OB - chapter 19 Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications
A woman is suspected of having abruptio placentae. Which of the following would the nurse expect to assess as a classic symptom? A. Painless, bright-red bleeding B. "Knife-like" abdominal pain C. Excessive nausea and vomiting D. Hypertension and headache.
"Knife-like" abdominal pain
The nurse is caring for a woman who is 28 weeks pregnant and has been hospitalized with moderate bleeding which seems to be stabilizing; she is asleep on her side. While checking the fetal monitor tape the nurse notices that the baseline has gradually increased with late decelerations. What is the first action the nurse will take? a) Reposition the mother in a semirecumbent position on her back. b) Administer oxygen to the mother. c) Decrease the rate of IV fluids. d) Notify the physician.
Administer oxygen to the mother. Immediate treatment is O2.
Rhogam (Rh immune globulin) will be ordered for an RH - mother undergoing which of the following tests? a) Contraction test b) Biophysical profile c) Amniocentesis d) Non-stress test
Amniocentesis
The nurse is required to assess a pregnant client who is complaining of vaginal bleeding. Which of the following assessments should be considered as a priority by the nurse? a) Monitoring uterine contractility b) Assessing signs of shock c) Determining the amount of funneling d) Assessing the amount and color of the bleeding
Assessing the amount and color of the bleeding
A patient is admitted at 22 weeks gestation with advanced cervical dilatation to 5 centimeters, cervical insufficiency, and a visible amniotic sac at the cervical opening. What is the primary goal for this patient at this point? a) Education on causes of cervical insufficiency for the future b) Bed rest to maintain pregnancy as long as possible c) Deliver vaginally d) Notification of social support for loss of pregnancy
Bed rest to maintain pregnancy as long as possible
A woman has been diagnosed as having pregnancy-induced hypertension. Which of the following is the most typical symptom of this? a) Susceptibility to infection b) Increased perspiration c) Blood pressure elevation d) Weight loss
Blood pressure elevation
When providing counseling on early pregnancy loss, the nurse should include what as the most common cause for spontaneous abortion? a) The age of the mother b) Chromosomal defect c) Maternal smoking d) Lack of prenatal care
Chromosomal defect
You are caring for a young woman who is in her 10th week of gestation. She comes into the clinic complaining of vaginal bleeding. Which assessment finding best correlates with a diagnosis of hydatidiform mole? a) Bright red painless vaginal bleeding b) Brisk deep tendon reflexes and shoulder pain c) Dark red, "clumpy" vaginal discharge d) Painful uterine contractions and nausea
Dark red, "clumpy" vaginal discharge
A pregnant client with hyperemesis gravidarum needs advice on how to minimize nausea and vomiting. Which of the following instructions should a nurse give this client? a) Avoid dry crackers, toast, and soda. b) Lie down or recline for at least 2 hours after eating. c) Decrease intake of carbonated beverages. d) Eat small, frequent meals throughout the day.
Eat small, frequent meals throughout the day.
A 28-year-old woman presents in the emergency room with severe abdominal pain. She has not had a normal period for 2 months but she reports that that is not abnormal for her. She has a history of endometriosis. What might the nurse suggest to the physician as a possible cause of the patient's abdominal pain? a) Molar pregnancy b) Placenta previa c) Ectopic pregnancy d) Healthy pregnancy
Ectopic pregnancy
During a routine prenatal visit, a client is found to have proteinuria and a blood pressure rise to 140/90 mm Hg. The nurse recognizes that the client has which of the following conditions? a) Gestational hypertension b) Mild pre-eclampsia c) Severe pre-eclampsia d) Eclampsia
Mild pre-eclampsia
A pregnant client has been admitted with complaints of brownish vaginal bleeding. On examination there is an elevated hCG level, absent fetal heart sounds and a discrepancy between the uterine size and the gestational age. The nurse interprets these findings to suggest which of the following? a) Placenta previa b) Molar pregnancy c) Ectopic pregnancy d) Abruption of placenta
Molar pregnancy
The nurse is required to monitor a pregnant client with fallopian tube rupture. Which of the following interventions should a nurse perform to identify development of hypovolemic shock in this client? a) Monitor the client's beta-hCG level. b) Monitor the client's vital signs, bleeding. c) Monitor the mass with transvaginal ultrasound. d) Monitor the fetal heart rate (FHR)
Monitor the client's vital signs, bleeding.
