Chapter 19

A pregnant client is brought to the health care facility with signs of premature rupture of the membranes (PROM). Which conditions and complications are associated with PROM? Select all that apply. placenta previa abruptio placenta preterm labor prolapsed cord spontaneous abortion

abruptio placenta preterm labor prolapsed cord

A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. The nurse determines that the medication is at a therapeutic level based on which finding? urinary output of 20 mL per hour deep tendons reflexes 2+ difficulty in arousing respiratory rate of 10 breaths/minute

deep tendons reflexes 2+

A novice nurse asks to be assigned to the least complex antepartum client. Which condition would necessitate the least complex care requirements? preeclampsia abruptio placenta gestational hypertension placenta previa

gestational hypertension

The nurse is teaching a prenatal class on potential problems during pregnancy to a group of expectant parents. The risk factors for placental abruption (abruptio placentae) are discussed. Which comment validates accurate learning by the parents? "If I develop this complication, I will have bright red vaginal bleeding," "Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain." "I need a cesarean section if I develop this problem." "Since I am over 30, I run a much higher risk of developing this problem."

"Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain."

A nurse suspects that a pregnant client may be experiencing a placental abruption based on assessment of which finding? Select all that apply. dark red vaginal bleeding insidious onset rigid uterus absence of pain absent fetal heart tones

Absent fetal heart tones Dark red vaginal bleeding Rigid uterus

The following hourly assessments are obtained by the nurse on a client with preeclampsia receiving magnesium sulfate: 97.3oF (36.2oC), HR 88, RR 12 breaths/min, BP 148/110 mm Hg. What other priority physical assessments by the nurse should be implemented to assess for potential toxicity? Magnesium sulfate level Reflexes Oxygen saturation Lung sounds

Reflexes

The nurse is caring for a woman at 32 weeks' gestation with severe preeclampsia. Which assessment finding should the nurse prioritize after the administration of hydralazine to this client? Gastrointestinal bleeding Tachycardia Sweating Halos around lights

Tachycardia

A nurse suspects that a client is developing HELLP syndrome. The nurse notifies the health care provider based on which finding? disseminated intravascular coagulation (DIC) hyperglycemia elevated liver enzymes elevated platelet count

elevated liver enzymes

The nurse is appraising the medical record of a pregnant client who is resting in a darkened room and receiving betamethasone and magnesium sulfate. The nurse recognizes the client is being treated for which condition? gestational diabetes gestational hypertension severe preeclampsia postterm pregnancy

severe preeclampsia

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? "Come to the health facility with any vaginal material passed." "Continue normal activity, but take the pulse every hour." "Maintain bed rest, and count the number of perineal pads used." "Come to the health care facility if uterine contractions begin."

"Come to the health facility with any vaginal material passed."

A woman is receiving magnesium sulfate as part of her treatment for severe preeclampsia. The nurse is monitoring the woman's serum magnesium levels. The nurse determines that the drug is at a therapeutic level based on which result? 3.3 mEq/L 8.4 mEq/L 6.1 mEq/L 10.8 mEq/L

6.1 mEq/L

A nurse is caring for a young woman who is in her 10th week of gestation. She comes into the clinic reporting vaginal bleeding. Which assessment finding best correlates with a diagnosis of hydatidiform mole? Bright red, painless vaginal bleeding Painful uterine contractions and nausea Dark red, "clumpy" vaginal discharge Brisk deep tendon reflexes and shoulder pain

Dark red, "clumpy" vaginal discharge

After a regular prenatal visit, a pregnant client asks the nurse to describe the differences between placental abruption (abruptio placentae) and placenta previa. Which statement will the nurse include in the teaching? Placenta previa causes painful, dark red vaginal bleeding during pregnancy. Placenta previa is an abnormally implanted placenta that is too close to the cervix. Placental abruption requires "watchful waiting" during labor and birth. Placental abruption results in painless, bright red vaginal bleeding during labor

Placenta previa is an abnormally implanted placenta that is too close to the cervix.

The nurse is caring for a multigravid who experienced a placental abruption 4 hours ago. For which potential situation will the nurse prioritize assessment? Uterine atony Blood incompatibilities Hypertensive crisis Maternal blood loss

Uterine atony

A pregnant woman is being evaluated for HELLP. The nurse reviews the client's diagnostic test results. An elevation in which result would the nurse interpret as helping to confirm this diagnosis? LDH white blood cells hematocrit platelet count

LDH

A client with preeclampsia is receiving magnesium sulfate to suppress or control seizures. Which nursing intervention should a nurse perform to determine the effectiveness of therapy? Monitor intake and output. Assess the client's skin turgor. Assess the client's mucous membrane. Assess deep tendon reflexes.

