Chapter 12 - High Risk Perinatal Care Gestational Conditions (Maternity) EAQ's

The quantitative human chorionic gonadotropin (β-hCG) levels are high in a patient who is on methotrexate therapy for dissolving abdominal pregnancy. Which instruction does the nurse give to this patient? 1 "Avoid sexual activity." 2 "Avoid next pregnancy." 3 "Avoid feeling sad and low." 4 "Take folic acid without fail."

1 - "Avoid sexual activity." pg 303 - High β-hCG levels indicate that the abdominal pregnancy is not yet dissolved. Therefore the nurse advises the patient to avoid sexual activity until the β-hCG levels drop and the pregnancy is dissolved completely. If the patient engages in vaginal intercourse, the pelvic pressure may rupture the mass and cause pain. Abdominal pregnancy increases the chances of infertility or recurrent ectopic pregnancy in patients. However, the nurse need not instruct the patient to avoid further pregnancy, because it may increase the feelings of sadness and guilt in the patient. The nurse encourages the patient to share feelings of guilt or sadness related to pregnancy loss. Folic acid is contraindicated with methotrexate therapy, because it may exacerbate ectopic rupture.

Which instructions does the nurse give to a patient who is prescribed methotrexate therapy for dissolving the tubal pregnancy? 1 "Discontinue folic acid supplements." 2 "Get adequate exposure to sunlight." 3 "Take stronger analgesics for severe pain." 4 "Vaginal intercourse is safe during the therapy."

1 - "Discontinue folic acid supplements." pg 303 - The nurse advises the patient to discontinue folic acid supplements as they interact with methotrexate and may exacerbate ectopic rupture in the patient. Exposure to sunlight is avoided as the therapy makes the patient photosensitive. Analgesics stronger than acetaminophen are avoided, because they may mask symptoms of tubal rupture. Vaginal intercourse is avoided until the pregnancy is dissolved completely.

After being rehydrated in the emergency department, a 24-year-old primipara in her 18th week of pregnancy is at home and is to rest at home for the next 2 days and take in small but frequent fluids and food as possible. Discharge teaching at the hospital by the nurse has been effective if the patient makes which statement? 1 "I'm going to eat five to six small servings per day, which contain such foods and fluids as tea, crackers, or a few bites of baked potato." 2 "A strip of bacon and a fried egg will really taste good as long as I eat them slowly." 3 "As long as I eat small amounts and allow enough time for digestion, I can eat almost anything, like barbequed chicken or spaghetti." 4 "I'm going to stay only on clear fluids for the next 24 hours and then add dairy products like eggs and milk."

1 - "I'm going to eat five to six small servings per day, which contain such foods and fluids as tea, crackers, or a few bites of baked potato." pg 296 - Once the vomiting has stopped, feedings are started in small amounts at frequent intervals. In the beginning, limited amounts of oral fluids and bland foods such as crackers, toast, or baked chicken are offered. Clear fluids alone do not contain enough calories and contain no protein. Most women are able to take nourishment by mouth after several days of treatment. They should be encouraged to eat small, frequent meals and foods that sound appealing (e.g., nongreasy, dry, sweet, and salty foods).

The nurse is caring for a pregnant patient who is receiving antibiotic therapy to treat a urinary tract infection (UTI). Which dietary changes does the nurse suggest for the pregnant patient who is receiving antibiotic therapy for UTI? 1 "Include yogurt, cheese, and milk in your diet." 2 "Avoid folic acid supplements until the end of therapy." 3 "Include vitamins C and E supplementation in your diet." 4 "Reduce your dietary fat intake by 40 to 50 g per day."

1 - "Include yogurt, cheese, and milk in your diet." pg 312 - The antibiotic therapy kills normal flora in the genitourinary tract, as well as pathologic organisms. Therefore the nurse instructs the patient to include yogurt, cheese, and milk in daily diet because they contain active acidophilus cultures. Folic acid should not be avoided, because it may affect the fetal development. Vitamins C and E supplementation is usually included in the diet to treat preeclampsia in a patient. Dietary fat is reduced in patients with cholecystitis or cholelithiasis, because it may cause epigastric pain.

A patient with gestational hypertension is prescribed labetalol hydrochloride (Normodyne) therapy, which is continued after giving birth. What does the nurse instruct the patient about breastfeeding? 1 "You may breastfeed the infant if you desire." 2 "Breastfeeding may cause convulsions in the infant." 3 "Breastfeed only once a day and use infant formulas." 4 "There may be high levels of the drug in the breast milk."

1 - "You may breastfeed the infant if you desire." pg 295 - Labetalol hydrochloride (Normodyne) has a low concentration in breast milk, so the patient can breastfeed the infant. Breastfeeding is safe and will not cause convulsions or any side effects in the infant. Infant formulas are used only if the mother is unable to breastfeed the infant or if the mother does not desire to breastfeed.

In caring for the patient with disseminated intravascular coagulation (DIC), what order should the nurse anticipate? 1 Administration of blood 2 Preparation of the patient for invasive hemodynamic monitoring 3 Restriction of intravascular fluids 4 Administration of steroids

1 - Administration of blood pg 310 - Primary medical management in all cases of DIC involves correction of the underlying cause, volume replacement, blood component therapy, optimization of oxygenation and perfusion status, and continued reassessment of laboratory parameters. Central monitoring would not be ordered initially in a woman with DIC because this can contribute to more areas of bleeding. Management of DIC includes volume replacement, not volume restriction. Steroids are not indicated for the management of DIC.

A pregnant patient reports abdominal pain in the right lower quadrant, along with nausea and vomiting. The patient's urinalysis report shows an absence of any urinary tract infection in the patient. A chest x-ray also rules out lower-lobe pneumonia. Which condition does the nurse suspect in the patient? 1 Appendicitis 2 Cholelithiasis 3 Placenta previa 4 Uterine rupture

1 - Appendicitis pg 312 - Abdominal pain in the right lower quadrant, accompanied by nausea and vomiting, indicates appendicitis in a pregnant patient. Cholelithiasis is characterized by right upper quadrant pain. Placenta previa is a condition wherein the placenta is implanted in the lower uterine segment covering the cervix, which causes bleeding when the cervix dilates. Uterine rupture is seen in a pregnant patient as a result of trauma, which may cause fetal death.

Which nursing interventions are implemented while caring for a pregnant patient with disseminated intravascular coagulation (DIC)? Select all that apply. 1 Assess for signs of bleeding. 2 Monitor urinary output. 3 Initiate electronic fetal monitoring. 4 Administer prescribed oxygen. 5 Provide suctioning once a day.

