OB EAQ
A primigravida is admitted to the emergency department with a sharp, shooting pain in the lower abdomen and vaginal spotting. A ruptured tubal pregnancy is diagnosed. During what week of gestation does this condition most commonly occur? 1 6th 2 12th 3 16th 4 18th
1 6th In the sixth week the fallopian tube can no longer expand to accommodate the size of the growing embryo. A tubal pregnancy cannot advance to the 12th, 16th, or 18th week because the tube cannot expand to accommodate the growing fetus.
In what disorder is stimulation of labor contraindicated? 1 Diabetes mellitus 2 Mild preeclampsia 3 Total placenta previa 4 Premature rupture of the membranes
3 Total placenta previa A total placenta previa requires a cesarean birth ; early intervention helps ensure a healthy neonate and mother. Diabetes mellitus and mild preeclampsia are both complications that may necessitate early birth to ensure a healthy neonate and mother. Induction of labor is indicated if the fetus is at term because prolonged rupture of membranes can lead to maternal and/or fetal sepsis.
A woman is being seen in the prenatal clinic at 36 weeks' gestation. The nurse is reviewing signs and symptoms that should be reported to health care provider with the mother. Which signs and symptoms require further evaluation by the health care provider? (Select all that apply.) 1 Decreased urine output 2 Blurred vision with spots 3 Urinary frequency without dysuria 4 Heartburn after eating a fatty meal 5 Contractions that are regular and 5 minutes apart 6 Shortness of breath after climbing a flight of stairs
1 Decreased urine output 2 Blurred vision with spots 5 Contractions that are regular and 5 minutes apart Decreased urine output, blurred vision, and severe headache may occur with pregnancy-associated hypertension. Contractions that become regular are associated with the onset of labor. Preparatory (Braxton Hicks) contractions ease when the client walks. Swelling of the face and hands is a warning sign. Urinary frequency occurs in the first trimester and again in the third trimester as the uterus settles back into the pelvis. The weight of the uterus may delay emptying of the stomach and make heartburn a more frequent problem. Shortness of breath would be expected after the client climbs a flight of stairs.
nurse on the postpartum unit is assessing several clients. Which clinical finding requires immediate investigation? 1 An inflamed episiotomy 2 A slow trickle of blood from the vagina 3 An estimated blood loss of half a liter during a vaginal birth 4 A boggy uterine fundus that becomes firm after prolonged massage
2 A slow trickle of blood from the vagina Vaginal bleeding may be an early sign of hemorrhage; hypovolemic shock can develop. An inflamed episiotomy is an expected finding; ice packs help resolve the inflammation. Expected blood loss for a vaginal birth is 300 to 500 mL. A fundus that has been overstretched or is multiparous may require prolonged massage until it becomes firm.
A client at 6 weeks' gestation who has type 1 diabetes is attending the prenatal clinic for the first time. The nurse explains that during the first trimester insulin requirements may decrease because: 1 Body metabolism is sluggish in the first trimester. 2 Morning sickness may lead to decreased food intake. 3 Fetal requirements of glucose in this period are minimal. 4 Hormones of pregnancy increase the body's need for insulin.
2 Morning sickness may lead to decreased food intake. Morning sickness , a common occurrence during pregnancy, contributes to decreased food intake; the insulin dosage must be reduced to prevent hypoglycemia. The body's metabolism increases during pregnancy because the needs of the fetus, as well as those of the mother, must be met. Rapid organogenesis requires large amounts of glucose. During the first trimester the blood glucose level is reduced and glycemic control is enhanced; glycemic control is more difficult to maintain later in the pregnancy.
A primigravida with type 1 diabetes is having her first prenatal visit. While discussing changes in insulin needs during pregnancy and after birth, the nurse explains that in light of the client's blood glucose readings she should expect to increase her insulin dosage. Between which weeks of gestation is this expected to occur? 1 10th and 12th weeks of gestation 2 18th and 22nd weeks of gestation 3 24th and 28th weeks of gestation 4 36th and 40th weeks of gestation
3 24th and 28th weeks of gestation At the end of the second trimester and the beginning of the third trimester, insulin needs increase because of an increase in maternal resistance to insulin. During the earlier part of pregnancy, fetal demands for maternal glucose may cause a tendency toward hypoglycemia. During the last weeks of pregnancy, maternal resistance to insulin decreases and insulin needs decrease accordingly.
