Perry/Hockenberry chapter 12. High Risk Perinatal Care: Gestational Conditions

A woman at 37 weeks of gestation is admitted with a placental abruption after a motor vehicle accident. Which assessment data are most indicative of her condition worsening?1Pulse (P) 112, respiration (R) 32, blood pressure (BP) 108/60; fetal heart rate (FHR) 166--1782P 98, R 22, BP 110/74; FHR 150--1623P 88, R 20, BP 114/70; FHR 140--1584P 80, R 18, BP 120/78; FHR 138--150

1

After being rehydrated in the emergency department, a 24 year-old primipara in her 18th week of pregnancy is at home and is to rest at home for the next two days and take in small but frequent fluids and food as possible. Discharge teaching at the hospital by the nurse has been effective if the patient makes which statement?1"I'm going to eat five to six small servings per day, which contain such foods and fluids as tea, crackers, or a few bites of baked potato."2"A strip of bacon and a fried egg will really taste good as long as I eat them slowly."3"As long as I eat small amounts and allow enough time for digestion, I can eat almost anything, like barbequed chicken or spaghetti."4"I'm going to stay only on clear fluids for the next 24 hours and then add dairy products like eggs and milk."

1

The nurse is caring for a pregnant patient who is receiving antibiotic therapy to treat a urinary tract infection (UTI). Which dietary changes does the nurse suggest for the pregnant patient who is receiving antibiotic therapy for UTI?1"Include yogurt, cheese, and milk in your diet."2"Avoid folic acid supplements until the end of therapy."3"Include vitamins C and E supplementation in your diet."4"Reduce your dietary fat intake by 40 to 50 g per day."

1

The nurse is caring for a pregnant patient who is scheduled for surgery. Which nursing intervention will help provide sufficient fetal oxygenation during the surgery?1Positioning the patient with a lateral tilt2Providing clear liquids before the surgery3Palpating uterine contractions (UCs) manually4Giving an antacid before administering anesthesia

1

The nurse observes that intravenous (I.V.) administration of magnesium sulfate has resulted in magnesium toxicity in a pregnant patient with preeclampsia. The nurse immediately discontinues the infusion and reports to the primary health care provider (PHP). For which drug does the nurse obtain a prescription from the PHP?1Calcium gluconate2Nifedipine (Adalat)3Hydralazine (Apresoline)4Labetalol hydrochloride (Normodyne)

1

Which actions does the nurse take when a pregnant patient has convulsions? Select all that apply.1 Obtains a prescription for magnesium sulfate2 Assesses the patient's airway, breathing, and pulse3 Lowers the bed and turns the patient onto one side4 Does not leave the patient for more than 10 minutes5 Raises the side rails of the bed and pads with pillows

1235

Which hypertensive disorders can occur during pregnancy? Select all that apply.1 Chronic hypertension2 Preeclampsia-eclampsia3 Hyperemesis gravidarum4 Gestational hypertension5 Gestational trophoblastic disease

124

A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits:1a sleepy, sedated affect.2a respiratory rate of 10 breaths/min.3deep tendon reflexes of 2+.4absent ankle clonus.

2

At 38 weeks of gestation, a 24-year-old primipara delivers a 6 pound 2 ounce infant whose five-minute Apgar was 8. How should the neonatal nurse evaluate the outcome of this pregnancy because his mother had been experiencing hyperemesis gravidarum since the eighth week of pregnancy?1High risk and needs extensive monitoring.2Within healthy parameters for gestation, weight, and Apgar.3Very small for gestational age and needs frequent feedings.4At high risk for hypoglycemia and tremors.

2

Which finding in a urine specimen of a pregnant patient indicates the client has proteinuria?1Value of ≥0.5+ protein in a dipstick testing2Protein concentration that is >300 mg/24 hours3Concentration of ≥1 g protein in a 24-hour urine collection4Protein concentration at 10 mg/dL in random urine specimen

2

Which intervention does the nurse implement for a patient immediately after a severe abdominal trauma?1Prep the patient for cesarean birth.2Send the patient for pelvic computed tomography (CT) scanning.3Provide fluids to the patient as part of the protocol for ultrasound examination.4Prepare to administer Rho(D) immunoglobulin.

