NU143- Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications

A nurse in the maternity triage unit is caring for a client with a suspected ectopic pregnancy. Which nursing intervention should the nurse perform first?

Assess the client's vital signs.

home uterine activity monitoring

a pressure sensor attached to a belt that is held against the abdomen and a recording/storage device that is carried on a belt or hung from the shoulder

The nurse is required to assess a pregnant client who is reporting vaginal bleeding. Which nursing action is the priority?

assessing the amount and color of the bleeding

ectopic pregnancy

any pregnancy in which the fertilized ovum implants outside the uterine cavity

preeclampsia

most common hypertensive disorder of pregnancy, which develops with proteinuria after 20 weeks' gestation It is a multisystem disease process, which is classified as mild or severe, depending on the severity of the organ dysfunction

blood incompatibility

most commonly involves one of two issues: blood type or the Rh factor arises when a mother with blood type O becomes pregnant with a fetus with a different blood type ABO incompatibility

A woman at 35 weeks' gestation with severe hydramnios is admitted to the hospital. The nurse recognizes that which concern is greatest regarding this client?

preterm rupture of membranes followed by preterm birth

premature rupture of membranes (PROM)

rupture of the bag of waters before the onset of true labor

Some women experience a rupture of their membranes before going into true labor. A nurse recognizes that a woman who presents with preterm premature rupture of membranes (PPROM) has completed how many weeks of gestation?

less than 37 weeks

high-risk pregnancy

one in which a condition exists that jeopardizes the health of the mother, her fetus, or both

A client at 11 weeks' gestation experiences pregnancy loss. The client asks the nurse if the bleeding and cramping that occurred during the miscarriage were caused by working long hours in a stressful environment. What is the most appropriate response from the nurse?

"I can understand your need to find an answer to what caused this. Let's talk about this further."

The nurse is teaching a client who is diagnosed with preeclampsia how to monitor her condition. The nurse determines the client needs more instruction after making which statement?

"If I have changes in my vision, I will lie down and rest."

The nurse is monitoring a client at 36 weeks' gestation who is bleeding. The nurse is preparing to insert a Foley catheter. Which explanation(s) should the nurse provide the client regarding the need for a urinary catheter? Select all that apply.

"The amount of urine output is an indication of tissue perfusion." "If urine output is less than 30 ml per hour, it is a sign of hemodynamic instability."

A primipara at 36 weeks' gestation is being monitored in the prenatal clinic for risk of preeclampsia. Which sign or symptom should the nurse prioritize?

A dipstick value of 2+ for protein

A nurse is caring for a client with hyperemesis gravidarum. Which nursing action is the priority for this client?

Administer IV normal saline with vitamins and electrolytes.

A primigravida 28-year-old client is noted to have Rh negative blood and her husband is noted to be Rh positive. The nurse should prepare to administer RhoGAM after which diagnostic procedure?

Amniocentesis

A nurse is preparing a nursing care plan for a client who is admitted at 22 weeks' gestation with advanced cervical dilation (dilatation) to 5 cm, cervical insufficiency, and a visible amniotic sac at the cervical opening. Which primary goal should the nurse prioritize at this point?

Bed rest to maintain pregnancy as long as possible

A woman in her 20s has experienced a spontaneous abortion (miscarriage) at 10 weeks' gestation and asks the nurse at the hospital what went wrong. She is concerned that she did something that caused her to lose her baby. The nurse can reassure the woman by explaining that the most common cause of miscarriage in the first trimester is related to which factor?

Chromosomal defects in the fetus

The nurse is caring for a pregnant client with fallopian tube rupture. Which intervention is the priority for this client?

Monitor the client's vital signs and bleeding.

A client at 25 weeks' gestation presents with a blood pressure of 152/99 mm Hg, pulse 78 beats/min, no edema, and urine negative for protein. What would the nurse do next?

Notify the health care provider

The following hourly assessments are obtained by the nurse on a client with preeclampsia receiving magnesium sulfate: 97.3F (36.2C), HR 88, RR 12 breaths/min, BP 148/110 mm Hg. What other priority physical assessments by the nurse should be implemented to assess for potential toxicity?

Reflexes

The nurse is caring for a woman at 32 weeks' gestation with severe preeclampsia. Which assessment finding should the nurse prioritize after the administration of hydralazine to this client?

Tachycardia

A young mother gives birth to twin boys who shared the same placenta. What serious complication are they at risk for?

