OB Quiz: High-Risk Pregnancy

A nurse is admitting a client who is at 36 weeks gestation and has painless, bright red vaginal bleeding. The nurse should recognize this finding as an indication of which of the following conditions? A. Abruptio placentae B. Placenta previa C. Precipitous labor D. Threatened abortion

B. Painless, bright red vaginal bleeding in the second or third trimester is a manifestation of placenta previa.

A nurse in an antepartum unit is triaging clients. Which of the following clients should the nurse see first? A. A client who is at 38 weeks of gestation with a temperature of 38.2 who reports a cough B. A client who has missed a period and reports vaginal spotting C. A client who is at 14 weeks of gestation and reports nausea and vomiting D. A client who is at 28 weeks of gestation with a HR of 90 who reports painless vaginal bleeding

D. Using the urgent vs. nonurgent approach to client care, the nurse should assess this client first. The nurse should suspect placenta previa when painless vaginal bleeding occurs after 24 weeks of gestation. A pregnant woman can lose up to 40% of blood before showing signs of shock, thus VS should not be used as an indicator of stability in the pregnant patient population.

A nurse is admitting a client who is at 30 weeks of gestation and is in preterm labor. The client has a new prescription for betamethasone and asks the nurse about the purpose of this medication. The nurse should provide which of the following explanations? A. "It is used to stop preterm labor contractions." B. "It halts cervical dilation." C. "It promotes fetal lung maturity." D. "It increases the fetal heart rate."

C. Betamethasone is a glucocorticoid that enhances fetal lung maturity by promoting the release of certain enzymes that help produce surfactant.

A nurse is completing discharge teaching to a client in her 35th week of pregnancy who has mild preeclampsia. Which of the following information about nutrition should be included in the teaching? A. Consume 40 to 50 g of protein daily. B. Avoid salting of foods during cooking. C. Drink 48 to 64 ounces of water daily. D. Limit intake of whole grains, raw fruits, and vegetables.

C. The client who has preeclampsia is encouraged to drink six to eight 8-ounce glasses of water (48 to 64 ounces) per day. She should avoid alcohol and limit intake of caffeinated beverages.

A nurse is assessing a client who received magnesium sulfate to treat preterm labor. Which of the following clinical findings should the nurse identify as an indication of toxicity to magnesium sulfate therapy and report to the provider? A. Respiratory depression B. Facial flushing C. Nausea D. Drowsiness

A. Magnesium sulfate toxicity can cause life-threatening adverse effects, including respiratory and CNS depression. The nurse should report a respiratory rate slower than 12/min immediately to the provider and stop the infusion.

A nurse in the antepartum unit is caring for a client who is at 36 weeks of gestation and has pregnancy-induced hypertension. Suddenly, the client reports continuous abdominal pain and vaginal bleeding. The nurse should suspect which of the following complications? A. Placenta previa B. Prolapsed cord C. Incompetent cervix D. Abruptio placentae

D. The classic signs of abruptio placentae include vaginal bleeding, abdominal pain, uterine tenderness, and contractions. These manifestations, coupled with the significant risk factor of HTN, are highly indicative of abruptio placentae.

A nurse is caring for a client who is in premature labor and is receiving terbutaline. The nurse should monitor the client for which of the following adverse effects that should be reported to the provider? A. Headaches B. Bradycardia C. Tremors D. Dyspnea

D. The presence of dyspnea is a manifestation of pulmonary edema, which is a potentially life-threatening complication of terbutaline. This finding should be reported to the provider immediately.

A nurse is completing a health history for a client who is at 6 weeks of gestation. The client informs the nurse that she smokes one pack of cigarettes per day. The nurse should advise the client that smoking places the client's newborn at risk for which of the following complications? A. Hearing loss B. Intrauterine growth restriction C. Type 1 diabetes mellitus D. Congenital heart defects

B. Clients who smoke place their newborns and themselves at risk for diverse complications, including fetal intrauterine growth restriction, placental abruption, placenta previa, preterm delivery, and fetal death.

A nurse is admitting a client who has severe preeclampsia at 35 weeks of gestation and is reviewing the provider's orders. Which of the following orders requires clarification? A. Assess deep tendon reflexes every hour. B. Obtain a daily weight. C. Continuous fetal monitoring D. Ambulate twice daily.

D. A provider's order to allow the client to ambulate requires clarification. The client who has severe preeclampsia should be placed on bedrest in a quiet, nonstimulating environment to prevent seizures and promote optimal placental blood flow.