2

A pregnant patient after 20 weeks' gestation reports painless, bright red vaginal bleeding. Upon assessment, the nurse finds that the patient's vital signs are normal. Which condition does the nurse suspect in the patient?1Eclampsia2Preeclampsia3Pyelonephritis4Placenta previa

4

A blunt abdominal trauma causes fetal hemorrhage in a pregnant patient. The nurse finds that the patient is Rh negative. What action does the nurse take?1Initiate magnesium sulfate per protocol.2Administer oxytocin (pitocin).3Administer prescribed Rho (D) immunoglobulin.4Prepare the patient for magnetic resonance imaging (MRI).

3

At 37 weeks of gestation, the patient is in a severe automobile crash where her abdomen was hit by the steering wheel and her seat belt. What priority action would the emergency room nurse expect to perform upon the patient's arrival at the hospital?1Stay with the patient, assure a patent airway is present, and keep the patient as calm as possible.2Move the patient's skirt to determine if any vaginal bleeding is present, find out who to call, and monitor the level of consciousness.3Assess the patient's vital signs, determine location and severity of pain, and establish continual fetal heart rate monitoring.4Obtain arterial blood gases, obtain a hemoglobin and hematocrit,and oxygen saturation rate.

3

The nurse is preparing to discharge a 30-year-old woman who has experienced a miscarriage at 10 weeks of gestation. Which statement by the woman indicates a correct understanding of the discharge instructions?1"I will not experience mood swings since I was only at 10 weeks of gestation."2"I will avoid sexual intercourse for 6 weeks and pregnancy for 6 months."3"I should eat foods that are high in iron and protein to help my body heal."4"I should expect the bleeding to be heavy and bright red for at least 1 week."

3

What does the nurse advise a pregnant patient who is prescribed phenazopyridine (Pyridium) for cystitis?1"Avoid sweet foods in diet."2"Limit exposure to sunlight."3"Do not wear contact lenses."4"Restrict oral fluids to 125 mL per hour."

3

What instruction does the nurse provide to a pregnant patient with mild preeclampsia?1"You need to be hospitalized for fetal evaluation."2"Nonstress testing can be done once every month."3"Fetal movement counts need to be evaluated daily."4"Take complete bed rest during the entire pregnancy."

3

Which intervention will help prevent the risk of pulmonary edema in a pregnant patient with severe preeclampsia?1Assess fetal heart rate (FHR) abnormalities regularly.2Place the patient on bed rest in a darkened environment.3Restrict total intravenous (I.V.) and oral fluids to 125 mL/hr.4Ensure that magnesium sulfate is administered as prescribed.

3

A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of:1eclamptic seizure.2rupture of the uterus.3placenta previa.4abruptio placentae.

4

What action does the nurse take before performing cardiopulmonary resuscitation (CPR) to revive a pregnant patient undergoing a cardiac arrest?1Administer normal saline solution.2Assess for fetal-maternal hemorrhage.3Call two staff nurses to hold the patient.4Place a rolled blanket under the patient's hips.

4

What does the nurse administer to a patient if there is excessive bleeding after suction curettage?1Nifedipine (Procardia)2Methyldopa (Aldomet)3Hydralazine (Apresoline)4Ergonovine (Methergine)

4

Which is a priority nursing action when a pregnant patient with severe gestational hypertension is admitted to the health care facility?1Prepare the patient for cesarean delivery.2Administer intravenous (I.V.) and oral fluids.3Provide diversionary activities during bed rest.4Administer the prescribed magnesium sulfate.

4

Which statement made by the nursing student about the management of reduced cervical competence (premature dilation of the cervix) in a pregnant patient indicates effective learning?1"Progesterone supplementation is the only effective treatment."2"An abdominal cerclage is performed at the first week of gestation."3"Surgical treatment is ineffective in patients with an extremely short cervix."4"A prophylactic cerclage is used to constrict the internal os of the cervix."

4

A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature of 37.1° C, pulse rate of 96 beats/min, respiratory rate of 24 breaths/min, blood pressure (BP) of 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for:a.Hydralazine.c.Diazepam.b.Magnesium sulfate bolus.d.Calcium gluconate.

