EXAM 3 CHAPTER 10- COMPLICATIONS OF PREGNANCY
A client is admitted to the hospital with vaginal staining but no pain. The client's history reveals amenorrhea for the last 2 months and pregnancy confirmation by her physician after her first missed period. She is admitted with a possible diagnosis of: A.Missed abortion B.Inevitable abortion C.Ectopic pregnancy D.Threatened abortion
D
A client with severe preeclampsia is admitted to the hospital and given an IV infusion of magnesium sulfate (MgSO4). The nurse recognizes that for this client magnesium sulfate is being given primarily because it is a: A.Hypotensive that relaxes smooth muscles B.Cholinergic that increases the release of acetylcholine C.Muscle relaxant that decreases the severity of uterine contractions D.Central nervous depressant that blocks neuromuscular transmission
D
A client with severe preeclampsia is receiving 2 g/hour of IV magnesium sulfate. To evaluate the effectiveness of this therapy, the nurse should assess for: A.A decreased respiratory rate B.An excessive urinary output C.An increase in blood pressure D. A diminished knee-jerk reflex
D
a life threatening disorder in which procoagulation and anticoagulation factors are activated simultaneously resulting in profuse bleeding from any vulnerable are
DIC
What teaching is needed for the woman having methotrexate therapy for an early ectopic pregnancy?
Explain the side effects, such as nausea and vomiting. Teach the woman to refrain from drinking alcohol, ingesting vitamins with folic acid, or having sexual intercourse until human chorionic gonadotropin (hCG) is not detectable in the serum (usually 2-4 weeks). Keeping follow-up appointments should also be emphasized.
persistent, uncontrollable vomiting that may cause excessive weight loss, dehydration, and electrolyte or acid base imbalance
HEG
What factors increase a woman's risk of an ectopic pregnancy?
History of previous ectopic pregnancy · Peak age-specific incidence 25-34 years · History of sexually transmitted diseases (gonorrhea, chlamydia) · Multiple sexual partners · Tubal sterilization and tubal reconstructions · Infertility · Assisted reproductive techniques such as gamete intrafallopian transfer · Multiple induced abortions
what are signs of magnesium toxicity?
RR below 12, hyporeflexia, sweating, flushing, altered sensorium, serum magnesium out of therapeutic range
Define the term spontaneous abortion. What is another term for this occurrence?
Termination of pregnancy without action taken by the woman or any other person. Miscarriage is a term generally by laypeople
A client at 35 weeks' gestation is admitted to the hospital with a small amount of bright red vaginal bleeding without contractions. After placing the client in bed, the nurse should: A.Check fetal heart tones B.Administer a Fleet enema C.Obtain an amniotomy setup D.Perform a vaginal examination
a
A client at 36 weeks gestation attends the prenatal clinic for a routine examination. The nurses identifies that the client's blood pressure has increased from 102/60 to 134/88 and is concerned she may be developing mild preeclampsia. The nurse should also assess the client for: A.Proteinuria B.Mild ankle edema C.Episodes of faintness on arising D.Weight gain of 2 pounds in 2 weeks
a
A nurse admits a client with preeclampsia to the hospital. After obtaining the vital signs the nurse should: A.Check the client's reflexes B.Call the physician immediately C.Determine the client's blood type D.Administer intravenous normal saline
a
A pregnant client is admitted to the hospital with abdominal pain and severe vaginal bleeding. After assessment, the nurse makes a nursing diagnosis of decreased cardiac output related to hemorrhage. A priority nursing action should be to: A.Administer oxygen B.Elevate the head of the bed C.Draw blood for Hgb and Hct D.Give an opioid intramuscularly for pain
a
a 19 year old gravida 1, para 0 client at 40 weeks gestation who is in labor is being treated with magnesium sulfate for seizure prophylaxis in preeclampsia. Which are priority assessments for this medication? SELECT ALL THAT APPLY a) check deep tendon reflexes b) observe for vaginal bleeding c) check respiratory rate d) note the urine output e) monitor for calf pain
a,c,d
what are the 2 major categories of heart disease?
acquired and congenital
how can Hashimotos thyroiditis affect the newborn?
adverse effects on the mental development of the fetus
what are the effects of the fetus in maternal Rh sensitization?
anemic, bilirubin concentration increases, and in extreme cases neurologic disease can occur
what are the major dangers to the fetus during the placental abruption?
anoxia, excessive blood loss, and delivery before maturity
what is the medical management for a pregnant woman with HIV infection?
