAm) to Rh negative woman at 28 weeks gestation within 72 hours after birth or abortion. Monitor during pregnancy and fetal assessments done to monitor the fetus.

Which insulin is contraindicated in a a patient during pregnancy?

Glargine insulin (lantus) pg. 105

What is gestation diabetes? Why does this occur? What are the complications of the neonate after birth?

Glucose intolerance with onset of pregnancy occurs increase resistance of cells to insulin increase speed of insulin. Infant complications: hypoglycemia, respiratory distress, injury caused by macrosomia.

Which factors predispose a patient for abruptio placentae?

Hypertension Poor Nutrition Folate Deficiency Cigarette smoking pg. 96

During the third trimester of pregnancy a patient has bright red vaginal bleeding and the fetus lies in the breech position at the lower part of the uterus. Which complication is the patient at risk for?

Infection pg. 95-96

Which compounds influence the insulin levels of pregnant patient?

Insulinase Estrogen Prolactin Progesterone pg-102

A pregnant patient has been administered Dilantin. Which conditions is the fetus at risk for based on this intervention?

Intellectual impairment craniofacial abnormalities. pg.115

Which is the earliest sign of an ectopic pregnancy?

Lower abdominal pain pg. 93

Which features are observed in an infant with fetal alcohol syndrome (FAS)?

Microcephaly Small palpebral fissure thin and flat upper lip pg. 114

Which assessment is included in the initial plan of care for a patient in the third trimester with placenta previa who presents with a small amount of vaginal bleeding?

Monitor the fetal heart rate. pg. 96

Which condition would result in erythroblastosis fetalis?

Mother is Rh negative and the fetus is Rh positive. pg. 101

A pregnant patient has undergone vacuum aspiration and D&E for a hydatidiform mole. Which nursing care is priority?

Observe for bleeding and shock. pg. 94

A pregnant patient in the third trimester of pregnancy is experiencing profuse vaginal bleeding and has symptoms of placenta previa. Which nursing interventions will be beneficial for the patient?

Providing oxygen to the patient. Monitoring vital signs every 15 minutes. Asking the patient to place a pillow under one hip. pg. 96

A patient with an ectopic pregnancy has severe shoulder and lower abdominal pain, vaginal bleeding is hypotensive. The fallopian tube is found to be ruptured. Which treatment is strategy is necessary?

Removing the fallopian tube pg 93

The nurse is collecting data on a prenatal patient and finds that the patient has gestational diabetes. Which complications would the nurse expect in the infant?

Weight of more than 4000g Hypocalcemia Pulmonary Disease Congenital anomalies pg 103

abruptio placentae

premature separation of the normally implanted placenta