Test 2 - Chpt 19 & 20

Before giving a repeat dose of magnesium sulfate to a pre-eclamptic patient, the nurse should assess the patient's condition. Which of the following conditions will require the nurse to temporarily suspend a repeat dose of magnesium sulfate? A. 100 cc. urine output in 4 hours B. Knee jerk reflex is (+)2 C. Serum magnesium level is 10mEg/L. D. Respiratory rate of 16/min

Correct Answer: A. 100 cc. urine output in 4 hours The minimum urine output expected for a repeat dose of MgSO4 is 30 cc/hr. If in 4 hours the urine output is only 100 cc this is low and can lead to poor excretion of Magnesium with a possible cumulative effect, which can be dangerous to the mother. Option B: As the plasma levels increase the muscle weakness becomes more pronounced and there is a marked reduction and then loss of deep tendon reflexes eventually leading to flaccid paralysis and respiratory arrest. Option C: Magnesium sulfate is the ideal drug for the prevention and treatment of eclampsia, and, indeed, its universal use is recommended by the World Health Organization. Nevertheless, the best regimen remains to be established and there is still no evidence that serum magnesium levels between 4 and 7?mEq/L, established in a retrospective study and still considered therapeutic, represent a guarantee that pregnant women with hypertensive disorders are protected against eclampsia. Option D: Magnesium sulfate has CNS and respiratory depressant effects. It acts peripherally, causing vasodilation; moderate doses cause flushing and sweating, whereas high doses cause hypotension. It prevents or controls seizures by blocking neuromuscular transmission.

Which of the following is the most common kind of placental adherence seen in pregnant women? A. Accreta B. Placenta previa C. Percreta D. Increta

Correct Answer: A. Accreta Placenta accreta is the most common kind of placental adherence seen in pregnant women and is characterized by slight penetration of myometrium. Option B: In placenta previa, the placenta does not embed correctly and results in what is known as a low-lying placenta. It can be marginal, partial, or complete in how it covers the cervical os, and it increases the patient's risk for painless vaginal bleeding during the pregnancy and/or delivery process. Option C: Placenta percreta leads to perforation of the uterus and is the most serious and invasive of all types of accrete. Option D: Placenta increta leads to deep penetration of the myometrium.

A pregnant client is diagnosed with partial placenta previa. In explaining the diagnosis, the nurse tells the client that the usual treatment for partial placenta previa is which of the following? A. Activity limited to bed rest. B. Platelet infusion. C. Immediate cesarean delivery. D. Labor induction with oxytocin.

Correct Answer: A. Activity limited to bed rest Treatment of partial placenta previa includes bed rest, hydration, and careful monitoring of the client's bleeding. Option B: The greatest risk of placenta previa is hemorrhage. Bleeding often occurs as the lower part of the uterus thins during the third trimester of pregnancy in preparation for labor. This may require blood transfusion during Cesarean section. Option C: In general, there is a higher Cesarean rate associated with placental edge-to-cervical os distances of less than 2 cm. Option D: Labor induction is the stimulation of uterine contractions during pregnancy before labor begins on its own to achieve a vaginal birth. It is not an option for placenta previa.

When developing a plan of care for a client newly diagnosed with gestational diabetes, which of the following instructions would be the priority? A. Dietary intake B. Medication C. Exercise D. Glucose monitoring

Correct Answer: A. Dietary intake Although all of the choices are important in the management of diabetes, diet therapy is the mainstay of the treatment plan and should always be the priority. The goal of dietary therapy is to avoid single large meals and foods with a large percentage of simple carbohydrates. Option B: Women diagnosed with gestational diabetes generally need only diet therapy without medication to control their blood sugar levels. A total of 6 feedings per day is preferred, with 3 major meals and 3 snacks to limit the amount of energy intake presented to the bloodstream at any interval. Option C: Exercise, is important for all pregnant women and especially for diabetic women, because it burns up glucose, thus decreasing blood sugar. However, dietary intake, not exercise, is the priority. The diet should include foods with complex carbohydrates and cellulose, such as whole-grain bread and legumes. Option D: All pregnant women with diabetes should have periodic monitoring of serum glucose. However, those with gestational diabetes generally do not need daily glucose monitoring. The standard of care recommends a fasting and 2-hour postprandial blood sugar level every 2 weeks.

The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what would be another tool useful in confirming the diagnosis? A. Doppler blood flow analysis B. Contraction stress test (CST) C. Amniocentesis D. Daily fetal movement counts

Correct Answer: A. Doppler blood flow analysis Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and the placenta. It is a helpful tool in the management of high-risk pregnancy due to intrauterine growth restriction (IUGR), diabetes mellitus, multiple fetuses, or preterm labor. Option B: Because of the potential risk of inducing labor and causing fetal distress, a CST is not performed on a woman whose fetus is preterm. Option C: Indications for an amniocentesis include diagnosis of genetic disorders or congenital anomalies, assessment of the pulmonary maturity, and the diagnosis of fetal hemolytic disease, not IUGR. Option D: Fetal kick count monitoring is performed to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation. Although it may be a useful tool at some point later in this woman's pregnancy, it is not used to diagnose IUGR.

The nurse should anticipate that hemorrhage related to uterine atony may occur postnatally if this condition was present during the delivery: A. Excessive analgesia was given to the mother. B. Placental delivery occurred within thirty minutes after the baby was born. C. An episiotomy had to be done to facilitate delivery of the head. D. The labor and delivery lasted for 12 hours.

Correct Answer: A. Excessive analgesia was given to the mother. Excessive analgesia can lead to uterine relaxation thus lead to hemorrhage postpartally. Both B and D are normal and C is at the vaginal introitus thus will not affect the uterus. Option B: The absolute time limit for delivery of the placenta, without evidence of significant bleeding, remains unclear. Periods ranging from 30-60 minutes have been suggested. Option C: An episiotomy is a minor incision made during childbirth to widen the opening of the vagina. A perineal tear or laceration often forms on its own during a vaginal birth. Rarely, this tear will also involve the muscle around the anus or the rectum. Both episiotomies and perineal lacerations require stitches to repair and ensure the best healing. Both are similar in recovery time and discomfort during healing. Option D: Normal labor usually begins within 2 weeks (before or after) the estimated delivery date. In a first pregnancy, labor usually lasts 12 to 18 hours on average; subsequent labors are often shorter, averaging 6 to 8 hours.

When uterine rupture occurs, which of the following would be the priority? A. Limiting hypovolemic shock. B. Obtaining blood specimens. C. Instituting complete bed rest. D. Inserting a urinary catheter.