A

Approximately 10% to 15% of all clinically recognized pregnancies end in miscarriage. Which is the most common cause of spontaneous abortion?a.Chromosomal abnormalitiesc.Endocrine imbalanceb.Infectionsd.Immunologic factors

A

Because pregnant women may need surgery during pregnancy, nurses should be aware that:a.The diagnosis of appendicitis may be difficult because the normal signs and symptoms mimic some normal changes in pregnancy.b.Rupture of the appendix is less likely in pregnant women because of the close monitoring.c.Surgery for intestinal obstructions should be delayed as long as possible because it usually affects the pregnancy.d.When pregnancy takes over, a woman is less likely to have ovarian problems that require invasive responses

A

In caring for an immediate postpartum client, you note petechiae and oozing from her IV site. You would monitor her closely for the clotting disorder:a.Disseminated intravascular coagulation (DIC)b.Amniotic fluid embolism (AFE)c.Hemorrhaged.HELLP syndrome

A

In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate?a.Administration of bloodb.Preparation of the client for invasive hemodynamic monitoringc.Restriction of intravascular fluidsd.Administration of steroids

A

In planning care for women with preeclampsia, nurses should be aware that:a.Induction of labor is likely, as near term as possible.b.If at home, the woman should be confined to her bed, even with mild preeclampsia.c.A special diet low in protein and salt should be initiated.d.Vaginal birth is still an option, even in severe cases.

A

Spontaneous termination of a pregnancy is considered to be an abortion if:a.The pregnancy is less than 20 weeks.b.The fetus weighs less than 1000 g.c.The products of conception are passed intact.d.No evidence exists of intrauterine infection.

A

The nurse caring for pregnant women must be aware that the most common medical complication of pregnancy is:a.Hypertension.c.Hemorrhagic complications.b.Hyperemesis gravidarum.d.Infections.

A

The priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy is to:a.Assess fetal heart rate (FHR) and maternal vital signsb.Perform a venipuncture for hemoglobin and hematocrit levelsc.Place clean disposable pads to collect any drainaged.Monitor uterine contractions

A

What nursing diagnosis would be the most appropriate for a woman experiencing severe preeclampsia?a.Risk for injury to the fetus related to uteroplacental insufficiencyb.Risk for eclampsiac.Risk for deficient fluid volume related to increased sodium retention secondary to administration of MgSO4d.Risk for increased cardiac output related to use of antihypertensive drugs

A

Which order should the nurse expect for a patient admitted with a threatened abortion?a.Bed restb.Ritodrine IVc.NPOd.Narcotic analgesia every 3 hours, prn

A

Your patient is being induced because of her worsening preeclampsia. She is also receiving magnesium sulfate. It appears that her labor has not become active despite several hours of oxytocin administration. She asks the nurse, "Why is it taking so long?" The most appropriate response by the nurse would be:a."The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor."b."I don't know why it is taking so long."c."The length of labor varies for different women."d."Your baby is just being stubborn."

A

The reported incidence of ectopic pregnancy in the United States has risen steadily over the past 2 decades. Causes include the increase in STDs accompanied by tubal infection and damage. The popularity of contraceptive devices such as the IUD has also increased the risk for ectopic pregnancy. The nurse who suspects that a patient has early signs of ectopic pregnancy should be observing her for symptoms such as (Select all that apply):a.Pelvic painb.Abdominal painc.Unanticipated heavy bleedingd.Vaginal spotting or light bleedinge.Missed period

ABDE

A client who has undergone a dilation and curettage for early pregnancy loss is likely to be discharged the same day. The nurse must ensure that vital signs are stable, bleeding has been controlled, and the woman has adequately recovered from the administration of anesthesia. To promote an optimal recovery, discharge teaching should include (Select all that apply):a.Iron supplementation.b.Resumption of intercourse at 6 weeks following the procedure.c.Referral to a support group if necessary.d.Expectation of heavy bleeding for at least 2 weeks.e.Emphasizing the need for rest.

ACE

A 26-year-old pregnant woman, gravida 2, para 1-0-0-1 is 28 weeks pregnant when she experiences bright red, painless vaginal bleeding. On her arrival at the hospital, what would be an expected diagnostic procedure?a.Amniocentesis for fetal lung maturityb.Ultrasound for placental locationc.Contraction stress test (CST)d.Internal fetal monitoring

B

A laboring woman with no known risk factors suddenly experiences spontaneous rupture of membranes (ROM). The fluid consists of bright red blood. Her contractions are consistent with her current stage of labor. There is no change in uterine resting tone. The fetal heart rate begins to decline rapidly after the ROM. The nurse should suspect the possibility of:a.Placenta previa.b.Vasa previa.c.Severe abruptio placentae.d.Disseminated intravascular coagulation (DIC).

