Ch. 18 Pregnancy at Risk: Gestational Onset

The client with blood type A, R h-negative, delivered yesterday. Her infant is blood type AB, R h-positive. Which statement indicates that teaching has been effective? A) "I need to get R h o G A M so I don't have problems with my next pregnancy." B) "Because my baby is R h-positive, I don't need R h o G A M." C) "If my baby had the same blood type I do, it might cause complications." D) "Before my next pregnancy, I will need to have a R h o G A M shot.

A) "I need to get R h o G A M so I don't have problems with my next pregnancy."

The client at 34 weeks' gestation has been stabbed in the low abdomen by her boyfriend. She is brought to the emergency department for treatment. Which statements indicate that the client understands the treatment being administered? Select all that apply. A) "The baby needs to be monitored to check the heart rate." B) "My bowel has probably been lacerated by the knife." C) "I might need an ultrasound to look at the baby." D) "The catheter in my bladder will prevent urinary complications." E) "The Ⅳ in my arm will replace the amniotic fluid if it is leaking."

A) "The baby needs to be monitored to check the heart rate." C) "I might need an ultrasound to look at the baby.

A client is concerned because she has been told that her blood type and her baby's are incompatible. What is the nurse's best response? A) "This is called ABO incompatibility. It is somewhat common but rarely causes significant hemolysis, a breakdown of red blood cells." B) "This is a serious condition, and additional blood studies are currently in process to determine whether you need a medication to prevent it from occurring with a future pregnancy." C) "This is a condition caused by a blood incompatibility between you and your husband, but does not affect the baby." D) "This type of condition is very co

A) "This is called ABO incompatibility. It is somewhat common but rarely causes significant hemolysis, a breakdown of red blood cells." *When blood types, not R h, are incompatible, it is called ABO incompatibility

During a prenatal exam, a client describes several psychosomatic symptoms and has several vague complaints. What could these behaviors indicate? A) Abuse B) Mental illness C) Depression D) Nothing, they are normal

A) Abuse *Chronic psychosomatic symptoms and vague complaints can be indicators of abuse

When blood pressure and other signs indicate that preeclampsia is worsening, hospitalization is necessary to monitor the woman's condition closely. At that time, which of the following should be assessed? Select all that apply. A) Fetal heart rate B) Blood pressure C) Temperature D) Urine color E) Pulse and respirations

A) Fetal heart rate B) Blood pressure C) Temperature E) Pulse and respirations *Urine color is not monitored. However, urine output, urine protein, and urine specific gravity are monitored.

A woman at 7 weeks' gestation is diagnosed with hyperemesis gravidarum. Which nursing diagnosis would receive priority? A) Fluid Volume: Deficient B) Cardiac Output, Decreased C) Injury, Risk for D) Nutrition, Imbalanced: Less than Body Requirements

A) Fluid Volume: Deficient

Infants of women with preeclampsia during pregnancy tend to be small for gestational age (SGA) because of which condition? A) Intrauterine growth restriction B) Oliguria C) Proteinuria D) Hypertension

A) Intrauterine growth restriction

The nurse is performing a preoperative assessment on a client who is in the second trimester of pregnancy. For which finding(s) should the nurse monitor? Select all that apply. A) Respiratory infection B) Fever C) Urinary tract infection D) Anemia E) ABO incompatibility

A) Respiratory infection B) Fever C) Urinary tract infection D) Anemia *ABO incompatibility is not routinely assessed as part of the preoperative assessment for the client who is pregnant, as it rarely has serious life-threatening consequences and is almost exclusively seen after the birth of the newborn

A primary herpes simplex infection in the first trimester can increase the risk of which of the following? A) Spontaneous abortion B) Preterm labor C) Intrauterine growth restriction D) Neonatal infection

A) Spontaneous abortion

A woman has a hydatidiform mole (molar pregnancy) evacuated, and is prepared for discharge. The nurse should make certain that the client understands that what is essential? A) That she not become pregnant until after the follow-up program is completed B) That she receive R h o G A M with her next pregnancy and birth C) That she has her blood pressure checked weekly for the next 30 days D) That she seek genetic counseling with her partner before the next pregnanc

A) That she not become pregnant until after the follow-up program is completed

The nurse is caring for a client at 35 weeks' gestation who has been critically injured in a shooting. Which statement by the paramedics bringing the woman to the hospital would cause the greatest concern? A) "Blood pressure 110/68, pulse 90." B) "Entrance wound present below the umbilicus." C) "Client is positioned in a left lateral tilt." D) "Clear fluid is leaking from the vagina."