Twin-to-twin transfusion syndrome (TTTS)

A nurse is assessing pregnant clients for the risk of placenta previa. Which client faces the greatest risk for this condition?

a client who had a myomectomy to remove fibroids

A woman is being discharged after receiving treatment for a hydatidiform molar pregnancy. The nurse should include which of the following in her discharge teaching? a. Do not become pregnant for at least a year; use contraceptives to prevent it b. Have the client's blood pressure checked weekly in the clinic c. RhoGAM must be given within the next month to her at the clinic d. An amniocentesis can detect a recurrence of this disorder in the future

a. Do not become pregnant for at least a year; use contraceptives to prevent it

RhoGAM is given to Rh-negative women to prevent maternal sensitization. In addition to pregnancy, Rh-negative women would also receive this medication after which of the following? a. Therapeutic or spontaneous abortion b. Head injury from a car accident c. Blood transfusion after a hemorrhage d. Unsuccessful artificial insemination procedure

a. Therapeutic or spontaneous abortion

A woman is suspected of having abruptio placentae. Which of the following would the nurse expect to assess as a classic symptom? a. Painless, bright-red bleeding b. "Knife-like" abdominal pain c. Excessive nausea and vomiting d. Hypertension and headache

b. "Knife-like" abdominal pain

placenta previa

bleeding condition that occurs during the last two trimesters of pregnancy the placenta implants over the cervical os

gestational hypertension

blood pressure elevation (140/90 mm Hg) identified after 20 weeks' gestation without proteinuria Blood pressure returns to normal by 12 weeks' postpartum

After teaching a woman about hyperemesis gravidarum and how it differs from the typical nausea and vomiting of pregnancy, which statement by the woman indicates that the teaching was successful? a. "I can expect the nausea to last through my second trimester." b. "I should drink fluids with my meals instead of in between them." c. "I need to avoid strong odors, perfumes, or flavors." d. "I should lie down after I eat for about 2 hours."

c. "I need to avoid strong odors, perfumes, or flavors."

When administering magnesium sulfate to a client with preeclampsia, the nurse explains to her that this drug is given to: a. Reduce blood pressure b. Increase the progress of labor c. Prevent seizures d. Lower blood glucose levels

c. Prevent seizures

A novice nurse asks to be assigned to the least complex antepartum client. Which condition would necessitate the least complex care requirements?

gestational hypertension

oligohydramnios

decreased amount of amniotic fluid (less than 500 mL) between 32 and 36 weeks' gestation

A woman is being closely monitored and treated for severe preeclampsia with magnesium sulfate. Which finding would alert the nurse to the development of magnesium toxicity in this client?

diminished reflexes

The nurse is appraising the medical record of a pregnant client who is resting in a darkened room and receiving oxytocin and magnesium sulfate. The nurse will continue to monitor this client for progression to which condition?

eclampsia

A woman at 9 weeks' gestation was unable to control the nausea and vomiting of hyperemesis gravidarum through conservative measures at home. With nausea and vomiting becoming severe, the woman was omitted to the obstetrical unit. Which action should the nurse prioritize?

establish IV for rehydration

A nurse is monitoring a client with PROM who is in labor and observes meconium in the amniotic fluid. What does the observation of meconium indicate?

fetal distress related to hypoxia

A pregnant woman is diagnosed with placental abruption (abruptio placentae). When reviewing the woman's physical assessment in her medical record, which finding would the nurse expect?

firm, rigid uterus on palpation

spontaneous abortion

most common complication of early pregnancy loss of a fetus resulting from natural causes, that is, not elective or therapeutically induced by a procedure

Chronic hypertension with superimposed preeclampsia

occurs in approximately 20% of pregnant women with increased maternal and fetal morbidity rates

A pregnant woman with preeclampsia is to receive magnesium sulfate IV. Which assessment should the nurse prioritize before administering a new dose?

patellar reflex

late bleeding during pregnancy

placenta previa, abruptio placentae, and placenta accreta, which usually occur after the 20th week of gestation

multiple gestation

pregnancy with two or more fetuses

cervical insufficiency

premature dilation of the cervix structurally defective cervix that spontaneously dilates in the absence of uterine contractions in the second trimester, or early third trimester, resulting in the loss of the pregnancy

hyperemesis gravidarum

severe form of nausea and vomiting of pregnancy associated with significant costs and psychosocial impacts

gestational trophoblastic disease (GTD)

spectrum of neoplastic disorders that originate in the placenta. There is abnormal hyperproliferation of trophoblastic cells that normally would develop into the placenta during pregnancy

polyhydramnios

too much amniotic fluid (more than 2,000 mL) surrounding the fetus between 32 and 36 weeks

transvaginal ultrasound

typically is done between 16 and 24 weeks' gestation to determine cervical length, evaluate for shortening, and attempt to predict an early preterm birth

The nurse is caring for a pregnant client with severe preeclampsia. Which nursing intervention should a nurse perform to institute and maintain seizure precautions in this client?

