CH 20: Conditions Occurring During Pregnancy

Hypertensive disorder BP in pregnancy

140/90 mm Hg

Which compound would the nurse have readily available for a client who is receiving magnesium sulfate to treat severe preeclampsia? A) calcium gluconate B) potassium chloride C) ferrous sulfate D) calcium carbonate

A) Calcium gluconate The antidote for magnesium sulfate is calcium gluconate, and this should be readily available in case the woman has signs and symptoms of magnesium toxicity

A pregnant client has tested positive for cytomegalovirus. What can this cause in the newborn? A) microcephaly B) bicuspid valve stenosis C) hypertension D) clubbed fingers and toes

A) microcephaly Signs that are likely to be present in the 10 percent of newborns who are symptomatic at birth include microcephaly, seizures, IUGR, hepatosplenomegaly, jaundice, and rash.

A woman is receiving magnesium sulfate as part of her treatment for severe preeclampsia. The nurse is monitoring the woman's serum magnesium levels. Which level would the nurse identify as therapeutic? A) 3.3 mEq/L B) 6.1 mEq/L C) 8.4 mEq/L D) 10.8 mEq/L

B) 6.1 mEq/L Although exact levels may vary among agencies, serum magnesium levels ranging from 4 to 7 mEq/L are considered therapeutic, whereas levels more than 8 mEq/dL are generally considered toxic.

A woman is to undergo an amnioinfusion. Which statement would be most appropriate to include when teaching the woman about this procedure? A) "You'll need to stay in bed while you're having this procedure." B) "We'll give you an analgesic to help reduce the pain." C) "After the infusion, you'll be scheduled for a cesarean birth." D) "A suction cup is placed on your baby's head to help bring it out."

A) "You'll need to stay in bed while you're having this procedure." An amnioinfusion involves the instillation of a volume of warmed, sterile normal saline or Ringer's lactate into the uterus via an intrauterine pressure catheter. The client must remain in bed during the procedure. The use of analgesia is unrelated to this procedure. A cesarean birth is necessary only if the FHR does not improve after the amnioinfusion. Application of a suction cup to the head of the fetus refers to a vacuum-assisted birth.

When assessing a pregnant woman with vaginal bleeding, the nurse would suspect a threatened abortion based on which finding? A) slight vaginal bleeding B) cervical dilation C) strong abdominal cramping D) passage of fetal tissue

A) Slight vaginal bleeding Slight vaginal bleeding early in pregnancy, no cervical dilation, and a closed cervical os are associated with a threatened abortion. Strong abdominal cramping is associated with an inevitable abortion. With an inevitable abortion, passage of the products of conception may occur. No fetal tissue is passed with a threatened abortion.

A pregnant woman has arrived to the office reporting vaginal bleeding. Which finding during the assessment would lead the nurse to suspect an inevitable abortion? A) strong abdominal cramping B) slight vaginal bleeding C) closed cervical os D) no passage of fetal tissue

A) Strong abdominal cramping Strong abdominal cramping is associated with an inevitable spontaneous abortion. Slight vaginal bleeding early in pregnancy and a closed cervical os are associated with a threatened abortion. With an inevitable abortion, passage of the products of conception may occur. No fetal tissue is passed with a threatened abortion.

The nurse is monitoring a pregnant patient who is receiving intravenous magnesium sulfate for eclampsia. During the last assessment, the nurse was unable to elicit a patellar reflex. What should the nurse do? A) Check fetal heart rate. B) Measure blood pressure. C) Stop the current infusion. D) Increase the infusion rate.

C) Stop the current infusion When infusing magnesium sulfate, the nurse should stop the infusion if deep tendon reflexes are absent. Checking the fetal heart rate and measuring blood pressure could waste time and provide the patient with more magnesium sulfate. The infusion rate should not be increased because this could lead to cardiac dysrhythmias and respiratory depression.

A nurse is caring for a client with hyperemesis gravidarum. Which nursing action is the priority for this client? A) Administer total parenteral nutrition. B) Administer an antiemetic. C) Set up for a percutaneous endoscopic gastrostomy. D) Administer IV NS with vitamins and electrolytes.