A woman is 9 weeks gestation and admitted to the obstetrical unit for hyperemesis gravidarum. The highest priority intervention the nurse should anticipate is which of the following? a) IV rehydration b) Administration of antiemetics c) Bed rest with bathroom privileges d) NPO for 24 hours
NPO for 24 hours
A pregnant woman with preeclampsia is to receive magnesium sulfate IV. Which of the following assessments would be most important prior to administering a new dose? a) Pulse rate b) Blood pressure c) Patellar reflex d) Anxiety level
Patellar reflex
A woman in labor has sharp fundal pain accompanied by slight vaginal bleeding. Which of the following would be the most likely cause of these symptoms? a) Placenta previa obstructing the cervix b) Premature separation of the placenta c) Possible fetal death or injury d) Preterm labor that was undiagnosed
Premature separation of the placenta
A woman develops HELLP syndrome. During labor, which of the following orders would you question? a) Assess her blood pressure every 15 minutes. b) Urge her to lie on her left side during labor. c) Prepare her for epidural anesthesia. d) Assess the urine output every hour.
Prepare her for epidural anesthesia.
A woman you care for has an Rh-negative blood type. Following the birth of her infant, you administer her Rho(D) (D immune globulin). The purpose of this is to a) Stimulate maternal D immune antigens. b) Prevent maternal D antibody formation. c) Prevent fetal RH blood formation. d) Promote maternal D antibody formation.
Prevent maternal D antibody formation.
A woman diagnosed with preeclampsia is to recieve magnesium sulfate. The rationale for this drug is to: A. Reduce CNS irritability and prevent seizures. B. Provide supplementation of an important mineral she needs C. Prevent constipation during and after the birthing process D. Decrease musculoskeletal tone to augment labor
Reduce CNS irritability and prevent seizures.
When assessing a woman with an ectopic pregnancy, which of the following would lead the nurse to suspect that the tube has ruptured? a) Nausea b) Referred shoulder pain c) Vaginal spotting d) Breast tenderness
Referred shoulder pain
A 45-year-old pregnant woman with type O blood has had an amniocentesis to rule out Down syndrome. The fetus has type AB blood. What can the nurse warn the patient is a likely outcome if some fetal blood mixed with maternal blood during the procedure? a) The baby will develop hemolytic anemia. b) Placental abruption c) The baby will have postdelivery jaundice. d) Preterm delivery
The baby will have postdelivery jaundice.
A woman and her partner present at her first antenatal obstetrics appointment. She is 6 weeks pregnant. Her blood tests show that she is Rh negative although she has not previously known this. She has no other children but suspects that she miscarried early in a pregnancy 2 years previously. She felt fine afterward so she never received medical attention for that suspected episode. Her partner reports that he is also Rh negative. What action will the nurse be likely to take? a) The nurse will perform all normal procedures and follow-up tasks because the Rh status of the patient and the child are not a concern at this time. b) If an antibody screen is negative, the nurse will administer RhoGam to the patient. c) The nurse will arrange for an amniocentesis to assess hemolytic disease in the fetus. d) If an antibody screen is positive, the nurse will administer RhoGam to the patient.
The nurse will perform all normal procedures and follow-up tasks because the Rh status of the patient and the child are not a concern at this time.
RhoGAM is given to Rh-negative women to prevent maternal sensitization. In addition to pregnancy, Rh-negative women would also receive this medication after which of the following? a. Therapeutic or spontaneous abortion b. Head injury from a car accident c. Blood transfusion after a hemorrhage d. Unsuccessful artificial insemination procedure
Therapeutic or spontaneous abortion
A woman of 16 weeks' gestation telephones you because she has passed some "berry-like" blood clots and now has continued dark brown vaginal bleeding. Which of the following would you instruct the woman to do? a) "Continue normal activity, but take your pulse every hour." b) "Maintain bed rest and count the number of perineal pads used." c) "Come to the health facility with any vaginal material passed." d) "Come to the health care facility if uterine contractions begin."
"Come to the health facility with any vaginal material passed."
A client at 11 weeks' gestation experiences pregnancy loss. The client asks the nurse if the bleeding and cramping that occurred during the miscarriage were caused by working long hours in a stressful environment. What is the most appropriate response from the nurse? a) "I can understand your need to find an answer to what caused this. Let's talk about this further." b) "Something was wrong with the fetus." c) "Your spontaneous bleeding is not work-related." d) "It is hard to know why a woman bleeds during early pregnancy."
"I can understand your need to find an answer to what caused this. Let's talk about this further."