B

A patient with pregnancy-induced hypertension is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs are an indication of:a.Anxiety due to hospitalization.b.Worsening disease and impending convulsion.c.Effects of magnesium sulfate.d.Gastrointestinal upset

B

An abortion in which the fetus dies but is retained within the uterus is called a(n):a.Inevitable abortionc.Incomplete abortionb.Missed abortiond.Threatened abortion

B

The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is:a.Bleeding.c.Uterine activity.b.Intense abdominal pain.d.Cramping.

B

The nurse caring for a woman hospitalized for hyperemesis gravidarum should expect that initial treatment to involve:a.Corticosteroids to reduce inflammation.b.IV therapy to correct fluid and electrolyte imbalances.c.An antiemetic, such as pyridoxine, to control nausea and vomiting.d.Enteral nutrition to correct nutritional deficits.

B

The patient that you are caring for has severe preeclampsia and is receiving a magnesium sulfate infusion. You become concerned after assessment when the woman exhibits:a.A sleepy, sedated affect.c.Deep tendon reflexes of 2.b.A respiratory rate of 10 breaths/min.d.Absent ankle clonus

B

The perinatal nurse is giving discharge instructions to a woman after suction curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. The best response from the nurse would be:a."If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if you desire a future pregnancy, it would be better for you to use the most reliable method of contraception available."b."The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, it would make the diagnosis of this cancer more difficult."c."If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy is rare. Therefore, to improve your chance of a successful pregnancy, it is better not to get pregnant at this time."d."Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pregnancy."

B

What laboratory marker is indicative of disseminated intravascular coagulation (DIC)?a.Bleeding time of 10 minutesc.Thrombocytopeniab.Presence of fibrin split productsd.Hyperfibrinogenemia

B

Which maternal condition always necessitates delivery by cesarean section?a.Partial abruptio placentaec.Ectopic pregnancyb.Total placenta previad.Eclampsia

B

Women with hyperemesis gravidarum:a.Are a majority, because 80% of all pregnant women suffer from it at some time.b.Have vomiting severe and persistent enough to cause weight loss, dehydration, and electrolyte imbalance.c.Need intravenous (IV) fluid and nutrition for most of their pregnancy.d.Often inspire similar, milder symptoms in their male partners and mothers.

B

A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment the nurse finds the following vital signs: temperature of 37.3° C, pulse rate of 88 beats/min, respiratory rate of 10 breaths/min, blood pressure (BP) of 148/90 mm Hg, absent deep tendon reflexes, and no ankle clonus. The client complains, "I'm so thirsty and warm." The nurse:a.Calls for a stat magnesium sulfate level.b.Administers oxygen.c.Discontinues the magnesium sulfate infusion.d.Prepares to administer hydralazine.

C

A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse?a.Blood pressure (BP) increase to 138/86 mm Hgb.Weight gain of 0.5 kg during the past 2 weeksc.A dipstick value of 3+ for protein in her urined.Pitting pedal edema at the end of the day

C

A woman arrives for evaluation of her symptoms, which include a missed period, adnexal fullness, tenderness, and dark red vaginal bleeding. On examination the nurse notices an ecchymotic blueness around the woman's umbilicus and recognizes this assessment finding as:a.Normal integumentary changes associated with pregnancy.b.Turner's sign associated with appendicitis.c.Cullen's sign associated with a ruptured ectopic pregnancy.d.Chadwick's sign associated with early pregnancy.

C

A woman presents to the emergency department with complaints of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary care provider finds that the cervix is closed. The anticipated plan of care for this woman would be based on a probable diagnosis of which type of spontaneous abortion?a.Incompletec.Threatenedb.Inevitabled.Septic

C

In providing nutritional counseling for the pregnant woman experiencing cholecystitis, the nurse would:a.Assess the woman's dietary history for adequate calories and proteins.b.Instruct the woman that the bulk of calories should come from proteins.c.Instruct the woman to eat a low-fat diet and avoid fried foods.d.Instruct the woman to eat a low-cholesterol, low-salt diet.

