Chapter 17: Pregnancy at Risk: Pregnancy-Related Complications

After a regular prenatal visit, a pregnant client asks the nurse to describe the differences between placental abruption (abruptio placentae) and placenta previa. Which statement will the nurse include in the teaching? Placenta previa causes painful, dark red vaginal bleeding during pregnancy. Placenta previa is an abnormally implanted placenta that is too close to the cervix. Placental abruption results in painless, bright red vaginal bleeding during labor. Placental abruption requires "watchful waiting" during labor and birth.

Placenta previa is an abnormally implanted placenta that is too close to the cervix.

A client in her 20th week of gestation develops HELLP syndrome. What are features of HELLP syndrome? Select all that apply. hyperthermia hemolysis elevated liver enzymes leukocytosis low platelet count

hemolysis elevated liver enzymes low platelet count

A client reporting she recently had a positive pregnancy test has reported to the emergency department stating one-sided lower abdominal pain. The health care provider has prescribed a series of tests. Which test will provide the most definitive confirmation of an ectopic pregnancy? Quantitative human chorionic gonadotropin (hCG) test Qualitative human chorionic gonadotropin (hCG) test Pelvic examination Abdominal ultrasound

Abdominal ultrasound

The nurse is reviewing the plan of care for a pregnant patient experiencing a threatened miscarriage. Which outcome would be appropriate for this patient? Bed rest is maintained until all bleeding stops. Less than one perineal pad is saturated per hour. Bleeding spontaneously stops within 24 to 48 hours. Normal coitus is resumed 1 week after the episode.

Bleeding spontaneously stops within 24 to 48 hours

A woman in her 20s has experienced a spontaneous abortion (miscarriage) at 10 weeks' gestation and asks the nurse at the hospital what went wrong. She is concerned that she did something that caused her to lose her baby. The nurse can reassure the woman by explaining that the most common cause of miscarriage in the first trimester is related to which factor? Exposure to chemicals or radiation Advanced maternal age Chromosomal defects in the fetus Faulty implantation

Chromosomal defects in the fetus

The nurse is evaluating care provided to a patient in the third trimester of pregnancy who has been diagnosed with gestational hypertension. Which finding indicates that treatment has been successful for this patient? Urine protein 0 Increased perspiration Weight gain of 1 lb/week Diastolic blood pressure 20 mmHg over normal level

Urine protein 0

A nurse suspects that a client is developing HELLP syndrome. The nurse notifies the health care provider based on which finding? hyperglycemia elevated platelet count disseminated intravascular coagulation (DIC) elevated liver enzymes

elevated liver enzymes

What would be the physiologic basis for a placenta previa? a loose placental implantation low placental implantation a placenta with multiple lobes a uterus with a midseptum

low placental implantation

A pregnant patient is diagnosed with placenta previa. Which action should the nurse implement immediately for this patient? Assess fetal heart sounds with an external monitor. Help the patient remain ambulatory to reduce bleeding. Assess uterine contractions by an internal pressure gauge. Prepare for a vaginal examination to assess the extent of bleeding.

Assess fetal heart sounds with an external monitor.

It is determined that a client's blood Rh is negative and her partner's is Rh positive. To help prevent Rh isoimmunization, the nurse would expect to administer Rho(D) immune globulin at which time? at 32 weeks' gestation and immediately before discharge 24 hours before birth and 24 hours after birth in the first trimester and within 2 hours of birth at 28 weeks' gestation and again within 72 hours after birth

at 28 weeks' gestation and again within 72 hours after birth

A client with severe preeclampsia is receiving magnesium sulfate as part of the treatment plan. To ensure the client's safety, which compound would the nurse have readily available? calcium gluconate potassium chloride ferrous sulfate calcium carbonate

calcium gluconate

A patient is admitted with a diagnosis of ectopic pregnancy. For what should the nurse anticipate preparing the patient? Immediate surgery Internal uterine monitoring Bed rest for the next 4 weeks Intravenous administration of a tocolytic

Immediate surgery

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? Check deep tendon reflexes. Measure fundal height. Palpate the fundus and check fetal heart rate. Obtain a voided urine specimen and determine blood type.

Palpate the fundus and check fetal heart rate.

Upon entering the room of a client who has had a spontaneous abortion (miscarriage), the nurse observes the client crying. Which response by the nurse would be most appropriate? "Why are you crying?" "Will a pill help your pain?" "I'm sorry you lost your baby." "A baby still wasn't formed in your uterus."

"I'm sorry you lost your baby."

