Maternity; Chapters 16 & 17.
Also called placental abruption:
abruptio placentae.
The premature separation of a normally implanted placenta:
abruptio placentae.
Early pregnancy loss, commonly known as "miscarriage" can occur for a variety of reasons. What is one of these reasons?
active maternal infection.
Woman with toxoplasmosis should:
avoid cleaning cat litter box. wear gloves when gardening. wash hands before and after handling raw meat. only eat meats cooked thoroughly. wash fruits and vegetables before eating.
A 30 year old gravida 1 has sickle cell anemia. She is not currently in crisis. Providing education on which topic is the highest nursing priority?
avoidance of infection.
Gestational diabetes is a form of diabetes mellitus that occurs during pregnancy. It is caused by insulin resistance. What is the result of gestational DM in a normal pregnancy?
blood glucose levels are higher than normal (mild hyperglycemia) after meals.
Emergency complication of epilepsy in which seizure activity continues for 5-30 minutes or more after treatment is initiated, or when three or more seizures occur without full recovery between seizures:
status epilepticus.
Hypertensive disorders are classified according to:
when in relation to the pregnancy the high blood pressure is first diagnosed. the presence or absence of proteinuria. whether or not the condition resolves spontaneously after delivery.
In twin-to-twin transfusion syndrome, one twin receives more _____ from the placenta than his or her sibling.
blood.
Placement of a purse-string type suture in the cervix to keep it from dilating:
cerclage.
Standard treatment for cervical insufficiency is cervical _____.
cerclage.
Cerclage is the surgical procedure used to treat:
cervical insufficiency.
Formerly known as incompetent cervix:
cervical insufficiency.
Presents with painless cervical dilatation with bulging of fetal membranes and sometimes fetal parts through the external os:
cervical insufficiency.
For a pregnancy woman that presents with painless bleeding, vaginal examination of the _____ is deferred until placenta previa is ruled out.
cervix.
If the woman has a lesion (herpes) at delivery, should delivery by _____ delivery to prevent baby from coming in contact with the virus.
cesarean.
The bacterium that causes chlamydia is:
chlamydia trachomatis.
Hearing impairment is most common defect assocaited with:
congenital rubella infection.
Because iron supplements may predispose the woman to _____, inform her about the importance of adequate _____, _____ regularly, and get plenty of _____ in her diet.
constipation. hydration. exercise. fiber.
The woman should _____ taking her asthma medications during pregnancy.
continue.
A pregnant woman with cardiovascular disease can usually continue to take her cardiac medications during pregnancy. What medication cannot be continued during pregnancy?
coumadin (warfarin).
During a sickle cell anemia crisis, RBCs sickle or change to a _____ shape; this prevents flow through _____ and cells clump together, blocking flow to an area resulting in tissue _____ and _____ at the side of the blockage.
crescent. capillaries. ischemia. pain.
Exacerbation of sickle cell anemia is called a:
crisis.
Nursing considerations for the pregnant woman with an STI include:
informing the woman about her risk for additional infections, and need for protection; risk for fetal complications from the infection, informing the woman about her treatment plan, and observing the woman for decreased self esteem.
T/F: Complete molar pregnancies contain fetal parts and an amniotic sac.
false.
T/F: Fentanyl should be avoided for laboring women with asthma because it may precipitate an asthmatic attack.
false.
T/F: Miscarriages are often related to maternal behavior.
false.
T/F: The CDC recommends HIV testing on all pregnant women at the 18th week of gestation.
false.
T/F: The fasting blood glucose levels of lessthan 90 mg/dL and not exceeding 130 mg/dL 2 hours after meals is a good goal during pregnancy.
false.
TORCH infections can lead to serious:
fetal anomalies and other complications.
_____ _____ is critical for the pregnant woman with diabetes.
fetal surveillance.
Fetal activity counts and non stress test are done to determine:
fetal well being.
Symptoms of trichomoniasis include:
foamy, yellow green vaginal discharge. vaginal itching. dysuria.
Rubella is also called:
german measles.
Occurs only during pregnancy but is similar to the disease process of type 2 diabetes mellitus:
gestational diabetes mellitus.
Occurs only during pregnancy is:
gestational diabetes.
The current term used to describe elevated blood pressure (systolic >140 mm Hg or diastolic >90 mm Hg) that develops for the first time during pregnancy after 20 weeks' gestation, without the presence of protein in the urine:
gestational hypertension.