A nurse is completing the admission assessment of a client who is at 38 weeks of gestation and has severe preeclampsia. Which of the following is an expected finding? A. Tachycardia B. Absence of clonus C. Polyuria D. Report of headache

D. Manifestations of severe preeclampsia include severe (usually frontal) headache, blurred vision, photophobia, scotomas, right upper quadrant pain, irritability, presence of clonus and brisk deep tendon reflexes, nausea, vomiting, hypertension, oliguria, and proteinuria.

A nurse in a prenatal clinic is teaching a client who is in her second trimester and has a new diagnosis of gestational diabetes. Which of the following statements by the client indicates a need for further teaching? A. "I should limit my carbohydrates to 40% of caloric intake." B. "I will reduce my exercise schedule to 3 days a week." C. "I will take my first insulin dose before breakfast." D. "I know I am at increased risk to develop type 2 diabetes."

B. Increased exercise benefits the client and can result in improved management of gestational diabetes.

A nurse in a provider's office is caring for a client who is at 34 weeks of gestation and at risk for placental abruption. The nurse should recognize that which of the following is the most common risk factor for abruption? A. Cocaine use B. Hypertension C. Blunt force trauma D. Cigarette smoking

B. Maternal hypertension, either chronic or related to pregnancy, is the most common risk factor for placental abruption.

A nurse is assessing a client who is pregnant for preeclampsia. Which of the following findings should indicate to the nurse that the client requires further evaluation for this disorder? A. Increased urine output B. Vaginal discharge C. Elevated blood pressure D. Joint pain

C. Hypertension is one of the cardinal symptoms of preeclampsia, along with excessive weight gain, edema, and albumin in the urine.

A nurse is caring for a client who is in preterm labor with a current L/S ratio of 1:1. Which of the following actions should the nurse take? A. Infuse a bolus of IV fluid. B. Administer hydralazine 25 mg IV. C. Prepare the client for immediate delivery. D. Administer betamethasone 12 mg IM.

D. Betamethasone is classified as a corticosteroid medication. Corticosteroids are often administered to the mother to assist in fetal lung maturity. These are usually administered by IM injection of 12 mg for the first two doses. The subsequent dosing should be 6 mg by IM every 12 hr x 4 doses.

A nurse is admitting a client who is at 37 weeks of gestation and has severe preeclampsia. Which of the following actions should the nurse expect to implement? (Select all that apply.) A. Administer magnesium sulfate IV. B. Provide a dark, quiet environment. C. Assess respiratory status every 6 hr. D. Administer pitocin for induction of labor. E. Ensure that calcium gluconate is readily available.

A, B, D, E. Administer magnesium sulfate IV is correct. Magnesium sulfate IV is given as a tocolytic medication for preterm labor to relax smooth muscle of the uterus and as a treatment for preeclampsia. The underlying pathophysiology of preeclampsia is vasospasm. The nurse should closely monitor the client for signs of magnesium toxicity, such as loss of patellar reflexes, respiratory depression, cardiac arrhythmias, cardiac arrest, urinary retention, and serum magnesium levels higher than 8 mEq/L. Provide a dark, quiet environment is correct. A dark, quiet environment helps to decrease CNS stimulation, which minimizes the risk of seizures. Assess respiratory status every 6 hr is incorrect. The nurse should monitor the client's respiratory status closely because the client is at risk for respiratory depression. A respiratory assessment of every 6 hours is not frequent enough. Administer pitocin for induction of labor is correct. Delivery is the only cure for preeclampsia, and since the fetus is term induction of labor can be expected. Ensure that calcium gluconate is readily available is correct. Calcium gluconate is the antidote for magnesium sulfate and should be readily available when administering magnesium sulfate. The nurse should be prepared to administer the medication in response to manifestations of magnesium toxicity, such as depressed respirations, oliguria, sudden drop in BP, loss of deep-tendon reflexes, and fetal distress.

A nurse in a hospital is caring for a client who is at 38 weeks of gestation and has a large amount of painless, bright red vaginal bleeding. The client is placed on a fetal monitor indicating a regular fetal heart rate of 138/min and no uterine contractions. The client's vital signs are: blood pressure 98/52 mm Hg, heart rate 118/min, respiratory rate 24/min, and temperature 36.4 degrees celsius (97.6 degrees Fahrenheit). Which of the following is the priority nursing action? A. Insert an indwelling urinary catheter. B. Initiate IV access. C. Witness the signature for informed consent for surgery. D. Prepare the abdominal and perineal areas.

