Maternity and Pediatrics - Ch 8: Nursing Care of Women With Complications in Pregnancy

The LPN/LVN is reviewing target blood glucose levels with a patient diagnosed with gestational diabetes. Which patient statement would indicate additional teaching is needed? 1."When waking up in the morning, my blood glucose needs to be at least 80." 2."One hour after lunch, my blood glucose should test at 140 maximum." 3."Two hours after dinner, I expect my blood glucose to be no higher than 120." 4."Before eating a meal, I should have a blood glucose of 95."

1."When waking up in the morning, my blood glucose needs to be at least 80."

The LPN/LVN is reinforcing teaching by the RN to a patient diagnosed with gestational diabetes. Which statement made by the LPN/LVN would be correct? 1."Your baby may be much larger than expected." 2."At birth, your newborn is at high risk for hyperglycemia." 3."You'll need to have appointments every 4 weeks." 4."You should eat six main meals and three snacks each day."

1."Your baby may be much larger than expected."

The LPN/LVN in a prenatal clinic assists in screening patients in their second trimester of pregnancy for gestational diabetes. Which patients would the LPN/LVN identify as being at greater risk? (SATA) 1.A patient who previously delivered a baby who was over 9 lb 2.A patient who is Korean American 3.A patient who takes daily walks with her dog 4.A patient with a body mass index (BMI) of 22. 5.A patient with a cousin who has type 2 diabetes mellitus

1.A patient who previously delivered a baby who was over 9 lb 2.A patient who is Korean American

The LPN/LVN is assisting with a patient who is admitted for a suspected partial placenta abruptio. Admission blood pressure (BP) is 90/64 mm Hg and the heart rate (HR) is 140 beats per minute. The patient exhibits restlessness and confusion. Which nursing interventions would the LPN/LVN implement? (SATA) 1.Checking capillary refill 2.Inspecting perineal pads 3.Noting peripheral pulses 4.Monitoring vital signs 5.Noting amount and color of blood

1.Checking capillary refill 3.Noting peripheral pulses 4.Monitoring vital signs

The LPN/LVN is assisting in the care of a patient admitted for hyperemesis gravidarum. When the LPN/LVN suggests frequent sips of fluids, the patient states, "You don't understand how sick I am!" Which information would the LPN/LVN share to promote patient adherence with the care plan? 1.Dehydration needs to be avoided for the well-being of the fetus. 2.Refusing liquids will cause the nausea and vomiting to become worse. 3.Explain that the alternative is to establish an IV for fluid administration. 4.The patient is more likely to experience preterm labor and delivery.

1.Dehydration needs to be avoided for the well-being of the fetus.

The LPN/LVN is assisting in the care of a patient who experienced a missed abortion at 10 weeks' gestation. The patient reports, "I received confirmation via ultrasound 3 days ago, but I haven't had any bleeding. " Which treatments would the LPN/LVN expect to be initiated for this patient? (SATA) 1.Dilation and curettage (D&C) 2.Misoprostol prescription 3.Antibiotic therapy 4.Administration of oxytocin 5.Complete blood count (CBC)

1.Dilation and curettage (D&C) 2.Misoprostol prescription 4.Administration of oxytocin

The LPN/LVN in an obstetrics clinic receives a call from a patient who is at 30 weeks' gestation. The patient states, "I am not going to make my appointment today. I have a terrible headache, and I feel very swollen in my hands and feet." Which action by the LPN/LVN would be of greatest priority? 1.Direct the patient to seek immediate medical assistance. 2.Ask the patient to come in for her regular appointment. 3.Find an RN to call the patient and the health care provider. 4.Inquire if the patient has bleeding or contractions.

1.Direct the patient to seek immediate medical assistance.

The patient with severe hyperemesis gravidarum is being monitored closely. The LPN/LVN reports to the RN the patient's urine dip-stick test is positive for ketones. Which information would the LPN/LVN provide as most important for the reinforcement of RN teaching? 1.Eat small, frequent meals. 2.Sip small amounts of fluids through the day. 3.Consume dry crackers before getting out of bed. 4.Avoid odors of foods that trigger nausea.

1.Eat small, frequent meals.