The four categories of hypertension are:
gestational hypertension. preeclampsia/eclampsia. chronic hypertension. preeclampsia superimposed on chronic hypertension.
Malignancy of the uterine lining:
gestational trophoblastic neoplasia.
The primary goal of treatment for pregnant women with diabetes is to maintain tight _____ control to help decrease incidence of maternal-fetal complications.
glycemia.
Glucose levels are determined by finger stick measurements and measuring: .
glycosylated hemoglobin (HbA1C).
Signs of an impending seizure include:
headache. blurred vision. epigastric pain. hyperactive reflexes. presence of clonus.
Rh and ABO incompatibility can cause _____ disease of the fetus/newborn.
hemolytic.
All infants need a three does _____ immunization series with first dose given at birth.
hepatitis B.
TORCH infections that are routinely screened for during pregnancy are:
hepatitis B. syphilis. ruella.
For the pregnant adolescent, inquiring about body _____ as it is, is an important consideration that may lead to attempts to limit weight gain during pregnancy.
image.
The warts with HPV have a tendency to _____ in size during pregnancy and can lead to heavy ______ during delivery.
increase. bleeding.
The bacterium that causes gonorrhea is:
neisseria gonorrhoeae.
Vitamin K supplementation during the lasts weeks of pregnancy helps to prevent:
neonatal hemorrhage.
Therapy during pregnancy is prophylactic administration of ______ ZDV throughout pregnancy.
oral.
Placenta previa causes ______, _____ _____ bleeding during pregnancy due to an abnormally implanted placenta that is too close to, or covers the cervix.
painless. bright red.
_____ care for the woman with epilepsy is highly recommended to minimize the risk to the woman and fetus and allows for ______ on antiepileptic medications that cause lower risk to the fetus.
preconception. stabilization.
Serious condition of pregnancy in which the blood pressure in a woman who has had normal blood pressure rises to >140 mm Hg systolic or >90 mm Hg diastolic on two separate occasions and is accompanied by proteinuria:
preeclampsia.
Women with poorly controlled asthma may experience a higher incidence of:
preeclampsia. premature labor. hemorrhage.
The major classifications of diabetes in the pregnancy woman are:
pregestational and gestational diabetes.
A woman who entered pregnancy with type 1 DM or type 2 DM is:
pregestational.
The pregnant woman with HIV/AIDS can pass the infection to her unborn child during:
pregnancy or childbirth or while breast feeding.
Infants of adolescent mothers are more likely to be born _____ or below normal birth weight.
premature.
Special concerns for the pregnant adolescent include:
prenatal care. screening for domestic violence. anemia. preterm delivery. preeclampsia-eclampsia.
The mode of delivery for the multiple gestation woman depends on several factors, but the most important of which is the:
presentation of each twin.
The pregnant woman with an STI is at an increased risk for:
preterm delivery.
Chlamydia can increase the woman's risk for:
preterm labor.
Trichomoniasis can increase the woman's risk for:
preterm labor.
The goal of treatment for the woman with sickle cell anemia is:
preventing a crisis.
The main goal of treatment for the pregnant woman with heart disease is:
prevention and early detection of cardiac decompensation.
The focus of treatment for sickle cell anemia is:
prevention of crisis.
_____ of infection is the best treatment strategy because many of the TORCH infections do not have effective treatment.
prevention.
The presence of protein in the urine:
proteinuria.
A _____ causes trichomoniasis.
protozoan.
For the woman with a molar pregnancy, you need to:
provide client information regarding follow up care. monitor hCG serum levels. teach about avoiding pregnancy for at least 1 year. report signs/symptoms of metastasis.
Treatment considerations for the pregnant woman with asthma include:
reinforcing information the woman has had previously.
A potentially fatal complication of an acute asthma attack:
status asthmaticus.
Severe asthma attack that does not respond to treatment (such as bronchodilators) and leads to hypoxemia (low O2 levels in the blood) and hypercapnia (increased CO2 levels in the blood) and can lead to respiratory failure:
status asthmaticus.
The most severe form of asthma is:
status asthmaticus.
An emergency complication of epilepsy whereby seizure activity continues for 5 to 30 minutes or more or when three or more seizures occur without full recovery:
status epilepticus.
If the fallopian tube ruptures, the woman experiences hemorrhage into the _____ _____ and may develop _____ shock.
abdominal cavity. hypovolemic.
