Chapter 10 Questions

For the client who delivered at 6:30am on January 10, Rho(D) immune globulin (RhoGAM) must be administered prior to a. 6:30 am on Jan 13 b. 6:30 pm on Jan 13 c. 6:30 pm on Jan 14 d. 6:30 am on Jan 15

a. 6:30 am on Jan 13 rationale: Rho(D) immune globulin (RhoGAM) must be administered within 72 hours after the birth of an Rh-positive infant.

A female client presents to the ED complaining of lower abdominal cramping with scant bleeding of approximately 2 days duration. This morning, the quality and location of the pain changed and she is now experiencing pain in her shoulder. The clients last menstrual period was 28 days ago, but she reports that her cycle is variable, ranging from 21 to 45 days. Which clinical diagnosis does the nurse suspect. a. Ectopic pregnancy b. appendicitis c. food poisoning d. gastroenteritis

a. Ectopic pregnancy rationale: Even though the clients menstraul cycle has variability, all women are considered to be pregnant until proven otherwise.

The clinic nurse is reviewing home care dietary instructions for the patient diagnosed with mild preeclampsia at 34 weeks gestation. The nurse determines that the client requires additional information when she makes which statement. a. I will limit my salt intake to 2 grams per day b. I will drink no less than 2500 mL of fluid per day c. I will make sure I eat 4 sources of protein per day d. my overall intake of calories per day should be around 2500

a. I will limit salt intake to 2 grams per day rationale: the diet should have ample protein, no less than 6 oz/day, and approximately 2500 calories during the second half of pregnancy.

Which intrapartal assessment should be avoided when caring for a client with HELLP syndrome a. Abdominal palpation b. venous sample of blood c. checking deep tendon reflexes d. auscultation of the heart and lungs.

a. abdominal palpation rationale: palpation of the abdomen and liver could result in a sudden increase in intraabdominal pressure, leading to rupture of the subscapular hematoma.

A laboratory finding indicative of DIC is a. decreased fibrinogen b. increased platelets c. increased hematocrit d. decreased thromboplastin time

a. decreased fibrinogen rationale: DIC develops when the blood clotting factor thromboplastin is released into the maternal bloodstream as a result of placental bleeding.

Which routine nursing assessment is contraindicated for a client admitted with suspected placenta previa. a. Determining cervical dilation and effacement b. Monitoring FHR and maternal vital signs c. Observing vaginal bleeding of leakage of amniotic fluid. d. determining frequency, duration, and intensity of contractions

a. determining cervical dilation and effacement rationale: Vaginal exam of the cervix may result in perforation of the placenta and subsequent hemorrhage.

A 32 year old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on which of the following. a. Hemorrhage is the major concern b. she will be unable to conceive in the future. c. bed rest and analgesics are the recommended treatment. d. A D&C will be performed to remove the products of conception

a. hemorrhage is the major concern rationale: severe bleeding occurs if the fallopian tube ruptures.

As the triage nurse in the ED, you are reviewing results for the high risk obstetric client who is in labor because of traumatic injury experienced as a result of a motor vehicle accident. You note that the Kleihauer-Betke test is positive. Based on this information, you anticipate that: a. immediate birth is required. b. the client should be transferred to the critical care unit for closer observation c. RhoGAM should be administered d. a tetanus shot should be administered

a. immediate birth is required rationale: A positive Kleihauer-Betke test indicates that fetal bleeding is occurring in the maternal circulation. This is a serious complication and because the client is a trauma victim, it is highly likely that she is experiencing an abruption

The physician suspects that the client may have gestational trophoblastic disease. Which clinical manifestations support this diagnosis. select all a. Increased levels of beta-hCG in the serum b. Fundal height correlating with reported gestational age c. Vaginal bleeding d. Vomiting e. Maternal hypotension

a. increased levels of beta-hCG in the serum c. vaginal bleeding d. vomiting rationale: clinical manifestations include: increased levels of beta-hCG, increased size of the uterus related to gestational age, nausea and vomiting, and evidence of vaginal bleeding.

A patient reports to the ED nurse that she is 10 weeks pregnant, with unilateral pelvic pain, shoulder pain, and faintness. Her color is pale, she is diaphoretic, and her heart rate is 140 bpm. What is the nurses priority action a. Initiate an ordered IV of lactated Ringers at 200 ml/hr b. take the patient for her ordered pelvic ultrasound c. Ask the patient if she has had any recent vaginal bleeding d. ask the patient if she has ever been told she has had salpingitis

a. initiate an ordered IV of lactated Ringers at 200 ml/hr rationale: this patient is presenting with classic signs of an ectopic pregnancy and hypovolemic shock. This is an obstetric emergency. Symptoms include sudden, severe pain in one of the lower quadrants of the abdomen as the tube tears open and the embryo is expelled into the pelvic cavity, often with profuse abdominal hemorrhage.

The ED charge nurse calls the labor and birth charge nurse and reports the ambulance is en route with a seizing pregnant patient at 36 weeks gestation. What medication will the charge nurse most likely direct the staff nurse to prepare to administer immediately on the patients arrival to the labor and birth unit a. Magnesium sulfate (magnesium) b. Hydralazine (Apresoline) c. Carbamazepine (Tegretol) d. Terbutaline (Brethine)

a. magnesium sulfate (magnesium) rationale: mag sulfate is the drug most often used for preeclamptic and eclamptic patients.

the nurse who suspects that a client has early signs of ectopic pregnancy should be observing her for which symptoms. select all a. pelvic pain b. missed period c. abdominal pain d. unanticipated heaving bleeding e. vaginal spotting or light bleeding

a. pelvic pain b. missed period c. abdominal pain e. vaginal spotting or light bleeding

A high risk labor client progresses from preeclampsia to eclampsia. Aggressive management is instituted, and the fetus is delivered via c-section. Which finding in the immediate post-operative period indicates that the client is at risk of developing HELLP syndrome a. Platelet count of 50,000/mL b. liver enzyme levels within normal range c. negative for edema d. no evidence of nausea or vomiting

a. platelet count of 50,000.mL rationale: HELLP syndrome is characterized by hemolysis, elevated liver enzyme levels, and a low platelet count. A platelet count of 50,000/mL indicates thrombocytopenia

Spontaneous termination of a pregnancy is considered to be an abortion if a. the pregnancy is less than 20 weeks b. the fetus weighs less than 1000g c. the products of conception are passed intact d. there is no evidence of intrauterine infection

a. the pregnancy is less than 20 weeks. rationale: an abortion is the termination of pregnancy before the age of viability.

What history would lead you to suspect an ectopic pregnancy in a client at 8 weeks gestation presenting with abdominal pain and bleeding a. Treated 1 yr ago for pelvic inflammatory disease (PID) b. oral contraception for last 3 years c. Urinary frequency for 1 week d. Irregular cycles for 1 year prior to conception

a. treated 1 yr ago for pelvic inflammatory disease (PID) rationale: PID causes fallopian tube damage. Blockage of the tube prevents movement of the fertilized ovum, resulting in implantation in the tube.

Which finding should be the nurses priority in a client suspected as having gestational trophoblastic disease a. Uterine contractions b. nausea and vomiting c. blood pressure of 130/80 mm Hg d. Increase discharge of vaginal mucus.

a. uterine contractions rationale: uterine contractions can cause trophoblastic tissue to be pulled into large venous sinusoids in the uterus, resulting in embolization of the tissue and respiratory distress.

A client who was pregnant had a spontaneous abortion at approximately 4 weeks gestation. At the time of miscarriage, it was thought that all products of conception were expelled. Two weeks later, the client presents at the clinic office complaining of "crampy" abdominal pain and a scant amount of serosanguineous vaginal drainage with a slight odor. The pregnancy test is negative. Vital signs reveal a temp of 100º with BP of 100/60, irregular pulse 88 bpm. Based on these assessment data, what does the nurse anticipate as a clinical diagnosis. a. Ectopic pregnancy b. Uterine infection c. Gestational trophoblastic disease d. endometriosis.

b. Uterine infection rationale: the client is exhibiting signs of uterine infection, with elevated temperature, vaginal discharge with odor, abdominal pain, and blood pressure and pulse manifesting as shock-trended vitals.

Which assessment finding suggests that your laboring clients blood magnesium level is too high a. Hyperactive reflexes b. absent reflexes c. Generalized seizure d. Urine output of 60 mL/hr

b. absent reflexes rationale: Magnesium acts as a central nervous system depressant by blocking neuromuscular transmission. Assessment of the deep tendon reflexes in an indication of the level of CNS depression. Absent reflexes indicates magnesium toxicity.

Which intervention would be the most effective if your client who is on magnesium sulfate has a RR of 10 breaths/min a. Give oxygen by mask at 8-10L/min b. Administer calcium gluconate via IV pyelogram (IVP) c. arouse client with tactile stimulation d. Continually assess pulse oximeter levels

b. administer calcium gluconate via IV pyelogram (IVP) rationale: A RR of less than 12 breaths/min in a client receiving magnesium sulfate is a sign of magnesium toxicity, which must be immediately reversed.

A client taking magnesium sulfate has a respiratory rate of 10 bpm. In addition to discontinuing the medication, which action should the nurse take. a. increase the clients IV fluids b. administer calcium gluconate c. vigorously stimulate the client. d. instruct the client to take deep breaths.

b. administer calcium gluconate. rationale: Calcium gluconate reverses the effects of magnesium sulfate.

Which of these interventions should the nurse recognize as the priority for the client diagnosed with an intact tubal pregnancy a. Assessment of pain level b. administration of methotrexate c. administration of Rh immune globulin d. Explanation of the common side effects of the treatment plan

b. administration of methotrexate rationale: the goal of medical management of an intact tube is to preserve the tube and improve the chance of future fertility.

The nurse is monitoring a client with severe preeclampsia who is on IV magnesium sulfate. Which signs of magnesium toxicity should the nurse monitor for. select all a. cool, clammy skin b. altered sensorium c. pulse oximeter reading of 95% d. respiratory rate of less than 12 e. absence of deep tendon reflexes

b. altered sensorium d. RR of less than 12 e. absence of deep tendon reflexes Signs of magnesium toxicity include the following: RR < 14 SpO2 < 95% absent deep tendon reflexes sweating, flushing altered sensorium hypotension serum mag above 4 to 8 mg/dL

The priority nursing intervention when admitting a pregnant client who has experienced a bleeding episode in late pregnancy is to a. monitor uterine contractions b. assess fetal heart rate and maternal vital signs c. place clean disposable pads to collect any drainage d. perform a venipuncture for hemoglobin and hematocrit levels.

b. assess fetal heart rate and maternal vital signs. rationale: assessment of the fetal heart rate and maternal vital signs will assist the nurse in determining the degree of the blood loss and its effect on the client and fetus.

A labor and birth nurse receives a call from the lab regarding preeclamptic patient receiving an IV infusion of magnesium sulfate. The laboratory technician reports that the patients magnesium level is 7.6 mg/dL. What is the nurses priority action a. Stop the infusion of magnesium b. Assess the patients respiratory rate c. assess the patients deep tendon reflexes d. Notify the HCP of the magnesium

b. assess the patients respiratory rate rationale: the therapeutic serum level for magnesium is 4 to 8 mg/dl although it is elevated in terms of normal lab values.

Which is the only known cure for preeclampsia a. Magnesium sulfate b. delivery of the fetus c. antihypertensive medications d. administration of aspirin (ASA) every day of the pregnancy.

b. delivery of the fetus rationale: if the fetus is viable and near term, birth is the only known cure for preeclampsia.

Rh incompatibility can occur if the client is Rh-negative and the a. fetus is Rh-negative b. fetus is Rh-positive c. father is Rh positive d. father and fetus are both Rh-negative.

b. fetus is Rh-positive. rationale: For Rh incompatibility to occur, the mother must be Rh-negative and her fetus Rh-positive.

Which information should the labor nurse recognize as being pertinent to a possible diagnosis of abruptio placentae a. Low back pain b. Firm, tender uterus c. Regular uterine contractions d. scant vaginal mucus drainage.

b. firm, tender uterus rationale: A firm, tender uterus is a classic sign of abruptio placentae; low back pain, regular uterine contractions, and scant vaginal mucus drainage are normal findings in a laboring client

Which finding could cause the nurse to suspect gestational trophoblastic disease in a client at 8 weeks gestation. a. blood pressure of 128/70 mm Hg b. fundal height of 12 cm c. nausea and vomiting d. weight gain of 3 pounds

b. fundal height of 12 cm rationale: gestational trophoblastic disease is characterized by proliferation and edema of the chorionic villi. The fluid-filled form grapelike clusters of tissue that can rapidly grow to fill the uterus to the size of a more advanced pregnancy.

