Antepartum Complications AQ

What is the optimal method for the nurse to use to assess blood loss in a client with placenta previa? Count or weigh perineal pads Monitor pulse and blood pressure Check hemoglobin and hematocrit values Measure or estimate the height of the fundus

Count or weigh perineal pads (An accurate measurement of the amount of blood loss may be obtained by counting or weighing perineal pads. The vital signs will reflect the effects of the blood loss rather than the amount. Laboratory results demonstrate the effects of the blood loss rather than the amount. The fundus may be higher than expected, because the low-lying placenta prevents the descent of the fetus into the pelvis, but the height cannot be used to estimate blood loss.)

While reviewing laboratory results of clients seen at the maternity clinic, the nurse notes that one client's maternal serum alpha-fetoprotein level is lower than expected. What does the nurse recognizes that this may be associated with? Fetal demise Down syndrome Neural tube defects Esophageal obstruction

Down syndrome (Chromosomal trisomies such as Down syndrome may be marked by a lower-than-typical level of alpha-fetoprotein. Fetal demise, neural tube defects, and esophageal obstruction typically result in increased levels of alpha-fetoprotein.)

The nurse is caring for a client who has had a spontaneous abortion. Which complication should the nurse assess this client for? Hemorrhage Dehydration Hypertension Subinvolution

Hemorrhage (Hemorrhage may result if placental tissue is retained or uterine atony occurs. There is no indication that the client has been deprived of fluids. Hypotension, not hypertension, may occur with postabortion hemorrhage. Subinvolution is more likely to occur after a full-term birth.)

A pregnant client experiences an episode of painless vaginal bleeding during the last trimester. What does the nurse suspect is the cause of this bleeding? Placenta previa Abruptio placentae Frequent sexual intercourse Excessive alcohol ingestion

Placenta previa (As the lower uterus contracts and dilates, the edge of the low-lying placenta separates from the walls of the uterus, thereby opening placental sinuses and allowing blood to escape. Abruptio placentae is usually accompanied by intense pain. Frequent sexual intercourse is probably not the cause unless placenta previa is present. Alcohol ingestion does not cause painless vaginal bleeding.)

A client at 34 weeks' gestation is receiving terbutaline subcutaneously. Her contractions increase to every 5 minutes, and her cervix dilates to 4 cm. The tocolytic is discontinued. What is the priority nursing care during this time? Promoting maternal-fetal well-being during labor Reducing the anxiety associated with preterm labor Supporting communication between the client and her partner Assisting the client and her partner with the breathing techniques needed as labor progresses

Promoting maternal-fetal well-being during labor (Labor is continuing, and the promotion of the well-being of the client and fetus is the priority nursing care during this period. Reducing the anxiety associated with preterm labor, supporting communication between the client and her partner, and assisting the client and her partner with breathing techniques each address one aspect of this client's needs; the priority is maternal/fetal well-being.)

A client at 28 weeks' gestation visits the clinic for a routine examination. Which finding is of greatest concern to the nurse? Puffy fingers Glycosuria 1+ Proteinuria 1+ Dependent edema

Puffy fingers (One sign of mild preeclampsia is puffiness of the fingers, eyes, and face. Glycosuria is a common finding in pregnancy; an increased glomerular filtration rate in conjunction with decreased capacity of the tubules to reabsorb glucose may cause spillage of glucose into urine. Minimal proteinuria may occur in a healthy pregnancy; the amount of protein that must be filtered exceeds the ability of the tubules to absorb it, causing small amounts to be lost in the urine. Venous obstruction from the gravid uterus decreases blood flow to the heart; as a result, fluid pools in the lower extremities; dependent edema is expected.)

A client is admitted with a marginal placenta previa. Which item should the nurse have readily available? One unit of freeze-dried plasma Vitamin K for intramuscular injection Two units of typed and screened blood Heparin sodium for intravenous injection

Two units of typed and screened blood (A sudden, severe hemorrhage may occur because of the location of the placenta near the cervical os; blood should be ready for administration to prevent shock. Freeze-dried plasma is not used in this situation. Adults manufacture their own vitamin K, and an injection will not help prevent bleeding from the placenta. Heparin sodium is contraindicated in the presence of hemorrhage.)

