NUAS240T - Chapter 19 - Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications

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. An inevitable abortion is characterized by vaginal bleeding that is greater than slight, rupture of membranes, cervical dilation, strong abdominal cramping, and possible passage of products of conception.

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. The woman should avoid noxious stimuli such as strong flavors, odors, or perfumes because they might trigger nausea and vomiting.

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. to prevent progression of preeclampsia into seizures.

Brisk reflexes; a common presenting symptom of preeclampsia and is the result of an irritable cortex.

Hyperreflexia

The most common cause for __________________ trimester abortions is fetal genetic abnormalities, usually unrelated to the mother.

first

Rh ____________ is a condition that develops when a woman with Rh-negative blood type is exposed to Rh-positive blood cells and subsequently develops circulating titers of Rh antibodies.

incompatibility

A foul odor of amniotic fluid indicates _________________.

infection

__________________ twins develop when a single, fertilized ovum splits during the first 2 weeks after conception.

monozygotic

A decreased amount of amniotic fluid (<500mL) between 32 and 36 weeks' gestation.

oligohydramnios

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? a. Assess the client's vital signs. b. Provide emotional support to the client and significant other. c. Obtain a surgical consent from the client. d. Administer oxygen to the client.

a. Assess the client's vital signs.

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? a. Keep the suction equipment readily available. b. Place the client in a supine position. c. Keep head of bed slightly elevated. d. Provide a well-lit room.

a. Keep the suction equipment readily available.

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? a. "It is hard to know why a woman bleeds during early pregnancy." b. "Your spontaneous bleeding is not work-related." c. "I can understand your need to find an answer to what caused this. Let's talk about this further." d. "Something was wrong with the fetus."

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

A young mother gives birth to twin boys who shared the same placenta. What serious complication are they at risk for? a. ABO incompatibility b. TORCH syndrome c. Twin-to-twin transfusion syndrome (TTTS) d. HELLP syndrome

c. Twin-to-twin transfusion syndrome (TTTS)

A woman of 16 weeks' gestation telephones the nurse because she has passed some "berry-like" blood clots and now has continued dark brown vaginal bleeding. Which action would the nurse instruct the woman to do? a. "Come to the health care facility if uterine contractions begin." b. "Come to the health facility with any vaginal material passed." c. "Continue normal activity, but take the pulse every hour." d. "Maintain bed rest, and count the number of perineal pads used."

b. "Come to the health facility with any vaginal material passed."

A woman in her 20s has experienced a 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 spontaneous miscarriage in the first trimester is related to which factor? a. Advanced maternal age b. Faulty implantation c. Exposure to chemicals or radiation d. Chromosomal defects in the fetus

d. Chromosomal defects in the fetus

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. because assessment of serum chorionic gonadotropin (hCG) is considered a specific tumor marker for gestational trophoblastic disease that isn't resolved. hCG levels are assayed at frequent intervals for up to a year. Pregnancy would obscure the evidence of choriocarcinoma by the normal secretion of hCG.

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. When the placenta separates from the uterine wall, it causes irritation and bleeding into the muscle fibers, which causes pain.

A client with preeclampsia is receiving magnesium sulfate to suppress or control seizures. Which nursing intervention should a nurse perform to determine the effectiveness of therapy? a. Assess deep tendon reflexes b. Monitor intake and output c. Assess client's mucous membrane d. Assess client's skin turgor

a. Assess deep tendon reflexes

When caring for a client with premature rupture of membranes (PROM), the nurse observes an increase in the client's pulse. What should the nurse do next? a. Assess the client's temperature b. Monitor the client for preterm labor c. Assess for cord compression d. Monitor the fetus for respiratory distress

a. Assess the client's temperature

The nurse is caring for a pregnant client with fallopian tube rupture. Which intervention is the priority for this client? a. Monitor the client's vital signs and bleeding. b. Monitor the fetal heart rate (FHR). c. Monitor the mass with transvaginal ultrasound. d. Monitor the client's beta-hCG level.

a. Monitor the client's vital signs and bleeding.