B) "Entrance wound present below the umbilicus."

The client presents to the clinic for an initial prenatal examination. She asks the nurse whether there might be a problem for her baby because she has type B R h-positive blood and her husband has type O R h-negative blood, or because her sister's baby had ABO incompatibility. What is the nurse's best answer? Select all that apply. A) "Your baby would be at risk for R h problems if your husband were R h-negative." B) "R h problems only occur when the mother is R h-negative and the father is not." C) "ABO incompatibility occurs only after the baby is born." D) "We don't know for sure, but we can test for ABO incompatibility." E) "Your husband's being type B puts you at risk for ABO incompatibility.

B) "R h problems only occur when the mother is R h-negative and the father is not." C) "ABO incompatibility occurs only after the baby is born." *ABO incompatibility is limited to type O mothers with a type A or B fetus and occurs after the baby is born. *R h incompatibility is a possibility when the mother is R h-negative and the father is R h-positive.

A woman is 16 weeks pregnant. She has had cramping, backache, and mild bleeding for the past 3 days. Her physician determines that her cervix is dilated to 2 centimeters, with 10% effacement, but membranes are still intact. She is crying, and says to the nurse, "Is my baby going to be okay?" In addition to acknowledging the client's fear, what should the nurse also say? A) "Your baby will be fine. We'll start IV, and get this stopped in no time at all." B) "Your cervix is beginning to dilate. That is a serious sign. We will continue to monitor you and the baby for now." C) "You are going to miscarry. But you should be relieved because most miscarriages are the result of abnormalities in the fetus." D) "I really can't say. However, when your physician comes, I'll ask her to talk to you about it.

B) "Your cervix is beginning to dilate. That is a serious sign. We will continue to monitor you and the baby for now." *If bleeding persists and abortion is imminent or incomplete, the woman may be hospitalized, Ⅳ therapy or blood transfusions may be started to replace fluid, and dilation and curettage (D&C) or suction evacuation is performed to remove the remainder of the products of conception

A client at 10 weeks' gestation has developed cholecystitis. If surgery is required, what is the safest time during pregnancy? A) Immediately, before the fetus gets any bigger B) Early in the second trimester C) As close to term as possible D) The risks are too high to do it anytime in pregnancy

B) Early in the second trimester *The early second trimester is the best time to operate because there is less risk of spontaneous abortion or early labor, and the uterus is not so large as to impinge on the abdominal field

The prenatal clinic nurse is caring for a client with hyperemesis gravidarum at 14 weeks' gestation. The vital signs are: blood pressure 95/48, pulse 114, respirations 24. Which order should the nurse implement first? A) Weigh the client. B) Give 1 liter of lactated Ringer's solution Ⅳ. C) Administer 30 m L Maalox (magnesium hydroxide) orally. D) Encourage clear liquids orally.

B) Give 1 liter of lactated Ringer's solution Ⅳ. *The vital signs indicate hypovolemia from dehydration, which leads to hypotension and increased pulse rate. Giving this client a liter of lactated Ringer's solution intravenously will reestablish vascular volume and bring the blood pressure up, and the pulse and respiratory rate down.

The nurse is assessing a client who has severe preeclampsia. What assessment finding should be reported to the physician? A) Excretion of less than 300 m g of protein in a 24-hour period B) Platelet count of less than 150,000/m m3 C) Urine output of 50 m L per hour D) 12 respirations

B) Platelet count of less than 150,000/m m **HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) complicates 10% to 20% of severe preeclampsia cases and develops prior to 37 weeks' gestation 50% of the time. Vascular damage is associated with vasospasm, and platelets aggregate at sites of damage, resulting in low platelet count (less than 150,000/m m3).

The community nurse is working with a client at 32 weeks' gestation who has been diagnosed with preeclampsia. Which statement by the client would indicate that additional information is needed? A) "I should call the doctor if I develop a headache or blurred vision." B) "Lying on my left side as much as possible is good for the baby." C) "My urine could become darker and smaller in amount each day." D) "Pain in the top of my abdomen is a sign my condition is worsening."

C) "My urine could become darker and smaller in amount each day." *Oliguria is a complication of preeclampsia.

