Ob test 2

A nurse is preparing to dismiss a woman and her infant from the hospital. The woman is Rh(D)-negative and the infant is Rh(D)-positive. This was her first pregnancy. Which nursing action is most appropriate? A. Administer Rho(D) immune globulin (RhoGAM) and document accurately. B. Assess the father to see if he has ever received an injection of RhoGAM. C. Educate the woman on the need for RhoGAM if she delivers an Rh(D)-negative baby. D. Instruct the woman to get RhoGAM with her next pregnancy, not for this one.

A

A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse? a. Blood pressure (BP) increase to 138/86 mm Hg b. Weight gain of 0.5 kg during the past 2 weeks c. A dipstick value of 3+ for protein in her urine d. Pitting pedal edema at the end of the day

A

Spontaneous termination of a pregnancy is considered to be an abortion if: a. The pregnancy is less than 20 weeks. b. The fetus weighs less than 1000 g. c. The products of conception are passed intact. d. No evidence exists of intrauterine infection.

A

The priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy is to: a. Assess fetal heart rate (FHR) and maternal vital signs b. Perform a venipuncture for hemoglobin and hematocrit levels c. Place clean disposable pads to collect any drainage d. Monitor uterine contractions

A

What is the usual cause of hemolysis of fetal erythrocytes during pregnancy? a. The mother's blood is Rh negative and the fetus is Rh positive. b. The parents differ in blood type. c. The mother receives Rh immunoglobulin early in the second pregnancy. d. Fetal antibodies enter the maternal circulation.

ANS: A

The patient who is 28 weeks pregnant presents with consistent hypertension. The home health nurse would give priority to the need for: a. Activity restriction b. Balanced nutrition c. Increased fluid intake to ensure adequate hydration d. Instruction about the effect of diuretics

ANS: A Bed rest reduces the flow of blood to skeletal muscles, making more blood available to the placenta and enhancing fetal oxygenation.

The nurse explains that the objective of magnesium sulfate therapy for the patient with preeclampsia is to: a. Prevent convulsions b. Promote diaphoresis c. Increase reflex irritability d. Act as a saline cathartic

ANS: A Magnesium sulfate is a central nervous system depressant given to prevent seizures.

Rh incompatibility occurs in which of the following situations: a. Rh-negative mother, Rh-positive fetus b. Rh-positive mother, Rh-negative fetus c. Rh-negative mother, Rh-negative fetus d. Rh-positive mother, Rh-positive fetus

ANS: A Rh incompatibility can only occur if the mother is Rh-negative and the fetus is Rh-positive.

A nurse is providing prenatal education. The nurse will explain that pregnancy affects glucose metabolism in what way? a. Placental hormones increase the resistance of cells to insulin. b. Insulin cells cannot meet the body's demands as the woman's weight increases. c. There is a decreased production of insulin during pregnancy.d. The speed of insulin breakdown is decreased during pregnancy.

ANS: A Hormones and enzymes produced by the placenta increase the resistance of cells to insulin

A nurse is assessing a woman in the perinatal clinical with diagnosed cervical insufficiency. The woman is in her 18th week of a viable pregnancy. Which action by the nurse is most appropriate? A. Assist with obtaining informed consent for a cerclage. B. Draw blood to assess the maternal Rh status. C. Facilitate a transvaginal and abdominal ultrasound. D. Refer the woman to a perinatal grief specialist.

ANS: ABecause the woman has diagnosed cervical insufficiency, a cerclage is appropriate therapy. This purse-string suture closes the cervix so the uterus can contain the pregnancy.

An abortion in which the fetus dies but is retained within the uterus is called a(n): a. Inevitable abortion c. Incomplete abortion b. Missed abortion d. Threatened abortion

ANS: B Missed abortion refers to retention of a dead fetus in the uterus. An inevitable abortion means that the cervix is dilating with the contractions. An incomplete abortion means that not all of the products of conception were expelled. With a threatened abortion the woman has cramping and bleeding but not cervical dilation.

A woman who is 9 weeks pregnant is experiencing heavy bleeding and cramping. She reports passing some tissue. Cervical dilation is noted on examination. This woman most likely had: a. An inevitable abortion b. An incomplete abortion c. A complete abortion d. A missed abortion

ANS: B Signs and symptoms of an incomplete abortion are similar to those of an inevitable abortion, but some tissue is passed.