Correct Answer: A. Limiting hypovolemic shock With uterine rupture, the client is at risk for hypovolemic shock. Therefore, the priority is to prevent and limit hypovolemic shock. Immediate steps should include giving oxygen, replacing lost fluids, providing drug therapy as needed, evaluating fetal responses, and preparing for surgery. Option B: Obtaining blood specimens can be done once the client is already in a stable condition. Option C: Complete bed rest is applicable for the patient who has uterine rupture. A pregnant uterus after laparoscopic adenomyomectomy might rupture easily by rather weak and short uterine contractions. Furthermore, uterine contractions followed by uterine bleeding might be useful for the diagnosis of uterine rupture. When uterine contractions are followed by uterine bleeding in pregnant women that have had a prior adenomyomectomy, this must be considered a potential sign of uterine rupture. Option D: Inserting a urinary catheter is necessary for preparation for surgery to remedy the rupture.

To prevent preterm labor from progressing, drugs are usually prescribed to halt the labor. The drugs commonly given are: A. Magnesium sulfate and terbutaline B. Prostaglandin and oxytocin C. Progesterone and estrogen D. Dexamethasone and prostaglandin

Correct Answer: A. Magnesium sulfate and terbutaline Magnesium sulfate acts as a CNS depressant as well as a smooth muscle relaxant. Terbutaline is a drug that inhibits the uterine smooth muscles from contracting. On the other hand, oxytocin and prostaglandin stimulate the contraction of smooth muscles. Option B: Prostaglandins act to mediate cervical ripening and to stimulate uterine contractions and indirectly to increase fundally dominant myometrial contractility by up-regulation of gap junctions, oxytocin, and arginine vasopressin receptors, and synchronizations of contractions. Oxytocin receptor antagonists (ORA), such as atosiban, have been specially developed for the treatment of preterm labor. ORA has been proposed as effective tocolytic agent for women in preterm labor to prolong pregnancy with fewer side effects than other tocolytic agents. Option C: In the first trimester, progesterone produced by the corpus luteum is critical to the maintenance of early pregnancy until the placenta takes over this function at 7 to 9 weeks of gestation, hence its name (pro-gestational steroidal ketone). Indeed, removal of the source of progesterone (the corpus luteum) or administration of a progesterone receptor antagonist readily induces abortion before 7 weeks (49 days) of gestation. Estrogen is one of the key hormones of labor. As the labor comes closer, the high levels of estrogens stimulate many different processes necessary for delivery. As the levels of estrogen rise, an increase in oxytocin receptors in the uterus is stimulated, as well as prostaglandins in the cervix. Option D: Dexamethasone accelerates maturation of fetal lungs, decreases the number of neonates with respiratory distress syndrome, and improves survival in preterm delivered neonates. Optimal gestational age for use of dexamethasone therapy is 31 to 34 weeks of gestation.

Which of the following information, when voiced by the mother, would indicate to the nurse that she understands home care instructions following the administration of diphtheria, tetanus, and pertussis injection? A. Measures to reduce fever. B. Need for dietary restrictions. C. Reasons for subsequent rash. D. Measures to control subsequent diarrhea.

Correct Answer: A. Measures to reduce fever The pertussis component may result in fever and the tetanus component may result in injection soreness. Therefore, the mother's verbalization of information about measures to reduce fever indicates understanding. Option B: No dietary restrictions are necessary after this injection is given. Option C: Subsequent rash is more likely to be seen 5 to 10 days after receiving the MMR vaccine, not diphtheria, pertussis, and tetanus vaccine. Option D: Diarrhea is not associated with this vaccine. Common side effects include soreness or swelling where the shot was given, fever, irritability, feeling tired, loss of appetite, and vomiting.

Which of the following factors would the nurse suspect as predisposing a client to placenta previa? A. Multiple gestation B. Uterine anomalies C. Abdominal trauma D. Renal or vascular disease

Correct Answer: A. Multiple gestation Multiple gestation is one of the predisposing factors that may cause placenta previa. Placenta previa is more common in older and multiparous women. The reason is not clear but it may be associated with the aging of the vasculature of the uterus. This causes placental hypertrophy and enlargement which increases the likelihood of the placenta encroaching on lower segment Option B: Patients with a unicornuate uterus had high rates of placenta or vasa previa, and three of five pregnancies with placenta previa also had placenta accreta. While this represents a small series, placenta accreta in those with placenta previa has been reported to occur with this frequency in women with multiple prior cesarean deliveries. Option C: The exact etiology of placental abruption is unknown. However, a number of factors are associated with its occurrence. Risk factors can be thought of in 3 groups: health history, including behaviors, and past obstetrical events, current pregnancy, and unexpected trauma. Option D: Complications of conservative management of placenta percreta described in the literature include bleeding, infection (endometritis, wound infection, peritonitis, pyelonephritis, uterine necrosis), sepsis and septic shock, fistula formation, thrombosis, pulmonary embolism, pulmonary edema, and the side-effects of methotrexate therapy. Acute renal failure has only been described in one case with methotrexate injection into the umbilical cord and was considered an acute side-effect of methotrexate therapy.

When administering magnesium sulfate to a client with preeclampsia, the nurse understands that this drug is given to: A. Prevent seizures. B. Reduce blood pressure. C. Slow the process of labor. D. Increase dieresis.

Correct Answer: A. Prevent seizures The chemical makeup of magnesium is similar to that of calcium and, therefore, magnesium will act like calcium in the body. As a result, magnesium will block seizure activity in a hyper-stimulated neurologic system by interfering with signal transmission at the neuromuscular junction. Option B: Magnesium sulfate may attenuate blood pressure by decreasing the vascular response to pressor substances. Option C: Since the primary therapeutic goal of tocolysis is to delay preterm delivery within 48 hours from the initiation of steroid prophylaxis, little evidence suggests that extended MgSO4 therapy is beneficial. Option D: There are rare cases of pregnant women who develop polyuria after receiving intravenous therapy of magnesium sulfate. It can be considered as another cause of solute diuresis.

Which of the following should the nurse expect to note as a frequent complication for a child with congenital heart disease? A. Susceptibility to respiratory infection B. Bleeding tendencies C. Frequent vomiting and diarrhea D. Seizure disorder

Correct Answer: A. Susceptibility to respiratory infection Children with congenital heart disease are more prone to respiratory infections. Children with congenital heart disease (CHD) are at risk for increased morbidity from viral lower respiratory tract infections because of anatomical cardiac lesions that can worsen an already compromised respiratory status. Option B: It has been recognized that patients with Cyanotic Congenital Heart Disease (CCHD) show significant bleeding tendency which can be secondary to coagulopathies in these patients. Some coagulation abnormalities are thrombocytopenia, factor deficiencies, fibrinolysis, and Disseminated Intravascular Coagulation (DIC). Option C: Vomiting and diarrhea are most likely experienced with a heart attack. Women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain. Option D: Although neurological morbidity has been consistently described in the congenital heart disease (CHD) population,1 no studies to date have examined the long-term risk of epilepsy in subjects with CHD compared with the general population.

A pregnant mother is admitted to the hospital with the chief complaint of profuse vaginal bleeding, AOG 36 wks, not in labor. The nurse must always consider which of the following precautions: A. The internal exam is done only at the delivery under strict asepsis with a double set-up. B. The preferred manner of delivering the baby is vaginal. C. An emergency delivery set for vaginal delivery must be made ready before examining the patient. D. Internal exams must be done following routine procedures.

