chapter 19 Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications
After a regular prenatal visit, a pregnant client asks the nurse to describe the differences between abruptio placenta and placenta previa. Which statement should the nurse include in the teaching?
"Placenta previa causes painless, bright red bleeding during pregnancy due to an abnormally implanted placenta that is too close to or covers the cervix; abruptio placenta is associated with dark red painful bleeding caused by premature separation of the placenta from the wall of the uterus before the end of labor."
When providing counseling on early pregnancy loss, the nurse should discuss which factor as the most common cause for spontaneous abortion? chromosomal abnormality lack of prenatal care maternal smoking the age of the mother
A
A client is admitted to labor and birth for management of severe preeclampsia. An IV infusion of magnesium sulfate is started. What is the primary goal for magnesium sulfate therapy? Lower blood pressure Prevent maternal seizures Induce labor Withhold labor
B
A 28-year-old woman presents in the emergency department 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 primary care provider as a possible cause of the client's abdominal pain? placenta previa molar pregnancy ectopic pregnancy healthy pregnancy
C
Which medication would the nurse prepare to administer if prescribed as treatment for an unruptured ectopic pregnancy? ondansetron promethazine methotrexate oxytocin
C
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? "Strict bedrest is necessary so as not to jeopardize this pregnancy." "There is no research evidence that I can recommend to you." "Carry on with the activity you engaged in before this happened." "Restrict your physical activity to moderate bedrest."
D
A nurse is monitoring a client with PROM who is in labor and observes meconium in the amniotic fluid. What does the observation of meconium indicate?
fetal distress related to hypoxia
A pregnant client with hyperemesis gravidarum needs advice on how to minimize nausea and vomiting. Which instruction should the nurse give this client? Eat spicy, fatty foods Eat small, frequent meals throughout the day. Only drink water in the mornings Eat 3 full meals a day
B
A nurse is caring for a young woman who is in her 10th week of gestation. She comes into the clinic reporting vaginal bleeding. Which assessment finding best correlates with a diagnosis of hydatidiform mole? painful uterine contractions and nausea dark red, "clumpy" vaginal discharge bright red painless vaginal bleeding brisk deep tendon reflexes and shoulder pain
B
A nurse is taking a history of a client of Asian ethnicity in the prenatal clinic. The client is 5 weeks' gestation and reports dark brown vaginal discharge, nausea, and vomiting. Which diagnosis should the nurse suspect? Placenta previa Abruptio placenta Gestational trophoblastic disease Eclampsia
C
A pregnant client has been admitted with reports 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 condition? placenta previa ectopic pregnancy gestational trophoblastic disease abruption of placenta
C
A woman at 8 weeks' gestation is admitted for ectopic pregnancy. She is asking why this has occurred. The nurse knows that which factor is a known risk factor for ectopic pregnancy? use of oral contraceptives high number of pregnancies use of IUD for contraception multiple gestation pregnancy
C
A woman in week 35 of her pregnancy 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
C
A woman is admitted with a diagnosis of ectopic pregnancy. For which action would the nurse anticipate beginning preparation? bed rest for the next 4 weeks intravenous administration of a tocolytic immediate surgery internal uterine monitoring
C
Which measure would the nurse include in the plan of care for a woman with premature rupture of membranes if her fetus's lungs are mature? administration of corticosteroids observation for signs of infection labor induction reduction in physical activity level
C
A woman who is 31 weeks pregnant presents at the emergency department with bright red vaginal bleeding. She says the onset of the bleeding was sudden and she has no pain. The nurse is most likely to assist the primary care provider or technician with which exam? an abdominal ultrasound a blood transfusion a digital cervical exam a transvaginal ultrasound
D
client has an Rh-negative blood type. Following the birth of her infant, the nurse administers her Rho(D) (D immune globulin). The purpose of this is to: prevent fetal RH blood formation. promote maternal D antibody formation. stimulate maternal D immune antigens. prevent maternal D antibody formation.
D
A 16-year-old client gave birth to a 12 weeks' gestation fetus last week. The client has come to the office for follow-up and while waiting in an examination room notices that on the schedule is written her name and "follow-up of spontaneous abortion." The client is upset about what is written on the schedule. How can the nurse best explain this terminology? "Spontaneous abortion is a more specific term used to describe a spontaneous miscarriage, which is a loss of pregnancy before 20 weeks. This term does not imply that you did anything to affect the pregnancy." "Abortion is a medical term for any interruption of pregnancy before a fetus is viable." "Spontaneous abortion is the medical name for a miscarriage." "Oh, that just means it was a miscarriage."
A
A 35-year-old client is seen for her 2-week postoperative appointment after a suction curettage was performed to evacuate a hydatidiform mole. The nurse explains that the human chorionic gonadotropin (hCG) levels will be reviewed every 2 weeks and teaches about the need for reliable contraception for the next 6 months to a year. The client states, "I'm 35 already. Why do I have to wait that long to get pregnant again?" What is the nurse's best response? "A contraceptive is used so that a positive pregnancy test resulting from a new pregnancy will not be confused with the increased level of hCG that occurs with a developing malignancy." "After a curettage procedure, it is recommended that you give your body some time to build up its stores." "You may need chemotherapy, so we don't want to risk pregnancy." "Since you are at the end of your reproductive years, it is suggested that you don't try to have any more pregnancies."
