Reproductive Quiz #2
Normal pregnancy hemoglobin and hematocrit
12-16g/dl 37 to 47%
What is considered hypertension?
140/90
Normal pregnancy platelets
150,00 to 400,000
When is induction of labor recommended fro preeclampsia woman?
37 weeks
What is the initial dose for magnesium sulfate?
4-6g of Magnesium sulfate infused over 15 to 30 minutes. Therapeutic level should be at 4 to 7 mEQ
A nurse is caring for a client whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of: Uterine contractions occurring every 8 to 10 minutes. A fetal heart rate (FHR) of 180 with absence of variability. The client needing to void. Rupture of the client's amniotic membranes.
A fetal heart rate (FHR) of 180 with absence of variability. A fetal heart rate (FHR) of 180 with absence of variability is nonreassuring; the oxytocin should be immediately discontinued and the physician should be notified. The oxytocin should also be discontinued if uterine hyperstimulation occurs. Uterine contractions that occur every 8 to 10 minutes do not qualify as hyperstimulation. The client needing to void is not an indication to discontinue the oxytocin induction immediately or to call the physician. The oxytocin does not need to be discontinued when the membranes rupture, but the physician should be notified.
Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy. Which statement regarding monitoring techniques is the most accurate? a.Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis. b.MSAFP screening is recommended only for women at risk for NTDs. c.PUBS is one of the triple-marker tests for Down syndrome. d.MSAFP is a screening tool only; it identifies candidates for more definitive diagnostic procedures.
ANS: D MSAFP is a screening tool, not a diagnostic tool. CVS provides a rapid result, but it is declining in popularity because of advances in noninvasive screening techniques. An MSAFP screening is recommended for all pregnant women. MSAFP screening, not PUBS, is part of the triple-marker tests for Down syndrome.
4+ deep tendon reflex
Brisk hyperactive w/ intermittent or transient clonus
Emergency meds for preeclampsia?
Hydralazine, Labetalol Nifedipine, Magnesium Sulfate, Calcium Gluconate, Calcium chloride
Preeclampsia platelets
Less than 100,000
How to treat/prevent preeclampsia?
Low dose aspirin late first trimester Abnormal uterine artery doppler velocimetry
For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse? Fetal heart rate of 116 beats/min Cervix dilated 2 cm and 50% effaced Score of 8 on the biophysical profile One fetal movement noted in 1 hour of assessment by the mother
One fetal movement noted in 1 hour of assessment by the mother Self-care in a postterm pregnancy should include performing daily fetal kick counts three times per day. The mother should feel four fetal movements per hour. If she feels fewer than four movements, she should count for 1 more hour. Fewer than four movements in that hour warrants evaluation. The findings described in the other choices are normal at 42 weeks of gestation.
What is diet recommendation for preeclampsia?
Regular diet 60-70g protein 1200mg calcium 600 mcg folic acid adequate zinc 11-12mg sodium 1.5g increase in fluids
1+ for deep tendon reflexes
Sluggish/diminished
Sx of magnesium toxicity
absent deep tendon reflexes, respiratory depression, blurred vision, slurred speech, severe muscle weakness, cardiac arrest
What is HELLP syndrome?
hepatic dysfunction characterized by: hemolysis, elevated liver enzymes, low platelets
When should gestational HTN end?
typically 1st week postpartum but can last up to 12 weeks postpartum
Chronic hypertension:
Hypertension present before pregnancy or diagnosed before week 20 of gestation Also if hypertension lasts longer than 12 weeks post partum
Bleeding disorders in late pregnancy include all of the following except: a. Placenta previa. b. Abruptio placentae. c. Spontaneous abortion. d. Cord insertion.
c. -Spontaneous abortion is another name for miscarriage; by definition it occurs early in pregnancy.
A woman who is at 36 weeks of gestation is having a nonstress test. Which statement by the woman would indicate a correct understanding of the test? a. "I will need to have a full bladder for the test to be done accurately." b. "I should have my husband drive me home after the test because I may be nauseous." c. "This test will help to determine whether the baby has Down syndrome or a neural tube defect." d. "This test will observe for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby."
d. "This test will observe for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby."
Eclampsia
development of convulsions or coma in a preeclamptic woman
Biophysical risks include factors that originate with either the mother or the fetus and affect the functioning of either one or both. The nurse who provides prenatal care should have an understanding of these risk factors. Match the specific pregnancy problem with the related risk factor. a.Polyhydramnios b.IUGR (maternal cause) c.Oligohydramnios d.Chromosomal abnormalities e.IUGR (fetoplacental cause) 1. Premature rupture of membranes 2. Advanced maternal age 3. Fetal congenital anomalies 4. Abnormal placenta development 5. Smoking, alcohol, and illicit drug use
1. ANS: C DIF: Cognitive Level: Understand REF: p. 635 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 2. ANS: D DIF: Cognitive Level: Understand REF: p. 635 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 3. ANS: A DIF: Cognitive Level: Understand REF: p. 635 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 4. ANS: E DIF: Cognitive Level: Understand REF: p. 635 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 5. ANS: B DIF: Cognitive Level: Understand REF: p. 635
How does the nurse document a NST during which two or more FHR accelerations of 15 beats per minute or more occur with fetal movement in a 20-minute period? a.Nonreactive b.Positive c.Negative d.Reactive
ANS: D The NST is reactive (normal) when two or more FHR accelerations of at least 15 beats per minute (each with a duration of at least 15 seconds) occur in a 20-minute period. A nonreactive result means that the heart rate did not accelerate during fetal movement. A positive result is not used with NST. CST uses positive as a result term. A negative result is not used with NST. CST uses negative as a result term.
