Week 1: High Risk and Bleeding Disorders in Pregnancy
B. Statis blood flow (Hematology Quiz)
All of the following are the normal hemostasic response to vascular injury, except: ? A. Endothelium B. Stasis of blood flow C. Platelets D. Coagulation factors
True
True or False: Expectant mothers who are HBsAg + may be candidates for the anti-viral treatment.
True
True or False: Most + HBsAg results picked up on antenatal screening represent chronic infection?
D.
You giving blood transfusion to a pregnant woman with thrombocytopenia. One unit of random donor platelet ideally increases the platelet count in an adult by? A. 20,000 B. 10,000 C. 15,000 D. 5,000
D.
Which of the following may happen if the uterus becomes overstimulated by oxytocin during the induction of labor? A. Increased restlessness and anxiety B. Increased pain with bright red vaginal bleeding C. Weak contraction prolonged to more than 70 seconds D. Tetanic contractions prolonged to more than 90 seconds
D.
A 35-year-old woman is evaluated for worsening thrombocytopenia; she is pregnant at 36 weeks' gestation. Medical history is significant for immune thrombocytopenic purpura. Previous platelet counts during this pregnancy have been 80,000 to 100,000/µL (80-100 × 109/L). Her only medication is a prenatal vitamin. Which of the ff is the most appropriate management of this patient's thrombocytopenia? A. Plasma exchange B. Prednisone C. Intravenous immune globulin D. Emergent delivery
The answers are A and B. The nurse would want to place the patient on their side (preferably the left-side...not supine) to help prevent the tongue from obstructing the airway, preventing aspiration, and improving blood flow to the placenta. In addition, the nurse would NOT want to restrain the patient, which can cause injury. Option C, D, and E are steps the nurse would want to take.
A 37 week pregnant patient is admitted with severe preeclampsia. The patient begins to experiences a tonic-clonic seizure. Which of the following would the nurse AVOID during the seizure? A. Placing the patient in a supine position B. Holding down the patient's head to prevent injury C. Staying with the patient and activating the emergency response team D. Timing the seizure E. Providing 8 to 10 L of oxygen
B, E, F, and G. These options are topics the nurse wants to include in the patient's teaching with preeclampsia. Option A is wrong because the patient should report a weight gain of >2 lbs (NOT 4 lbs) in one week. Option C is wrong become it is no longer recommended the patient restrict salt in diet but limit it. Option D is wrong because a headache and vision changes are serious complications that may indicate the development of eclampsia, and the patient should report it immediately.
A 37-year-old female patient who is 36 weeks pregnant is diagnosed with mild preeclampsia. The nurse will include what information in the patient's education? Select all that apply: A. Report weight gain of >4 lbs in one week to physician B. Incorporate foods like eggs, nuts, fish, meat in your diet C. Follow a no salt diet D. Headache and vision changes are expected side effects of this condition and cause no reason for concern. E. Importance of monitoring urine protein at home F. Lying on left-side is recommended along with rest G. Report a decrease in fetal activity immediately
E. The nurse should monitor for Magnesium Sulfate toxicity. Signs of this include: EARLY: flushing or feeling hot/warm, later on: decreased or absent reflexes (finding of 4+ Deep tendon reflex is considered HYPERreflexia), Respiratory rate less than 12 breaths per minute, Urinary output of less than 30 mL/hr, EKG changes.
A 39 week pregnant patient is in labor. The patient has preeclampsia. The patient is receiving IV Magnesium Sulfate. Which finding below indicates Magnesium Sulfate toxicity and requires you to notify the physician? A. Deep tendon reflex 4+ B. Respiratory rate of 13 breaths per minute C. Urinary output of 600 mL over 12 hours D. Clonus presenting in the lower extremities E. Patient reports flushing or feeling hot
B. Women hospitalized with severe preeclampsia need decreased CNS stimulation to prevent a seizure. Seizure precautions provide environmental safety should a seizure occur. Because of edema, daily weight is important but not the priority. Preeclampsia causes vasospasm and therefore can reduce utero-placental perfusion. The client should be placed on her left side to maximize blood flow, reduce blood pressure, and promote diuresis.
A client with severe preeclampsia is admitted with of BP 160/110, proteinuria, and severe pitting edema. Which of the following would be most important to include in the clients plan of care? A. Daily weights B. Seizure precautions C. Right lateral positioning D. Stress reduction
D.
