Prelabor & Intrapartum Complications NCLEX

Answer: 2 Explanation: 1. Second- and third-trimester bleeding increases the risk for PPROM. 2. There is no evidence indicating that bed rest in a subsequent pregnancy decreases the risk for PPROM. 3. A urinary tract infection (UTI) increases the risk for PPROM. 4. Multifetal gestation increases the risk for PPROM.

1) The nurse is caring for a client at 30 weeks' gestation who is experiencing preterm premature rupture of membranes (PPROM). Which statement indicates that the client needs additional teaching? 1. "If I have bleeding in the third trimester of my next pregnancy, I might rupture membranes again." 2. "If I want to become pregnant again, I will have to plan on being on bed rest for the whole pregnancy." 3. "If I develop a urinary tract infection in my next pregnancy, I might rupture membranes early again." 4. "If I were having a singleton pregnancy instead of twins, my membranes would probably not have ruptured."

Answer: 3 Explanation: 1. This is less than recommended for a twin-gestation pregnancy. 2. This is less than recommended for a twin-gestation pregnancy. 3. This is the recommended caloric and protein intake in a twin-gestation pregnancy. 4. This is recommended if the twins are underweight.

10) The nurse is counseling a newly pregnant gravida 1 at 8 weeks' gestation with twins about the need for increased caloric intake. What should the nurse emphasize as being the minimum recommended intake? 1. 2500 kcal and 120 g protein 2. 3000 kcal and 150 g protein 3. 3500 kcal and 175 g protein 4. 4000 kcal and 190 g protein

Answer: 3 Explanation: 1. The perinatal mortality rate for monoamniotic siblings is 10% to 32%. 2. Twins are more likely to have complications than are singleton births. 3. This is true. Spontaneously conceived twins are less likely to develop complications. 4. Primiparous women with twin pregnancies are more likely to develop complications.

11) A client pregnant with twins asks if the pregnancy will be uncomplicated. How should the nurse respond to this client? 1. "The perinatal mortality rate for monoamniotic siblings is 50%." 2. "Twins are less likely to have complications than are singleton births." 3. "Spontaneously conceived twins are less likely to develop complications." 4. "Primiparous women pregnant with twins are less likely to develop complications."

Answer: 1 Explanation: 1. The incidence of cord compression and resulting fetal distress is high when there is an inadequate amount of amniotic fluid to cushion the umbilical cord. Thus, the client with oligohydramnios should come to the hospital in early labor to detect any fetal intolerance of labor that might develop. 2. Gestational diabetes can lead to polyhydramnios but does not cause oligohydramnios. 3. The risk of fetal demise is increased with oligohydramnios. Labor is usually induced when the client reaches term pregnancy to prevent fetal demise. 4. Oligohydramnios occurs in 1% to 3% of pregnancies. It rarely recurs in subsequent pregnancies.

12) A client at 38 weeks' gestation is diagnosed with oligohydramnios. Which statement indicates that teaching has been effective? 1. "When I go into labor, I should come to the hospital right away." 2. "My gestational diabetes may have caused this problem to develop." 3. "Women with this condition usually go into labor after their due date." 4. "This problem is common and will likely occur with my next pregnancy."

Answer: 1, 2, 3 Explanation: 1. The exact cause of hydramnios is unknown. 2. Hydramnios can cause maternal shortness of breath and edema. 3. Hydramnios is associated with maternal diabetes. 4. Hydramnios is not associated with large-for-gestational-age infants. 5. Renal malformation or dysfunction and postmaturity can cause oligohydramnios.

13) A pregnant client diagnosed with hydramnios asks for more information about this health problem. What should the nurse include in this teaching? Select all that apply. 1. The exact cause is unknown. 2. It can cause shortness of breath and edema. 3. It can be associated with maternal diabetes. 4. It occurs in large-for-gestational-age infants. 5. It is associated with renal malformation or dysfunction.

Answer: 1, 2, 3, 4 Explanation: 1. As soon as the fetus is term, induction is typically scheduled because the fetus is at an increased risk for intrauterine fetal demise. 2. Decreased amniotic fluid can contribute to fetal head compression, which can manifest itself as early decelerations. 3. Because there is less fluid available for the fetus to use during fetal breathing movements, pulmonary hypoplasia may develop. 4. Less amniotic fluid lessens the cushioning effect, and cord compression is more likely. 5. Labor progress is slower than average due to the decreased fluid volume.

14) When caring for a client with oligohydramnios, on what should the nurse focus? Select all that apply. 1. Induction is typically scheduled. 2. Early decelerations are more likely. 3. Fetal pulmonary hypoplasia can develop. 4. There is an increased risk of cord compression. 5. Labor progress is often more rapid than average.

Answer: 4 Explanation: 1. Hydramnios is not suspected simply by virtue of a twin gestation. 2. A quadruple screen is not used to determine hydramnios. 3. Hydramnios occurs when there is more amniotic fluid than normal for gestation. 4. The increased amount of amniotic fluid will increase the fundal height disproportionately to the gestation.