The nurse is counseling a pregnant client with type 1 diabetes regarding medication changes as pregnancy progresses. Which medication will be needed in increased dosages during the second half of her pregnancy? Insulin Antihypertensives Pancreatic enzymes Estrogenic hormones

Insulin (Usually as pregnancy progresses there are alterations in glucose tolerance and in the metabolism and utilization of insulin. The result is an increased need for exogenous insulin. Antihypertensives are administered only to clients with severe hypertensive preeclampsia. Pancreatic enzymes or hormones other than insulin are not taken by pregnant women with diabetes. Estrogenic hormones are not administered during pregnancy. )

A pregnant client arrives on the birthing unit from the emergency department with frank blood running down both legs and a reported low blood pressure. What is the priority nursing intervention? Assessing fetal heart tones Assessing for a prolapsed cord Starting an intravenous (IV) infusion Inserting a uterine pressure catheter

Assessing fetal heart tones (The priority is determining fetal viability, because it will determine the next intervention. Assessing the client for a prolapsed cord is not the priority. An IV line will be inserted, but it is not the priority. Inserting a pressure catheter might increase the bleeding; it will not yield useful information.)

A client is scheduled for a sonogram at 36 weeks' gestation. Shortly before the test she tells the nurse that she is experiencing severe abdominal pain. Assessment reveals heavy vaginal bleeding, a drop in blood pressure, and an increased pulse rate. Which complication does the nurse suspect? Hydatidiform mole Vena cava syndrome Marginal placenta previa Complete abruptio placentae

Complete abruptio placentae (Severe pain accompanied by bleeding at term or close to it is symptomatic of complete premature detachment of the placenta (abruptio placentae). A hydatidiform mole is diagnosed before 36 weeks' gestation; it is not accompanied by severe pain. There is no bleeding with vena cava syndrome. Bleeding caused by placenta previa should not be painful.)

A client is admitted to the birthing suite with a blood pressure of 150/90 mm Hg, 3+ proteinuria, and edema of the hands and face. A diagnosis of severe preeclampsia is made. What other clinical findings support this diagnosis? Select all that apply. Headache Constipation Abdominal pain Vaginal bleeding Visual disturbances

Headache Abdominal pain Visual disturbances (Headache in severe preeclampsia is related to cerebral edema. Abdominal pain in severe preeclampsia is related to decreased circulating blood volume and generalized edema. Visual disturbances in severe preeclampsia are related to retinal edema. Constipation and vaginal bleeding are not related to preeclampsia.)

A pregnant client is admitted with abdominal pain and heavy vaginal bleeding. What is the priority nursing action? Administering oxygen Elevating the head of the bed Drawing blood for a hematocrit level Giving an intramuscular analgesic

Administering oxygen (Abdominal pain and heavy vaginal bleeding indicate significant blood loss. To compensate for decreased cardiac output, oxygen is given to maintain the well-being of both mother and fetus. Elevating the head of the bed will decrease blood flow to vital centers in the brain. Drawing blood for a hematocrit level is not the priority. Giving an intramuscular analgesic may mask abdominal pain and sedate an already compromised fetus; also, it requires a primary healthcare provider's prescription.)

A client attending the prenatal clinic for a follow-up appointment has been diagnosed with mild preeclampsia. How should the nurse instruct the client regarding her fluid and nutritional intake? "Restrict fluid intake." "Stay on a low-salt diet." "Continue the pregnancy diet." "Increase carbohydrate consumption."

"Continue the pregnancy diet." (If the client with mild preeclampsia is following the recommended pregnancy diet, she should continue it. Fluids should not be restricted during pregnancy. Salt restriction may activate an angiotensin response, which could cause an increase in blood pressure; moderate salt intake is recommended. There is no reason for the client with mild preeclampsia to increase her intake of carbohydrates.)

A nurse teaches the warning signs that should be reported throughout pregnancy. Which statement by the client indicates an understanding of the prenatal instructions? "I'll call the clinic if I have abdominal pain." "Mild, irregular contractions mean that my labor is starting." "I need to call the clinic if my ankles start to swell at night." "A whitish vaginal discharge means that I'm getting an infection."

"I'll call the clinic if I have abdominal pain." (Abdominal pain should be reported immediately, because it may indicate abruptio placentae or the epigastric discomfort of severe preeclampsia. Mild, irregular contractions are preparatory (Braxton Hicks) contractions, which are common and are believed to help prepare the uterus for labor. Swelling of the ankles at night is physiologic edema of pregnancy, caused by pressure of the gravid uterus that impedes venous return; it disappears with elevation of the legs. Leukorrhea occurs during pregnancy as a result of increases in the estrogen and progesterone levels, which cause the vaginal discharge to become more alkaline.)