A 26-year-old pregnant woman, gravida 2, para 1-0-0-1 is 28 weeks pregnant when she experiences bright red, painless vaginal bleeding. On her arrival at the hospital, what would be an expected diagnostic procedure? a. Amniocentesis for fetal lung maturity b. Ultrasound for placental location c. Contraction stress test (CST) d. Internal fetal monitoring

ANS: B The presence of painless bleeding should always alert the health care team to the possibility of placenta previa. This can be confirmed through ultrasonography. Amniocentesis would not be performed on a woman who is experiencing bleeding. In the event of an imminent delivery, the fetus would be presumed to have immature lungs at this gestational age, and the mother would be given corticosteroids to aid in fetal lung maturity. A CST would not be performed at a preterm gestational age. Furthermore, bleeding would be a contraindication to this test. Internal fetal monitoring would be contraindicated in the presence of bleeding.

The perinatal nurse is giving discharge instructions to a woman after suction curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. The best response from the nurse would be: a. "If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if you desire a future pregnancy, it would be better for you to use the most reliable method of contraception available." b. "The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, it would make the diagnosis of this cancer more difficult." c. "If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy is rare. Therefore, to improve your chance of a successful pregnancy, it is better not to get pregnant at this time." d. "Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pregnancy."

ANS: B This is an accurate statement. b-Human chorionic gonadotropin (hCG) levels will be drawn for 1 year to ensure that the mole is completely gone. There is an increased chance of developing choriocarcinoma after the development of a hydatidiform mole. The goal is to achieve a "zero" hCG level. If the woman were to become pregnant, it could obscure the presence of the potentially carcinogenic cells. Women should be instructed to use birth control for 1 year after treatment for a hydatidiform mole. The rationale for avoiding pregnancy for 1 year is to ensure that carcinogenic cells are not present. Any contraceptive method except an intrauterine device is acceptable.

A laboring woman with no known risk factors suddenly experiences spontaneous rupture of membranes (ROM). The fluid consists of bright red blood. Her contractions are consistent with her current stage of labor. There is no change in uterine resting tone. The fetal heart rate begins to decline rapidly after the ROM. The nurse should suspect the possibility of: a. Placenta previa. b. Vasa previa. c. Severe abruptio placentae. d. Disseminated intravascular coagulation (DIC).

ANS: B Vasa previa is the result of a velamentous insertion of the umbilical cord. The umbilical vessels are not surrounded by Wharton jelly and have no supportive tissue. They are at risk for laceration at any time, but laceration occurs most frequently during ROM. The sudden appearance of bright red blood at the time of ROM and a sudden change in the fetal heart rate without other known risk factors should immediately alert the nurse to the possibility of vasa previa. The presence of placenta previa most likely would be ascertained before labor and would be considered a risk factor for this pregnancy. In addition, if the woman had a placenta previa, it is unlikely that she would be allowed to pursue labor and a vaginal birth. With the presence of severe abruptio placentae, the uterine tonicity would typically be tetanus (i.e., a boardlike uterus). DIC is a pathologic form of diffuse clotting that consumes large amounts of clotting factors and causes widespread external bleeding, internal bleeding, or both. DIC is always a secondary diagnosis, often associated with obstetric risk factors such as HELLP syndrome. This woman did not have any prior risk factors.

A nurse is assessing a 52-year-old primigravida woman who presents complaining of moderate dark-brown vaginal bleeding. On physical exam, her uterus is large for dates. Which action by the nurse is most appropriate? A. Assess the woman's diet for folic acid intake. B. Facilitate an ultrasound examination. C. Instruct the woman on a fetal kick count. D. Prepare the woman for pelvic cultures.

ANS: BThe incidence of gestational trophoblastic disease (GTD), including hydatidiform mole, increases in women of advanced age (especially over 50). Dark-brown vaginal bleeding is one symptom of this condition, and the nurse should be cognizant of its possibility. Because hydatidiform mole is diagnosed with ultrasound, the nurse should facilitate this testing. A diet low in folic acid is a risk factor, but the nurse should delay assessing for risk factors until after he or she has facilitated the ultrasound. Because molar pregnancies are either associated with no fetus or one that is generally spontaneously aborted, instructing the woman on fetal kick counts is not appropriate. The patient does not need pelvic cultures for this condition.