1 - Assess for signs of bleeding. 2 - Monitor urinary output. 3 - Initiate electronic fetal monitoring. 4 - Administer prescribed oxygen. pg 310/311 - DIC causes extensive external bleeding as a result of the destruction of clotting factors. Therefore the nurse needs to assess the patient for signs of bleeding, rapid replacement of blood products, and clotting factors. DIC also causes renal failure, so the nurse needs to monitor urinary output in the patient as well. Urinary output needs to be more than 30 mL/hr. Continuous electronic fetal monitoring is necessary to assess whether the fetus has sufficient oxygenation. The nurse needs to administer the prescribed oxygen through a nonrebreather face mask to maintain adequate fetal oxygenation. Suctioning is necessary in patients when the airway is obstructed, for instance, after a convulsion.

The nurse observes that intravenous (IV) administration of magnesium sulfate has resulted in magnesium toxicity in a pregnant patient with preeclampsia. The nurse immediately discontinues the infusion and reports to the primary health care provider (PHP). For which drug does the nurse obtain a prescription from the PHP? 1 Calcium gluconate 2 Nifedipine (Adalat) 3 Hydralazine (Apresoline) 4 Labetalol hydrochloride (Normodyne)

1 - Calcium gluconate pg 291 - The nurse needs to obtain a prescription for calcium gluconate because it acts as an antidote to magnesium toxicity. Nifedipine (Adalat) and labetalol hydrochloride (Normodyne) are antihypertensive medications, which are prescribed for gestational hypertension or severe preeclampsia. Hydralazine (Apresoline) is also an antihypertensive medication used for treating hypertension intrapartum.

Which hypertensive disorders can occur during pregnancy? Select all that apply. 1 Chronic hypertension 2 Preeclampsia-eclampsia 3 Hyperemesis gravidarum 4 Gestational hypertension 5 Gestational trophoblastic disease

1 - Chronic hypertension 2 - Preeclampsia-eclampsia 4 - Gestational hypertension pg 281/282 - Chronic hypertension refers to hypertension that developed in the pregnant patient before 20 weeks of gestation. Preeclampsia refers to hypertension and proteinuria that develop after 20 weeks of gestation. Eclampsia is the onset of seizure activity in a pregnant patient with preeclampsia. Gestational hypertension is the onset of hypertension after 20 weeks' gestation. Gestational trophoblastic disease and hyperemesis gravidarum are not hypertensive disorders. Gestational trophoblastic disease refers to a disorder without a viable fetus that is caused by abnormal fertilization. Hyperemesis gravidarum is excessive vomiting during pregnancy that may result in weight loss and electrolyte imbalance.

The nurse observes that eclampsia has developed in a pregnant patient after starting magnesium sulfate therapy. What action does the nurse take? 1 Continue to administer magnesium sulfate per protocol. 2 Administer regional anesthesia to the patient. 3 Administer calcium gluconate simultaneously. 4 Prepare the patient for immediate cesarean birth.

1 - Continue to administer magnesium sulfate per protocol. pg 294 - The nurse needs to administer additional magnesium sulfate because it will help in treating eclamptic seizures and preventing repeated seizures. Regional anesthesia is not recommended for eclamptic patients because of the risk of maternal complications. Calcium gluconate is administered as an antidote for magnesium toxicity. Immediate cesarean birth is a priority when the patient is in shock after a trauma.

The nurse is caring for a woman who is at 24 weeks of gestation with suspected severe preeclampsia. Which signs and symptoms should the nurse expect to observe? Select all that apply. 1 Decreased urinary output and irritability 2 Transient headache and +1 proteinuria 3 Ankle clonus and epigastric pain 4 Platelet count of less than 100,000/mm3 and visual problems 5 Seizure activity and hypotension

1 - Decreased urinary output and irritability 3 - Ankle clonus and epigastric pain 4 - Platelet count of less than 100,000/mm3 and visual problems pg 283/287/292 - Decreased urinary output and irritability are signs of severe eclampsia. Ankle clonus and epigastric pain are signs of severe eclampsia. Platelet count of less than 100,000/mm3 and visual problems are signs of severe preeclampsia. A transient headache and +1 proteinuria are signs of preeclampsia and should be monitored. Seizure activity and hyperreflexia are signs of eclampsia.

Which conditions during pregnancy can result in preeclampsia in the patient? Select all that apply. 1 Genetic abnormalities 2 Dietary deficiencies 3 Abnormal trophoblast invasion 4 Cardiovascular changes 5 Maternal hypotension

1 - Genetic abnormalities 2 - Dietary deficiencies 3 - Abnormal trophoblast invasion 4 - Cardiovascular changes pg 282 - Current theories consider that genetic abnormalities and dietary deficiencies can result in preeclampsia. Abnormal trophoblast invasion causes fetal hypoxia and results in maternal hypertension. Cardiovascular changes stimulate the inflammatory system and result in preeclampsia in the pregnant patient. Maternal hypertension, and not hypotension, after 20 weeks of gestation is known as preeclampsia.

A woman diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At the present time, for what is she at the greatest risk? 1 Hemorrhage 2 Infection 3 Urinary retention 4 Thrombophlebitis

1 - Hemorrhage pg 306 - Hemorrhage is the most immediate risk because the lower uterine segment has limited ability to contract to reduce blood loss. Infection is a risk because of the location of the placental attachment site; however, it is not a priority concern at this time. Placenta previa poses no greater risk for urinary retention than with a normally implanted placenta. There is no greater risk for thrombophlebitis than with a normally implanted placenta.

An 8-month-pregnant patient presents with preeclampsia. Which clinical findings in the patient indicate that the disease has progressed to HELLP syndrome? Select all that apply. 1 Hepatic dysfunction 2 Elevated liver enzymes 3 Vaginal bleeding 4 Low platelet count 5 Chronic hypertension

1 - Hepatic dysfunction 2 - Elevated liver enzymes 4 - Low platelet count pg 284 - Hepatic dysfunction in a patient with preeclampsia indicates that the disease has progressed to HELLP syndrome. It can result in both endothelial damage and fibrin deposits in the liver. Hepatic tissue damage results in elevated liver enzymes. Narrowed blood vessels damage the red blood cells (RBCs) and they become hemolyzed, resulting in a decreased RBC and platelet count. Vaginal bleeding is sometimes seen in patients with severe gestational hypertension or those who are at risk for miscarriage. Chronic hypertension is a condition in which patients develop hypertension before the pregnancy. It is not related to HELLP syndrome.

A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature 37.1° C, pulse rate 96 beats/min, respiratory rate 24 breaths/min, blood pressure 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the health care provider, anticipating an order for what? 1 Hydralazine 2 Magnesium sulfate bolus 3 Diazepam 4 Calciumgluconate

1 - Hydralazine pg 291/293 - Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. An additional bolus of magnesium sulfate may be ordered for increasing signs of central nervous system irritability related to severe preeclampsia (e.g., clonus) or if eclampsia develops. Diazepam sometimes is used to stop or shorten eclamptic seizures. Calcium gluconate is used as the antidote for magnesium sulfate toxicity. The patient is not currently displaying any signs or symptoms of magnesium toxicity.