After teaching a woman about hyperemesis gravidarum and how it differs from the typical nausea and vomiting of pregnancy, which statement by the woman indicates that the teaching was successful? a. "I can expect the nausea to last through my second trimester." b. "I should drink fluids with my meals instead of in between them." c. "I need to avoid strong odors, perfumes, or flavors." d. "I should lie down after I eat for about 2 hours."
"I need to avoid strong odors, perfumes, or flavors."
Select the statement by the pregnant woman that indicates the need for more teaching about preeclampsia. a) "If I have changes in my vision, I will lie down and rest." b) "I will weigh myself every morning after voiding before breakfast." c) "I will count my baby's movements twice a day." d) "If I have a slight headache I'll take Tylenol and call if unrelieved."
"If I have changes in my vision, I will lie down and rest."
A client experiences a threatened abortion. She is concerned about losing the pregnancy and asks what activity level she should maintain. What is the most appropriate response from the nurse? a) "Carry on with the activity you engaged in before this happened." b) "There is no research evidence that I can recommend to you." c) "Restrict your physical activity to moderate bedrest." d) "Strict bedrest is necessary so as not to jeopardize this pregnancy."
"Restrict your physical activity to moderate bedrest."
Which of the following changes in B/P assessment findings during the second trimester indicate the highest risk for preeclampsia. a) Initial BP 110/60, current BP 112/86. b) Initial BP 120/80, current BP 130/88. c) Initial BP 100/70, current BP 140/90. d) Initial BP 140/85, current BP 130/80.
Initial BP 100/70, current BP 140/90
A nurse is caring for a client with hyperemesis gravidarum. Which of the following should be the first choice for fluid replacement for this client? a) IV fluids and antiemetics b) Total parenteral nutrition c) 5% dextrose in lactated Ringer solution with vitamins and electrolytes d) Percutaneous endoscopic gastrostomy
5% dextrose in lactated Ringer solution with vitamins and electrolytes
A nurse is assessing pregnant clients for the risk of placenta previa. Which of the following clients faces the greatest risk for this condition? a) A client who had undergone a myomectomy to remove fibroids b) A client with a history of alcohol ingestion c) A client with a structurally defective cervix d) A 23-year-old client
A client who had undergone a myomectomy to remove fibroids
A primipara at 36 weeks gestation is being monitored in the prenatal clinic for risk of preeclampsia. Which of the following signs or symptoms is the priority concern for the nurse? a) A systolic blood pressure increase of 10 mm hg. b) A dipstick value of 2+ for protein. c) Pedal edema. d) Weight gain of 1.2 lb during the past 1 week.
A dipstick value of 2+ for protein.
A client in her first trimester has just experienced a miscarriage. The nurse knows that which of the following is the most likely cause of the miscarriage? a) Lack of sufficient progesterone produced by the corpus luteum b) Implantation abnormality c) Rejection of the embryo through an immune response d) Abnormal fetal development
Abnormal fetal development
A postpartum mother has the following lab data recorded: RH negative and rubella titer is positive. What is the appropriate nursing intervention? a) Administer RhoGam within 72 hours. b) Administer rubella vaccine before discharge. c) Assess the RH of the baby. d) Assess the rubella of the baby
Administer RhoGam within 72 hours.
A pregnant client is admitted to a health care unit with disseminated intravascular coagulation (DIC). Which of the following orders is the nurse most likely to receive regarding the therapy for such a client? a) Give each unit of blood to raise the hematocrit by 3 g/dL b) Administer a ratio of 1 unit of blood to 4 units of frozen plasma c) Aim at keeping the client's hematocrit above 20% d) Administer cryoprecipitate and platelets
Administer cryoprecipitate and platelets
A pregnant woman is admitted to the hospital with a diagnosis of placenta previa. Which of the following would be the priority for this woman on admission? a) Performing a vaginal examination to assess the extent of bleeding b) Helping the woman remain ambulatory to reduce bleeding c) Assessing uterine contractions by an internal pressure gauge d) Assessing fetal heart tones by use of an external monitor
Assessing fetal heart tones by use of an external monitor
A nurse is caring for a pregnant client with eclamptic seizure. Which of the following should the nurse know as a characteristic of eclampsia? a) Respiration fails after the seizure. b) Coma occurs after seizure. c) Respirations are rapid during the seizure. d) Muscle rigidity is followed by facial twitching.
Coma occurs after seizure.