Assess deep tendon reflexes.

A nurse is conducting a presentation for a group of pregnant women about conditions that can occur during pregnancy and that place the woman at high-risk. When discussing blood incompatibilities, which measure would the nurse explain as most effective in preventing isoimmunization during pregnancy? cerclage blood typing of mothers with type A or B blood Rho(D) immune globulin administration to Rh-negative women amniocentesis

Rho(D) immune globulin administration to Rh-negative women

Which assessment findings, experienced by the client at 36 weeks' gestation, would the nurse document as diagnostic signs of severe preeclampsia? Select all that apply. +1 proteinuria blood pressure of 164/110 mm Hg Elevated serum creatinine elevated liver enzymes edema

+1 proteinuria blood pressure of 164/110 mm Hg Elevated serum creatinine elevated liver enzymes

A pregnant 36-year-old woman has presented to the emergency department with vaginal bleeding. While reviewing the client's history, the nurse suspects placenta previa when which risk factors are found in her record? Select all that apply. previous induced surgical abortion advancing maternal age infertility treatment hypotension smoking

Everything but hypotension

The nurse is preparing the plan of care for a woman hospitalized for hyperemesis gravidarum. Which interventions would the nurse most likely include? Select all that apply. administering antiemetic agents monitoring intake and output maintaining NPO status for the first day or two preparing the woman for insertion of a feeding tube obtaining baseline blood electrolyte levels

Everything but preparing for insertion of feeding tube

A client is suspected of having a ruptured ectopic pregnancy. Which assessment would the nurse identify as the priority? infection edema jaundice hemorrhage

hemorrhage

Some women experience a rupture of their membranes before going into true labor. A nurse recognizes that a woman who presents with premature prelabor rupture of membranes (PPROM) has completed how many weeks of gestation? less than 38 weeks less than 40 weeks less than 39 weeks less than 37 weeks

less than 37 weeks

At 37 weeks' gestation, a woman presents to labor and delivery complaining of intense, knife-like abdominal pain that started suddenly about 1 hour ago and has not subsided. On palpation, the abdomen is rigid and board-like and no vaginal bleeding is evident. What should the nurse do next? Assess fetal heart rate Prepare the client for an epidural Insert a Foley catheter Administer oxygen by face mask

Assess fetal heart rate

The nurse is assessing a new client who is being admitted with gestational hypertension. Which nursing diagnosis should the nurse prioritize for this client? Decreased reflexes due to medication administration Imbalanced nutrition related to decreased sodium levels Deficient fluid volume related to vasospasm of arteries Risk for injury related to fetal distress

Deficient fluid volume related to vasospasm of arteries

A client reports bright red, painless vaginal bleeding during her 32nd week of pregnancy. A sonogram reveals that the placenta has implanted low in the uterus and is partially covering the cervical os. Which immediate care measures are initiated? Select all that apply. Place the woman on bed rest maintaining the supine position. Determine the time the bleeding began and about how much blood has been lost. Obtain baseline vital signs and compare to those vital signs previously obtained. Assist the client in stirrups and perform a pelvic examination. Attach external monitoring equipment to record fetal heart sounds and kick counts.

Determine the time the bleeding began and about how much blood has been lost. Obtain baseline vital signs and compare to those vital signs previously obtained. Attach external monitoring equipment to record fetal heart sounds and kick counts.

A woman at 34 weeks' gestation presents to labor and delivery with vaginal bleeding. Which finding from the obstetric examination would lead to a diagnosis of placental abruption (abruptio placentae)? Fetus is in a breech position Sonogram shows the placenta covering the cervical os Uterus is soft between contractions Onset of vaginal bleeding was sudden and painful

Onset of vaginal bleeding was sudden and painful

A client at 36 weeks' gestation experiences vaginal bleeding. Which conditions might be the cause of the client's bleeding? Select all that apply. Bloody show Placental abruption (abruptio placentae) Ectopic pregnancy Placenta previa Spontaneous abortion (miscarriage)

Placental abruption (abruptio placentae) Placenta previa Bloody Show

A client at 37 weeks' gestation presents to the emergency department with a BP 150/108 mm Hg, 1+ pedal edema, 1+ proteinuria, and normal deep tendon reflexes. Which assessment should the nurse prioritize as the client is administered magnesium sulfate IV? Hemoglobin Ability to sleep Urine protein Respiratory rate