A couple who wants to conceive but has been unsuccessful during the last 2 years has undergone many diagnostic procedures. When discussing the situation with the nurse, one partner states, "We know several friends in our age group and all of them have their own child already, Why can't we have one?". Which of the following would be the most pertinent nursing diagnosis for this couple? A. Fear related to the unknown B. Pain related to numerous procedures. C. Ineffective family coping related to infertility. D. Self-esteem disturbance related to infertility.
B. 3+ dipstick urine protein D. 0800: blood pressure 142/92, 1230: blood pressure: 144/98
A patient is currently 34 weeks pregnant with her first baby. Which findings below could indicate the development of preeclampsia in this patient that would need to be reported to the physician? Select all that apply: A. 1600: blood pressure 144/100, 1700: blood pressure 120/80 B. 3+ dipstick urine protein C. 1 hour glucose tolerance test 90 mg/dL D. 0800: blood pressure 142/92, 1230: blood pressure: 144/98 E. <300 mg/dL 24-hour urine protein
D. eat a cup of broccoli. This question is tricky! Taking a multivitamin with folic acid, eating a bowl of cereal with 100% of the DV of folic acid, and taking a folic acid supplement, are all ways to be sure that you are getting enough folic acid every day. This question is tricky because broccoli is a natural source of food folate, however you would have to eat 5 cups of broccoli in order to meet the daily requirement of 400 micrograms of folic acid. There are three ways women can get enough folic acid to prevent spina bifida and anencephaly. They can choose to: 1) Take a vitamin supplement (either multivitamin or folic acid supplement) containing 400 micrograms of folic acid daily. 2) Eat a fortified breakfast cereal daily which contains 100% of the daily value of folic acid (400 micrograms). 3) Increase consumption of foods fortified with folic acid (e.g., enriched cereal, bread, rice, pasta, and other grain products) in addition to consuming food folate from a varied diet (e.g., orange juice and green vegetables).
All of the following are ways to be sure that you are getting enough folic acid everyday EXCEPT: A. 400 micrograms (mcg) of folic acid everyday B. eat a bowl of cereal with 100% of the DV (Daily Value) of folic acid C. take a folic acid supplement D. eat a cup of broccoli
Barbiturates are rapidly transferred across the placental barrier. and lack of an antagonist makes them generally inappropriate during active labor. Option A: Neonatal side effects of barbiturates include central nervous system depression. prolonged drowsiness. delayed establishment of feeding (e.g. due to poor sucking reflex or poor sucking pressure). Tranquilizers are associated with neonatal effects such as hypotonia. hypothermia. generalized drowsiness. and reluctance to feed for the first few days. Option B: Narcotic analgesic readily crosses the placental barrier. causing depressive effects in the newborn 2 to 3 hours after intramuscular injection. Option D: Regional anesthesia is associated with adverse reactions such as maternal hypotension. allergic or toxic reaction. or partial or total respiratory failure.
Barbiturates are usually not given for pain relief during active labor for which of the following reasons? A. The neonatal effects include hypotonia. hypothermia. generalized drowsiness. and reluctance to feed for the first few days. B. These drugs readily cross the placental barrier. causing depressive effects in the newborn 2 to 3 hours after intramuscular injection. C. They rapidly transfer across the placenta. and lack of an antagonist make them generally inappropriate during labor. D. Adverse reactions may include maternal hypotension. allergic or toxic reaction or partial or total respiratory failure
C. The best time to do a monthly self-breast exam is about 3 to 5 days after your period starts. Do it at the same time every month. Your breasts are not as tender or lumpy at this time in your monthly cycle. If you have gone through menopause, do your exam on the same day every month
Breast self examination is best done by the woman on herself every month during? A. Just before the menstrual period to determine if ovulation has occurred B. During the menstrual period C. Right after the menstrual period so that the breast is not being affected by the increase in hormones particularly estrogen D. The middle of her cycle to ensure that she is ovulating
The answer is C: To check for clonus the nurse will have the patient dangle the leg and support the patient's lower leg. Then the nurse will quickly dorsiflex the foot. The nurse is assessing for bouncing or beating of the foot (hence the foot attempts to plantarflex). If the foot attempts to bounce or beat 3 or more times, it is positive for clonus.
How would the nurse check for clonus in a patient with preeclampsia? A. Assess the patellar and bicep tendon with a reflex hammer and grade the reaction. B. Assess for muscular rigidity by having the patient extend the arms and place resistance against the arms. C. Assess for beating of the foot when the foot is quickly dorsiflexed. D. Assess for dorsiflexion of the foot by quickly plantar flexing the foot.