Which actions does the nurse take when a pregnant patient has convulsions? Select all that apply. 1 Obtains a prescription for magnesium sulfate 2 Assesses the patient's airway, breathing, and pulse 3 Lowers the bed and turns the patient onto one side 4 Does not leave the patient for more than 10 minutes 5 Raises the side rails of the bed and pads with pillows

1 - Obtains a prescription for magnesium sulfate 2 - Assesses the patient's airway, breathing, and pulse 3 - Lowers the bed and turns the patient onto one side 5 - Raises the side rails of the bed and pads with pillows pg 294 - The nurse obtains a prescription for magnesium sulfate to prevent further convulsions. The nurse assesses the patient's airway, breathing, and pulse to understand the maternal condition. The nurse may need to suction secretions to clear the airway and administer oxygen to maintain sufficient oxygenation in the patient. The nurse lowers the bed and turns the patient onto one side to prevent aspiration of vomitus. The nurse raises the side rails of the bed and pads with pillows to prevent a fall. The nurse may call for help but should not leave the patient's bedside as the patient is in a serious condition.

The nurse is caring for a pregnant patient who is scheduled for surgery. Which nursing intervention will help provide sufficient fetal oxygenation during the surgery? 1 Positioning the patient with a lateral tilt 2 Providing clear liquids before the surgery 3 Palpating uterine contractions (UCs) manually 4 Giving an antacid before administering anesthesia

1 - Positioning the patient with a lateral tilt pg 313 - The nurse positions the pregnant patient on the operating table with a lateral tilt to avoid compression of the maternal vena cava. This improves fetal oxygenation during the surgery. Clear liquids are administered to the patient for bowel preparation before the surgery. The nurse may palpate UCs manually to evaluate the fetal status. An antacid is administered to the patient before administering anesthesia to prevent vomiting and aspiration.

Which condition is seen in a pregnant patient if uterine artery Doppler measurements in the second trimester of pregnancy are abnormal? 1 Preeclampsia 2 HELLP syndrome 3 Molar pregnancy 4 Gestational hypertension

1 - Preeclampsia pg 285 - Preeclampsia is a condition in which patients develop hypertension and proteinuria after 20 weeks' gestation. It can be diagnosed if uterine artery Doppler measurements in the second trimester of pregnancy are abnormal. HELLP syndrome is characterized by hemolysis (H), elevated liver enzymes (EL), and low platelet count (LP) in a patient with preeclampsia. Molar pregnancy refers to the growth of the placental trophoblast due to abnormal fertilization. Gestational hypertension is a condition in which hypertension develops in a patient after 20 weeks of gestation.

What does the nurse assess to detect the presence of a hypertensive disorder in a pregnant patient? Select all that apply. 1 Proteinuria 2 Epigastric pain 3 Placenta previa 4 Presence of edema 5 Blood pressure (BP)

1 - Proteinuria 2 - Epigastric pain 4 - Presence of edema 5 - Blood pressure (BP) pg 281/284 - Proteinuria indicates hypertension in a pregnant patient. Proteinuria is concentration ≥300 mg/24 hours in a 24-hour urine collection. The nurse needs to assess the patient for epigastric pain because it indicates severe preeclampsia. Hypertension is likely to cause edema or swollen ankles as a result of greater hydrostatic pressure in the lower parts of the body. Therefore the nurse needs to assess the patient for the presence of edema. Accurate measurement of BP will help detect the presence of any hypertensive disorder. A systolic BP greater than 140 mm Hg or a diastolic BP greater than 90 mm Hg will indicate hypertension. Placenta previa is a condition wherein the placenta is implanted in the lower uterine segment covering the cervix, which causes bleeding when the cervix dilates.

Which clinical reports does the nurse evaluate to identify ectopic pregnancy in a patient? Select all that apply. 1 Quantitative human chorionic gonadotropin (β-hCG) levels 2 Transvaginal ultrasound 3 Progesterone level 4 Thyroid test reports 5 Kleihauer-Betke (KB) test

1 - Quantitative human chorionic gonadotropin (β-hCG) levels 2 - Transvaginal ultrasound 3 - Progesterone level pg 302/303 - An ectopic pregnancy is indicated when β-hCG levels are >1500 milli-international units/mL but no intrauterine pregnancy is seen on the transvaginal ultrasound. A transvaginal ultrasound is repeated to verify if the pregnancy is inside the uterus. A progesterone level <5 ng/mL indicates ectopic pregnancy. Thyroid test reports need to be evaluated in case the patient has hyperemesis gravidarum, as hyperthyroidism is associated with this disorder. The KB test is used to determine transplacental hemorrhage.

Which condition in a pregnant patient with severe preeclampsia is an indication for administering magnesium sulfate? 1 Seizure activity 2 Renal dysfunction 3 Pulmonary edema 4 Low blood pressure (BP)

1 - Seizure activity pg 289 - Severe preeclampsia may cause seizure activity or eclampsia in the patient, which is treated with magnesium sulfate. Magnesium sulfate is not administered for renal dysfunction and can cause magnesium toxicity in the patient. Pulmonary enema can be prevented by restricting the patient's fluid intake to 125 mL/hr. Increasing magnesium toxicity can cause low BP in the patient.

Which conditions does the nurse remain alert for in a pregnant patient with preeclampsia? Select all that apply. 1 Seizures 2 Scotoma 3 Renal disease 4 Cerebral edema 5 Chronic hypertension

1 - Seizures 2 - Scotoma 4 - Cerebral edema pg 282/284 - Seizures may be seen as a result of the central nervous system irritability in the patient. Scotoma is a visual disturbance that is seen in a patient with preeclampsia; it results from arteriolar vasospasms and decreased blood flow to the retina. Cerebral edema is a neurologic complication associated with preeclampsia. Chronic hypertension is seen in pregnant patients before pregnancy and is not associated with preeclampsia. Renal disease is a risk factor that may cause preeclampsia in the patient.

A 24-year-old primipara, who is 18 weeks pregnant, has been having increasing vomiting since she was 8 weeks pregnant. Upon arrival at the emergency department, her skin turgor is diminished, temperature is 99.2° F, pulse is 102, respiration is 18, blood pressure is 102/68, and she has deep furrows on her tongue. What would the nurse expect to do to care for her? Select all that apply. 1 Start an intravenous infusion. 2 Check her urine for ketones. 3 Crossmatch blood for a transfusion. 4 Obtain a complete history. 5 Obtain blood for a complete blood count.