Which clinical manifestations would the LPN/LVN expect when assisting with a patient who is in the first trimester of a pregnancy with twins? (SATA) 1.Greater maternal weight gain 2.Detection of simultaneous fetal movements 3.Higher levels of human chorionic gonadotropin (hCG) and alpha-fetoprotein 4.Auscultation of multiple fetal heartbeats 5.Uterine size is larger than anticipated

1.Greater maternal weight gain 3.Higher levels of human chorionic gonadotropin (hCG) and alpha-fetoprotein 4.Auscultation of multiple fetal heartbeats 5.Uterine size is larger than anticipated

The LPN/LVN reviews a patient's urinalysis results at 35 weeks' gestation. Which result would the LPN/LVN associate with the presence of infection? 1.High levels of protein 2.High levels of glucose 3.Low levels of ketones 4.Low levels of white blood cells (WBCs)

1.High levels of protein

Three months after vacuum evacuation of a hydatidiform mole, a patient is diagnosed with uterine choriocarcinoma. Which follow-up instructions would be of greatest priority to reinforce to the patient? 1.Importance of obtaining the prescribed chest x-ray 2.The cure rate for cancer developing from the condition 3.The reason why pregnancy needs to be avoided 4.Race, age, and reproductive history related to future risks of the condition

1.Importance of obtaining the prescribed chest x-ray

The LPN/LVN assists with a patient who is 28 weeks' gestation and experiencing hyperemesis gravidarum. Which complications would the LPN/LVN monitor for in the patient? (SATA) 1.Indications of uterine contractions 2.Increase in blood pressure 3.Dark colored, concentrated urine 4.Weight decrease from 140 to 130 lb 5.Increased heart rate with decreased blood pressure

1.Indications of uterine contractions 2.Increase in blood pressure 5.Increased heart rate with decreased blood pressure

Which facts would the LPN/LVN identify as being correct in regard to placental bleeding? (SATA) 1.May require performance of a hysterectomy 2.Causes fetal disseminated intravascular coagulation (DIC) 3.Can result in a change of management during labor 4.Can be the cause of uterine rupture 5.May result from the use of cocaine

1.May require performance of a hysterectomy 3.Can result in a change of management during labor 4.Can be the cause of uterine rupture 5.May result from the use of cocaine

The LPN/LVN is assisting with caring for a patient at 34 weeks' gestation who has gestational diabetes. The patient has gained more weight than is expected. Which nursing care would the LPN/LVN provide? 1.Reinforce the dietary plan from the patient's dietitian. 2.Teach the patient how to perform capillary fingerstick. 3.Monitor for signs of diabetic ketoacidosis (DKA) and hyperglycemia. 4.Administer oral hypoglycemic medications.

1.Reinforce the dietary plan from the patient's dietitian.

Which information about Rh incompatibility between a mother and a fetus would be accurate? (SATA) 1.RhoGAM is given at 28 weeks' gestation for a positive indirect Coombs' test. 2.A rise of bilirubin in amniotic fluid can indicate fetal distress. 3.If antibodies attack Rh-positive fetal blood, the fetus cannot compensate. 4.All pregnant women need testing for Rh factor and blood type. 5.An Rh-negative mother poses greatest risk for the firstborn fetus.

1.RhoGAM is given at 28 weeks' gestation for a positive indirect Coombs' test. 2.A rise of bilirubin in amniotic fluid can indicate fetal distress. 4.All pregnant women need testing for Rh factor and blood type.

A patient who is Rh-negative is pregnant with her second child. The patient states, "My first child was Rh-negative, so I am not worried that this baby is Rh-positive." Which information would the LPN/LVN expect the RN to teach the patient to explain the need for close monitoring? (SATA) 1.The formation of antibodies can occur during a pregnancy. 2.Fetal blood can be transferred during this pregnancy to the mother from trauma. 3.Any invasive procedure to the uterus can result in blood transfer. 4.Blood is most likely to have passed from fetus to mother during the first delivery. 5.With an early spontaneous abortion, blood of unidentified Rh factor may transfer.

1.The formation of antibodies can occur during a pregnancy. 2.Fetal blood can be transferred during this pregnancy to the mother from trauma. 3.Any invasive procedure to the uterus can result in blood transfer. 5.With an early spontaneous abortion, blood of unidentified Rh factor may transfer.

The LPN/LVN is assisting the RN with a patient who is newly diagnosed with gestational diabetes. The patient states, "I don't understand. Why am I suddenly diabetic?" Which explanation would the LPN/LVN expect the RN to provide? 1.The hormones of pregnancy block the effects of insulin. 2.The pancreas is unable to keep up with the insulin of both the mother and fetus. 3.The placenta will produce extra insulin to help prevent high blood glucose. 4.When the fetus cannot draw insulin across the placenta, the fetus becomes hyperglycemic.

1.The hormones of pregnancy block the effects of insulin.