A woman arrives at the clinic seeking confirmation that she is pregnant. The following information is obtained: She is 24 years old with a body mass index (BMI) of 17.5. She admits to having used cocaine "several times" during the past year and occasionally drinks alcohol. Her blood pressure is 108/70 mm Hg. The family history is positive for diabetes mellitus and cancer. Her sister recently gave birth to an infant with a neural tube defect (NTD). Which characteristics places this client in a high-risk category? a.Blood pressure, age, BMI b.Drug and alcohol use, age, family history c.Family history, blood pressure (BP), BMI d.Family history, BMI, drug and alcohol abuse
ANS: D The woman's family history of an NTD, her low BMI, and her drug and alcohol use abuse are high risk factors of pregnancy. The woman's BP is normal, and her age does not put her at risk. Her BMI is low and may indicate poor nutritional status, which is a high risk.
2+ deep tendon reflex
Active/ expected/ normal
What is the main pathogenic factor for preeclampsia?
Poor placental perfusion
A woman with severe preeclampsia is being treated with an IV infusion of magnesium sulfate. This treatment is considered successful if: Blood pressure is reduced to prepregnant baseline. Seizures do not occur. Deep tendon reflexes become hypotonic. Diuresis reduces fluid retention.
Seizures do not occur. Magnesium sulfate is a central nervous system (CNS) depressant given primarily to prevent seizures. A temporary decrease in blood pressure can occur but is not the purpose of administering this medication. Hypotonia is a sign of an excessive serum level of magnesium. It is critical that calcium gluconate be on hand to counteract the depressant effects of magnesium toxicity. Diuresis is not an expected outcome of magnesium sulfate administration.
A pregnant woman who is at 21 weeks of gestation has an elevated blood pressure of 140/98. Past medical history reveals that the woman has been treated for hypertension. On the basis of this information, the nurse would classify this patient as having: Preeclampsia. Gestational hypertension. Superimposed preeclampsia. Chronic hypertension.
Superimposed preeclampsia. Because this patient already has a medical history of hypertension and is now exhibiting hypertension prior after the 20th week of gestation, she would be considered to have superimposed pre-eclampsia. Pre-eclampsia would be the classification in a patient without a history of hypertension who was hypertensive following the 20th week of pregnancy. Gestational hypertension occurs after the 20th week of pregnancy in a patient who was previously normotensive. Even though the patient has chronic hypertension, the fact that she is now pregnant determines that she would be classified as having superimposed pre-eclampsia.
Pregnancy onset snoring is a risk factor for HTN and preeclampsia [T or F]
True
What is Betamethasone used for?
Used to enhance lung maturity in the fetus if preterm delivery is likely
Which clinical finding is a major use of ultrasonography in the first trimester? a.Amniotic fluid volume b.Presence of maternal abnormalities c.Placental location and maturity d.Cervical length
ANS: B Ultrasonography can detect certain uterine abnormalities such as bicornuate uterus, fibroids, and ovarian cysts. Amniotic fluid volume, placental location and maturity, and cervical length are not available via ultrasonography until the second or third trimester.
A woman presents to the emergency department complaining of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary health care provider finds that the cervix is closed. The anticipated plan of care for this woman is based on a probable diagnosis of which type of spontaneous abortion? Incomplete Inevitable Threatened Septic
Threatened A woman with a threatened abortion presents with spotting, mild cramps, and no cervical dilation. Heavy bleeding, mild to severe cramping, and cervical dilation are the presentation for both incomplete abortion and inevitable abortion. A woman with a septic abortion presents with malodorous bleeding and, typically, a dilated cervix.
Preeclamptic Hgb and Hematocrit
may increase
What is clonus?
pressure on tendons causes beating hyperactive reflexes
In planning for an expected cesarean birth for a woman who has given birth by cesarean section previously and who has a fetus in the transverse presentation, the nurse includes which information? "Because this is a repeat procedure, you are at the lowest risk for complications." "Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." "Because this is your second cesarean birth, you will recover faster." "You will not need preoperative teaching because this is your second cesarean birth."
"Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." The statement in B is most appropriate. The statements in A, C, and D are not accurate. Maternal and fetal risks are associated with every cesarean section. Physiologic and psychologic recovery from a cesarean section is multifactorial and individual to each client each time. Preoperative teaching should always be performed regardless of whether the client has already had this procedure.
How does preeclampsia affect the fetus?
Fetal growth restriction Decreased amniotic fluid volume Abnormal fetal oxygenation Low birth weight Preterm birth
A woman with severe preeclampsia has been receiving magnesium sulfate by IV infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature 37.1° C, pulse rate 96 beats/min, respiratory rate 24 breaths/min, blood pressure 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for: Hydralazine. Magnesium sulfate bolus. Diazepam. Calcium gluconate.
Hydralazine. Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. An additional bolus of magnesium sulfate may be ordered for increasing signs of central nervous system irritability related to severe preeclampsia (e.g., clonus) or if eclampsia develops. Diazepam sometimes is used to stop or shorten eclamptic seizures. Calcium gluconate is used as the antidote for magnesium sulfate toxicity. The client is not currently displaying any signs or symptoms of magnesium toxicity.
Thrombocytopenia platelet count
less than 100,000/mm3
A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits: A sleepy, sedated affect. A respiratory rate of 10 breaths/min. Deep tendon reflexes of 2+. Absence of ankle clonus.
A respiratory rate of 10 breaths/min. A respiratory rate of 10 breaths/min indicates that the client is experiencing respiratory depression (bradypnea) from magnesium toxicity. Because magnesium sulfate is a central nervous system (CNS) depressant, the client will most likely become sedated when the infusion is initiated. Deep tendon reflexes of 2+ are a normal finding, as is absence of ankle clonus.
