OB Chapt 19 Nursing Management of Pregnancy at Risk
A woman of 16 weeks' gestation telephones you because she has passed some "berry-like" blood clots and now has continued dark brown vaginal bleeding. Which of the following would you instruct the woman to do? a) "Come to the health care facility if uterine contractions begin." b) "Maintain bed rest and count the number of perineal pads used." c) "Continue normal activity, but take your pulse every hour." d) "Come to the health facility with any vaginal material passed."
"Come to the health facility with any vaginal material passed." Correct Explanation: This is a typical time in pregnancy for gestational trophoblastic disease to present. Asking the woman to bring any material passed vaginally would be important so it can be assessed for this.
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? a) "There is no research evidence that I can recommend to you." b) "Restrict your physical activity to moderate bedrest." c) "Strict bedrest is necessary so as not to jeopardize this pregnancy." d) "Carry on with the activity you engaged in before this happened."
"Restrict your physical activity to moderate bedrest." Correct Explanation: With a threatened abortion, moderate bedrest and supportive care are recommended. Regular physical activity may increase the chances of miscarriage. Strict bedrest is not necessary. Activity restrictions are part of standard medical management.
A client is 11 weeks pregnant after many years trying to conceive. After arriving home from a normal prenatal visit, she experiences mild cramping and has a gush of bright red vaginal bleeding. She calls the nurse and reports having soaked a pad with fresh blood in fewer than 30 minutes. The uterine cramping is worsening. What is the most appropriate response from the nurse? a) "I am sorry. There is nothing you can do, because you are likely miscarrying." b) "This is nothing to worry about. Many women bleed during pregnancy." c) "Lie down and call your health care provider tomorrow if symptoms continue." d) "You need to seek immediate attention from the primary care provider."
"You need to seek immediate attention from the primary care provider." Correct Explanation: Pregnancy loss during the early weeks of pregnancy may seem like a heavy menstrual period. A primary care provider should assess blood loss of this amount with or without uterine cramping as soon as possible.
A primipara at 36 weeks gestation is being monitored in the prenatal clinic for risk of preeclampsia. Which of the following signs or symptoms is the priority concern for the nurse? a) Pedal edema. b) A dipstick value of 2+ for protein. c) A systolic blood pressure increase of 10 mm hg. d) Weight gain of 1.2 lb during the past 1 week.
A dipstick value of 2+ for protein. Correct Explanation: The increasing amount of protein in the urine is a concern the preeclampsia may be progressing to severe preeclampsia. The woman needs further assessment by the health care provider. Dependent edema may be seen in the majority of pregnant women and is not an indicator of progression from preeclampsia to eclampsia. Weight gain is no longer considered an indicator for the progression of preeclampsia. A systolic blood pressure increase is not the highest priority concern for the nurse, since we have no idea what the baseline blood pressure was.
A woman who is 31 weeks pregnant presents at the emergency room 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 physician or technician with which exam? a) A digital cervical exam b) A transvaginal ultrasound c) A blood transfusion d) An abdominal ultrasound
A transvaginal ultrasound Correct Explanation: The use of a transvaginal ultrasound is the diagnostic test of choice; it is 100% accurate in prediction of placenta previa, while abdominal ultrasound is only 95% accurate. A digital cervical exam is contraindicated in this patient and the scenario described does not indicate the need for a blood transfusion.
A postpartum mother has the following lab data recorded: RH negative and rubella titer is positive. What is the appropriate nursing intervention? a) Administer rubella vaccine before discharge. b) Administer RhoGam within 72 hours. c) Assess the rubella of the baby d) Assess the RH of the baby.
Administer RhoGam within 72 hours. Explanation: The rubella is a virus and the mother has a positive titer indicating she is immune, this is important data for prenatal care and only has a bearing if the patient were negative. The RH is negative for the mother and the infant status is unknown, to protect future pregnancies the mother should be given RhoGam. It would not be appropriate to administer the rubella vaccine, assess the rubella titer of the baby, or assess the Rh status of the baby.
