Chapter 19 OB: test 2

which condition is at increased risk for hydramnios during pregnancy? a. HTN b. isoimmunization c. diabetes d. late maternal age

c

A nurse in the ED is caring for a client who reports abrupt, sharp, right-sided lower quadrant abdominal pain and bright red vaginal bleeding. The client states she missed one menstrual cycle and cannot be pregnant because she has an IUD. The nurse should suspect which of the following? A. Missed abortion B. Ectopic pregnancy C. Severe preeclampsia D. Hydatidiform mole

B

A pregnant woman has been admitted to the hospital due to severe preeclampsia. Which measure will be important for the nurse to include in the care plan? A) Institute NPO status. B) Plan for immediate induction of labor. C) Institute and maintain seizure precautions. D) Admit the client to the middle of ICU where she can be constantly monitored.

C) Institute and maintain seizure precautions. The woman with severe preeclampsia should be maintained on complete bed rest in a dark and quiet room to avoid stimulation. The client is at risk for seizures; therefore, institution and maintenance of seizure precautions should be in place.

A bleeding condition that occurs during last 2 trimesters. When the placenta abnormally implants in lower segment of uterus near or over cervical os instead of attaching to fundus. Risk factor: previous c-section

Placenta previa

This condition caused hyperbilirubinemia in the infant

ABO incompatibility

Findings of placenta previa

insidious onset, visible bleeding, bright red blood, painless, soft contender uterus, normal FHR, normal vitals, decreased urine output

The home care nurse is monitoring a pregnant client with gestational hypertension who is at risk for preeclampsia. At each home care visit, the nurse assesses the client for which classic signs of preeclampsia? Select all that apply. a) Proteinuria b) Hypertension c) Low-grade fever d) Generalized edema e) Increased pulse rate f) Increased respiratory rate

A, B, D - Rationale: The three classic signs of preeclampsia are hypertension, generalized edema, and proteinuria. A low-grade fever, increased pulse rate, or increased respiratory rate is not associated with preeclampsia.

A nurse is caring for a client who has suspected hyperemesis gravidarum and is reviewing the client's laboratory reports. Which of the following findings is a manifestation of this condition? A. Hgb 12.2 g/dL B. Urine ketones present C. Alanine amniotransferase 20 IU/L D. Serum glucose 114 mg/dL

B

A woman with an incomplete abortion is to receive misoprostol. The woman asks the nurse, "Why am I getting this drug?" The nurse responds to the client, integrating understanding that this drug achieves which effect? A) suppresses the immune response to prevent isoimmunization B) ensures passage of all the products of conception C) halts the progression of the abortion D) alleviates strong uterine cramping

B) ensures passage of all the products of conception Misoprostol is used to stimulate uterine contractions and evacuate the uterus after an abortion to ensure passage of all the products of conception. Rh (D) immunoglobulin is used to suppress the immune response and prevent isoimmunization.

Blood pressure diagnosis of preeclampsia

BP of 140/900 mm Hg on two occasions 6 hours apart

A proliferation and degeneration of trophoblastic villi in the placenta that becomes swollen, fluid-filled, and takes on the appearance of grape-like clusters. Embryo fails to develop beyond primitive state and these structures are associated with choriocarinoma.

Gestational trophoblastic disease

A nurse is providing care for a client who is at 32 weeks of gestation and who has a placenta previa. The nurse notes that the client is actively bleeding. Which of the following types of medications should the nurse anticipate the provider will prescribe? A. Betamethasone B. Indomethacin C. Nifedipine D. Methylergonovine

A. Betamethasone to promote lung maturity

Severe form of nausea and vomiting past 1st trimester

Hyperemesis Gravidarum

Detects fetal cells in maternal circulation

Kleinhauer-Betke test

Management of ectopic pregnancy

Medical: IM methotrexate if future pregnancy is desired Surgical: salpingostomy or salpingectomy (removal of tube)

Sometimes an ectopic pregnancy occurs outside the woman's uterus. This usually occurs in one of the fallopian tubes. If the embryo continues to grow, it may rupture the tube. What are the signs and symptoms of a ruptured fallopian tube? a) Rectal pain b) Unilateral abdominal pain c) Shoulder pain d) Bilateral abdominal pain

c. Shoulder pain Explanation: Rarely, a woman may present with late signs, such as shoulder pain or hypovolemic shock. These signs are associated with tubal rupture, which occurs when the pregnancy expands beyond the tube's ability to stretch.