A client with a multiple gestation has come to a health care facility for a regular antenatal check-up. When educating the client on pregnancy, about which complication should the nurse inform the client? hypotension fetal macrosomia frequent diarrhea placental dysfunction

placental dysfunction

A woman at 34 weeks' gestation presents to labor and delivery with vaginal bleeding. Which finding from the obstetric examination would lead to a diagnosis of placental abruption (abruptio placentae)? Onset of vaginal bleeding was sudden and painful Fetus is in a breech position Sonogram shows the placenta covering the cervical os Uterus is soft between contractions

Onset of vaginal bleeding was sudden and painful

A client comes to the clinic reporting swelling in the hands and feet, blurred vision, a pounding headache and nausea and vomiting. The client had a positive pregnancy test 15 weeks ago, but has had no prenatal care. This is the client's third pregnancy, and she says that her uterus never grew this big or this fast with the previous pregnancies. Based on the client's reason for seeking care, the nurse would collect additional data to rule out the presence of which conditions? Select all that apply. Preeclampsia Molar pregnancy Placental abruption (abruptio placentae) Missed abortion Ectopic pregnancy

Preeclampsia Molar pregnancy

A client whose membranes have prematurely ruptured is admitted to the hospital. Which nursing intervention is a priority? Routine monitoring of vital signs Continuous fetal monitoring Urine dipstick daily Strict intake and output

Routine monitoring of vital signs

The nurse is caring for a client who has a multifetal pregnancy. What topic should the nurse prioritize during health education? Signs of preterm labor Risk for blood incompatibilities Risk for hypertension Parenting skills

Signs of preterm labor

The nurse is monitoring a pregnant patient who is receiving intravenous magnesium sulfate for eclampsia. During the last assessment, the nurse was unable to elicit a patellar reflex. What should the nurse do? Check fetal heart rate. Measure blood pressure. Stop the current infusion. Increase the infusion rate.

Stop the current infusion.

A pregnant woman is admitted to the hospital with a diagnosis of placenta previa. Which action would be the priority for this woman on admission? performing a vaginal examination to assess the extent of bleeding helping the woman remain ambulatory to reduce bleeding assessing fetal heart tones by use of an external monitor assessing uterine contractions by an internal pressure gauge

assessing fetal heart tones by use of an external monitor

A client visits a health care facility reporting amenorrhea for 10 weeks, fatigue, and breast tenderness. Which assessment finding(s) will the nurse prioritize for immediate intervention? Select all that apply. elevated human chorionic gonadotropin (hCG) levels whitish discharge from the vagina absence of fetal heart sounds dyspareunia hyperemesis gravidarum

elevated human chorionic gonadotropin (hCG) levels absence of fetal heart sounds hyperemesis gravidarum

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 condition? mild preeclampsia gestational hypertension severe preeclampsia eclampsia

mild preeclampsia

A nurse is reviewing a client's history and physical examination findings. Which information would the nurse identify as contributing to the client's risk for an ectopic pregnancy? use of oral contraceptives for 5 years ovarian cyst 2 years ago recurrent pelvic infections heavy, irregular menses

recurrent pelvic infections

A woman in week 16 of her pregnancy calls her primary care provider's office to report that she has experienced abdominal cramping, cervical dilation (dilatation), vaginal spotting, and the passing of tissue. The nurse instructs the client to bring the passed tissue to the hospital with her. What is the correct rationale for this instruction? to determine whether gestational trophoblastic disease is present to determine whether infection is present to determine whether the fetus is viable to determine the stage of development of the fetus

to determine whether gestational trophoblastic disease is present

A client with a history of cervical insufficiency is seen for reports of pink-tinged discharge and pelvic pressure. The primary care provider decides to perform a cervical cerclage. The nurse teaches the client about the procedure. Which client response indicates that the teaching has been effective? "Staples are put in the cervix to prevent it from dilating." "The cervix is glued shut so no amniotic fluid can escape." "Purse-string sutures are placed in the cervix to prevent it from dilating." "A cervical cap is placed so no amniotic fluid can escape."

"Purse-string sutures are placed in the cervix to prevent it from dilating."