Which would indicate concealed hemorrhage in abruptio placentae a. bradycardia. b. hard boardlike abdomen c. decrease in fundal height d. decrease in abdominal pain.

b. hard board-like abdomen. rationale: concealed hemorrhage occurs when the edges of the placenta do not separate. The formation of a hematoma behind the placenta and subsequent infiltration of the blood into the uterine muscle results in a very firm, board-like abdomen.

A client is admitted with vaginal bleeding at approximately 10 weeks gestation. Her fundal height is 13cm. Which potential problem should be investigated. a. Placenta previa b. hydatidiform mole c. Abruptio placentae d. disseminated intravascular coagulation.

b. hydatidiform mole rationale: gestational trophoblastic disease (hydatidiform) is usually detected in the first trimester. The frequency of this condition is highest at both ends of a womans reproductive life.

An abortion when the fetus dies but is retained in the uterus is called a. inevitable b. missed c. incomplete d. threatened

b. missed rationale: a missed abortion refers to a dead fetus being retained in the uterus.

Which orders should the nurse expect for a client admitted with a threatened abortion. a. NPO b. Pad count c. ritodrine IV d. Meperidine (demerol) 50 mg now.

b. pad count rationale: A client admitted with a threatened abortion should be instructed to count the number of pads used and to note the quantity and color of blood on the pads.

Which assessment by the nurse would differentiate a placenta previa from an abruptio placentae a. Saturated perineal pad in 1 hour b. pain level 0 on a scale of 0 - 10 c. Cervical dilation at 2 cm d. fetal heart rate at 160 bpm

b. pain level 0 on a scale of 0-10 rationale: the classic sign of placenta previa is the sudden onset of painless uterine bleeding, whereas abruptio placentae results in abdominal pain and uterine tenderness; heavy bleeding, cervical dilation, and fetal heart rate of 160 bpm could be associated with both conditions

Which data found on a clients health history would place her at risk for an ectopic pregnancy. a. Ovarian cyst 2 years ago b. recurrent pelvic infections c. use of oral contraceptives for 5 years d. heavy menstrual flow of 4 days duration

b. recurrent pelvic infections rationale: infection and subsequent scarring of the fallopian tubes prevent normal movement of the fertilized ovum into the uterus for implantation.

Which assessment finding indicates an adverse response to magnesium sulfate. a. Urine output of 30mL/hr b. respiratory rate of 11 bpm c. hypoactive patellar reflex d. blood pressure reading of 110/80 mm Hg.

b. respiratory rate of 11 bpm rationale: a respiratory rate less than 12 bpm indicates magnesium toxicity and requires immediate intervention.

A HCP reports to the labor nurse that a patient is being transferred from the clinic directly to the hospital with possible preeclampsia. What is the nurses priority action when the patient is admitted a. Obtain the patients weight b. take the patients vital signs c. start an IV with lactated Ringers at 75 mL/hr d. ask support persons to leave the birthing room

b. take the patients vital signs rationale: the hallmark signs of preeclampsia are hypertension and proteinuria.

Which explanation of a marginal placenta previa would the nurse provide to her client a. The placenta is in the lower uterus, completely covering the internal cervical os b. The placenta is in the lower uterus, more than 3 cm from the internal cervical os c. The placenta is in the lower uterus, less than 3 cm from the internal cervical os d. The placenta is in the lower uterus, at the edge and partially covering the cervical os.

b. the placenta is in the lower uterus, more than 3 cm from the internal cervical os. rationale: A marginal placenta, also called a low-lying placenta, is more than 3 cm from the internal cervical os.

Which maternal condition always necessitates birth by cesarean section. a. partial abruptio placentae b. total placenta previa. c. ectopic pregnancy. d. eclampsia.

b. total placenta previa. in total placenta previa, the placenta completely covers the cervical os. The fetus would die if a vaginal birth occurred.

A nurse is explaining to the nursing students working on the antepartum unit how to assess edema. Which edema assessment score indicates edema of the lower extremities, face, hands, and sacral area. a. +1 b. +2 c. +3 d. +4

c. +3 rationale: edema of the extremities, face, and sacral area is classified as +3 edema.

A preeclamptic patient is receiving an IV infusion of magnesium sulfate. On assessment, the nurse notes that the patients urinary output has been 20 mL/hr for the past 2 hours and her deep tendon reflexes are absent. The HCP prescribes calcium gluconate, 1 g of a 10% solution. The standard rate of infusion is 1 mL/min. How many minutes will it take for the nurse to administer the prescribed calcium a. 1 b. 5 c. 10 d. 15

c. 10 rationale: a 10% solution contains 10 g in 100 mL

A blood soaked peripad weighs 900 g. the nurse would document a blood loss of ________ a. 1800 b. 450 c. 900 d. 90

c. 900 rationale: One G = 1mL of blood.

A patient presents to labor and birth with complaints of persistent acute back pain at 36 weeks gestation. The nursing assessment reveals a taught abdomen, fundal height at 40 cm, and late decelerations, with an FHR range of 124 to 128 bpm. The nurse will implement the protocol for which obstetric condition a. Placenta previa b. Hypovolemic shock c. abruptio placentae or abruption d. DIC

c. abruptio placentae of abruption rationale: there are five classic signs and symptoms of abruptio placentae and include the following: bleeding, uterine tenderness, uterine irritability, abdominal or low back pain, an high uterine resting tone

A client with preeclampsia is being treated with bed rest and intravenous magnesium sulfate. The drug classification of this medication is a. diuretic b. tocolytic c. anticonvulsant d. antihypertensive.

c. anticonvulsant rationale: anticonvulsant drugs act by blocking neuromuscular transmission and depress the central nervous system to control seizure activity.

The most appropriate nursing action for the client complaining of continuous headache 24 hours postpartum after a normal vaginal birth is to a. encourage bed rest b. administer analgesic c. assess blood pressure d. assess for pitting edema

c. assess blood pressure rationale: the first indication of preeclampsia is usually hypertension. Continuous headache indicates poor cerebral perfusion and may be a precursor of seizures; encouraging bed rest, administering an analgesic, and assessing for edema are not interventions to determine the source of the clients headache.

a 17 yr old primigravida has gained 4 pounds since her last prenatal visit. Her blood pressure is 140/92 mm Hg. The most important nursing action is to a. advise her to cut down on fast foods that are high in fat b. caution her to avoid salty foods and to return in 2 weeks c. assess weight gain, location of edema, and urine for protein. d. recommend she stay home from school for a few days to reduce stress.

c. assess weight gain, location of edema, and urine for protein. rationale: the nurse should further assess the client for hypertension, generalized edema, and proteinuria, which are classic signs of pregnancy induced hypertension.

You are taking care of a client who had a therapeutic abortion following an episode of vaginal bleeding and ultrasound confirmation of a blighted ovum. Lab work is ordered 2 weeks post procedure as a follow up. Which result indicates the additional intervention is needed. a. Hemoglobin, 13.2 mg/dL b. white blood cell count 10,000 mm3 c. Beta-hCG detected in serum d. fasting blood glucose level 80 mg/dL

c. beta-hcg detected in serum rationale: the presence of beta-hcg in serum 2 weeks after the procedure is clinically significant and indicates the possibility that there may have been a molar pregnancy (hydatidiform).

Which finding in the assessment of a client following an abruption placenta could indicate a major complication a. urine output of 30 ml in 1 hour b. blood pressure of 110/60 mm Hg c. Bleeding at IV insertion site d. Respiratory rate of 16 breath/min

c. bleeding at IV insertion site rationale: DIC is a life threatening defect in coagulation that may occur following abruptio placentae

Which finding in the exam of a client with a diagnosis of threatened abortion would change the diagnosis to inevitable abortion a. Presence of backache b. ris in hCG level c. clear fluid from vagina d. pelvic pressure

c. clear fluid from vagina rationale: clear fluid from the vagina indicates rupture of the membranes.

In addition to obtaining vital signs and FHT, what is a priority for the client with placenta previa. a. Determining cervical dilation b. monitoring uterine contractions c. estimating blood loss d. starting a pitocin drip

c. estimating blood loss rationale: nursing assessments for the client with placenta previa focus on determining the amount of blood loss.

Which finding on a prenatal visit at 10 weeks might suggest a hydatidiform mole a. blood pressure of 120/80 mm Hg b. complaint of frequent mild nausea c. Fundal height measurement of 18cm d. history of bright red spotting for 1 day weeks ago.

c. fundal height measurement of 18 cm. rationale: the uterus in a hydatidiform molar pregnancy is often larger than would be expected on the basis of the duration of the pregnancy.

The clinic nurse is performing a prenatal assessment on a pregnant client at risk for preeclampsia. Which clinical sign is not included as a symptom of preeclampsia. a. Edema b. proteinuria c. glucosuria d. hyptertension

c. glucosuria rationale: glucose into the urine is not one of the three classic symptoms of preeclampsia.

Fraternal twins are delivered by your Rh-negative client. Twin A is Rh-positive and twin B is Rh-negative. Prior to administering Rho(D) immune globulin (RhoGAM), the nurse should determine the results of the a. direct coombs test of twin A b. direct coombs test of twin B c. indirect Coombs test of the mother d. transcutaneous bilirubin level for both twins

c. indirect Combs test of the mother rationale: administration of RhoGAM is based on the results of the indirect Coombs test on the client

What is the priority nursing intervention for the client who has had an incomplete abortion. a. Methylergonovine (Methergine), 0.2 mg IM b. Preoperative teaching for surgery c. insertion of IV line for fluid replacement d. Positioning of client in left side lying position

c. insertion of IV line for fluid replacement. rationale: initial treatment of an incomplete abortion should be focused on stabilizing the clients cardiovascular state.

The labor and birth nurse is reviewing the risk factors for placenta previa with a group of nursing students. The nurse determines that the students understood the discussion when they identify which patient being at the highest risk for developing a placenta previa. a. Female fetus, Mexican American primigravida b. male fetus, Asian American, previous preterm birth c. Male fetus, African American, previous C-section d. Female fetus, European-American, previous spontaneous abortion

c. male fetus, African American, previous C section rationale: the rate of placenta previa is increasing. It is more common in older women, multiparous women, women who have had c-sections, and women who had suction curettage for an induced or spontaneous abortion.

Which assessment in a client diagnosed with preeclampsia who is taking magnesium sulfate would indicate a therapeutic level of medication a. drowsiness b. urinary output of 20 mL/hr c. normal deep tendon reflexes d. Respiratory rate of 10 to 12 bmp

c. normal deep tendon reflexes rationale: magnesium sulfate is administered for preeclampsia to reduce the risk of seizures from cerebral irritability.

The primary symptom present in abruptio placentae that distinguishes it from placenta previa is: a. vaginal bleeding b. rupture of membranes c. presence of abdominal pain d. changes in maternal vital signs.

c. presence of abdominal pain rationale: Pain in abruptio placentae occurs in response to increased pressure behind the placenta and within the uterus.

What should the nurse recognize as evidence that the client is recovering from preeclampsia. a. 1+ protein b. 2+ pitting edema in lower extremities c. urine output >100mL/hr d. Deep tendon reflexes +2

c. urine output >100mL/hr rationale: rapid reduction of the edema associated with preeclampsia results in urinary output of 4 to 6 L/day as interstitial fluids shift back to the circulatory system.

The nurse is providing care to a patient who just learned her baby has died in utero at 26 weeks gestation. What is the nurses next action a. Contact the patients clergy member b. enroll the patient in a grief and loss class c. Determine if the patient is a victim of violence d. Ask the patient when she last felt the baby move.

d. ask the patient when she last felt the baby move rationale: determining fetal movement will give the nurse a basis for how long the fetus has been expired.

the nurse is providing care to a laboring woman who is Rh-negative. The patient has a standing prescription to receive RhoGAM, if indicated. When will the nurse plan on administering the RhoGAM, if indicated a. Approximately 2 hours prior to birth b. At the birth of the placenta c. One hour after the birth of the infant d. between 48 and 72 hours after birth of the infant

d. between 48 and 72 hours after birth of the infant rationale: If the mother is Rh-negative, umbilical cord blood is taken at birth to determine blood type, Rh factor, and antibody titer (direct Coombs test) of the newborn. Rh-negative unsensitized mothers who give birth to Rh-positive infants are given an IM injection of Rho(D) immune globulin (RhoGAM) within 72 hours after birth.

