Chp. 14 - Pregestational Problems

The nurse on the high-risk antepartal unit has received the shift change report. Which patient should the nurse see first? 1. Primip at 26 weeks with prolonged premature rupture of membranes, experiencing chills 2. Multip at 28 weeks with premature rupture of membranes reporting leakage of clear vaginal fluid 3. Primip at 30 weeks with premature rupture of membranes due for a betamethasone injection 4. Multip at 32 weeks with prolonged premature rupture of membranes and a hemoglobin of 11.0

Correct Answer: 1 Rationale 1: Chills indicate fever, which in turn indicates infection. Prolonged premature rupture of membranes increases the risk of maternal infection, specifically chorioamnionitis. Intrauterine infection can be life-threatening to the fetus or to a neonate. This patient requires immediate intervention, including contacting the physician. Rationale 2: Premature rupture of membranes is the leakage of amniotic fluid; continued leaking of clear fluid does not indicate the development of further complications. Rationale 3: Scheduled medications are important, but when a patient is experiencing complications, medications are less important. Rationale 4: Although this patient has prolonged premature rupture of membranes, there is no indication of any further complications. This patient is a low priority.

During a prenatal exam, a patient describes several psychosomatic symptoms and has several vague complaints. What could these behaviors indicate? 1. Abuse 2. Mental illness 3. Depression 4. Nothing, they are normal.

Correct Answer: 1 Rationale 1: Chronic psychosomatic symptoms and vague complaints can be indicators of abuse. Rationale 2: Chronic psychosomatic symptoms and vague complaints are not indicators of mental illness. Rationale 3: Chronic psychosomatic symptoms and vague complaints are not indicators of depression. Rationale 4: These signs should not be discounted as normal.

A woman is being treated for preterm labor with magnesium sulfate. The nurse is concerned that the patient is experiencing early drug toxicity. What assessment finding by the nurse indicates early magnesium sulfate toxicity? 1. Patellar reflexes are weak or absent. 2. Complaints by the patient of feeling flushed and warm 3. Respiratory rate of 16 4. Fetal heart rate of 120

Correct Answer: 1 Rationale 1: Early signs of magnesium sulfate toxicity are related to a decrease in deep tendon reflexes. Rationale 2: The peripheral vasodilation will cause flushing and a feeling of warmth; this is a side effect, not a toxic effect. Rationale 3: Late signs of toxicity are a respiratory rate less than 12, urine output less than 30 cc/hour, and confusion. Rationale 4: Magnesium typically has no effect on fetal heart rate.

A woman has a hydatidiform mole (molar pregnancy) evacuated, and is prepared for discharge. The nurse should make certain that the patient understands that it is essential that she: 1. Not become pregnant until after the follow-up program is completed. 2. Receive RhoGAM with her next pregnancy and birth. 3. Have her blood pressure checked weekly for the next 30 days. 4. Seek genetic counseling with her partner before the next pregnancy.

Correct Answer: 1 Rationale 1: Follow-up care consists of monitoring hCG levels weekly until they are negative three consecutive times, then monthly for 6 months. Patients are advised not to get pregnant due to potential confusion between tumor growth and pregnancy. Rationale 2: There is no indication for the administration of RhoGAM. Rationale 3: There is no indication of blood pressure problems or preeclampsia. Rationale 4: This is not a genetic defect that genetic counseling could/would resolve.

The patient with blood type A, Rh-negative, delivered yesterday. Her infant is blood type AB, Rh-positive. Which statement indicates that teaching has been effective? 1. "I need to get RhoGAM so I don't have problems with my next pregnancy." 2. "Because my baby is Rh-positive, I don't need RhoGAM." 3. "If my baby had the same blood type I do, it might cause complications." 4. "Before my next pregnancy, I will need to have a RhoGAM shot."

Correct Answer: 1 Rationale 1: Rh-negative mothers who give birth to Rh-positive infants should receive Rh immune globulin (RhoGAM) to prevent alloimmunization, which could cause fetal anemia and other complications during the next pregnancy. Rationale 2: If the baby is Rh-negative, the mother does not need RhoGAM. Rationale 3: It is specifically the Rh factor that causes complications; ABO grouping does not cause alloimmunization. Rationale 4: The injection must be given with 72 hours after delivery to prevent alloimmunization.

