Exam 3 Ch. 26, 27, 28
There are many associated risk factors in the development of placenta previa. SATA A.Jogger with low body mass index B.First time mother who smokes 2 packs of cigarettes per day C.Registered nurse who works 3 busy 12 hour shifts a week on a med-surg floor. D.A client who delivered at 32 weeks SVD with her last pregnancy due to pre-eclampsia E.Client pregnant with triplets F.A client who has a history of two previous cesarean sections
B, E, F
What are the nursing considerations concerning a cerclage placement?
Monitor for PTL, SROM, infection; amount of activity determined by HCP
•How is medical management determined for the patient experiencing a miscarriage?
•Medical management and/or surgery depends on classification of miscarriage •Threatened, Inevitable, Incomplete, Complete, Missed
•How is DIC likely to present?
•Premature separation of the placenta causes a massive increase in thrombin to create a clot at the placental bleeding site as body tries to stop the bleeding. Increased clotting depletes the platelets and clotting factors needed to control bleeding, causing excessive and massive bleeding. May see bruising, petechiae, vaginal bleeding
•Why is the follow-up so important? (molar pregnancy)
•These patients have a higher risk of developing choriocarcinoma (CC); CC creates high hCG levels; monitor for rising levels. Difficult to distinguish CC in presence of Pregnancy since rising hCG levels of pregnancy may mask CC.
A patient presents to the emergency department c/o abdominal discomfort. The obstetrician performs an ultrasound and diagnoses a 10-week fetus with positive heart tones located in the ampulla region of the fallopian tube. The nurse understands that the best plan of care for this patient is: (page 678) A.Surgical removal of the pregnancy. B.Dilation and curettage procedure. C.Methotrexate administration. D.Dilation and extraction procedure.
A
All of the following are included in a Biophysical Profile except: A.Doppler blood flow analysis of the umbilical artery B.Ultrasound measurement of amniotic fluid volume C.Ultrasound evaluation of fetal movements D.Ultrasound determination of fetal tone E.Fetal heart rate reactivity as measured by non-stress test. F.Ultrasound evaluation of fetal breathing movements
A Each measurement can get a score of 2 or zero. A score >8/10 is NORMAL. Less than 8, suspect chronic asphyxia
Which of the following statements regarding maternal serum alpha-fetoprotein (MSAFP) tests is false? A.MSAFP is used as a screening tool for chromosomal abnormalities in pregnancy. B.MSAFP screening should occur between 15-20 weeks gestation, ideally between 16-18 weeks. C.If MSAFP levels are elevated, the next step is a Level III ultrasound. D.Inaccurate EDC, multifetal pregnancy, and inaccurately recorded maternal age, race, weight, and presence of IDDM can cause false positive results on the MSAFP.
A MSAFP is used as a screening tool for neural tube defects in pregnancy.
A client has been diagnosed with severe pre-eclampsia at 39 weeks. The client is admitted for delivery. The SVE is 3cm/70/-2. Which orders and nursing interventions are appropriate for this client? SATA A.Foley Catheter B.Magnesium bolus 6 grams over 30 minutes C.Celestone/Betamethasone 12 mg IM now and repeat in 24 hours D.Continuous FHR monitoring E.Type and Hold, hemogram (CBC), OB panel, and Magnesium level F.Artificial rupture of membranes
B, D, E
A 25-year-old client is admitted at 12 weeks gestation for vaginal bleeding, no fetal heartbeat is seen on ultrasound. The client is experiencing what type of loss and what is an appropriate treatment? A.Incompetent cervix, cerclage placement B.Missed abortion, amniocentesis C.Inevitable abortion, dilation and curettage D.Incomplete abortion, Cytotec (Misoprostil) induction
C
A client begins to experience an eclamptic seizure. What is the nursing priority? A.Administer Valium (Diazepam) IV B.Suction the client's PO secretions C.Place the client on the external fetal monitor D.Protect the client's head and displace her uterus to the left
D
A pregnant woman is being discharged from the hospital after placement of cerclage due to a history of recurrent pregnancy loss secondary to an incompetent cervix. Discharge teaching should emphasize that: A.She will need to make arrangements so that she can be on strict bed rest at home. B.She will need to deliver via cesarean section. C.The patient will be placed on antibiotics throughout the remainder of her pregnancy. D.The presence of any uterine cramping or low back pain should be reported to her health care provider.