A woman who is 35 weeks pregnant has a total placenta previa. She asks the nurse, "Will I be able to deliver vaginally?" The nurse should explain: a. "Yes, you can deliver vaginally until 36 weeks." b. "A vaginal delivery can be attempted, but if bleeding occurs, a cesarean section is done." c. "A cesarean section is performed when the mother has a total placenta previa." d. "There is no reason why you cannot have a vaginal delivery."

ANS: C A cesarean delivery is done for a partial or total placenta previa.

A primigravida in her first trimester is Rh-negative. To prevent anti-Rh antibodies from forming, this woman would receive: a. Rh immune globulin during labor b. Intrauterine transfusions with O-negative blood c. Rh immune globulin at 28 weeks and within 72 hours after the birth of an Rh-positive infant d. Rh immune globulin now and again in the last trimester

ANS: C An Rh-negative woman would receive Rh immune globulin at 28 weeks of gestation and within 72 hours after the birth of an Rh-positive infant or abortion.

The nurse would suspect abruptio placentae when the pregnant woman presents with: a. Painless vaginal bleeding b. Uterine irritability with contractions c. Vaginal bleeding and back pain d. Premature rupture of membranes

ANS: C Bleeding accompanied by abdominal or lower back pain is a typical manifestation of abruptio placentae.

The drug the nurse plans to have available for immediate IV administration whenever magnesium sulfate is administered to a maternity patient is: a. Ergonovine maleate (Ergotrate) b. Oxytocin c. Calcium gluconate d. Hydralazine (Apresoline)

ANS: C Calcium gluconate reverses the effects of magnesium sulfate and should be available for immediate use when a woman receives magnesium sulfate.

Methotrexate is recommended as part of the treatment plan for which obstetric complication? a. Complete hydatidiform mole c. Unruptured ectopic pregnancy b. Missed abortion d. Abruptio placentae

ANS: C Methotrexate is an effective, nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is unruptured and less than 4 cm in diameter. Methotrexate is not indicated or recommended as a treatment option for complete hydatidiform mole, missed abortion, and abruptio placentae

A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment the nurse finds the following vital signs: temperature 37.3° C, pulse rate 88 beats/min, respiratory rate 10 breaths/min, blood pressure (BP) 148/90 mm Hg, absent deep tendon reflexes, and no ankle clonus. The client complains, "I'm so thirsty and warm." The nurse: a. Calls for a stat magnesium sulfate level b. Administers oxygen c. Discontinues the magnesium sulfate infusion d. Prepares to administer hydralazine

ANS: C The client is displaying clinical signs and symptoms of magnesium toxicity. Magnesium should be discontinued immediately. Additionally, calcium gluconate, the antidote for magnesium, may be administered.

A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment the nurse finds the following vital signs: temperature of 37.3° C, pulse rate of 88 beats/min, respiratory rate of 10 breaths/min, blood pressure (BP) of 148/90 mm Hg, absent deep tendon reflexes, and no ankle clonus. The client complains, "I'm so thirsty and warm." The nurse: a. Calls for a stat magnesium sulfate level. b. Administers oxygen. c. Discontinues the magnesium sulfate infusion. d. Prepares to administer hydralazine.

ANS: C The client is displaying clinical signs and symptoms of magnesium toxicity. Magnesium should be discontinued immediately. In addition, calcium gluconate, the antidote for magnesium, may be administered. Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. Typically it is administered for a systolic BP greater than 160 mm Hg or a diastolic BP greater than 110 mm Hg.

What finding on a prenatal visit at 10 weeks could suggest a hydatidiform mole? a. Complaint of frequent mild nausea b. Blood pressure of 120/80 mm Hg c. Fundal height measurement of 18 cm d. History of bright red spotting for 1 day, weeks ago

ANS: C The uterus in a hydatidiform molar pregnancy is often larger than would be expected on the basis of the duration of the pregnancy. Nausea increases in a molar pregnancy because of the increased production of hCG. A woman with a molar pregnancy may have early-onset pregnancy-induced hypertension. In the patient's history, bleeding is normally described as brownish.