A client at 36 weeks' gestation experiences vaginal bleeding. Which conditions might be the cause of the client's bleeding? Select all that apply. Placenta previa Placental abruption (abruptio placentae) Bloody show Ectopic pregnancy Spontaneous abortion (miscarriage)

Placenta previa Placental abruption (abruptio placentae) Bloody show

A pregnant client diagnosed with hyperemesis gravidarum is prescribed intravenous fluids for rehydration. When preparing to administer this therapy, which solution would the nurse anticipate being prescribed initially? normal saline dextrose 5% and water 0.45% sodium chloride albumin

normal saline

A pregnant woman with preeclampsia is to receive magnesium sulfate IV. Which assessment should the nurse prioritize before administering a new dose? blood pressure patellar reflex heart rate anxiety level

patellar reflex

A nurse in the maternity triage unit is caring for a client with a suspected ectopic pregnancy. Which nursing intervention should the nurse perform first? Assess the client's vital signs. Administer oxygen to the client. Obtain a surgical consent from the client. Provide emotional support to the client and significant other.

Assess the client's vital signs.

A 17-year-old G2 P0010 patient develops hypertension at 32 weeks and is required to limit her intake of sodium and increase her protein intake. The patient is out of work and does not attend school. Her time is spent primarily at the local shopping mall with friends. The best dietary suggestion that the home visiting nurse can make to this patient is: Bring water and a lunch from home rather than eating at the food court Eat salad with chicken from the food court Ice cream has protein and is available at the food court Make fewer trips to the shopping mall

Bring water and a lunch from home rather than eating at the food cour

A woman of 16 weeks' gestation telephones the nurse because she has passed some "berry-like" blood clots and now has continued dark brown vaginal bleeding. Which action would the nurse instruct the woman to do? "Maintain bed rest, and count the number of perineal pads used." "Come to the health care facility if uterine contractions begin." "Continue normal activity, but take the pulse every hour." "Come to the health facility with any vaginal material passed."

"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? "Your spontaneous bleeding is not work-related." "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." "Something was wrong with the fetus."

"I can understand your need to find an answer to what caused this. Let's talk about this further."

After teaching a woman who has had an evacuation for gestational trophoblastic disease (hydatidiform mole or molar pregnancy) about her condition, which statement indicates that the nurse's teaching was successful? "I will be sure to avoid getting pregnant for at least 1 year." "My intake of iron will have to be closely monitored for 6 months." "My blood pressure will continue to be increased for about 6 more months." "I won't use my birth control pills for at least a year or two."

"I will be sure to avoid getting pregnant for at least 1 year."

The nurse is teaching a prenatal class on potential problems during pregnancy to a group of expectant parents. The risk factors for placental abruption (abruptio placentae) are discussed. Which comment validates accurate learning by the parents? "I need a cesarean section if I develop this problem." "If I develop this complication, I will have bright red vaginal bleeding," "Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain." "Since I am over 30, I run a much higher risk of developing this problem."

"Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain."

A client experiencing a threatened abortion is concerned about losing the pregnancy and asks what she can do to help save her baby. What is the most appropriate response from the nurse? "Carry on with the activity you engaged in before this happened." "Restrict your physical activity to moderate bed rest." "Strict bed rest is necessary so as not to jeopardize this pregnancy." "There is no research evidence that I can recommend to you."

"Restrict your physical activity to moderate bed rest."

A client in her first trimester arrives at the emergency room with reports of severe cramping and vaginal spotting. On examination, the health care provider informs her that no fetal heart sounds are evident and orders a dilatation and curettage. The client looks frightened and confused and states that she does not believe in abortion. Which statement by the nurse is best? "Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications." "I know that it is sad but the pregnancy must be terminated to save your life." "The choice is up to you but the health care provider is recommending an abortion." "You have experienced an incomplete miscarriage and must have the placenta and any other tissues cleaned out."

"Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications."

A woman at 37 weeks' gestation presents to the labor and delivery area with symptoms of placental abruption (abruptio placentae). Which action should the nurse prioritize? Ensure that large-bore IV access is obtained Placement of the mother on her back Complete a urine dipstick for proteinuria Obtain vital signs, especially blood pressure

Ensure that large-bore IV access is obtained

A client tells that nurse in the doctor's office that her friend developed high blood pressure on her last pregnancy. She is concerned that she will have the same problem. What is the standard of care for preeclampsia? Take a low-dose antihypertensive prophylactically. Have her blood pressure checked at every prenatal visit. Monitor the client for headaches or swelling on the body. Take one aspirin every day.

Have her blood pressure checked at every prenatal visit.

The nurse is identifying nursing diagnoses for a client with gestational hypertension. Which diagnosis would be the most appropriate for this client? Risk for injury related to fetal distress Imbalanced nutrition related to decreased sodium levels Ineffective tissue perfusion related to poor heart contraction Ineffective tissue perfusion related to vasoconstriction of blood vessels

Ineffective tissue perfusion related to vasoconstriction of blood vessels

A patient recovering from an uneventful vaginal delivery is prescribed Rho(D) immune globulin (RhIG). What should the nurse explain to the patient regarding the purpose of this medication? It prevents fetal Rh blood formation. It stimulates maternal D immune antigens. It prevents maternal D antibody formation. It promotes maternal D antibody formation.

