WEEKS 3,4,5 QUIZ: INTRAPARTAL COMPLICATIONS, THERAPEUTIC MGT, BLEEDING DISORDERS, POSTPARTUM COMPLICATIONS

Abruptio placentae

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?

The ultrasound identifies blood flow through the umbilical cord

A client at 36 weeks gestation is scheduled for a routine ultrasound prior to amniocentesis. After teaching the client about the purpose of the ultrasound, which of the following client statements would indicate to the nurse in charge that the client needs further instruction?

Gently massage her fundus until firm.

A patient has just given birth four hours ago. As you check her, you find her uterus to be boggy in consistency and to the left of the midline. Your initial action is to: Give her due Methergine early.

Prolapsed umbilical cord

A patient is admitted and upon assessment, you know that there is an oblique lie during labor. From this understanding you know which one of the following is more likely to occur?

Place the woman in a knee-chest or Trendelenburg's position.

A patient is admitted to the labor room. You discover a prolapsed cord. The first nursing intervention should be to:

Endometritis

A postpartum patient was in labor for 30 hours and had ruptured membranes for 24 hours. For which of the following would the nurse be alert?

Activity limited to bed rest.

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?

Perineum

A primigravida in active labor is about 9 days post-term. The client desires a bilateral pudendal block anesthesia before delivery. After the nurse explains this type of anesthesia to the client, which of the following locations identified by the client as the area of relief would indicate to the nurse that the teaching was effective?

Sudden excruciating pain in lower abdomen.

An expected symptom of a ruptured ectopic pregnancy would be:

Two arteries carrying wastes and gases from the fetus.

As you begin explaining what is happening to the patient, you recall that which of the following statements most accurately describes the umbilical cord?

Oxytocin causes water intoxication

Because cervical effacement and dilation are not progressing in a patient in labor, the doctor orders I.V. administration of oxytocin (Pitocin). Why must the nurse monitor the patient's fluid intake and output closely during oxytocin administration?

At the beginning of each fetal movement.

During a nonstress test (NST), the electronic tracing displays a relatively flat line for fetal movement, making it difficult to evaluate the fetal heart rate (FHR). To mark the strip, the nurse in charge should instruct the client to push the control button at which time?

Early detection of fetal heart tones.

Hydatidiform mole is a benign neoplasm of the chorion in which chorionic villi degenerate. Symptoms of this abnormal condition would include all of the following except:

Massages the uterus and applies traction to the umbilical cord.

In assisting with an emergency delivery, the nurse is using unsafe interventions if she:

Vaginal hematoma.

Mrs. Berces complains of severe pain in the upper vaginal area and a sense of fullness. Her uterus is firm. Her lochia is of normal amount, but her Bp dropped somewhat over the past 24 hours. Which of the following postpartal complications do you suspect?

Maintain bed rest and put in left side-lying position

Mrs. Cruz , 32 y/o , is a G3P2 at 34 weeks AOG. She has been admitted with premature labor. Her membranes are intact. Her cervix is 40 % effaced and 1 cm dilated. You are assigned to care for Mrs. Cruz during her hospitalization. Which one of the following nursing action would you do first?

Apply ice packs the first 24 hours.

Mrs. Del Fierro, 33, delivers a healthy baby girl. You are the nurse assigned to care for her. This is Mrs. Del Fierro's second child. One day post delivery, Mrs. Del Fierro complains of pain. An appropriate nursing intervention for post-partum episiotomy pain is to:

Take her to surgery for D&C.

Mrs. Javier delivered an 8 lb. girl two weeks ago. She has begun having heavier vaginal bloody discharge which contains some clots. On examination in the emergency room, her uterus is boggy and massage expels more clots. You expect Mrs. Javier's OB to treat her in which of the following ways?

etained placental fragments.

Mrs. Javier delivered an 8 lb. girl two weeks ago. She has begun having heavier vaginal bloody discharge which contains some clots. On examination in the emergency room, her uterus is boggy and massage expels more clots. You expect what postpartal complication to be present?

Offering oral fluids q15 minutes for 2 to 3 hours to ensure adequate renal output.

Mrs. Luna, a primigravida, age 36, delivered an 8 lb. 6 oz. baby girl by CS. Which one of the following nursing actions would not be included in Mrs. Luna's immediate postoperative care?

Uterine subinvolution.

Mrs. Martha is having lochia alba and complains of a dragging backache. She is five weeks postpartum. You suspect which of the following?