A client who is 11 weeks pregnant presents to the emergency department with complaints of dizziness, lower abdominal pain, and right shoulder pain. Laboratory tests reveal a beta-hCG at a lower-than-expected level for this gestational age. An adnexal mass is palpable. Ultrasound confirms no intrauterine gestation. The client is crying and asks what is happening. The nurse knows that the most likely diagnosis is an ectopic pregnancy. Which statement should the nurse include? A) "You're feeling dizzy because the pregnancy is compressing your vena cava." B) "The pain is due to the baby putting pressure on nerves internally." C) "The baby is in the fallopian tube; the tube has ruptured and is causing bleeding." D) "This is a minor problem. The doctor will be right back to explain it to you."

C) "The baby is in the fallopian tube; the tube has ruptured and is causing bleeding." *The woman who experiences one-sided lower abdominal pain or diffused lower abdominal pain, vasomotor disturbances such as fainting or dizziness, and referred right shoulder pain from blood irritating the subdiaphragmatic phrenic nerve is experiencing an ectopic pregnancy.

A woman is experiencing preterm labor. The client asks why she is on betamethasone. Which is the nurse's best response? A) "This medication will halt the labor process until the baby is more mature." B) "This medication will relax the smooth muscles in the infant's lungs so the baby can breathe." C) "This medication is effective in stimulating lung development in the preterm infant." D) "This medication is an antibiotic that will treat your urinary tract infection, which caused preterm labor."

C) "This medication is effective in stimulating lung development in the preterm infant." *Betamethasone or dexamethasone is often administered to the woman whose fetus has an immature lung profile to promote fetal lung maturation

If the woman is R h negative and not sensitized, she is given R h immune globulin to prevent what? A) The potential for hemorrhage B) Hyperhomocysteinemia C) Antibody formation D) Tubal pregnanc

C) Antibody formation *If the woman is R h negative and not sensitized, she is given R h immune globulin to prevent antibody formation.

The nurse is supervising care in the emergency department. Which situation most requires an intervention? A) Moderate vaginal bleeding at 36 weeks' gestation; client has an Ⅳ of lactated Ringer's solution running at 125 m L/hour B) Spotting of pinkish-brown discharge at 6 weeks' gestation and abdominal cramping; ultrasound scheduled in 1 hour C) Bright red bleeding with clots at 32 weeks' gestation; pulse = 110, blood pressure 90/50, respirations = 20 D) Dark red bleeding at 30 weeks' gestation with normal vital signs; client reports an absence of fetal movement

C) Bright red bleeding with clots at 32 weeks' gestation; pulse = 110, blood pressure 90/50, respirations = 20 *Bleeding in the third trimester is usually due to placenta previa or placental abruption. Observe the woman for indications of shock, such as pallor, clammy skin, perspiration, dyspnea, or restlessness. Monitor vital signs, particularly blood pressure and pulse, for evidence of developing shock.

A woman is hospitalized with severe preeclampsia. The nurse is meal-planning with the client and encourages a diet that is high in what? A) Sodium B) Carbohydrates C) Protein D) Fruits

C) Protein *The client who experiences preeclampsia is losing protein.

The community health nurse is teaching a class about causes of traumatic injury leading to pregnancy complications. What statement should the nurse include in the teaching? A) "Although falls are an uncommon cause of trauma, it is important to know what to do in the case of these incidents." B) "In early pregnancy, the woman is at a greater risk for injury due to decreased balance and coordination." C) "The pregnant woman should be given the same care as any person suffering from trauma." D) "Violence, including domestic violence, is the most common cause of injury for pregnant women, after motor vehicle accidents."

D) "Violence, including domestic violence, is the most common cause of injury for pregnant women, after motor vehicle accidents." *Violence, including domestic violence, is the next most common cause of injury for clients who are pregnant after motor vehicle accidents.

A clinic nurse is planning when to administer R h immune globulin (R h o G A M) to an R h-negative pregnant client. When should the first dose of R h o G A M be administered? A) After the birth of the infant B) 1 month postpartum C) During labor D) At 28 weeks' gestation

D) At 28 weeks' gestation

The nurse is presenting a class to newly pregnant families. What form of trauma will the nurse describe as the leading cause of fetal and maternal death? A) Falls B) Domestic violence C) Gun accidents D) Motor vehicle accidents

D) Motor vehicle accidents

complete abortion

all contents of the pregnancy have been expelled from the uterus.

The most common location for implantation of an ectopic pregnancy is

the ampulla of the tube

threatened abortion

the cervix is not dilated, and the placenta is still attached to the uterine wall, but some bleeding occurs

incomplete abortion

the embryo/fetus has passed out of the uterus; however, the placenta remains

imminent abortion

the placenta has separated from the uterine wall, the cervix has dilated, and the amount of bleeding has increased.