A client who had premature rupture of the membranes (PROM) earlier in the pregnancy at 28 weeks returns to the labor unit 1 week later complaining that she is now in labor. The labor and birth nurse performs the following assessments. The vaginal exam is deferred until the physician is in attendance. The client is placed on electronic fetal monitoring and a baseline FHR of 130 bpm is noted. No contraction pattern is observed. The client is then transferred to the antepartum unit for continued observation. Several hours later, the client complains that she does not feel the baby move. Examination of the abdomen reveals a fundal height of 34 cm. Muscle tone is no different from earlier in the hospital admission. The client is placed on the EFM and no fetal heart tones are observed. What does the nurse suspect is occurring. a. Placental previa b. Active labor has started c. placental abruption d. hidden placental abruption

d. hidden placental abruption rationale: the clients signs and symptoms indicate that a hidden abruption is occurring. Fundal height has increased and there is an absence of fetal heart tones. This is a medical emergency and the physician should be contacted to come directly to the unit for intervention and imminent birth

In which situation would a dilation and curettage (D&C) be indicated a. complete abortion at 8 weeks b. incomplete abortion at 16 weeks c. threatened abortion at 6 weeks d. incomplete abortion at 10 weeks.

d. incomplete abortion at 10 weeks rationale: D&C is carried out to remove the products of conception from the uterus and can be done safely until week 14 of gestation.

A placenta previa when the placental edge just reaches the internal os is called a. total b. partial c. low-lying d. marginal

d. marginal rationale: a placenta previa that does not cover any part of the cervix is termed marginal. partial previa - placenta within 3cm of cervix

A primigravida of 28 years old is admitted to the antepartum unit with a diagnosis of hyperemesis gravidarum. Nursing care is based on which of the following. a. She should be isolated from her family b. this condition is caused by psychogenic factors c. the treatment is similar to that for morning sickness d. she should be assessed for signs of dehydration and starvation.

d. she should be assessed for signs of dehydration and starvation rationale: the cause of hyperemesis gravidarum is unknown, but dehydration and starvation are the major complications.

A client with no prenatal care delivers a health male infant via the vaginal route, with minimal blood loss. During the labor period, vital signs were normal. At birth, significant maternal hypertension is noted. When the client is questioned, she relates that there is history of heart disease in her family but that she has never been treated for hypertension. Blood pressure is treated in the hospital setting and the client is discharged. The client returns at her scheduled 6-week checkup and is found to be hypertensive. Which type of hypertension do you think the client is exhibiting. a. pregnancy-induced hypertension (PIH) b. gestational hypertension c. pre-eclampsia superimposed on chronic hypertension d. undiagnosed chronic hypertension

d. undiagnosed chronic hypertension rationale: even though the client has no documented prenatal care or medical history, she does relate a family history that is positive for heart disease

Which assessment finding on the fetal monitor strip supports a diagnosis of abruptio placentae. a. FHR of 150 bpm b. Moderate variability of FHR c. contractions every 3 mins d. uterine resting tone of 30 mm Hg

d. uterine resting tone of 30 mm Hg rationale: Abruptio placentae results in uterine irritability and a high resting uterine tone.

which assessment finding indicates the development of pre-eclampsia in the antepartum client a. slight edema of feet and ankles b. increased urine output c. blood pressure of 128/80 mm Hg d. weight gain of 3 pounds in 1 week

d. weight gain of 3 pounds in 1 week rationale: generalized edema often occurs with pre-eclampsia. Edema may first manifest as a rapid weight gain

A client with preeclampsia is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs indicate a. gastrointestinal upset b. effects of magnesium sulfate c. anxiety caused by hospitalization d. worsening disease and impending convulsion

d. worsening disease and impending convulsion rationale: headache and visual disturbances are caused by increased cerebral edema.

Which patient may need a cesarean delivery because of complications related to gestational diabetes? 1 A patient with a big fetus 2 A patient with uterine growth 3 A patient with reduced fetal movement 4 A patient with less than normal pelvic brim

1 Fetal macrosomia is a common complication associated with gestational diabetes. Hypersecretion of fetal insulin hormone as a response to maternal hyperglycemia results in an increased size of the fetus. Maternal hyperglycemia does not cause the development of uterine growths. Fetal movements may be cause for a cesarean, but they are not associated with the patient's gestational diabetes. The size of the pelvic brim is not altered by maternal hyperglycemia.

Which condition in a pregnant patient with severe preeclampsia is an indication for administering magnesium sulfate? 1 Seizure activity 2 Renal dysfunction 3 Pulmonary edema 4 Low blood pressure (BP)

1 Severe preeclampsia may cause seizure activity or eclampsia in the patient, which is treated with magnesium sulfate. Magnesium sulfate is not administered for renal dysfunction and can cause magnesium toxicity in the patient. Pulmonary enema can be prevented by restricting the patient's fluid intake to 125 mL/hr. Increasing magnesium toxicity can cause low BP in the patient

What is the classic sign of placenta previa, occurring in the last half of pregnancy? 1 Sudden painless uterine bleeding 2 Slow-onset painful uterine bleeding 3 Vaginal "spotting" with mild cramping 4 Sudden uterine bleeding with severe cramping

1 Sudden painless uterine bleeding is the classic sign of placenta previa. Bleeding is not slow-onset or painful. Vaginal spotting is not a sign of placenta previa. Cramping is not a sign of placenta previa.

A nurse is working with a diabetic patient who recently found out she is pregnant. In coordinating an interdisciplinary team to help manage the patient throughout the pregnancy, the nurse would include whom? Select all that apply. 1 Family practice physician 2 Dietician 3 Perinatologist 4 Occupational therapist 5 Neonatologist 6 Speech therapist

1,2,3,5 A dietician would be included in the interdisciplinary care team to help the patient with dietary planning. A perinatologist would be included in the interdisciplinary care team to take care of both the mother and the fetus. A nephrologist would be included in the interdisciplinary care team to monitor renal function. A family practice physician would not be included, but rather an internal medicine practitioner would be a member of the interdisciplinary care team. There is no need for an occupational therapist to be included unless there are other issues presented. There is no need for a speech therapist to be included unless there are other issues presented.

Hypothyroidism occurs in two to three pregnancies per 1000. Pregnant women with untreated hypothyroidism are at risk for what? Select all that apply. 1 Miscarriage 2 Macrosomia 3 Gestational hypertension 4 Placental abruption 5 Stillbirth

1,3,4,5 Hypothyroidism is often associated with both infertility and an increased risk for miscarriage. These outcomes can be improved with early diagnosis and treatment. Pregnant women with hypothyroidism are more likely to experience both preeclampsia and gestational hypertension. Placental abruption and stillbirth are risks associated with hypothyroidism. Infants born to mothers with hypothyroidism are more likely to be of low birth weight or preterm.

A patient gains excessive weight during pregnancy, her laboratory reports reveal low levels of placental growth factors, and she is expected to deliver during the colder months of the year. Which medication would help in reducing risk of preeclampsia in the patient? 1 Nifedipine (Adalat) 2 Low-dose aspirin (Anacin) 3 Magnesium sulfate (Sulfamag) 4 Vitamin C supplement (Vita-C)

2 A nonobese patient who gains excessive weight during pregnancy is at an increased risk of developing preeclampsia. The low levels of placental growth factor and expected delivery during colder months of the year also increase the risk for preeclampsia. Low-dose aspirin (Anacin) helps lower the risk of preeclampsia and maintain general health. Nifedipine (Adalat) is an antihypertensive drug, not highly effective in preventing preeclampsia. Magnesium sulfate (Sulfamag) is the drug of choice for treating eclamptic seizures and preventing repeated seizures. A vitamin C supplement (Vita-C) does not help prevent preeclampsia.

Which is an important nursing intervention when a patient has an incomplete miscarriage with heavy bleeding? 1 Initiate expectant management at once. 2 Prepare the patient for dilation and curettage. 3 Administer the prescribed oxytocin (Pitocin). 4 Obtain a prescription for ergonovine (Methergine).

2 In the case of an incomplete miscarriage, sometimes there is heavy bleeding and excessive cramping and some part of fetal tissue remains in the uterus. Therefore the nurse needs to prepare the patient for dilation and curettage for the removal of the fetal tissue. Expectant management is initiated if the pregnancy continues after a threatened miscarriage. Oxytocin (Pitocin) is administered to prevent hemorrhage after evacuation of the uterus. Ergonovine (Methergine) is administered to contract the uterus.

A pregnant patient is on tocolytic therapy with magnesium sulfate. Under which patient circumstance would the nurse suggest discontinuing the therapy? 1 Blood pressure is 120/80 mm Hg. 2 Respiratory rate is 10 breaths per minute. 3 Urine output is 40 mL per hour. 4 Serum magnesium level is 5 mEq/L.

2 Magnesium sulfate is used as a tocolytic. However, it can cause severe adverse effects. Therefore the nurse should closely monitor the patient. A respiratory rate of 10 breaths per minute indicates that the patient has respiratory depression, which is an adverse effect of magnesium sulfate. Therefore the nurse should stop administration of the drug. A blood pressure of 120/80 mm Hg is normal and does not require discontinuation of magnesium sulfate. Urine output of 40 mL per hour indicates normal urine output; hence, the nurse need not discontinue the therapy. The therapeutic serum magnesium level should be 5 mEq/L to exert its action. Therefore if the serum magnesium level is 5 mEq/L, the nurse need not discontinue the therapy, because it would not cause toxic effects.

What is the best sign of threatened abortion? 1 Dilated cervix 2 Vaginal bleeding 3 Uterine contractions 4 Ruptured membranes

2 Vaginal bleeding is a sign of threatened abortion. Signs of inevitable abortion are a dilated cervix, uterine contractions, and ruptured membranes.

A pregnant patient is diagnosed with abruptio placentae. What signs and symptoms would the nurse find in the patient? Select all that apply. 1 Hypoglycemia 2 Abdominal pain 3 Vaginal bleeding 4 Delayed menses 5 Uterine tenderness

2,3,5 Premature separation of the placenta from the uterus is called as abruptio placentae. Vaginal bleeding, abdominal pain, and uterine tenderness are signs and symptoms of abruptio placentae. Abruptio placentae does not affect blood glucose level; therefore, it does not cause hypoglycemia. Delayed menses is a sign of an ectopic pregnancy.

A pregnant patient with chronic hypertension is at risk for placental abruption. Which symptoms of abruption does the nurse instruct the patient to be alert for? Select all that apply. 1 Weight loss 2 Abdominal pain 3 Vaginal bleeding 4 Shortness of breath 5 Uterine tenderness

2,3,5 The nurse instructs the pregnant patient to be alert for abdominal pain, vaginal bleeding, and uterine tenderness, because they indicate placental abruption. Weight loss indicates fluid and electrolyte loss, not placental abruption. Shortness of breath indicates inadequate oxygen, which is usually seen in a patient who is having cardiac arrest.

Which patient is most likely to be referred to home care? 1 An adolescent who had an accident 2 A pregnant patient nearing the end of term 3 A pregnant patient at risk for preterm labor 4 An infant with respiratory distress syndrome

3 Home care is appropriate for a pregnant patient who is at risk for preterm labor. It may not be feasible for the patient to make regular visits to a health care facility. An adolescent who had an accident would be admitted to a health care facility for proper treatment and surgery. A pregnant patient without any complications at term does not need home care. An infant with respiratory distress syndrome may develop complications and should be provided care in the hospital accordingly.

A patient experiences a single episode of heavy bleeding with abdominal pain. On assessment, the nurse finds that the period was also delayed. Which other factor does the nurse need to evaluate to determine the possible cause of this episode? 1 Evaluate bone density test report. 2 Evaluate for gastrointestinal bleeding. 3 Evaluate renal function reports. 4 Evaluate serum β-human chorionic gonadotropin (hCG) pregnancy test results.

4 A single episode of heavy bleeding and abdominal pain may indicate an early pregnancy loss. Therefore, the nurse needs to evaluate the patient's serum β-hCG pregnancy test results. A bone density report is a priority when the patient is at risk for fractures. Dark-colored stools, not heavy bleeding, indicate gastrointestinal bleeding. Renal function tests are not a priority at this stage, because they will not shed any light on the cause of the bleeding.