Crowing. which occurs when the newborn's head or presenting part appears at the vaginal opening. occurs during the second stage of labor. Option A: During the first stage of labor. cervical dilation and effacement occur. Option C: During the third stage of labor. the newborn and placenta are delivered. Option D: The fourth stage of labor lasts from 1 to 4 hours after birth. during which time the mother and newborn recover from the physical process of birth and the mother's organs undergo the initial readjustment to the nonpregnant state.
During which of the following stages of labor would the nurse assess "crowning"? A. First B. Second C. Third D. Fourth
Answer: D. The FHR can be auscultated with a fetoscope at about 20 week's gestation. FHR usually is auscultated at the midline suprapubic region with Doppler ultrasound transducer at 10 to 12 week's gestation. FHR, cannot be heard any earlier than 10 weeks' gestation.
FHR can be auscultated with a fetoscope as early as which of the following? A. 5 weeks gestation B. 10 weeks gestation C. 13 weeks gestation D. 20 weeks gestation
C: The signs and symptoms of preeclampsia are mainly occurring because substances released by the ischemic placenta cause damage to the ENDOTHELIAL CELLS in mom's body, which injures organs.
Fill-in-the-blank: The signs and symptoms of preeclampsia are mainly occurring because substances released by the ischemic placenta cause damage to the _________________ in mom's body, which injures organs.* A. spiral arteries B. epithelial cells C. endothelial cells D. juxtaglomerular cells
Answer: B. Fetal macrosomia is most commonly caused by a mother with uncontrolled diabetes — pregestational or gestational. Higher amounts of sugar in the mother's system pass through the placenta and converts into fat, leading to a larger baby.
Folic acid reduces the risk for except A. anencephaly B. macrosomia C. spina bifida D. neural tube defects
A. To check for clonus the nurse will have the patient dangle the leg and support the patient's lower leg. Then the nurse will quickly dorsiflex the foot. The nurse is assessing for bouncing or beating of the foot (hence the foot attempts to plantarflex). If the foot attempts to bounce or beat 3 or more times, it is positive for clonus.
How would the nurse check for clonus in a patient with preeclampsia? A. Assess for beating of the foot when the foot is quickly dorsiflexed. B. Assess the patellar and bicep tendon with a reflex hammer and grade the reaction. C. Assess for muscular rigidity by having the patient extend the arms and place resistance against the arms. D. Assess for dorsiflexion of the foot by quickly plantar flexing the foot.
The answers are A and B. Option A indicates positive clonus and Option B is indicative of hyperreflexia. If these findings are present it demonstrates that the central nervous system is irritated and there is a high risk of potential seizure activity. Seizure precautions should be initiated and the physician notified.
In a patient with preeclampsia, what signs and symptoms indicate that the patient has a high risk of experiencing a seizure due to central nervous system irritability? Select all that apply: A. You note bouncing of the foot when it is quickly dorsiflexed. B. Patellar and bicep deep tendon reflexes are graded 4+. C. Platelet count 200,000 D. Patient reports a decrease in headache pain.
C.
In ff which is a hereditary hemolytic anaemia: A. Megaloblastic anaemia B. Thalassemia C. All D. Aplastic anaemia
D.
In order to help prevent neural tube defects folic acid must be taken: A. After a woman has her first prenatal visit B. During the third trimester C. After a woman discovers she is pregnant D. Before and during the first few months of pregnancy
17 days
In sickle cell anemia, life span of RBC is:
C.
In thrombotic thrombocytopenia purpura (TTP) which of the following is true? A. APTT is prolonged B. PT is prolonged C. Both PT and APTT are normal D. Both PT and APTT are prolonged
A. Kernicterus is a type of brain damage that can result from high levels of bilirubin in a baby's blood. It can cause athetoid cerebral palsy and hearing loss. Kernicterus develops when the rate of bilirubin deposition becomes overwhelming as a result of high serum bilirubin concentration, low albumin-binding capacity, or low serum pH. Low serum albumin levels or the use of drugs that displace bilirubin from albumin can increase the risk for kernicterus.
Kernicterus, which may occur as a complication of jaundice, is a pathological condition of: A. Brain B. Kidney C. Liver D. Heart
B, D, E
Most adolescents' eating habits are very imbalanced, what are some complications can poor nutrition cause during pregnancy. Select all that apply: A. Urinary tract infections B. Intrauterine growth restrictions C. Weight loss D. Premature births E. Increased death rate
B, C, D, E, and G. Risk factors for preeclampsia include: History of preeclampsia or family history, first pregnancy (primigravida), significant health history prior to pregnancy: diabetes, lupus, high blood pressure, kidney disease, Obese: BMI >30, having more than one baby (twins, triplets etc.), age (young <18 or advanced >35).