Keep the suction equipment readily available.

A nurse is caring for a client who just experienced a spontaneous abortion (miscarriage) in her first trimester. When asked by the client why this happened, which is the best response from the nurse?

abnormal fetal development

chronic hypertension

hypertension that exists prior to pregnancy or that develops before 20 weeks' gestation

early bleeding during pregnancy

spontaneous abortion, uterine fibroids, ectopic pregnancy, GTD, and cervical insufficiency

A woman at 8 weeks' gestation is admitted for ectopic pregnancy. She is asking why this has occurred. The nurse knows that which factor is a known risk factor for ectopic pregnancy?

use of IUD for contraception

A pregnant woman is admitted to the hospital with a diagnosis of placenta previa. Which action would be the priority for this woman on admission?

assessing fetal heart tones by use of an external monitor

placenta accreta

potentially life-threatening obstetrical hemorrhagic condition that requires a multidisciplinary approach to management

A nurse is providing care to a client who has been diagnosed with a common benign form of gestational trophoblastic disease. The nurse identifies this as:

hydatidiform mole.

A 25-year-old client at 22 weeks' gestation is noted to have proteinuria and dependent edema on her routine prenatal visit. Which additional assessment should the nurse prioritize and convey to the RN or health care provider?

initial BP 100/70 mm Hg; current BP 140/90 mm Hg

A pregnant women calls the clinic to report a small amount of painless vaginal bleeding. What response by the nurse is best?

"Please come in now for an evaluation by your health care provider."

A client with a history of cervical insufficiency is seen for reports of pink-tinged discharge and pelvic pressure. The primary care provider decides to perform a cervical cerclage. The nurse teaches the client about the procedure. Which client response indicates that the teaching has been effective?

"Purse-string sutures are placed in the cervix to prevent it from dilating."

A nurse is assessing a pregnant client with preeclampsia for suspected dependent edema. Which description of dependent edema is most accurate?

Dependent edema may be seen in the sacral area if the client is on bed rest.

eclampsia

Onset of seizure activity in a woman with preeclampsia

A woman at 34 weeks' gestation presents to labor and delivery with vaginal bleeding. Which finding from the obstetric examination would lead to a diagnosis of placental abruption (abruptio placentae)?

Onset of vaginal bleeding was sudden and painful

The nurse is caring for a multigravid who experienced a placental abruption 4 hours ago. For which potential situation will the nurse prioritize assessment?

Uterine atony

Which of the following women should receive RhoGAM postpartum? a. Nonsensitized Rh-negative mother with a Rh-negative newborn b. Nonsensitized Rh-negative mother with a Rh-positive newborn c. Sensitized Rh-negative mother with a Rh-positive newborn d. Sensitized Rh-negative mother with a Rh-negative newborn

a. Nonsensitized RH-negative mother with a Rh-negative newborn

A client who has experienced an incomplete abortion is prescribed mifepristone to assist in removing the retained products of conception. Which medication would the nurse expect to administer if prescribed before administering mifepristone?

antiemetic to minimize nausea

A woman who is Rh negative asks the nurse how many children she will be able to have before Rh incompatibility causes them to die in utero. The nurse's best response would be that:

as long as she receives Rho(D) immune globulin, there is no limit.

A pregnant woman, approximately 12 weeks' gestation, comes to the emergency department after calling her health care provider's office and reporting moderate vaginal bleeding. Assessment reveals cervical dilation and moderately strong abdominal cramps. She reports that she has passed some tissue with the bleeding. The nurse interprets these findings to suggest which of the following? a. Threatened abortion b. Inevitable abortion c. Incomplete abortion d. Missed abortion

b. Inevitable abortion

A nurse is providing care to a pregnant woman with preterm prelabor rupture of membranes (PPROM). On admission, the client's baseline information was as follows: temperature, 97.6°F (36.5°C); pulse, 76 beats/minute; fetal heart rate, 136 beats/minute; white blood cell count, 7 x 103cells/mm3 (7.0 x 109/L). Now, 8 hours later, assessment reveals the following: temperature, 99.6°F (37.7°C); pulse, 82 beats/minute; fetal heart rate, 180 beats/minute; white blood cell count, 8.5 x 103 cells/mm3 (8.5 X 109/L). The nurse suspects a possible infection based on the change in which parameter?

fetal heart rate

abruptio placentae

premature separation of a normally implanted placenta after the 20th week of gestation prior to birth, which leads to hemorrhage It is a significant cause of third-trimester bleeding, with a high mortality rate