Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications
A primigravida 28-year-old client is noted to have Rh negative blood and her husband is noted to be Rh positive. The nurse should prepare to administer RhoGAM after which diagnostic procedure? Amniocentesis Biophysical profile Nonstress test Contraction test
Amniocentesis
A 28-year-old client with a history of endometriosis presents to the emergency department with severe abdominal pain and nausea and vomiting. The client also reports her periods are irregular with the last one being 2 months ago. The nurse prepares to assess for which possible cause for this client's complaints? Placenta previa Ectopic pregnancy Molar pregnancy Healthy pregnancy
Ectopic pregnancy
A woman in labor suddenly reports sharp fundal pain accompanied by slight dark red vaginal bleeding. The nurse should prepare to assist with which situation? Preterm labor that was undiagnosed Possible fetal death or injury Placenta previa obstructing the cervix Premature separation of the placenta
Premature separation of the placenta
A client at 27 weeks' gestation is admitted to the obstetric unit after reporting headaches and edema of her hands. Review of the prenatal notes reveals blood pressure consistently above 136/90 mm Hg. The nurse anticipates the health care provider will prescribe magnesium sulfate to accomplish which primary goal? Reverse edema Prevent maternal seizures Decrease protein in urine Decrease blood pressure
Prevent maternal seizures
The following hourly assessments are obtained by the nurse on a client with preeclampsia receiving magnesium sulfate: 97.3oF (36.2oC), HR 88, RR 12 breaths/min, BP 148/110 mm Hg. What other priority physical assessments by the nurse should be implemented to assess for potential toxicity? Reflexes Lung sounds Oxygen saturation Magnesium sulfate level
Reflexes
A woman who is Rh negative asks the nurse how many children she will be able to have before Rh incompatibility causes them to die in utero. The nurse's best response would be that: no more than three children is recommended. she will have to ask her primary care provider. as long as she receives Rho(D) immune globulin, there is no limit. only her next child will be affected.
as long as she receives Rho(D) immune globulin, there is no limit.
A woman is being admitted to the obstetric unit for severe preeclampsia. When assigning room placement, which area would be most appropriate? beside the supply room at the end of the hallway across from the nurse's station near the staff elevator
at the end of the hallway
A woman is being closely monitored and treated for severe preeclampsia with magnesium sulfate. Which finding would alert the nurse to the development of magnesium toxicity in this client? serum magnesium level of 6.5 mEq/L diminished reflexes elevated liver enzymes seizures
diminished reflexes
A nurse is conducting a refresher program for a group of perinatal nurses. Part of the program involves a discussion of HELLP. The nurse determines that the group needs additional teaching when they identify which aspect as a part of HELLP? hemolysis liver enzyme elevation low platelet count elevated lipoproteins
elevated lipoproteins
A woman at 9 weeks' gestation was unable to control the nausea and vomiting of hyperemesis gravidarum through conservative measures at home. With nausea and vomiting becoming severe, the woman was omitted to the obstetrical unit. Which action should the nurse prioritize? instruct on NPO status administration of antiemetics bed rest with bathroom privileges establish IV for rehydration
establish IV for rehydration
A nurse is providing care to a client who has been diagnosed with a common benign form of gestational trophoblastic disease. The nurse identifies this as: hydramnios. hydatidiform mole. placenta accrete. ectopic pregnancy.
hydatidiform mole.
A pregnant woman with preeclampsia is to receive magnesium sulfate IV. Which assessment should the nurse prioritize before administering a new dose? heart rate anxiety level blood pressure patellar reflex
patellar reflex
A nursing instructor identifies which factor as increasing the chances of infection when coupled with prolonged labor? multiple births number of previous pregnancies maternal age premature rupture of membranes
premature rupture of membranes
A woman at 35 weeks' gestation with severe hydramnios is admitted to the hospital. The nurse recognizes that which concern is greatest regarding this client? development of eclampsia hemorrhaging preterm rupture of membranes followed by preterm birth development of gestational trophoblastic disease
preterm rupture of membranes followed by preterm birth
Which medication will the nurse anticipate the health care provider will prescribe as treatment for an unruptured ectopic pregnancy? ondansetron promethazine methotrexate oxytocin
methotrexate
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? "If I develop this complication, I will have bright red vaginal bleeding," "Since I am over 30, I run a much higher risk of developing this problem." "I need a cesarean section if I develop this problem." "Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain."
"Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain."
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? Measure fundal height. Obtain a voided urine specimen and determine blood type. Palpate the fundus and check fetal heart rate. Check deep tendon reflexes.
Palpate the fundus and check fetal heart rate.