A woman at 7 weeks' gestation is diagnosed with hyperemesis gravidarum. Which nursing diagnosis would receive priority? 1. Fluid Volume Deficit 2. Decreased Cardiac Output 3. Risk for Injury 4. Alteration in Nutrition: Less than body requirements

Correct Answer: 1 Rationale 1: The newly admitted patient with hyperemesis gravidarum has been experiencing excessive vomiting, and is in a fluid volume-deficit state. Rationale 2: Because no preexisting cardiac condition is present, the body has compensated for this fluid loss. Rationale 3: The risk for injury is present due to the symptoms of fluid volume deficit; however, it is not the priority. Rationale 4: The nutrition status of the patient is compromised until the emesis and the fluid volume status are corrected. But it is not the first priority.

The nurse is reviewing labs on a new admit. The patient's hemoglobin is 8.0; platelets are 75,000, AST 75. Which nursing action is best? 1. Contact the physician. 2. Request the labs to be redrawn. 3. Assess blood pressure. 4. Determine the client's blood type and Rh.

Correct Answer: 1 Rationale 1: This client has HELLP syndrome, a life-threatening condition. Further orders are needed from the physician. Rationale 2: Redrawing the labs is not the best action. Rationale 3: The blood pressure is likely to be high, but notifying the physician of this life-threatening set of labs is a higher priority. Rationale 4: Although blood type and Rh would need to be known after delivery to determine whether the client requires RhoGAM, this is not the highest priority.

A patient is concerned because she has been told her blood type and her baby's are incompatible. The best response by the nurse would be: 1. "This is called ABO incompatibility, and if the baby becomes jaundiced, she can be treated with a special light treatment." 2. "This is a serious condition, and additional blood studies are currently in process to determine whether you need a medication to prevent it from occurring with a future pregnancy." 3. "This is a condition caused by a blood incompatibility between you and your husband, but does not affect the baby." 4. "This type of condition is very common, and the baby can receive a medication to prevent jaundice from occurring."

Correct Answer: 1 Rationale 1: When blood types, not Rh, are incompatible, it is called ABO incompatibility. The mother has a blood type that has antibodies against the newborn blood cells and causes these cells to break down. Rationale 2: Although this can be serious, additional blood studies are not typically done. There is no medication that can be given to the mother to prevent this from occurring. Rationale 3: The incompatibility is not between the mother's and father's blood but between the mother's and the infant's blood. Rationale 4: ABO incompatibility is common, but there is no medication to give the baby that will prevent jaundice.

The nurse knows that a mother who has been treated for Beta streptococcus passes this risk on to her newborn. Risk factors for neonatal sepsis caused by Beta streptococcus include: Select all that apply. 1. Prematurity. 2. Maternal intrapartum fever. 3. Membranes ruptured for longer than 18 hours. 4. A previously infected infant with GBS disease. 5. An older mother having her first baby.

Correct Answer: 1,2,3,4 Rationale 1: Prematurity is a risk factor. Rationale 2: Maternal intrapartum fever is a risk factor. Rationale 3: Prolonged rupture of membranes is a risk factor. Rationale 4: A previously infected infant increases the risk. Rationale 5: Young maternal age is a risk factor.

The nurse educator is presenting a class on the different kinds of miscarriages. Miscarriages, or spontaneous abortions, are classified clinically into different categories, including: Select all that apply. 1. Threatened abortion. 2. Incomplete abortion. 3. Complete abortion. 4. Missed abortion. 5. Acute abortion.

Correct Answer: 1,2,3,4 Rationale 1: Unexplained cramping, bleeding, or backache indicate the fetus might be in jeopardy. Rationale 2: Part of the products of conception is retained, usually the placenta. Rationale 3: All the products of conception are expelled in a complete abortion. Rationale 4: In a missed abortion, the fetus dies in utero but is not expelled. Rationale 5: There is no such thing as acute abortion.

The nurse is presenting a class on the pathophysiology of the different abortions. Some of the causes are: Select all that apply. 1. Chromosomal defects. 2. Insufficient or excessive hormonal levels. 3. Sexual intercourse in the first trimester. 4. Infections in the first trimester. 5. Cervical insufficiency.

Correct Answer: 1,2,4,5 Rationale 1: Chromosomal defects are usually the cause of abortions between 4 and 8 weeks. Rationale 2: Insufficient or excessive hormone levels usually cause an abortion by the 10th week. Rationale 3: Sexual intercourse does not cause miscarriage. Rationale 4: Infections can cause fetal loss in the first trimester. Rationale 5: Later abortions usually have a maternal cause, such as an insufficient cervix.