Correct Answer: A. The internal exam is done only at the delivery under strict asepsis with a double set-up. Painless vaginal bleeding during the third trimester may be a sign of placenta praevia. Option B: If the bleeding is due to soft tissue injury in the birth canal, immediate vaginal delivery may still be possible so the set up for vaginal delivery will be used. Option C: A double set-up means there is a set-up for cesarean section and a set-up for vaginal delivery to accommodate immediately the necessary type of delivery needed. In both cases, strict asepsis must be observed. Option D: If an internal examination is done in this kind of condition, this can lead to even more bleeding and may require immediate delivery of the baby by cesarean section.

In a gravido-cardiac mother, the first 2 hours postpartum (4th stage of labor and delivery) particularly in a cesarean section is a critical period because at this stage A. There is a fluid shift from the placental circulation to the maternal circulation which can overload the compromised heart. B. The maternal heart is already weak and the mother can die. C. The delivery process is strenuous to the mother. D. The mother is tired and weak which can distress the heart. ADVERTISEMENTS 5. Maternity Nursing (OB Maternal & Newborn) NCLEX Practice Quiz

Correct Answer: A. There is a fluid shift from the placental circulation to the maternal circulation which can overload the compromised heart. During the pregnancy, there is an increase in maternal blood volume to accommodate the need of the fetus. When the baby and placenta have been delivered, there is a fluid shift back to the maternal circulation as part of physiologic adaptation during the postpartum period. In a cesarean section, the fluid shift occurs faster because the placenta is taken out right after the baby is delivered giving it less time for the fluid shift to gradually occur. Option B: Heart rate increases in a linear fashion during pregnancy by 10 to 20 bpm over baseline and returns to pre-pregnant levels in 6 weeks postpartum. There is ventricular remodeling during pregnancy and left ventricular wall thickness and mass increase by 28% to 52% above pre-pregnancy values. Cardiac contractility and ventricular ejection fraction don't undergo any significant change during the entire peripartum period. Option C: There is generalized physical fatigue immediately after delivery. The pulse rate may be elevated a few hours after the childbirth, due to excitement or pain, and usually normalizes on the second day. The blood pressure could be elevated due to pain or excitement but is generally in the normal range Option D: Cardiac output increases throughout pregnancy. However, in the immediate postpartum period, following delivery, there is an increase in circulating blood volume from the contraction of the uterus and an increase in preload from the relief of inferior vena cava obstruction, leading to an increase in stroke volume and heart rate leading to a 60 to 80% rise in cardiac output, which rapidly declines to pre-labor values in 1 to 2 hours following delivery and to pre-pregnancy values in two weeks postpartum.

A 39-year-old at 37 weeks gestation is admitted to the hospital with complaints of vaginal bleeding following the use of cocaine 1 hour earlier. Which complication is most likely causing the client's complaint of vaginal bleeding? A. Placenta previa B. Abruptio placentae C. Ectopic pregnancy D. Spontaneous abortion

Correct Answer: B. Abruptio placentae The major maternal adverse reactions from cocaine use in pregnancy include spontaneous abortion first, not third, trimester abortion and abruptio placentae. The hypertension and increased levels of catecholamines caused by cocaine abuse are thought to be responsible for a vasospasm in the uterine blood vessels that causes placental separation and abruption. Option A: A pregnant woman who uses cocaine experiences a constriction of the blood vessels throughout her body. A fetus needs this blood flow for its oxygen supply. After cocaine abuse, the heart rate of the fetus goes up along with the blood pressure, but it may suffer a lack of oxygen (hypoxia). This restricted blood supply can also permanently damage sections of the placenta which can result in loss of the baby. Option C: Ectopic pregnancy (EP) is defined as the implantation and development of a fertilized ovum anywhere outside of the uterine cavity. Such a pregnancy may lead to tubal rupture and intra abdominal hemorrhage and represents the major cause of maternal death in the first trimester. Option D: Cocaine use early in pregnancy decreases uterine and placental blood flow by inhibiting the reuptake of norepinephrine, which causes arterial vasoconstriction. In most, but not all, previous studies of cocaine use during pregnancy and spontaneous abortion, the women's current use of cocaine, as assessed by self-reports or urine analysis, was related to their history of spontaneous abortion.

Smoking is contraindicated in pregnancy because: A. Nicotine causes vasodilation of the mother's blood vessels. B. Carbon monoxide binds with the hemoglobin of the mother reducing available hemoglobin for the fetus. C. The smoke will make the fetus, and the mother feels dizzy. D. Nicotine will cause vasoconstriction of the fetal blood vessels.

Correct Answer: B. Carbon monoxide binds with the hemoglobin of the mother reducing available hemoglobin for the fetus. Carbon monoxide is one of the substances found in cigarette smoke. This substance diminishes the ability of the hemoglobin to bind with oxygen thus reducing the amount of oxygenated blood reaching the fetus. Option A: There is blood flow restriction to the placenta due to the vasoconstrictive effects of catecholamines released from the adrenals and nerve cells after nicotine activation. Option C: Nicotine is rapidly absorbed when the tobacco smoke reaches the small airways and alveoli of the lung. This causes a quick rise in blood nicotine concentrations, but due to the eventual burnout of the cigarette, these levels also peak early and thereafter drop to lower levels. Option D: Direct effects on nicotinic acetylcholine receptors (nAChRs), which are present and functional very early in the fetal brain [5] are also likely to contribute.

Which of the following would the nurse assess in a client experiencing abruptio placenta? A. Bright red, painless vaginal bleeding B. Concealed or external dark red bleeding C. Palpable fetal outline D. Soft and nontender abdomen

Correct Answer: B. Concealed or external dark red bleeding A client with abruptio placentae may exhibit concealed or dark red bleeding, possibly reporting sudden intense localized uterine pain. The uterus is typically firm to board-like, and the fetal presenting part may be engaged. Option A: Painless vaginal bleeding during the second or third trimester of pregnancy is the usual presentation in placenta previa. The bleeding may be provoked from intercourse, vaginal examinations, labor, and at times there may be no identifiable cause. On speculum examination, there may be minimal bleeding to active bleeding. Option C: On physical examination, the uterus tends to be soft and fetal parts are readily palpable. With placenta previa, the presenting part is unengaged and malpresentation is common, seen in up to 50% of cases. Option D: Abdominal examination usually finds the uterus non-tender, soft and relaxed. Leopold's Maneuvers may find the fetus in an oblique or breech position or lying transverse as a result of the abnormal position of the placenta. Malpresentation is found in about 35% cases.

Which of the following signs will distinguish threatened abortion from imminent abortion? A. Severity of bleeding. B. Dilation of the cervix. C. Nature and location of pain. D. Presence of uterine contraction.