A client has been admitted to the hospital with a diagnosis of severe pre-eclampsia. Which of the following is the priority nursing? a) Administer oxygen by face mask b) Keep the client on her side so that secretions can drain from her mouth c) Confine the client to bed rest in a darkened room d) Check for vaginal bleeding every 15 minutes
Confine the client to bed rest in a darkened room
You are caring for a patient with preeclampsia. You know that you need to auscultate this patient's lung sounds every two hours. Why would you do this? a) Pulmonary emboli b) Pulmonary hypertension c) Pulmonary atelectasis d) Pulmonary edema
Pulmonary edema
The nurse is caring for a pregnant client with severe preeclampsia. Which of the following nursing interventions should a nurse perform to institute and maintain seizure precautions in this client? a) Keep head of bed slightly elevated. b) Provide a well-lit room. c) Keep the suction equipment readily available. d) Place the client in a supine position.
Keep the suction equipment readily available.
When administering magnesium sulfate to a woman with severe preeclampsia, which finding would alert the nurse to the development of magnesium toxicity? a) Serum magnesium level of 6.5 mEq/L b) Elevated liver enzymes c) Diminished reflexes d) Seizures
Diminished reflexes
A woman with an incomplete abortion is to receive misoprostol. The nurse understands that the rationale for administering this drug is to: a) Ensure passage of all the products of conception b) Halt the progression of the abortion c) Alleviate strong uterine cramping d) Suppress the immune response to prevent isoimmunization
Ensure passage of all the products of conception
A nurse is monitoring a client with PROM who is in labor and observes meconium in the amniotic fluid. What does this indicate? a) Fetal distress related to hypoxia b) Central nervous system (CNS) involvement c) Infection d) Cord compression
Fetal distress related to hypoxia
A pregnant woman is diagnosed with abruptio placentae. When reviewing the woman's medical record, which of the following would the nurse expect to find? a) Firm, rigid uterus on palpation b) Fetal heart rate within normal range c) Bright red vaginal bleeding d) Absence of pain
Firm, rigid uterus on palpation
A novice nurse asks to be assigned to the least complex antepartum patient. Which of the following conditions would necessitate the least complex care requirements? a) Pre-ecalmpsia. b) Abruptio placenta. c) Gestational hypertension. d) Placenta previa.
Gestational hypertension.
To which of the following patients being discharged for home must the nurse stress that it is absolutely critical the patient return for monthly follow-up visits? A woman who: a) Has experienced a complete spontaneous abortion b) Has experienced an ectopic pregnancy c) Has experienced a molar pregnancy d) Is Rh negative
Has experienced a molar pregnancy
A woman is admitted with a diagnosis of ectopic pregnancy. For which of the following would you anticipate beginning preparation? a) Bed rest for the next 4 weeks b) Intravenous administration of a tocolytic c) Internal uterine monitoring d) Immediate surgery
Immediate surgery
A woman is being admitted to your hospital unit for severe preeclampsia. When deciding on where to place her, which of the following areas would be most appropriate? a) In the back hallway where there is a quiet, private room b) Near the elevator so she can be transported quickly c) Near the nurse's station so she can be observed closely d) By the nursery so she can maintain hope she will have a child
In the back hallway where there is a quiet, private room
A pregnant woman, approximately 12 weeks' gestation, comes to the emergency department after calling her health care provider's office and reporting moderate vaginal bleeding. Assessment reveals cervical dilation and moderately strong abdominal cramps. She reports that she has passed some tissue with the bleeding. The nurse interprets these findings to suggest which of the following? a. Threatened abortion b. Inevitable abortion c. Incomplete abortion d. Missed abortion
Inevitable abortion
When caring for a client with premature rupture of membranes (PROM), the nurse observes an increase in the client's pulse. What does this increase in pulse indicate? a) Preterm labor b) Cord compression c) Respiratory distress syndrome d) Infection
Infection
Which of the following would the nurse include in the plan of care for a woman with premature rupture of membranes if her fetus's lungs are mature? a) Reduction in physical activity level b) Administration of corticosteroids c) Labor induction d) Observation for signs of infection
Labor induction
A client is seeking advice for his pregnant wife, who is experiencing mild elevations in blood pressure. In which of the following positions should a nurse recommend the pregnant client rest? a) Left lateral lying position b) Lateral recumbent position c) Head of the bed slightly elevated d) Supine position
Lateral recumbent position
Which of the following would be the physiologic basis for a placenta previa? a) A placenta with multiple lobes b) Low placental implantation c) A uterus with a midseptum d) A loose placental implantation
Low placental implantation
Which of the following would the nurse prepare to administer if ordered as treatment for an unruptured ectopic pregnancy? a) Promethazine b) Methotrexate c) Oxytocin d) Ondansetron
Methotrexate
A pregnant client with severe pre-eclampsia has developed the HELLP syndrome. In addition to the observations necessary for pre-eclampsia, what other nursing intervention is critical for this patient? a) Maintaining a patent airway b) Monitoring for infection c) Administration of a tocolytic, if prescribed d) Observation for bleeding
Observation for bleeding
A 32-year-old gravida 3 para 2 at 36 weeks' gestation comes to the obstetric department reporting abdominal pain. Her blood pressure is 164/90 mm/Hg, her pulse is 100 beats per minute, and her respirations are 24 per minute. She is restless and slightly diaphoretic with a small amount of dark red vaginal bleeding. What assessment should the nurse make next? a) Obtain a voided urine specimen and determine blood type. b) Measure fundal height. c) Check deep tendon reflexes. d) Palpate the fundus and check fetal heart rate.