antiretroviral medications
A client at 36 weeks' gestation is admitted because of a weight gain of 5 pounds in the previous week and a pronounced rise in the blood pressure. Appropriate nursing care would include: A.Preparing for imminent cesarean birth B.Providing a dark, quiet room with minimal stimuli C.Instituting prescribed furosemide (Lasix) IV therapy D.Administering prescribed calcium gluconate to lower blood pressure
b
how is placenta previa managed in the home?
bed rest, no sexual intercourse, an adult present at all times, and availability of emergency transport to the hospital at all times
what are the signs of threatened abortion and how do they differ from those of inevitable abortion?
bleeding, inevitable abortion includes rupture of membranes and cervical dilation and bleeding
what are the 5 classic signs and symptoms of placental abruption>
bleeding, uterine tenderness, uterine irritability, abdominal pain, high uterine resting tone
A client is admitted to the hospital with uterine tenderness and minimal, dark red vaginal bleeding. She is diagnosed as having abruptio placentae. Upon admission, the priority assessment would include vital signs, skin color, urine output, and: A.Her past obstetric history B.Fundal height or abdominal girth C.The time and amount of last meal D. Family history of bleeding disorders
c
A client with frank vaginal bleeding is admitted to the birthing unit at 30 weeks' gestation. The admission data indicate: BP, 110/70; P, 90; R, 22; FHR, 132 and regular; uterus non-tender and no contractions, and membranes are intact. Based on this information, the nurse suspects that this client has: A.Preterm labor B.Uterine inertia C.Placenta previa D.Abruptio placentae
c
A multigravid client is admitted to the hospital with a diagnosis of ectopic pregnancy. The nurse anticipates that, because of the client's fallopian tube has not yet ruptured, which of the following may be ordered? A.Progestin contraceptives (Hylutin) B.Medroxyprogesterone (Depo-Provera) C.Methotrexate D. Dyphylline (Dilor)
c
A multigravida client thought to be at 14 weeks' gestation reports that she is experiencing such severe morning sickness that "she has not been able to keep anything down for a week." The nurse should assess for signs and symptoms of which of the following? A.Hypercalcemia B.Hypobilirubinemia C.Hypokalemia D. Hyperglycemia
c
Before administering IV magnesium sulfate therapy to a client with preeclampsia, the nurse should assess the client's: A.Temperature, blood pressure, and respirations B.Urinary glucose, acetone, and specific gravity C.Urinary output, respirations, and patella reflexes D.Level of consciousness, fundascope appearance, and knee reflex
c
The client is 32 weeks pregnant with a diagnosis of complete placenta previa and experiencing heavy vaginal bleeding. The plan of care is immediate blood transfusion and emergency cesarean section. The client tells the nurse that she does not want the blood transfusion because she is concerned about getting hepatitis from it. The clients partner shares her concern, and the couple is declining the transfusion. How should the nurse proceed? a) allow the client to decline the blood transfusion, move her quickly to the operating room to prepare for emergency c-section, and inform the obstetrician that the client has declined the transfusion b) quickly inform the client that the blood transfusion is mandatory because of the amount of bleeding that she is experiencing. State that there is virtually no risk of blood borne infection c) speak quickly and intently to the couple while moving to the operating room. Collaberate with the obstetrician to quickly counsel the couple about the risk to benefit ratio she is facing d) call the blood bank and request that they come to the bedside and outline the risks and benefits of blood transfusion in this case before the surgery is allowed to start
c
a 25 year old gravida 2, para 1 client has come to the obstetric triage area at 32 weeks gestation reporting painless vaginal bleeding. The nurse is providing orientation for a new RN on the unit. Which statement by the new RN to the client would require the nurse to promptly intervene? a) I am going to check your vital signs b) I am going to apply a fetal monitor and contraction monitor c) I am going to perform a sterile vaginal exam to see if you have dilated d) I am going to feel your abdomen to check the position of the baby
c
what effects do the hormones of pregnancy have on maternal glucose metabolism?
cause resistance of maternal cells to insulin which increases the availability of glucose for the fetus
what type of abortion is this: When all products of conception are expelled from the uterus. Symptoms of pregnancy are no longer present.
complete
what are the possible fetal effects of type 1 DM?
congenital malformations, small or large fetal size, fetal hypoxemia and polycythemia
how is HBV transmitted? how are newborns treated?
contact with infected secretions, HB immune globulin and vaccine after scrub bath after birth
how can taxoplasmosis be prevented?