The LPN/LVN is assisting with a patient who was admitted because of threatened abortion after 16 weeks' gestation. Which events would prompt the LPN/LVN to notify the RN immediately? (SATA) 1.The patient reports a gush of fluid. 2.The LPN/LVN notices foul-smelling vaginal discharge. 3.The patient denies worsening of uterine pain. 4.The patient asks the LPN/LVN for a perineal pad. 5.The LPN/LVN finds the patient's vital signs stable.

1.The patient reports a gush of fluid. 2.The LPN/LVN notices foul-smelling vaginal discharge. 4.The patient asks the LPN/LVN for a perineal pad.

Which manifestations would alert the LPN/LVN to the possibility of placenta abruptio? (SATA) 1.There is an absence of vaginal bleeding. 2.The patient appears stressed and anxious. 3.The abdominal wall feels hard when palpated. 4.Patient reports uterine tenderness with touch. 5.Maternal blood pressure (BP) is low and heart rate (HR) is elevated.

1.There is an absence of vaginal bleeding. 3.The abdominal wall feels hard when palpated. 4.Patient reports uterine tenderness with touch. 5.Maternal blood pressure (BP) is low and heart rate (HR) is elevated.

The LPN/LVN is reinforcing teaching by the RN to a patient with chronic hypertension who is planning to become pregnant. Which information would be most important to reinforce regarding management of the patient's condition? 1.Drink eight glasses of water a day. 2.Eat a low-sodium diet. 3.Take and record daily blood pressure. 4.Take daily antihypertensive drugs as prescribed.

2.Eat a low-sodium diet.

A patient who is 35 weeks' gestation reports upper right quadrant abdominal pain along with malaise and anorexia. The LPN/LVN reviews the results of prescribed laboratory tests and learns the patient has elevated liver enzymes and low platelet count. Which intervention would the nurse expect the health care provider to prescribe? 1.Prescribe bedrest at home for probable flu. 2.Immediate hospitalization for HELLP syndrome. 3.Prescribe medications to manage gastritis. 4.Schedule testing to rule out gallbladder disease.

2.Immediate hospitalization for HELLP syndrome.

A patient presents to the emergency department and reports, "I think I am pregnant, but something is seriously wrong." Testing reveals an ectopic pregnancy located in a fallopian tube. Which finding would the LPN/LVN recognize as a medical reason for surgery? 1.The patient has a history of frequent sexually transmitted infections (STIs). 2.The fetus is 3.8 cm in length and has cardiac activity. 3.The patient's fallopian tube is intact. 4.The patient's vital signs are all within normal limits

2.The fetus is 3.8 cm in length and has cardiac activity.

The LPN/LVN is assisting the RN with a patient in active labor with possible placenta previa. Which information would prompt the LPN/LVN to notify the RN immediately? 1.Blood has been collected for typing and cross-matching. 2.There are abnormal heart rate patterns. 3.IV site appears cool and puffy. 4.Patient expresses concern about fetal well-being.

2.There are abnormal heart rate patterns.

A patient is receiving magnesium sulfate for a diagnosis of eclampsia. In which order would the nurse assess for a patellar reflex? Place the options in the correct order. All options must be used. 1.Place a hand on the patient's thigh 2.Note the contraction of the quadriceps and knee extension 3.Place the patient on the side of the bed with legs dangling 4.Strike the distal patellar tendon just below the kneecap

3, 1, 4, 2

In which order would the steps for checking the brachial reflex be performed? Place the options in the correct order. All options must be used. 1.The caregiver places their thumb over the patient's tendon 2.A normal response is recognized as a slight flexion of the forearm. 3.The patient's arm is supported by laying it on the caregiver's forearm 4.The patient is instructed to relax and let their arm go limp 5.The thumb is struck with the small end of the reflex hammer

3, 4, 1, 5, 2

The LPN/LVN is assisting with care for a patient admitted for hyperemesis gravidarum. The patient begins to cry and states, "I can't be here. I have two preschool children at home." Which comment would be most appropriate by the nurse? 1."Maybe your partner can take off work and care for the children." 2."Family members are usually willing to help in situations like this." 3."I can ask the hospital social worker to come and talk with you." 4."My church has women who are willing to come and help with such situations."

3."I can ask the hospital social worker to come and talk with you."

The LPN/LVN is reinforcing prenatal teaching provided by the RN with a patient who is 22 weeks' gestation with triplets. Which comment by the patient would initiate additional reinforcement by the LPN/LVN is needed? 1."I cannot get through the day without several rest periods." 2."If I didn't have so many doctor appointments, I would feel neglected." 3."I feel so full that I can hardly force myself to eat a meal." 4."When they all start moving at the same time, my bladder will leak."