Correct Answer: B. Dilation of the cervix In imminent abortion, the pregnancy will definitely be terminated because the cervix is already open unlike in threatened abortion where the cervix is still closed. Option A: Nearly 25% of pregnant women have some degree of vaginal bleeding during the first two trimesters and about 50% of these progress to loss of the pregnancy. The bleeding during a threatened abortion is typically mild to moderate. Option C: A threatened abortion occurs when a pregnant patient at less than 20 weeks gestation presents with vaginal bleeding. The cervical os is closed on a physical exam. The patient may also experience abdominal cramping, pelvic pain, pelvic pressure, and/or back pain. Option D: A pelvic exam is mandatory to determine the type of abortion. Determining factors include the amount and site of bleeding, whether the cervix is dilated, and whether fetal tissue has passed. In a threatened abortion, the vaginal exam may reveal a closed cervical os with no tissue. There is usually no cervical motion tenderness.

A patient in her 14th week of pregnancy has presented with abdominal cramping and vaginal bleeding for the past 8 hours. She has passed several clots. What is the primary nursing diagnosis for this patient? A. Knowledge deficit B. Fluid volume deficit C. Anticipatory grieving D. Pain

Correct Answer: B. Fluid volume deficit If bleeding and clots are excessive, this patient may become hypovolemic. Pad count should be instituted. Blood volume expands during pregnancy, and a considerable portion of the weight of a pregnant woman is retained water. Option A: Knowledge deficit is an appropriate nursing diagnosis because the woman might not have any knowledge on how to manage her symptoms. However, this is not a priority diagnosis. Option C: Anticipatory grieving is the name given to the tumultuous set of feelings and reactions that occur when someone is expecting the death of a loved one. Option D: Pain may be felt due to abdominal cramping accompanied by bleeding. This is not a cause of alarm since true labor pain includes strong and regular contractions and lower back pain.

A client makes a routine visit to the prenatal clinic. Although she is 14 weeks pregnant, the size of her uterus approximates that in an 18- to 20-week pregnancy. Dr. Charles diagnoses gestational trophoblastic disease and orders ultrasonography. The nurse expects ultrasonography to reveal: A. An empty gestational sac. B. Grapelike clusters. C. A severely malformed fetus. D. An extrauterine pregnancy.

Correct Answer: B. Grapelike clusters. In a client with gestational trophoblastic disease, an ultrasound performed after the 3rd month shows grapelike clusters of transparent vesicles rather than a fetus. The vesicles contain a clear fluid and may involve all or part of the decidual lining of the uterus. Usually, no embryo (and therefore no fetus) is present because it has been absorbed. Option A: An anembryonic pregnancy is characterized by a gestational sac that forms and grows while an embryo fails to develop. Etiologies include morphological abnormalities of an embryo that prevents implantation or prevents long term survival of the embryo after implantation; chromosomal abnormalities that collectively include autosomal trisomy, polyploidy, sex chromosomal polysomy, and monosomy X likely represent the most common etiologies for early pregnancy loss; and other genetic and chromosomal abnormalities include translocations, inversions, single-gene perturbations, and placental mosaicism. Option C: Congenital anomalies are also known as birth defects, congenital disorders or congenital malformations. Congenital anomalies can be defined as structural or functional anomalies (for example, a severely malformed fetus) that occur during intrauterine life and can be identified prenatally, at birth, or sometimes may only be detected later in infancy, such as hearing defects. Option D: Because there is no fetus, there can be no extrauterine pregnancy. An extrauterine pregnancy is seen with an ectopic pregnancy.

A client 12 weeks' pregnant came to the emergency department with abdominal cramping and moderate vaginal bleeding. Speculum examination reveals 2 to 3 cm cervical dilation.The nurse would document these findings as which of the following? A. Threatened abortion B. Imminent abortion C. Complete abortion D. Missed abortion

Correct Answer: B. Imminent abortion Cramping and vaginal bleeding coupled with cervical dilation signify that termination of the pregnancy is inevitable and cannot be prevented. Thus, the nurse would document an imminent abortion. Option A: In a threatened abortion, cramping and vaginal bleeding are present, but there is no cervical dilation. The symptoms may subside or progress to abortion. Option C: In a complete abortion all the products of conception are expelled. Option D: A missed abortion is early fetal intrauterine death without expulsion of the products of conception.

A gravidocardiac mother is advised to observe bed rest primarily to: A. Allow the fetus to achieve normal intrauterine growth. B. Minimize oxygen consumption which can aggravate the condition of the compromised heart of the mother. C. Prevent perinatal infection. D. Reduce incidence of premature labor.

Correct Answer: B. Minimize oxygen consumption which can aggravate the condition of the compromised heart of the mother. The activity of the mother will require more oxygen consumption. Since the heart of a gravido-cardiac is compromised, there is a need to put a mother on bedrest to reduce the need for oxygen. Option A: In cases of maternal decompensation, fetal monitoring should also be done to ensure fetal well-being. Women with moderate-risk or high-risk lesions, especially cyanotic lesions, have an increased risk of fetal growth restriction and should be followed with monthly ultrasound examinations for fetal growth. Option C: The 2011 update to the American Heart Association guideline for the prevention of cardiovascular disease (CVD) in women recommends that risk assessment at any stage of life include a detailed history of pregnancy complications. Gestational diabetes, preeclampsia, preterm birth, and birth of an infant small for gestational age are ranked as major risk factors for CVD. Option D: During the third trimester, cardiac output is further influenced by body position, where the supine position causes caval compression by the gravid uterus. This leads to a decrease in venous return, which can cause supine hypotension of pregnancy. Stroke volume normally increases in the first and second trimester and decreases in the third trimester. This decrease is due to partial vena cava obstruction.

Which of the following would be the priority nursing diagnosis for a client with an ectopic pregnancy? A. Risk for infection B. Pain C. Knowledge Deficit D. Anticipatory Grieving

Correct Answer: B. Pain For the client with an ectopic pregnancy, lower abdominal pain, usually unilateral, is the primary symptom. Thus, pain is the priority. Option A: Although the potential for infection is always present, the risk is low in ectopic pregnancy because pathogenic microorganisms have not been introduced from external sources. Option C: The client may have limited knowledge of the pathology and treatment of the condition. The mechanisms responsible for ectopic implantation are unknown. The four main possibilities are anatomic obstruction to the passage of the zygote, an abnormal conceptus, abnormalities in the mechanisms responsible for tubal motility, and transperitoneal migration of the zygote. Option D: By far the most common emotional reaction after having an ectopic pregnancy is finding oneself suddenly overcome with intense emotions of reliving some aspects of the diagnosis and treatment of the ectopic pregnancy when the woman did not want to. She may also get palpitations, or feel anxious or agitated when reminded of the ectopic pregnancy. These are called flashbacks. She may experience nightmares or bad dreams and have a sense of being "on edge", irritable, or more anxious. Some women also experience a sense of being detached and numb and that the ectopic pregnancy has changed them in some negative way.