The nurse is caring for an Rh-negative nonimmunized client at 14 weeks' gestation. What information would the nurse provide to the client? a. Obtain RhoGAM at 28 weeks' gestation b. Consume a well-balanced, nutritional diet c. Avoid sexual activity until after 28 weeks d. Undergo periodic transvaginal ultrasounds

a. Obtain RhoGAM at 28 weeks' gestation

A 32-year-old gravida 3 para 2 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 per minute. She is restless and slightly diaphoretic with a small amount of dark red vaginal bleeding. What assessment should the nurse make next? a. Palpate the fundus, and check fetal heart rate. b. Measure fundal height. c. Obtain a voided urine specimen, and determine blood type. d. Check deep tendon reflexes.

a. Palpate the fundus, and check fetal heart rate.

A nurse is caring for a client undergoing treatment for ectopic pregnancy. Which symptom is observed in a client if rupture or hemorrhaging occurs before the ectopic pregnancy is successfully treated? a. Phrenic nerve irritation b. Painless bright red vaginal bleeding c. Fetal distress d. Tetanic contractions

a. Phrenic nerve irritation

A pregnant client is brought to the health care facility with signs of premature rupture of the membranes (PROM). Which conditions and complications are associated with PROM? (Select all that apply.) a. Prolapsed cord b. Abruptio placenta c. Spontaneous abortion d. Placenta previa e. Preterm labor

a. Prolapsed cord b. Abruptio placenta e. Preterm labor

A community health nurse is teaching a group of clients about the zika virus. Which statements by the clients indicate to the nurse that the teaching was effective? (Select all that apply.) a. There is no treatment for newborns with zika, but they will have supportive care based on the defects. b. Zika can be transmitted by mosquitoes, sexual activity, and blood exposure. c. Women who have been exposed to zika should wait six months before attempting conception. d. It is best for men who have been exposed to zika to wait six months before attempting conception. e. A pregnant woman with zika may have a baby with microcephaly and other congenital anomalies.

a. There is no treatment for newborns with zika, but they will have supportive care based on the defects. b. Zika can be transmitted by mosquitoes, sexual activity, and blood exposure. d. It is best for men who have been exposed to zika to wait six months before attempting conception. e. A pregnant woman with zika may have a baby with microcephaly and other congenital anomalies.

A client visits a health care facility reporting amenorrhea for 10 weeks, fatigue, and breast tenderness. Which assessment findings should the nurse prioritize for immediate intervention? (Select all that apply.) a. elevated hCG levels b. dyspareunia c. whitish discharge from the vagina d. absence of fetal heart sound e. hyperemesis gravidarum

a. elevated hCG levels d. absence of fetal heart sound e. hyperemesis gravidarum

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. ensures passage of all the products of conception b. halts the progression of the abortion c. suppresses the immune response to prevent isoimmunization d. alleviates strong uterine cramping

a. ensures passage of all the products of conception

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: a. hydatidiform mole. b. ectopic pregnancy. c. placenta accrete. d. hydramnios.

a. hydatidiform mole.

A pregnant woman has arrived to the office reporting vaginal bleeding. Which finding during the assessment would lead the nurse to suspect an inevitable abortion? a. strong abdominal cramping b. no passage of fetal tissue c. slight vaginal bleeding d. closed cervical os

a. strong abdominal cramping

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? a. use of IUD for contraception b. use of oral contraceptives c. multiple gestation pregnancy d. high number of pregnancies

a. use of IUD for contraception

The nurse is teaching a prenatal class on potential problems during pregnancy to a group of expectant parents. The risk factors for placental abruption are discussed. What comment validates accurate learning by the parents? a. "Since I am over 30, I run a much higher risk of developing this problem." b. "Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain." c. "I need a cesarean section if I develop this problem." d. "If I develop this complication, I will have bright red vaginal bleeding,"

b. "Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain."

A 28-year-old client and her current partner present for the first antenatal OB appointment. The client has no children but does question a possible miscarriage 2 years ago; however, she never sought medical attention because she felt fine. Labs reveal both client and partner are Rh negative. Which action should the nurse prioritize? a. Continue with routine procedures and tasks b. Assess client for anti-D antibodies c. Arrange for an amniocentesis d. Perform direct Coombs test

b. Assess client for anti-D antibodies

A nurse is monitoring a client with spontaneous abortion who has been prescribed misoprostol. Which symptoms are common adverse effects associated with misoprostol? (Select all that apply.) a. Constipation b. Dyspepsia c. Headache d. Hypotension e. Tachycardia

b. Dyspepsia d. Hypotension e. Tachycardia

The nurse is required to assess a client for HELLP syndrome. Which are the signs and symptoms of this condition? (Select all that apply.) a. Blood pressure higher than 160/110 b. Epigastric pain c. Oliguria d. Upper right quadrant pain e. Hyperbilirubinemia