The patient at 34 weeks' gestation has been stabbed in the low abdomen by her boyfriend. She is brought to the emergency department for treatment. Which statements indicate that the patient understands the treatment being administered? Select all that apply. 1. "The baby needs to be monitored to check the heart rate." 2. "My bowel has probably been lacerated by the knife." 3. "I might need an ultrasound to look at the baby." 4. "The catheter in my bladder will prevent urinary complications." 5. "The IV in my arm will replace the amniotic fluid if it is leaking."

Correct Answer: 1,3 Rationale 1: Penetrating trauma to the abdomen during advanced pregnancy often results in ruptured membranes, with external leaking of fluid. The baby will be evaluated with electronic fetal monitoring and ultrasound examination to determine hemodynamic stability and look for injuries. Rationale 2: The pregnancy usually sustains the majority of the damage, sparing the bowel from injury. Rationale 3: The baby will be evaluated with electronic fetal monitoring and ultrasound examination to determine hemodynamic stability and look for injuries. Rationale 4: The Foley catheter is placed to assess for hematuria. Rationale 5: The IV will replace intravascular volume, not amniotic fluid.

A patient at 18 weeks' gestation has been diagnosed with a hydatidiform mole. In addition to vaginal bleeding, which signs or symptoms would the nurse expect to see? Select all that apply. 1. Hyperemesis and hypertension 2. Diarrhea and hyperthermia 3. Uterine enlargement greater than expected 4. Polydipsia 5. Vaginal bleeding

Correct Answer: 1,3,5 Rationale 1: These are often seen in patients with hydatidiform mole. Rationale 2: Neither of these is seen with hydatidiform mole. Rationale 3: This is a classic sign of hydatidiform mole. Rationale 4: This is not associated with hydatidiform mole. Rationale 5: This is a classic symptom of hydatidiform mole.

A patient is admitted to the labor suite. It is essential that the nurse assess the woman's status in relation to which infectious diseases? Select all that apply. 1. Hepatitis B 2. Rubeola 3. Varicella 4. Group B streptococcus 5. HIV/AIDS

Correct Answer: 1,4,5 Rationale 1: Hepatitis B should be assessed. Rationale 2: This is not of immediate importance. Rationale 3: This is not of immediate importance. Rationale 4: Streptococcus B should definitely be assessed. Rationale 5: HIV/AIDS should be assessed.

The nurse is assessing a client who has severe preeclampsia. The assessment finding that should be reported to the physician is: 1. Proteinuria. 2. Platelet count of 20,000. 3. Urine output of 50 ml per hour. 4. 21 DTRs.

Correct Answer: 2 Rationale 1: The 11 spilling of protein is abnormal, but this is acceptable for a client with preeclampsia. Rationale 2: The client could be experiencing HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count). This condition is sometimes associated with severe preeclampsia, and women who experience this multiple-organ-failure syndrome have high morbidity and mortality rates. A platelet count lower than 20,000 is critically low. Rationale 3: A urine output of at least 30 ml/hour is normal. Rationale 4: The DTRs of 21 are normal.

The nurse identifies the following assessment findings on a client with preeclampsia: blood pressure 158/100; urinary output 50 mL/hour; lungs clear to auscultation; urine protein 11 on dipstick; and edema of the hands, ankles, and feet. On the next hourly assessment, which new assessment finding would be an indication of worsening of the preeclampsia? 1. Blood pressure 158/104 2. Urinary output 20 mL/hour 3. Reflexes 21 4. Platelet count 150,000

Correct Answer: 2 Rationale 1: The blood pressure has not had a significant rise. Rationale 2: The decrease in urine output is an indication of decrease in GFR, which indicates a loss of renal perfusion. The most abnormal and life-threatening assessment finding is the urine output change. Rationale 3: The reflexes are normal at 21. Rationale 4: The platelet count is normal, although it is at the lower end.

A patient has preeclampsia. She is 36 weeks pregnant, and comes to the high-risk screening center for a contraction stress test. The nurse should explain to the patient that the contraction stress test is being done to determine: 1. What effect her hypertension has had on the fetus. 2. Whether the fetus will be able to tolerate labor. 3. Whether fetal movement increases with contractions. 4. What effect contractions will have on her blood pressure.