_____ ______ is loss of pregnancy before the fetus is able to survive outside the uterus on his or her own.
spontaneous abortion.
Signs and symptoms of ectopic pregnancy include:
missed menstrual period. nausea and vomiting. abdominal pain. shoulder pain. vaginal spotting or bleeding.
Although there is not a clear understanding of what causes hyperemesis gravidarum, several conditions have been linked with it. What is one condition that has been linked with hyperemesis gravidarum?
molar pregnancy.
Nursing interventions for the pregnant woman with heart disease include:
monitoring activity levels. managing stress. diet modification. medication therapy.
Nursing interventions for the pregnant woman with DM include:
monitoring the therapeutic regimen. screening for maternal and fetal injury risk woman's risk for infection. fetal macrosomia.
The woman who develops gestational diabetes is at increased risk for developing:
type 2 DM after pregnancy.
A woman presents to the prenatal clinic for her 28-week prenatal visit. She has gestational diabetes mellitus (GDM). Which type of diabetes does GDM most closely resemble?
type 2.
Abortions are classified according to whether or not the:
uterus is emptied. for how long the products of conception are retained.
The fetus can contract HPV through contact with _____ secretions during birth.
vaginal.
Virus that causes chicken pox:
varicella.
Spasm of the arteries:
vasospasm.
Iron supplements are best absorbed with:
vitamin C.
TORCH stands for:
Toxoplasmosis. Other: hepatitis B, syphilis, varicella, herpes zoster. Rubella. Cytomegalovirus (CMV). Herpes simplex virus (HSV).
Women of childbearing age that has not had chickenpox should be vaccinated and avoid pregnant for at least _____ _____ after vaccination.
1 month.
The woman takes high dose folic acid supplements _____ to _____ months before and throughout pregnancy to help prevent:
1. 3. neural tube defects.
The LPN/LVN is assisting with the admission of a 28-year-old G1P1 at 37 weeks' gestation to the labor and delivery unit. Which of the following statements made by the woman should be reported to the RN? (select all that apply)
"I was treated for a yeast infection last week." "I checked my blood sugar this morning and it was about 250." "the baby has been very sleepy today."
The impact of childbearing for women over _____ years old is an increased risk for complications of pregnancy.
35.
Preventing isoimmunization of the woman is done by administering RhoGAM to the Rh-negative woman within ______ hours of spontaneous abortion, birth, or invasive procedures, such as amniocentesis.
72.
Combination therapies, or _____, are ordered to keep viral loads throughout pregnancy.
HAART.
_____ syndrome is a laboratory diagnosis for a variant form of severe preeclampsia.
HELLP.
Breast feeding is contraindicated in those with:
HIV/AIDS.
_____ is a virus that causes genital warts.
HPV.
_____ is the most common viral sexually transmitted infection in the United States.
HPV.
Development of a safety plan is a key intervention in:
IPV victims.
Gonorrhea increases the risk of:
PID. spontaneous abortion. preterm delivery.
Acronym for a special group of infections that can be acquired during pregnancy and transmitted through the placenta to the fetus:
TORCH.
Risk factors for spontaneous abortion include:
advancing maternal age. history of previous spontaneous abortion. smoking. alcohol and substance abuse. increasing graviditiy. uterine defects and tumors. active maternal infection. chronic maternal health factors (DM, renal disease).
Sickle cell anemia is most commonly. seen in:
african americans. hispanic individuals.
_____ is done to determine fetal lung maturing in the _____ trimester and may help determine the optimim time for delivery.
amniocentesis. third.
Gonorrhea and chlamydia are treated with:
antibiotics.
Chlamydia is frequently ______ but easily treated with antibiotics.
asymptomatic.
The periods of greatest risk for the pregnant woman with cardiac disease are:
at the end of the second trimester, when blood volume peaks.
Care for the woman with pregestational diabetes includes glycemic control to prevent or minimize fetal consequences from hyperglycemia such as:
birth defects. still birth. hypertensive disorders. polyhydramnios. preterm delivery. macrosomia.
The nursing process is used to develop the plan of care for a woman with a _____ disorder.
bleeding.
Which data collection finding best correlates with a diagnosis of hydatidiform mole?
dark red, "clumpy" vaginal discharge.
Abruptio placentae is associated with _____ _____, ______ bleeding caused by the premature separation of the placenta form the wall of the uterus at any time before the end of labor.
dark red. painful.
The woman with sickle cell anemia is at risk for:
decreased renal function. stroke. heart dysfunction. leg ulcers. sepsis.