Which sign would the nurse observe in a patient with hydatidiform mole? 1 Clear vaginal discharge 2 A small uterus 3 Decreased fetal heart rate 4 Dark brown vaginal discharge

4 Hydatidiform mole is characterized by the degeneration of the chorionic villi, in which the villi become vesicle-like. These vesicle-like substances are expelled from the vagina through a dark-brown or bright-red discharge. These are definite signs that the patient has hydatidiform mole. Clear vaginal discharge may be a normal finding during pregnancy and may not indicate any complications. The fundal height is unusually more in molar pregnancy. The fetal heartbeat is absent as there is no viable fetus.

The nurse is caring for a pregnant patient diagnosed with mitral valve stenosis. Which position would the nurse suggest to the patient to ensure a safe labor? 1 Supine 2 Standing 3 Lithotomy 4 Side-lying

4 Mitral valve stenosis occurs for various reasons, such as a stiffening of the valve leaflets resulting from rheumatic heart disease. During labor for patients with mitral valve stenosis, it is very important to have adequate pain control to prevent tachycardia. A side-lying position is desired in these patients to prevent tachycardia. A supine position does not provide comfort; rather, it may cause supine hypotension in the patient. A standing position is not preferred in patients with mitral valve stenosis. The lithotomic position may increase the risk of pulmonary edema in patients with mitral valve stenosis.

The ultrasound report of a 12-week-pregnant woman shows snowstorm pattern. Upon further examination, the nurse finds elevated human chorionic gonadotropin (hCG) levels and dark brown vaginal discharge. What complication does the nurse expect in the patient? 1 Hemorrhage 2 Hypertension 3 Hyperglycemia 4 Molar pregnancy

4 Snowstorm pattern in the ultrasound, elevated hCG, and dark brown vaginal discharge indicate that the patient has a hydatidiform mole. The risk of hemorrhage is predominant in a patient with placenta previa. The blood pressure of the patient is not affected by the hydatidiform mole. Therefore, the patient would not be at a risk of hypertension. A hydatidiform mole does not alter the blood glucose levels. Therefore, the patient would not necessarily have hyperglycemia.

Which interventions may be indicated for the clinical management of hyperemesis gravidarum (HEG). Select all a. pyridoxine b. total parenteral nutrition TPN for severe cases c. Promethazine (Phenergan) d. Levaquin (Levofloxacin) e. Omeprazole (Prilosec) f. diphenhydramine (Benadryl)

A, B, C, E, F An antibiotic such as Levaquin is not indicated for the treatment of this disease

32. As the triage nurse in the emergency room, you are reviewing results for the high- risk obstetric client who is in labor because of traumatic injury experienced as a result of a motor vehicle accident (MVA). You note that the Kleihauer-Betke test is positive. Based on this information, you anticipate that: a. immediate birth is required. b. the client should be transferred to the critical care unit for closer observation. c. RhoGAM should be administered. d. a tetanus shot should be administered.

ANS: A A positive Kleihauer-Betke test indicates that fetal bleeding is occurring in the maternal circulation. This is a serious complication and, because the client is a trauma victim, it is highly likely that she is experiencing an abruption. Therefore, the client should be delivered as quickly as possible to improve outcomes. There is no evidence to support that RhoGAM should be administered, because we have no information related to Rh factor and/or blood type. Similarly, a tetanus shot is not indicated at this time because there is no evidence of penetrating trauma. The client should be transferred to the obstetric area for birth, not the critical care unit setting. PTS: 1 DIF: Cognitive Level: Analysis REF: 516

8. Spontaneous termination of a pregnancy is considered to be an abortion if: a. the pregnancy is less than 20 weeks. b. the fetus weighs less than 1000 g. c. the products of conception are passed intact. d. there is no evidence of intrauterine infection.

ANS: A An abortion is the termination of pregnancy before the age of viability (20 weeks). The weight of the fetus is not considered because some fetuses of an older age may have a low birth weight. A spontaneous abortion may be complete or incomplete. A spontaneous abortion may be caused by many problems, one being intrauterine infection. PTS: 1 DIF: Cognitive Level: Understanding REF: 505

23. A laboratory finding indicative of DIC is: a. decreased fibrinogen. b. increased platelets. c. increased hematocrit. d. decreased thromboplastin time.

ANS: A DIC develops when the blood-clotting factor thromboplastin is released into the maternal bloodstream as a result of placental bleeding. Thromboplastin activates widespread clotting, which uses the available fibrinogen, resulting in a decreased fibrinogen level. The platelet count will decrease. The hematocrit may decrease if bleeding is pronounced. The thromboplastin time is prolonged. PTS: 1 DIF: Cognitive Level: Analysis REF: 507

28. A female client presents to the emergency room complaining of lower abdominal cramping with scant bleeding of approximately 2 days' duration. This morning, the quality and location of the pain changed and she is now experiencing pain in her shoulder. The client's last menstrual period was 28 days ago, but she reports that her cycle is variable, ranging from 21 to 45 days. Which clinical diagnosis does the nurse suspect? a. Ectopic pregnancy b. Appendicitis c. Food poisoning d. Gastroenteritis

ANS: A Even though the client's menstrual cycle has variability, all women are considered to be pregnant until proven otherwise. The client's presenting symptoms are typical for ectopic pregnancy, so the client should be monitored for the possible complication of rupture and shock. PTS: 1 DIF: Cognitive Level: Application REF: 507, 508

31. A high-risk labor client progresses from preeclampsia to eclampsia. Aggressive management is instituted, and the fetus is delivered via cesarean section. Which finding in the immediate postoperative period indicates that the client is at risk of developing HELLP syndrome? a. Platelet count of 50,000/mL b. Liver enzyme levels within normal range c. Negative for edema d. No evidence of nausea or vomiting

ANS: A HELLP syndrome is characterized by hemolysis, elevated liver enzyme levels, and a low platelet count. A platelet count of 50,000/mL indicates thrombocytopenia. PTS: 1 DIF: Cognitive Level: Analysis REF: 529

62. The emergency room charge nurse calls the labor and birth charge nurse and reports the ambulance is en route with a seizing pregnant patient at 36 weeks' gestation. What medication will the charge nurse most likely direct the staff nurse to prepare to administer immediately on the patient's arrival to the labor and birth unit? a. Magnesium sulfate (magnesium) b. Hydralazine (Apresoline) c. Carbamazepine (Tegretol) d. Terbutaline (Brethine)

ANS: A Magnesium sulfate is the drug most often used for preeclamptic and eclamptic patients. It is a CNS depressant. Apresoline is administered for hypertension and is often given to pregnant clients with severe preeclampsia. Tegretol is administered for seizure activity in nonpregnant patients. Brethine is a smooth muscle relaxant administered for preterm labor. PTS: 1 DIF: Cognitive Level: Application REF: 523

46. What history would lead you to suspect an ectopic pregnancy in a client at 8 weeks' gestation presenting with abdominal pain and bleeding? a. Treated 1 year ago for pelvic inflammatory disease (PID) b. Oral contraception for last 3 years c. Urinary frequency for 1 week d. Irregular cycles for 1 year prior to conception

ANS: A PID causes fallopian tube damage. Blockage of the tube prevents movement of the fertilized ovum, resulting in implantation in the tube. Oral contraception for the last 3 years, urinary frequency for 1 week, and irregular cycles for 1 year prior to conception have no effect on the development of ectopic pregnancy. PTS: 1 DIF: Cognitive Level: Analysis REF: 508

4. Which intrapartal assessment should be avoided when caring for a client with HELLP syndrome? a. Abdominal palpation b. Venous sample of blood c. Checking deep tendon reflexes d. Auscultation of the heart and lungs

ANS: A Palpation of the abdomen and liver could result in a sudden increase in intraabdominal pressure, leading to rupture of the subcapsular hematoma. Assessment of heart and lungs is performed on every patient. Checking reflexes is not contraindicated. Venous blood is checked frequently to observe for thrombocytopenia. PTS: 1 DIF: Cognitive Level: Application REF: 529

54. For the client who delivered at 6:30 AM on January 10, Rho(D) immune globulin (RhoGAM) must be administered prior to: a. 6:30 AM on January 13. b. 6:30 PM on January 13. c. 6:30 PM on January 14. d. 6:30 AM on January 15.

ANS: A Rho(D) immune globulin (RhoGAM) must be administered within 72 hours after the birth of an Rh-positive infant. 6:30 PM on January 13, 6:30 PM on January 14, and 6:30 AM on January 15 do not fall within the established time frame. PTS: 1 DIF: Cognitive Level: Application REF: 532

26. A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on which of the following? a. Hemorrhage is the major concern. b. She will be unable to conceive in the future. c. Bed rest and analgesics are the recommended treatment. d. A D&C will be performed to remove the products of conception.

ANS: A Severe bleeding occurs if the fallopian tube ruptures. If the tube must be removed, her fertility will decrease but she will not be infertile. The recommended treatment is to remove the pregnancy before hemorrhaging. A D&C is done on the inside of the uterine cavity. The ectopic is located within the tubes. PTS: 1 DIF: Cognitive Level: Understanding REF: 507, 508

60. The clinic nurse is reviewing home care dietary instructions for the patient diagnosed with mild preeclampsia at 34 weeks' gestation. The nurse determines that the client requires additional information when she makes which statement? a. "I will limit my salt intake to 2 grams per day." b. "I will drink no less than 2500 mL of fluid per day." c. "I will make sure I eat 4 sources of protein per day." d. "My overall intake of calories per day should be around 2500."

ANS: A The diet should have ample protein, no less than 6 ounces/day, and approximately 2500 calories during the second half of pregnancy. A regular diet without salt or fluid restriction is usually prescribed. Adequate amounts of protein are essential, especially because there is pathologic protein loss with preeclampsia. PTS: 1 DIF: Cognitive Level: Application REF: 530

56. A patient reports to the emergency room nurse that she is 10 weeks pregnant, with unilateral pelvic pain, shoulder pain, and faintness. Her color is pale, she is diaphoretic, and her heart rate is 140 bpm. What is the nurse's priority action? a. Initiate an ordered IV of lactated Ringer's at 200 mL/hr. b. Take the patient for her ordered pelvic ultrasound. c. Ask the patient if she has had any recent vaginal bleeding. d. Ask the patient if she has ever been told she has had salpingitis.

ANS: A This patient is presenting with classic signs of an ectopic pregnancy and hypovolemic shock. This is an obstetric emergency. Symptoms include sudden, severe pain in one of the lower quadrants of the abdomen as the tube tears open and the embryo is expelled into the pelvic cavity, often with profuse abdominal hemorrhage. Radiating pain under the scapula may indicate bleeding into the abdomen caused by phrenic nerve irritation. Hypovolemic shock (acute peripheral circulatory failure from loss of circulating blood) is a major concern because systemic signs of shock may be rapid and extensive without external bleeding. The nurse must first start the IV to initiate rapid fluid replacement. Further assessment will result in a delay of care. PTS: 1 DIF: Cognitive Level: Synthesis REF: 509

37. Which finding should be the nurse's priority in a client suspected as having gestational trophoblastic disease? a. Uterine contractions b. Nausea and vomiting c. Blood pressure of 130/80 mm Hg d. Increase discharge of vaginal mucus

ANS: A Uterine contractions can cause trophoblastic tissue to be pulled into large venous sinusoids in the uterus, resulting in embolization of the tissue and respiratory distress. Nausea and vomiting and blood pressure of 130/80 mm Hg represent no immediate danger to the client and can be addressed later. Increased discharge of vaginal mucus is a normal finding in pregnancy. PTS: 1 DIF: Cognitive Level: Analysis REF: 510

21. Which routine nursing assessment is contraindicated for a client admitted with suspected placenta previa? a. Determining cervical dilation and effacement b. Monitoring FHR and maternal vital signs c. Observing vaginal bleeding or leakage of amniotic fluid d. Determining frequency, duration, and intensity of contractions

ANS: A Vaginal examination of the cervix may result in perforation of the placenta and subsequent hemorrhage. Monitoring FHR and maternal vital signs is a necessary part of the assessment for this client. Monitoring for bleeding and rupture of membranes is not contraindicated with this client. Monitoring contractions is not contraindicated with this client. PTS: 1 DIF: Cognitive Level: Analysis REF: 512