A client who is in labor is admitted 30 hours after her membranes ruptured. For what condition does the nurse anticipate that the client is most at risk? 1 Cord prolapse 2 Placenta previa 3 Chorioamnionitis 4 Abruptio placentae
3 Chorioamnionitis The risk of developing chorioamnionitis (intra-amniotic infection) is increased with prolonged rupture of the membranes; foul-smelling fluid is a sign of infection. A prolapsed cord usually occurs shortly after the membranes rupture, not 1½ days later. Placenta previa is an abnormally implanted placenta; it is unrelated to ruptured membranes. Premature separation of the placenta is unrelated to ruptured membranes.
A client with severe preeclampsia is receiving an IV infusion of magnesium sulfate. The nurse remembers that magnesium sulfate is a: 1 Hypotensive that relaxes smooth muscles 2 Cholinergic that increases the release of acetylcholine 3 Muscle relaxant that decreases the severity of uterine contractions 4 Central nervous system depressant that blocks neuromuscular transmissions
4 Central nervous system depressant that blocks neuromuscular transmissions Eclamptic seizures may be prevented with the administration of IV magnesium sulfate, which is a central nervous system depressant. Although magnesium sulfate is a neuromuscular sedative that relaxes smooth muscle and decreases blood pressure, it is not considered an antihypertensive and is not given for that purpose. Magnesium sulfate decreases, not increases, the quantity of acetylcholine. Decreased uterine contractions are not associated with magnesium sulfate administration.
A nurse is caring for a client with type 1 diabetes on her first postpartum day. When planning care for this client, what changes in the client's insulin requirements does the nurse expect? 1 Slowly decrease 2 Quickly increase 3 Suddenly decrease 4 Usually remain unchanged
Correct3 Suddenly decrease Insulin requirements may decrease suddenly, not decrease slowly or increase, during the first 24 to 48 postpartum hours, because the endocrine changes of pregnancy are reversed. Insulin requirements do not usually remain unchanged in the postpartum period.
At 37 weeks' gestation a client's membranes spontaneously rupture but she does not have contractions. What action is most important in the nursing plan of care for this client? 1 Monitoring for the presence of fever 2 Monitoring for signs of preeclampsia 3 Monitoring for heavy vaginal bleeding 4 Making preparations for fetal scalp pH sampling
Correct1 Monitoring for the presence of fever The possibility of an ascending infection increases when membranes have ruptured and birth is not imminent; the client must be monitored for signs of infection. Preeclampsia is unrelated to spontaneous rupture of the membranes. Heavy vaginal bleeding is a sign of placenta previa, which is generally diagnosed before membranes rupture. Fetal scalp pH sampling is not indicated with spontaneous rupture of membranes; it is indicated if persistent late decelerations are noted on the fetal monitor during labor.
What are the primary nursing interventions when a client is receiving an infusion of magnesium sulfate for severe preeclampsia? (Select all that apply.) 1 Restricting visitors 2 Limiting fluid intake 3 Preparing for a precipitate birth 4 Maintaining a quiet environment 5 Keeping magnesium gluconate at the bedside
Correct 1 Restricting visitors Correct 4 Maintaining a quiet environment Visitors should be limited to significant others to reduce excessive stimuli that could precipitate a seizure . A quiet room helps reduce stimuli and therefore the risk of seizures. Fluid intake should not be restricted. A precipitous birth is not a usual side effect of magnesium sulfate therapy. Calcium gluconate, not magnesium gluconate, is the antagonist for magnesium sulfate and should be readily available if signs of toxicity appear.
A client is admitted to the birthing suite with a blood pressure of 150/90 mm Hg, 3+ proteinuria, and edema of the hands and face. A diagnosis of severe preeclampsia is made. What other clinical findings support this diagnosis? (Select all that apply.) 1 Headache 2 Constipation 3 Abdominal pain 4 Vaginal bleeding 5 Visual disturbances
1 Headache 3 Abdominal pain 5 Visual disturbances Headache in severe preeclampsia is related to cerebral edema. Abdominal pain in severe preeclampsia is related to decreased circulating blood volume and generalized edema. Visual disturbances in severe preeclampsia are related to retinal edema. Constipation is not related to preeclampsia; nor is vaginal bleeding.