1 - Start an intravenous infusion. 2 - Check her urine for ketones. 4 - Obtain a complete history. 5 - Obtain blood for a complete blood count. pg 295/296 - Whenever a pregnant woman has nausea and vomiting, the first priority is a thorough assessment to determine the severity of the problem. In most cases the woman should be told to come immediately to the health care provider's office or the emergency department because the severity of the illness often is difficult to determine by telephone conversation. The assessment should include frequency, severity, and duration of episodes of nausea and vomiting. If the woman reports vomiting, the assessment also should include the approximate amount and color of the vomitus. The woman is asked to report any precipitating factors relating to the onset of her symptoms. Any pharmacologic or nonpharmacologic treatment measures used should be recorded. Prepregnancy weight and documented weight gain or loss during pregnancy are important to note. The woman's weight and vital signs are measured, and a complete physical examination is performed, with attention to signs of fluid and electrolyte imbalance and nutritional status. The most important initial laboratory test to be obtained is a determination of ketonuria. Other laboratory tests that may be prescribed are a urinalysis, a complete blood cell count, electrolytes, liver enzymes, and bilirubin levels. At this time, there is no supportive evidence that a blood transfusion is required. Based on provided objective data that the patient has deep furrows on her tongue, this may suggest a vitamin B deficiency which should be investigated further.

Which tests does the nurse need to evaluate while assessing a patient with hyperemesis gravidarum? Select all that apply. 1 Urinalysis 2 Thyroid test 3 Liver function test 4 Kleihauer-Betke (KB) test 5 Complete blood cell count

1 - Urinalysis 2 - Thyroid test 3 - Liver function test 5 - Complete blood cell count pg 296 - Ketonuria indicates hyperemesis gravidarum in a patient. Therefore the nurse should assess the urinalysis reports. Hyperemesis gravidarum and hyperthyroidism are associated, so the nurse needs to assess the thyroid test reports, which may help in identifying the cause of the disorder. Liver function test and complete blood cell count help rule out any other underlying disease such as gastroenteritis, pyelonephritis, pancreatitis, cholecystitis, peptic ulcer, and hepatitis. The KB test is not used for the assessment of hyperemesis gravidarum. The KB test is used to determine the presence of fetal-to-maternal bleeding.

A 24-year-old primipara, 10 weeks pregnant, who has been experiencing vomiting every morning for the past few weeks, asks the nurse at her check-up how long this "morning sickness" will continue. Which statement by the nurse is most accurate? 1 "It will end by the 15th week of pregnancy." 2 "It usually subsides by the 20th week of pregnancy." 3 "It's a very common but not serious problem." 4 "In some women, it can last throughout the pregnancy and become serious."

2 - "It usually subsides by the 20th week of pregnancy." pg 295 - This discomfort of pregnancy usually subsides by the 20th week of pregnancy. An absolute definite end of vomiting during pregnancy can never be stated.

A pregnant patient with severe preeclampsia who is being transported to a tertiary care center needs to be administered magnesium sulfate injection for seizure activity. What actions does the nurse take when administering the drug? Select all that apply. 1 A 10-g dose is administered in the buttock. 2 A local anesthetic is added to the solution. 3 The Z-track technique is used to inject the drug. 4 The injection site is massaged after the injection. 5 The subcutaneous route is used to inject the drug.

2 - A local anesthetic is added to the solution. 3 - The Z-track technique is used to inject the drug. 4 - The injection site is massaged after the injection. pg 291 - The nurse adds a local anesthetic to the solution to reduce pain that is caused by the injection. The Z-track technique is used to inject the drug so that the drug is injected in the intramuscular (IM) tissue safely. The nurse gently massages the site after administering the injection to reduce pain. The nurse administers two separate injections of 5 g in each buttock. Magnesium sulfate injections are administered in the IM layer and not the subcutaneous layer.

A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits what? 1 A sleepy, sedated affect 2 A respiratory rate of 10 breaths/min 3 Deep tendon reflexes of 2+ 4 Absent ankle clonus

2 - A respiratory rate of 10 breaths/min pg 291 - A respiratory rate of 10 breaths/min indicates that the patient is experiencing respiratory depression (bradypnea) from magnesium toxicity. Because magnesium sulfate is a central nervous system (CNS) depressant, the woman will most likely become sedated when the infusion is initiated. Deep tendon reflexes of 2+ are a normal finding. Absent ankle clonus is a normal finding.

A pregnant patient with chronic hypertension is at risk for placental abruption. Which symptoms of abruption does the nurse instruct the patient to be alert for? Select all that apply. 1 Weight loss 2 Abdominal pain 3 Vaginal bleeding 4 Shortness of breath 5 Uterine tenderness

2 - Abdominal pain 3 - Vaginal bleeding 5 - Uterine tenderness pg 308 - The nurse instructs the pregnant patient to be alert for abdominal pain, vaginal bleeding, and uterine tenderness as these indicate placental abruption. Weight loss indicates fluid and electrolyte loss and not placental abruption. Shortness of breath indicates inadequate oxygen, which is usually seen in a patient who is having cardiac arrest.

What action does the nurse take to relieve choking in a pregnant patient who is in the third trimester? 1 Administering anesthesia 2 Administering chest thrusts 3 Placing a towel under the hips 4 Positioning the patient onto one side

2 - Administering chest thrusts pg 317 - Choking is often relieved in patients by administering abdominal thrusts. However if the patient is in the third trimester of pregnancy, chest thrusts are administered to prevent injury to the uterus. Administering anesthesia or positioning the patient onto one side will not help dislodge the object and relieve choking. The nurse needs to place a towel under the hips to displace the uterus while administering cardiopulmonary resuscitation (CPR).

The emergency department nurse is assessing a pregnant trauma victim who just arrived at the hospital. What are the nurse's most appropriate actions? Select all that apply. 1 Place the patient in a supine position. 2 Assess for point of maximal impulse at fourth intercostal space. 3 Collect urine for urinalysis and culture. 4 Monitor vital signs frequently. 5 Assist with ambulation to decrease risk of thrombosis.

2 - Assess for point of maximal impulse at fourth intercostal space. 3 - Collect urine for urinalysis and culture. 4 - Monitor vital signs frequently. pg 314 - The heart is displaced upward and to the left in pregnant patients. During pregnancy, there is dilation of the ureters and urethra, and the bladder is displaced forward placing the pregnant trauma patient at higher risk for urinary stasis, infection, and bladder trauma. The trauma patient can suffer blood loss and other complications, necessitating frequent monitoring of vital signs. Passive regurgitation may occur if patient is supine, leading to high risk for aspiration.While the pregnant patient is at risk for thrombus formation, the patient must be cleared by the health care provider before ambulating. The pregnant trauma patient is at higher risk for pelvic fracture, and therefore this condition must be ruled out first as well.

What is a priority nursing action after administering magnesium sulfate to a pregnant patient? 1 Assess the patient's weight. 2 Assess serum magnesium level. 3 Restrict fluid intake to 250 mL/hr. 4 Evaluate fetal movement counts hourly.

2 - Assess serum magnesium level. pg 291 - Magnesium sulfate can cause toxicity in the patient if the renal system does not function properly. Therefore the nurse needs to assess the serum magnesium levels so that prompt action can be taken. The nurse needs to assess the patient's weight if there is a risk for edema. Fluids are restricted if the patient is at risk for edema. Magnesium sulfate does not affect the fetal heart rate (FHR), so assessing fetal movements is not a priority.