Which is not a cause of bleeding early in pregnancy? a. GTD b. spontaneous abortion c. placenta previa d. ectopic pregnancy

c. placenta previa

RhoGAM should be administered to Rh-_________ women

negative

When administering magnesium sulfate to a woman with severe preeclampsia, which finding would alert the nurse to the development of magnesium toxicity? a) Diminished reflexes b) Seizures c) Elevated liver enzymes d) Serum magnesium level of 6.5 mEq/L

a. diminished reflexes

A primagravida is receiving magnesium sulfate for the treatment of pregnancy induced hypertension (PIH). The nurse who is caring for the client is performing assessments every 30 minutes. Which assessment finding would be of most concern to the nurse? a. Urinary output of 20 ml since the previous assessment b. Deep tendon reflexes of 2+ c. Respiratory rate of 10 BPM d. Fetal heart rate of 120 BPM

ANSWER C. Magnesium sulfate depresses the respiratory rate. If the respiratory rate is less than 12 breaths per minute, the physician or other health care provider needs to be notified, and continuation of the medication needs to be reassessed. A urinary output of 20 ml in a 30 minute period is adequate; less than 30 ml in one hour needs to be reported. Deep tendon reflexes of 2+ are normal. The fetal heart rate is WNL for a resting fetus.

A pregnant woman is diagnosed with abruptio placentae. When reviewing the woman's medical record, the nurse would expect which finding? A) soft, relaxed uterus on palpation B) sudden dark, vaginal bleeding C) fetal heart rate within normal range D) absence of pain

B) sudden dark, vaginal bleeding The uterus is firm to rigid to the touch with abruptio placentae; it is soft and relaxed with placenta previa. Bleeding associated with abruptio placentae occurs suddenly and is usually dark in color. Bleeding also may not be visible. Bright red vaginal bleeding is associated with placenta previa. Fetal distress or absent fetal heart rate may be noted with abruptio placentae. The woman with abruptio placentae usually experiences constant uterine tenderness on palpation.

A nurse is caring for a client who has a diagnosis of ruptured ectopic pregnancy. Which of the following findings is seen with this condition? A. No alteration in menses B. Transvaginal ultrasound indicating a fetus in the uterus C. Serum progesterone greater than the expected reference range D. Report of severe shoulder pain

D

What makes the diagnosis of gestational hypertension different from the diagnosis of preeclampsia? a) Ketonuria b) The hypertension of gestation disappears after delivery. The hypertension of preeclampsia does not. c) Severity of hypertension d) Proteinuria

D

A nurse is caring for a client who is receiving IV magnesium sulfate. Which of the following medications should the nurse anticipate administering if magnesium sulfate toxicity is suspected? A. Nifedipine B. Pyridoxine C. Ferrous sulfate D. Calcium gluconate

D. Calcium gluconate

This test determines whether the mother developed isoimmunity to Rh antigen

Indirect coombs test

Which of the following would the nurse interpret as indicating that a pregnant client with gestational hypertension has developed severe preeclampsia? a) Blood pressure of 150/100 mm Hg b) Proteinuria of 300 mg/24 hours c) Blurred vision d) Mild facial edema

c. blurred vision

A common benign form of gestational trophoblastic disease

hydatidiform mole

A woman who presents with PPROM has completed how many weeks of gestation?

less than 37 weeks

Management for cervical insufficiency

shirodkar procedure (cerclage: purse string sutures)

A nurse is administering magnesium sulfate IV to a client who has severe preeclampsia for seizure prophylaxis. Which of the following indicates magnesium sulfate toxicity? (Select all that apply) A. Respirations less than 12/min B. Urinary output less than 30 mL/hr C. Hyperreflexic deep-tendon reflexes D. Decreased LOC E. Flushing and sweating

A,B,D

A nurse is caring for a client who is at 14 weeks of gestation and has hyperemesis gravidarum. The nurse should identify that which of the following are risk factors for the client? (Select all that apply) A. Obesity B. Multifetal pregnancy C. Maternal age greater than 40 D. Migraine headache E. Oligohydramnios

A,B,D

A nurse is caring for a pregnant client with severe preeclampsia who is receiving IV magnesium sulfate. Select all nursing interventions that apply in the care for the client. a. Monitor maternal vital signs every 2 hours b. Notify the physician if respirations are less than 18 per minute. c. Monitor renal function and cardiac function closely d. Keep calcium gluconate on hand in case of a magnesium sulfate overdose e. Monitor deep tendon reflexes hourly f. Monitor I and O's hourly g. Notify the physician if urinary output is less than 30 ml per hour.

ANSWER C, D, E, F, and G. When caring for a client receiving magnesium sulfate therapy, the nurse would monitor maternal vital signs, especially respirations, every 30-60 minutes and notify the physician if respirations are less than 12, because this would indicate respiratory depression. Calcium gluconate is kept on hand in case of magnesium sulfate overdose, because calcium gluconate is the antidote for magnesium sulfate toxicity. Deep tendon reflexes are assessed hourly. Cardiac and renal function is monitored closely. The urine output should be maintained at 30 ml per hour because the medication is eliminated through the kidneys.