3."I feel so full that I can hardly force myself to eat a meal."

A patient is in her first trimester of pregnancy after taking a fertility drug. Which statement would the LPN/LVN make when reinforcing patient teaching by the RN? 1."You are at increased risk for miscarriage." 2."Hormone therapy will help you maintain this pregnancy." 3."You have an increased possibility of twins." 4."You'll likely need fertility drugs for future pregnancies."

3."You have an increased possibility of twins."

Which medical intervention would aid in managing gestational diabetes? 1.Screen obese patients for elevated blood glucose. 2.Require diagnosed patients to test capillary blood glucose levels once daily. 3.All patients receive an oral glucose tolerance test (GTT) between the 24th and 28th week of pregnancy. 4.Patients with a history of polycystic ovary syndrome (PCOS) are always treated as gestational diabetics.

3.All patients receive an oral glucose tolerance test (GTT) between the 24th and 28th week of pregnancy.

A patient in the first trimester of pregnancy calls the health care provider's office and reports uterine cramping, bleeding, and passage of "clotlike material." The patient denies continued cramping and bleeding. The LPN/LVN understands that which event most likely would have occurred? 1.Threatened abortion 2.Incomplete abortion 3.Complete abortion 4.Missed abortion

3.Complete abortion

The LPN/LVN is assisting with the care of a patient being treated for eclampsia. The RN is administering magnesium sulfate as prescribed. Which information would the LPN/LVN report to the RN immediately as an indication of toxicity? 1.Depressed deep tendon reflexes (DTRs) 2.Seizure activity 3.Hypotension 4.Increased nausea

3.Hypotension

A patient who is at 32 weeks' gestation reports to the LPN/LVN that she thinks she has the flu. The LPN/LVN takes the patient's vitals and reports a blood pressure of 164/122 mm Hg to the RN. Lab results indicate the patient has HELLP syndrome. Which important nursing intervention would help manage the patient's condition? 1.Promoting delivery of the baby as soon as possible 2.Beginning magnesium sulfate therapy 3.Maintaining a quiet environment for the patient 4.Using corticosteroid therapy to promote fetal lung maturity

3.Maintaining a quiet environment for the patient

The LPN/LVN is assisting with the care of a patient diagnosed with gestational diabetes. The health care provider has just increased the patient's insulin prescription. When assessing the patient, the LPN/LVN notices sweating and confusion. The patient reports nausea and a headache. Which action would the LPN/LVN take first? 1.Report the patient's symptoms to the RN. 2.Give the patient a snack that contains sugar. 3.Obtain a capillary blood glucose level immediately. 4.Ask the unit clerk to put in a STAT lab order.

3.Obtain a capillary blood glucose level immediately.

The LPN/LVN is reviewing admission notes for a patient who is at 8 weeks' gestation in her third pregnancy. The patient's reproductive history is G3, T0, P0, A2, L0. Which medical management would the LPN/LVN expect for this patient? 1.Close monitoring for gestational diabetes 2.Medications to treat hypertension 3.Placement of a cerclage 4.Maintenance of bedrest for duration of pregnancy

3.Placement of a cerclage

The LPN/LVN is assisting with the care of a patient who just underwent a salpingectomy because of a ruptured ectopic pregnancy. Which finding on the patient's medical record would alert the LPN/LVN to a time-sensitive intervention? 1.This is the patient's first pregnancy. 2.The patient is positive for a bacterial sexually transmitted infection (STI). 3.The patient has a negative Rh factor. 4.The patient's labs indicate mild anemia.

3.The patient has a negative Rh factor.

The LPN/LVN is obtaining the vital signs of a patient during her first prenatal visit. The patient has missed her first menstrual cycle and reports mild morning sickness 4 to 5 days a week. Which condition would the LPN/LVN suspect if the patient's blood pressure is 160/88 mm Hg? 1.The patient is likely to develop pre-eclampsia. 2.The patient is exhibiting signs of pre-eclampsia. 3.The patient has undiagnosed chronic hypertension. 4.The patient is already showing signs of eclampsia.

3.The patient has undiagnosed chronic hypertension.

Uterine bleeding at any time during pregnancy is abnormal. Which risk would be the greatest associated with uterine bleeding in the first trimester of pregnancy? 1.Loss of life to both the patient and the fetus. 2.Fetal oxygen is interrupted or decreased. 3.The viability of the pregnancy is threatened. 4.Placenta is retained.

3.The viability of the pregnancy is threatened.