15) For which reason should the nurse suspect hydramnios in a pregnant client? 1. The client is pregnant with twins. 2. The quadruple screen comes back positive. 3. There is less amniotic fluid than normal for gestation. 4. The fundal height increases disproportionately to the gestation.

Answer: 21 g

16) A client with premature rupture of membranes received 4 g of magnesium sulfate at 1600 hours, followed by 2 g/hr beginning at 1700 hours. Birth occurred at 0130 hours. How many grams of magnesium sulfate did this client receive? Calculate to the nearest whole number.

Answer: 2, 3, 5 Explanation: 1. Flushing is a maternal adverse effect of magnesium sulfate. 2. Fetal side effects of magnesium sulfate may include lethargy that persists for 1 or 2 days following birth. 3. Fetal side effects of magnesium sulfate may include hypotonia that persists for 1 or 2 days following birth. 4. Poor sucking reflex is not an adverse effect of magnesium sulfate. 5. Respiratory depression in the newborn can also occur after maternal magnesium sulfate.

17) The nurse is caring for the newborn of a client who received magnesium sulfate for preterm labor. Which fetal effects should the nurse attribute to the client's medication treatment? Select all that apply. 1. Flushing 2. Lethargy 3. Hypotonia 4. Poor sucking reflex 5. Respiratory depression

Answer: 1 Explanation: 1. In a marginal placenta previa, the edge of the placenta is covered. 2. The internal os is completely covered in a complete placenta previa. 3. The internal os is partially covered in a partial placenta previa. 4. In a low-lying placenta previa, the placenta is implanted in the lower uterine segment but does not cover the os.

18) The nurse selects the following diagram to instruct a pregnant client with placenta previa. What should the nurse specifically teach the client about this health problem? 1. The edge of the placenta is covered. 2. The placenta completely covers the internal os. 3. The placenta is implanted with partial covering of the internal os. 4. The placenta is implanted in the lower uterine segment not covering the os.

Answer: 1, 2 Explanation: 1. Transabdominal cerclage placement typically results in a cesarean section birth. 2. Transabdominal cerclage placement requires a laparotomy for placement and removal. 3. Transabdominal cerclage placement does not increase the risk for hydramnios. 4. Transabdominal cerclage placement does not increase the risk for abruptio placentae. 5. Transabdominal cerclage placement does not increase the risk for premature rupture of membranes.

19) A pregnant client is scheduled for a transabdominal cerclage. What teaching information should the nurse prepare for this client? Select all that apply. 1. Cesarean section birth 2. Preoperative laparotomy 3. Potential for hydramnios 4. Risk for abruptio placentae 5. Premature rupture of membranes

Answer: 4 Explanation: 1. An uncomplicated elective cerclage may be done as an outclient. 2. An emergency cerclage requires hospitalization for 5 to 7 days or longer. 3. After 37 completed weeks' gestation, the suture may be cut and vaginal birth permitted, or the suture may be left in place and a cesarean birth performed. 4. Decompression of a bulging amniotic sac is not a contraindication to cerclage; rather, the amniotic sac must be decompressed immediately before the procedure.

2) The clinical instructor reviews postoperative care of cerclage with a group of nursing students. Which student statement indicates the need for further information? 1. "Sometimes cerclage can be performed on an outclient basis." 2. "If cerclage is performed emergently, the client will usually be hospitalized for at least 5 days." 3. "After 37 weeks' gestation, the client's cerclage may be cut in order to allow for vaginal delivery." 4. "If the client's amniotic sac is bulging, the cerclage is contraindicated and the procedure cannot be performed."

Answer: 71 kg

20) A client who weighed 60 kg before becoming pregnant with twins is having a routine prenatal examination at gestational week 24. What should be this client's weight in kilograms at this time? (Round to the nearest whole number.)

Answer: 2 Explanation: 1. Contractions are not associated with cervical insufficiency. 2. Cervical insufficiency is painless dilatation of the cervix without contractions due to a structural or functional defect of the cervix. 3. Cervical pain is not a manifestation of cervical insufficiency. 4. Contractions are not associated with cervical insufficiency.

3) A pregnant client is diagnosed with cervical insufficiency. How should the nurse expect this client to explain symptoms of this condition? 1. "I've been having contractions every 4 hours." 2. "I'm not having any pain and I do not feel any contractions." 3. "My cervical pain has gotten much worse over the past 2 days." 4. "I'm not having any pain, but my contractions are getting stronger."

Answer: 3 Explanation: 1. Grade 1 abruptio placentae creates slight vaginal bleeding. The urge to push indicates that delivery is near. This client is not the highest priority. 2. Late decelerations are an abnormal finding, but put only the fetus at risk. This client is not the highest priority. 3. Bleeding with a placenta previa is a complication that can be life threatening to both the mother and baby. This client is the highest priority. 4. Although pregnancy-induced hypertension increases the risk for developing abruptio placentae, there is no indication that this client is experiencing this complication. This client is not the highest priority.

