Chapter 28 AQ (test 3)

A woman diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At the present time, she is at the greatest risk for what problem? A. Hemorrhage B. Infection C. Urinary retention D. Thrombophlebitis

A. 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 than with a normally implanted placenta. There is no greater risk for thrombophlebitis than with a normally implanted placenta.

The nurse is preparing a client for abortion. Which medicine is administered to the client after the evacuation of the uterus to prevent hemorrhage? A. Oxytocin (Pitocin) B. Misoprostol (Cytotec) C. Vitamin K (Aqua-Mephyton) D. Magnesium sulfate (Sulfamag)

A. Oxytocin (Pitocin)

What dietary instructions does the nurse give a client who has experienced miscarriage? A. "Increase folic acid and zinc in your diet." B. "Eat foods that are high in iron and protein." C. "Restrict fluid intake to 125 milliliters per hour." D. "Reduce dietary fat intake by 40 to 50 grams per day."

B. "Eat foods that are high in iron and protein." -The nurse advises the client to eat foods that are high in iron and protein to help in tissue repair and red blood cell (RBC) replacement.

A pregnant client is diagnosed with abruptio placentae. What signs and symptoms would the nurse find in the client? Select all that apply. A. Hypoglycemia B. Abdominal pain C. Vaginal Bleeding D. Delayed menses E. Uterine tenderness

B. Abdominal pain C. Vaginal Bleeding E. Uterine tenderness

The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is what? A. Bleeding B. Intense abdominal pain C. Uterine activity D. Cramping

B. Intense abdominal pain

The nurse is assessing a pregnant client at 6 weeks of gestation. Upon reviewing the client's medical history, the nurse finds that the client had undergone a large cone biopsy. Which treatment strategy does the nurse expect to be most beneficial to prevent miscarriage in the client? A. Administering misoprostol (Cytotec) orally for 7 days B. Performing abdominal cerclage at 11 weeks of gestation C. Placing a rescue cerclage in the cervix at 23 weeks of gestation D. Administering ergonovine (Methergine) during the 3rd trimester

B. Performing abdominal cerclage at 11 weeks of gestation - client who has undergone a large cone biopsy may be at risk of miscarriage due to the presence of an extremely short cervix. Therefore, the primary health care provider would perform an abdominal cerclage at 11 or 13 weeks of gestation in order to prevent the opening of the cervical os.

The nurse is caring for a client who is 35 weeks pregnant, and reports moderate vaginal bleeding. The ultrasonographic reports indicate abruptio placentae. Which immediate interventions should the nurse provide? A. Determine hemoglobin level B. Prepare the client for delivery C. Determine blood and fluid volume D. Provide oxygen therapy

B. Prepare the client for delivery

Which is an important nursing intervention when a client has an incomplete miscarriage with heavy bleeding? A. Initiate expectant management at once. B. Prepare the client for dilation and curettage. C. Administer the prescribed oxytocin (Pitocin). D. Obtain a prescription for ergonovine (Methergine).

B. Prepare the client for dilation and curettage.

The primary health care provider prescribes methotrexate (MTX) to treat ectopic pregnancy in a client. The nurse instructs the client to avoid taking any analgesic stronger than acetaminophen (Tylenol). What could be the reason for giving this instruction? A. MTX has an interaction with other analgesics. B. Stronger analgesics can mask symptoms of the tubal rupture. C. Other analgesics may cause liver function impairment in the client. D. Other analgesics may cause renal function impairment in the client.

B. Stronger analgesics can mask symptoms of the tubal rupture.

The nurse correctly explains to the nursing student that the majority of ectopic pregnancies are located where? A. Uterine fundus B. Cervical os C. Ampulla D. Fimbriae

C. Ampulla

A client reports mild vaginal bleeding, pain, and cramping in her lower abdomen at 6 weeks of gestation. Upon performing a pelvic examination, the nurse finds that the client's cervical os is closed. What is the priority intervention in this condition? A. Administer intravenous fluids to the client B. Administer methylcarboprost tromethamine (Hemabate) to the client. C. Determine the client's human chorionic gonadotropin and progesterone levels D. Prompt termination of pregnancy in the patient by dilation and curettage method.