67. The nurse who suspects that a client has early signs of ectopic pregnancy should be observing her for which symptoms? (Select all that apply.) a. Pelvic pain b. Missed period c. Abdominal pain d. Unanticipated heavy bleeding e. Vaginal spotting or light bleeding

ANS: A, B, C, E A missed period or spotting can easily be mistaken by the client as early signs of pregnancy. More subtle signs depend on exactly where the implantation occurs. The nurse must be thorough in her assessment because pain is not a normal symptom of early pregnancy. As the fallopian tube tears open and the embryo is expelled, the client often exhibits severe pain accompanied by intraabdominal hemorrhage. This may progress to hypovolemic shock with minimal or even no external bleeding. In about 50% of women, shoulder and neck pain occurs because of irritation of the diaphragm from the hemorrhage. PTS: 1 DIF: Cognitive Level: Application REF: 509

65. Which interventions may be indicated for the clinical management of hyperemesis gravidarum (HEG)? (Select all that apply.) a. Pyridoxine b. Total parenteral nutrition (TPN) for severe cases c. Promethazine (Phenergan) d. Levaquin (Levofloxacin) e. Omeprazole (Prilosec) f. Diphenhydramine (Benadryl)

ANS: A, B, C, E, F Pyridoxine (vitamin B6) may be indicated for the treatment of HEG. TPN is indicated for severe conditions. Phenergan, an antiemetic, and Prilosec, a gastric acid inhibitor, are also used for treatment of this condition. Benadryl is also used for treatment. An antibiotic such as Levaquin is not indicated for the treatment of this disease. PTS: 1 DIF: Cognitive Level: Analysis REF: 506

66. The physician suspects that the client may have gestational trophoblastic disease. Which clinical manifestations support this diagnosis? (Select all that apply.) a. Increased levels of beta-hCG in the serum b. Fundal height correlating with reported gestational age c. Vaginal bleeding d. Vomiting e. Maternal hypotension

ANS: A, C, D In gestational trophoblastic disease (molar pregnancy), the following clinical manifestations would appear: increased serum beta-hCG levels, increased size of the uterus related to gestational age, nausea and vomiting, and evidence of vaginal bleeding. Development of preeclampsia earlier in the pregnancy would be noted, resulting in hypertension, not hypotension. PTS: 1 DIF: Cognitive Level: Analysis REF: 518

18. Which orders should the nurse expect for a client admitted with a threatened abortion? a. NPO b. Pad count c. Ritodrine IV d. Meperidine (Demerol), 50 mg now

ANS: B A client admitted with a threatened abortion should be instructed to count the number of perineal pads used and to note the quantity and color of blood on the pads. Ritodrine is not the first drug of choice for tocolytic medications. There is no reason for having the client NPO. At times, dehydration may produce contractions, so hydration is important. Demerol will not decrease the contractions but may mask the severity of the contractions. PTS: 1 DIF: Cognitive Level: Application REF: 505

45. Which information should the labor nurse recognize as being pertinent to a possible diagnosis of abruptio placentae? a. Low back pain b. Firm, tender uterus c. Regular uterine contractions d. Scant vaginal mucus drainage

ANS: B A firm, tender uterus is a classic sign of abruptio placentae; low back pain, regular uterine contractions, and scant vaginal mucus drainage are normal findings in a laboring client. PTS: 1 DIF: Cognitive Level: Analysis REF: 515

44. Which explanation of a marginal placenta previa would the nurse provide to her client? a. The placenta is in the lower uterus, completely covering the internal cervical os. b. The placenta is in the lower uterus, more than 3 cm from the internal cervical os. c. The placenta is in the lower uterus, less than 3 cm from the internal cervical os. d. The placenta is in the lower uterus, at the edge and partially covering the cervical os.

ANS: B A marginal placenta, also called a low-lying placenta, is more than 3 cm from the internal cervical os. The placenta in the lower uterus, completely covering the internal cervical os, describes a total placenta previa. The placenta in the lower uterus, less than 3 cm from the internal cervical os, and the placenta in the lower uterus, at the edge and partially covering the cervical os, are both descriptions of a partial placenta previa. PTS: 1 DIF: Cognitive Level: Application REF: 513

9. An abortion when the fetus dies but is retained in the uterus is called: a. inevitable. b. missed. c. incomplete. d. threatened.

ANS: B A missed abortion refers to a dead fetus being retained in the uterus. An inevitable abortion means that the cervix is dilating with the contractions. An incomplete abortion means that not all the products of conception were expelled. With a threatened abortion, the client has cramping and bleeding but not cervical dilation. PTS: 1 DIF: Cognitive Level: Understanding REF: 506

35. Which assessment finding indicates an adverse response to magnesium sulfate? a. Urine output of 30 mL/hr b. Respiratory rate of 11 breaths/min c. Hypoactive patellar reflex d. Blood pressure reading of 110/80 mm Hg

ANS: B A respiratory rate less than 12 breaths/min indicates magnesium toxicity and requires immediate intervention. A urine output of 30 mL/hr is normal urinary output; a hypoactive patellar reflex and blood pressure reading of 110/80 mm Hg are normal findings in the client receiving magnesium sulfate. PTS: 1 DIF: Cognitive Level: Analysis REF: 525

52. Which intervention would be the most effective if your client who is on magnesium sulfate has a respiratory rate of 10 breaths/min? a. Give oxygen by mask at 8-10 L/min. b. Administer calcium gluconate via IV pyelogram (IVP). c. Arouse client with tactile stimulation. d. Continually assess pulse oximeter levels.

ANS: B A respiratory rate of less than 12 breaths/min in a client receiving magnesium sulfate is a sign of magnesium toxicity, which must be immediately reversed. Calcium gluconate opposes the effects of magnesium at the neuromuscular junction and is an antidote for magnesium toxicity. Oxygen by mask at 8 to 10 L/min, arousing a client with tactile stimulation, and continually assessing pulse oximeter levels will not be effective until the magnesium toxicity has been reversed. PTS: 1 DIF: Cognitive Level: Application REF: 525

12. The priority nursing intervention when admitting a pregnant client who has experienced a bleeding episode in late pregnancy is to: a. monitor uterine contractions. b. assess fetal heart rate and maternal vital signs. c. place clean disposable pads to collect any drainage. d. perform a venipuncture for hemoglobin and hematocrit levels.

ANS: B Assessment of the fetal heart rate (FHR) and maternal vital signs will assist the nurse in determining the degree of the blood loss and its effect on the client and fetus. Monitoring uterine contractions is important, but not the top priority. It is important to assess future bleeding, but the top priority is client and fetal well-being. The most important assessment is to check client and fetal well-being. The blood levels can be obtained later. PTS: 1 DIF: Cognitive Level: Application REF: 516

25. A client taking magnesium sulfate has a respiratory rate of 10 breaths/min. In addition to discontinuing the medication, which action should the nurse take? a. Increase the client's IV fluids. b. Administer calcium gluconate. c. Vigorously stimulate the client. d. Instruct the client to take deep breaths.

ANS: B Calcium gluconate reverses the effects of magnesium sulfate. Increasing the client's IV fluids will not reverse the effects of the medication. Stimulation will not increase the respirations. Deep breaths will not be successful in reversing the effects of the magnesium sulfate. PTS: 1 DIF: Cognitive Level: Application REF: 525

11. Which would indicate concealed hemorrhage in abruptio placentae? a. Bradycardia b. Hard boardlike abdomen c. Decrease in fundal height d. Decrease in abdominal pain

ANS: B Concealed hemorrhage occurs when the edges of the placenta do not separate. The formation of a hematoma behind the placenta and subsequent infiltration of the blood into the uterine muscle results in a very firm, boardlike abdomen. The client will have shock symptoms that include tachycardia. The fundal height will increase as bleeding occurs. Abdominal pain may increase. PTS: 1 DIF: Cognitive Level: Analysis REF: 516

16. Rh incompatibility can occur if the client is Rh-negative and the: a. fetus is Rh-negative. b. fetus is Rh-positive. c. father is Rh-positive. d. father and fetus are both Rh-negative.

ANS: B For Rh incompatibility to occur, the mother must be Rh-negative and her fetus Rh-positive. If the fetus is Rh-negative, the blood types are compatible and no problems should occur. The father's Rh factor is a concern only as it relates to the possible Rh factor of the fetus. If the fetus is Rh-negative, the blood type with the mother is compatible. The father's blood type does not enter into the problem. PTS: 1 DIF: Cognitive Level: Understanding REF: 530

6. A client is admitted with vaginal bleeding at approximately 10 weeks of gestation. Her fundal height is 13 cm. Which potential problem should be investigated? a. Placenta previa b. Hydatidiform mole c. Abruptio placentae d. Disseminated intravascular coagulation (DIC)

ANS: B Gestational trophoblastic disease (hydatidiform mole) is usually detected in the first trimester of pregnancy. The frequency of this condition is highest at both ends of a woman's reproductive life. Placenta previa usually occurs in the third trimester. Painless uterine bleeding is the classic symptom. Abruptio placentae usually occurs in the third trimester. Painful uterine bleeding is the classic symptom. DIC is a life-threatening complication of abruptio placentae, in which procoagulation and anticoagulation factors are simultaneously activated. PTS: 1 DIF: Cognitive Level: Analysis REF: 510

36. Which finding could cause the nurse to suspect gestational trophoblastic disease in a client at 8 weeks' gestation? a. Blood pressure of 128/70 mm Hg b. Fundal height of 12 cm c. Nausea and vomiting d. Weight gain of 3 pounds

ANS: B Gestational trophoblastic disease is characterized by proliferation and edema of the chorionic villi. The fluid-filled villi form grapelike clusters of tissue that can rapidly grow to fill the uterus to the size of a more advanced pregnancy. Blood pressure of 128/70 mm Hg, nausea and vomiting, and weight gain of 3 pounds are all normal findings in the first trimester. PTS: 1 DIF: Cognitive Level: Analysis REF: 510

2. Which is the only known cure for preeclampsia? a. Magnesium sulfate b. Delivery of the fetus c. Antihypertensive medications d. Administration of aspirin (ASA) every day of the pregnancy

ANS: B If the fetus is viable and near term, birth is the only known cure for preeclampsia. Magnesium sulfate is one of the medications used to treat but not cure preeclampsia. Antihypertensive medications are used to lower the dangerously elevated blood pressures in preeclampsia and eclampsia. Low doses of aspirin (60 to 80 mg) have been administered to women at high risk for developing preeclampsia. PTS: 1 DIF: Cognitive Level: Understanding REF: 519

7. Which maternal condition always necessitates birth by cesarean section? a. Partial abruptio placentae b. Total placenta previa c. Ectopic pregnancy d. Eclampsia

ANS: B In total placenta previa, the placenta completely covers the cervical os. The fetus would die if a vaginal birth occurred. If the client has stable vital signs and the fetus is alive, a vaginal birth can be attempted. If the fetus has died, a vaginal birth is preferred. The most common ectopic pregnancy is a tubal pregnancy, which is usually detected and treated in the first trimester. Labor can be safely induced if the eclampsia is under control. PTS: 1 DIF: Cognitive Level: Understanding REF: 512

19. Which data found on a client's health history would place her at risk for an ectopic pregnancy? a. Ovarian cyst 2 years ago b. Recurrent pelvic infections c. Use of oral contraceptives for 5 years d. Heavy menstrual flow of 4 days' duration

ANS: B Infection and subsequent scarring of the fallopian tubes prevent normal movement of the fertilized ovum into the uterus for implantation. Ovarian cysts do not cause scarring of the fallopian tubes. Oral contraceptives do not increase the risk for ectopic pregnancies. Heavy menstrual flow of 4 days' duration will not cause scarring of the fallopian tubes, which is the main risk factor for ectopic pregnancies. PTS: 1 DIF: Cognitive Level: Understanding REF: 508

50. Which assessment finding suggests that your laboring client's blood magnesium level is too high? a. Hyperactive reflexes b. Absent reflexes c. Generalized seizure d. Urine output of 60 mL/hr

ANS: B Magnesium acts as a central nervous system depressant by blocking neuromuscular transmission. Assessment of the deep tendon reflexes is an indication of the level of CNS depression. Absent reflexes indicates magnesium toxicity; hyperactive reflexes, generalized seizure, and urine output of 60 mL/hr are not symptoms of magnesium toxicity. PTS: 1 DIF: Cognitive Level: Analysis REF: 526