Postpartal hemorrhage

Mrs. Romero delivered a 9 lb., 12 oz. boy 6 hours ago. On a postpartal check, you find her uterus to be located in the midline and boggy on palpation. Though her pad is not heavily saturated, uterine massage produces large clots. Her pulse is 120, respirations 34, temperature 97 deg Fahrenheit, BP 80/60. She is experiencing:

Uterine rupture.

Mrs. Santos is a G2P1 admitted in active labor. Her previous child was delivered by CS, per a midline incision. She was scheduled to have a repeat section 3 days from now. Shortly after admission she complaints of severe, agonizing pain in her abdomen. Her contractions cease and she quickly appears pale and diaphoretic, though vaginal bleeding is minimal. No FHTs can be found. You suspect what complication has occurred.

Cervical lacerations

Mrs. Villa delivered a 9 lb. infant in a quick precipitous delivery. She has been having moderate bright red bleeding and her fundus is firm on palpation. You suspect what postpartal complication as the cause of the bleeding?

Bethamethasone

Ms. Lim is admitted due to premature labor. She is concerned about her baby's ability to survive. She has heard about respiratory problems in premature infants. The nurse explains that the following medication has been ordered to promote fetal lung maturation.

Threatened abortion.

Ms. Miranda is 10 weeks pregnant. She is having some slight uterine bleeding and mild cramping. Upon examination, cervical dilation and tissue passage is absent. She is experiencing a (an):

An incompetent cervical os

Ms. Ruiz experience uterine bleeding and mild cramping at 20 weeks. She has previously aborted 2 pregnancies at 20 weeks. This history is indicative of:

Monitoring BP every 3 to 5 minutes until stabilized.

Nursing care of the mother receiving regional anesthesia would include:

Abnormally small sized baby.

Of the following conditions, which one does not necessarily indicate the need for a cesarean delivery?

Respiratory distress

One of the known complications in infants delivered by cesarean section is:

Firm and one to three fingerbreadths below the umbilicu

Postpartum assessment of the newly delivered mother includes checking the uterine fundus for firmness and position. On the second day postpartum, you would normally expect Mrs. Del Fierro's fundus to be?

Incomplete abortion

Rina is 11 weeks pregnant and is seen in the emergency room for severe abdominal pain and heavy internal bleeding. Her cervix is open with some fetal tissue. This indicates what type of abortion?

Kehrs sign

Shoulder pain secondary to blood irritating the diaphragm is medically termed as?

Cerclage operation

Surgical treatment for a pregnant woman with habitual abortion would be?

Tocolytics

The correct medical management for this type of abortion in the previous question about Mrs. Miranda would be?

Completion currettage

The correct surgical management for this type of abortion of Rina would be?

Serial testing

The most accurate diagnostic test for ectopic pregnancy?

Threatened abortion.

The most common cause of bleeding in the first half of pregnancy is:

Prematurity

The most common fetal complication of elective CS is:

A defect of the embryo

The most frequent cause of early spontaneous abortion that is not considered maternal factor is?

Encourage fluid intake.

The nurse is providing care for a postpartum client who has been diagnosed with a perineal infection and who is being treated with antibiotics. What is the nurse's most appropriate intervention?

A third degree laceration is one which involves:

The perineal skin, vaginal mucosa, muscles and fascia of perineal body, and extends into the anal sphincter.

Termination of pregnancy at any time before viability.

The term "abortion" is defined as

Shirodkar procedure

The treatment commonly associated with Ms. Ruiz' OB history is the use of some modified form of an operative technique known as the:

Methylergonovine maleate

To prevent or treat postpartal hemorrhage, defined as the loss of 500 ml or more blood within the first 24 hours after delivery, the nurse administers which of the following drugs?

Septic abortion

Upon IE the Obstetrician have noticed foul smelling discharge leaking from the cervix, and the patient had a fever. What could be the possible type of abortion?

Prevent seizures.

When administering magnesium sulfate to a client with preeclampsia, the nurse understands that this drug is given to

Wear support hose or anti-embolic stockings.

Which instruction would the nurse include in the teaching plan for a postpartum client with a history of thromboembolism to reduce the risk of a recurrence?

Hypertension

Which of the following is NOT a complication of Induced abortion?

Last obstetrician visits and expected discharge.

You are doing a postpartal check on Mrs. Lim on her first postpartal day. Of the following observations, which one is the least important?