C. Determine the client's human chorionic gonadotropin and progesterone levels -Mild vaginal bleeding, pain in the lower abdomen, and mild uterine cramps with a closed cervical os are the symptoms of threatened miscarriage. Therefore, the nurse should determine the human chorionic gonadotropin and progesterone levels in the client to find whether the fetus is alive in the uterus.

Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. What is an appropriate management approach? A. Prepare the woman for a dilation and curettage (D&C). B. Place the woman on bed rest for at least 1 week and reevaluate. C. Prepare the woman for an ultrasound and blood work. D. Comfort the woman by telling her that if she loses this baby, she may attempt to get pregnant again in 1 month.

C. Prepare the woman for an ultrasound and blood work.

A nurse is evaluating several obstetrical clients for their risk for cervical insufficiency. Which client would be considered most at risk? A. Primipara B. Grand multipara who has previously had all vaginal deliveries without a problem C. Primipara who has a cervical cone biopsy performed for cervical dysplasia prior to the pregnancy. D. Multipara who had her previous delivery via C section due to cephalopelvic disproportion (CPD).

C. Primipara who has a cervical cone biopsy performed for cervical dysplasia prior to the pregnancy.

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? A. incomplete B. inevitable C. Threatened D. Septic

C. Threatened

The nurse is working in an obstetric ward. Which client in the ward is at the highest risk of developing hydatidiform mole? A. A client with hypothyroidism B. A client with diabetes mellitus C. A client with lupus erythematosus D. A client with prior molar pregnancy

D. A client with prior molar pregnancy

Which sign would the nurse observe in a client with hydatidiform mole? A. Clear vaginal discharge B. A small uterus C. Decreased fetal heart rate D. Dark brown vaginal discharge

D. Dark brown vaginal discharge -Hydatidiform mole is characterized by the degeneration of the chorionic villi, in which the villi become vesicle-like. These vesicle-like substances are expelled from the vagina through a dark-brown or bright-red discharge. These are definite signs that the client has hydatidiform mole.

What does the nurse administer to a client if there is excessive bleeding after suction curettage? A. Nifedipine (Procardia) B. Methyldopa (Aldomet) C. Hydralazine (Apresoline) D. Ergonovine (Methergine)

D. Ergonovine (Methergine) -Ergonovine (Methergine) is an ergot product, which is administered to contract the uterus when there is excessive bleeding after suction curettage.

The ultrasound report of a 12-week pregnant woman shows snowstorm pattern. Upon further examination, the nurse finds elevated human chorionic gonadotropin (hCG) levels and dark brown vaginal discharge. What complication does the nurse expect in the client? A. Hemorrhage B. Hypertension C. Hyperglycemia D. Molar pregnancy

D. Molar Pregnancy

A pregnant client after 20 weeks of gestation reports painless bright red vaginal bleeding. Upon assessment the nurse finds that the client's vital signs are normal. Which condition does the nurse suspect in the patient? A. Eclampsia B. Preeclampsia C. Pyelonephritis D. Placenta previa

D. Placenta previa -Placenta previa is indicated by painless bright red vaginal bleeding during the second or third trimester of pregnancy. The client's vital signs may be normal even after blood loss, because a pregnant client can lose up to 40% of the blood volume without any signs of shock.

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 of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of what condition? A. Eclamptic seizure B. Rupture of the uterus C. Placenta previa D. Placental abruption

D. 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.

A pregnant client is diagnosed with succenturiate placenta. What should the nurse understand about the client's condition? A. The placenta separates prematurely from the uterus. B. The placenta is implanted in the lower uterine segment. C. The placental trophoblasts have undergone proliferative growth. D. The placenta is divided into more lobes, rather than a single lobe.

D. The placenta is divided into more lobes, rather than a single lobe.