What are the possible causes of miscarriage during early pregnancy? Select all that apply. 1 Premature dilation of cervix 2 Chromosomal abnormalities 3 Endocrine imbalance 4 Hypothyroidism 5 Antiphospholipid antibodies

2 - Chromosomal abnormalities 3 - Endocrine imbalance 4 - Hypothyroidism 5 - Antiphospholipid antibodies pg 297 - Chromosomal abnormalities account for 50% of all early pregnancy losses. Endocrine imbalance is caused by luteal phase defects, hypothyroidism, and diabetes mellitus in pregnant patients and results in miscarriage. Antiphospholipid antibodies also increase the chances of miscarriage in pregnant patients. Premature dilation of the cervix may cause a second-trimester loss and is usually seen in patients between 12 and 20 weeks of gestation.

What is the most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa)? 1 Bleeding 2 Intense abdominal pain 3 Uterine activity 4 Cramping

2 - Intense abdominal pain pg 306/308 - Pain is absent with placenta previa but may be agonizing with abruptio placentae. Bleeding may be present in varying degrees for both placental conditions. Uterine activity may be present with both placental conditions. Cramping is a form of uterine activity that may be present in both placental conditions.

A pregnant patient has a systolic blood pressure that exceeds 160 mm Hg. Which action should the nurse take for this patient? 1 Administer magnesium sulfate intravenously. 2 Obtain a prescription for antihypertensive medications. 3 Restrict intravenous and oral fluids to 125 mL/hr. 4 Monitor fetal heart rate (FHR) and uterine contractions (UCs).

2 - Obtain a prescription for antihypertensive medications. pg 281 - Systolic blood pressure exceeding 160 mm Hg indicates severe hypertension in the patient. The nurse should alert the health care provider and obtain a prescription for antihypertensive medications, such as nifedipine (Adalat) and labetalol hydrochloride (Normodyne). Magnesium sulfate would be administered if the patient was experiencing eclamptic seizures. Oral and intravenous fluids are restricted when the patient is at risk for pulmonary edema. Monitoring FHR and UCs is a priority when the patient experiences a trauma so that any complications can be addressed immediately.

The nurse observes that a pregnant patient with gestational hypertension who is on magnesium sulfate therapy is prescribed nifedipine (Adalat). What action does the nurse take? 1 Evaluates the patient's renal function test 2 Obtains a prescription for a change of drug 3 Reduces the nifedipine (Adalat) dose by 50% 4 Administers both medications simultaneously

2 - Obtains a prescription for a change of drug pg 293 - Concurrent use of nifedipine (Adalat) and magnesium sulfate can result in skeletal muscle blockade in the patient. Therefore the nurse needs to report immediately to the primary health care provider (PHP) and obtain a prescription for a change of drug. The nurse assesses the patient's renal function to determine the risk for toxicity after administering any drug. However, it is not a priority in this case. Reducing the nifedipine (Adalat) dose is not likely to prevent the drug interaction in the patient. The nurse does not administer both drugs simultaneously because it may be harmful for the patient.

Which is an important nursing intervention when a patient has an incomplete miscarriage with heavy bleeding? 1 Initiate expectant management at once. 2 Prepare the patient for dilation and curettage. 3 Administer the prescribed oxytocin (Pitocin). 4 Obtain a prescription for ergonovine (Methergine).

2 - Prepare the patient for dilation and curettage. pg 297/299 - In the case of an incomplete miscarriage, sometimes there is heavy bleeding and excessive cramping and some part of fetal tissue remains in the uterus. Therefore the nurse needs to prepare the patient for dilation and curettage for the removal of the fetal tissue. Expectant management is initiated if the pregnancy continues after a threatened miscarriage. Oxytocin (Pitocin) is administered to prevent hemorrhage after evacuation of the uterus. Ergonovine (Methergine) is administered to contract the uterus.

Which finding in a urine specimen of a pregnant patient indicates the client has proteinuria? 1 Value of ≥0.5 protein in a dipstick testing 2 Protein concentration that is ≥300 mg/24 hours 3 Concentration of ≥1 g protein in a 24-hour urine collection 4 Protein concentration at 10 mg/dL in random urine specimen

2 - Protein concentration that is ≥300 mg/24 hours pg 282 - Proteinuria is determined from dipstick testing on a clean-catch or catheterized urine specimen or evaluation of a 24-hour urine collection. Protein concentration that is ≥300 mg/24 hours in a 24-hour urine specimen indicates proteinuria. A concentration of ≥5 g protein in a 24-hour urine collection will indicate severe preeclampsia. Protein concentration ≥30 mg/dL in at least two random urine specimens collected at least 6 hours apart will indicate proteinuria. Value of ≥1 g on dipstick measurement indicates proteinuria.

What does the nurse include in the plan of care of a pregnant patient with mild preeclampsia? Select all that apply. 1 Ensure prolonged bed rest. 2 Provide diversionary activities. 3 Encourage the intake of more fluids. 4 Restrict sodium and zinc in the diet. 5 Refer to Internet-based support group.

2 - Provide diversionary activities. 3 - Encourage the intake of more fluids. 5 - Refer to Internet-based support group. pg 288 - Activity is restricted in patients with preeclampsia, so it is necessary to provide diversionary activities to such patients to prevent boredom. The nurse encourages the patient to increase fluid intake to enhance renal perfusion and bowel function. The nurse can suggest Internet-based support groups to reduce boredom and stress in the patient. Patients need to restrict activity, but complete bed rest is not advised because it may cause cardiovascular deconditioning, muscle atrophy, and psychological stress. The patient needs to include adequate zinc and sodium in the diet for proper fetal development.

A woman with severe preeclampsia is being treated with an intravenous infusion of magnesium sulfate. This treatment is considered successful if what occurs? 1 Blood pressure is reduced to prepregnant baseline 2 Seizures do not occur 3 Deep tendon reflexes become hypotonic 4 Diuresis reduces fluid retention

2 - Seizures do not occur pg 289 - Magnesium sulfate is a central nervous system (CNS) depressant given primarily to prevent seizures. A temporary decrease in blood pressure can occur; however, this is not the purpose of administering this medication. Hypotonia is a sign of an excessive serum level of magnesium. It is critical that calcium gluconate be on hand to counteract the depressant effects of magnesium toxicity. Diuresis is not an expected outcome of magnesium sulfate administration.

Which intervention does the nurse implement for a patient immediately after a severe abdominal trauma? 1 Prepare the patient for cesarean birth. 2 Send the patient for pelvic computed tomography (CT) scanning. 3 Provide fluids to the patient as part of the protocol for ultrasound examination. 4 Prepare to administer Rho(D) immunoglobulin.

2 - Send the patient for pelvic computed tomography (CT) scanning. pg 318 - Pelvic CT scanning helps visualize extraperitoneal and retroperitoneal structures and the genitourinary tract. The nurse needs to prepare the patient for cesarean birth if there is no evidence of a maternal pulse. Ultrasound examination is not as effective as electronic fetal monitoring for determining placental abruption in the patient after the trauma. Therefore the nurse prepares the patient for a CT scan after a severe abdominal trauma. The nurse needs to administer Rho(D) immunoglobulin in an Rh-negative pregnant trauma patient. This helps protect the patient from isoimmunization.