A premature separation of placenta from uterus. This is the leading cause of maternal death. This separation occurs after 20 weeks of gestation. This is an emergency situation!

Abruptio placentae

Coagulation defect, such as disseminated intravascular coagulopathy (DIC) is often associated with this condition.

Abruptio placentae

The nurse is reviewing the health care provider's (HCP's) prescriptions for a client admitted for premature rupture of the membranes. Gestational age of the fetus is determined to be 37 weeks. Which prescription should the nurse question? a) Monitor fetal heart rate continuously. b) Monitor maternal vital signs frequently. c) Perform a vaginal examination every shift. d) Administer ampicillin 1 g as an intravenous piggyback every 6 hours.

C - Rationale: Vaginal examinations should not be done routinely on a client with premature rupture of the membranes because of the risk of infection. The nurse would expect to monitor fetal heart rate, monitor maternal vital signs, and administer an antibiotic.

In the 12th week of gestation, a client completely expels the products of conception. Because the client is Rh negative, the nurse must: a. Admister RhoGAM within 72 hours b. Make certain she receives RhoGAM on her first clinic visit c. Not give RhoGAM, since it is not used with the birth of a stillborn d. Make certain the client does not receive RhoGAM, since the gestation only lasted 12 weeks.

ANSWER A. RhoGAM is given within 72 hours postpartum if the client has not been sensitized already.

What does HELLP stand for?

hemolysis, elevated liver enzymes, and low platelets (syndrome of preeclampsia/eclampsia)

Severe preeclampsia findings

high blood pressure of more than 160/110 mm Hg, proteinuria of more than 5 g/24 hr, oliguria of less than 400mL/24 hr, cerebral and visual symptoms, rapid weight gain.

Rho (D) immune globulin (RhoGAM) is prescribed for a woman following delivery of a newborn infant and the nurse provides information to the woman about the purpose of the medication. The nurse determines that the woman understands the purpose of the medication if the woman states that it will protect her next baby from which of the following? a. Being affected by Rh incompatibility b. Having Rh positive blood c. Developing a rubella infection d. Developing physiological jaundice

ANSWER A. Rh incompatibility can occur when an Rh-negative mom becomes sensitized to the Rh antigen. Sensitization may develop when an Rh-negative woman becomes pregnant with a fetus who is Rh positive. During pregnancy and at delivery, some of the baby's Rh positive blood can enter the maternal circulation, causing the woman's immune system to form antibodies against Rh positive blood. Administration of Rho (D) immune globulin prevents the woman from developing antibodies against Rh positive blood by providing passive antibody protection against the Rh antigen.

A nurse is monitoring a pregnant client with pregnancy induced hypertension who is at risk for Preeclampsia. The nurse checks the client for which specific signs of Preeclampsia (select all that apply)? a. Elevated blood pressure b. Negative urinary protein c. Facial edema d. Increased respirations

ANSWER A and C. The three classic signs of preeclampsia are hypertension, generalized edema, and protenuria. Increased respirations are not a sign of preeclampsia.

A pregnant client in the last trimester has been admitted to the hospital with a diagnosis of severe preeclampsia. A nurse monitors for complications associated with the diagnosis and assesses the client for: a. Any bleeding, such as in the gums, petechiae, and purpura. b. Enlargement of the breasts c. Periods of fetal movement followed by quiet periods d. Complaints of feeling hot when the room is cool

ANSWER A. Severe Preeclampsia can trigger disseminated intravascular coagulation (DIC) because of the widespread damage to vascular integrity. Bleeding is an early sign of DIC and should be reported to the M.D.

A nurse is caring for a pregnant client with Preeclampsia. The nurse prepares a plan of care for the client and documents in the plan that if the client progresses from Preeclampsia to eclampsia, the nurse's first action is to: a. Administer magnesium sulfate intravenously b. Assess the blood pressure and fetal heart rate c. Clean and maintain an open airway d. Administer oxygen by face mask

ANSWER C. The immediate care during a seizure (eclampsia) is to ensure a patent airway. The other options are actions that follow or will be implemented after the seizure has ceased.

A nurse is preparing for the admission of a client in the third trimester of pregnancy who is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the health care provider's prescriptions and should question which prescription? a) Prepare the client for an ultrasound. b) Obtain equipment for a manual pelvic examination. c) Prepare to draw a hemoglobin and hematocrit blood sample. d) Obtain equipment for external electronic fetal heart rate monitoring.