Rhogam (Rh immune globulin) will be ordered for an RH - mother undergoing which of the following tests? a) Biophysical profile b) Contraction test c) Non-stress test d) Amniocentesis
Amniocentesis Correct Explanation: Amniocentesis is a procedure requiring a needle to enter into the amniotic sac. There is a risk of mixing of the fetal and maternal blood which could result in blood incompatibility. A contraction test, a non-stress test, and biophysical profile are not invasive, so there would be no indication for Rhogam to be administered.
A patient 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 patient at this point? a) Notification of social support for loss of pregnancy b) Education on causes of cervical insufficiency for the future c) Bed rest to maintain pregnancy as long as possible d) Deliver vaginally
Bed rest to maintain pregnancy as long as possible Correct Explanation: At 22 weeks gestation, the fetus is not viable. The woman would be placed on bed rest, total, with every attempt made to halt any further progression of dilatation as long as possible. You would not want to deliver this fetus vaginally at this stage of gestation. It is not your responsibility to notify the patient's social support of a possible loss of the pregnancy. It is not appropriate at this time to educate the mother on causes of cervical insufficiency for future pregnancies.
A woman has been diagnosed as having pregnancy-induced hypertension. Which of the following is the most typical symptom of this? a) Blood pressure elevation b) Susceptibility to infection c) Weight loss d) Increased perspiration
Blood pressure elevation Correct Explanation: The symptom of hypertension of pregnancy is blood pressure elevation (140/90 mm Hg).
Which of the following would the nurse interpret as indicating that a pregnant client with gestational hypertension has developed severe preeclampsia? a) Blood pressure of 150/100 mm Hg b) Proteinuria of 300 mg/24 hours c) Blurred vision d) Mild facial edema
Blurred vision Correct Explanation: Visual symptoms such as blurred vision and blind spots suggest severe preeclampsia. Severe preeclampsia is characterized by a blood pressure of 160/110 mm Hg. Mild facial edema or hand edema occurs with mild preeclampsia. Proteinuria in severe preeclampsia is greater than 500 mg/24 hours.
When providing counseling on early pregnancy loss, the nurse should include what as the most common cause for spontaneous abortion? a) Lack of prenatal care b) Maternal smoking c) Chromosomal defect d) The age of the mother
Chromosomal defect Correct Explanation: The most common cause for the loss of a fetus in the first trimester is associated with a genetic defect or chromosomal defect. There is nothing that can be done and the mother should feel no fault. The nurse needs to educate the parents to speak with a health care provider for further information and questions related to genetic testing. Early pregnancy loss is not associated with maternal smoking, lack of prenatal care, or the age of the mother.
A client has been admitted to the hospital with a diagnosis of severe pre-eclampsia. Which of the following is the priority nursing? a) Confine the client to bed rest in a darkened room b) Administer oxygen by face mask c) Check for vaginal bleeding every 15 minutes d) Keep the client on her side so that secretions can drain from her mouth
Confine the client to bed rest in a darkened room Correct Explanation: With severe pre-eclampsia, most women are hospitalized so that bed rest can be enforced and a woman can be observed more closely than she can be on home care. Darken the room if possible because a bright light can also trigger seizures. The other interventions listed pertain to a client who has experienced a seizure and has thus progressed to eclampsia.
A 28-year-old woman presents in the emergency room 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 physician as a possible cause of the patient's abdominal pain? a) Placenta previa b) Molar pregnancy c) Ectopic pregnancy d) Healthy pregnancy
Ectopic pregnancy Correct Explanation: Ectopic pregnancy can present with severe unilateral abdominal pain. Given the history of the client , the amount of pain, the possibility of ectopic pregnancy needs to be considered. A healthy pregnancy would not present with severe abdominal pain unless the patient were term and she was in labor. With a molar pregnancy the woman typically presents between 8 to 16 weeks' gestation with complaints of painless (usually) brown to bright red vaginal bleeding. Placenta previa typically presents with painless, bright red bleeding that begins with no warning.
A novice nurse asks to be assigned to the least complex antepartum patient. Which of the following conditions would necessitate the least complex care requirements? a) Gestational hypertension. b) Placenta previa. c) Pre-ecalmpsia. d) Abruptio placenta.