Correct Answer: 2 Rationale 1: The fetal heart rate response to movement is assessed in a non-stress test. Rationale 2: Contraction stress tests are performed to assess the ability of the fetus to tolerate labor. Rationale 3: With contractions, the nurse is assessing for a heart rate response, not for movement. Rationale 4: The effect of contractions on blood pressure would be noted, but this is not the purpose.

The nurse is caring for a patient at 35 weeks' gestation who has been critically injured in a shooting. Which statement by the paramedics bringing the woman to the hospital would cause the greatest concern? 1. "Blood pressure 110/68, pulse 90." 2. "Entrance wound present below the umbilicus." 3. "Patient is positioned in a left lateral tilt." 4. "Clear fluid is leaking from the vagina."

Correct Answer: 2 Rationale 1: These are normal vital signs, indicating a hemodynamically stable client. Rationale 2: Penetrating abdominal trauma has a 59-80% fetal injury rate. This fetus is at great risk for injury. Rationale 3: Positioning the client in a lateral tilt position prevents vena cava syndrome. Rationale 4: Clear fluid from the vagina could be amniotic fluid from spontaneous rupture of the membranes. Although this is not a normal finding at 35 weeks, this fetus is near term, and would likely survive birth at this time.

A woman is 16 weeks pregnant. She has had cramping, backache, and mild bleeding for the past 3 days. Her physician determines that her cervix is dilated to 2 centimeters, with 10% effacement, but membranes are still intact. She is crying, and says to the nurse, "Is my baby going to be okay?" In addition to acknowledging the patient's fear, the nurse should also say: 1. "Your baby will be fine. We'll start IV, and get this stopped in no time at all." 2. "Your cervix is beginning to dilate. That is a serious sign. We will continue to monitor you and the baby for now." 3. "You are going to miscarry. But you should be relieved, because most miscarriages are the result of abnormalities in the fetus." 4. "I really can't say. However, when your physician comes, I'll ask her to talk to you about it."

Correct Answer: 2 Rationale 1: This is a serious situation. The patient should not be offered false hope of everything being fine. Rationale 2: A cerclage can be performed in the first trimester and early into the second trimester. Many interventions can be attempted to prevent further dilation and effacement. Rationale 3: The nurse should avoid justification of the miscarriage. Rationale 4: The nurse should not defer the conversation to someone else (e.g., the physician).

The prenatal clinic nurse is caring for a patient with hyperemesis gravidarum at 14 weeks' gestation. The vital signs are: blood pressure 95/48, pulse 114, respirations 24. Which order should the nurse implement first? 1. Weigh the client. 2. Give 1 liter of lactated Ringer's solution IV. 3. Administer 30 ml Maalox (magnesium hydroxide) orally. 4. Encourage clear liquids orally.

Correct Answer: 2 Rationale 1: Weighing the client provides information on weight gain or loss, but is not the top priority in a patient with excessive vomiting during pregnancy. The vital signs indicate hypovolemia. Rationale 2: The vital signs indicate hypovolemia. Giving this patient a liter of lactated Ringer's solution intravenously will re-establish vascular volume and bring the blood pressure up, and the pulse and respiratory rate down. Rationale 3: The vital signs indicate hypovolemia. There is no indication that the patient has dyspepsia. Rationale 4: Lack of tolerance of oral fluids through excessive vomiting is what has led to the hypovolemia.

The patient presents to the clinic for an initial prenatal examination. She asks the nurse whether there might be a problem for her baby because she has type B Rh-positive blood and her husband has type O Rh-negative blood, or because her sister's baby had ABO incompatibility. What is the nurse's best answer? Select all that apply. 1. "Your baby would be at risk for Rh problems if your husband were Rh-negative." 2. "Rh problems only occur when the mother is Rh-negative and the father is not." 3. "ABO incompatibility occurs only after the baby is born." 4. "We don't know for sure, but we can test for ABO incompatibility." 5. "Your husband's being type B puts you at risk for ABO incompatibility."