B. Insertion of a large-bore IV catheter is the priority nursing action. The client is losing blood rapidly, has hypotension, and tachycardia. IV access will allow IV fluids and blood to be administered quickly if hypovolemia develops.

A nurse is caring for a client who is at 28 weeks of gestation and received terbutaline. Which of the following findings should the nurse expect? A. Fetal heart rate 100/min B. Weakened uterine contractions C. Enhanced production of fetal lung surfactant D. Maternal blood glucose 63 mg/dL

B. Terbutaline is a beta2-adrenergic agonist that acts to relax uterine smooth muscles. Terbutaline is used to stop contractions in a client who is experiencing preterm labor.

A nurse is caring for several clients. The nurse should recognize that it is safe to administer tocolytic therapy to which of the following clients? A. A client who is experiencing fetal death at 32 weeks of gestation B. A client who is experiencing preterm labor at 26 weeks of gestation C. A client who is experiencing Braxton-Hicks contractions at 36 weeks of gestation D. A client who has a post-term pregnancy at 42 weeks of gestation

B. Tocolytic medications, such as terbutaline, indomethacin, and nifedipine are used to relax the uterus in preterm labor. A client who is in preterm labor at 26 weeks of gestation is a candidate for tocolytic therapy.

A nurse in a clinic is caring for a client who is at 11 weeks of gestation and reports that she has had slight occasional vaginal bleeding over the past 2 weeks. Following an examination by the provider, the client is told that the fetus has died and that the placenta, fetus, and tissues remain in the uterus. How should the nurse document these findings? A. Incomplete miscarriage B. Missed miscarriage C. Inevitable miscarriage D. Complete miscarriage

B. With a missed miscarriage, the fetus has died but the client retains the products of conception for several weeks. The client might have spotting or no bleeding at all.

A nurse is caring for an adolescent client who is gravida 1 and para 0. The client was admitted to the hospital at 38 weeks of gestation with a diagnosis of preeclampsia. Which of the following findings should the nurse identify as inconsistent with preeclampsia? A. 1+ pitting sacral edema B. 3+ protein in the urine C. Blood pressure 148/98 mm Hg D. Deep tendon reflexes of +1

D. Deep tendon reflexes of +1 are decreased. In a client who has preeclampsia, the nurse should expect to find an increased, rather than a decreased, deep tendon reflex.

A nurse is admitting a client who has a diagnosis of preterm labor. The nurse anticipates a prescription by the provider for which of the following medications? (Select all that apply). A. Prostaglandin E2 B. Indomethacin C. Magnesium sulfate D. Methylergonovine E. Oxytocin

B, C. Prostaglandin E2 is incorrect. Prostaglandin E2 is used to stimulate cervical ripening and hasten the onset of labor. Indomethacin is correct. Indomethacin is used to relax uterine smooth muscles and suppress uterine activity in clients who have a diagnosis of preterm labor. Magnesium sulfate is correct. Magnesium sulfate is a tocolytic and stops contractions in clients experiencing preterm labor. Methylergonovine is incorrect. Methylergonovine promotes uterine contractions to manage postpartum hemorrhage. Oxytocin is incorrect. Oxytocin is used to induce and augment labor.

A nurse on the obstetric unit is caring for a client who experienced abruptio placentae. The nurse observes petechiae and bleeding around the IV access site. The nurse should recognize that this client is at risk for which of the following complications? A. Anaphylactoid syndrome of pregnancy B. Disseminated intravascular coagulation C. Preeclampsia D. Puerperal infection

B. Clinical manifestations of disseminated intravascular coagulation (DIC) include oozing from intravenous access and venipuncture sites; petechiae, especially under the site of the blood pressure cuff; spontaneous bleeding from the gums and nose; other signs of bruising; and hematuria.

A nurse receives report about assigned clients at the start of the shift. Which of the following clients should the nurse plan to see first? A. A client who experienced a cesarean birth 4 hr ago and reports pain B. A client who has preeclampsia with a BP of 138/90 mm Hg C. A client who experienced a vaginal birth 24 hr ago and reports moderate lochia with small clots D. A client who is scheduled for discharge following a laparoscopic tubal ligation

A. Using Maslow's hierarchy of needs, assessment of pain and meeting the physiological needs of a surgical client are the priority nursing actions.