When preparing a teaching plan for a client who is to receive a rubella vaccine during the postpartum period, the nurse in charge should include which of the following? A. The vaccine prevents a future fetus from developing congenital anomalies. B. Pregnancy should be avoided for 3 months after the immunization. C. The client should avoid contact with children diagnosed with rubella. D. The injection will provide immunity against the 7-day measles.

Correct Answer: B. Pregnancy should be avoided for 3 months after the immunization After administration of rubella vaccine, the client should be instructed to avoid pregnancy for at least 3 months to prevent the possibility of the vaccine's toxic effects to the fetus. Option A: The role of the vaccine postpartum is to protect the mother against rubella in the future pregnancies as well as measles and mumps, since it is given together. Option C: Protection against measles, mumps, and rubella starts to develop around 2 weeks after having the MMR vaccine. Option D: One dose of MMR vaccine is 93% effective against measles, 78% effective against mumps, and 97% effective against rubella.

After an Rh(-) mother has delivered her Rh (+) baby, the mother is given RhoGam. This is done in order to: A. Prevent the recurrence of Rh(+) babies in future pregnancies. B. Prevent the mother from producing antibodies against the Rh(+) antigen that she may have gotten when she delivered to her Rh(+) baby. C. Ensure those future pregnancies will not lead to maternal illness. D. To prevent the newborn from having problems of incompatibility when it breastfeeds

Correct Answer: B. Prevent the mother from producing antibodies against the Rh(+) antigen that she may have gotten when she delivered to her Rh(+) baby In Rh incompatibility, a Rh(-) mother will produce antibodies against the fetal Rh (+) antigen which she may have gotten because of the mixing of maternal and fetal blood during labor and delivery. Giving her RhoGam right after birth will prevent her immune system from being permanently sensitized to Rh antigen. Option A: RhoGAM is a prescription medicine that is used to prevent Rh immunization, a condition in which an individual with Rh-negative blood develops antibodies after exposure to Rh-positive blood. Option C: RhoGAM prevents the Rh-negative mother from making antibodies directed against her baby's Rh-positive red blood cells during her pregnancy. Option D: Rho(D) immune globulin is immune globulin (IgG) rich in IgG antibodies against erythrocyte antigen Rho(D). IgG is a normal component of breastmilk. Rho(D) immune globulin is frequently used in nursing mothers and no adverse effects have been reported in breastfed infants. No special precautions are required.

Which of the following would the nurse most likely expect to find when assessing a pregnant client with abruption placenta? A. Excessive vaginal bleeding B. Rigid, board-like abdomen C. Tetanic uterine contractions D. Premature rupture of membranes

Correct Answer: B. Rigid, board-like abdomen The most common assessment finding in a client with abruption placenta is a rigid or boardlike abdomen. Pain, usually reported as a sharp stabbing sensation high in the uterine fundus with the initial separation, also is common. Option A: It's possible for the blood to become trapped inside the uterus, so even with a severe placental abruption, there might be no visible bleeding. Option C: Uterine contractions are a common finding with placental abruption. Contractions progress as the abruption expands, and uterine hypertonus may be noted. Contractions are painful and palpable. Option D: Increased frequency of placental abruption was found in patients with early rupture of membranes. The incidence was 50% and 44% when rupture of the membranes occurred before 20 weeks or between 20-24 weeks of pregnancy, respectively.

In which of the following conditions can the causative agent pass through the placenta and affect the fetus in utero? A. Gonorrhea B. Rubella C. Candidiasis D. Moniliasis

Correct Answer: B. Rubella Rubella is caused by a virus and viruses have low molecular weight thus can pass through the placental barrier. Relatively few pathogens are capable of placental and fetal infections in humans and even for these, maternal infection does not guarantee placental or fetal infection. Option A: Other STIs, like gonorrhea, chlamydia, hepatitis B, and genital herpes, can pass from the mother to the baby as the baby passes through the birth canal. This infection in an infant can cause eye infections, pneumonia, or infections of the joints or blood. Treating gonorrhea as soon as it is detected in pregnant women will reduce the risk of transmission. Option C: Candida infection of the fetus results in prematurity and death, infection can occur across intact membranes, and systemic candidiasis in the fetus is likely to be associated with an intrauterine device. The pathology of the placenta includes microscopic granulomata and presence of filaments or spores on the cord and histological change of the membrane or chorionic plate revealing intense chorioamnionitis with occasional focal granuloma. Option D: Bacterial or viral infection of the mother during the course of pregnancy can cross the placenta and actively infect the fetus. However, especially for bacteria, it is more common for mothers to experience an infection that can be treated without overt fetal infection.

Which of the following statements best describes hyperemesis gravidarum? A. Severe anemia leading to an electrolyte, metabolic, and nutritional imbalances in the absence of other medical problems. B. Severe nausea and vomiting leading to an electrolyte, metabolic, and nutritional imbalances in the absence of other medical problems C. Loss of appetite and continuous vomiting that commonly results in dehydration and ultimately decreasing maternal nutrients. D. Severe nausea and diarrhea that can cause gastrointestinal irritation and possibly internal bleeding.

Correct Answer: B. Severe nausea and vomiting leading to the electrolyte, metabolic, and nutritional imbalances in the absence of other medical problems. The description of hyperemesis gravidarum includes severe nausea and vomiting, leading to the electrolyte, metabolic, and nutritional imbalances in the absence of other medical problems. Option A: Hyperemesis is not a form of anemia. The exact cause of nausea and vomiting during pregnancy is not known. However, it is believed to be caused by a rapidly rising blood level of a hormone called human chorionic gonadotropin (HCG). HCG is released by the placenta. Mild morning sickness is common. Hyperemesis gravidarum is less common and more severe. Option C: Loss of appetite may occur secondary to nausea and vomiting of hyperemesis, which, if it continues, can deplete the nutrients transported to the fetus. Women with hyperemesis gravidarum have extreme nausea and vomiting during pregnancy. It can cause a weight loss of more than 5% of body weight. The condition can happen in any pregnancy, but is a little more likely if the woman is pregnant with twins (or more babies), or if she has a hydatidiform mole. Women are at higher risk for hyperemesis if they have had the problem in previous pregnancies or are prone to motion sickness. Option D: Diarrhea does not occur with hyperemesis. Constipation is one of the symptoms. Increase fluids during times of the day when there is a feeling of nausea. Seltzer, ginger ale, or other sparkling drinks may help. The woman can also try using low-dose ginger supplements or acupressure wrist bands to ease symptoms

The nurse in-charge is reviewing a patient's prenatal history. Which finding indicates a genetic risk factor? A. The patient is 25 years old. B. The patient has a child with cystic fibrosis. C. The patient was exposed to rubella at 36 weeks' gestation. D. The patient has a history of preterm labor at 32 weeks' gestation.

Correct Answer: B. The patient has a child with cystic fibrosis Cystic fibrosis is a recessive trait; each offspring has a one in four chance of having the trait or the disorder. Option A: Maternal age is not a risk factor until age 35, when the incidence of chromosomal defects increases. Option C: Maternal exposure to rubella during the first trimester may cause congenital defects. Option D: Although a history or preterm labor may place the patient at risk for preterm labor, it does not correlate with genetic defects.