4) The nurse has received end of shift report in the high-risk maternity unit. Which client should the nurse see first? 1. 35 weeks' gestation with grade 1 abruptio placentae in labor who has a strong urge to push 2. 30 weeks' gestation with placenta previa whose fetal monitor strip shows late decelerations 3. 26 weeks' gestation with placenta previa experiencing blood on toilet tissue after a bowel movement 4. 37 weeks' gestation with pregnancy-induced hypertension whose membranes ruptured spontaneously

Answer: 4, 5 Explanation: 1. Multiparity does not cause the same release of thromboplastin that triggers DIC. 2. Preterm labor does not cause the same release of thromboplastin that triggers DIC. 3. Diabetes does not cause the same release of thromboplastin that triggers DIC. 4. Abruptio placentae leaves intrauterine arteries open and bleeding. This results in release of thromboplastin into the maternal blood supply and triggers the development of DIC. 5. In prolonged retention of the fetus after demise, thromboplastin is released from the degenerating fetal tissues into the maternal bloodstream, which activates the extrinsic clotting system. This triggers the formation of multiple tiny clots, which deplete the fibrinogen and factors V and VII, and result in DIC.

5) The nurse is planning an educational program about disseminated intravascular coagulation (DIC) in pregnancy. What risk factors should the nurse include about this health problem? Select all that apply. 1. Multiparity 2. Preterm labor 3. Diabetes mellitus 4. Abruptio placentae 5. Prolonged retention of a fetus after demise

Answer: 4 Explanation: 1. Blood pressure measurements every 2 hours are unnecessary. They can be done on a routine basis or prn. 2. Fetal heart rate monitoring will be done with an external fetal monitor. The placenta is covering the cervical os, and therefore the fetal scalp cannot be accessed to apply an internal monitor. 3. Vaginal examinations are contraindicated because the examination can stimulate bleeding. 4. Blood loss, pain, and uterine contractibility need to be assessed for client comfort and safety.

6) A client at 30 weeks' gestation is experiencing painless late vaginal bleeding. What should the nurse expect in the management of this client? 1. Assessing blood pressure every 2 hours 2. Evaluating the fetal heart rate with an internal monitor 3. Limiting vaginal examinations to only one per 24-hour period 4. Monitoring for blood loss, pain, and uterine contractibility

Answer: 1, 3, 4 Explanation: 1. Abruptio placentae can cause anxiety for both the client and fetus. 2. There is no information regarding the gestational age of this client. The fetus may not be premature. 3. Maternal mortality and perinatal fetal mortality are concerns due to blood loss. 4. Maternal mortality and perinatal fetal mortality are concerns due to hypoxia. 5. Abruptio placentae is a premature separation of the placenta, not a genetic abnormality

7) A multigravida client with suspected abruptio placentae is admitted in active labor. Which nursing diagnoses should the nurse identify as appropriate for this client? Select all that apply. 1. Anxiety related to concern for own safety 2. Ineffective Coping related to premature birth 3. Fluid Volume, Risk for Deficit, related to hypovolemia 4. Tissue Perfusion, Risk for Altered, related to blood loss 5. Knowledge Deficit related to lack of information about inherited genetic defects

Answer: 3 Explanation: 1. This describes a marginal placenta separation, grade 1. 2. With complete separation, there is total separation of the placenta from the uterine wall, and massive bleeding ensues. 3. With the central type of placental separation, blood is trapped between the placenta and uterine wall with concealed bleeding. 4. This describes a marginal placenta separation, grade 1.

8) A pregnant client is diagnosed with central abruptio placentae. What can the nurse infer about the client's condition? 1. The slight separation of the client's placenta from the uterine wall will not produce any bleeding. 2. The total separation of the client's placenta from the uterine wall will lead to massive hemorrhage. 3. Blood is trapped between the client's placenta and the uterine wall, and there may be concealed bleeding. 4. Blood is passing between the fetal membranes and the client's uterine wall, which will lead to some vaginal bleeding.

Answer: 3 Explanation: 1. Preeclampsia is not diagnosed until the 20th week of gestation. This client is only at 18 weeks. Further, blood pressure can be assessed in either arm when the client is in a sitting position; in a side-lying position, the blood pressure should be assessed in the upper arm. 2. Preterm labor is not diagnosed until 20 weeks. This client is only at 18 weeks. Fetal fibronectin (fFN) testing is not indicated at this time. 3. A diet containing 3500 kcal (minimum) and 175 g protein is recommended for a client with normal-weight twins. Teaching about protein sources facilitates adequate fetal growth. 4. Although the incidence of multifetal pregnancy is higher in pregnancies resulting from infertility treatment than in those that are spontaneous pregnancies, the cause of the multifetal pregnancy does not impact nursing care.

9) The home health nurse is visiting the home of a client who is 18 weeks pregnant with twins. Which nursing action is most important? 1. Assess the client's blood pressure in the upper right arm. 2. Collect a cervicovaginal fetal fibronectin (fFN) specimen. 3. Teach the client about foods that are good sources of protein. 4. Determine whether the pregnancy is a result of infertility treatment.