OB exam 1

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

methotrexate

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? "The choice is up to you but the healthcare provider is recommending an abortion." "Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications." "I know that it is sad but the pregnancy must be terminated to save your life." "You have experienced an incomplete miscarriage and must have the placenta and any other tissues cleaned out."

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

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

Administer IV NS with vitamins and electrolytes. The first choice for fluid replacement is generally NS with vitamins and electrolytes added. If the client does not improve after several days of bed rest, "gut rest," IV fluids, and antiemetics, then total parenteral nutrition or percutaneous endoscopic gastrostomy tube feeding is instituted to prevent malnutrition.

The nurse is caring for a client with preeclampsia and understands the need to auscultate this client's lung sounds every 2 hours. Why would the nurse do this? Pulmonary emboli Pulmonary edema Pulmonary atelectasis Pulmonary hypertension

Pulmonary edema Rationale: In the hospital, monitor blood pressure at least every four hours for mild preeclampsia and more frequently for severe disease. In addition, it is important to auscultate the lungs every two hours. Adventitious sounds may indicate, developing pulmonary edema.

A 35-year-old client is seen for her 2-week postoperative appointment after a suction curettage was performed to evacuate a hydatidiform mole. The nurse explains that the human chorionic gonadotropin (hCG) levels will be reviewed every 2 weeks and teaches about the need for reliable contraception for the next 6 months to a year. The client states, "I'm 35 already. Why do I have to wait that long to get pregnant again?" What is the nurse's best response? - "A contraceptive is used so that a positive pregnancy test resulting from a new pregnancy will not be confused with the increased level of hCG that occurs with a developing malignancy." - "You may need chemotherapy, so we don't want to risk pregnancy." - "Since you are at the end of your reproductive years, it is suggested that you don't try to have any more pregnancies." - "After a curettage procedure, it is recommended that you give your body some time to build up its stores."

"A contraceptive is used so that a positive pregnancy test resulting from a new pregnancy will not be confused with the increased level of hCG that occurs with a developing malignancy." Because of the risk of choriocarcinoma, the woman receives extensive treatment. Therapy includes baseline chest X-ray to detect lung metastasis physical exam including pelvic exam. Serum B-hCG levels weekly until negative results are obtained three consecutive times, then monthly for 6 to 12 months. The woman is cautioned to avoid pregnancy during this time because the increasing B-hCG levels associated with pregnancy would cause confusion as to whether cancer had developed. If after a year B-hCG seruim titers are within normal levels, a normal pregnancy can be achieved.

A client in her 20th week of gestation develops HELLP syndrome. Which of the following should the nurse consider as features of HELLP syndrome? Select all that apply. a) Elevated liver enzymes b) Hemolysis c) Low platelet count d) Leukocytosis e) Hyperthermia

-Elevated liver enzymes • Hemolysis • Low platelet count Correct Explanation: The HELLP syndrome is a syndrome involving hemolysis (microangiopathic hemolytic anemia), elevated liver enzymes, and a low platelet count. Hyperthermia and leukocytosis are not features of HELLP syndrome.

The client arrives in the office and reports that her feet and legs swelling. During a client evaluation, the nurse notes that she can elicit a 4-mm skin depression that disappears in 10 to 15 seconds. The nurse correctly documents this finding as: 4+ pitting edema. 3+ pitting edema. 2+ pitting edema. 1+ pitting edema.

2+ pitting edema.

A woman in week 35 of her pregnancy with severe hydramnios is admitted to the hospital. The nurse recognizes that which concern is greatest regarding this client? development of eclampsia hemorrhaging development of gestational trophoblastic disease preterm rupture of membranes followed by preterm birth

Preterm rupture of membranes followed by preterm birth Correct Explanation: Even with precautions, in most instances of hydramnios, there will be preterm rupture of the membranes because of excessive pressure, followed by preterm birth. The other answers are not as big of concerns as preterm birth, in this situation.