A client at 24 weeks' gestation is admitted in early labor. What should the nurse take into consideration regarding this client's early gestation? If contractions are regular, labor cannot be stopped effectively. Birth at this gestational age usually results in a severely compromised neonate. Attempts will be made to sustain the pregnancy for 2 or 3 more weeks to ensure neonatal survival. Infants born at 30 to 34 weeks' gestation have a low morbidity rate because of advances in neonatal health care.

Birth at this gestational age usually results in a severely compromised neonate. (Morbidity and mortality rates among preterm neonates are highest between 24 and 26 weeks' gestation; complications include immature lung tissue, altered cardiac output, patent ductus arteriosus, intraventricular hemorrhage, necrotizing enterocolitis, and infection. Depending on the status of cervical effacement and dilation the decision may be made to try halting labor with the use of tocolytic medications and limited activity. If possible, the pregnancy should be maintained past 37 weeks' gestation. Neonates born at 34 weeks' gestation are still at high risk.)

The nurse admits a client with preeclampsia to the high-risk prenatal unit. What is the next nursing action after the vital signs have been obtained? Calling the primary healthcare provider Checking the client's reflexes Determining the client's blood type Administering the prescribed intravenous (IV) normal saline

Checking the client's reflexes (The client is exhibiting signs of preeclampsia. The presence of hyperreflexia indicates central nervous system irritability, a sign of a worsening condition. Checking the client's reflexes will help direct the primary healthcare provider to appropriate interventions and alert the nurse to the possibility of seizures. Although the primary healthcare provider will be called, a complete assessment should be performed first to obtain the information needed. Determining the client's blood type is not necessary at this time; assessment of neurologic status is the priority. An IV may be started after the assessment; however, a more dilute saline solution will be prescribed.)

A nurse is assessing the effectiveness of a teaching plan regarding self-care and conservative management of gestational hypertension. The nurse confirms that the teaching has been understood when the client notes the importance of what? Eating a low-protein diet Ensuring adequate sodium intake Joining a weight-reduction program Following the prescribed diuretic regimen

Ensuring adequate sodium intake (Sodium is not restricted, because restriction decreases blood volume, which in turn reduces placental perfusion. Women at risk for preeclampsia are advised to eat a high-protein diet. Losing weight is contraindicated during pregnancy and does not reduce the risk of preeclampsia. Diuretic therapy is contraindicated because it decreases blood volume, which in turn reduces placental perfusion.)

What should the plan of care for a client with a tentative diagnosis of partial abruptio placentae include? Bed rest with sedation Trendelenburg position and hydration Preparation for emergency cesarean birth External fetal monitoring and oxygenation

External fetal monitoring and oxygenation (Fetal monitoring and oxygen administration should be instituted to protect the fetus. Some placental separation has occurred, and it may progress further. Sedation is contraindicated; it may further stress an already compromised fetus. The Trendelenburg position may shift the heavy uterus against the diaphragm and lead to compromised maternal respiratory function, further depriving the fetus of oxygen. Hydration is not a priority at this time. Further assessment of fetal status and progression of abruption placentae is needed before a cesarean birth is considered.)

A nurse teaching a prenatal class is asked why infants of diabetic mothers are larger than those born to women who do not have diabetes. On what information about pregnant women with diabetes should the nurse base the response? Taking exogenous insulin stimulates fetal growth. Consuming more calories covers the insulin secreted by the fetus. Extra circulating glucose causes the fetus to acquire fatty deposits. Fetal weight gain increases as a result of the common response of maternal overeating.

Extra circulating glucose causes the fetus to acquire fatty deposits. (It is difficult to maintain maternal normoglycemia throughout pregnancy; excess glucose passes into the fetus, where it is converted to fat. The problem is excess glucose, which is why exogenous insulin must be administered. Although all pregnant women consume extra calories to meet the increased metabolism associated with pregnancy, fetal insulin does not pass from the fetus to the mother. Stating that fetal weight gain increases because pregnant women commonly overeat is a stereotypical statement; not all clients with diabetes overeat.)