D) Administer IV NS with vitamins and electrolytes. The first choice for fluid replacement is generally NS with vitamins and electrolytes added. If the client does not improve after several days of bed rest, "gut rest," IV fluids, and antiemetics, then total parenteral nutrition or percutaneous endoscopic gastrostomy tube feeding is instituted to prevent malnutrition.

The nurse is caring for a pregnant client with severe preeclampsia. Which nursing intervention should a nurse perform to institute and maintain seizure precautions in this client? A) Provide a well-lit room. B) Keep head of bed slightly elevated. C) Place the client in a supine position. D) Keep the suction equipment readily available.

D) Keep the suction equipment readily available. The nurse should institute and maintain seizure precautions such as padding the side rails and having oxygen, suction equipment, and call light readily available to protect the client from injury. The nurse should provide a quiet, darkened room to stabilize the client. The nurse should maintain the client on complete bed rest in the left lateral lying position and not in a supine position. Keeping the head of the bed slightly elevated will not help maintain seizure precautions.

Which symptom may indicate a complication (not a common discomfort) in the second or third trimester of pregnancy? A) Dyspnea on exertion or while lying supine B) Backache after long periods of standing C) Lower extremity edema in the evening in the absence of proteinuria D) Braxton Hicks contractions at 38 weeks E) Pain underneath the ribs on the right side

E) Pain underneath the ribs on the right side Pain underneath the ribs, especially on the right, may be epigastric pain. Epigastric pain can be a late sign of preeclampsia

Partial molar pregnancy

Fetal tissue and amniotic sac present, usually with multiple congenital anomalies. Not compatible with life.

The most common site for ectopic pregnancy is in the _________ __________.

Middle third of the Fallopian tube; the ampulla

Inevitable abortion

Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.

preeclampsia

abnormal condition associated with pregnancy, marked by high blood pressure, proteinuria, edema, and headache

Complete abortion

all products of conception are expelled

Threatened abortion

bleeding with the threat of miscarriage

Missed abortion

death of a fetus or embryo within the uterus that is not naturally expelled after death

Symmetric IUGR

growth restriction in which the weight, length, and head circumference are all affected- may cause neurological problems

What does HELLP stand for?

hemolysis, elevated liver enzymes, low platelets

monozygotic twins

identical twins formed when one zygote splits into two separate masses of cells, each of which develops into a separate embryo. Share the same ovum.

eclampsia

is preeclampsia with tonic-clonic siezures

complete molar pregnancy

no embryonic or fetal parts

magnesium sulfate is given in patient to prevent ______?

seizures

dizygotic twins

twins who are produced when two separate ova are fertilized by two separate sperm at roughly the same time

Recurrent abortion

two or more consecutive spontaneous abortions. (also called HABITUAL ABORTION)

Multizygotic

2 or more eggs fertilized at the same time.

ectopic pregnancy

A pregnancy outside of the womb, usually in a fallopian tube

A client in her first trimester arrives at the emergency room with reports of severe cramping and vaginal spotting. On examination, the health care provider informs her that no fetal heart sounds are evident and orders a dilatation and curettage. The client looks frightened and confused and states that she does not believe in abortion. Which statement by the nurse is best? A) "Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications." B) "I know that it is sad but the pregnancy must be terminated to save your life." C) "The choice is up to you but the healthcare provider is recommending an abortion." D) "You have experienced an incomplete miscarriage and must have the placenta and any other tissues cleaned out."

A) "Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications." The nurse should not inform the client what she must do but supply information about what has happened and teach the client about the treatments which are used to correct the situation. A threatened miscarriage becomes an imminent (inevitable) miscarriage if uterine contractions and cervical dilation occur. A woman who reports cramping or uterine contractions is asked to seek medical attention. If no fetal heart sounds are detected and an ultrasound reveals an empty uterus or nonviable fetus, her health care provider may perform a dilatation and curettage (D&C) or a dilation and evacuation (D&E) to ensure all products of conception are removed. Be certain the woman has been told the pregnancy was already lost and all procedures, such as suction curettage, are to clear the uterus and prevent further complications such as infection, not to end the pregnancy. This scenario does not involve an elective abortion or an incomplete miscarriage