A pregnant woman arrives on the labor and delivery unit and informs the nurse that her infant is in a breech presentation. This presentation is associated with an increased risk for childhood handicap; therefore this baby will likely be delivered by cesarean birth. The client may wish to undergo an external cephalic version (ECV) in an attempt to manually reposition the baby into a vertex presentation. A number of interventions may be implemented to support this procedure and increase the likelihood of success. Studies have shown which intervention to be the most successful? A. Tocolysis B. Nitrous oxide C. Spinal or epidural analgesia D. Amnioinfusion
A. Tocolysis
A woman is undergoing a nipple-stimulated CST. She is having contractions that occur every 3 minutes. The fetal heart rate (FHR) has a baseline heart rate of approximately 120 beats per minute without any decelerations. What is the correct interpretation of this test? a.Negative b.Positive c.Satisfactory d.Unsatisfactory
ANS: A Adequate uterine activity necessary for a CST consists of three contractions in a 10-minute time frame. If no decelerations are observed in the FHR pattern with the contractions, then the findings are considered to be negative. A positive CST indicates the presence of repetitive late FHR decelerations. The terms satisfactory or unsatisfactory are not applicable.
Which information is the highest priority for the nurse to comprehend regarding the BPP? a.BPP is an accurate indicator of impending fetal well-being. b.BPP is a compilation of health risk factors of the mother during the later stages of pregnancy. c.BPP consists of a Doppler blood flow analysis and an amniotic fluid index (AFI). d.BPP involves an invasive form of an ultrasonic examination.
ANS: A An abnormal BPP score is one indication that labor should be induced. The BPP evaluates the health of the fetus, requires many different measures, and is a noninvasive procedure.
A client asks her nurse, "My doctor told me that he is concerned with the grade of my placenta because I am overdue. What does that mean?" What is the nurse's best response? a."Your placenta changes as your pregnancy progresses, and it is given a score that indicates how well it is functioning." b."Your placenta isn't working properly, and your baby is in danger." c."We need to perform an amniocentesis to detect if you have any placental damage." d."Don't worry about it. Everything is fine."
ANS: A An explanation of what is meant by the "grade of my placenta" is the most appropriate response. If the client desires further information, the nurse can explain that calcium deposits are significant in postterm pregnancies, and ultrasonography can also be used to determine placental aging. Although stating that the client's placenta is not working properly and that the baby is in danger may be a valid response, it does not reflect therapeutic communication techniques and is likely to alarm the client. An ultrasound, not amniocentesis, is the method of assessment used to determine placental maturation. Telling the client not to worry is not appropriate and discredits her concerns.
A 39-year-old primigravida woman believes that she is approximately 8 weeks pregnant, although she has had irregular menstrual periods all her life. She has a history of smoking approximately one pack of cigarettes a day; however, she tells the nurse that she is trying to cut down. Her laboratory data are within normal limits. What diagnostic technique would be useful at this time? a.Ultrasound examination b.Maternal serum alpha-fetoprotein (MSAFP) screening c.Amniocentesis d.Nonstress test (NST)
ANS: A An ultrasound examination could be performed to confirm the pregnancy and to determine the gestational age of the fetus. An MSAFP screening is performed at 16 to 18 weeks of gestation; therefore, it is too early in the woman's pregnancy to perform this diagnostic test. An amniocentesis is performed if the MSAFP levels are abnormal or if fetal or maternal anomalies are detected. An NST is performed to assess fetal well-being in the third trimester.
Of these psychosocial factors, which has the least negative effect on the health of the mother and/or fetus? a.Moderate coffee consumption b.Moderate alcohol consumption c.Cigarette smoke d.Emotional distress
ANS: A Birth defects in humans have not been related to caffeine consumption. Pregnant women who consume more than 300 mg of caffeine daily may be at increased risk for miscarriage or IUGR. Although the exact effects of alcohol in pregnancy have not been quantified, it exerts adverse effects on the fetus including fetal alcohol syndrome, fetal alcohol effects, learning disabilities, and hyperactivity. A strong, consistent, causal relation has been established between maternal smoking and reduced birth weight. Childbearing triggers profound and complex physiologic and psychologic changes on the mother. Evidence suggests a relationship between emotional distress and birth complications.
The nurse sees a woman for the first time when she is 30 weeks pregnant. The client has smoked throughout the pregnancy, and fundal height measurements now are suggestive of intrauterine growth restriction (IUGR) in the fetus. In addition to ultrasound to measure fetal size, what is another tool useful in confirming the diagnosis? a.Doppler blood flow analysis b.Contraction stress test (CST) c.Amniocentesis d.Daily fetal movement counts
ANS: A Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and the placenta. It is a helpful tool in the management of high-risk pregnancies because of IUGR, diabetes mellitus, multiple fetuses, or preterm labor. Because of the potential risk of inducing labor and causing fetal distress, a CST is not performed on a woman whose fetus is preterm. Indications for an amniocentesis include diagnosis of genetic disorders or congenital anomalies, assessment of pulmonary maturity, and the diagnosis of fetal hemolytic disease, not IUGR. Fetal kick count monitoring is performed to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation. Although this may be a useful tool at some point later in this woman's pregnancy, it is not used to diagnose IUGR.
The indirect Coombs' test is a screening tool for Rh incompatibility. If the titer is greater than ______, amniocentesis may be a necessary next step. a.1:2 b.1:4 c.1:8 d.1:12
ANS: C If the maternal titer for Rh antibodies is greater 1:8, then an amniocentesis is indicated to determine the level of bilirubin in the amniotic fluid. This testing will determine the severity of fetal hemolytic anemia.