The neonate of a mother with diabetes mellitus is prone to developing hypoglycemia because: A. The pancreas is immature and unable to secrete the needed insulin. B. There is rapid diminution of glucose level in the baby's circulating blood and his pancreas is normally secreting insulin. C. The baby is reacting to the insulin given to the mother. D. His kidneys are immature leading to a high tolerance for glucose.

Correct Answer: B. There is rapid diminution of glucose level in the baby's circulating blood and his pancreas is normally secreting insulin. If the mother is diabetic, the fetus while in utero has a high supply of glucose. When the baby is born and is now separate from the mother, it no longer receives a high dose of glucose from the mother. In the first few hours after delivery, the neonate usually does not feed yet thus this can lead to hypoglycemia. Option A: The primary function of ?-cells is to store and secrete insulin in response to glucose load. When ?-cells lose the ability to adequately sense blood glucose concentration, or to release sufficient insulin in response, this is classified as ?-cell dysfunction. ?-cell dysfunction is thought to be the result of prolonged, excessive insulin production in response to chronic fuel excess Option C: ?-cell dysfunction is exacerbated by insulin resistance. Reduced insulin-stimulated glucose uptake further contributes to hyperglycemia, overburdening the ?-cells, which have to produce additional insulin in response. The direct contribution of glucose to ?-cell failure is described as glucotoxicity. Thus, once ?-cell dysfunction begins, a vicious cycle of hyperglycemia, insulin resistance, and further ?-cell dysfunction is set in motion. Option D: Insulin resistance occurs when cells no longer adequately respond to insulin. At the molecular level, insulin resistance is usually a failure of insulin signaling, resulting in inadequate plasma membrane translocation of glucose transporter 4 (GLUT4)—the primary transporter that is responsible for bringing glucose into the cell to use as energy.

Which of the following assessment findings would lead the nurse to suspect Down syndrome in an infant? A. Small tongue B. Transverse palmar crease C. Large nose D. Restricted joint movement

Correct Answer: B. Transverse palmar crease Down syndrome is characterized by the following a transverse palmar crease (simian crease), separated sagittal suture, oblique palpebral fissures, small nose, depressed nasal bridge, high arched palate, excess and lax skin, wide spacing and plantar crease between the second and big toes, hyperextensible and lax joints, large protruding tongue, and muscle weakness. Option A: Tongue-tie, also known as ankyloglossia, is a condition some babies are born with that limits their tongue movements. But for babies with tongue-tie, there's a problem with the lingual frenulum. That's the small stretch of tissue that connects the underside of the tongue to the bottom of the mouth. It might be too short and tight or attached way up near the tip of the tongue. Option C: A newborn's nose may be pushed in or flat because of the tight squeeze during labor and delivery. It may take a week or longer before his or her nose looks more normal. Option D: Muscle tone represents one of the important concepts for characterizing changes in the state of the developing nervous system. It can be manifested in the level of activity of flexors and extensors and in muscle reactions to its passive stretching (StR) or shortening (ShR).

In the past, factors to determine whether a woman was likely to have a high-risk pregnancy were evaluated primarily from a medical point of view. A broader, more comprehensive approach to high-risk pregnancy has been adopted. There are now four categories based on threats to the health of the woman and the outcome of pregnancy. Which of the options listed here is not included as a category? A. Biophysical B. Psychosocial C. Geographic D. Environmental

Correct Answer: C. Geographic The fourth category is correctly referred to as the sociodemographic risk category. Several risk factors for high-risk pregnancy were present before pregnancy, including multiple pregnancies, maternal age under 16 or over 35 years, and interval between pregnancies less than one year. Option A: A fetal biophysical profile is a prenatal test used to check on a baby's well-being. The test combines fetal heart rate monitoring (nonstress test) and fetal ultrasound to evaluate a baby's heart rate, breathing, movements, muscle tone and amniotic fluid level. Option B: A pregnancy may be determined to be at high risk because of obstetric factors in previous pregnancies or the present one; conditions that are, themselves, psychosocial: anxiety disorders (GAD, OCD, panic disorder, PTSD), mood disorders, and schizophrenia, all of which are a background for a disturbed pregnancy and might complicate a pregnancy denominated high risk for some other reason. Option D: Environmental factors that have been implicated in adverse pregnancy outcomes include smoking, video display terminals, anesthetic gases, antineoplastic drugs and exposure to lead, selenium and inorganic mercury.

In placenta previa marginalis, the placenta is found at the: A. Internal cervical os partly covering the opening. B. External cervical os slightly covering the opening. C. Lower segment of the uterus with the edges near the internal cervical os. D. Lower portion of the uterus completely covering the cervix.

Correct Answer: C. Lower segment of the uterus with the edges near the internal cervical os Placenta marginalis is a type of placenta previa wherein the placenta is implanted at the lower segment of the uterus thus the edges of the placenta are touching the internal cervical opening/os. The normal site of placental implantation is the upper portion of the uterus. Option A: Marginal placenta previa is where the placental edge is within 2cm of the internal os. Nearly 90% of placentas identified as "low lying" will ultimately resolve by the third trimester due to placental migration. The placenta itself does not move but grows toward the increased blood supply at the fundus, leaving the distal portion of the placenta at the lower uterine segment with relatively poor blood supply to regress and atrophy. Option B: The trophoblast adheres to the decidua basalis of the endometrium, forming a normal pregnancy. Prior uterine scars provide an environment that is rich in oxygen and collagen. The trophoblast can adhere to the uterine scar leading to the placenta covering the cervical os or the placenta invading the walls of the myometrium. Option D: Migration can also take place by the growing lower uterine segment thus increasing the distance from the lower margin of the placenta to the cervix.

In which of the following types of spontaneous abortions would the nurse assess dark brown vaginal discharge and a negative pregnancy test? A. Threatened B. Imminent C. Missed D. Incomplete

Correct Answer: C. Missed In a missed abortion, there is early fetal intrauterine death, and products of conception are not expelled. The cervix remains closed; there may be a dark brown vaginal discharge, negative pregnancy test, and cessation of uterine growth and breast tenderness. Option A: A threatened abortion is evidenced with cramping and vaginal bleeding in early pregnancy, with no cervical dilation. Option B: An imminent-abortion indicated by bleeding and pain along with an effaced cervix. Option D: An incomplete abortion involves only expulsion of part of the products of conception and bleeding occurs with cervical dilation.

Which of the following is TRUE in Rh incompatibility? A. The condition can occur if the mother is Rh(+) and the fetus is Rh(-). B. Every pregnancy of an Rh(-) mother will result in erythroblastosis fetalis. C. On the first pregnancy of the Rh(-) mother, the fetus will not be affected. D. RhoGam is given only during the first pregnancy to prevent incompatibility.