Gestational hypertension. Correct Explanation: Hypertensive disorders represent the most common complication of pregnancy. Gestational hypertension is elevated blood pressure without proteinuria, other signs of pre-eclampsia, or pre-existing hypertension. Abruptio placenta (separation of the placenta from the uterine wall), placenta previa (placenta covering the cervical os), and pre-eclampsia are high-risk, potentially life-threatening conditions for the fetus and mother during labor and birth.
To which of the following patients being discharged for home must the nurse stress that it is absolutely critical the patient return for monthly follow-up visits? A woman who: a) Has experienced a complete spontaneous abortion b) Is Rh negative c) Has experienced a molar pregnancy d) Has experienced an ectopic pregnancy
Has experienced a molar pregnancy Correct Explanation: Molar pregnancies can indicate the possibility of developing malignancy. The woman will need close observation and follow-up for the year following the diagnosis. Follow-up visits after an ectopic pregnancy or a complete spontaneous abortion are typically scheduled at six weeks, not monthly. A woman who is Rh negative does not need a follow-up visit because of her Rh status.
A woman is being admitted to your hospital unit for severe preeclampsia. When deciding on where to place her, which of the following areas would be most appropriate? a) Near the nurse's station so she can be observed closely b) By the nursery so she can maintain hope she will have a child c) Near the elevator so she can be transported quickly d) In the back hallway where there is a quiet, private room
In the back hallway where there is a quiet, private room Correct Explanation: A sudden noise can trigger a seizure in a severely preeclamptic woman. Room placement, therefore, should not be near noise, such as the nursery, the elevator, or nurse's station.
Which of the following would the nurse prepare to administer if ordered as treatment for an unruptured ectopic pregnancy? a) Oxytocin b) Methotrexate c) Promethazine d) Ondansetron
Methotrexate Correct Explanation: Methotrexate, a folic acid antagonist that inhibits cell division in the developing embryo, is most commonly used to treat ectopic pregnancy. Oxytocin is used to stimulate uterine contractions and would be inappropriate for use with an ectopic pregnancy. Promethazine and ondansetron are antiemetics that may be used to treat 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 of the following conditions? a) Severe pre-eclampsia b) Gestational hypertension c) Eclampsia d) Mild pre-eclampsia
Mild pre-eclampsia Correct Explanation: A woman is said to have gestational hypertension when she develops an elevated blood pressure (140/90 mm Hg) but has no proteinuria or edema. If a seizure from gestational hypertension occurs, a woman has eclampsia, but any status above gestational hypertension and below a point of seizures is pre-eclampsia. A woman is said to be mildly pre-eclamptic when she has proteinuria and a blood pressure rise to 140/90 mm Hg, taken on two occasions at least 6 hours apart. A woman has passed from mild to severe pre-eclampsia when her blood pressure rises to 160 mm Hg systolic and 110 mm Hg diastolic or above on at least two occasions 6 hours apart at bed rest (the position in which blood pressure is lowest) or her diastolic pressure is 30 mm Hg above her prepregnancy level. Marked proteinuria, 3+ or 4+ on a random urine sample or more than 5 g in a 24-hour sample, and extensive edema are also present. A woman has passed into eclampsia when cerebral edema is so acute a grand-mal seizure (tonic-clonic) or coma has occurred.
A pregnant client with severe pre-eclampsia has developed the HELLP syndrome. In addition to the observations necessary for pre-eclampsia, what other nursing intervention is critical for this patient? a) Administration of a tocolytic, if prescribed b) Monitoring for infection c) Maintaining a patent airway d) Observation for bleeding
Observation for bleeding Correct Explanation: Because of the low platelet count associated with this condition, women with the HELLP syndrome need extremely close observation for bleeding, in addition to the observations necessary for pre-eclampsia. Maintaining a patent airway is a critical intervention needed for a patient with eclampsia while she is having a seizure. Administration of a tocolytic would be appropriate for halting labor. Monitoring for infection is not a priority intervention in this situation.
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? a) Obtain a voided urine specimen and determine blood type. b) Palpate the fundus and check fetal heart rate. c) Measure fundal height. d) Check deep tendon reflexes.
Palpate the fundus and check fetal heart rate. Correct Explanation: The classic signs of abruption placentea are pain, dark red vaginal bleeding, a rigid, board-like abdomen, hypertonic labor, and fetal distress.