What is the likely cause of painless, bright red, vaginal bleeding during the last trimester? a. Ectopic pregnancy b. Abruptio placentae c. Disseminated intravascular coagulation (DIC) d. Placenta previa

ANS: D

Which of the following statements applies to eclampsia? a. Elevated blood pressure returns to normal after delivery. b. Kidney and liver function remain normal. c. It commonly develops with ectopic pregnancies. d. Blood pressure is very high and seizures may occur.

ANS: D

A placenta previa in which the placental edge just reaches the internal os is more commonly known as: a. Total c. Complete b. Partial d. Marginal

ANS: D A placenta previa that does not cover any part of the cervix is termed marginal. With a total placenta previa, the placenta completely covers the os. When the patient experiences a partial placenta previa, the lower border of the placenta is within 3 cm of the internal cervical os but does not completely cover the os. A complete placenta previa is termed total. The placenta completely covers the internal cervical os.

An ultrasound on a woman who is 32 weeks pregnant reveals the placenta implanted over the entire cervical os. The nurse understands that this condition is known as: a. Low-lying placenta b. Marginal placenta previa c. Partial placenta previa d. Total placenta previa

ANS: D A total placenta previa describes a condition in which the placenta completely covers the cervical opening.

A woman seeking prenatal care relates a history of macrosomic infants, two stillbirths, and polyhydramnios with each pregnancy. The nurse recognizes that these factors are highly suggestive of: a. Toxoplasmosis b. Abruptio placentae c. Hydatidiform mole d. Diabetes mellitus

ANS: D Large (macrosomic) infants over 9 pounds are linked to gestational diabetes.

A new nurse is caring for a woman previously diagnosed with preeclampsia who was admitted to the high-risk OB unit after suffering a seizure in the perinatal clinic. The new nurse is preparing to administer a dose of magnesium sulfate (Sulfamag). Which action by the nurse warrants intervention by the unit manager? A. Explains to the patient that her vital signs and EKG will be monitored frequently B. Piggybacks the Sulfamag into a main line using an infusion pump C. Places 10% calcium gluconate in a secure location in the patient's room D. Runs the Sulfamag as the main IV line through an infusion pump

ANS: D Magnesium sulfate should be infused on an infusion pump piggybacked into the main line, not as the primary IV line. The other actions are appropriate.

. A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on the knowledge that: a. Bed rest and analgesics are the recommended treatment. b. She will be unable to conceive in the future. c. A D&C will be performed to remove the products of conception. d. Hemorrhage is the major concern.

ANS: D Severe bleeding occurs if the fallopian tube ruptures. The recommended treatment is to remove the pregnancy before rupture in order to prevent hemorrhaging. If the tube must be removed, the woman's fertility will decrease; however, she will not be infertile.

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: a. Eclamptic seizure b. Rupture of the uterus c. Placenta previa d. Abruptio placentae

ANS: D Uterine tenderness in the presence of increasing tone may be the earliest finding of abruptio placentae. Women with preeclampsia are at increased risk for an abruption due to decreased placental perfusion.

A woman with placenta previa is being treated with expectant management. The woman and fetus are stable. The nurse is assessing the woman for possible discharge home. Which statement by the woman would suggest to the nurse that home care might be inappropriate? A) "My mother lives next door and can drive me here if necessary." B) "I have a toddler and preschooler at home who need my attention." C) "I know to call my health care provider right away if I start to bleed again." D) "I realize the importance of following the instructions for my care."

Ans: B Having a toddler and preschooler at home needing attention suggest that the woman would have difficulty maintaining bed rest at home. Therefore, expectant management at home may not be appropriate. Expectant management is appropriate if the mother and fetus are both stable, there is no active bleeding, the client has readily available access to reliable transportatio

It is determined that a client's blood Rh is negative and her partner's is positive. To help prevent Rh isoimmunization, when should the client receive RhoGAM? At 32 weeks' gestation and immediately before discharge 24 before delivery and 24 hours after delivery In the first trimester and within 2 hours of delivery At 28 weeks' gestation and again within 72 hours after delivery

Ans: D Response:To prevent isoimmunization, the woman should receive RhoGAM at 28 weeks and again within 72 hours after delivery.