Correct Answer: C. On the first pregnancy of the Rh(-) mother, the fetus will not be affected On the first pregnancy, the mother still has no contact with Rh(+) blood thus it has not antibodies against Rh(+). After the first pregnancy, even if terminated into an abortion, there is already the possibility of mixing of maternal and fetal blood so this can trigger the maternal blood to produce antibodies against Rh(+) blood. The fetus takes its blood type usually from the father. Option A: The most common cause of Rh incompatibility is exposure from an Rh-negative mother by Rh-positive fetal blood during pregnancy or delivery. As a consequence, blood from the fetal circulation may leak into the maternal circulation, and, after a significant exposure, sensitization occurs leading to maternal antibody production against the foreign Rh antigen. Option B: In women who are prone to Rh incompatibility, the second pregnancy with an Rh-positive fetus often produces a mildly anemic infant, whereas succeeding pregnancies produce more seriously affected infants who ultimately may die in utero from massive antibody-induced hemolytic anemia. Option D: The exact mechanism by which passive administration of Rh IgG prevents Rh immunization is unknown. The most likely hypothesis is that the Rh immune globulin coats the surface of fetal RBCs containing Rh antigens. These exogenous antibody-antigen complexes cross the placenta before they can stimulate the maternal endogenous immune system B cells to produce IgG antibodies.

While assessing a child with pyloric stenosis, the nurse is likely to note which of the following? A. Regurgitation B. Steatorrhea C. Projectile vomiting D. "Currant jelly" stools

Correct Answer: C. Projectile vomiting Projectile vomiting is a key symptom of pyloric stenosis. Vomiting intensity also increases until pathognomonic projectile vomiting ensues. Although vomiting may initially be infrequent, over several days it becomes more predictable, occurring at nearly every feeding. Option A: Regurgitation is seen more commonly with GERD. Regurgitation occurs with varying degrees of severity in approximately 80% of GERD patients. This symptom is usually described as a sour taste in the mouth or a sense of fluid moving up and down in the chest. Option B: Steatorrhea occurs in malabsorption disorders such as celiac disease. During celiac disease, steatorrhea was caused by the decreased enzymatic function of the pancreas, asynchronism of the food, and bile supply to the intestinal lumen, disorders of absorption of lipolysis products. Option D: "Currant jelly" stools are characteristic of intussusception. The trapped section of the bowel may have its blood supply cut off, which causes ischemia. The mucosa is sensitive to ischemia and responds by causing sloughing off into the gut. This creates a "red currant jelly" stool, which is sloughed mucosa, blood, and mucus.

A patient with pregnancy-induced hypertension probably exhibits which of the following symptoms? A. Proteinuria, headaches, vaginal bleeding B. Headaches, double vision, vaginal bleeding C. Proteinuria, headaches, double vision D. Proteinuria, double vision, uterine contractions

Correct Answer: C. Proteinuria, headaches, double vision A patient with pregnancy-induced hypertension complains of a headache, double vision, and sudden weight gain. A urine specimen reveals proteinuria. Option A: Pre-eclampsia increases the risk for placental abruption, a condition in which the placenta separates from the inner wall of the uterus before delivery. Severe abruption can cause heavy bleeding, which can be life-threatening for both the baby and the mother. Option B: Any hypertensive disorder of pregnancy can result in preeclampsia. It occurs in up to 35% of women with gestational hypertension and up to 25% of those with chronic hypertension. The underlying pathophysiology that upholds this transition to, or superposition of, preeclampsia is not well understood; however, it is thought to be related to a mechanism of reduced placental perfusion inducing the systemic vascular endothelial dysfunction. Option D: Symptoms of preeclampsia may include visual disturbances, typically scintillations and scotomata, presumed to be due to cerebral vasospasm. The woman may describe new-onset headache that is frontal, throbbing, or similar to a migraine headache, and gastrointestinal complaints of sudden, new-onset, constant epigastric pain that may be moderate to severe in intensity and due to hepatic swelling and inflammation, with stretch of the liver capsule.

Barbiturates are usually not given for pain relief during active labor for which of the following reasons? A. The neonatal effects include hypotonia, hypothermia, generalized drowsiness, and reluctance to feed for the first few days. B. These drugs readily cross the placental barrier, causing depressive effects in the newborn 2 to 3 hours after intramuscular injection. C. They rapidly transfer across the placenta, and the lack of an antagonist makes them generally inappropriate during labor. D. Adverse reactions may include maternal hypotension, allergic or toxic reaction, or partial or total respiratory failure.

Correct Answer: C. They rapidly transfer across the placenta, and the lack of an antagonist makes them generally inappropriate during labor. Barbiturates are rapidly transferred across the placental barrier, and the lack of an antagonist makes them generally inappropriate during active labor. Option A: Neonatal side effects of barbiturates include central nervous system depression, prolonged drowsiness, delayed establishment of feeding (e.g. due to poor sucking reflex or poor sucking pressure). Tranquilizers are associated with neonatal effects such as hypotonia, hypothermia, generalized drowsiness, and reluctance to feed for the first few days. Option B: Narcotic analgesic readily crosses the placental barrier, causing depressive effects in the newborn 2 to 3 hours after intramuscular injection. Option D: Regional anesthesia is associated with adverse reactions such as maternal hypotension, allergic or toxic reaction, or partial or total respiratory failure.

At which of the following ages would the nurse expect to administer the varicella zoster vaccine to a child? A. At birth B. 2 months C. 6 months D. 12 months

Correct Answer: D. 12 months The varicella zoster vaccine (VZV) is a live vaccine given after age 12 months. The first dose of hepatitis B vaccine is given at birth to 2 months, then at 1 to 4 months, and then again at 6 to 18 months. DTaP is routinely given at 2, 4, 6, and 15 to 18 months and a booster at 4 to 6 years. Option A: CDC recommends two doses of chickenpox vaccine for children, adolescents, and adults. Children should receive two doses of the vaccine—the first dose at 12 through 15 months old and a second dose at 4 through 6 years old. Option B: If the second dose is administered after the 7th birthday, the minimum interval between doses is ?3 months for children age <13 years and 4 weeks for persons age ?13 years Option C: If it has been more than 8 weeks since the first dose, the second dose may be given without restarting the schedule.

Which of the following would the nurse use as the basis for the teaching plan when caring for a pregnant teenager concerned about gaining too much weight during pregnancy? A. 10 pounds per trimester. B. 1 pound per week for 40 weeks. C. ½ pound per week for 40 weeks. D. A total gain of 25 to 30 pounds.

Correct Answer: D. A total gain of 25 to 30 pounds To ensure adequate fetal growth and development during the 40 weeks of a pregnancy, a total weight gain of 25 to 30 pounds is recommended: Option A: 1.5 pounds in the first 10 weeks; 9 pounds by 30 weeks; and 27.5 pounds by 40 weeks. The pregnant woman should gain less weight in the first and second trimester than in the third. Option B: During the first trimester, the client should only gain 1.5 pounds in the first 10 weeks, not 1 pound per week. Option C: A weight gain of ½ pound per week would be 20 pounds for the total pregnancy, less than the recommended amount.