A pregnant woman with preeclampsia is to receive magnesium sulfate IV. Which of the following assessments would be most important prior to administering a new dose? a) Blood pressure b) Anxiety level c) Patellar reflex d) Pulse rate
Patellar reflex Correct Explanation: A symptom of magnesium sulfate toxicity is loss of deep tendon reflexes. Assessing for one of these before administration is assurance the drug administration will be safe.
A woman in week 35 of her pregnancy with severe hydramnios is admitted to the hospital. The nurse recognizes that which of the following is the biggest concern regarding this client? a) Development of eclampsia b) Development of gestational trophoblastic disease c) Preterm rupture of membranes followed by preterm birth d) Hemorrhaging
Preterm rupture of membranes followed by preterm birth Correct Explanation: Even with precautions, in most instances of hydramnios, there will be preterm rupture of the membranes because of excessive pressure, followed by preterm birth. The other answers are not as big of concerns as preterm birth, in this situation.
You are caring for a patient with preeclampsia. You know that you need to auscultate this patient's lung sounds every two hours. Why would you do this? a) Pulmonary edema b) Pulmonary emboli c) Pulmonary atelectasis d) Pulmonary hypertension
Pulmonary edema Correct Explanation: In the hospital, monitor blood pressure at least every four hours for mild preeclampsia and more frequently for severe disease. In addition, it is important to auscultate the lungs every two hours. Adventitious sounds may indicate, developing pulmonary edema
When assessing a woman with an ectopic pregnancy, which of the following would lead the nurse to suspect that the tube has ruptured? a) Referred shoulder pain b) Vaginal spotting c) Nausea d) Breast tenderness
Referred shoulder pain Correct Explanation: Referred pain to the shoulder area indicates bleeding into the abdomen caused by phrenic nerve irritation when a tubal pregnancy ruptures. Vaginal spotting, nausea, and breast tenderness are typical findings of early pregnancy and an unruptured ectopic pregnancy.
The following hourly assessments are obtained by the nurse on a patient with preeclampsia receiving Magnesium Sulfate: 97.3, P88, R10, blood pressure 148/110. What other priority physical assessment by the nurse should be implemented to assess for potential toxicity? a) Reflexes b) Lung sounds c) Oxygen saturation d) Magnesium sulfate level
Reflexes Correct Explanation: Reflex assessment is part of the standard assessment for patients on magnesium sulfate. The first change when developing magnesium toxicity may be a decrease in reflex activity. The health care provider needs to be notified immediately. A change in lung sounds and oxygen saturation are not indicative of magnesium sulfate toxicity. Hourly blood draws to gain information on the magnesium sulfate level are not indicated.
Which measure would be most effective in preventing isoimmunization during pregnancy? a) Amniocentesis b) RhoGAM administration to Rh-negative women c) Cerclage d) Blood typing of mothers with type A or B blood
RhoGAM administration to Rh-negative women Correct Explanation: Rh incompatibility can be prevented with the use of RhoGAM. Hemolysis associated with ABO incompatibility is limited to mothers with type O blood and their fetuses with type A or B blood. Amniocentesis would be appropriate for treatment of polyhydramnios, not isoimmunization. Cerclage is a treatment for cervical insufficiency.
A woman in labor is at risk for abruptio placentae. Which of the following assessments would most likely lead you to suspect that this has happened? a) An increased blood pressure and oliguria. b) Sharp fundal pain and discomfort between contractions. c) Painless vaginal bleeding and a fall in blood pressure. d) Pain in a lower quadrant and increased pulse rate.
Sharp fundal pain and discomfort between contractions. Correct Explanation: An abruptio placentae refers to premature separation of the placenta from the uterus. As the placenta loosens, it causes sharp pain. Labor begins with a continuing nagging sensation. Painless vaginal bleeding and a fall in blood pressure are indicative of placenta previa. Pain in a lower quadrant and increased pulse rate are indicative of an ectopic pregnancy. Hypertension and oliguria are indicative of preeclampsia.