The LPN/LVN is assisting with care of a patient who is 37 years of age and at 32 weeks' gestation with her second child. The patient's first child was born 11 months ago by cesarean delivery. Based upon this objective data, the LPN/LVN would expect the health care provider to schedule an ultrasound for which reason? 1.To diagnose fetal chromosomal defects 2.To determine the possibility of vaginal delivery 3.To assess for placenta accreta 4.To assess if fetal growth is as expected

3.To assess for placenta accreta

The LPN/LVN assists the RN in providing care to a patient diagnosed with gestational diabetes. The patient asks how her blood glucose levels go up and down. Which information would the LPN/LVN expect the RN to provide? Place the options in the correct order. All options must be used. 1.Glucose stimulates the release of insulin 2.Blood glucose levels are lowered 3.Glucose is facilitated into the cell by insulin 4.A meal is eaten and blood glucose levels rise 5.A decreased amount of insulin is secreted

4, 1, 3, 2, 5

A patient with pregnancy-induced hypertension (PIH) asks the LPN/LVN about the cause of the condition. Which answer, based upon research, would be best for the LPN/LVN to provide? 1."The definite cause is the placenta." 2."Strong evidence supports the belief that this condition is mostly genetic." 3."Liver disease caused by drinking alcohol is frequently a cause." 4."The actual cause is still unknown."

4."The actual cause is still unknown."

The LPN/LVN understands the relationship between vasoconstriction and hypertension. Using this knowledge, how would the LPN/LVN associate this process with pregnancy-induced hypertension? 1.Maternal vasoconstriction caused by hormones elevates blood pressure. 2.An underdeveloped fetus will lack the capacity to handle maternal blood supply. 3.Weight gain increases circulation demands and causes interrupted blood flow. 4.Abnormal placenta development interferes with blood perfusion.

4.Abnormal placenta development interferes with blood perfusion.

The LPN/LVN is assisting in the care of a patient who is 34 weeks' gestation. The patient is positive for gestational diabetes. Which sign or symptom would indicate the patient is developing ketoacidosis? 1.Increased maternal fasting blood glucose levels 2.Decreased thirst 3.Higher than expected weight gain 4.Blood glucose level of 200 mg/dL

4.Blood glucose level of 200 mg/dL

A patient in her first trimester of pregnancy is diagnosed with hyperemesis gravidarum. It is determined the patient will need medical management for the condition. The patient requests conservative medication measures only. Which medication would be prescribed? 1.Promethazine 2.Ondansetron 3.Metoclopramide 4.Doxylamine

4.Doxylamine

The LPN/LVN is assisting with the care of a patient during a follow-up visit after the placement of surgical cerclage. Which finding would indicate a possible complication? 1.Absences of vaginal leakage 2.Clear vaginal discharge 3.Stated anxiety about miscarriage 4.Fever and chills

4.Fever and chills

The LPN/LVN is reinforcing teaching by the RN for a patient after diagnosis of an ectopic pregnancy. The health care provider prescribes methotrexate treatment. Which teaching by the RN would the LPN/LVN reinforce? 1.Signs and symptoms of fallopian tube rupture 2.Preparation for emergency surgery 3.Care of permanently blocked fallopian tube 4.Foods that are high in folic acid

4.Foods that are high in folic acid

A patient who is 34 weeks' gestation is admitted for severe pre-eclampsia. The LPN/LVN is informed by the RN that the patient is now considered as having eclampsia. Which nursing intervention would the LPN/LVN initiate? 1.Darken the room and reduce environmental noise. 2.Validate the patient is receiving a liquid diet. 3.Place a bedside commode in the patient's room. 4.Pad the side rails and place suction at the bedside.

4.Pad the side rails and place suction at the bedside.

The LPN/LVN is providing care to a pregnant patient diagnosed with gestational diabetes. The health care provider has just increased her insulin dose. Which teaching initially provided by the RN would the LPN/LVN reinforce with the patient? 1.Dietary plan ordered by the registered dietitian 2.How to perform capillary fingerstick 3.Signs of diabetic ketoacidosis 4.Signs of low blood sugar

4.Signs of low blood sugar

The LPN/LVN is assisting with the care of a patient being treated for eclampsia. The patient has received the loading dose of magnesium sulfate and one maintenance dose. The LPN/LVN observes that the patient is in a darkened room and appears to be sleeping. Which additional observation would cause the LPN/LVN to alert the RN immediately? 1.Patient breathing at a rate of 12 breaths per minute. 2.The patient's urinary output over an hour is 40 mL. 3.The patient's current oxygen saturation is 95%. 4.The patient is drowsy and difficult to arouse.

4.The patient is drowsy and difficult to arouse.