Which of the following is described as premature separation of a normally implanted placenta during the second half of pregnancy, usually with severe hemorrhage? A. Placenta previa B. Ectopic pregnancy C. Incompetent cervix D. Abruptio placenta

Correct Answer: D. Abruptio placentae Abruptio placenta is described as premature separation of a normally implanted placenta during the second half of pregnancy, usually with severe hemorrhage. Option A: Placenta previa refers to implantation of the placenta in the lower uterine segment, causing painless bleeding in the third trimester of pregnancy. Option B: Ectopic pregnancy refers to the implantation of the products of conception in a site other than the endometrium. Option C: Incompetent cervix is a conduction characterized by painful dilation of the cervical os without uterine contractions.

A client with eclampsia begins to experience a seizure. Which of the following would the nurse in charge do first? A. Pad the side rails. B. Place a pillow under the left buttock. C. Insert a padded tongue blade into the mouth. D. Maintain a patent airway.

Correct Answer: D. Maintain a patent airway The priority for the pregnant client having a seizure is to maintain a patent airway to ensure adequate oxygenation to the mother and the fetus. Additionally, oxygen may be administered by face mask to prevent fetal hypoxia. Option A: Padding the side rails should be done as a precaution before a seizure, not during the seizure. Option B: The client should be placed on a flat, firm surface to avoid any injuries. Option C: There should be nothing inserted inside the client's mouth to maintain airway patency and prevent obstruction and aspiration

Which of the following amounts of blood loss following birth marks the criterion for describing postpartum hemorrhage? A. More than 200 ml B. More than 300 ml C. More than 400 ml D. More than 500 ml

Correct Answer: D. More than 500 ml Postpartum hemorrhage is defined as blood loss of more than 500 ml following birth. Any amount less than this is not considered postpartum hemorrhage. Option A: The amount of 200 ml is less than the amount considered as postpartum hemorrhage. Postpartum hemorrhage (PPH) is the leading cause of maternal mortality. All women who carry a pregnancy beyond 20 weeks' gestation are at risk for PPH and its sequelae. Although maternal mortality rates have declined greatly in the developed world, PPH remains a leading cause of maternal mortality elsewhere. Option B: 300 ml is less than the amount considered as postpartum hemorrhage. PPH is defined as blood loss of more than 500 mL following vaginal delivery or more than 1000 mL following cesarean delivery. A loss of these amounts within 24 hours of delivery is termed early or primary PPH, whereas such losses are termed late or secondary PPH if they occur 24 hours after delivery. Option C: At term, the estimated blood flow to the uterus is 500-800 mL/min, which constitutes 10-15% of cardiac output. Most of this flow traverses the low-resistance placental bed. The uterine blood vessels that supply the placental site traverse a weave of myometrial fibers. As these fibers contract following delivery, myometrial retraction occurs. Retraction is the unique characteristic of the uterine muscle to maintain its shortened length following each successive contraction. The blood vessels are compressed and kinked by this crisscross latticework, and, normally, blood flow is quickly occluded. This arrangement of muscle bundles has been referred to as the "living ligatures" or "physiologic sutures" of the uterus.

A client with type 1 diabetes mellitus who is a multigravida visits the clinic at 27 weeks gestation. The nurse should instruct the client that for most pregnant women with type 1 diabetes mellitus: A. Weekly fetal movement counts are made by the mother. B. Contraction stress testing is performed weekly. C. Induction of labor is begun at 34 weeks' gestation. D. Nonstress testing is performed weekly until 32 weeks' gestation

Correct Answer: D. Nonstress testing is performed weekly until 32 weeks' gestation For most clients with type 1 diabetes mellitus, non-stress testing is done weekly until 32 weeks' gestation and twice a week to assess fetal well-being. Option A: Increased fetal activity may minimize the impact of hyperglycemia on subsequent birth weight. The inactive fetus appears to be at a higher risk for glucose-mediated macrosomia. Option B: Contraction stress test may be done weekly with reassuring results of no heart rate deceleration in response to 3 contractions in 10 minutes. Option C: Nonstress test may be done twice a week with reassuring results of 2 heart rate acceleration in 20 minutes.

A primigravida client at about 35 weeks gestation in active labor has had no prenatal care and admitted to cocaine use during the pregnancy. Which of the following persons must the nurse notify? A. Nursing unit manager so appropriate agencies can be notified. B. Head of the hospital's security department. C. Chaplain in case the fetus dies in utero. D. Physician who will attend the delivery of the infant.

Correct Answer: D. Physician who will attend the delivery of the infant. The fetus of a cocaine-addicted mother is at risk for hypoxia, meconium aspiration, and intrauterine growth retardation (IUGR). Therefore, the nurse must notify the physician of the client's cocaine use because this knowledge will influence the care of the client and neonate. The information is used only in relation to the client's care. Option A: Informing the nursing unit manager would be inappropriate since the physician would be the one who will have the knowledge on how to manage the fetus. Option B: The knowledge should only be used in relation to the client's care. Notifying the head of the security department is unnecessary and would be against the data privacy act. Option C: Informing the physician first of the cocaine use would most likely save the fetus' life in utero.

A 40-year-old woman with a high body mass index (BMI) is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time? A. Biophysical profile B. Amniocentesis C. Maternal serum alpha-fetoprotein (MSAFP) D. Transvaginal ultrasound

Correct Answer: D. Transvaginal ultrasound An ultrasound is the method of biophysical assessment of the infant that is performed at this gestational age. Transvaginal ultrasound is especially useful for obese women, whose thick abdominal layers cannot be penetrated adequately with the abdominal approach. Option A: A biophysical profile is a method of biophysical assessment of fetal well-being in the third trimester. Option B: An amniocentesis is performed after the fourteenth week of pregnancy. Option C: A MSAFP test is performed from week 15 to week 22 of the gestation (weeks 16 to 18 are ideal).

A client with severe preeclampsia is admitted with BP 160/110, proteinuria, and severe pitting edema. Which of the following would be most important to include in the client's plan of care? A. Daily weights B. Seizure precautions C. Right lateral positioning D. Stress reduction

orrect Answer: B. Seizure precautions Women hospitalized with severe preeclampsia need decreased CNS stimulation to prevent a seizure. Seizure precautions provide environmental safety should a seizure occur. Option A: Because of edema, daily weight is important but not the priority. High pregnancy weight gain was more strongly associated with term preeclampsia than early preterm preeclampsia (eg, 64% versus 43% increased odds per 1 z score difference in weight gain in normal-weight women, and 30% versus 0% in obese women, respectively). Option C: Preeclampsia causes vasospasm and therefore can reduce uteroplacental perfusion. The client should be placed on her left side to maximize blood flow, reduce blood pressure, and promote diuresis. Option D: Interventions to reduce stress and anxiety are very important to facilitate coping and a sense of control, but seizure precautions are the priority.