A pregnant patient is at risk for cardiac arrest as a result of profound hypovolemia after a trauma. Which action does the nurse take? 1 The nurse assesses airway, breathing, and pulse rate. 2 The nurse administers warmed crystalloid solutions. 3 The nurse administers calcium gluconate intravenously. 4 The nurse obtains a prescription for magnesium sulfate.

2 - The nurse administers warmed crystalloid solutions. pg 316 - The nurse administers warmed crystalloid solutions for massive fluid resuscitation in the patient who has profound hypovolemia after a trauma. The nurse needs to assess the airway, breathing, and pulse in a patient after a convulsion so that prompt actions can be taken to stabilize the patient. The nurse administers calcium gluconate as an antidote to a patient who has magnesium toxicity. The nurse may administer magnesium sulfate for the treatment of eclamptic seizures in a patient with preeclampsia.

The nurse finds diuresis, weight loss, and muscle atrophy in a pregnant patient with mild preeclampsia. What does the nurse conclude from these findings? 1 The patient was mostly on a liquid diet. 2 The patient was on prolonged bed rest. 3 The patient has developed HELLP syndrome. 4 The patient is at risk for placental abruption.

2 - The patient was on prolonged bed rest. pg 288 - Prolonged bed rest in patients with preeclampsia may result in diuresis and fluid, electrolyte, and weight loss. Therefore the nurse advises the patient to restrict activity instead of taking complete bed rest. A liquid diet may contribute to weight loss, but it does not cause diuresis or muscle atrophy. HELLP syndrome is characterized by hemolysis (H), elevated liver enzymes (EL), and low platelet count (LP) in a patient with preeclampsia. Vaginal bleeding will indicate placental abruption in the patient.

At 38 weeks of gestation, a 24-year-old primipara delivers a 6-lb 2-oz infant whose five-minute Apgar was 8. How should the neonatal nurse evaluate the outcome of this pregnancy because his mother had been experiencing hyperemesis gravidarum since the eighth week of pregnancy? 1 High-risk and needs extensive monitoring. 2 Within healthy parameters for gestation, weight, and Apgar. 3 Very small for gestational age and needs frequent feedings. 4 At high risk for hypoglycemia and tremors.

2 - Within healthy parameters for gestation, weight, and Apgar. pg 295 - Fetal and neonatal complications include small-for-gestational-age fetuses, low birth weight, prematurity, and five-minute Apgar scores less than 7. This infant is a reasonable weight for the gestation and Apgar score.

What does the nurse advise a pregnant patient who is prescribed phenazopyridine (Pyridium) for cystitis? 1 "Avoid sweet foods in diet." 2 "Limit exposure to sunlight." 3 "Do not wear contact lenses." 4 "Restrict oral fluids to 125 mL per hour."

3 - "Do not wear contact lenses." pg 311 - Phenazopyridine (Pyridium) colors the tears orange. Therefore the nurse instructs the patient to avoid wearing contact lenses. Sweet foods are avoided in patients with diabetes mellitus, because they can cause fluctuating glucose levels, which may harm the fetus. Exposure to sunlight is avoided when the patient is receiving methotrexate therapy, because it causes photosensitivity. Oral fluids are restricted in patients who are at risk for pulmonary edema.

What instruction does the nurse provide to a pregnant patient with mild preeclampsia? 1 "You need to be hospitalized for fetal evaluation." 2 "Nonstress testing can be done once every month." 3 "Fetal movement counts need to be evaluated daily." 4 "Take complete bed rest during the entire pregnancy."

3 - "Fetal movement counts need to be evaluated daily." pg 287 - Preeclampsia can affect the fetus and may cause fetal growth restrictions, decreased amniotic fluid volume, abnormal fetal oxygenation, low birth weight, and preterm birth. Therefore the fetal movements need to be evaluated daily. Patients with mild preeclampsia can be managed at home effectively and need not be hospitalized. Nonstress testing is performed once or twice per week to determine fetal well-being. Patients need to restrict activity, but complete bed rest is not advised because it may cause cardiovascular deconditioning, muscle atrophy, and psychological stress.

Which statement made by the nursing student about the management of molar pregnancy indicates effective learning? 1 "Methotrexate therapy is prescribed to abort molar pregnancy." 2 "Expectant management is initiated as per the amount of bleeding." 3 "Suction curettage is the safest way of terminating molar pregnancy." 4 "Induction of labor with oxytocic agents is one of the treatment options."

3 - "Suction curettage is the safest way of terminating molar pregnancy." pg 305 - In molar pregnancy, the avascular transparent vesicles in the uterus may cause uterine distention. Therefore suction curettage is used for rapid and effective evacuation of the hydatidiform mole. Methotrexate therapy is prescribed to dissolve an ectopic pregnancy. Expectant management is initiated in case of a normal fetus and not molar pregnancy. Induction of labor with oxytocic agents is not a safe method, because it has a risk of embolization of trophoblastic tissue.

A blunt abdominal trauma causes fetal hemorrhage in a pregnant patient. The nurse finds that the patient is Rh negative. What action does the nurse take? 1 Initiate magnesium sulfate per protocol. 2 Administer oxytocin (Pitocin). 3 Administer prescribed Rho(D) immunoglobulin. 4 Prepare the patient for magnetic resonance imaging (MRI).

3 - Administer prescribed Rho(D) immunoglobulin. pg 318 - The nurse administers the prescribed Rho(D) immunoglobulin to the patient to protect the patient from isoimmunization. The nurse needs to obtain a prescription for magnesium sulfate if there are eclamptic seizures in a patient with preeclampsia. Oxytocin (Pitocin) is administered to prevent bleeding after birth or the evacuation of the uterus. Magnetic resonance imaging (MRI) is used to assess injuries in a patient after trauma.

A patient with severe gestational hypertension is prescribed hydralazine (Apresoline). What is a priority nursing intervention in this case? 1 Assess for visual disturbances. 2 Assess airway, breathing, and pulse. 3 Assess blood pressure frequently. 4 Prepare the patient for nonstress testing.

3 - Assess blood pressure frequently. pg 293 - Hydralazine (Apresoline) is an antihypertensive medication. The nurse assesses the patient's blood pressure (BP) frequently because a precipitous drop in BP can lead to shock and placental abruption. Visual disturbances are symptoms of severe preeclampsia and not a side effect of hydralazine (Apresoline). The nurse needs to assess airway, breathing, and pulse to stabilize a pregnant patient after a convulsion. Nonstress testing is performed once or twice weekly to assess fetal well-being.