Which assessment finding in a pregnant client should prompt the nurse to notify the primary healthcare provider? Slight dependent edema at 38 weeks' gestation Fundal height at the umbilicus at 16 weeks' gestation Fetal heart rate of 150 beats/min at 24 weeks' gestation Maternal heart rate of 92 beats/min at 28 weeks' gestation

Fundal height at the umbilicus at 16 weeks' gestation (Fundal height should be at the umbilicus at 20 weeks' gestation. This early fundal height increase indicates a hydatidiform mole, a multiple gestation, or a fetal congenital anomaly; at 16 weeks' gestation the fundus is below the umbilicus in a healthy, single pregnancy. Foot and ankle edema is common as pregnancy reaches term; the enlarged uterus presses on the femoral veins, impeding the flow of venous blood from the extremities. A fetal heart rate of 150 beats/min at 24 weeks' gestation and a maternal heart rate of 92 beats/min at 28 weeks' gestation are within the expected ranges during pregnancy.)

A client with severe preeclampsia develops eclampsia. After the seizure, the client has a temperature of 102° F (38.9° C). What does the nurse suspect as the cause of the elevated temperature? Excessive muscular activity Development of a systemic infection Dehydration caused by rapid fluid loss Irregularity in the cerebral thermal center

Irregularity in the cerebral thermal center (Increased electrical charges in the brain during a seizure may disturb the cerebral thermoregulation center in the hypothalamus. Excessive muscular activity usually causes perspiration, leading to a drop in body temperature. One increased reading is not a conclusive sign of infection. Rapid fluid loss does not occur during a seizure; clients with preeclampsia have fluid retention.)

A client who is in the first trimester is being discharged after a week of hospitalization for hyperemesis gravidarum. She is to be maintained at home with rehydration infusion therapy. What is the priority nursing activity for the home health nurse? Determining fetal well-being Monitoring for signs of infection Monitoring the client for signs of electrolyte imbalances Teaching about changes in nutritional needs during pregnancy

Monitoring the client for signs of electrolyte imbalances (Rehydration fluids contain only saline and dextrose; if the client continues to vomit, she will lose electrolytes. Monitoring the fetus is not the priority at this time. Although there is a danger of infection when an intravenous line is in place, monitoring for it is not the priority. Teaching about nutritional needs is a nontherapeutic nursing action while the client is still vomiting.)

At 32 weeks' gestation a client undergoes an ultrasound examination, which reveals a low-lying placenta. What complication should the nurse anticipate as the client's pregnancy approaches term? Sharp abdominal pain Painless vaginal bleeding Increased lower back pain Early rupture of membranes

Painless vaginal bleeding (Because the process of effacement occurs in the latter part of pregnancy, placental separation from the uterus may occur, causing painless bleeding. There is pain with premature separation of a normally implanted placenta (abruptio placentae). Lower back pain is not associated with placenta previa. Rupture of membranes usually does not occur before the placenta starts to separate.)

While mopping the kitchen floor, a client at 37 weeks' gestation experiences a sudden sharp pain in her abdomen with a period of fetal hyperactivity. When the client arrives at the prenatal clinic, the nurse examines her and detects fundal tenderness and a small amount of dark-red bleeding. What does the nurse conclude is the probable cause of these clinical manifestations? True labor Placenta previa Partial abruptio placentae Abdominal muscular injury

Partial abruptio placentae (Typical manifestations of abruptio placentae are sudden sharp localized pain and small amounts of dark-red bleeding caused by some degree of placental separation. True labor begins with regular contractions, not sharp localized pain. There is no pain with placenta previa, just the presence of bright-red bleeding. There are no data to indicate that the client sustained an injury.)

A pregnant client with type 1 diabetes is visiting the prenatal clinic for the first time. What is the primary long-term goal for this client? Insulin dosages will decrease Dietary fluctuations will be minimized The blood glucose level will remain stable Pregnancy will end with the birth of a healthy infant

Pregnancy will end with the birth of a healthy infant (In any prenatal situation, the goal is an optimally healthy mother and newborn, no matter what other factors are involved. Insulin is given as necessary to maintain an acceptable glucose level. Minimizing dietary fluctuations is important, but it is not the priority. Stabilizing the blood glucose level is an ongoing goal, not a long-term goal.)