A nurse is conducting a refresher program for a group of perinatal nurses. Part of the program involves a discussion of HELLP. The nurse determines that the group needs additional teaching when they identify which aspect as a part of HELLP? A) elevated lipoproteins B) hemolysis C) liver enzyme elevation D) low platelet count

A) Elevated lipoproteins The acronym HELLP represents hemolysis, elevated liver enzymes, and low platelets. This syndrome is a variant of preeclampsia/eclampsia syndrome that occurs in 10% to 20% of clients whose diseases are labeled as severe.

A 25-week-gestation client presents with a blood pressure of 152/99, pulse 78, no edema, and urine negative for protein. What would the nurse do next? A) Notify the health care provider B) Provide health education C) Assess the client for ketonuria D) Document the client's blood pressure

A) Notify the health care provider The client is exhibiting a sign of gestational hypertension, elevated blood pressure greater than or equal to 140/90 mm Hg that develops for the first time during pregnancy. The health care provider should be notified to assess the client. Without the presence of edema or protein in the urine, the client does not have preeclampsia.

A nurse is describing the use of Rho(D) immune globulin as the therapy of choice for isoimmunization in Rh-negative women and for other conditions to a group of nurses working at the women's health clinic. The nurse determines that additional teaching is needed when the group identifies which situation as an indication for Rho(D) immune globulin? A) STIs B) amniocentesis C) molar pregnancy D( maternal trauma

A) STIs Indications for Rho(D) immune globulin include isoimmunization, ectopic pregnancy, chorionic villus sampling, amniocentesis, prenatal hemorrhage, molar pregnancy, maternal trauma, percutaneous umbilical sampling, therapeutic or spontaneous abortion, fetal death, or fetal surgery.

What special interventions would the nurse implement in a client who is carrying twin fetuses? A) Schedule non-stress tests (NST) starting at 16 weeks. B) Demonstrate to the client how to perform fetal movement counts after 32 weeks. C) Assist the physician on doing uterine ultrasounds every 2 weeks to monitor fetal size and placental information. D) Remind the client to monitor her intake since she does not need any more food for a multiple pregnancy than she would ingest for a singleton pregnancy.

B) Demonstrate to the client how to perform fetal movement counts after 32 weeks. A woman carrying a multiple gestation needs to keep up with how her fetuses are doing, and an excellent way to do that is by doing fetal movement counts, or "kick counts" as they are sometimes called. This starts at around 32 weeks' gestation for an uncomplicated pregnancy and continues until delivery. Weekly or bi-weekly NSTs begin after 32 weeks. Obstetrical ultrasounds are done every 4 to 6 weeks after confirmation of a multiple fetal pregnancy. The client needs to increase her intake, along with her iron and folic acid intake, to provide adequate nutrition for both fetuses.

A pregnant woman has just found out that she is having twin girls. She asks the nurse the difference between fraternal and identical twins. The nurse explains that with one set of twins there is fertilization of two ova, and with the other set one fertilized ovum splits. What type of twins result from the split ovum? A) fraternal B) identical C) neither type results from a split ovum D) both types can result from the split ovum

B) Identical The incidence of twins is about 1 in 30 conceptions, with about 2/3 being from the fertilization of two ova (fraternal) and about 1/3 from the splitting of one fertilized ovum (identical).

A student nurse is preparing for a presentation which will illustrate the various physiologic changes in the woman's body during pregnancy. Which cardiovascular changes up through the 26th week should the student point out? A) Decreased pulse rate and increased blood pressure B) Increased pulse rate and decreased blood pressure C) Increased pulse rate and blood pressure D) No change in pulse rate or blood pressure

B) Increased pulse rate and decreased blood pressure Pulse rate frequently increases during pregnancy, although the amount varies from a slight increase to 10 to 15 beats per minute. Blood pressure generally decreases slightly during pregnancy, reaching its lowest point during the second trimester.