When assessing a pregnant woman with vaginal bleeding, which finding would lead the nurse to suspect an inevitable abortion? a) Closed cervical os b) Strong abdominal cramping c) Slight vaginal bleeding d) No passage of fetal tissue
Strong abdominal cramping Correct Explanation: Strong abdominal cramping is associated with an inevitable abortion. Slight vaginal bleeding early in pregnancy and a closed cervical os are associated with a threatened abortion. With an inevitable abortion, passage of the products of conception may occur. No fetal tissue is passed with a threatened abortion.
A young woman presents at the emergency department with complaints of lower abdominal cramping and spotting at 12 weeks' gestation. The physician performs a pelvic examination and finds that the cervix is closed. What does the physician suspect is the cause of the cramps and spotting? a) Habitual abortion b) Threatened abortion c) Ectopic pregnancy d) Cervical insufficiency
Threatened abortion Correct Explanation: Spontaneous abortion occurs along a continuum: threatened, inevitable, incomplete, complete, missed. The definition of each category is related to whether or not the uterus is emptied, or for how long the products of conception are retained.
Vaginal bleeding during pregnancy is always a deviation from the normal. a) True b) False
True Correct Explanation: Vaginal bleeding during pregnancy is always a deviation from the normal, is always potentially serious, may occur at any point during pregnancy, and is always frightening. It must always be carefully investigated because it can impair both the outcome of the pregnancy and the woman's life or health. (less)
A young mother delivers twin boys who shared the same placenta. What serious complication are they at risk for? a) HELLP syndrome b) ABO incompatability c) TORCH syndrome d) Twin-to-twin transfusion syndrome (TTTS)
Twin-to-twin transfusion syndrome (TTTS) Correct Explanation: When twins share a placenta, a serious condition called twin-to-twin transfusion syndrome (TTTS) can occur.
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? a) "It is hard to know why a woman bleeds during early pregnancy." b) "Something was wrong with the fetus." c) "I can understand your need to find an answer to what caused this. Let's talk about this further." d) "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." Correct Explanation: Talking with the client may assist her to explore her feelings. She and her family may search for a cause for a spontaneous early bleeding so they can plan for future pregnancies. Even with modern technology and medical advances, however, a direct cause cannot usually be determined.
Select the statement by the pregnant woman that indicates the need for more teaching about preeclampsia. a) "I will weigh myself every morning after voiding before breakfast." b) "If I have changes in my vision, I will lie down and rest." c) "If I have a slight headache I'll take Tylenol and call if unrelieved." d) "I will count my baby's movements twice a day."
"If I have changes in my vision, I will lie down and rest." Correct Explanation: Changes in the visual field may indicate the patient has moved from preeclampsia to severe preeclampisa and is at risk for developing a seizure due to changes in cerebral blood flow. The patient would require immediate assessment and intervention. Options B, C, and D would not indicate that more teaching about preeclampsia is indicated.
You are caring for a young woman who is in her 10th week of gestation. She comes into the clinic complaining of vaginal bleeding. Which assessment finding best correlates with a diagnosis of hydatidiform mole? a) Brisk deep tendon reflexes and shoulder pain b) Painful uterine contractions and nausea c) Bright red painless vaginal bleeding d) Dark red, "clumpy" vaginal discharge
Dark red, "clumpy" vaginal discharge Explanation: If a complete molar pregnancy continues into the second trimester undetected, other signs and symptoms appear. The woman often presents with complaints of dark to bright red vaginal bleeding and pelvic pain. Infrequently, she will report passage of grapelike vesicles.
Which of the following nursing diagnoses would be most appropriate for a woman diagnosed with pregnancy-induced hypertension? a) Deficient fluid volume related to vasospasm of arteries b) Risk for injury related to fetal distress c) Ineffective tissue perfusion related to poor heart contraction d) Imbalanced nutrition related to decreased sodium levels
Deficient fluid volume related to vasospasm of arteries Correct Explanation: Hypertension of pregnancy is caused by vascular spasm. This leads to increased blood pressure and edema. Extensive edema leads to a deficiency of fluid volume.