40. Which assessment by the nurse would differentiate a placenta previa from an abruptio placentae? a. Saturated perineal pad in 1 hour b. Pain level 0 on a scale of 0 to 10 c. Cervical dilation at 2 cm d. Fetal heart rate at 160 bpm

ANS: B The classic sign of placenta previa is the sudden onset of painless uterine bleeding, whereas abruptio placentae results in abdominal pain and uterine tenderness; heavy bleeding, cervical dilation, and fetal heart rate of 160 bpm could be associated with both conditions. PTS: 1 DIF: Cognitive Level: Analysis REF: 513

29. A client who was pregnant had a spontaneous abortion at approximately 4 weeks' gestation. At the time of the miscarriage, it was thought that all products of conception were expelled. Two weeks later, the client presents at the clinic office complaining of "crampy" abdominal pain and a scant amount of serosanguineous vaginal drainage with a slight odor. The pregnancy test is negative. Vital signs reveal a temperature of 100° F, with blood pressure of 100/60 mm Hg, irregular pulse 88 beats/min (bpm), and respirations, 20 breaths/min. Based on these assessment data, what does the nurse anticipate as a clinical diagnosis? a. Ectopic pregnancy b. Uterine infection c. Gestational trophoblastic disease d. Endometriosis

ANS: B The client is exhibiting signs of uterine infection, with elevated temperature, vaginal discharge with odor, abdominal pain, and blood pressure and pulse manifesting as shock-trended vitals. Because the pregnancy test is negative, an undiagnosed ectopic pregnancy and gestational trophoblastic disease are ruled out. There is no supportive evidence to indicate a clinical diagnosis of endometriosis at this time; however, it is more likely that this is an infectious process that must be aggressively treated. PTS: 1 DIF: Cognitive Level: Analysis REF: 506

47. Which of these interventions should the nurse recognize as the priority for the client diagnosed with an intact tubal pregnancy? a. Assessment of pain level b. Administration of methotrexate c. Administration of Rh immune globulin d. Explanation of the common side effects of the treatment plan

ANS: B The goal of medical management of an intact tube is to preserve the tube and improve the chance of future fertility. Methotrexate (a folic acid antagonist) is used to inhibit cell division and stop growth of the embryo. Assessment of pain level, administration of Rh immune globulin, and explaining common side effects of the treatment plan should be implemented in conjunction with or soon after treatment with methotrexate has begun. PTS: 1 DIF: Cognitive Level: Analysis REF: 509

59. A health care provider reports to the labor nurse that a patient is being transferred from the clinic directly to the hospital with possible preeclampsia. What is the nurse's priority action when the patient is admitted? a. Obtain the patient's weight. b. Take the patient's vital signs. c. Start an IV with lactated Ringer's at 75 mL/hr. d. Ask support persons to leave the birthing room.

ANS: B The hallmark signs of preeclampsia are hypertension and proteinuria. These parameters must be evaluated first. Obtaining the patient's weight may indicate excess fluid gain, but fluid retention does not occur in all cases of preeclampsia. An IV will be beneficial; however, assessment precedes implementation in this case to obtain baseline data. Promoting a nonstimulating environment can help decrease blood pressure; however, loss of support during this frightening time can increase anxiety in this initial assessment phase and actually increase the patient's blood pressure. PTS: 1 DIF: Cognitive Level: Application REF: 519

61. A labor and birth nurse receives a call from the laboratory regarding a preeclamptic patient receiving an IV infusion of magnesium sulfate. The laboratory technician reports that the patient's magnesium level is 7.6 mg/dL. What is the nurse's priority action? a. Stop the infusion of magnesium. b. Assess the patient's respiratory rate. c. Assess the patient's deep tendon reflexes. d. Notify the health care provider of the magnesium level.

ANS: B The therapeutic serum level for magnesium is 4 to 8 mg/dL although it is elevated in terms of normal lab values. Adverse reactions to magnesium sulfate usually occur if the serum level becomes too high. The most important is CNS depression, including depression of the respiratory center. Magnesium is excreted solely by the kidneys, and the reduced urine output that often occurs in preeclampsia allows magnesium to accumulate to toxic levels in the woman. Frequent assessment of serum magnesium levels, deep tendon reflexes, respiratory rate, and oxygen saturation can identify CNS depression before it progresses to respiratory depression or cardiac dysfunction. Monitoring urine output identifies oliguria that would allow magnesium to accumulate and reach excessive levels. Discontinue magnesium if the respiratory rate is below 12 breaths/min, a low pulse oximeter level (<95%) persists, or deep tendon reflexes are absent. Additional magnesium will make the condition worse. PTS: 1 DIF: Cognitive Level: Analysis REF: 524

68. The nurse is monitoring a client with severe preeclampsia who is on IV magnesium sulfate. Which signs of magnesium toxicity should the nurse monitor for? (Select all that apply.) a. Cool, clammy skin b. Altered sensorium c. Pulse oximeter reading of 95% d. Respiratory rate of less than 12 breaths/min e. Absence of deep tendon reflexes

ANS: B, D, E Signs of magnesium toxicity include the following: · Respiratory rate of less than 12 breaths/min (hospitals may specify a rate < 14 breaths/min) · Maternal pulse oximeter reading lower than 95% · Absence of deep tendon reflexes · Sweating, flushing · Altered sensorium (confused, lethargic, slurred speech, drowsy, disoriented) · Hypotension · Serum magnesium value above the therapeutic range of 4 to 8 mg/dL Cold, clammy skin and a pulse oximeter reading of 95% would not be signs of toxicity. PTS: 1 DIF: Cognitive Level: Analysis REF: 508

63. A preeclamptic patient is receiving an IV infusion of magnesium sulfate. On assessment, the nurse notes that the patient's urinary output has been 20 mL/hr for the past 2 hours and her deep tendon reflexes are absent. The health care provider prescribes calcium gluconate, 1 g of a 10% solution. The standard rate of infusion is 1 mL/min. How many minutes will it take for the nurse to administer the prescribed calcium? a. 1 b. 5 c. 10 d. 15

ANS: C A 10% solution contains 10 g in 100 mL. X minutes = 1 minute ´ 100 mL ´ 1 g = 10 minutes 1 mL 10 g PTS: 1 DIF: Cognitive Level: Analysis REF: 528

53. Fraternal twins are delivered by your Rh-negative client. Twin A is Rh-positive and twin B is Rh-negative. Prior to administering Rho(D) immune globulin (RhoGAM), the nurse should determine the results of the: a. direct Coombs test of twin A. b. direct Coombs test of twin B. c. indirect Coombs test of the mother. d. transcutaneous bilirubin level for both twins.

ANS: C Administration of RhoGAM is based on the results of the indirect Coombs test on the client. A negative results confirms that the mother has not been sensitized by the positive Rh factor of twin A and that RhoGAM is indicated. A direct Coombs test is a diagnostic test used to determine maternal antibodies in fetal blood and to guide treatment of the newborn when Rh and ABO incompatibilities occur. Transcutaneous bilirubin is a noninvasive measure to determine the level of bilirubin in a newborn. PTS: 1 DIF: Cognitive Level: Analysis REF: 530

1. A client with preeclampsia is being treated with bed rest and intravenous magnesium sulfate. The drug classification of this medication is a: a. diuretic. b. tocolytic. c. anticonvulsant. d. antihypertensive.

ANS: C Anticonvulsant drugs act by blocking neuromuscular transmission and depress the central nervous system to control seizure activity. Diuresis is a therapeutic response to magnesium sulfate. A tocolytic drug slows the frequency and intensity of uterine contractions but is not used for that purpose in this scenario. Decreased peripheral blood pressure is a therapeutic response (side effect) of the anticonvulsant magnesium sulfate. PTS: 1 DIF: Cognitive Level: Understanding REF: 523

48. Which finding in the exam of a client with a diagnosis of threatened abortion would change the diagnosis to inevitable abortion? a. Presence of backache b. Rise in hCG level c. Clear fluid from vagina d. Pelvic pressure

ANS: C Clear fluid from the vagina indicates rupture of the membranes. Abortion is usually inevitable (cannot be stopped) when the membranes rupture, the presence of backache and pelvic pressure are common symptoms in threatened abortion, and a rise in the hCG level is consistent with a viable pregnancy. PTS: 1 DIF: Cognitive Level: Analysis REF: 506

39. Which finding in the assessment of a client following an abruption placenta could indicate a major complication? a. Urine output of 30 mL in 1 hour b. Blood pressure of 110/60 mm Hg c. Bleeding at IV insertion site d. Respiratory rate of 16 breaths/min

ANS: C DIC is a life-threatening defect in coagulation that may occur following abruptio placentae. DIC allows excess bleeding from any vulnerable area such as IV sites, incisions, gums, or nose. A urine output of 30 mL in 1 hour, blood pressure of 110/60 mm Hg, and respiratory rate of 16 breaths/min are normal findings in a postpartum client. PTS: 1 DIF: Cognitive Level: Analysis REF: 507

5. A nurse is explaining to the nursing students working on the antepartum unit how to assess edema. Which edema assessment score indicates edema of the lower extremities, face, hands, and sacral area? a. +1 b. +2 c. +3 d. +4

ANS: C Edema of the extremities, face, and sacral area is classified as +3 edema. Edema classified as +1 indicates minimal edema of the lower extremities. Marked edema of the lower extremities is +2 edema. Generalized massive edema (+4) includes the accumulation of fluid in the peritoneal cavity. PTS: 1 DIF: Cognitive Level: Application REF: 526

3. The clinic nurse is performing a prenatal assessment on a pregnant client at risk for preeclampsia. Which clinical sign is not included as a symptom of preeclampsia? a. Edema b. Proteinuria c. Glucosuria d. Hypertension

ANS: C Glucose into the urine is not one of the three classic symptoms of preeclampsia. The first sign noted by the pregnant client is rapid weight gain and edema of the hands and face. Proteinuria usually develops later than the edema and hypertension. The first indication of preeclampsia is usually an increase in the maternal blood pressure. PTS: 1 DIF: Cognitive Level: Application REF: 521

38. What is the priority nursing intervention for the client who has had an incomplete abortion? a. Methylergonovine (Methergine), 0.2 mg IM b. Preoperative teaching for surgery c. Insertion of IV line for fluid replacement d. Positioning of client in left side-lying position

ANS: C Initial treatment of an incomplete abortion should be focused on stabilizing the client's cardiovascular state. Methylergonovine would be administered after surgical treatment, preoperative teaching is not a priority until the client is stabilized, and the left side-lying position provides no benefit to the client in this situation. PTS: 1 DIF: Cognitive Level: Application REF: 506

24. Which assessment in a client diagnosed with preeclampsia who is taking magnesium sulfate would indicate a therapeutic level of medication? a. Drowsiness b. Urinary output of 20 mL/hr c. Normal deep tendon reflexes d. Respiratory rate of 10 to 12 breaths/min

ANS: C Magnesium sulfate is administered for preeclampsia to reduce the risk of seizures from cerebral irritability. Hyperreflexia (deep tendon reflexes above normal) is a symptom of cerebral irritability. If the dosage of magnesium sulfate is effective, reflexes should decrease to normal or slightly below normal levels. Drowsiness is another sign of CNS depression from magnesium toxicity. A urinary output of 20 mL/hr is not adequate output. A respiratory rate of 10 to 12 breaths/min is too slow and could be indicative of magnesium toxicity. PTS: 1 DIF: Cognitive Level: Analysis REF: 525

43. In addition to obtaining vital signs and FHT, what is a priority for the client with placenta previa? a. Determining cervical dilation b. Monitoring uterine contractions c. Estimating blood loss d. Starting a Pitocin drip

ANS: C Nursing assessments for the client with placenta previa focus on determining the amount of blood loss. The nurse does not perform vaginal exams on a client with placenta previa because of the risk of perforating the placenta, the client may or may not be experiencing contractions, and induction is not indicated for a client with placenta previa. PTS: 1 DIF: Cognitive Level: Application REF: 512

41. A blood-soaked peripad weighs 900 g. The nurse would document a blood loss of _____ mL. a. 1800 b. 450 c. 900 d. 90

ANS: C One g equals 1 mL of blood. PTS: 1 DIF: Cognitive Level: Application REF: 511

22. The primary symptom present in abruptio placentae that distinguishes it from placenta previa is: a. vaginal bleeding. b. rupture of membranes. c. presence of abdominal pain. d. changes in maternal vital signs.