b. Epigastric pain d. Upper right quadrant pain e. Hyperbilirubinemia

A nurse is monitoring a client with PROM who is in labor and observes meconium in the amniotic fluid. What does this indicate? a. Cord compression b. Fetal distress related to hypoxia c. Infection d. Central nervous system "CNS" involvement

b. Fetal distress related to hypoxia

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 alert the RN or health care provider? a. Initial BP 110/60 mm Hg; current BP 112/86 mm Hg b. Initial BP 100/70 mm Hg; current BP 140/90 mm Hg c. Initial BP 120/80mm Hg; current BP 130/88 mm Hg d. Initial BP 140/85 mm Hg; current BP 130/80 mm Hg

b. Initial BP 100/70 mm Hg; current BP 140/90 mm Hg

A client is seeking advice for his pregnant wife, who is experiencing mild elevations in blood pressure. In which position should a nurse recommend the pregnant client rest? a. Supine position b. Lateral recumbent position c. Left lateral lying position d. Head of the bed slightly elevated

b. Lateral recumbent position

A woman in labor suddenly reports sharp fundal pain accompanied by slight dark red vaginal bleeding. The nurse should prepare to assist with which situation? a. Possible fetal death or injury b. Premature separation of the placenta c. Preterm labor that was undiagnosed d. Placenta previa obstructing the cervix

b. Premature separation of the placenta

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? a. performing a vaginal examination to assess the extent of bleeding b. assessing fetal heart tones by use of an external monitor c. assessing uterine contractions by an internal pressure gauge d. helping the woman remain ambulatory to reduce bleeding

b. assessing fetal heart tones by use of an external monitor

A pregnant client at 20 weeks' gestation arrives at the health care facility reporting excessive vaginal bleeding and no fetal movements. Which assessment finding would the nurse anticipate in this situation? a. ectopic pregnancy b. cervical incompetence c. placenta previa d. congenital malformations

b. cervical incompetence

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? a. serum magnesium level of 6.5 mEq/L b. diminished reflexes c. elevated liver enzymes d. seizures

b. diminished reflexes

A 44-year-old client has lost several pregnancies over the last 10 years. For the past 3 months, she has had fatigue, nausea, and vomiting. She visits the clinic and takes a pregnancy test; the results are positive. Physical examination confirms a uterus enlarged to 13 weeks' gestation; fetal heart tones are heard. Ultrasound reveals that the client is experiencing some bleeding. Considering the client's prenatal history and age, what does the nurse recognize as the greatest risk for the client at this time? a. premature birth b. pregnancy loss c. preterm labor d. hypertension

b. pregnancy loss

A nursing instructor is conducting a session exploring the signs and symptoms of eclampsia to a group of student nurses. The instructor determines the session is successful after the students correclty choose which signs indicating eclampsia? (Select all that apply.) a. auditory hallucinations b. proteinuria c. hypereflexia d. blurring of vision e. hyperglycemia

b. proteinuria c. hypereflexia d. blurring of vision

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? a. "Staples are put in the cervix to prevent it from dilating." b. "A cervical cap is placed so no amniotic fluid can escape." c. "Purse-string sutures are placed in the cervix to prevent it from dilating." d. "The cervix is glued shut so no amniotic fluid can escape."

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

A client in her first trimester arrives at the emergency room with reports of severe cramping and vaginal spotting. On examination, the health care provider informs her that no fetal heart sounds are evident and orders a dilatation and curettage. The client looks frightened and confused and states that she does not believe in abortion. Which statement by the nurse is best? a. "I know that it is sad but the pregnancy must be terminated to save your life." b. "The choice is up to you but the healthcare provider is recommending an abortion." c. "Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications." d. "You have experienced an incomplete miscarriage and must have the placenta and any other tissues cleaned out."

c. "Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications."