A
A novice nurse asks to be assigned to the least complex antepartum client. Which condition would necessitate the least complex care requirements? gestational hypertension preecalmpsia placenta previa abruptio placenta
A
A pregnant woman with preeclampsia is to receive magnesium sulfate IV. Which assessment would be most important prior to administering a new dose? patellar reflex pulse rate blood pressure anxiety level
A
A primipara at 36 weeks' gestation is being monitored in the prenatal clinic for risk of preeclampsia. Which sign or symptom is the priority concern for the nurse? a dipstick value of 2+ for protein nausea and vomiting edema headache
A
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 eclampsia severe preeclampsia
A
The nurse is caring for a pregnant client with fallopian tube rupture. Which intervention is the priority for this client? Monitor the client's vital signs and bleeding. Monitor the fetal heart rate (FHR). Monitor the mass with transvaginal ultrasound. Monitor the client's beta-hCG level.
A
The nurse is preparing the plan of care for a woman hospitalized for hyperemesis gravidarum. Which interventions would the nurse most likely include? Select all that apply. obtaining baseline blood electrolyte levels maintaining NPO status for the first day or two monitoring intake and output administering antiemetic agents preparing the woman for insertion of a feeding tube
A, B, C, D
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. What are features of an acute increase in blood pressure? Select all that apply. proteinuria auditory hallucinations blurring of vision hypereflexia hyperglycemia
A, C, D
A client has been admitted to the hospital with a diagnosis of severe preeclampsia. Which nursing intervention is the priority? Check for vaginal bleeding every 15 minutes. Confine the client to bed rest in a darkened room. Keep the client on her side so that secretions can drain from her mouth. Administer oxygen by face mask.
B
A client is 20 weeks pregnant. At a prenatal visit, the nurse begins the prenatal assessment. Which finding would necessitate calling the primary care provider to assess the client? The client has rhinitis and epistaxis. The client has pink vaginal discharge and pelvic pressure. The client has a white vaginal discharge. The client vomited.
B
A client 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 client at this point? give birth vaginally bed rest to maintain pregnancy as long as possible education on causes of cervical insufficiency for the future notification of social support for loss of pregnancy
B
A postpartum mother has the following lab data recorded: Rh is negative, and rubella titer is positive. What is the appropriate nursing intervention? Assess the Rh of the baby. Administer Rho(D) immune globulin within 72 hours. Administer rubella vaccine before discharge. Assess the rubella titer of the baby.
B
A woman in labor has sharp fundal pain accompanied by slight vaginal bleeding. What is the most likely cause of these symptoms? placenta previa obstructing the cervix premature separation of the placenta possible fetal death or injury preterm labor that was undiagnosed
B
A young woman presents at the emergency department reporting lower abdominal cramping and spotting at 12 weeks' gestation. The primary care provider performs a pelvic examination and finds that the cervix is closed. What does the care provider suspect is the cause of the cramps and spotting? ectopic pregnancy threatened abortion habitual abortion cervical insufficiency
B
Rho(D) immune globulin will be prescribed for an Rh negative mother undergoing which test? contraction test amniocentesis biophysical profile nonstress test
B
The nurse is transcribing messages from the answering service. Which phone message should the nurse return first? a 25-year-old, 31-week G1P0 client with blood pressure of 100/80 mm Hg and left flank pain; the client's last blood pressure was 100/77 mm Hg and she had no proteinuria a 35-year-old, 21-week G3P2 client with blood pressure of 160/110 mm Hg, blurred vision, and whose last blood pressure was 143/99 mm Hg and urine dipstick showed a +2 proteinuria a 20-year-old, 31-week G1P0 client with malaise and rhinitis; the client's last blood pressure was 120/80 mm Hg, and she had no proteinuria an 18-year-old, 38-week G2P1 client with intermittent cramping; the client's last blood pressure was 98/50 mm Hg, and proteinuria was 1+
B
When assessing a woman with an ectopic pregnancy, the nurse would suspect that the tube has ruptured based on which finding? nausea referred shoulder pain breast tenderness vaginal spotting
B
client is admitted to labor and birth for management of severe preeclampsia. An IV infusion of magnesium sulfate is started. What is the primary goal for magnesium sulfate therapy? decrease protein in urine prevent maternal seizures decrease blood pressure reverse edema
B
woman with severe preeclampsia is receiving magnesium sulfate. The woman serum magnesium level is 9.0mEq/L. Which finding would the nurse most likely note? elevated liver enzymes diminished reflexes seizures serum magnesium level of 6.5 mEq/L
B
The clinic nurse routinely assesses all pregnant clients for signs of hypertension. Which symptoms experienced by the client would the nurse document as diagnostic signs of preeclampsia? Select all that apply. edema elevated liver enzymes blood pressure of 140/90 mm Hg +1 proteinuria
B, C, D
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."
C
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 fundus Notify healthcare provider Transport to surgery Assess the client's vital signs.h
D
The nurse is required to assess a pregnant client who is reporting vaginal bleeding. Which nursing action is the priority? monitoring uterine contractility assessing signs of shock determining the amount of funneling assessing the amount and color of the bleeding
D
When assessing a pregnant woman with vaginal bleeding, the nurse would suspect a threatened abortion based on which finding? strong abdominal cramping passage of fetal tissue cervical dilation slight vaginal bleeding
D
Which statement by a pregnant client indicates the need for more teaching about preeclampsia? "I will weigh myself every morning after voiding before breakfast." "I will count my baby's movements twice a day." "If I have a slight headache, I'll take acetaminophen and call if unrelieved." "If I have changes in my vision, I will lie down and rest."
D
The nurse is caring for a client with preeclampsia and understands the need to auscultate this client's lung sounds every two hours. Why would the nurse do this? pulmonary atelectasis pulmonary hypertension pulmonary emboli pulmonary edema
d