ANS: C Pain in abruptio placentae occurs in response to increased pressure behind the placenta and within the uterus. Placenta previa manifests with painless vaginal bleeding. Both abruptio placentae and placenta previa may have vaginal bleeding. Rupture of membranes may occur with both conditions. Maternal vital signs may change with both if bleeding is pronounced. PTS: 1 DIF: Cognitive Level: Understanding REF: 515

51. What should the nurse recognize as evidence that the client is recovering from preeclampsia? a. 1+ protein in urine b. 2+ pitting edema in lower extremities c. Urine output >100 mL/hr d. Deep tendon reflexes +2

ANS: C Rapid reduction of the edema associated with preeclampsia results in urinary output of 4 to 6 L/day as interstitial fluids shift back to the circulatory system. 1+ protein in urine and 2+ pitting edema in lower extremities are signs of continuing preeclampsia. Deep tendon reflexes are not a reliable sign, especially if the client has been treated with magnesium. PTS: 1 DIF: Cognitive Level: Analysis REF: 525

34. The most appropriate nursing action for the client complaining of continuous headache 24 hours postpartum after a normal vaginal birth is to: a. encourage bed rest. b. administer analgesic. c. assess blood pressure. d. assess for pitting edema.

ANS: C The first indication of preeclampsia is usually hypertension. Continuous headache indicates poor cerebral perfusion and may be a precursor of seizures; encouraging bed rest, administering an analgesic, and assessing for edema are not interventions to determine the source of the client's headache. PTS: 1 DIF: Cognitive Level: Application REF: 521

14. A 17-year-old primigravida has gained 4 pounds since her last prenatal visit. Her blood pressure is 140/92 mm Hg. The most important nursing action is to: a. advise her to cut down on fast foods that are high in fat. b. caution her to avoid salty foods and to return in 2 weeks. c. assess weight gain, location of edema, and urine for protein. d. recommend she stay home from school for a few days to reduce stress.

ANS: C The nurse should further assess the client for hypertension, generalized edema, and proteinuria, which are classic signs of pregnancy-induced hypertension. Cutting down on fast foods will not relieve the symptoms of pregnancy-induced hypertension. She is at risk for pregnancy-induced hypertension and should be evaluated at this visit. Rest may be the treatment at first, but she needs further assessment to determine if pregnancy-induced hypertension is the problem. PTS: 1 DIF: Cognitive Level: Application REF: 526

27. You are taking care of a client who had a therapeutic abortion following an episode of vaginal bleeding and ultrasound confirmation of a blighted ovum. Lab work is ordered 2 weeks postprocedure as a follow-up to medical care. Which result indicates that additional intervention is needed? a. Hemoglobin, 13.2 mg/dL b. White blood cell count, 10,000 mm3 c. Beta-hCG detected in serum d. Fasting blood glucose level, 80 mg/dL

ANS: C The presence of beta-hCG in serum 2 weeks after the procedure is clinically significant and indicates the possibility that there may have been a molar pregnancy (hydatidiform). Thus, further examination is required. None of the other lab results warrant intervention because they are within normal limits. PTS: 1 DIF: Cognitive Level: Analysis REF: 509

57. The labor and birth nurse is reviewing the risk factors for placenta previa with a group of nursing students. The nurse determines that the students understood the discussion when they identify which patient being at the highest risk for developing a placenta previa? a. Female fetus, Mexican-American, primigravida b. Male fetus, Asian-American, previous preterm birth c. Male fetus, African-American, previous cesarean section d. Female fetus, European-American, previous spontaneous abortion

ANS: C The rate of placenta previa is increasing. It is more common in older women, multiparous women, women who have had cesarean births, and women who had suction curettage for an induced or spontaneous abortion. It is also more likely to recur if a woman has had a placenta previa. African or Asian ethnicity also increases the risk. Cigarette smoking and cocaine use are personal habits that add to a woman's risk for a previa. Previa is more likely if the fetus is male. The Mexican-American primipara has no risk factors for developing a placenta previa. The Asian-American multipara has two risk factors for developing a previa. The African-American multipara has three risk factors for developing a previa. The European-American multigravida has one risk factor for developing a placenta previa. PTS: 1 DIF: Cognitive Level: Synthesis REF: 513

20. Which finding on a prenatal visit at 10 weeks might suggest a hydatidiform mole? a. Blood pressure of 120/80 mm Hg b. Complaint of frequent mild nausea c. Fundal height measurement of 18 cm d. History of bright red spotting for 1 day weeks ago

ANS: C The uterus in a hydatidiform molar pregnancy is often larger than would be expected on the basis of the duration of the pregnancy. A client with a molar pregnancy may have early-onset, pregnancy-induced hypertension. Nausea increases in a molar pregnancy because of the increased production of human chorionic gonadotropin (hCG). The history of bleeding is normally described as being of a brownish color. PTS: 1 DIF: Cognitive Level: Analysis REF: 510

58. A patient presents to labor and birth with complaints of persistent acute back pain at 36 weeks' gestation. The nursing assessment reveals a taught abdomen, fundal height at 40 cm, and late decelerations, with an FHR range of 124 to 128 bpm. The nurse will implement the protocol for which obstetric condition? a. Placenta previa b. Hypovolemic shock c. Abruptio placentae or abruption d. DIC

ANS: C There are five classic signs and symptoms of abruptio placentae and include the following: bleeding, which may be evident vaginally or be concealed behind the placenta; uterine tenderness, which may be localized at the site of the abruption; uterine irritability, with frequent low-intensity contractions and poor relaxation between contractions; abdominal or low back pain that may be described as aching or dull; and high uterine resting tone identified with the use of an intrauterine pressure catheter. Additional signs include nonreassuring FHR patterns, signs of hypovolemic shock, and fetal death. With a placenta previa there is bright red and painless bleeding. Hypovolemic shock can result from an abruption; however, if the protocol for shock is initiated, some of the blood work that can confirm an abruption will be omitted (e.g., a Kleihauer-Betke test). DIC can result from an abruption. First, look for the cause. PTS: 1 DIF: Cognitive Level: Analysis REF: 515

10. A placenta previa when the placental edge just reaches the internal os is called: a. total. b. partial. c. low-lying. d. marginal.

ANS: D A placenta previa that does not cover any part of the cervix is termed marginal. With a total placenta previa, the placenta completely covers the os. With a partial previa, the lower border of the placenta is within 3 cm of the internal cervical os but does not completely cover the os. A complete previa is termed total. The placenta completely covers the internal cervical os. PTS: 1 DIF: Cognitive Level: Understanding REF: 513

42. Which assessment finding on the fetal monitor strip supports a diagnosis of abruptio placentae? a. FHR of 150 bpm b. Moderate variability of FHR c. Contractions every 3 minutes d. Uterine resting tone of 30 mm Hg

ANS: D Abruptio placentae results in uterine irritability and a high resting uterine tone. A normal resting tone is from 5 to 15 mm Hg; FHR of 150 bpm, moderate variability of FHR, and contractions every 3 minutes are normal labor findings. PTS: 1 DIF: Cognitive Level: Analysis REF: 515

17. In which situation would a dilation and curettage (D&C) be indicated? a. Complete abortion at 8 weeks b. Incomplete abortion at 16 weeks c. Threatened abortion at 6 weeks d. Incomplete abortion at 10 weeks

ANS: D D&C is carried out to remove the products of conception from the uterus and can be done safely until week 14 of gestation. If all the products of conception have been passed (complete abortion), a D&C is not done. If the pregnancy is still viable (threatened abortion), a D&C is not done. PTS: 1 DIF: Cognitive Level: Understanding REF: 506

55. The nurse is providing care to a patient who just learned her baby has died in utero at 26 weeks' gestation. What is the nurse's next action? a. Contact the patient's clergy member. b. Enroll the patient in a grief and loss class. c. Determine if the patient is a victim of violence. d. Ask the patient when she last felt the baby move.

ANS: D Determining fetal movement will give the nurse a basis for how long the fetus has been expired. This patient is at risk for developing DIC, and the longer the fetus has been expired, the greater the risk. All the interventions listed are worth considering for this patient; however, the nurse must meet the patient's immediate physical needs first. PTS: 1 DIF: Cognitive Level: Synthesis REF: 523

30. A client with no prenatal care delivers a healthy male infant via the vaginal route, with minimal blood loss. During the labor period, vital signs were normal. At birth, significant maternal hypertension is noted. When the client is questioned, she relates that there is history of heart disease in her family but that she has never been treated for hypertension. Blood pressure is treated in the hospital setting and the client is discharged. The client returns at her scheduled 6-week checkup and is found to be hypertensive. Which type of hypertension do you think the client is exhibiting? a. Pregnancy-induced hypertension (PIH) b. Gestational hypertension c. Preeclampsia superimposed on chronic hypertension d. Undiagnosed chronic hypertension

ANS: D Even though the client has no documented prenatal care or medical history, she does relate a family history that is positive for heart disease. Additionally, the client's blood pressure increased following birth and was treated in the hospital and resolved. Now the client appears at the 6-week checkup with hypertension. Typically, gestational hypertension resolves by the end of the 6-week postpartum period. The fact that this has not resolved is suspicious for undiagnosed chronic hypertension. There is no evidence to suggest that the client was preeclamptic prior to the birth. PTS: 1 DIF: Cognitive Level: Analysis REF: 515

49. Which assessment finding indicates the development of preeclampsia in the antepartum client? a. Slight edema of feet and ankles. b. Increased urine output c. Blood pressure of 128/80 mm Hg d. Weight gain of 3 pounds in 1 week

ANS: D Generalized edema often occurs with preeclampsia. Edema may first manifest as a rapid weight gain. Normal weight gain in the second and third trimesters is 1 pound per week; slight edema of feet and ankles, increased urine output, and blood pressure of 128/80 mm Hg are normal findings in pregnancy. PTS: 1 DIF: Cognitive Level: Analysis REF: 521, 522

15. A client with preeclampsia is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs indicate: a. gastrointestinal upset. b. effects of magnesium sulfate. c. anxiety caused by hospitalization. d. worsening disease and impending convulsion.

ANS: D Headache and visual disturbances are caused by increased cerebral edema. Epigastric pain indicates distention of the hepatic capsules and often warns that a convulsion is imminent. Gastrointestinal upset is not an indication as severe as the headache and visual disturbance. She has not yet been started on magnesium sulfate as a treatment. The signs and symptoms do not describe anxiety. PTS: 1 DIF: Cognitive Level: Analysis REF: 520

64. The nurse is providing care to a laboring woman who is Rh-negative. The patient has a standing prescription to receive RhoGAM, if indicated. When will the nurse plan on administering the RhoGAM, if indicated? a. Approximately 2 hours prior to birth b. At the birth of the placenta c. One hour after the birth of the infant d. Between 48 and 72 hours after birth of the infant

ANS: D If the mother is Rh-negative, umbilical cord blood is taken at birth to determine blood type, Rh factor, and antibody titer (direct Coombs test) of the newborn. Rh-negative unsensitized mothers who give birth to Rh-positive infants are given an intramuscular injection of Rho(D) immune globulin (RhoGAM) within 72 hours after birth. If RhoGAM is given to the mother in the first 72 hours after the birth of an Rh-positive infant, Rh antigens present in her blood are destroyed before she forms antibodies to the Rh factor. If the infant is Rh-negative, Rh antibodies are not formed and RhoGAM is not necessary. Patients of the Jehovah's Witness faith decline blood-based products, and RhoGAM is derived from blood. It is the responsibility of the nurse to make sure that patients of this faith understand the characteristics of RhoGAM and are fully informed of the consequences of declining the administration of RhoGAM. PTS: 1 DIF: Cognitive Level: Application REF: 530

13. A primigravida of 28 years of age is admitted to the antepartum unit with a diagnosis of hyperemesis gravidarum. Nursing care is based on which of the following? a. She should be isolated from her family. b. This condition is caused by psychogenic factors. c. The treatment is similar to that for morning sickness. d. She should be assessed for signs of dehydration and starvation.