Nursing care of hyperemesis gravidarum focuses on:
decreasing trigger factors. assisting the woman with regaining fluid balance. obtaining nutrition needed for healthy fetal development.
An area on the body surface supplied by a particular sensory nerve:
dermatome.
Fetal complications from maternal diabetes include:
diabetic woman is more likely to experience a cesarean birth. fetus may be large for gestational age or develop macrosomia. birth weight over 8.8 lbs. macrosomic fetus is at risk for birth trauma. delayed lung maturity. increased risk later in life for health issues (HTN, impaired glucose tolerance, obesity).
The cornerstone of therapy for gestational diabetes is:
diet therapy.
Care for the woman with pregestational diabetes also includes:
diet therapy. ongoing fetal surveillance.
Herpes simplex virus spreads by ______ contact.
direct.
The presence of seizure activity or coma in a woman with preeclampsia:
eclampsia.
A pregnancy that occurs outside of the uterus:
ectopic pregnancy.
Normal blood glucose levels:
euglycemia.
_____ is another way to hep control blood sugar for the woman with diabetes.
exercise.
Tension building is followed by the _____ phase, which then leads to the honeymoon phase.
explosion.
Molar pregnancy; characterized by benign growth of placental tissue:
hydatidiform mole.
Low CO2 levels in the blood:
hypercapnia.
Disorder of early pregnancy that is characterized by severe nausea and vomiting that results in weight loss, nutritional deficiencies, and electrolyte and acid base imbalance:
hyperemesis gravidarum.
The multiple gestation woman is more likely to experience:
hyperemesis gravidarum. pyelonephritis. preterm labor. placenta previa. preeclampsia-eclampsia. postpartum hemorrhage.
A diagnosis of _____ gravidarum is made when vomiting becomes excessive enough to cause weight loss and fluid and electrolyte imbalances.
hyperemesis.
Blood glucose levels are higher than normal:
hyperglycemia.
Elevated blood glucose:
hyperglycemia.
Insulin levels are increased:
hyperinsulinemia.
Blood glucose levels are lower than normal:
hypoglycemia.
Low O2 levels in the blood:
hypoxemia.
The pancreas of the woman with type 1 diabetes does not produce _____, so she must receive insulin.
insulin.
Decreased production of red blood cells characterizes _____ deficiency anemia.
iron.
Iron deficiency anemia requires _____ supplementation and a diet high in ______ rich foods.
iron. iron.
The goal of therapy for Rh incompatibility is to prevent:
isoimmunization of the woman.
Which instruction is appropriate to give to a woman with hyperemesis gravidarum?
limit fluids with meals to increase retention of food.
A 25 year old woman is in for her first prenatal visist at 28 weeks gestation. Which assessment finding would cause the nurse to further investigate the possibility of intimate partner violence?
multiple bruises in varying stages of healing.
Either birth weight over 8.8 lbs (4,000 grams) or as greater than or equal to the 90th percentile for gestational age:
macrosomia.
Larger than average newborn is:
macrosomia.
Monitoring fetal growth is done to observe for:
macrosomia.
The focus of care for a woman with a bleeding disorder is:
maintain placental perfusion and fluid volume. avoiding maternal and fetal injury. preventing maternal injury. reducing anxiety and pain.
Interventions for those with anemias include:
maintaining adequate hydration. avoiding infection and stress. getting adequate rest.
Priority nursing interventions for the woman with preeclampsia-eclampsia include:
maintaining bed rest in a side lying position. monitoring neurological status, blood pressure, urinary output, and daily weights. maintaining a minimally stimulating environment. institution seizure precautions. observing for signs of impending seizure. assisting the RN with administering the magnesium sulfate. monitoring the fetus (fetal counts, FHR, NSTs).
Things that can be done to help prevent a sickle cell anemia crisis include:
maintaining hydration. avoiding infection. getting adequate rest. eating a balanced diet.
The treatment choice of trichomoniasis is:
metronidazole (flagyl) given orally.
A 32 year old gravida 1, para 0 at 36 weeks gestation comes to the obstetric department reporting abdominal pain. Her blood pressure is 164/90 mm Hg, her pulse is 100 beats per minute, and her respirations are 24 breaths per minute. She is restless and slightly diaphoretic with a small amount of dark red vaginal bleeding. What should the nurse's next intervention be?
palpate the fundus and check FHR.