Which analysis of maternal serum may predict chromosomal abnormalities in the fetus? a.Multiple-marker screening b.L/S ratio c.BPP d.Blood type and crossmatch of maternal and fetal serum
ANS: A Maternal serum can be analyzed for abnormal levels of alpha-fetoprotein, human chorionic gonadotropin, and estriol. The multiple-marker screening may predict chromosomal defects in the fetus. The L/S ratio is used to determine fetal lung maturity. A BPP is used for evaluating fetal status during the antepartum period. Five variables are used, but none is concerned with chromosomal problems. The blood type and crossmatch would not predict chromosomal defects in the fetus.
Which information is an important consideration when comparing the CST with the NST? a.The NST has no known contraindications. b.The CST has fewer false-positive results when compared with the NST. c.The CST is more sensitive in detecting fetal compromise, as opposed to the NST. d.The CST is slightly more expensive than the NST.
ANS: A The CST has several contraindications. The NST has a high rate of false-positive results and is less sensitive than the CST but relatively inexpensive.
A pregnant woman's BPP score is 8. She asks the nurse to explain the results. How should the nurse respond at this time? a."The test results are within normal limits." b."Immediate delivery by cesarean birth is being considered." c."Further testing will be performed to determine the meaning of this score." d."An obstetric specialist will evaluate the results of this profile and, within the next week, will inform you of your options regarding delivery."
ANS: A The normal biophysical score ranges from 8 to 10 points if the amniotic fluid volume is adequate. A normal score allows conservative treatment of high-risk clients. Delivery can be delayed if fetal well-being is indicated. Scores less than 4 should be investigated, and delivery could be initiated sooner than planned. The results of the BPP are usually available immediately after the procedure is performed. Since this score is within normal range, no further testing is required at this time.
Which assessments are included in the fetal BPP? (Select all that apply.) a.Fetal movement b.Fetal tone c.Fetal heart rate d.AFI e.Placental grade
ANS: A, B, C, D Fetal movement, tone, heart rate, and AFI are all assessed in a BPP. The placental grade is determined by ultrasound and is not included in the criteria of assessment factors for a BPP.
IUGR is associated with which pregnancy-related risk factors? (Select all that apply.) a.Poor nutrition b.Maternal collagen disease c.Gestational hypertension d.Premature rupture of membranes e.Smoking
ANS: A, B, C, E Poor nutrition, maternal collagen disease, gestational hypertension, and smoking are risk factors associated with the occurrence of IUGR. Premature rupture of membranes is associated with preterm labor, not IUGR.
Transvaginal ultrasonography is often performed during the first trimester. While preparing a 6-week gestational client for this procedure, she expresses concerns over the necessity for this test. The nurse should explain that this diagnostic test may be indicated for which situations? (Select all that apply.) a.Multifetal gestation b.Obesity c.Fetal abnormalities d.Amniotic fluid volume e. Ectopic pregnancy
ANS: A, B, C, E Transvaginal ultrasound is useful in women who are obese whose thick abdominal layers cannot be penetrated with traditional abdominal ultrasound. This procedure is also used to identify multifetal gestation, ectopic pregnancy, estimating gestational age, confirming fetal viability, and identifying fetal abnormalities. Amniotic fluid volume is assessed during the second and third trimester; conventional ultrasound would be used.
Cell-free deoxyribonucleic acid (DNA) screening is a new method of noninvasive prenatal testing (NIPT) that has recently become available in the clinical setting. This technology can provide a definitive diagnosis of which findings? (Select all that apply.) a.Fetal Rh status b.Fetal gender c.Maternally transmitted gene disorder d.Paternally transmitted gene disorder e.Trisomy 21
ANS: A, B, D, E The NIPT cannot actually distinguish fetal from maternal DNA. It can determine fetal Rh status, gender, trisomies 13, 18, and 21, as well as paternally transmitted gene disorders. The test can be performed any time after 10 weeks of gestation and is recommended for women who have previously given birth to a child with chromosomal abnormalities.
An MSAFP screening indicates an elevated level of alpha-fetoprotein. The test is repeated, and again the level is reported as higher than normal. What is the next step in the assessment sequence to determine the well-being of the fetus? a.PUBS b.Ultrasound for fetal anomalies c.BPP for fetal well-being d.Amniocentesis for genetic anomalies
ANS: B If MSAFP findings are abnormal, then follow-up procedures include genetic counseling for families with a history of NTD, repeated MSAFP screenings, an ultrasound examination, and possibly amniocentesis. Indications for the use of PUBS include prenatal diagnosis of inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of fetuses with IUGR, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus. A BPP is a method of assessing fetal well-being in the third trimester. Before an amniocentesis, the client would have an ultrasound for direct visualization of the fetus.
The nurse is planning the care for a laboring client with diabetes mellitus. This client is at greater risk for which clinical finding? a.Oligohydramnios b.Polyhydramnios c.Postterm pregnancy d.Chromosomal abnormalities
ANS: B Polyhydramnios or amniotic fluid in excess of 2000 ml is 10 times more likely to occur in the client with diabetes mellitus rather than in nondiabetic pregnancies. This complication places the mother at risk for premature rupture of membranes, premature labor, and postpartum hemorrhage. Prolonged rupture of membranes, IUGR, intrauterine fetal death, and renal agenesis (Potter syndrome) place the client at risk for developing oligohydramnios. Anencephaly, placental insufficiency, and perinatal hypoxia contribute to the risk for postterm pregnancy. Maternal age older than 35 years and balanced translocation (maternal and paternal) are risk factors for chromosomal abnormalities.