Palpate the fundus and check fetal heart rate.
A 44-year-old client has lost several pregnancies over the last 10 years. For the past 3 months, she has had fatigue, nausea, and vomiting. She visits the clinic and takes a pregnancy test; the results are positive. Physical examination confirms a uterus enlarged to 13 weeks' gestation; fetal heart tones are heard. Ultrasound reveals that the client is experiencing some bleeding. Considering the client's prenatal history and age, what does the nurse recognize as the greatest risk for the client at this time? a) Hypertension. b) Pregnancy loss. c) Premature birth. d) Preterm labor.
Pregnancy loss.
A woman in week 35 of her pregnancy with severe hydramnios is admitted to the hospital. The nurse recognizes that which of the following is the biggest concern regarding this client? a) Hemorrhaging b) Development of eclampsia c) Preterm rupture of membranes followed by preterm birth d) Development of gestational trophoblastic disease
Preterm rupture of membranes followed by preterm birth
A patient is admitted to labor and delivery for management of severe preeclampsia. An IV infusion of magnesium sulfate is started. What is the primary goal for magnesium sulfate therapy? a) Reverse edema b) Prevent maternal seizures c) Decrease blood pressure d) Decrease protein in urine
Prevent maternal seizures
A client in her 38th week of gestation is admitted into the labor and birth unit with painless bleeding from the vagina. The client is diagnosed with placenta previa. When reviewing the client's history, which of the following would the nurse identify as a risk factor for placenta previa? a) Maternal age more than 30 years b) Primigravida status c) Previous cesarean birth d) Living in coastal areas
Previous cesarean birth
What makes the diagnosis of gestational hypertension different from the diagnosis of preeclampsia? a) Proteinuria b) Ketonuria c) Severity of hypertension d) The hypertension of gestation disappears after delivery. The hypertension of preeclampsia does not.
Proteinuria
The following hourly assessments are obtained by the nurse on a patient with preeclampsia receiving Magnesium Sulfate: 97.3, P88, R10, blood pressure 148/110. What other priority physical assessment by the nurse should be implemented to assess for potential toxicity? a) Reflexes b) Lung sounds c) Magnesium sulfate level d) Oxygen saturation
Reflexes
A patient with preeclampsia is receiving magnesium sulfate. Which of the following nursing assessments should be ongoing while the medication is being administered? a) Hemoglobin. b) Ability to sleep. c) Respiratory rate. d) Urine protein.
Respiratory rate.
A woman in labor is at risk for abruptio placentae. Which of the following assessments would most likely lead you to suspect that this has happened? a) Painless vaginal bleeding and a fall in blood pressure. b) Sharp fundal pain and discomfort between contractions. c) Pain in a lower quadrant and increased pulse rate. d) An increased blood pressure and oliguria.
Sharp fundal pain and discomfort between contractions.
Sometimes an ectopic pregnancy occurs outside the woman's uterus. This usually occurs in one of the fallopian tubes. If the embryo continues to grow, it may rupture the tube. What are the signs and symptoms of a ruptured fallopian tube? a) Shoulder pain b) Unilateral abdominal pain c) Rectal pain d) Bilateral abdominal pain
Shoulder pain
When assessing a pregnant woman with vaginal bleeding, which finding would lead the nurse to suspect an inevitable abortion? a) No passage of fetal tissue b) Strong abdominal cramping c) Slight vaginal bleeding d) Closed cervical os
Strong abdominal cramping
In returning to the hospital floor after a weekend off, the nurse takes over care of a pregnant patient who is resting in a darkened room. The patient is receiving betamethasone and magnesium sulfate. What could the nurse deduce from those findings? a) The patient is suffering from severe preeclampsia and the care team is attempting to prevent advancement of the disorder to eclampsia; they are attempting to help the baby's lungs mature quickly so that they can deliver as soon as possible. b) The patient is suffering from hypertension and the care team is trying to lower her blood pressure so that she may return home until the baby is full term. c) The patient is suffering from eclampsia and the care team is attempting to prevent stroke and induce labor. d) The patient is suffering from mild preeclampsia and the care team is attempting to stabilize her and the baby before discharging her to home.