When administering magnesium sulfate to a woman with severe preeclampsia, which finding would alert the nurse to the development of magnesium toxicity? a) Diminished reflexes b) Seizures c) Elevated liver enzymes d) Serum magnesium level of 6.5 mEq/L
Diminished reflexes Correct Explanation: Diminished or absent reflexes occur when a client develops magnesium toxicity. Elevated liver enzymes are unrelated to magnesium toxicity and may indicate the development of HELLP syndrome. The onset of seizure activity indicates eclampsia. A serum magnesium level of 6.5 mEq/L would fall within the therapeutic range of 4 to 7 mEq/L.
A pregnant woman is diagnosed with abruptio placentae. When reviewing the woman's medical record, which of the following would the nurse expect to find? a) Fetal heart rate within normal range b) Absence of pain c) Firm, rigid uterus on palpation d) Bright red vaginal bleeding
Firm, rigid uterus on palpation Correct Explanation: The uterus is firm to rigid to the touch with abruptio placentae; it is soft and relaxed with placenta previa. Bleeding associated with abruptio placentae occurs suddenly and is usually dark in color. Bleeding also may not be visible. Bright red vaginal bleeding is associated with placenta previa. Fetal distress or absent fetal heart rate may be noted with abruptio placentae. The woman with abruptio placentae usually experiences constant uterine tenderness on palpation.
A woman is admitted with a diagnosis of ectopic pregnancy. For which of the following would you anticipate beginning preparation? a) Immediate surgery b) Internal uterine monitoring c) Bed rest for the next 4 weeks d) Intravenous administration of a tocolytic
Immediate surgery Correct Explanation: Ectopic pregnancy means an embryo has implanted outside the uterus, usually in the fallopian tube. Surgery is usually necessary to remove the growing structure before the tube ruptures or to repair the tube if rupture has occurred already.
Which of the following would the nurse include in the plan of care for a woman with premature rupture of membranes if her fetus's lungs are mature? a) Observation for signs of infection b) Labor induction c) Reduction in physical activity level d) Administration of corticosteroids
Labor induction Correct Explanation: With premature rupture of membranes in a woman whose fetus has mature lungs, induction of labor is initiated. Reducing physical activity, observing for signs of infection, and giving corticosteroids may be used for the woman with PROM when the fetal lungs are immature.
A pregnant client has been admitted with complaints 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 of the following? a) Placenta previa b) Ectopic pregnancy c) Molar pregnancy d) Abruption of placenta
Molar pregnancy Correct Explanation: The client is most likely experiencing molar pregnancy. In molar pregnancy, there is an abnormal proliferation and eventual degeneration of the trophoblastic villi. The signs and symptoms of molar pregnancy include brownish vaginal bleeding, elevated hCG levels, discrepancy between the uterine size and the gestational age, and absent fetal heart sounds. Abruption of placenta is characterized by premature separation of the placenta. Ectopic pregnancy is a condition where there is implantation of the blastocyst outside the uterus. In placenta previa the placental attachment is at the lower uterine segment.
A woman in labor has sharp fundal pain accompanied by slight vaginal bleeding. Which of the following would be the most likely cause of these symptoms? a) Premature separation of the placenta b) Preterm labor that was undiagnosed c) Possible fetal death or injury d) Placenta previa obstructing the cervix
Premature separation of the placenta Correct Explanation: Premature separation of the placenta begins with sharp fundal pain, usually followed by vaginal bleeding. Placenta previa usually produces painless bleeding; labor contractions are more often described as cramping.
A woman develops HELLP syndrome. During labor, which of the following orders would you question? a) Prepare her for epidural anesthesia. b) Assess her blood pressure every 15 minutes. c) Assess the urine output every hour. d) Urge her to lie on her left side during labor.
Prepare her for epidural anesthesia. Correct Explanation: A consequence of the HELLP syndrome is poor blood coagulation. Epidural anesthesia is not recommended when blood coagulation is in doubt.
A patient is admitted to labor and delivery for management of severe preeclampsia. An IV infusion of magnesium sulfate is started. What is the primary goal for magnesium sulfate therapy? a) Decrease blood pressure b) Reverse edema c) Decrease protein in urine d) Prevent maternal seizures
Prevent maternal seizures Correct Explanation: The primary therapy goal for any preeclamptic patient is to prevent maternal seizures. Use of magnesium sulfate is the drug therapy of choice for severe preeclampsia and is only used to manage and attempt to prevent progression to eclampsia. Magnesium sulfate therapy does not have as its primary goal a decrease in blood pressure, a decrease in protein in the urine, nor the reversal of edema.