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? "Something was wrong with the fetus." "It is hard to know why a woman bleeds during early pregnancy." "Your spontaneous bleeding is not work-related." "I can understand your need to find an answer to what caused this. Let's talk about this further."
"I can understand your need to find an answer to what caused this. Let's talk about this further."
A pregnant client with preterm premature rupture of the membranes is being discharged home. A nurse is preparing the client's discharge teaching plan. Which instructions would the nurse include? Select all that apply. "Gently massage your breasts at least once each day." "Check your temperature each day, reporting any increase immediately." "Be sure to perform fetal kick counts about once every 3 days." "If you notice your belly starting to tighten, call your health care provider." "Take tub baths instead of showers." SUBMIT ANSWER
"If you notice your belly starting to tighten, call your health care provider." "Check your temperature each day, reporting any increase immediately."
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? "Purse-string sutures are placed in the cervix to prevent it from dilating." "Staples are put in the cervix to prevent it from dilating." "A cervical cap is placed so no amniotic fluid can escape." "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 nurse has been assigned to assess a pregnant client for placental abruption (abruptio placentae). For which classic manifestation of this condition should the nurse assess? generalized vasospasm painless bright red vaginal bleeding "knife-like" abdominal pain with vaginal bleeding increased fetal movement
"knife-like" abdominal pain with vaginal bleeding
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? Qualitative human chorionic gonadotropin (hCG) test Quantitative human chorionic gonadotropin (hCG) test Pelvic examination Abdominal ultrasound
Abdominal ultrasound
A nurse is preparing a nursing care plan for a client who is admitted at 22 weeks' gestation with advanced cervical dilation (dilatation) to 5 cm, cervical insufficiency, and a visible amniotic sac at the cervical opening. Which primary goal should the nurse prioritize at this point? Notification of social support for loss of pregnancy Education on causes of cervical insufficiency for the future Bed rest to maintain pregnancy as long as possible Give birth vaginally
Bed rest to maintain pregnancy as long as possible
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? Advanced maternal age Faulty implantation Chromosomal defects in the fetus Exposure to chemicals or radiation
Chromosomal defects in the fetus
The nurse is caring for a pregnant client with fallopian tube rupture. Which intervention is the priority for this client? Monitor the fetal heart rate (FHR). Monitor the client's vital signs and bleeding. Monitor the mass with transvaginal ultrasound. Monitor the client's beta-hCG level.
Monitor the client's vital signs and bleeding.
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)? Fetus is in a breech position Onset of vaginal bleeding was sudden and painful Sonogram shows the placenta covering the cervical os Uterus is soft between contractions
Onset of vaginal bleeding was sudden and painful
The nurse is required to assess a pregnant client who is reporting vaginal bleeding. Which nursing action is the priority? assessing signs of shock assessing the amount and color of the bleeding determining the amount of funneling monitoring uterine contractility
assessing the amount and color of the bleeding
A pregnant client is brought to the health care facility with signs of premature rupture of the membranes (PROM). Which conditions and complications are associated with PROM? Select all that apply. preterm labor placental abruption (abruptio placentae) placenta previa prolapsed cord spontaneous abortion (miscarriage)
prolapsed cord placental abruption (abruptio placentae) preterm labor
A client at 37 weeks' gestation presents to the emergency department with a BP 150/108 mm Hg, 1+ pedal edema, 1+ proteinuria, and normal deep tendon reflexes. Which assessment should the nurse prioritize as the client is administered magnesium sulfate IV? respiratory rate ability to sleep urine protein hemoglobin
respiratory 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? spontaneous abortion (miscarriage) hypertension premature birth preterm labor
spontaneous abortion (miscarriage)
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? Administer oxygen to the client. Provide emotional support to the client and significant other. Assess the client's vital signs. Obtain a surgical consent from the client.
Assess the client's vital signs.
A 25-year-old client at 22 weeks' gestation is noted to have proteinuria and dependent edema on her routine prenatal visit. Which additional assessment should the nurse prioritize and convey to the RN or health care provider? initial BP 120/80mm Hg; current BP 130/88 mm Hg initial BP 140/85 mm Hg; current BP 130/80 mm Hg initial BP 110/60 mm Hg; current BP 112/86 mm Hg initial BP 100/70 mm Hg; current BP 140/90 mm Hg
initial BP 100/70 mm Hg; current BP 140/90 mm Hg
What would be the physiologic basis for a placenta previa? a uterus with a midseptum a loose placental implantation a placenta with multiple lobes low placental implantation
low placental implantation
A pregnant woman has arrived to the office reporting vaginal bleeding. Which finding during the assessment would lead the nurse to suspect an inevitable spontaneous abortion (miscarriage)? strong abdominal cramping slight vaginal bleeding no passage of fetal tissue closed cervical os
strong abdominal cramping