A client is seeking advice for his pregnant wife who is experiencing mild elevations in blood pressure. In which position should a nurse recommend the pregnant client rest? A) supine position B) lateral recumbent position C) left lateral lying position D) head of the bed slightly elevated

B) Lateral recumbent position The nurse should encourage a client with mild elevations in blood pressure to rest as much as possible in the lateral recumbent position to improve uteroplacental blood flow, reduce blood pressure, and promote diuresis. The nurse should maintain the client with severe preeclampsia on complete bed rest in the left lateral lying position. Keeping the head of the bed slightly elevated will not help to improve the condition of the client with mild elevations in blood pressure.

A pregnant woman at 12 weeks' gestation comes to the office reporting she has begun minimal fresh vaginal spotting. She is distressed because her primary care provider indicates after examining her that they will "wait and see." Which response would be most appropriate from the nurse in answering this client's concerns? A) Advise her to ask for a second care provider opinion. B) Tell her that medication to prolong a 12-week pregnancy usually is not advised. C) Explain that her care provider meant for her to maintain strict bed rest by "wait and see." D) Suggest she take an over-the-counter tocolytic just to feel secure.

B) Tell her that medication to prolong a 12-week pregnancy usually is not advised. Because many early pregnancy losses occur as the result of chromosome abnormalities, an aggressive approach to prolong these is not usually recommended. It would not be appropriate for the nurse to suggest an over-the-counter tocolytic, nor to tell the client that the care provider meant something else such as maintaining strict bed rest. Advising the client to seek a second opinion would not change the end results.

A client with a history of cervical insufficiency is seen for reports of pink-tinged discharge and pelvic pressure. The primary care provider decides to perform a cervical cerclage. The nurse teaches the client about the procedure. Which client response indicates that the teaching has been effective? A) "Staples are put in the cervix to prevent it from dilating." B) "The cervix is glued shut so no amniotic fluid can escape." C) "Purse-string sutures are placed in the cervix to prevent it from dilating." D) "A cervical cap is placed so no amniotic fluid can escape."

C) "Purse-string sutures are placed in the cervix to prevent it from dilating." The cerclage, or purse string suture is inserted into the cervix to prevent preterm cervical dilatation and pregnancy loss. Staples, glue, or a cervical cap will not prevent the cervix from dilating.

A pregnant woman with type 2 diabetes is scheduled for a laboratory test of glycosylated hemoglobin (HbA1C). What does the nurse tell the client is a normal level for this test? A) 8% B) 14% C) 6% D) 12%

C) 6% The upper normal level of HbA1C is 6% of total hemoglobin.

A pregnant woman diagnosed with diabetes should be instructed to perform which action? A) Discontinue insulin injections until 15 weeks gestation. B) Ingest a smaller amount of food prior to sleep to prevent nocturnal hyperglycemia. C) Notify the primary care provider if unable to eat because of nausea and vomiting. D) Prepare foods with increased carbohydrates to provide needed calories.

C) Notify the primary care provider if unable to eat because of nausea and vomiting. During pregnancy, the insulin levels change in response to the production of HPL. The client needs to alert her provider if she is not able to eat or hold down appropriate amounts of nutrition. The client is at risk for episodes of hypoglycemia during the first trimester. She should never discontinue insulin therapy without her provider's directions. The increase of carbohydrates needs to be balanced with protein, and smaller meals would result in hypoglycemia rather than hyperglycemia.

A nurse is conducting an in-service program for a group of nurses working at the women's health facility about the causes of spontaneous abortion. The nurse determines that the teaching was successful when the group identifies which condition as the most common cause of first trimester abortions? A) maternal disease B) cervical insufficiency C) fetal genetic abnormalities D) uterine fibroids

C) fetal genetic abnormalities The causes of spontaneous abortion are varied and often unknown. The most common cause for first-trimester abortions is fetal genetic abnormalities, usually unrelated to the mother. Chromosomal abnormalities are more likely causes in first trimester, and maternal disease is more likely in the second trimester. Those occurring during the second trimester are more likely related to maternal conditions, such as cervical insufficiency, congenital, or acquired anomaly of the uterine cavity (uterine septum or fibroids), hypothyroidism, diabetes mellitus, chronic nephritis, use of crack cocaine, inherited and acquired thrombophilias, lupus, polycystic ovary syndrome, severe hypertension, and acute infection such as rubella virus, cytomegalovirus, herpes simplex virus, bacterial vaginosis, and toxoplasmosis.