Correct Answer: 2,3 Rationale 1: Rh incompatibility is a possibility when the mother is Rh-negative and the father is Rh-positive. Rationale 2: Rh incompatibility is a possibility when the mother is Rh-negative and the father is Rh-positive. Rationale 3: ABO incompatibility occurs when the mother is type O and the baby is type A or B or AB at the time the placenta delivers. Rationale 4: ABO incompatibility occurs when the mother is type O and the baby is type A or B or AB at the time the placenta delivers. Rationale 5: The husband's blood type is not an issue for ABO incompatibility, which causes hemolysis and jaundice in babies and does not affect mothers.

A patient is being admitted to the labor area with the diagnosis of eclampsia. Which actions by the nurse are appropriate at this time?Select all that apply. 1. Tape a tongue blade to the head of the bed. 2. Pad the siderails and head of the bed. 3. Provide the patient with needed stimulation. 4. Provide the patient with grief counseling. 5. Pull the blinds and provide a dark, quiet environment.

Correct Answer: 2,5 Rationale 1: It is dangerous to insert a tongue blade into the mouth of a seizing patient. Rationale 2: The siderails and headboard should be padded. Rationale 3: Excess stimulation can precipitate a seizure. Rationale 4: There is no reason to provide grief counseling. Rationale 5: This patient's room should be dark and quiet so as not to precipitate any seizure.

A patient has been admitted with a diagnosis of hyperemesis. Which orders written by the primary health care provider are the highest priority for the nurse to implement? Select all that apply. 1. Obtain complete blood count. 2. Start intravenous with multivitamins. 3. Check admission weight. 4. Obtain urine for urinalysis. 5. Give a medication to stop the nausea and vomiting.

Correct Answer: 2,5 Rationale 1: This is important, but not a priority. Rationale 2: This is a priority if the patient has been vomiting. Rationale 3: This is important, but not a priority. Rationale 4: This is important, but not a priority. Rationale 5: This is a priority to stop the nausea and vomiting.

The nurse is supervising care in the emergency department. Which situation most requires an intervention? 1. Moderate vaginal bleeding at 36 weeks' gestation; client has an IV of lactated Ringer's solution running at 125 mL/hour 2. Spotting of pinkish-brown discharge at 6 weeks' gestation and abdominal cramping; ultrasound scheduled in 1 hour 3. Bright red bleeding with clots at 32 weeks' gestation; pulse = 110, blood pressure 90/50, respirations = 20 4. Dark red bleeding at 30 weeks' gestation with normal vital signs; patient reports an absence of fetal movement

Correct Answer: 3 Rationale 1: Bleeding in the third trimester is usually a placenta previa or placental abruption. Blood loss can be heavy and rapid, so having an IV stabilizes the client's vascular volume. Rationale 2: Bleeding in the first trimester can be indicative of spontaneous abortion beginning, or of an ectopic pregnancy. An ultrasound will diagnose which situation is occurring, and will determine care. Rationale 3: Bleeding in the third trimester is usually a placenta previa or placental abruption. Blood loss can be heavy and rapid. This patient has a low blood pressure with an increased pulse rate, which indicates hypovolemic shock, which can be fatal to the mother and therefore the baby. Rationale 4: Watery, dark red bleeding in the third trimester can indicate placental abruption with ruptured membranes. Normal vital signs indicate a normal vascular volume. A lack of fetal movement could indicate fetal hypoxia or fetal demise. The fetus is at greatest risk in this situation; the mother is stable.

A patient who is 11 weeks pregnant presents to the emergency department with complaints of dizziness, lower abdominal pain, and right shoulder pain. Laboratory tests reveal a beta-hCG at a lower-than-expected level for this gestational age. An adnexal mass is palpable. Ultrasound confirms no intrauterine gestation. The patient is crying and asks what is happening. The nurse knows that the most likely diagnosis is an ectopic pregnancy. Which statement should the nurse include? 1. "You're feeling dizzy because the pregnancy is compressing your vena cava." 2. "The pain is due to the baby putting pressure on nerves internally." 3. "The baby is in the fallopian tube; the tube has ruptured and is causing bleeding." 4. "This is a minor problem. The doctor will be right back to explain it to you."

Correct Answer: 3 Rationale 1: Dizziness from vena cava compression occurs in the third trimester when women are supine. Rationale 2: The fetus is too small to be putting pressure on the nerves. Rationale 3: Dizziness and abdominal pain with shoulder pain are symptoms of internal bleeding. A lower-than-expected beta-hCG indicates either an ectopic pregnancy or a pregnancy that is miscarrying; in this case, it is an ectopic pregnancy. Rationale 4: Therapeutic communication requires giving the patient an answer rather than referring the patient to someone else.