Respiratory rate

A client who has experienced an incomplete abortion is prescribed mifepristone to assist in removing the retained products of conception. Which medication would the nurse expect to administer if prescribed before administering mifepristone? vitamin K to reduce bleeding opioid analgesic for relief of cramping diuretic to promote fluid loss antiemetic to minimize nausea

antiemetic to minimize nausea

A client with severe preeclampsia is receiving magnesium sulfate as part of the treatment plan. To ensure the client's safety, which compound would the nurse have readily available? ferrous sulfate potassium chloride calcium gluconate calcium carbonate

calcium gluconate

A pregnant client at 20 weeks' gestation arrives at the health care facility reporting excessive vaginal bleeding and no fetal movements. Which assessment finding would the nurse anticipate in this situation? congenital malformations placenta previa ectopic pregnancy cervical insufficiency

cervical insufficiency

A woman is being closely monitored and treated for severe preeclampsia with magnesium sulfate. Which finding would alert the nurse to the development of magnesium toxicity in this client? seizures serum magnesium level of 6.5 mEq/L diminished reflexes elevated liver enzymes

diminished reflexes

A nurse is reviewing an article about preterm prelabor rupture of membranes. Which factors would the nurse expect to find placing a woman at high risk for this condition? Select all that apply. low socioeconomic status single gestations smoking high body mass index urinary tract infection

low socioeconomic status smoking urinary tract infection

Which medication will the nurse anticipate the health care provider will prescribe as treatment for an unruptured ectopic pregnancy? oxytocin promethazine ondansetron methotrexate

methotrexate

A nurse is providing care to a multiparous client. The client has a history of cesarean births. The nurse anticipates the need to closely monitor the client for which condition? placenta accreta preeclampsia oligohydramnios placenta abruption

placenta accreta

A woman pregnant with twins comes to the clinic for an evaluation. While assessing the client, the nurse would be especially alert for signs and symptoms for which potential problem? chorioamnionitis post-term labor preeclampsia oligohydramnios

preeclampsia

The nurse is caring for a client with preeclampsia and understands the need to auscultate this client's lung sounds every 2 hours. Why would the nurse do this? pulmonary atelectasis pulmonary edema pulmonary hypertension pulmonary emboli

pulmonary edema

While assessing a pregnant woman, the nurse suspects that the client may be at risk for hydramnios. Which information would the nurse use to support this suspicion? Select all that apply. reports of shortness of breath difficulty obtaining fetal heart rate history of diabetes fundal height below that for expected gestational age identifiable fetal parts on abdominal palpation

reports of shortness of breath difficulty obtaining fetal heart rate history of diabetes

The nurse is required to assess a client for HELLP syndrome. Which are the signs and symptoms of this condition? Select all that apply. epigastric pain blood pressure higher than 160/110 mm Hg hyperbilirubinemia oliguria upper right quadrant pain

epigastric pain hyperbilirubinemia upper right quadrant pain

A client at 27 weeks' gestation is admitted to the obstetric unit after reporting headaches and edema of her hands. Review of the prenatal notes reveals blood pressure consistently above 136/90 mm Hg. The nurse anticipates the health care provider will prescribe magnesium sulfate to accomplish which primary goal? Decrease protein in urine Prevent maternal seizures Reverse edema Decrease blood pressure

Prevent maternal seizures

A young woman presents at the emergency department reporting lower abdominal cramping and spotting at 12 weeks' gestation. The primary care provider performs a pelvic examination and finds that the cervix is closed. What does the care provider suspect is the cause of the cramps and spotting? Threatened abortion Cervical insufficiency Ectopic pregnancy Habitual abortion

Threatened abortion

A home health care nurse is visiting a pregnant client with preeclampsia who is being managed at home. The nurse is reviewing the situations for which the client should contact the nurse. The nurse determines that the client demonstrates understanding when identifying which situation(s) as needing to be reported? Select all that apply. blurred vision excessive heartburn increased urination dizziness sinus headache

dizziness excessive heartburn blurred vision

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? halts the progression of the abortion ensures passage of all the products of conception alleviates strong uterine cramping suppresses the immune response to prevent isoimmunization

ensures passage of all the products of conception

A client in her 20th week of gestation develops HELLP syndrome. What are features of HELLP syndrome? Select all that apply. leukocytosis hemolysis elevated liver enzymes low platelet count hyperthermia

hemolysis elevated liver enzymes low platelet count

A 44-year-old client has lost several pregnancies over the last 10 years. For the past 3 months, she has had fatigue, nausea, and vomiting. She visits the clinic and takes a pregnancy test; the results are positive. Physical examination confirms a uterus enlarged to 13 weeks' gestation; fetal heart tones are heard. Ultrasound reveals that the client is experiencing some bleeding. Considering the client's prenatal history and age, what does the nurse recognize as the greatest risk for the client at this time? spontaneous abortion (miscarriage) preterm labor premature birth hypertension

spontaneous abortion (miscarriage)