A 41-week pregnant multigravida arrives at the labor and delivery unit after a NST indicated that her fetus could be experiencing some difficulties in utero. Which diagnostic tool yields more detailed information about the condition of the fetus? a.Ultrasound for fetal anomalies b.Biophysical profile (BPP) c.MSAFP screening d.Percutaneous umbilical blood sampling (PUBS)
ANS: B Real-time ultrasound permits a detailed assessment of the physical and physiologic characteristics of the developing fetus and a cataloging of normal and abnormal biophysical responses to stimuli. The BPP is a noninvasive, dynamic assessment of a fetus that is based on acute and chronic markers of fetal disease. An ultrasound for fetal anomalies would most likely have occurred earlier in the pregnancy. It is too late in the pregnancy to perform an MSAFP. Furthermore, it does not provide information related to fetal well-being. Indications for PUBS include prenatal diagnosis or inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of the fetus with IUGR, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus.
Which nursing intervention is necessary before a first-trimester transabdominal ultrasound? a.Place the woman on nothing by mouth (nil per os [NPO]) for 12 hours. b.Instruct the woman to drink 1 to 2 quarts of water. c.Administer an enema. d.Perform an abdominal preparation
ANS: B When the uterus is still in the pelvis, visualization may be difficult. Performing a first-trimester transabdominal ultrasound requires the woman to have a full bladder, which will elevate the uterus upward and provide a better visualization of the fetus; therefore, being NPO is not appropriate. Neither an enema nor an abdominal preparation is necessary for this procedure.
In the past, factors to determine whether a woman was likely to develop a high-risk pregnancy were primarily evaluated from a medical point of view. A broader, more comprehensive approach to high-risk pregnancy has been adopted today. Four categories have now been established, based on the threats to the health of the woman and the outcome of pregnancy. Which category should not be included in this group? a.Biophysical b.Psychosocial c.Geographic d.Environmental
ANS: C A geographic category is correctly referred to as sociodemographic risk. These factors stem from the mother and her family. Ethnicity may be one of the risks to pregnancy; however, it is not the only factor in this category. Low income, lack of prenatal care, age, parity, and marital status also are included. Biophysical is one of the broad categories used for determining risk. These include genetic considerations, nutritional status, and medical and obstetric disorders. Psychosocial risks include smoking, caffeine, drugs, alcohol, and psychologic status. All of these adverse lifestyles can have a negative effect on the health of the mother or fetus. Environmental risks are risks that can affect both fertility and fetal development. These include infections, chemicals, radiation, pesticides, illicit drugs, and industrial pollutants.
At 35 weeks of pregnancy, a woman experiences preterm labor. Although tocolytic medications are administered and she is placed on bed rest, she continues to experience regular uterine contractions and her cervix is beginning to dilate and efface. What is an important test for fetal well-being at this time? a.PUBS b.Ultrasound for fetal size c.Amniocentesis for fetal lung maturity d.NST
ANS: C Amniocentesis is performed to assess fetal lung maturity in the event of a preterm birth. The fluid is examined to determine the lecithin to sphingomyelin (L/S) ratio. Indications for PUBS include prenatal diagnosis or inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of the fetus with IUGR, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus. Determination of fetal size by ultrasound is typically performed during the second trimester and is not indicated in this scenario. An NST measures the fetal response to fetal movement in a noncontracting mother.
A client in the third trimester has just undergone an amniocentesis to determine fetal lung maturity. Which statement regarding this testing is important for the nurse in formulating a care plan? a.Because of new imaging techniques, an amniocentesis should have been performed in the first trimester. b.Despite the use of ultrasonography, complications still occur in the mother or infant in 5% to 10% of cases. c.Administration of Rho(D) immunoglobulin may be necessary. d.The presence of meconium in the amniotic fluid is always a cause for concern.
ANS: C As a result of the possibility of fetomaternal hemorrhage, administration of Rho(D) immunoglobulin is the standard of practice after amniocentesis for women who are Rh negative. Amniocentesis is possible after the 14th week of pregnancy when the uterus becomes an abdominal organ. Complications occur in less than 1% of cases; many have been minimized or eliminated through the use of ultrasonography. Meconium in the amniotic fluid before the beginning of labor is not usually a problem.
While working with the pregnant client in her first trimester, what information does the nurse provide regarding when CVS can be performed (in weeks of gestation)? a.4 b.8 c.10 d.14
ANS: C CVS can be performed in the first or second trimester, ideally between 10 and 13 weeks of gestation. During this procedure, a small piece of tissue is removed from the fetal portion of the placenta. If performed after 9 completed weeks of gestation, then the risk of limb reduction is no greater than in the general population.
Which information should nurses provide to expectant mothers when teaching them how to evaluate daily fetal movement counts (DFMCs)? a.Alcohol or cigarette smoke can irritate the fetus into greater activity. b.Kick counts should be taken every hour and averaged every 6 hours, with every other 6-hour stretch off. c.The fetal alarm signal should go off when fetal movements stop entirely for 12 hours. d.A count of less than four fetal movements in 1 hour warrants future evaluation.
ANS: C No movement in a 12-hour period is cause for investigation and possibly intervention. Alcohol and cigarette smoke temporarily reduce fetal movement. The mother should count fetal activity (kick counts) two or three times daily for 60 minutes each time. A count of less than 3 in 1 hour warrants further evaluation by a NST.