Select all the risk factors below that increases a woman's risk for developing preeclampsia: A. Nulligravida B. Primigravida C. BMI 34 D. Pregnant with twins E. Maternal history of preeclampsia F. Age: 25-years-old G. History of Lupus and Diabetes
A.
Spinnabarkeit is an indicator of ovulation which is characterized as: A. Thin watery mucus which can be stretched into a long strand about 10 cm B. Thick mucus that is detached from the cervix during ovulation C. Thin mucus that is yellowish in color with fishy odor D. Thick mucus vaginal discharge influence by high level of estrogen
A. Clostridium perfringens
The most fulminant acquired hemolytic anemia due to bacterial toxins encountered during pregnancy is caused by A. Clostridium perfringens B. Staphylococcus aureus C. Escherichia coli D. Proteus spp.
C. Preeclampsia tends to occur AFTER 20 weeks gestation.
The nurse knows that preeclampsia tends to occur during what time in a pregnancy? A. before 20 weeks B. in the third trimester and postpartum C. after 20 weeks D. in the first and second trimester
A, C, D
What risk factors are included in Biophysical Factors. Select all that apply: A. Nutritional status B. Alcohol C. Genetic makeup D. Medical and obstetric history E. Parity
B, C, D, E
What risk factors of pregnancy are included in environmental factors. Select all answers that apply. A. Ethnicity B. Stress C. Radiation D. Hazardous chemicals E. Air quality
B. The normal heart rate for a newborn that is sleeping is approximately 100 beats per minute. If the newborn was awake, the normal heart rate would range from 120 to 160 beats per minute.
When assessing the newborn's heart rate, which of the following ranges would be considered normal if the newborn were sleeping? A. 80 beats per minute B. 100 beats per minute C. 120 beats per minute D. 140 beats per minute
C. A key point to consider when preparing the client for a cesarean delivery is to modify the preoperative teaching to meet the needs of either a planned or emergency cesarean birth, the depth and breadth of instruction will depend on circumstances and time available. Allowing the mother's support person to remain with her as much as possible is an important concept, although doing so depends on many variables. Arranging for necessary explanations by various staff members to be involved with the client's care is a nursing responsibility. The nurse is responsible for reinforcing the explanations about the surgery, expected outcome, and type of anesthetic to be used. The obstetrician is responsible for explaining about the surgery and outcome and the anesthesiology staff is responsible for explanations about the type of anesthesia to be used.
When preparing a client for cesarean delivery, which of the following key concepts should be considered when implementing nursing care? A. Instruct the mother's support person to remain in the family lounge until after the delivery B. Arrange for a staff member of the anesthesia department to explain what to expect postoperatively C. Modify preoperative teaching to meet the needs of either a planned or emergency cesarean birth D. Explain the surgery, expected outcome, and kind of anesthetics
B. Doppler placed midline at the suprapubic region At 12 weeks gestation, the uterus rises out of the pelvis and is palpable above the symphysis pubis. The Doppler intensifies the sound of the fetal pulse rate so it is audible. The uterus has merely risen out of the pelvis into the abdominal cavity and is not at the level of the umbilicus. The fetal heart rate at this age is not audible with a stethoscope. The uterus at 12 weeks is just above the symphysis pubis in the abdominal cavity, not midway between the umbilicus and the xiphoid process. At 12 weeks the FHR would be difficult to auscultate with a fetoscope. Although the external electronic fetal monitor would project the FHR, the uterus has not risen to the umbilicus at 12 weeks.
When preparing to listen to the fetal heart rate at 12 weeks gestation, the nurse would use? A. Stethoscope placed midline at the umbilicus B. Doppler placed midline at the suprapubic region C. Fetoscope placed midway between the umbilicus and the xiphoid process D. External electronic fetal monitor placed at the umbilicus
C.
When talking with a pregnant client who is experiencing aching swollen, leg veins, the nurse would explain that this is most probably the result of which of the following? A. Thrombophlebitis B. Pregnancy-induced hypertension C. Pressure on blood vessels from the enlarging uterus D. The force of gravity pulling down on the uterus
A.