At 37 weeks of gestation, the patient is in a severe automobile crash where her abdomen was hit by the steering wheel and her seat belt. What priority action would the emergency room nurse expect to perform upon the patient's arrival at the hospital? 1 Stay with the patient, assure a patent airway is present, and keep the patient as calm as possible. 2 Move the patient's skirt to determine if any vaginal bleeding is present, find out who to call, and monitor the level of consciousness. 3 Assess the patient's vital signs, determine location and severity of pain, and establish continual fetal heart rate monitoring. 4 Obtain arterial blood gases, obtain a hemoglobin and hematocrit, and oxygen saturation rate.

3 - Assess the patient's vital signs, determine location and severity of pain, and establish continual fetal heart rate monitoring. pg 314 - Full assessment of the patient and her fetus are essential and include vital signs, continual fetal heart rate monitoring, determining the location and severity of pain, whether any vaginal bleeding is dark red or bright red, and the status of the abdomen, which would be expected to be rigid or "board like." Staying with the patient, assuring a patent airway is present, and keeping the patient as calm as possible would be appropriate at the crash site before the arrival of emergency medical services (EMS). The current status of the patient and fetus are the priority. The health care provider would prescribe the arterial blood gases and other laboratory work after the patient is assessed and stabilized.

A labor and delivery nurse is in the process of admitting a patient who is 39 and at 5 weeks of gestation with a diagnosis of preeclampsia. The nurse has evaluated vital signs, weight, and deep tendon reflexes. Although the presence of edema is no longer included in the definition of preeclampsia, it is an important component of the nurse's evaluation. Edema is assessed for distribution, degree and pitting. Although the amount of edema is difficult to quantify, it is important to record the relative degrees of edema formation. From the graphic below, please select the illustration that best displays +3 edema.

3 - C pg 285 - The graphic illustrates a depth of 6 mm when the nurse applies finger pressure to the swollen area. This measurement indicates a +3 measurement for edema. Upon applying finger pressure, a 2-mm depression would be the equivalent of a +1, a 4-mm depression a +2, and an 8-mm depression a +4.

A labor and delivery nurse is in the process of admitting a patient who is 39 and at 5 weeks of gestation with a diagnosis of preeclampsia. The nurse has evaluated vital signs, weight, and deep tendon reflexes. Although the presence of edema is no longer included in the definition of preeclampsia, it is an important component of the nurse's evaluation. Edema is assessed for distribution, degree and pitting. Although the amount of edema is difficult to quantify, it is important to record the relative degrees of edema formation. From the graphic below, please select the illustration that best displays +3 edema. 1 - A 2 - B 3 - C 4 - D

3 - C pg 285 - The graphic illustrates a depth of 6 mm when the nurse applies finger pressure to the swollen area. This measurement indicates a +3 measurement for edema. Upon applying finger pressure, a 2-mm depression would be the equivalent of a +1, a 4-mm depression a +2, and an 8-mm depression a +4.

The nurse observes that maternal hypotension has decreased uterine and fetal perfusion in a pregnant patient. What does the nurse need to assess further to understand the maternal status? 1 D-dimer blood test 2 Kleihauer-Betke (KB) test 3 Electronic fetal monitoring 4 Electrocardiogram reading

3 - Electronic fetal monitoring pg 314 - Electronic fetal monitoring reflects fetal cardiac responses to hypoxia and hypoperfusion and helps to assess maternal status after a trauma. The D-dimer blood test is used to rule out the presence of a thrombus. The KB test is used to evaluate transplacental hemorrhage. Electrocardiogram reading is more useful to assess the cardiac functions in nonpregnant cardiac patients.

Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. What is an appropriate management approach for this type of abortion? 1 Prepare the woman for a dilation and curettage (D&C). 2 Place the woman on bed rest for at least 1 week and reevaluate. 3 Prepare the woman for an ultrasound and bloodwork. 4 Comfort the woman by telling her that if she loses this baby, she may attempt to get pregnant again in 1 month.

3 - Prepare the woman for an ultrasound and bloodwork. pg 298 - Repetitive transvaginal ultrasounds and measurement of human chorionic gonadotropin (hCG) and progesterone levels may be performed to determine if the fetus is alive and within the uterus. If the pregnancy is lost, the woman should be guided through the grieving process. D&C is not considered until signs of the progress to an inevitable abortion are noted or the contents are expelled and incomplete. Bed rest is recommended for 48 hours initially. Telling the woman that she can get pregnant again soon is not a therapeutic response because it discounts the importance of this pregnancy.

Which intervention will help prevent the risk of pulmonary edema in a pregnant patient with severe preeclampsia? 1 Assess fetal heart rate (FHR) abnormalities regularly. 2 Place the patient on bed rest in a darkened environment. 3 Restrict total intravenous (IV) and oral fluids to 125 mL/hr. 4 Ensure that magnesium sulfate is administered as prescribed.

3 - Restrict total intravenous (IV) and oral fluids to 125 mL/hr. pg 289 - Pulmonary edema may be seen in patients with severe preeclampsia. Therefore the nurse needs to restrict total IV and oral fluids to 125 mL/hr. FHR monitoring helps assess any fetal complications. The patient is placed on bed rest in a darkened environment to prevent stress. Magnesium sulfate is administered to prevent eclamptic seizures.

Which maternal risk is associated with placenta previa? 1 Preeclampsia 2 Placental abruption 3 Surgery-related trauma 4 Gestational hypertension

3 - Surgery-related trauma pg 306/307 - A patient with placenta previa has a cesarean birth and is at risk for surgery-related trauma to the sutures adjacent to the uterus. Preeclampsia is a condition in which the patient has hypertension and proteinuria after 20 weeks of gestation. The patient is at risk for a placental abruption if the patient experiences a trauma. Gestational hypertension is a hypertensive disorder in a pregnant patient and is not related to placenta previa.

Which statement made by the nursing student about the management of reduced cervical competence (premature dilation of the cervix) in a pregnant patient indicates effective learning? 1 "Progesterone supplementation is the only effective treatment." 2 "An abdominal cerclage is performed at the first week of gestation." 3 "Surgical treatment is ineffective in patients with an extremely short cervix." 4 "A prophylactic cerclage is used to constrict the internal os of the cervix."

4 - "A prophylactic cerclage is used to constrict the internal os of the cervix." pg 299/300 - The best treatment option for premature dilation of the cervix is to surgically place a prophylactic cerclage to constrict the internal os of the cervix. It is usually placed at 11 to 15 weeks of gestation. Progesterone supplementation may not be effective in constricting the cervix, and surgical intervention may be necessary. An abdominal cerclage is necessary in case of a failed vaginal cerclage and is usually placed at 11 to 13 weeks of gestation in patients by means of a laparotomy. In patients with an extremely short cervix, an abdominal cerclage is used, which is followed by a cesarean birth.

Which pregnant patient is a likely candidate for expectant management? 1 A patient with a molar pregnancy that has a risk for vaginal bleeding. 2 A patient who is 32 6/7 weeks of gestation and likely to deliver soon. 3 A patient diagnosed with preeclampsia who is taking an antihypertensive medication. 4 A patient with a threatened miscarriage that has no bleeding or infection.