A nurse is caring for a client who has severe preeclampsia and is receiving magnesium sulfate IV at 2g/hr. Which of the following findings indicates that it is safe for the nurse to continue the infusion? A. Deep-tendon reflexes of +1 B. Respiratory rate of 16/min C. Urine output of 50 mL in 4hr D. Heart rate of 56/min

B. The client's respiratory rate should be at least 12/min to maintain adequate respiratory function. Magnesium toxicity causes bradypnea. Based on this finding, the nurse may continue the infusion.

A nurse is caring for a client who is at 37 weeks of gestation and has placenta previa. The client asks the nurse why the provider does not do an internal examination. Which of the following explanations of the primary reason should the nurse provide? A. "There is an increased risk of introducing infection." B. "This could initiate preterm labor." C. "This could result in profound bleeding." D. "There is an increased risk of rupture of the membranes."

C. "Pelvic rest" is essential for clients who have placenta previa because any disruption of placental blood vessels in the lower uterine segment could cause premature separation of the placenta and life-threatening hemorrhage. This means no vaginal examinations, no douching, and no vaginal intercourse.

A nurse is caring for a client who is at 22 weeks of gestation and has been unable to control her gestational diabetes mellitus with diet and exercise. The nurse should anticipate a prescription from the provider for which of the following medications for the client? A. Acarbose B. Repaglinide C. Insulin D. Glipizide

C. There are currently no oral hypoglycemic agents that are FDA approved for use in pregnant women. Over the years limited research has been conducted on certain oral hypoglycemic agents with varying results. A few studies have demonstrated effectiveness and safety associated with glyburide and less commonly metformin. However, the most recent ACOG guidelines (as of Feb. 2018) recommend use of insulin in pregnant women when pharmacological treatment is indicated. Approximately 20% of clients who have gestational diabetes mellitus will require insulin. Insulin lowers blood glucose levels without harming the fetus.

A nurse is admitting a client who is at 33 weeks of gestation and has a diagnosis of placenta previa. Which of the following is the priority nursing action? A. Monitor vaginal bleeding. B. Administer glucocorticoids. C. Insert an IV catheter. D. Apply an external fetal monitor.

D. Based on Maslow's hierarchy of needs, the nurse should immediately apply the fetal monitor to determine if the fetus is in distress.

A nurse in a prenatal clinic is caring for a client who is at 38 weeks of gestation and reports heavy, red vaginal bleeding. The bleeding started spontaneously in the morning and is not accompanied by contractions. The client is not in distress and she states that she can "feel the baby moving." An ultrasound is scheduled stat. The nurse should explain to the client that the purpose of the ultrasound is to determine which of the following? A. Fetal lung maturity B. Location of the placenta C. Viability of the fetus D. The biparietal diameter

B. Painless, spontaneous vaginal bleeding might indicate that the client has placenta previa. Placenta previa is a condition in which the placenta is implanted low in the uterus, sometimes to the point of covering the cervical os. As the cervix effaces, the client begins to bleed. The ultrasound will show the location of the placenta and help to determine what sort of delivery the client requires and how emergent it is.

A nurse admits a woman who is at 38 weeks of gestation and in early labor with ruptured membranes. The nurse determines that the client's oral temperature is 38.9 degrees celsius (102 degrees fahrenheit). Besides notifying the provider, which of the following is an appropriate nursing action? A. Recheck the client's temperature in 4 hr. B. Administer glucocorticoids intramuscularly. C. Assess the odor of the amniotic fluid. D. Prepare the client for emergency cesarean section.

C. Chorioamnionitis is an infection of the amniotic cavity that presents with maternal fever, tachycardia, increased uterine tenderness, and foul-smelling amniotic fluid.

A nurse is preparing to administer magnesium sulfate IV to a client who is experiencing preterm labor. Which of the following is the priority nursing assessment for this client? A. Temperature B. Fetal heart rate (FHR) C. Bowel sounds D. Respiratory rate

D. Magnesium sulfate is typically administered to a client in preterm labor to achieve the tocolytic (uterine relaxation) effect. Magnesium sulfate depresses the function of the central nervous system, causing respiratory depression. Baseline assessment of respiratory status, checking the respiratory rate frequently, and reassessment of respiratory status with each change in dosage of magnesium sulfate is the primary focus when assessing the client. There is a narrow margin between what is considered a therapeutic dose and a toxic dose of magnesium sulfate.