When uterine rupture occurs, which of the following would be the priority? A. Limiting hypovolemic shock B. Obtaining blood specimens C. Instituting complete bed rest D. Inserting a urinary catheter
D. During the first trimester, common emotional reactions include ambivalence, fear, fantasies, or anxiety. The second trimester is a period of well-being accompanied by the increased need to learn about fetal growth and development. Common emotional reactions during this trimester include narcissism, passivity, or introversion. At times the woman may seem egocentric and self-centered. During the third trimester, the woman typically feels awkward, clumsy, and unattractive, often becoming more introverted or reflective of her own childhood.
Which of the ff common emotional rx to pregnancy would the nurse expect to occur during the 1st trimester? A. Introversion, egocentrism, narcissism B. Awkwardness, clumsiness, and unattractiveness C. Anxiety, passivity, extroversion D. Ambivalence, fear, fantasies
B. Danger signs that require prompt reporting leaking of amniotic fluid, vaginal bleeding, blurred vision, rapid weight gain, and elevated blood pressure. Constipation, breast tenderness, and nasal stuffiness are common discomforts associated with pregnancy.
Which of the ff danger signs should be reported promptly during the antepartum period? A. Breast tenderness B. Leaking amniotic fluid C. Nasal stuffiness D. Constipation
C.
Which of the following best reflects the frequency of reported postpartum "blues"? A. Between 10% and 40% of all new mothers report some form of postpartum blues B. Between 30% and 50% of all new mothers report some form of postpartum blues C. Between 50% and 80% of all new mothers report some form of postpartum blues D. Between 25% and 70% of all new mothers report some form of postpartum blues
B.
Which of the following may happen if the uterus becomes overstimulated by oxytocin during the induction of labor? A. Weak contraction prolonged to more than 70 seconds B. Tetanic contractions prolonged to more than 90 seconds C. Increased pain with bright red vaginal bleeding D. Increased restlessness and anxiety
D. During the third stage of labor. which begins with the delivery of the newborn. the nurse would promote parent-newborn interaction by placing the newborn on the mother's abdomen and encouraging the parents to touch the newborn. Option A: Collecting a urine specimen and other laboratory tests is done on admission during the first stage of labor. Option B: Assessing uterine contractions every 30 minutes is performed during the latent phase of the first stage of labor. Option C: Coaching the client to push effectively is appropriate during the second stage of labor.
Which of the following nursing interventions would the nurse perform during the third stage of labor? A. Obtain a urine specimen and other laboratory tests. B. Assess uterine contractions every 30 minutes. C. Coach for effective client pushing D. Promote parent-newborn interaction.
The answer is B. This is the only correct statement. When preeclampsia occurs it is because the spiral arteries of the uterus failed to widen in diameter due to poor trophoblast invasion during the beginning of the pregnancy. Overtime, this causes problems (usually after 20 weeks gestation) and the placenta experiences ischemia. When the placenta becomes ischemic is releases substances into mom's circulation that are very toxic to her endothelial cells, which causes all the signs and symptoms seen in preeclampsia. Severity varies in patients.
You're providing an in-service to a group of new labor and delivery nurse graduates about the pathophysiology of preeclampsia. Which statement by one of the group participants demonstrates they understood how this condition develops? A. "The basal arteries of the myometrium fail to widen to support blood flow to the placenta." B. "The placenta experiences ischemia because the spiral arteries of the uterus fail to reshape and increase in diameter." C. "The cardiovascular system of the mother fails to compensate for the increased blood flow from the fetus and placental ischemia occurs." D. "If the mother experience uncontrolled hypertension and proteinuria, it compromises blood flow to the placenta and leads to preeclampsia."
The answers are: B, C, D, and F. HELLP Syndrome causes of Hemolysis of RBCs (abnormal RBC peripheral smear), Elevated Liver enzymes (>70 IU/L for AST or ALT), Low Platelets (<100,000 μL ).
Your patient is 36 weeks pregnant with severe preeclampsia. The physician has ordered lab work to assess for HELLP Syndrome. Which findings on the patient's lab results correlate with HELLP Syndrome? A. Hemoglobin 12 g/dL B. Platelets 90,000 μL C. ALT 100 IU/L D. AST 90 IU/L E. Glucose 350 mg/dL F. Abnormal RBC peripheral smear
D: The antidote for Magnesium Sulfate is Calcium Gluconate. The nurse should have this on hand in case Magnesium toxicity occurs.
Your patient with preeclampsia is started on Magnesium Sulfate. The nurse knows to have what medication on standby? A. Acetylcysteine B. Calcium carbonate C. Oxytocin D. Calcium gluconate