A 30-year-old gravida 3, para 2-0-0-2 is at 18 weeks of gestation. Which screening test should the nurse recommend be ordered for this client? a.BPP b.Chorionic villi sampling c.MSAFP screening d.Screening for diabetes mellitus
ANS: C The biochemical assessment MSAFP test is performed from week 15 to week 20 of gestation (weeks 16 to 18 are ideal). A BPP is a method of biophysical assessment of fetal well-being in the third trimester. Chorionic villi sampling is a biochemical assessment of the fetus that should be performed from the 10th to 12th weeks of gestation. Screening for diabetes mellitus begins with the first prenatal visit.
In comparing the abdominal and transvaginal methods of ultrasound examination, which information should the nurse provide to the client? a.Both require the woman to have a full bladder. b.The abdominal examination is more useful in the first trimester. c.Initially, the transvaginal examination can be painful. d.The transvaginal examination allows pelvic anatomy to be evaluated in greater detail.
ANS: D The transvaginal examination allows pelvic anatomy to be evaluated in greater detail than the abdominal method and also allows intrauterine pregnancies to be diagnosed earlier. The abdominal examination requires a full bladder; the transvaginal examination requires an empty one. The transvaginal examination is more useful in the first trimester; the abdominal examination works better after the first trimester. Neither the abdominal nor the transvaginal method of ultrasound examination should be painful, although the woman will feel pressure as the probe is moved during the transvaginal examination.
In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate? Administration of blood Preparation of the woman for invasive hemodynamic monitoring Restriction of intravascular fluids Administration of steroids
Administration of blood Primary medical management in all cases of DIC involves correction of the underlying cause, volume replacement (not volume restriction), blood component therapy, optimization of oxygenation and perfusion status, and continued reassessment of laboratory parameters. Central monitoring would not be ordered initially in a woman with DIC because it could contribute to more areas of bleeding. Steroids are not indicated for the management of DIC.
The majority of ectopic pregnancies are located in the: Uterine fundus. Cervical os. Ampulla. Fimbriae.
Ampulla. A pregnancy within the uterus would be considered a normal pregnancy. Implantation of the pregnancy at the cervical os would be a significant abnormality. The majority of ectopic pregnancies, approximately 80%, are located in the ampulla or largest portion of the tube.
Which of the following presentations is associated with early pregnancy loss, occurring in less than 12 weeks gestation? Select all that apply. Chromosomal abnormalities Infection Cystitis Antiphospholipid syndrome Hypothyroidism Caffeine use
Chromosomal abnormalities Antiphospholipid syndrome Hypothyroidism 50% of early pregnancy loss results from genetic abnormalities. Hypothyroidism and antiphospholipid syndrome are associated with early pregnancy loss. Caffeine use is associated with second-trimester losses as a result of maternal behavior. Infection is not a likely source of early pregnancy loss. Cystitis in not associated with early pregnancy loss.
A woman diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At present she is at the greatest risk for: Hemorrhage. Infection. Urinary retention. Thrombophlebitis.
Hemorrhage. Hemorrhage is the most immediate risk because the lower uterine segment has limited ability to contract to reduce blood loss. Infection is a risk because of the location of the placental attachment site; however, it is not a priority concern at this time. Placenta previa poses no greater risk for urinary retention or thrombophlebitis than does a normally implanted placenta.
A nurse is examining a patient who has been admitted for possible ectopic pregnancy who is approximately 8 weeks pregnant. Which finding would be a priority concern? No FHT heard via Doppler Scant vaginal bleeding noted on peri pad Ecchymosis noted around umbilicus Blood pressure 100/80
Ecchymosis noted around umbilicus Because this patient is most likely in the early stages of pregnancy, FHT would not be able to be auscultated at this time. Scant vaginal bleeding would not be a priority concern but should still be monitored by the nurse. Ecchymosis around the umbilicus indicates Cullen sign, which indicates hematoperitoneum, and may also develop in an undiagnosed, ruptured intraabdominal ectopic pregnancy.
Which of the following antihypertensive medications would cause a pregnant woman to have a positive Coombs test result? Nifedipine (Procardia) Methyldopa (Aldomet) Labetalol hydrochloride (Trandate) Hydralazine (Apresoline)
Methyldopa (Aldomet) A positive Coombs test result can occur in about 20% of patients taking methyldopa (Aldomet). None of the other drugs listed would have this effect.
3+ deep tendon reflex
More brisk than expected, slightly hyperactive
What medication is used to prevent preeclamptic seizures?
Magnesium sulfate [also inhibits contractions--side note]
HELLP Syndrome increases the risk for what?
Maternal death adverse perinatal outcomes [pulmonary edema] acute renal failure Disseminated intravascular coagulopathy Placental abruption Liver hemorrhage ARDS sepsis Stroke
Which statement is most likely to be associated with a breech presentation? Least common malpresentation Descent rapid Diagnosis by ultrasound only High rate of neuromuscular disorders
High rate of neuromuscular disorders Fetuses with neuromuscular disorders have a higher rate of breech presentation, perhaps because they are less capable of movement within the uterus. Breech is the most common malpresentation, affecting 3% to 4% of all labors. Descent is often slow because the breech is not as good a dilating wedge as the fetal head. Diagnosis is made by abdominal palpation and vaginal examination, and is confirmed by ultrasound.
A nurse caring for pregnant women must be aware that the most common medical complication of pregnancy is: Hypertension. Hyperemesis gravidarum. Hemorrhagic complications. Infections.
Hypertension. Preeclampsia and eclampsia are two noted, deadly forms of hypertension, which is the most common medical complication of pregnancy. A large percentage of pregnant women have nausea and vomiting, but a relative few have the severe form called hyperemesis gravidarum. Hemorrhagic complications are the second most common medical complication of pregnancy.
The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is: Bleeding. Intense abdominal pain. Uterine activity. Cramping.