A client who is in preterm labor at 34 weeks' gestation is receiving intravenous tocolytic therapy. The frequency of her contractions increases to every 10 minutes, and her cervix dilates to 4 cm. The infusion is discontinued. Toward what outcome should the priority nursing care be directed at this time? Reduction of anxiety associated with preterm labor Promotion of maternal and fetal well-being during labor Supportive communication with the client and her partner Helping the family cope with the impending preterm birth

Promotion of maternal and fetal well-being during labor (Labor is continuing, and promotion of the well-being of both client and fetus is the priority nursing care during this period. Reduction of anxiety associated with preterm labor, supportive communication with the client and her partner, and helping the family cope with the impending preterm birth each address just one aspect of this client's needs and must be dealt with in the context of the priority need.)

A client at 36 weeks' gestation is admitted to the high-risk unit because she has gained 5 lb (2.3 kg) in the previous week and there is a pronounced increase in blood pressure. What is the initial intervention in the client's plan of care? Preparing for an imminent cesarean birth Providing a dark, quiet room with minimal stimuli Initiating intravenous (IV) furosemide to promote diuresis Administering calcium gluconate to lower the blood pressure

Providing a dark, quiet room with minimal stimuli (Increasing cerebral edema may predispose the client to seizures; therefore stimuli of any kind should be minimized. It is too early to plan for a cesarean birth; other therapies will be tried first. The client will probably be given IV magnesium sulfate to prevent a seizure, not furosemide to promote diuresis. Magnesium sulfate will be used; calcium gluconate is its antidote.)

A client at 30 weeks' gestation is being examined in the prenatal clinic. The nurse identifies a respiratory rate of 26 breaths/min, blood pressure of 100/60 mm Hg, and diaphragmatic tenderness. The client also reports increased urinary output. Which of these findings indicates that the client may be experiencing a complication? Urinary output Blood pressure Respiratory rate Diaphragmatic tenderness

Respiratory rate (The increased respiratory rate is one sign of cardiac decompensation; cardiac output and blood volume peak during the second trimester, and signs and symptoms of cardiac disease become prominent at this time. Oliguria (not increased urine output), accompanied by edema of the face, legs, and fingers, is a sign of cardiac complications. The client's blood pressure is within the expected range for a pregnant woman. Diaphragmatic tenderness is a vague symptom that is not related to heart disease.)

A 16-year-old primigravida at 32 weeks' gestation is admitted to the high-risk unit. Her blood pressure is 170/110 mm Hg and she has 4+ proteinuria. She has gained 50 lb (22.7 kg) during the pregnancy, and her face and extremities are edematous. Which complication is this client experiencing? Eclampsia Severe preeclampsia Chronic hypertension Gestational hypertension

Severe preeclampsia (With severe preeclampsia, arteriolar spasms result in hypertension and decreased arterial perfusion of the kidneys. This in turn causes an alteration in the glomeruli, resulting in oliguria and proteinuria, retention of sodium and water, and edema. Eclampsia is characterized by seizures; there is no data to indicate that the client is having or has had seizures. Chronic hypertension is hypertension diagnosed before pregnancy or before 20 weeks' gestation. Hypertension that is first diagnosed during pregnancy that persists beyond the postpartum period is also considered chronic hypertension. Gestational hypertension is hypertension that first occurs during midpregnancy without proteinuria; it is definitively diagnosed when the hypertension resolves 12 weeks after delivery.)

Intravenous magnesium sulfate therapy is instituted for a client with severe preeclampsia who has a blood pressure of 170/110 mm Hg, a pulse of 108 beats/min, and a respiratory rate of 24 breaths/min. Eight hours later her blood pressure is 150/110 mm Hg, the pulse is 98 beats/min, the respiratory rate is 10 breaths/min, and the knee-jerk reflex is absent. What should the nurse do next? Stop the infusion of magnesium sulfate and notify the primary healthcare provider. Administer calcium gluconate, because it is an antidote to magnesium sulfate. Continue the magnesium sulfate infusion, because the blood pressure is still high. Check vital signs and reflexes in 1 hour and then discontinue the infusion if necessary.

Stop the infusion of magnesium sulfate and notify the primary healthcare provider. (Near-toxic levels of magnesium sulfate are suggested by the disappearance of the knee-jerk reflex and by depressed respirations (fewer than 12 breaths/min). This is a life-threatening situation, and the primary healthcare provider must be notified immediately. Calcium gluconate may be given as an antidote, but the infusion of magnesium sulfate must be stopped first. Magnesium sulfate is not an antihypertensive. Waiting may put the client in danger of respiratory arrest; signs of toxicity require immediate intervention.)