What makes the diagnosis of gestational hypertension different from the diagnosis of preeclampsia? a) Ketonuria b) The hypertension of gestation disappears after delivery. The hypertension of preeclampsia does not. c) Severity of hypertension d) Proteinuria
Proteinuria Correct Explanation: Gestational hypertension is the current term used to describe elevated blood pressure (greater than or equal to 140/90 mm/Hg) that develops for the first time during pregnancy without the presence of protein in the urine.
A patient with preeclampsia is receiving magnesium sulfate. Which of the following nursing assessments should be ongoing while the medication is being administered? a) Ability to sleep. b) Urine protein. c) Hemoglobin. d) Respiratory rate.
Respiratory rate. Correct Explanation: The level of magnesium in therapeutic range is 4 to 8 mg/dL. If magnesium toxicity occurs, one sign in the patient will be a decrease in the respiratory rate and a potential respiratory arrest. Respiratory rate will be monitored when on this medication. The patient's hemoglobin and ability to sleep are not factors for on-going assessments for the patient on magnesium sulfate. Urinary output is measured hourly on the preeclamptic patient receiving magnesium sulfate, but urine protein is not an ongoing assessment.
Sometimes an ectopic pregnancy occurs outside the woman's uterus. This usually occurs in one of the fallopian tubes. If the embryo continues to grow, it may rupture the tube. What are the signs and symptoms of a ruptured fallopian tube? a) Rectal pain b) Unilateral abdominal pain c) Shoulder pain d) Bilateral abdominal pain
Shoulder pain Explanation: Rarely, a woman may present with late signs, such as shoulder pain or hypovolemic shock. These signs are associated with tubal rupture, which occurs when the pregnancy expands beyond the tube's ability to stretch.
A 45-year-old pregnant woman with type O blood has had an amniocentesis to rule out Down syndrome. The fetus has type AB blood. What can the nurse warn the patient is a likely outcome if some fetal blood mixed with maternal blood during the procedure? a) Preterm delivery b) The baby will have postdelivery jaundice. c) The baby will develop hemolytic anemia. d) Placental abruption
The baby will have postdelivery jaundice. Correct Explanation: The infant and mother have ABO incompatibility. The result is a development of antibodies and breaking down of the blood resulting in jaundice in the infant after delivery. The mixing of some fetal blood with maternal blood during the amniocentesis would not cause placental abruption or preterm delivery. Hemolytic anemia is caused by Rh incompatibility, not ABO incompatibility.
A woman and her partner present at her first antenatal obstetrics appointment. She is 6 weeks pregnant. Her blood tests show that she is Rh negative although she has not previously known this. She has no other children but suspects that she miscarried early in a pregnancy 2 years previously. She felt fine afterward so she never received medical attention for that suspected episode. Her partner reports that he is also Rh negative. What action will the nurse be likely to take? a) If an antibody screen is negative, the nurse will administer RhoGam to the patient. b) If an antibody screen is positive, the nurse will administer RhoGam to the patient. c) The nurse will perform all normal procedures and follow-up tasks because the Rh status of the patient and the child are not a concern at this time. d) The nurse will arrange for an amniocentesis to assess hemolytic disease in the fetus.
The nurse will perform all normal procedures and follow-up tasks because the Rh status of the patient and the child are not a concern at this time. Correct Explanation: If the woman is Rh negative and her partner is Rh negative the fetus will also be Rh negative and the woman will not require treatment with RhoGam. Therefore options A, B, and C are incorrect.