D
Are there any complications for the mother and baby as a result exposure to pre-eclampsia and/or Magnesium Sulfate? SATA A."This is not a concern, we have caught the disease before it had an opportunity to cause long term problems." B."Infants who are exposed to Magnesium Sulfate during pregnancy are more likely to develop cerebral palsy." C."All women who are exposed to pre-eclampsia are more likely to experience Diabetes Mellitus in the future." D."Pre-eclampsia increases your risk for developing chronic hypertension and cardiovascular disease." E."Magnesium exposure during pregnancy can lead spasticity of muscles and contractures."
D
The nurse is discharging a client after delivery and resolution of a molar pregnancy. The most important aspect of teaching to impart to this client is A.Avoid conception/pregnancy for 3-6 months B.Using sunscreen while taking Doxycycline/Targadox C.Follow-up with an ultrasound in 6 months D.Follow-up with serial lab values weekly
D
Which finding is most concerning if exhibited by a client diagnosed with preeclampsia at 30 weeks gestation? A.Heartburn with nausea and vomiting, client denies right upper quadrant pain B.Blood pressure ranging 130-150's/70-90's C.DTR's 3+/0 clonus D.Fundal height measurement of 24 cm for the last two weeks
D
Which of the following statements about the contraction stress test(CST) (oxytocin challenge test) is false? A.The CST provides an earlier warning of fetal compromise than the NST and produces fewer false positive results. B.It should not be performed on women for whom labor in contraindicated at the time the test is done. C.The CST may occur via nipple stimulation or through the IV administration of oxytocin. D.CST results are reported as reactive, nonreactive, suspicious, or equivocal.
D
The nurse is teaching a prenatal client about cell-free DNA (cf-DNA)screening of maternal blood. Which of the following statements indicates a need for additional education of the client about this test? A.cf-DNA testing is a screening test for fetal aneuploidy. B.It is a non-invasive prenatal test (NIPT) that requires a maternal blood sample between 10-12 weeks gestation. C.The detection accuracy of cf-DNA is 99% for Trisomy 21 and 18, and 80% for Trisomy 13. D.This test is now offered to all pregnant women.
D Test is only offered to women who are at greater risk of chromosomal abnormalities: age >35, abnl MSAFP; abnl U/S screens,. Less accurate in obese women.
A nurse is educating a client about chorionic villus sampling (CVS). Which of the following statements indicates a need for additional education of the client about this procedure? A.CVS can be performed in the 1st or 2nd trimester, ideally between 10-13 weeks gestation. B.CVS can be done transcervically or transabdominally. C.It takes a small sample of the placenta to evaluate fetal DNA. D.The pregnancy loss rate is 2 times higher with CVS compared to amniocentesis.
D The pregnancy loss rate of CVS and amnio are EQUAL
•What is the significance of a Cullen sign? When is the Cullen sign likely to present?
•Cullen sign is a hemorrhagic discoloration of the umbilical area due to intraperitoneal hemorrhage from any cause •Appears after abruption; pancreatitis
•What discharge instructions are paramount after a miscarriage/dilation and curettage procedure?
•Discharge teaching: No tub baths or tampons x 2 wks; monitor for S&S of infection; eat foods high in iron and protein; refer to support group if appropriate
•What is the follow-up for patients s/p delivery of a molar (Gestational Trophoblastic Disease) pregnancy?
•Followed with serial hCG levels; asked to avoid pregnancy x 1 year
What are the nursing considerations concerning methotrexate administration?
•Hemodynamically stable •Normal LFTs & kidney function •Serial hCG levels until undetectable (up to 6 wks) •RhoGAM prn
Which of the following is NOT a maternal or fetal indication for antepartal testing? A. Chronic hypertension B.Post-term pregnancy C.Decreased fetal movement D.Preterm pre-labor rupture of membranes E.Increased fetal activity
E
1.How would a patient with cervical insufficiency present?
Early dilation of the cervical os , prolapsing fetal membranes, abnormally short cervix; loss usually occurs around 16 weeks
Emergency cerclage?
Rescue cerclage placed between 14-23 weeks for women w/sx of cervical insufficiency; removed at 36 weeks
How would a patient with placental abruption present?
Sudden onset intense, localized uterine pain, with or without vaginal bleeding.
.FHR tracings? What are the nursing actions? (placental abruption)
Late decels; UNCOIL
1.When is a patient with a placenta previa considered stable enough to be discharged home?