A woman presents to the perinatal clinic with abdominal pain. She has missed one period and, following a transvaginal ultrasound, pregnancy is confirmed. However, implantation has occurred in the right fallopian tube. The ectopic mass is 3 cm and has not ruptured. The nurse prepares the patient for which therapy? A. Laparoscopic salpingostomy B. Methotrexate C. Partial salpingectomy D. Salpingectomy by laparotomy

B

A nurse is caring for a woman on a continuous IV of magnesium sulfate. Which actions are appropriate for patient safety? (Select all that apply.) A. Administer the bolus from the main bag, then change to the maintenance rate. B. Double-check each new bag and dose/rate change with another nurse. C. Ensure that a supply of romazicon (Flumazenil) is available in the patient's room. D. Perform handoff report at the bedside, verifying the dose and orders by both nurses. E. Place color-coded tags on each IV line, bag, and pump to label them clearly.

B, D, E Magnesium sulfate is a high-risk, high-alert drug and the nurse must be cautious about administering this drug safely. Some appropriate actions include double-checking any rate or dose changes with a second nurse, performing the handoff report at the bedside so that both nurses can verify the orders and compare them to the IV bag and pump rate, and color-coding IV lines, bags, and pumps for easy identification. The nurse should ensure that a supply of the antidote (calcium gluconate 10%) is available. However, romazicon is the antidote for benzodiazepine overdose. The nurse should use a small-volume IV piggyback for the bolus dose instead of using the main bag to give the bolus to the patient, and then change the infusion rate to the maintenance setting.

A 22-year-old woman presents to the emergency department with abdominal pain andvaginal bleeding. Her blood pressure is 90/58 mm Hg, her pulse is 120 beats/minute, and she complains of dizziness. Which action by the nurse takes priority? A. Assess the woman for sexually transmitted infections. B. Collect a urine sample for pregnancy testing. C. Obtain informed consent for a salpingectomy. D. Start two large-bore IVs for fluid replacement.

D

A patient on the high-risk OB unit is receiving magnesium sulfate. The nurse notes that her magnesium level is 14 mEq/L. Which of the following actions by the nurse is most appropriate? A. Bring the crash cart to the patient's room. B. Document the findings in the woman's chart. C. Order another blood level in 6 hours. D. Prepare to administer calcium gluconate.

D

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: a. Eclamptic seizure. c. Placenta previa. b. Rupture of the uterus. d. Placental abruption.

D

The young prenatal patient with gestational diabetes mellitus (GDM) says, "I am frightened that I will have to deal with insulin injections for the rest of my life." What is the best response by the nurse? a. "After delivery your doctor will prescribe oral hypoglycemic medication to control your disease. Pills are so much simpler than insulin injections." b. "Have you considered an insulin pump?" c. "After a while those insulin injections won't seem so bad." d. "It will most likely resolve 6 weeks or so after the baby is born."

D

nurse is caring for a patient who has been diagnosed with an incomplete molar pregnancy. Which action by the nurse is most appropriate? A. Advise the woman that she can try to get pregnant in 3 months. B. Arrange a consultation with a radiation oncology nurse. C. Facilitate screening for systemic lupus erythematosus (SLE). D. Give the patient information on perinatal loss support groups.

D

A patient with pregnancy-induced hypertension is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs are an indication of: a. Anxiety due to hospitalization. b. Worsening disease and impending convulsion. c. Effects of magnesium sulfate. d. Gastrointestinal upset.

b

A woman presents to the emergency department with complaints of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary care provider finds that the cervix is closed. The anticipated plan of care for this woman would be based on a probable diagnosis of which type of spontaneous abortion? a. Incomplete c. Threatened b. Inevitable d. Septic

c

The nurse assesses a pregnant woman for pregnancy-induced hypertension. What is the first sign of fluid retention suggestive of this complication? a. Abdominal enlargement b. Facial swelling c. Sudden weight gain d. Swelling of the feet and ankles

c

A nurse is teaching a woman pregnant in the second trimester who has been diagnosed with a partial placenta previa. Which information is most important to document? A. Patient and partner show no anxiety or helplessness and were given educational support material. B. Patient instructed that bleeding may occur as placenta totally covers the cervical os. C. Patient instructed to tell all health-care providers that vaginal exams are prohibited. D. Patient received information about placenta previa and understood it well.

c.

In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes that the most important factor affecting pregnancy outcome is the: a. Mother's age. b. Number of years since diabetes was diagnosed. c. Amount of insulin required prenatally. d. Degree of glycemic control during pregnancy.

d