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? Hemoglobin Urine protein Respiratory rate Ability to sleep

Respiratory rate

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? Weight gain of 1.2 lb (0.54 kg) during the past 1 week Pedal edema A dipstick value of 2+ for protein A systolic blood pressure increase of 10 mm Hg

a dipstick value of 2+ for protein The increasing amount of protein in the urine is a concern the preeclampsia may be progressing to severe preeclampsia. The woman needs further assessment by the health care provider. Dependent edema may be seen in the majority of pregnant women and is not an indicator of progression from preeclampsia to eclampsia. Weight gain is no longer considered an indicator for the progression of preeclampsia. A systolic blood pressure increase is not the highest priority concern for the nurse, since there is no indication what the baseline blood pressure was

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

assessing the amount and color of the bleeding

A nurse is conducting a refresher program for a group of perinatal nurses. Part of the program involves a discussion of HELLP. The nurse determines that the group needs additional teaching when they identify which aspect as a part of HELLP? liver enzyme elevation hemolysis low platelet count elevated lipoproteins

elevated lipoproteins The acronym HELLP represents hemolysis, elevated liver enzymes, and low platelets. This syndrome is a variant of preeclampsia/eclampsia syndrome that occurs in 10% to 20% of clients whose diseases are labeled as severe.

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? central nervous system (CNS) involvement fetal distress related to hypoxia infection cord compression

fetal distress related to hypoxia

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? premature birth preterm labor pregnancy loss hypertension

pregnancy loss

A 24-year-old client presents in labor. The nurse notes there is an order to administer RhoGAM after the birth of her infant. When asked by the client the reason for this injection, which reason should the nurse point out? prevent fetal Rh blood formation. stimulate maternal D immune antigens. promote maternal D antibody formation. prevent maternal D antibody formation.

prevent maternal D antibody formation.

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? closed cervical os strong abdominal cramping no passage of fetal tissue slight vaginal bleeding

strong abdominal cramping

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? "Come to the health facility with any vaginal material passed." "Come to the health care facility if uterine contractions begin." "Continue normal activity, but take the pulse every hour." "Maintain bed rest, and count the number of perineal pads used."

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

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? "I will count my baby's movements after each meal." "I will weigh myself every morning after voiding before breakfast." "If I have a severe headache, I'll call the clinic." "If I have changes in my vision, I will lie down and rest."

"If I have changes in my vision, I will lie down and rest." Changes in the visual field may indicate the client has moved from preeclampsia to severe preeclampisa and is at risk for developing a seizure due to changes in cerebral blood flow. The client would require immediate assessment and intervention. Gaining weight is not necessarily a sign of worsening preeclampsia. The other choices are instructions which the client may be given to follow.

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

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

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. Provide emotional support to the client and significant other. Obtain a surgical consent from the client. Administer oxygen to the client.

Assess the client's vital signs.

The nurse is comforting and listening to a young couple who just suffered a miscarriage. When asked why this happened, which reason should the nurse share as a common cause? The age of the mother Lack of prenatal care Chromosomal abnormality Maternal smoking

Chromosomal abnormality

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? Faulty implantation Chromosomal defects in the fetus Exposure to chemicals or radiation Advanced maternal age

Chromosomal defects in the fetus

A nurse is caring for a young woman who is in her 10th week of gestation. She comes into the clinic reporting vaginal bleeding. Which assessment finding best correlates with a diagnosis of hydatidiform mole? Dark red, "clumpy" vaginal discharge Painful uterine contractions and nausea Brisk deep tendon reflexes and shoulder pain Bright red, painless vaginal bleeding

Dark red, "clumpy" vaginal discharge Rationale: If a complete molar pregnancy continues into the second trimester undetected, other signs and symptoms appear. The woman often presents with complaints of dark to bright red vaginal bleeding and pelvic pain. Infrequently, she will report passage of grapelike vesicles.

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

Monitor the client's vital signs and bleeding.

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? Obtain a voided urine specimen, and determine blood type. Palpate the fundus, and check fetal heart rate. Check deep tendon reflexes. Measure fundal height.

Palpate the fundus and check fetal heart rate. Rationale: The classic signs of abruption placentea are pain, dark red vaginal bleeding, a rigid, board-like abdomen, hypertonic labor, and fetal distress.