A _____ is an obstetrician who has received advanced training and specializes in the care of at-risk pregnancies where it is from a pre-existing medical condition or from a complication of pregnancy.
perinatologist.
A woman with Class III heart disease is in for a prenatal visit. If she is in early heart failure, which sign is the nurse most likely to discover during physical assessment?
persistent rales in the base of the lungs.
The woman who requires insulin can self-inject insulin or use an insulin pump, which allows for more _____ ____ of the hormone.
physiologic concentrations.
Condition in which the placenta is implanted close to or covers the cervical os:
placenta previa.
Warfarin (Coumadin) crosses the _____ and increases the risk of _____ anomalies.
placenta. congenital.
Excess levels of amniotic fluid:
polyhydramnios.
Excessive levels of amniotic fluid is:
polyhydramnios.
The woman remains at risk for heart failure in the:
postpartum period.
Nonimmune women should be vaccinated for _____ before becoming pregnant and should wait at least 28 days after vaccination before attempting pregnancy.
rubella.
Interventions for those who are victims of IPV are directed toward:
safety assessment and planning.
Removal of the fallopian tube:
salpingectomy.
Infection of the fallopian tube:
salpingitis.
Nursing care for the woman who is a victim of IPV includes:
screening of all pregnant women to identify victims of IPV.
Symptoms of metastasis for the woman with a molar pregnancy, that need to be reported include:
severe persistent headache. cough or bloody sputum. unexpected vaginal bleeding.
Chlamydia is spread through _____ contact.
sexual.
Hepatitis B is transmitted:
sexually or through contact with blood or body fluids.
Individuals must inherit the trait from both parents to have:
sickle cell anemia.
Nutrition and _____ ______ are important areas for data collection with the pregnant adolescent.
social support.
The loss of a pregnancy before 20 weeks of gestation:
spontaneous abortion.
During labor, it is particularly important that the woman with heart disease avoid a _____ position.
supine.
A _____ closes the cervix with the goal that the woman will be able to carry the. pregnancy to near-term.
suture.
Woman who develop gestational diabetes do not always experience ______; therefore, screening is a standard of obstetric care for all woman.
symptoms.
The nurse is preforming data collection on a woman at the pregnancy clinic. Which of the following should be reported to RN? (Select all that apply)
the pregnant woman states that her mother had preeclampsia during her first pregnancy. the pregnant woman states her previous health care provider prescribed antihypertensives for her to take.
TORCH is an acronym for a special group of infections that can be acquired during pregnancy and transmitted through the placenta to the fetus. Why is TORCH so important during pregnancy?
they are teratogenic.
A 28-year-old gravida 4, para 0 is at the prenatal clinic for complaints of lower abdominal cramping and spotting at 12 weeks' gestation. The nurse-midwife performs a pelvic examination and finds that the cervix is closed. What does the nurse suspect is the cause of the cramps and spotting?
threatened abortion.
The six types of spontaneous abortion are:
threatened. inevitable. incomplete. complete. missed. habitual (recurrent).
A young woman has delivered a molar pregnancy. You are giving her discharge instructions when she asks you why she has to have blood drawn every 1 to 2 weeks by her primary caregiver. What is your best response?
to detect malignancy, which treatable if caught early.
_____ rarely produces symptoms in the woman.
toxoplasmosis.
TORCH stands for:
toxoplasmosis. others (hep b, syphilis, varicella, herpes zoster). rubella. CMV (cytomegalovirus). HSV (herpes simplex virus).
The major risk to a pregnancy during seizures from epilepsy is _____.
trauma.
T/F: Ectopic pregnancy is the leading pregnancy-related cause of first trimester maternal mortality.
true.
T/F: One of the first signs of magnesium sulfate toxicity is an absence of reflexes.
true.
T/F: Use of cocaine can precipitate a premature separation of the placenta partly because of the hypertension that the drug can induce.
true.
T/F: A woman with Rh-negative blood type who does not receive Rho(D) immune globulinfollowing a miscarriage is at risk for isoimmunization with subsequent pregnancies.
true.
T/F: Development of a safety plan is a key nursing intervention for victims of intimate partner violence.
true.
T/F: Intimate partner violence (IPV) is a reality in our society. It is important to assess every pregnant woman for IPB because pregnancy is a very vulnerable time for a woman in a relationship where IPV is a component:
true.
T/F: Preconception counseling is a critical factor in the care management of the pregnancy of a woman with cardiac disease.
true.