Ch 19: Nursing Manage of Pregnancy at Risk: Pregnancy-Related Complications

A woman of 16 weeks' gestation telephones the nurse because she has passed some "berry-like" blood clots and now has continued dark brown vaginal bleeding. Which action would the nurse instruct the woman to do? A) "Continue normal activity, but take the pulse every hour." B) "Maintain bed rest, and count the number of perineal pads used." C) "Come to the health facility with any vaginal material passed." D) "Come the health care facility if uterine contractions begin."

C) "Come to the health facility with any vaginal material passed." This is a typical time in pregnancy for gestational trophoblastic disease to present. Asking the woman to bring any material passed vaginally would be important so it can be assessed for this.

A client has come to the office for a prenatal visit during her 22nd week of gestation. On examination, it is noted that her blood pressure has increased to 138/90 mm Hg. Her urine is negative for proteinuria. The nurse recognizes which factor as the potential cause? A) chronic hypertension B) preeclampsia C) HELLP D) gestational hypertension

D) gestational hypertension Gestational hypertension is characterized by hypertension without proteinuria after 20 weeks of gestation resolving by 12 weeks postpartum. It is defined as systolic blood pressure of greater than 140 mm Hg and/or diastolic of greater than 90 mm Hg on at least two occasions at least 6 hours apart after the 20th week of gestation, in women known to be normotensive prior to this time and prior to pregnancy. HELLP is an acronym that refers to hemolysis, elevated liver enzymes, and low platelets. Preeclampsia may result if hypertension is not controlled or advances to a more severe state.

A nurse is working as part of a community group focusing efforts on preventing isoimmunization during pregnancy at the local women's health clinic. Which measure would the group encourage? A) Rho(D) immune globulin administration to Rh-negative women B) amniocentesis C) cerclage D) blood typing of mothers with type A or B blood

A) Rho(D) immune globulin administration to Rh-negative women Rh incompatibility can be prevented with the use of Rho(D) immune globulin. Hemolysis associated with ABO incompatibility is limited to mothers with type O blood and their fetuses with type A or B blood. Amniocentesis would be appropriate for treatment of polyhydramnios not isoimmunization. Cerclage is a treatment for cervical insufficiency.

Rho(D) immune globulin will be prescribed for an Rh negative mother undergoing which test? A) amniocentesis B) biophysical profile C) nonstress test D) contraction test

A) amniocentesis Amniocentesis is a procedure requiring a needle to enter into the amniotic sac. There is a risk of mixing of the fetal and maternal blood which could result in blood incompatibility. A contraction test, a nonstress test, and biophysical profile are not invasive, so there would be no indication for Rho(D) immune globulin to be administered.

The nurse is transcribing messages from the answering service. Which phone message should the nurse return first? A) a 25-year-old, 31-week G1P0 client with blood pressure of 100/80 mm Hg and left flank pain; the client's last blood pressure was 100/77 and she had no proteinuria B) a 35-year-old, 21-week G3P2 client with blood pressure of 160/110 mm Hg, blurred vision, and whose last blood pressure was 143/99 mm Hg and urine dipstick showed a +2 proteinuria C) an 18-year-old, 38-week G2P1 client with intermittent cramping; the client's last blood pressure was 98/50 mm Hg, and proteinuria was 1+ D) a 20-year-old, 31-week G1P0 client with malaise and rhinitis; the client's last blood pressure was 120/80 mm Hg, and she had no proteinuria

B) a 35-year-old, 21-week G3P2 client with blood pressure of 160/110 mm Hg, blurred vision, and whose last blood pressure was 143/99 mm Hg and urine dipstick showed a +2 proteinuria The nurse should call the at-risk 35-year-old client first. She is 21 weeks and has symptoms (blurred vision) of preeclampsia. She also had an increase of protein in her urine (2+) and a 15% increase in her BP. The nurse will need more information to determine if the 38-week client may be in the early stages of labor, and if the 31-week client with flank pain has a kidney infection. The client with malaise and rhinitis will need to talk to the nurse last to find out what over-the-counter medication she is able to take.

A woman with an incomplete abortion is to receive misoprostol. The woman asks the nurse, "Why am I getting this drug?" The nurse responds to the client, integrating understanding that this drug achieves which effect? A) suppresses the immune response to prevent isoimmunization B) ensures passage of all the products of conception C) halts the progression of the abortion D) alleviates strong uterine cramping

B) ensures passage of all the products of conception Misoprostol is used to stimulate uterine contractions and evacuate the uterus after an abortion to ensure passage of all the products of conception. Rh (D) immunoglobulin is used to suppress the immune response and prevent isoimmunization.

A pregnant woman is diagnosed with abruptio placentae. When reviewing the woman's medical record, the nurse would expect which finding? A) soft, relaxed uterus on palpation B) sudden dark, vaginal bleeding C) fetal heart rate within normal range D) absence of pain

B) sudden dark, vaginal bleeding The uterus is firm to rigid to the touch with abruptio placentae; it is soft and relaxed with placenta previa. Bleeding associated with abruptio placentae occurs suddenly and is usually dark in color. Bleeding also may not be visible. Bright red vaginal bleeding is associated with placenta previa. Fetal distress or absent fetal heart rate may be noted with abruptio placentae. The woman with abruptio placentae usually experiences constant uterine tenderness on palpation.

A young mother gives birth to twin boys who shared the same placenta. What serious complication are they at risk for? A) ABO incompatibility B) twin-to-twin transfusion syndrome (TTTS) C) TORCH syndrome D) HELLP syndrome

B) twin-to-twin transfusion syndrome (TTTS) When twins share a placenta, a serious condition called twin-to-twin transfusion syndrome (TTTS) can occur.

A pregnant woman has been admitted to the hospital due to severe preeclampsia. Which measure will be important for the nurse to include in the care plan? A) Institute NPO status. B) Plan for immediate induction of labor. C) Institute and maintain seizure precautions. D) Admit the client to the middle of ICU where she can be constantly monitored.

C) Institute and maintain seizure precautions. The woman with severe preeclampsia should be maintained on complete bed rest in a dark and quiet room to avoid stimulation. The client is at risk for seizures; therefore, institution and maintenance of seizure precautions should be in place.

A client is admitted at 22 weeks' gestation with advanced cervical dilatation to 5 centimeters, cervical insufficiency, and a visible amniotic sac at the cervical opening. What is the primary goal for this client at this point? A) give birth vaginally B) education on causes of cervical insufficiency for the future C) bed rest to maintain pregnancy as long as possible D) notification of social support for loss of pregnancy

C) bed rest to maintain pregnancy as long as possible At 22 weeks' gestation, the fetus is not viable. The woman would be placed on bed rest, total, with every attempt made to halt any further progression of dilatation as long as possible. The nurse would not want this fetus to be born vaginally at this stage of gestation. It is not the nurse's responsibility to notify the client's social support of a possible loss of the pregnancy. It is not appropriate at this time to educate the mother on causes of cervical insufficiency for future pregnancies.