A nurse is describing the use of Rho(D) immune globulin as the therapy of choice for isoimmunization in Rh-negative women and for other conditions to a group of nurses working at the women's health clinic. The nurse determines that additional teaching is needed when the group identifies which situation as an indication for Rho(D) immune globulin? maternal trauma amniocentesis STIs molar pregnancy

STIs Indications for Rho(D) immune globulin include isoimmunization, ectopic pregnancy, chorionic villus sampling, amniocentesis, prenatal hemorrhage, molar pregnancy, maternal trauma, percutaneous umbilical sampling, therapeutic or spontaneous abortion, fetal death, or fetal surgery.

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? Gastrointestinal bleeding Tachycardia Sweating Halos around lights

Tachycardia

A young woman presents at the emergency department reporting lower abdominal cramping and spotting at 12 weeks' gestation. The primary care provider performs a pelvic examination and finds that the cervix is closed. What does the care provider suspect is the cause of the cramps and spotting? Habitual abortion Cervical insufficiency Ectopic pregnancy Threatened abortion

Threatened abortion Rationale: Spontaneous abortion occurs along a continuum: threatened, inevitable, incomplete, complete, missed. The definition of each category is related to whether or not the uterus is emptied, or for how long the products of conception are retained.

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? congenital malformations cervical incompetence ectopic pregnancy placenta previa

cervical incompetence This client has reported symptoms of a spontaneous abortion or miscarriage of the second trimester. Miscarriages in the second trimester are most often related to maternal factors such as cervical incompetence, congenital or acquired anomaly of the uterine cavity, hypothyroidism, diabetes mellitus, chronic nephritis, use of crack cocaine, inherited and acquired thrombophilias, lupus, polycystic ovary syndrome, severe hypertension, and acute infection such as rubella virus, cytomegalovirus, herpes simplex virus, bacterial vaginosis, and toxoplasmosis. Cervical incompetence is a condition where there is painless cervical dilatation and results in second trimester fetal loss or can progress to preterm premature rupture of membranes. Ectopic pregnancy, congenital malformations, and placenta previa are not involved in causing second trimester fetal loss. Ectopic pregnancy usually leads to first trimester fetal loss. Placenta previa is a condition in which there is implantation of the placenta to the lower uterine segment. Congenital malformations result in first trimester fetal loss.

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

ensures passage of all the products of conception

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? HELLP preeclampsia chronic hypertension gestational hypertension

gestational hypertension

A nurse is taking a history of a client at 5 weeks' gestation in the prenatal clinic; however, the client is reporting dark brown vaginal discharge, nausea, and vomiting. Which diagnosis should the nurse suspect? pregnancy-induced depression placenta previa gestational trophoblastic disease hyperemesis gravidarum

gestational trophoblastic disease Explanation: This client has risk factors of a "molar" pregnancy: Asian ethnicity and nausea and vomiting at an early gestational week. The early nausea/vomiting can be due to a high HCG level, which is a sign of gestational trophoblastic disease. There is only one sign/symptom of hyperemesis gravidarum. Placenta previa is marked by bright red bleeding and tends to happen later in gestation. There are no data to support any psychosis at this stage.

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: ectopic pregnancy. placenta accrete. hydramnios. hydatidiform mole.

hydatidiform mole.

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

low placental implantation

The nurse understands the need to be aware of the potential of bleeding disorders in her pregnant clients. Which disorder should she be aware of that occurs in the second trimester? Hydatidiform mole Ectopic pregnancy Spontaneous abortion Placenta previa Cervical insufficiency

placenta previa

The following hourly assessments are obtained by the nurse on a client with preeclampsia receiving magnesium sulfate: 97.3oF (36.2oC), HR 88, RR 1, BP 148/110 mm Hg. What other priority physical assessments by the nurse should be implemented to assess for potential toxicity? Reflexes Lung sounds Oxygen saturation Magnesium sulfate level

reflexes

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 multiple gestation pregnancy use of oral contraceptives high number of pregnancies

use of IUD for contraception

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? Healthy pregnancy Placenta previa Molar pregnancy Ectopic pregnancy

Ectopic pregnancy

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) HELLP syndrome ABO incompatibility TORCH syndrome

Twin-to-twin transfusion syndrome (TTTS) Rationale: When twins share a placenta, a serious condition called twin-to-twin transfusion syndrome (TTTS) can occur.