C

Magnesium sulfate is given to women with preeclampsia and eclampsia to:a.Improve patellar reflexes and increase respiratory efficiency.b.Shorten the duration of labor.c.Prevent and treat convulsions.d.Prevent a boggy uterus and lessen lochial flow.

C

Methotrexate is recommended as part of the treatment plan for which obstetric complication?a.Complete hydatidiform molec.Unruptured ectopic pregnancyb.Missed abortiond.Abruptio placentae

C

Nurses should be aware that HELLP syndrome:a.Is a mild form of preeclampsia.b.Can be diagnosed by a nurse alert to its symptoms.c.Is characterized by hemolysis, elevated liver enzymes, and low platelets.d.Is associated with preterm labor but not perinatal mortality.

C

Preeclampsia is a unique disease process related only to human pregnancy. The exact cause of this condition continues to elude researchers. The American College of Obstetricians and Gynecologists has developed a comprehensive list of risk factors associated with the development of preeclampsia. Which client exhibits the greatest number of these risk factors?a.A 30-year-old obese Caucasian with her third pregnancyb.A 41-year-old Caucasian primigravidac.An African-American client who is 19 years old and pregnant with twinsd.A 25-year-old Asian-American whose pregnancy is the result of donor insemination

C

The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion, the nurse reviews the woman's latest laboratory test findings, which reveal a platelet count of 90,000, an elevated aspartate transaminase (AST) level, and a falling hematocrit. The nurse notifies the physician because the laboratory results are indicative of:a.Eclampsia.b.Disseminated intravascular coagulation (DIC).c.HELLP syndrome.d.Idiopathic thrombocytopenia

C

What condition indicates concealed hemorrhage when the patient experiences an abruptio placentae?a.Decrease in abdominal painc.Hard, boardlike abdomenb.Bradycardiad.Decrease in fundal height

C

What finding on a prenatal visit at 10 weeks could suggest a hydatidiform mole?a.Complaint of frequent mild nauseab.Blood pressure of 120/80 mm Hgc.Fundal height measurement of 18 cmd.History of bright red spotting for 1 day, weeks ago

C

Which condition would not be classified as a bleeding disorder in late pregnancy?a.Placenta previa.c.Spontaneous abortion.b.Abruptio placentae.d.Cord insertion.

C

A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on the knowledge that:a.Bed rest and analgesics are the recommended treatment.b.She will be unable to conceive in the future.c.A D&C will be performed to remove the products of conception.d.Hemorrhage is the major concern

D

A placenta previa in which the placental edge just reaches the internal os is more commonly known as:a.Totalc.Completeb.Partiald.Marginal

D

A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of:a.Eclamptic seizure.c.Placenta previa.b.Rupture of the uterus.d.Placental abruption.

D

A woman with preeclampsia has a seizure. The nurse's primary duty during the seizure is to:a.Insert an oral airway.b.Suction the mouth to prevent aspiration.c.Administer oxygen by mask.d.Stay with the client and call for help.

D

As related to the care of the patient with miscarriage, nurses should be aware that:a.It is a natural pregnancy loss before labor begins.b.It occurs in fewer than 5% of all clinically recognized pregnancies.c.It often can be attributed to careless maternal behavior such as poor nutrition or excessive exercise.d.If it occurs before the twelfth week of pregnancy, it may manifest only as moderate discomfort and blood loss.

D

Nurses should be aware that chronic hypertension:a.Is defined as hypertension that begins during pregnancy and lasts for the duration of pregnancy.b.Is considered severe when the systolic blood pressure (BP) is greater than 140 mm Hg or the diastolic BP is greater than 90 mm Hg.c.Is general hypertension plus proteinuria.d.Can occur independently of or simultaneously with gestational hypertension.

D

Your patient has been receiving magnesium sulfate for 20 hours for treatment of preeclampsia. She just delivered a viable infant girl 30 minutes ago. What uterine findings would you expect to observe/assess in this client?a.Absence of uterine bleeding in the postpartum periodb.A fundus firm below the level of the umbilicusc.Scant lochia flowd.A boggy uterus with heavy lochia flow

D