It prevents maternal D antibody formation

A woman who is 10 weeks' pregnant calls the physician's office reporting "morning sickness" but, when asked about it, tells the nurse that she is nauseated and vomiting all the time and has lost 5 pounds. What interventions would the nurse anticipate for this client? Lab work will be drawn to rule out acid-base imbalances. An ultrasound will be done to reassess the correctness of gestational dates. Since morning sickness is a common problem for pregnant women, the nurse will suggest the woman drink more fluids and eat crackers. The nurse will encourage the woman to lie down and rest whenever she feels ill.

Lab work will be drawn to rule out acid-base imbalances.

Which medication will the nurse anticipate the health care provider will prescribe as treatment for an unruptured ectopic pregnancy? oxytocin promethazine ondansetron methotrexate

Methotrexate

A client at 25 weeks' gestation presents with a blood pressure of 152/99 mm Hg, pulse 78 beats/min, no edema, and urine negative for protein. What would the nurse do next? Notify the health care provider Provide health education Assess the client for ketonuria Document the client's blood pressure

Notify the health care provider

A young mother gives birth to twin boys who shared the same placenta. What serious complication are they at risk for? Twin-to-twin transfusion syndrome (TTTS) HELLP syndrome TORCH syndrome ABO incompatibility

Twin-to-twin transfusion syndrome (TTTS)

A pregnant client at 32 weeks' gestation is treated with magnesium sulfate for seizure management. The nurse assesses which of the following for evidence of magnesium toxicity? frequency of micturition absence of knee jerk response increased blood pressure increased rate of respiration

absence of knee jerk response

A pregnant client with multiple gestation arrives at the maternity clinic for a regular antenatal check up. The nurse would be aware that client is at risk for which perinatal complication? postterm birth maternal hypotension congenital anomalies fetal nonimmune hydrops

congenital anomalies

A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. The nurse determines that the medication is at a therapeutic level based on which finding? urinary output of 20 mL per hour respiratory rate of 10 breaths/minute deep tendons reflexes 2+ difficulty in arousing

deep tendons reflexes 2+

A nurse is taking a history of a client at 5 weeks' gestation in the prenatal clinic; however, the client is reporting dark brown vaginal discharge, nausea, and vomiting. Which diagnosis should the nurse suspect? placenta previa hyperemesis gravidarum gestational trophoblastic disease pregnancy-induced depression

gestational trophoblastic disease

A pregnant client has been admitted with reports of brownish vaginal bleeding. On examination, there is an elevated human chorionic gonadotropin (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 condition? ectopic pregnancy placenta previa gestational trophoblastic disease placental abruption (abruption placentae)

gestational trophoblastic disease

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? premature birth hypertension spontaneous abortion (miscarriage) preterm labor

spontaneous abortion (miscarriage)

A client with hyperemesis gravidarum is admitted to the facility after being cared for at home without success. What would the nurse expect to include in the client's plan of care? clear liquid diet total parenteral nutrition nothing by mouth administration of labetalol

nothing by mouth

A pregnant women calls the clinic to report a small amount of painless vaginal bleeding. What response by the nurse is best? "Please come in now for an evaluation by your health care provider." "Lie on your left side and drink lots of water and monitor the bleeding." "If the bleeding lasts more than 24 hours, call us for an appointment." "Bleeding during pregnancy happens for many reasons, some serious and some harmless."

"Please come in now for an evaluation by your health care provider."

The nurse is caring for a woman at 32 weeks' gestation with severe preeclampsia. Which assessment finding should the nurse prioritize after the administration of hydralazine to this client? Gastrointestinal bleeding Halos around lights Tachycardia Sweating

Tachycardia

A 25-year-old pregnant client has just been diagnosed with hyperemesis gravidarum. Which instruction should the nurse prioritize during a teaching session? Eat mainly high-fat foods to supply sufficient calories. Increase fluid intake with meals to increase retention of food. Do all your own cooking so you will build up a tolerance for food odors. Take your anti-nausea medicine around the clock.

Take your anti-nausea medicine around the clock.

The obstetric nurse is caring for a pregnant client who has been diagnosed with hydatidiform mole. What assessment should the nurse prioritize? Vaginal bleeding Blood pressure Pain Severe nausea and vomiting

Vaginal bleeding