The patient is suffering from severe preeclampsia and the care team is attempting to prevent advancement of the disorder to eclampsia; they are attempting to help the baby's lungs mature quickly so that they can deliver as soon as possible.
A young woman presents at the emergency department with complaints of lower abdominal cramping and spotting at 12 weeks' gestation. The physician performs a pelvic examination and finds that the cervix is closed. What does the physician suspect is the cause of the cramps and spotting? a) Habitual abortion b) Ectopic pregnancy c) Threatened abortion d) Cervical insufficiency
Threatened abortion
Vaginal bleeding during pregnancy is always a deviation from the normal. a) False b) True
True
A young mother delivers twin boys who shared the same placenta. What serious complication are they at risk for? a) TORCH syndrome b) ABO incompatability c) HELLP syndrome d) Twin-to-twin transfusion syndrome (TTTS)
Twin-to-twin transfusion syndrome (TTTS)
A woman at 8 weeks' gestation is admitted for ectopic pregnancy. She is asking why this has occurred. The nurse knows that which of the following is a known risk factor for ectopic pregnancy? a) Use of IUD for contraception b) Use of oral contraceptives c) Multiple gestation pregnancy d) High number of pregnancies
Use of IUD for contraception
A client visits a health care facility with complaints of amenorrhea for 10 weeks, fatigue, and breast tenderness. Which of the following additional signs and symptoms suggest the presence of molar pregnancy? Select all that apply. a) Dyspareunia b) Whitish discharge from the vagina c) Elevated hCG levels d) Absence of fetal heart sound e) Hyperemesis gravidarum
• Elevated hCG levels • Absence of fetal heart sound • Hyperemesis gravidarum
A client in her 20th week of gestation develops HELLP syndrome. Which of the following should the nurse consider as features of HELLP syndrome? Select all that apply. a) Hemolysis b) Elevated liver enzymes c) Low platelet count d) Hyperthermia e) Leukocytosis
• Hemolysis • Elevated liver enzymes • Low platelet count
Which of the following would the nurse most likely include when planning the care for a woman requiring hospitalization for hyperemesis gravidarum? Select all that apply. a) Obtaining baseline blood electrolyte levels b) Monitoring intake and output c) Maintaining NPO status for the first day or two d) Administering antiemetic agents e) Preparing the woman for insertion of a feeding tube
• Maintaining NPO status for the first day or two • Administering antiemetic agents • Obtaining baseline blood electrolyte levels • Monitoring intake and output
A client reports to her obstetrician complaining of a significant amount of bright red, painless vaginal bleeding. A sonogram reveals that her placenta has implanted low in the uterus and is partially covering the cervical os. Which of the following immediate care measures should the nurse initiate? (Select all that apply.) a) Perform a pelvic examination b) Continue to assess blood pressure every 5 to 15 minutes c) Determine from the client the time the bleeding began and about how much blood has been lost d) Place the woman on bed rest in a side-lying position e) Obtain baseline vital signs f) Attach external monitoring equipment to record fetal heart sounds
• Place the woman on bed rest in a side-lying position • Determine from the client the time the bleeding began and about how much blood has been lost • Obtain baseline vital signs • Continue to assess blood pressure every 5 to 15 minutes • Attach external monitoring equipment to record fetal heart sounds
A pregnant client is brought to the health care facility with signs of PROM. Which of the following are the associated conditions and complications of premature rupture of the membranes? Select all that apply. a) Placenta previa b) Prolapsed cord c) Preterm labor d) Abruptio placenta e) Spontaneous abortion
• Prolapsed cord • Abruptio placenta • Preterm labor
A nurse is explaining to a group of nursing students that eclampsia or seizures in pregnant women are preceded by an acute increase in maternal blood pressure. Which of the following are features of an acute increase in blood pressure? Select all that apply. a) Proteinuria b) Blurring of vision c) Auditory hallucinations d) Hypereflexia e) Hyperglycemia
• Proteinuria • Hypereflexia • Blurring of vision