When condition is stable; no bleeding x 48 hours; able to be on BR w/BRP at home; live within a short distance of the hospital; have constant access to transportation; and verbalize understanding of risks associated w/placenta
A nurse is learning about the use of ultrasonography in pregnancy. The nurse has a good understand of the use of third trimester uses for ultrasonography when he identifies all of the following uses EXCEPT: A.Determine placental position B.Evaluation of the fetus' other structures during chorionic villus sampling C.Detect congenital abnormalities D.Determine fetal position
B
A patient at 18 weeks gestation has been diagnosed with gestational trophoblastic disease. In addition to vaginal bleeding, what symptom would the nurse expect to see? A.Severe unilateral pain B.Hyperemesis gravidarum C.Fetal heart tones via Doppler D.Chronic hypertension
B
A client asks the nurse about nuchal translucency screening. The nurse is correct when she identifies this as (SATA) A.An ultrasound measurement of the fluid at the nape of the fetal neck B.Performed between 20-24 weeks gestation C.Identifies increased risk of Trisomy 13, 18, and 21 D.>3 mm is considered abnormal
A, C, D Performed between 10-14 weeks gestation; if abnormal, genetic testing is recommended
Which of the following statements regarding the Coombs tests are true? SATA A.The Coombs tests is a test for Rh incompatibility. B.The Indirect Coombs tests is a test of the mother's blood; the Direct Coombs test is a test of the newborn baby's or fetal blood. C.If the maternal Coombs test is positive, it will give a titer for RH antibodies in the maternal blood. A titer of >1:8 indicates a need for fetal evaluation. D.Fetal middle cerebral artery doppler flow studies are used to determine the severity of fetal hemolytic anemia.
A, B, C, D
In order to be eligible to be discharged home with a diagnosis of placenta previa at 28 weeks gestation, the client must meet all of following criteria. SATA A.Biophysical profile score 8/8 B.NST appropriate for gestational age C.There is a 3 cm area of bright red blood on the peri pad D.The hemoglobin and hematocrit are stable E.The client reports mild pain with her 10 contractions this last hour F.The client has access to reliable transportation and a telephone
A, B, D, F
A client has received Methotrexate IM for resolution of ectopic pregnancy. What is the most important follow-up information to impart to this client? A.If you experience sharp unilateral abdominal pain, seek medical care immediately. B.Be certain to avoid pregnancy for a year by taking oral contraceptives. C.Be sure to consume a balanced diet with no restrictions. D.Take your prenatal vitamins and iron for 6 weeks.
A
A nurse is monitoring a client's DTR's who has been on Magnesium Sulfate for 12 hours. Which finding is expected? A.Bilateral DTR's noted as 2+/0 clonus B.Bilateral DTR's noted as 4+/ 2 beats of bilateral clonus C.Client reports pain and soreness during the DTR exam D.Clonus is elicited when the DTR's are assessed
A
A patient is admitted to the labor and delivery unit with vaginal bleeding. To differentiate between placenta previa and placental abruption, the nurse will assess? A.Abdominal pain B.Fetal heart rate pattern C.Pad counts D.Hgb and Hct counts
A
A nurse is caring for a client who is being induced with pre-eclampsia. What finding supports the placement of a Foley catheter? A.The client's DTR's are 1+/0 clonus and the client reports feeling weak B.The client's total urine output over the last 8 hours was 175 ml C.The Magnesium protocol requires that the client not ambulate D.The client needs assistance with getting on the bedpan every 2-3 hours
B
3.How would the contraction pattern of a placental abruption appear?
As the myometrium becomes engorged with blood the contractions become irregular and eventually stop.
A client is in labor with a diagnosis of HELLP and DIC. The nurse notes the PT and PTT times are prolonged. Fibrinogen is decreased. What symptom will the nurse expect to see in this client? A.Variable decelerations B.Petechiae C.Positive Cullen sign D.Patellar reflexes 2+/0 clonus
B
A client is one-hour status post dilatation and curettage. Which finding would warrant immediate assessment and intervention? A.The client reports her uterine pain as a 4 on a numeric 0-10 scale B.Half of the peri pad is saturated with bright red blood C.Blood pressure is 108/68 and pulse is 88 D.The client reports extreme sadness over the situation and is crying silently
B
In order to be eligible to discharged home with a diagnosis of pre-eclampsia, the client must meet all of the following criteria except? A.Have access to reliable transportation and phone B.The last seizure was 24 hours ago C.Be able to perform and monitor kick counts D.Be able to monitor weight and blood pressure and return if symptoms worsen
B
Which of the following signs/symptoms would the nurse expect to see in the woman with placental abruption? A.Pain-free vaginal bleeding B.Increasing abdominal girth C.Fetal heart rate accelerations D.Blood pressure 110/60, pulse 80
B
A woman has been diagnosed with a ruptured ectopic pregnancy. What is the priority? A.Administer Methotrexate IM B.Bolus the intravenous line with 500-1000 ml of crystalloid fluid C.Assess the abdomen for a Cullen sign D.Perform orthostatic vital signs
B Crystalloid solutions are mainly used to increase the intravascular volume when it is reduced. This reduction could be caused by hemorrhage, dehydration or loss of fluid during surgery. The most frequently used crystalloid fluid is sodium chloride 0.9% (normal saline 0.9%).