4 - A patient with a threatened miscarriage that has no bleeding or infection. pg 298 - If bleeding and infection do not occur after a threatened miscarriage, then the patient is managed expectantly to continue the pregnancy successfully. Molar pregnancy is terminated as soon as it is identified; therefore there is no need for expectant management. A patient who is 32 6/7 weeks of gestation who has no indication of giving birth immediately needs to be managed expectantly, because the mother and the neonate may need intensive care. A patient with preeclampsia who is taking an antihypertensive medication does not need expectant management because the condition can be managed at home.

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 what? 1 Eclamptic seizure 2 Rupture of the uterus 3 Placenta previa 4 Abruptio placentae

4 - Abruptio placentae pg 308 - Women with hypertension are at increased risk for an abruption. Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture presents as hypotonic uterine activity, signs of hypovolemia, and in many cases the absence of pain. Placenta previa presents with bright red, painless vaginal bleeding. Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption).

Which is a priority nursing action when a pregnant patient with severe gestational hypertension is admitted to the health care facility? 1 Prepare the patient for cesarean delivery. 2 Administer intravenous (IV) and oral fluids. 3 Provide diversionary activities during bed rest. 4 Administer the prescribed magnesium sulfate.

4 - Administer the prescribed magnesium sulfate. pg 288 - The nurse administers the prescribed magnesium sulfate to the patient to prevent eclamptic seizures. IV oral fluids are indicated when there is severe dehydration in the patient. It is important to provide diversionary activities during bed rest, but it is secondary in this case. A patient who has experienced a multisystem trauma is prepared for cesarean delivery if there is no evidence of a maternal pulse, which increases the chance of maternal survival.

What does the nurse administer to a patient if there is excessive bleeding after suction curettage? 1 Nifedipine (Procardia) 2 Methyldopa (Aldomet) 3 Hydralazine (Apresoline) 4 Ergonovine (Methergine)

4 - Ergonovine (Methergine) pg 300 - Ergonovine (Methergine) is an ergot product, which is administered to contract the uterus when there is excessive bleeding after suction curettage. Nifedipine (Procardia) is prescribed for gestational hypertension or severe preeclampsia. Methyldopa (Aldomet) is an antihypertensive medication indicated for pregnant patients with hypertension. Hydralazine (Apresoline) is also an antihypertensive medication used for treating hypertension intrapartum.

Which fetal risk is associated with an ectopic pregnancy? 1 Miscarriage 2 Fetal anemia 3 Preterm birth 4 Fetal deformity

4 - Fetal deformity pg 302 - In an ectopic pregnancy, the risk for fetal deformity is high because of the pressure deformities caused by oligohydramnios. There may be facial or cranial asymmetry, various joint deformities, limb deficiency, and central nervous system (CNS) anomalies. Miscarriage is not likely to happen in an ectopic pregnancy. Instead, the patient is at risk for pregnancy-related death resulting from ectopic rupture. Fetal anemia is a risk associated with placenta previa. Preterm birth is not possible because the pregnancy is dissolved when it is diagnosed or a surgery is performed to remove the fetus.

A patient reports excessive vomiting in the first trimester of the pregnancy, which has resulted in nutritional deficiency and weight loss. The urinalysis report of the patient indicates ketonuria. Which disorder does the patient have? 1 Preeclampsia 2 Hyperthyroid disorder 3 Gestational hypertension 4 Hyperemesis gravidarum

4 - Hyperemesis gravidarum pg 295 - Hyperemesis gravidarum is characterized by excessive vomiting during pregnancy, which causes nutritional deficiency and weight loss. The presence of ketonuria is another indication of this disorder. Preeclampsia refers to hypertension and proteinuria in patients after 20 weeks of gestation. Hyperthyroid disorder may be one of the causes of hyperemesis gravidarum. Gestational hypertension also develops after 20 weeks of gestation.

Which is a priority nursing intervention while caring for a pregnant patient with hyperemesis gravidarum? 1 Initiate parenteral nutrition. 2 Observe the patient for seizures. 3 Administer magnesium sulfate. 4 Initiate intravenous (IV) fluid therapy.

4 - Initiate intravenous (IV) fluid therapy. pg 295 - Hyperemesis gravidarum results in weight loss and electrolyte imbalance in a patient. Therefore the nurse needs to initiate and monitor IV fluid therapy to prevent further deterioration of the patient's health. Parenteral nutrition has potential risks and is initiated only if multiple medical management and enteral tube feeding attempts have not been successful. Hyperemesis gravidarum does not cause seizures; it causes nutritional deficiencies. Magnesium sulfate is administered to a patient with eclamptic seizures.

What action does the nurse take before performing cardiopulmonary resuscitation (CPR) to revive a pregnant patient undergoing a cardiac arrest? 1 Administer normal saline solution. 2 Assess for fetal-maternal hemorrhage. 3 Call two staff nurses to hold the patient. 4 Place a rolled blanket under the patient's hips.

4 - Place a rolled blanket under the patient's hips. pg 316 - The nurse needs to displace the uterus to enhance cardiac output in the patient during CPR. Therefore the nurse places a rolled blanket under the patient's hips, which helps displace the uterus manually. The nurse may administer normal saline solution to a patient who has profound hypovolemia after a trauma for massive fluid resuscitation. Fetal-maternal hemorrhage is a concern in a patient who has experienced a trauma. It is not necessary to have two nurses to hold the patient. The nurse is trained to start the CPR during an emergency.

A pregnant patient after 20 weeks of gestation reports painless, bright red vaginal bleeding. Upon assessment, the nurse finds that the patient's vital signs are normal. Which condition does the nurse suspect in the patient? 1 Eclampsia 2 Preeclampsia 3 Pyelonephritis 4 Placenta previa

4 - Placenta previa pg 306 - Placenta previa is indicated by painless, bright red vaginal bleeding during the second or third trimester of pregnancy. The patient's vital signs may be normal even after blood loss, because a pregnant patient can lose up to 40% of the blood volume without any signs of shock. Eclampsia is the onset of seizure activity in a patient with preeclampsia. Preeclampsia is indicated by hypertension and proteinuria after 20 weeks of gestation. Pyelonephritis is an infection caused by Escherichia coli organism, which is identified by fever, shaking chills, and aching in the lumbar area of the back.

Which condition does the nurse monitor in a pregnant patient diagnosed with acute pyelonephritis? 1 Eclampsia 2 Miscarriage 3 Placenta previa 4 Pulmonary injury

4 - Pulmonary injury pg 311/312 - Acute pyelonephritis is an infection caused by the Escherichia coli organism. The endotoxins from gram-negative bacteria damage the alveolar tissue and may cause pulmonary injury. Eclampsia is the onset of seizure activity in a patient with preeclampsia. Acute pyelonephritis is associated with preterm labor and not miscarriage. Placenta previa is a condition wherein the placenta is implanted in the lower uterine segment covering the cervix, which causes bleeding when the cervix dilates.