A nurse is caring for a pregnant client with eclamptic seizure. Which is a characteristic of eclampsia? a. Muscle rigidity is followed by facial twitching b. Respirations are rapid during the seizure c. Coma occurs after seizure d. Respiration fails after the seizure

c. Coma occurs after seizure

A pregnant client with hyperemesis gravidarum needs advice on how to minimize nausea and vomiting. Which instruction should the nurse give this client? a. Lie down or recline for at least 2 hours after eating b. Avoid dry crackers, toast, and soda c. Eat small, frequent meals throughout the day d. Decrease intake of carbonated beverages

c. Eat small, frequent meals throughout the day

A 28-year-old client with a history of endometriosis presents to the emergency department with severe abdominal pain and nausea and vomiting. The client also reports her periods are irregular with the last one being 2 months ago. The nurse prepares to assess for which possible cause for this client's complaints? a. Healthy pregnancy b. Molar pregnancy c. Ectopic pregnancy d. Placenta previa

c. Ectopic pregnancy

A client has come to the office for a prenatal visit during her 22nd week of gestation. On examination, it is noted that her blood pressure has increased to 138/90 mm Hg. Her urine is negative for proteinuria. The nurse recognizes which factor as the potential cause? a. chronic hypertension b. HELLP c. gestational hypertension d. preeclampsia

c. gestational hypertension

What would be the physiologic basis for a placenta previa? a. a loose placental implantation b. a uterus with a midseptum c. low placental implantation d. a placenta with multiple lobes

c. low placental implantation

The presence of rhythmic involuntary contractions, most often at the foot or ankle.

clonus

A nurse is assessing pregnant clients for the risk of placenta previa. Which of the following clients faces the greatest risk for this condition? a. A 23-year-old multigravida client b. A client with a history of alcohol abuse c. A client with a structurally defective cervix d. A client who had a myomectomy to remove fibroids

d. A client who had a myomectomy to remove fibroids

A nurse is caring for a client with hyperemesis gravidarum. Which nursing action is the priority for this client? a. Administer total parenteral nutrition b. Administer an antiemetic c. Set up for a percutaneous endoscopic gastrostomy d. Administer IV NS with vitamins and electrolytes

d. Administer IV NS with vitaimins 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? a. Contraction test b. Nonstress test c. Biophysical profile d. Amniocentesis

d. Amniocentesis

A nurse is assessing a pregnant client with preeclampsia for suspected dependent edema. Which description of dependent edema is most accurate? a. Dependent edema leaves a small depression or pit after finger pressure is applied to a swollen area. b. Dependent edema occurs only in clients on bed rest. c. Dependent edema can be measured when pressure is applied. d. Dependent edema may be seen in the sacral area if the client is on bed rest

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

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? a. infection b. central nervous system (CNS) involvement c. cord compression d. fetal distress related to hypoxia

d. fetal distress related to hypoxia

A ___________________ abortion refers to the loss of a fetus resulting from natural causes - that is, not elective or therapeutically induced by a procedure.

spontaneous

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. Any time there is a pregnancy with the chance of maternal and fetal blood mixing, RhoGAM is needed to prevent sensitization or antibody production.

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

Which medication would the nurse prepare to administer if prescribed as treatment for an unruptured ectopic pregnancy? a. methotrexate b. promethazine c. oxytocin d. ondansetron

a. methotrexate

A novice nurse asks to be assigned to the least complex antepartum client. Which condition would necessitate the least complex care requirements? a. abruptio placenta b. preecalmpsia c. gestational hypertension d. placenta previa

c. gestational hypertension

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. Plan for immediate induction of labor. b. Admit the client to the middle of ICU where she can be constantly monitored. c. Institute NPO status. d. Institute and maintain seizure precautions.

d. Institute and maintain seizure precautions.

A woman in labor suddenly reports sharp fundal pain accompanied by slight dark red vaginal bleeding. The nurse should prepare to assist with which situation? a. Possible fetal death or injury b. Preterm labor that was undiagnosed c. Placenta previa obstructing the cervix d. Premature separation of the placenta

d. Premature separation of the placenta

A client at 37 weeks' gestation presents to the emergency department with a BP 150/108 mm Hg, 1+ pedal edema, 1+ proteinuria, and normal deep tendon reflexes. Which assessment should the nurse prioritize as the client is administered magnesium sulfate IV? a. Urine protein b. Ability to sleep c. Hemoglobin d. Respiratory rate

d. Respiratory rate

The nurse is required to assess a pregnant client who is reporting vaginal bleeding. Which nursing action is the priority? a. determining the amount of funneling b. monitoring uterine contractility c. assessing signs of shock d. assessing the amount and color of the bleeding

d. assessing the amount and color of the bleeding

___________________ hypertension is characterized by hypertension without proteinuria after 20 weeks' gestation and a return of the blood pressure to normal postpartum.

gestational

The time interval from rupture of membranes to the onset of regular contractions

latent period