A client who is HIV-positive is in her second trimester and remains asymptomatic. She voices concern about her newborn's risk for the infection. Which statement by the nurse would be mostappropriate? A) "You'll probably have a cesarean birth to prevent exposing your newborn." B) "Antibodies cross the placenta and provide immunity to the newborn." C) "Wait until after the infant is born, and then something can be done." D) "Antiretroviral medications are available to help reduce the risk of transmission."

D) "Antiretroviral medications are available to help reduce the risk of transmission." Drug therapy is the mainstay of treatment for pregnant women infected with HIV. The goal of therapy is to reduce the viral load as much as possible; this reduces the risk of transmission to the fetus. Decisions about the method of birth should be based on the woman's viral load, duration of ruptured membranes, progress of labor, and other pertinent clinical factors. The newborn is at risk for HIV because of potential perinatal transmission. Waiting until after the infant is born may be too late.

A pregnant patient with intermittent preterm contractions at 30 weeks has been on weekly home care assessments for 1 month without health care visits to the doctor or any activities outside the home. The nurse has established adequate fetal growth and is aware that contractions have been occurring roughly two times a day. The patient makes little effort to look at the nurse or discuss her plans for the upcoming delivery. The nurse makes which diagnosis of the current needs of this patient? A) Threatened preterm delivery related to contractions, as evidenced by reports by the patient of contractions before 38 weeks' gestation B) Inadequate dietary intake related to activity restriction C) At risk for venous thromboembolism because of restricted activity D) At risk for depression because of extended activity restriction, as evidenced by affect

D) At risk for depression because of extended activity restriction, as evidenced by affect A patient who has limited interaction with her environment may develop depression and loneliness. No information indicates a poor diet or a venous thromboembolism; those answers are similar and can be eliminated. The contractions are controlled at this point in time. The patient's affect points to depression and loneliness, which can occur after lengthy activity restriction.

A pregnant woman asks you how the uterine arteries will be able to supply blood to the uterus after the uterus increases to four times its prepregnant size. You would explain that this will happen easily because of which of the following? A) More arteries form during pregnancy. B) The muscle of the uterus decreases during pregnancy. C) Venous congestion causes stasis of arterial blood. D) The normally twisted and coiled uterine vessels uncoil and elongate.

D) The normally twisted and coiled uterine vessels uncoil and elongate. No new arteries form during pregnancy; those already present uncoil and elongate.

A nurse is assessing a pregnant woman with gestational hypertension. Which finding would lead the nurse to suspect that the client has developed severe preeclampsia? A) urine protein 300 mg/24 hours B) blood pressure 150/96 mm Hg C) mild facial edema D) hyperreflexia

D) hyperreflexia Severe preeclampsia is characterized by blood pressure over 160/110 mm Hg, urine protein levels greater than 500 mg/24 hours, and hyperreflexia. Mild facial edema is associated with mild preeclampsia.

TORCH infections

Toxoplasmosis Other Rubella Cytomegalovirus Herpes

Molar pregnancy

also known as gestational trophoblastic disease; abnormal proliferation of trophoblastic cells in the first trimester sperm fertilized an ovum that contained no genetic material, and no fetal parts are present.

Asymmetric IUGR

baby stops growing normally; the head continues to grow

gestational trophoblastic disease ( Molar pregnancy)

condition in which trophoblastic tissue overtakes the pregnancy and propagates throughout the uterine cavity

Oligiohydramnios

deficiency of amniotic fluid

Polyhyrdaminos

excessive amniotic fluid

Implantation bleeding

light bleeding from the implantation of the sperm to the egg; not a period. Usually occurring 6-11 days after fertilization occurs. Blood is bright red or dark brown.

hyperemesis gravidarum

severe nausea and vomiting in pregnancy that can cause severe dehydration in the mother and fetus

a miscarriage is also know as a _______?

spontaneous abortion