A nurse is educating a client about amniocentesis. Which of the following statements indicates a need for additional education of the client about this procedure? A.In amniocentesis a needle is passed through the cervix under ultrasonic visualization so a small amount of amniotic fluid can be withdrawn. B.It is possible to perform amniocentesis after 10 weeks gestation. C.It is used to diagnose fetal genetic diseases and fetal lung maturity, D.Complications in the mother or fetus from this procedure are rare.
B It is possible to perform amniocentesis after 14 weeks gestation when the uterus is a pelvic organ and enough amniotic fluid has developed.
A nurse is educating a client about Percutaneous Umbilical Blood Sampling (PUBS). Which of the following statements indicates a need for additional education of the client about this procedure? A.PUBS is also known as Cordocentesis B.PUBS may be conducted in all trimesters C.PUBS can be used for fetal blood sampling or fetal transfusion D.CVS has replaced PUBS in many centers because improvements in diagnostic testing no longer require fetal blood.
B PUBS may be conducted in only the 2nd and 3rd trimesters
A nurse is administering a Magnesium Sulfate bolus to client diagnosed with pre-eclampsia at 32 weeks. Which finding(s) are expected at this time? SATA A.DTR's will decrease and clonus will resolve in 15 minutes. B.Nausea and vomiting C.Decrease in blood pressure by about 20% D.Flushing and feeling hot E.Increase in urine output F.The nurse informs the client that he will return in 15 minutes
B, D
A client at 14 weeks is status post cerclage placement in the recovery room. Which finding is most concerning? A.Temperature of 97.6 and the client reports feeling cold B.The fetal heart rate is 125 and the client denies feeling any movement C.The client reports some mild lower abdominal cramping D.There is a 1 cm size spot of pinkish-red discharge on her pad.
C
A nurse is educating a pregnant client about kick counts. The client demonstrates a need for additional teaching when she states: A.I should begin kick counts at 24 weeks gestation. B.There are a lots of different ways to do kick counts. C.It is normal for babies to move less as they approach term. D.I may need a non-stress test if I feel fewer than 3 movements in one hour.
C
A woman G40210 is admitted at 12 weeks gestation for cerclage placement. Which of the following long-term outcomes is appropriate for this patient? A.The patient will gain less than 25 pounds during the pregnancy. B.The baby will be classified as appropriate for gestational age at birth. C.The patient will deliver as close to term as possible. D.The patient will now have a normal pregnancy.
C
The priority intervention for a client experiencing Magnesium toxicity is A.Administer Calcium Gluconate B.Notify the HCP C.Discontinue the Magnesium Sulfate D.Use an ammonia capsule under the client's nostrils
C
A client at 24 weeks of gestation is admitted to the emergency department after sustaining severe internal injuries during a motor vehicle accident. The nurse suspects internal bleeding and placental abruption. The suspicion is supported by which finding? A.Early decelerations are noted on the EFM B.Kleihauer Betke is positive C.Late decelerations are noted on the EFM D.The blood pressure was 110/58 an hour ago and is now 108/56
C Kleihauer Betke stain (KB stain) measures the amount of fetal hemoglobin transferred from a fetus to a mother's bloodstream but is not of diagnostic value in abruption
How do we medically manage ectopic pregnancy?
DX with quant hCG and U/S; methotrexate <6 weeks (unruptured small mass, <3.5 cm); salpingostomy/salpingectomy (if tubal) > 6 weeks
1.How do patients with ectopic pregnancies present?
Pain, bleeding, + pregnancy test; menses may be delayed
3.What should nurses impart to the patient with a prophylactic cerclage?
Placed at 12-14 weeks to prevent loss to prevent premature cervical dilation; removed at 36 weeks
•What is a molar (AKA hydatidiform mole) pregnancy?
•Chorionic villi of placenta develop into transparent grape-like vesicles from an abnormally fertilized egg. Usually no fetus present.