Intense abdominal pain. Pain is absent with placenta previa and may be agonizing with abruptio placentae. Bleeding, uterine activity, and cramping may be present in varying degrees for both placental conditions.
Nurses should be aware that HELLP syndrome: Is a mild form of preeclampsia. Can be diagnosed by a nurse alert to its symptoms. Is characterized by hemolysis, elevated liver enzymes, and low platelets. Is associated with preterm labor but not perinatal mortality.
Is characterized by hemolysis, elevated liver enzymes, and low platelets. The acronym HELLP stands for hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). HELLP syndrome is a variant of severe preeclampsia. It is difficult to identify, because the symptoms often are not obvious. It must be diagnosed in the laboratory. Preterm labor is greatly increased with HELLP syndrome, and so is perinatal mortality.
A nurse providing care to a woman in labor should be aware that cesarean birth: Is declining in frequency in the United States. Is more likely to be performed in the poor in public hospitals who do not receive the nurse counseling that wealthier clients do. Is performed primarily for the benefit of the fetus. Can be either elected or refused by women as their absolute legal right.
Is performed primarily for the benefit of the fetus. The most common indications for cesarean birth are danger to the fetus related to labor and birth complications. Cesarean births are increasing in the United States. Wealthier women who have health insurance and who give birth in a private hospital are more likely to experience cesarean birth. A woman's right to elect cesarean surgery is in dispute, as is her right to refuse it if in doing so she endangers the fetus. Legal issues are not absolutely clear.
With regard to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that: The drugs can be given efficaciously up to the designated beginning of term at 37 weeks. There are no important maternal (as opposed to fetal) contraindications. Its most important function is to afford the opportunity to administer antenatal glucocorticoids. If pulmonary edema develops while the client is receiving tocolytics, IV fluids should be given.
Its most important function is to afford the opportunity to administer antenatal glucocorticoids. Buying time for antenatal glucocorticoids to accelerate fetal lung development might be the best reason to use tocolytics. Once the pregnancy has reached 34 weeks, the risks of tocolytic therapy outweigh the benefits. There are important maternal contraindications to tocolytic therapy. Tocolytic-induced edema can be caused by IV fluids.
A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. Which intervention is the nurse's top priority? Place the woman in the knee-chest position. Cover the cord in a sterile towel saturated with warm normal saline. Prepare the woman for a cesarean birth. Start oxygen by face mask.
Place the woman in the knee-chest position. The woman is assisted into a position (e.g., modified Sims position, Trendelenburg position, or knee-chest position) in which gravity keeps the pressure of the presenting part off the cord. Relieving pressure on the cord is the nursing priority. The nurse may also use her gloved hand or two fingers to lift the presenting part off the cord. If the cord is protruding from the vagina it may be covered with a sterile towel soaked in saline. The nurse should administer O2 by facial mask at 8 to 10 L/min until delivery is complete. If the cervix is fully dilated, the nurse should prepare for immediate vaginal delivery. Cesarean birth is indicated only if cervical dilation is not complete.
A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency to every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of: Eclamptic seizure. Rupture of the uterus. Placenta previa. Placental abruption.
Placental abruption. Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption). Women with hypertension are at increased risk for an abruption. Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture manifests with hypotonic uterine activity, signs of hypovolemia, and in many cases the absence of pain, and placenta previa with bright red, painless vaginal bleeding.
Which laboratory values would be found in a patient diagnosed with preeclampsia? Select all that apply. Hemoglobin 8g/dL Platelet count of 75,000 LDH 100 units/L Burr cells BUN 25 mg/dL
Platelet count of 75,000 LDH 100 units/L BUN 25 mg/dL Thrombocytopenia below 100,000, an increase in LDH, and an increase in BUN would be noted. Hemoglobin levels would be increased, but 8 g/dL reflects a decreased level.Burr cells would not be present in preeclampsia but would in HELLP syndrome.
A nurse is monitoring a patient's reflexes (DTRs) while receiving magnesium sulfate therapy for treatment of preeclampsia. Which assessment finding indicates a cause for concern? Bilateral DTRs noted at 2+ DTRs response has been noted at 1+ since onset of therapy Positive clonus response elicited unilaterally Patient reports no pain upon examination of DTRs by nurse
Positive clonus response elicited unilaterally Positive clonus response elicited unilaterally is a cause for concern as it suggests a hyperactive response. Typically, there is no pain associated with determination of DTRs so this finding would be considered to be normal, as would bilateral DTRs noted at 2+.Even though DTRs at 1+ indicate a sluggish or decreased response, this finding is unchanged since the initiation of therapy. The nurse would continue to monitor.
With regard to preeclampsia and eclampsia, nurses should be aware that: Preeclampsia is a condition of the first trimester; eclampsia is a condition of the second and third trimesters. Preeclampsia results in decreased function in such organs as the placenta, kidneys, liver, and brain. The causes of preeclampsia and eclampsia are well documented. Severe preeclampsia is defined as preeclampsia plus proteinuria.
Preeclampsia results in decreased function in such organs as the placenta, kidneys, liver, and brain. Vasospasms diminish the diameter of blood vessels, which impedes blood flow to all organs. Preeclampsia occurs after week 20 of gestation and can run the duration of the pregnancy. The causes of preeclampsia and eclampsia are unknown, although several have been suggested. Preeclampsia includes proteinuria; severe cases are characterized by greater proteinuria or any of nine other conditions.
Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. What is an appropriate management approach for this type of abortion? Prepare the woman for a dilation and curettage (D&C). Put the woman on bed rest for at least 1 week and reevaluate. Prepare the woman for an ultrasound and blood work. Comfort the woman by telling her that if she loses this baby, she may attempt to get pregnant again in 1 month.