The community nurse is working with a patient at 32 weeks' gestation who has been diagnosed with preeclampsia. Which statement by the patient would indicate that additional information is needed? 1. "I should call the doctor if I develop a headache or blurred vision." 2. "Lying on my left side as much as possible is good for the baby." 3. "My urine could become darker and smaller in amount each day." 4. "Pain in the top of my abdomen is a sign my condition is worsening."

Correct Answer: 3 Rationale 1: Headache and blurred vision or other visual disturbances are an indication of worsening preeclampsia and should be reported to the physician. Rationale 2: The left lateral position maximizes uterine and renal blood flow, and therefore is the optimal position for a patient with preeclampsia. Rationale 3: Oliguria is a complication of preeclampsia caused by renal involvement, and is a sign that the condition is worsening. Oliguria should be reported to the physician. Rationale 4: Epigastric pain is an indication of liver enlargement, a symptom of worsening preeclampsia, and should be reported to the physician.

A woman is hospitalized with severe preeclampsia. The nurse is meal-planning with the patient and encourages a diet that is high in: 1. Sodium. 2. Carbohydrates. 3. Protein. 4. Fruits.

Correct Answer: 3 Rationale 1: It is important that the patient limit her intake of sodium. Rationale 2: While it is important that the patient have an adequate intake of carbohydrates, another food group is more important. Rationale 3: The client who experiences preeclampsia is losing protein. Rationale 4: It is important that the patient have adequate intake of fruits, but another food group is more important.

The nurse receives the following report on a patient who delivered 36 hours ago: para 1, rubella-immune, A-negative, antibody screen negative, newborn B-positive, Coombs' negative, discharge orders are written for both mother and newborn. What should be the priority action by the nurse? 1. Ask whether the mother is breast- or bottle-feeding. 2. Administer rubella vaccine. 3. Determine whether RhoGAM has been given. 4. Discuss the discharge education with the patient.

Correct Answer: 3 Rationale 1: This is important but is not the top priority. Rationale 2: The client is rubella-immune, and does not need the rubella vaccine. Rationale 3: The patient is A-negative and the newborn B-positive. The patient needs RhoGAM prior to discharge. Without RhoGAM, the patient will make antibodies against Rh-positive blood, and future pregnancies would be in jeopardy. Rationale 4: Discharge education is always important, but in this case is not the most important action.

A woman is experiencing preterm labor. The patient asks why she is on betamethasone (Celestone). The best response by the nurse would be "This medication: 1. "Will halt the labor process until the baby is more mature." 2. "Will relax the smooth muscles in the infant's lungs so the baby can breathe." 3. "Is effective in stimulating lung development in the preterm infant." 4. "Is an antibiotic that will treat your urinary tract infection, which caused preterm labor."

Correct Answer: 3 Rationale 1: This medication has no effect on the labor process or on the smooth muscles in the lungs. Rationale 2: This medication has no effect on the labor process or on the smooth muscles in the lungs. Rationale 3: Betamethasone (Celestone) has been found to induce pulmonary maturation, and thereby decrease the risk of respiratory problems in the preterm infant. Rationale 4: This medication is not an antibiotic, and therefore will not help resolve a urinary tract infection.

Which maternal-child patient should the nurse see first? 1. Blood type O, Rh-negative 2. Indirect Coombs' test negative 3. Direct Coombs' test positive 4. Blood type B, Rh-positive

Correct Answer: 3 Rationale 1: This patient is Rh-negative, but there is no indication that the alloimmunization has occurred. Rationale 2: An indirect Coombs' test looks for Rh antibodies in the maternal serum; a negative result indicates the patient has not been alloimmunized. Rationale 3: A direct Coombs' test looks for Rh antibodies in the fetal blood circulation. A positive result indicates that that there is an Rh incompatibility between mother and infant, and that the baby is making anti-Rh antibodies, which in turn leads to hemolysis. This infant is at risk for anemia and hyperbilirubinemia. Rationale 4: This patient's blood type creates no problems.