cooking meat thoroughly, avoid cat litter,
A client with preeclampsia is admitted to the labor and birthing suite. Her blood pressure is 130/90; she has 2+ protein in her urine, and edema of the hands and face. As part of the admission history, the nurse should ask the client about: A.Constipation, edema, visual problems and headache B.Visual disturbances, headache, constipation and bleeding C.Leakage of fluid, bleeding, edema, and abdominal pain D.Headache, visual disturbances, edema, and abdominal pain
d
The nurse administers the prescribed dose of magnesium sulfate intravenously to a client with severe preeclampsia. When evaluating her response to the medication, it is important to observe for: A.Visual blurring B.Epigastric pain C.Fetal tachycardia D.Respiratory depression
d
The nurse would suspect an ectopic pregnancy if the client complained of: A.An adherent painful ovarian mass B.Lower abdominal cramping for a long period of time C.Leukorrhea and dysuria a few days after the first missed period D.Sharp lower right or left abdominal pain radiating to the shoulder
d
what nursing assessments should be made for the woman with preclampsia?
daily weights, degree and location of edema, vital signs, hourly urine output, protein in urine, deep tendon reflexes, headache, visual disturbances and epigastric pain
how should magnesium toxicity be managed?
discontinue the drug, notify the provider, administer calcium gluconate
what are the 2 phases of treatment for hydatidiform mole?
evacuation of the molar pregnancy from the uterus, follow up to detect malignant changes in remaining trophoblastic tissue
why is critical thinking particularly important in the care of the woman with HEG?
examine personal biases that may result in lack of comfort and support for women with hyper emesis
what is the recommended supportive care for pregnant women with Bell's palsy?
eye patching, applying oitment to the eyes, facial massage and psychological support
what are the fetal and neonatal effects of parvovirus B19 infection?
failure of red blood cell production, anemia, hydrops and heart failure
what are the effects of maternal vasospasm on the fetus?
fetal hypoxemia, intrauterine growth restriction, fetal death
why should the administration of fluids, both oral and intravenous, be monitored closely during labor?
fluid overload
what are the major causes of recurrent spontaneous abortion?
genetic or chromosomal abnmormalities or anomolies of the reproductive tract
what is the importance of the glycosylated hemoglobin measurement in monitoring diabetes mellitus?
gives an accurate evaluation of blood glucose levels for the past 2-3 months and is not affected by the recent intake or restriction of food.
what does the acronym HELLP stand for?
hemolysis, elevated liver enzymes, low platelets
what are the major dangers to the mother during the placental abruption?
hemorrhagic shock
a form of gestational trophoblastic disease that involves abnormal development of the placenta as the fetal part of the pregancy fails to develop
hydatidiform mole
what are the signs and symptoms of preeclampsia?
hypertension, proteinuria, headache, hyperreflexia, visual disturbances, and epigastric pain
what are the possible neonatal effects of type 1 DM?
hypoglycemia, hypocalcemia, hyperbilirubinemia, and respiratory distress syndrome
what are neonatal effects of iron deficiency anemia?
hypoxic
how are infants born to mothers with varicella treated?
immunization
what type of abortion is this: When some but not all products of conception are expelled from the uterus. Active uterine bleeding and severe abdominal cramping.
incomplete
what are maternal and fetal effects of SLE?
increased incidence of abortion, fetal death and preterm delivery
how do the cardiovascular changes of pregnancy affect the coordination of the woman who has a cardiac defect?
increased intravascular volume and increased cardiac output place an added burden on he heart of a woman who has a cardiac defect
why is the 4th stage of labor particularily dangerous for the woman with heart disease?
increased load on the heart due to 500 ml of blood being returned to central nervous system during each contraction
what are the fetal and neonatal effects of folic acid deficiency?
increased risk of spontaneous abortion, abruption of placenta and fetal anomolies such as neural tube defects
why is the incidence of ectopic pregnancy increasing in the US?
increasing incidence of PID due to STI's.
what type of abortion is this: Ruptured membranes or cervical dilation
inevitable
how do insulin needs vary from the first trimester through the postpartum period?
insulin needs decrease during the first trimester, and increase sharply during the 2nd and 3rd trimesters
in what ways does pregnancy effect RA?
it often improves during pregnancy
why is ectopic pregnancy sometimes called a disaster of reproduction?
it remains a significant cause of meternal death due to hemorrhage and it can reduce the womans chance of subsequent pregnancies.
what are the nursing goals in therapeutic management of HEG?
maintain hydration, replace electrolytes and vitamins, maintain nutrition, and provide emotional support
why is supplemental iron needed by most women who are pregnant?
many women do not have adequate iron stores to support the demands of pregnancy
why is the fetus sometimes affected if ABO incompatability occurs?
many women with type O blood have anti A or antiB antibodies
How is ectopic pregnancy treated?