B - NCLEX Maternity Practice Questions Rationale: Placenta previa is an improperly implanted placenta in the lower uterine segment near or over the internal cervical os. Manual pelvic examinations are contraindicated when vaginal bleeding is apparent until a diagnosis is made and placenta previa is ruled out. Digital examination of the cervix can lead to hemorrhage. A diagnosis of placenta previa is made by ultrasound. The hemoglobin and hematocrit levels are monitored, and external electronic fetal heart rate monitoring is initiated. Electronic fetal monitoring (external) is crucial in evaluating the status of the fetus, who is at risk for severe hypoxia.

What is hydramnios?

a condition in which excess amniotic fluid accumulates during pregnancy

A nurse at an antepartum clinic is caring for a client who is at 4 months of gestation. The client reports continued nausea and vomiting and scant, prune-colored discharge. She has experienced no weight loss and has a fundal height larger than expected. Which of the following complications should the nurse suspect? A. Hyperemesis gravidarum B. Threatened abortion C. Hydatidiform mole D. Preterm labor

C

Which of the following would the nurse prepare to administer if ordered as treatment for an unruptured ectopic pregnancy? a) Oxytocin b) Methotrexate c) Promethazine d) Ondansetron

b. Methotrexate Explanation: Methotrexate, a folic acid antagonist that inhibits cell division in the developing embryo, is most commonly used to treat ectopic pregnancy. Oxytocin is used to stimulate uterine contractions and would be inappropriate for use with an ectopic pregnancy. Promethazine and ondansetron are antiemetics that may be used to treat hyperemesis gravidarum.

Condition where placenta attaches itself too deeply into the wall of uterus. Cesarean birth increases risk

placenta accreta

Findings of Abruptio placentae

sudden onset, concealed or visible, dark red blood, constant sharp, firm rigid uterus, fetal distress, contractions with hypertonicity, clinical findings of hypovolemic shock

An ultrasound is performed on a client at term gestation who is experiencing moderate vaginal bleeding. The results of the ultrasound indicate that abruptio placentae is present. On the basis of these findings, the nurse should prepare the client for which anticipated prescription? a) Delivery of the fetus b) Strict monitoring of intake and output c) Complete bed rest for the remainder of the pregnancy d) The need for weekly monitoring of coagulation studies until the time of delivery

A - Rationale: Abruptio placentae is the premature separation of the placenta from the uterine wall after the twentieth week of gestation and before the fetus is delivered. The goal of management in abruptio placentae is to control the hemorrhage and deliver the fetus as soon as possible. Delivery is the treatment of choice if the fetus is at term gestation or if the bleeding is moderate to severe and the client or fetus is in jeopardy. Because delivery of the fetus is necessary, options B, C, and D are incorrect regarding management of a client with abruptio placentae.

The nurse is assessing a pregnant client in the second trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which assessment finding should the nurse expect to note if this condition is present? a) Soft abdomen b) Uterine tenderness c) Absence of abdominal pain d) Painless, bright red vaginal bleeding

B - Rationale: Abruptio placentae is the premature separation of the placenta from the uterine wall after the twentieth week of gestation and before the fetus is delivered. In abruptio placentae, acute abdominal pain is present. Uterine tenderness accompanies placental abruption, especially with a central abruption and trapped blood behind the placenta. The abdomen feels hard and boardlike on palpation as the blood penetrates the myometrium and causes uterine irritability. A soft abdomen and painless, bright red vaginal bleeding in the second or third trimester of pregnancy is a sign of placenta previa.

The nurse in a maternity unit is reviewing the clients' records. Which client would the nurse identify as being at the most risk for developing disseminated intravascular coagulation? a) A primigravida with mild preeclampsia b) A primigravida who delivered a 10-lb infant 3 hours ago c) A gravida II who has just been diagnosed with dead fetus syndrome d) A gravida IV who delivered 8 hours ago and has lost 500 mL of blood

C In a pregnant client, disseminated intravascular coagulation (DIC) is a condition in which the clotting cascade is activated, resulting in the formation of clots in the microcirculation. Dead fetus syndrome is considered a risk factor for DIC. Severe preeclampsia is considered a risk factor for DIC; a mild case is not. Delivering a large newborn is not considered a risk factor for DIC. Hemorrhage is a risk factor for DIC; however, a loss of 500 mL is not considered hemorrhage.

A nurse is providing care for a client who is diagnosed with a marginal abruptio placentae. The nurse is aware that which of the following findings are risk factors for developing the condition? (Select all that apply) A. Fetal position B. Blunt abdominal trauma C. Cocaine use D. Maternal age E. Cigarette smoking

B,C,E