Prepare the woman for an ultrasound and blood work. Repetitive transvaginal ultrasounds and measurement of human chorionic gonadotropin (hCG) and progesterone levels may be performed to determine whether the fetus is alive and within the uterus. Bed rest is recommended for 48 hours initially. D&C is not considered until signs of the progress to inevitable abortion are noted or the contents are expelled and incomplete. If the pregnancy is lost, the woman should be guided through the grieving process. Telling the client that she can get pregnant again soon is not a therapeutic response because it discounts the importance of this pregnancy.
common risk factors for pre-eclampsia
Primigravida less than 19 y/o or older than 40 y/o Pre-eclampsia in prior pregnancy Family Hx Paternal Hx [womans partner fathered a baby with another woman who had preeclampsia] Preexisting medical condition [Chronic HTN, renal disease, pregestationsl DM, connective tissue disease, thrombophilia]
A nurse is evaluating several obstetric patients for their risk for cervical insufficiency. Which patient would be considered to be most at risk? Primipara Grandmultip who has previously had all vaginal deliveries without a problem Primip who undergoes a cervical cone biopsy for cervical dysplasia prior to the pregnancy Multip who had her previous delivery via C section due to cephalopelvic disproportion (CPD)
Primip who undergoes a cervical cone biopsy for cervical dysplasia prior to the pregnancy Any patient who has had previous surgical interventions (cone biopsy) is at greater risk for cervical insufficiency. There is no indication that a primip is at risk for cervical insufficiency. A grandmultip who has previously had vaginal deliveries without incidence is not necessarily at an increased risk for cervical insufficiency. A multip who has delivered via C section as a result of CPD would not necessarily be at an increased risk as the issue involves pelvic adequacy as determined by pelvic measurements in relationship to the fetus.
Which factors would lead to an increased likelihood of uterine rupture? Select all that apply. Preterm singleton pregnancy G3P3 with all vaginal deliveries Short interval between pregnancies Patient receiving a trial of labor (TOL) following a VBAC delivery Patient who had a primary caesarean section with a classic incision
Short interval between pregnancies Patient receiving a trial of labor (TOL) following a VBAC delivery Patient who had a primary caesarean section with a classic incision The shorter the interval between pregnancies/deliveries, the higher the risk of uterine rupture. A patient who is having a TOL following a VBAC and a patient who has had a C section with a classic incision into the uterus are at increased risk for uterine rupture. A pregnant woman with a singleton pregnancy (one fetus), even if preterm, is not considered to be at increased risk for uterine rupture; nor is a multipara who has delivered all her infants vaginally.
A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding indicates that preterm labor is occurring? Estriol is not found in maternal saliva. Irregular, mild uterine contractions are occurring every 12 to 15 minutes. Fetal fibronectin is present in vaginal secretions. The cervix is effacing and dilated to 2 cm.
The cervix is effacing and dilated to 2 cm. Cervical changes such as shortened endocervical length, effacement, and dilation are predictors of imminent preterm labor. Changes in the cervix accompanied by regular contractions indicate labor at any gestation. Irregular, mild contractions that do not cause cervical change are not considered a threat. Estriol is a form of estrogen produced by the fetus that is present in plasma at 9 weeks of gestation. Levels of salivary estriol have been shown to increase before preterm birth. The presence of fetal fibronectin in vaginal secretions between 24 and 36 weeks of gestation could predict preterm labor, but it has only a 20% to 40% positive predictive value. Of more importance are other physiologic clues of preterm labor, such as cervical changes.
With regard to dysfunctional labor, nurses should be aware that: Women who are underweight are more at risk. Women experiencing precipitous labor are about the only women experiencing dysfunctional labor who are not exhausted. Hypertonic uterine dysfunction is more common than hypotonic dysfunction. Abnormal labor patterns are most common in older women.
Women experiencing precipitous labor are about the only women experiencing dysfunctional labor who are not exhausted. Precipitous labor lasts less than 3 hours. Short women more than 30 pounds overweight are more at risk for dysfunctional labor. Hypotonic uterine dysfunction, in which the contractions become weaker, is more common. Abnormal labor patterns are more common in women younger than 20 years.
Should a woman with pre-eclampsia be on activity restriction?
Yes, advised, but there is no sure or known way if this is beneficial to the mother
A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature of 37.1° C, pulse rate of 96 beats/min, respiratory rate of 24 breaths/min, blood pressure (BP) of 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for: a. Hydralazine. b. Magnesium sulfate bolus. c. Diazepam. d. Calcium gluconate.
a. -Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. Typically it is administered for a systolic BP over 160 mm Hg or a diastolic BP over 110 mm Hg.
In caring for an immediate postpartum woman, you note petechiae and oozing from her IV site. You monitor her closely for which clotting disorder? a. Disseminated intravascular coagulation (DIC) b. Amniotic fluid embolism (AFE) c. Hemorrhage d. HELLP syndrome
a. Disseminated intravascular coagulation (DIC)
A client at 36 weeks of gestation presents to labor and delivery complaining of a constant headache for the past 2 days. She also states that her face "seems more swollen than usual." What should be the nurse's first action? a. Obtain a urine sample. b. Place the client on a fetal heart monitor. c. Notify the physician of the client's concerns. d. Take the client's blood pressure.
d. Take the client's blood pressure.
preeclampsia
development of hypertension and proteinuria in a previously normotensive woman after 20 weeks of gestation. Signs: thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, cerebral or visual symptoms
gestational hypertension
onset of hypertension without proteinuria or edema, or other systemic findings diagnositic for preeclampsia after 20 weeks of pregnancy; resolves after delivery