medication such as methotrexate or surgeries such as salpingostomy or salpingectomy
what type of abortion is this: Fetus dies during the first half of pregnancy but is retained in the uterus. Uterus stops growing and decreases in size. Vaginal bleeding of a red or brownish color may or may not occur.
missed
what are the prominent signs and symptoms of HELLP syndrome?
pain and tenderness in RUQ, nausea, vomiting, and severe edema
what are the signs and symptoms of placenta previa?
painless vaginal bleeding in the latter part of pregnancy
compare preclampsia with chronic hypertension in terms of onset and treatment
preeclampsia only occurs during pregnancy and in the early post partem period
what are the maternal effects of type 1 diabetes mellitus?
preeclampsia, UTI, ketoacidosis, and preterm labor
what are the maternal effects of sickle cell disease?
pregnancy may worsen sickle cell disease the risk of sickle cell crisis is increased
what are primary goals for management of heart disease in terms of diet, activity, and weight gain?
prevent anemia, folic acid and iron supplements, limit physical activity
why do unsensitized rh- expectant mothers receive RhoGAM during pregnancy and after an abortion, amniocentesis, and child birth?
prevents development of maternal anti Rh antibodies
what are effects of magnesium sulfate, including the primary adverse effect?
prevents seizures, CNS depression
what are the major complications of eclampsia?
pulmonary edema, circulatory or renal failure, aspiration of gastric contents, and cerebral hemorrhage
what type of abortion is this: 3 or more spontaneous abortions.
recurrent
what measures may be initiated to prevent or manage seizures?
reduce external stimuli, and maintain a therapeutic level of magnesium
Why is reduced activity a part of management for preeclampsia?
rest increases maternal cardiac return and circulatory volume
what is the effect of vasospasm on the brain?
rupture of cerebral capillaries and small cerebral hemorrhages
what interventions can nurses provide for families experiencing grief as a result of early pregnancy loss?
show empathy and acceptance, inform them that abortion is due to factors that could not be avoided
how can injury during seizure be prevented?
side rails should be padded and raised, bed should be in lowest position with wheels locked, oxygen and suction should be readily available,
what complications should the nurse assess during the intrapartum period for an obese patient ?
signs of dysfunctional labor
why is iron supplementation often not recommended for women with thalassemia?
thalassemia is associated with increased iron absorption and storage making women with this condition more likely to have iron overload
why is rubella infection most dangerous in the first trimester?
the first trimester is when the organs are developing
why are the effects of ABO incompatability milder than those of RH sensitization?
the primary antibodies of the ABO system do not readily cross the placenta
how do morning sickness and HEG compare in terms of onset, duration, and effect in the woman?
they both begin in the first trimester, morning sickness is self limiting and causes no serious complications.
what is the major concern about administering anticonvulsant drugs for the pregnant woman with epilepsy?
they may be teratogenic
what type of abortion is this: Vaginal bleeding during the 1st half of pregnancy. May be together with cramping, persistent backache, or feelings of pelvic pressure.
threatened
why should the liver not be palpated in a woman with HELLP syndrome?
trauma could occur including rupture of the subscapular hematoma
how can rubella be prevented?
vaccine after pregnancy, pregnancy avoided after 4 weeks of vaccine
how does vertical transmission of herpesvirus occur?
when organisms ascend after rupture of membranes and during birth when the fetus comes in contact with the infectious tissue and secretions
how much should the pregnant obese patient gain during pregnancy?
11-20 lbs
The nurse notes a new mother has type B negative blood. Her baby's blood type is AB positive. The nurse is aware that the mother's plan of care should include: A.Obtaining an order for RhoGAM B.Observing for ABO incompatibility C.Determining the father's blood type D.Immediate typing and cross matching of her blood
A
what is the difference between GCT and OGTT?
A glucose challenge test (GCT) is a screening procedure only and requires no fasting before the woman drinks a 50-g glucose solution and has a serum glucose drawn 1 hour later. A 3-hour oral glucose tolerance test (OGTT) is performed to diagnose diabetes mellitus, including gestational diabetes. The OGTT requires measurement of a fasting blood glucose level followed by intake of 100 g of glucose solution. Blood glucose levels are determined hourly after the solution is taken, at 1, 2, and 3 hours.
What is the possible significance of sudden pain in the area of the scapula during early pregnancy?
Abrupt onset of shoulder pain may occur with a ruptured ectopic pregnancy because blood accumulated in the abdomen irritates the phrenic nerve.
what are the classifications of heart disease?
Class I- no limitations on activity, Class II- slight restriction if necessary, Class III - marked limitation, Class IV - person has symptoms such as dyspnea at rest