A woman at 8 weeks' gestation is admitted for ectopic pregnancy. She is asking why this has occurred. The nurse knows that which of the following is a known risk factor for ectopic pregnancy? a) High number of pregnancies b) Use of IUD for contraception c) Use of oral contraceptives d) Multiple gestation pregnancy
Use of IUD for contraception Correct Explanation: Use of an IUD with progesterone has a known increased risk for development of ectopic pregnancies. The nurse needs to complete a full history of the patient to determine if she had any other risk factors for an ectopic pregnancy. Adhesions, scarring, and narrowing of the tubal lumen may block the zygote's progress to the uterus. Any condition or surgical procedure that can injure a fallopian tube increases the risk. Examples include salpingitis, infection of the fallopian tube, endometriosis, history of prior ectopic pregnancy, any type of tubal surgery, congenital malformation of the tube, and multiple elective abortions. Conditions that inhibit peristalsis of the tube can result in tubal pregnancy. Hormonal factors may play a role because tubal pregnancy occurs more frequently in women who take fertility drugs or who use progesterone intrauterine contraceptive devices (IUDs). A high number of pregnancies, multiple gestation pregnancy, and the use of oral contraceptives are not known risk factors for ectopic pregnancy.
A woman who is Rh negative asks you how many children she will be able to have before Rh incompatibility causes them to die in utero. Your best response would be that a) only her next child will be affected. b) she will have to ask her physician. c) as long as she receives RhIG, there is no limit. d) no more than three children is recommended.
as long as she receives RhIG, there is no limit. Correct Explanation: Because RhIG supplies passive antibodies, it prevents the woman from forming antibodies. Without antibodies that could affect the fetus, the woman could have as many children as she wants.
A woman you care for has an Rh-negative blood type. Following the birth of her infant, you administer her RhIG (D immune globulin). The purpose of this is to a) prevent fetal Rh blood formation. b) prevent maternal D antibody formation. c) promote maternal D antibody formation. d) stimulate maternal D immune antigens.
prevent maternal D antibody formation. Correct Explanation: Because RhIG contains passive antibodies, the solution will prevent the woman from forming long-lasting antibodies.
A client reports to her obstetrician complaining of a significant amount of bright red, painless vaginal bleeding. A sonogram reveals that her placenta has implanted low in the uterus and is partially covering the cervical os. Which of the following immediate care measures should the nurse initiate? (Select all that apply.) a) Perform a pelvic examination b) Attach external monitoring equipment to record fetal heart sounds c) Determine from the client the time the bleeding began and about how much blood has been lost d) Obtain baseline vital signs e) Continue to assess blood pressure every 5 to 15 minutes f) Place the woman on bed rest in a side-lying position
• Attach external monitoring equipment to record fetal heart sounds • Determine from the client the time the bleeding began and about how much blood has been lost • Obtain baseline vital signs • Continue to assess blood pressure every 5 to 15 minutes • Place the woman on bed rest in a side-lying position Correct Explanation: With the exception of performing a pelvic examination, all of the answers are appropriate immediate care measures for the client with placenta previa. Never attempt a pelvic or rectal examination with painless bleeding late in pregnancy because any agitation of the cervix when there is a placenta previa might tear the placenta further and initiate massive hemorrhage, possibly fatal to both mother and child.
A client visits a health care facility with complaints of amenorrhea for 10 weeks, fatigue, and breast tenderness. Which of the following additional signs and symptoms suggest the presence of molar pregnancy? Select all that apply. a) Elevated hCG levels b) Dyspareunia c) Absence of fetal heart sound d) Hyperemesis gravidarum e) Whitish discharge from the vagina
• Elevated hCG levels • Absence of fetal heart sound • Hyperemesis gravidarum Correct Explanation: The signs and symptoms of molar pregnancy include an elevated hCG level, absence of fetal heart sounds, and hyperemesis gravidarum. Whitish discharge from the vagina and dyspareunia (painful sexual intercourse) are seen in cases of infection, and not in molar pregnancy. In molar pregnancy a brownish vaginal bleeding is seen.
A client in her 20th week of gestation develops HELLP syndrome. Which of the following should the nurse consider as features of HELLP syndrome? Select all that apply. a) Elevated liver enzymes b) Hemolysis c) Low platelet count d) Leukocytosis e) Hyperthermia
• Elevated liver enzymes • Hemolysis • Low platelet count Correct Explanation: The HELLP syndrome is a syndrome involving hemolysis (microangiopathic hemolytic anemia), elevated liver enzymes, and a low platelet count. Hyperthermia and leukocytosis are not features of HELLP syndrome.