During her first prenatal visit to the clinic at 7 weeks' gestation, a 24-year-old primiparous patient comments, "My blood type is A negative, and my husband's blood type is B positive. Will that cause problems with my pregnancy?" The nurse's best response would be: 1. "There is no danger to your baby, but there could be a few minor complications for you. Let's talk about what we can do to prevent those." 2. "We will do a blood test to see whether your body is responding to the baby's blood type. If so, we will give the baby some medication to prevent harm." 3. "Because your partner is positive and you are negative, there is some risk to the baby, but because this is your first pregnancy, the risks are very small." 4. "If you were O negative, you might have ABO incompatibility because of your partner's blood type; but since you are type A, there should be no problem."

Correct Answer: 3 Rationale 1: This patient is at risk for Rh incompatibility because she is Rh-negative and the father of the baby is Rh-positive. Rationale 2: It is recommended that a Coombs' blood test be drawn to assess for antibody formation at the first prenatal visit and again at 28 weeks. Rh immune globulin (RhoGAM) will be given to the mother (not the fetus) at 28 weeks. Rationale 3: This client is at risk for Rh incompatibility because she is Rh-negative and the father of the baby is Rh-positive. Because this is her first pregnancy, it is extremely unlikely that she has been exposed to Rh-positive blood, which would stimulate the development of antibodies. These antibodies cross the placenta and cause fetal hemolysis, which can lead to severe anemia that could cause fetal loss. It is recommended that a Coombs' blood test be drawn to assess for antibody formation at the first prenatal visit and again at 28 weeks. Rh immune globulin (RhoGAM) will be given to the mother (not the fetus) at 28 weeks, and again after delivery if the baby is Rh-positive, to prevent antibody formation. Rationale 4: This is not an issue of ABO incompatibility.

A clinic nurse is planning when to administer Rh immune globulin (RhoGAM) to an Rh-negative pregnant patient. When should the first dose of RhoGAM be administered? 1. After the birth of the infant 2. 1 month postpartum 3. During labor 4. At 28 weeks' gestation

Correct Answer: 4 Rationale 1: After birth would be too late for the first dose of RhoGAM if transplacental hemorrhage, which is possible during pregnancy, has occurred. Rationale 2: 1 month postpartum would be too late for the first dose of RhoGAM if transplacental hemorrhage, which is possible during pregnancy, has occurred. Rationale 3: During labor would be too late for the first dose of RhoGAM if transplacental hemorrhage, which is possible during pregnancy, has occurred. Rationale 4: Since transplacental hemorrhage is possible during pregnancy, an antibody screen is performed on an Rh-negative woman at 28 weeks' gestation. If she has no antibody titer, she is given an IM injection of 300 mcg Rh immune globulin (RhoGAM).

The nurse is presenting a class to newly pregnant families. What form of trauma will the nurse describe as the leading cause of fetal and maternal death? 1. Falls 2. Domestic violence 3. Gun accidents 4. Motor vehicle accidents

Correct Answer: 4 Rationale 1: Falls are not the leading cause of death. Rationale 2: Domestic violence is not the leading cause of death. Rationale 3: Gun accidents are not common in pregnancy. Rationale 4: The leading cause of fetal and maternal death in pregnancy is motor vehicle accidents.

The nurse is caring for a patient who was just admitted to rule out ectopic pregnancy. Which orders are the most important for the nurse to perform? Select all that apply. 1. Assess the patient's temperature. 2. Document the time of the patient's last meal. 3. Obtain urine for urinalysis and culture. 4. Report complaints of dizziness or weakness. 5. Have lab draw blood for B-hCG level every 48 hours.

Correct Answer: 4,5 Rationale 1: This is important, but not the most important to perform first. Rationale 2: This is not an important action. Rationale 3: This is not an important action. Rationale 4: This is important, as it can indicate hypovolemia from internal bleeding. Rationale 5: This is important, as the level rises much more slowly in ectopic pregnancy than normal pregnancy.

A patient at 10 weeks' gestation has developed cholecystitis. If surgery is required, the safest time during pregnancy would be: 1. Immediately, before the fetus gets any bigger. 2. Early in the second trimester. 3. As close to term as possible. 4. The risks are too high to do it anytime in pregnancy.

Rationale 1: The risk of miscarriage is greater in the first trimester. Rationale 2: Early in the second trimester, the risk of spontaneous abortion and early labor is lower, and the fetus is not so large that it might interfere with the abdominal field. Rationale 3: A fetus close to term is so large that it might interfere with the abdominal field. Rationale 4: There is always a risk, but it is greater in the first and third trimesters.