ANS: D The cause of hyperemesis gravidarum is unknown, but dehydration and starvation are the major complications. Emotional support is essential to the care of this client. She needs the opportunity to express how it feels to live with constant nausea. The cause is unknown. The first attempts to control the nausea are to treat it like morning sickness, but if treatment is not successful, further care is needed. PTS: 1 DIF: Cognitive Level: Application REF: 518

33. A client who had premature rupture of the membranes (PROM) earlier in the pregnancy at 28 weeks returns to the labor unit 1 week later complaining that she is now in labor. The labor and birth nurse performs the following assessments. The vaginal exam is deferred until the physician is in attendance. The client is placed on electronic fetal monitoring (EFM) and a baseline FHR of 130 bpm is noted. No contraction pattern is observed. The client is then transferred to the antepartum unit for continued observation. Several hours later, the client complains that she does not feel the baby move. Examination of the abdomen reveals a fundal height of 34 cm. Muscle tone is no different from earlier in the hospital admission. The client is placed on the EFM and no fetal heart tones are observed. What does the nurse suspect is occurring? a. Placental previa b. Active labor has started c. Placental abruption d. Hidden placental abruption

ANS: D The client's signs and symptoms indicate that a hidden abruption is occurring. Fundal height has increased and there is an absence of fetal heart tones. This is a medical emergency and the physician should be contacted to come directly to the unit for intervention and imminent birth. PTS: 1 DIF: Cognitive Level: Analysis REF: 515

The nurse is caring for a pregnant patient with an arrhythmia. Which medication would be the safest to administer? 1 Digoxin (Lanoxin) 2 Verapamil (Calan) 3 Quinidine (Quinidex) 4 Lidocaine (Xylocaine)

1 Digoxin (Lanoxin) has shown no evidence of producing unfavorable side effects on the fetus. Therefore, the drug can be used to treat an arrhythmia in the patient. Limited data are available regarding verapamil (Calan). Therefore, prescribing verapamil (Calan) to the patient may not be safe and may cause teratogenic effects. Quinidine (Quinidex) may cause transient neonatal thrombocytopenia and damage to the eighth cranial nerve. There is no evidence that lidocaine (Xylocaine) has unfavorable side effects on the fetus, but high serum levels may cause central nervous system depression at birth. Therefore, verapamil (Calan), quinidine (Quinidex), and lidocaine (Xylocaine) should not be prescribed to the patient.

A pregnant patient has a sudden onset of seizures during the third trimester of pregnancy. After reviewing the patient's medical history, the nurse learns that the patient had hypertension and proteinuria since 21 weeks of gestation. What will the nurse infer from these findings? 1 The patient has eclampsia. 2 The patient has preeclampsia. 3 The patient has chronic hypertension. 4 The patient has gestational hypertension.

1 Eclampsia is a serious complication of pregnancy that is associated with the sudden onset of seizures. Eclampsia is usually preceded by premonitory signs and symptoms, including headache, blurred vision, abdominal pain, and altered mental status. However, convulsions can appear suddenly and without warning in a seemingly stable woman with only minimally elevated blood pressure. Preeclampsia is a condition in which the patient has hypertension and proteinuria after 20 weeks of gestation, but preeclampsia is not associated with seizures. If the patient has hypertension for more than 12 weeks after delivery, it indicates that patient has chronic hypertension. Gestational hypertension is not associated with onset of seizures and proteinuria. Therefore, the nurse would not infer that the patient has gestational hypertension.

The nurse is assessing a patient who is 18 weeks pregnant. The patient reports heavy bleeding, infection, and excessive cramping. Which treatment strategy should be included in the treatment plan? 1 Vacuum curettage 2 McDonald technique 3 Administration of methotrexate (MTX) 4 Administration of misoprostol (Cytotec)

1 Heavy bleeding, infection, and excessive cramping are signs and symptoms of miscarriage. In this situation, fetal or placental tissue must be removed from the uterus by suction curettage. McDonald technique is used in case of cervical insufficiency. In this technique, suture is placed around the cervix beneath the mucosa to constrict the internal os of the cervix. MTX is used in the treatment of ectopic pregnancy. Misoprostol (Cytotec) is prostaglandin drug. If bleeding and infection are absent, then misoprostol (Cytotec) is used for miscarriage.

The quantitative human chorionic gonadotropin (β-hCG) levels are high in a patient who is on methotrexate therapy for dissolving abdominal pregnancy. Which instruction does the nurse give to this patient? 1 "Avoid sexual activity." 2 "Avoid becoming pregnant again." 3 "Avoid feeling sad and low." 4 "Take folic acid without fail."

1 High β-hCG levels indicate that the abdominal pregnancy is not yet dissolved. Therefore the nurse advises the patient to avoid sexual activity until the β-hCG levels drop and the pregnancy is dissolved completely. If the patient engages in vaginal intercourse, the pelvic pressure may rupture the mass and cause pain. Abdominal pregnancy increases the chances of infertility or recurrent ectopic pregnancy in patients. However, the nurse need not instruct the patient to avoid further pregnancy, because it may increase the feelings of sadness and guilt in the patient. The nurse encourages the patient to share feelings of guilt or sadness related to pregnancy loss. Folic acid is contraindicated with methotrexate therapy, because it may exacerbate ectopic rupture.

The nurse is caring for a diabetic pregnant patient. Which conditions should the nurse expect to find in the patient's newborn? 1 Hypoglycemic and overweight 2 Hyperglycemic and normal weight 3 Hypoglycemic and underweight 4 Hyperglycemic and underweight

1 Maternal hyperglycemia produces fetal hyperglycemia by stimulating hyperinsulinemia and islet cell hyperplasia. This results in the impaired regulation of the hormone insulin in the fetus. Therefore, the newborn of a diabetic pregnant patient may be hypoglycemic and overweight. This happens from the loss of a maternal glucose source after birth. Hyperglycemia is observed in the fetus before birth. The child born to a diabetic mother will never be underweight. Therefore, the newborn will not be hyperglycemic and underweight.

The nurse is assessing a pregnant patient at 16 weeks of gestation. Which diagnostic test should the nurse say is used to identify neural tube defects in the fetus? 1 Serum alpha-fetoprotein 2 Fetal echocardiography 3 Glycosylated hemoglobin 4 Nonstress test (NST

1 Measurement of maternal serum alpha-fetoprotein is performed between 16 and 18 weeks of gestation to determine the risk of neural tube defects. The fetus is at increased risk for neural tube defects such as spina bifida, anencephaly, and microcephaly. Fetal echocardiography is performed between 20 and 22 weeks of gestation to detect cardiac anomalies. Glycosylated hemoglobin is measured to assess glycemic control over the previous 4 to 6 weeks. The nonstress test (NST) is performed between 28 and 32 weeks of gestation in patients with vascular disease or poor glucose control. The NST is used to evaluate fetal well-being.

The nurse is preparing a patient for abortion. Which medicine is administered to the patient after the evacuation of the uterus to prevent hemorrhage? 1 Oxytocin (Pitocin) 2 Misoprostol (Cytotec) 3 Vitamin K (Aqua-Mephyton) 4 Magnesium sulfate (Sulfamag)

1 Oxytocin (Pitocin) is administered to the patient to prevent hemorrhage after evacuation of the uterus. It prevents hemorrhage by causing contractions of the uterus. Misoprostol (Cytotec) is used to complete a missed miscarriage within 7 days. It helps by expelling the products of conception from the uterus. Vitamin K (Aqua-Mephyton) is used for the treatment of disseminated intravascular coagulation. Magnesium sulfate (Sulfamag) is used for tocolysis to suppress uterine contractions.

The nurse is assessing a group of pregnant women at a community health center. Which patients would be at highest risk for pregnancy-related complications? 1 The patient with uncontrolled diabetes mellitus 2 The patient who is of African-American descent 3 The patient who is between 30 and 33 years old 4 The patient with a history of alcohol consumptio

1 Patients with uncontrolled diabetes are at a higher risk of complications associated with pregnancy. If the pregnant mother develops uncontrolled hyperglycemia, this may produce hyperglycemia in the fetus. This in turn stimulates fetal hyperinsulinemia and islet cell hyperplasia. Hyperinsulinemia prevents fetal lung maturation and places the neonate at an increased risk of respiratory distress. African-American patients have an increased chance of having dizygotic twins. They do not have an increased risk of pregnancy-related complications. Patients within the age group of 30 to 33 years are not at risk for complications associated with pregnancy. Alcohol consumption during pregnancy leads to respiratory complications and fetal alcohol syndrome. However, patients with a history of alcohol consumption do not usually have pregnancy-related complications

The registered nurse is caring for a patient with anemia. The nurse advises the patient to have genetic counseling as a part of the preconception care. What type of anemia does the patient most likely have? 1 Sickle cell anemia 2 Megaloblastic anemia 3 Iron deficiency anemia 4 Folate deficiency anemia

1 Sickle cell anemia is a type of genetic blood disorder. It is caused from a genetic mutation of hemoglobin, which causes the patient to have sickle-shaped red blood cells. Therefore, patients with sickle cell anemia are recommended to have genetic counseling before becoming pregnant. Megaloblastic anemia occurs due to a defect in maturation of erythrocytes, which is not hereditary. Iron deficiency anemia can be treated with iron supplements and does not require any genetic counseling. Folate deficiency anemia is due to folic acid deficiency, and it is not a genetic disorder.

The nurse is caring for a patient with pulmonary stenosis. Upon conducting an echocardiogram, the nurse finds that the patient has a right-to-left shunt and right ventricular hypertrophy. What is the probable reason for these anatomical abnormities in the patient? 1 The patient has tetralogy of Fallot. 2 The patient has atrial septal defect. 3 The patient has patent duct arteriosus. 4 The patient has Marfan syndrome

1 Tetralogy of Fallot is a common cyanotic heart disease observed in patients during pregnancy. The disease is characterized by ventricular septal defect, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy. Tetralogy of Fallot also causes a right-to-left shunt in patients. Left-to-right shunt is observed in atrial septal defect and patent duct arteriosus. Marfan syndrome is a genetic disorder. Patients with Marfan syndrome have joint deformities and ocular lens dislocation. Marfan syndrome is not associated with right-to-left shunt or right ventricular hypertrophy.

What is the relatively common anemia know as thalassemia? 1 An insufficient amount of hemoglobin is produced to fill the red blood cells (RBCs). 2 RBCs have a normal life span but are sickled in shape. 3 Folate deficiency occurs. 4 There are inadequate levels of vitamin B12.

1 Thalassemia is a hereditary disorder that involves the abnormal synthesis of the α or β chains of hemoglobin. An insufficient amount of hemoglobin is produced to fill the RBCs. This is the underlying description for sickle cell anemia. Folate deficiency is the most common cause of megaloblastic anemias during pregnancy. B12 deficiency must also be considered if the pregnant woman presents with anemia.

The nurse is reviewing lab values to determine Rh incompatibility between mother and fetus. Which specific lab result should the nurse assess? 1 Indirect Coombs test 2 Hemoglobin level 3 Human chorionic gonadotropin (hCG) level 4 Maternal serum alpha-fetoprotein (MSAFP)

1 The indirect Coombs test is a screening tool for Rh incompatibility. If the maternal titer for Rh antibodies is greater than 1:8, amniocentesis for determination of bilirubin in amniotic fluid is indicated to establish the severity of fetal hemolytic anemia. Hemoglobin reveals the oxygen carrying capacity of the blood. hCG is the hormone of pregnancy. MSAFP levels are used as a screening tool for neural tube defects in pregnancy.

Which instructions does the nurse give to a patient who is prescribed methotrexate therapy for dissolving the tubal pregnancy? 1 "Discontinue folic acid supplements." 2 "Get adequate exposure to sunlight." 3 "Take stronger analgesics for severe pain." 4 "Vaginal intercourse is safe during the therapy."

1 The nurse advises the patient to discontinue folic acid supplements because they interact with methotrexate and may exacerbate ectopic rupture in the patient. Exposure to sunlight is avoided because the therapy makes the patient photosensitive. Analgesics stronger than acetaminophen are avoided because they may mask symptoms of tubal rupture. Vaginal intercourse is avoided until the pregnancy is dissolved completely.

The nurse observes that intravenous administration of magnesium sulfate has resulted in magnesium toxicity in a pregnant patient with preeclampsia. The nurse immediately discontinues the infusion and reports to the primary health care provider (PHP). For which drug does the nurse obtain a prescription from the PHP? 1 Calcium gluconate 2 Nifedipine (Adalat) 3 Hydralazine (Apresoline) 4 Labetalol hydrochloride (Normodyne)

1 The nurse needs to obtain a prescription for calcium gluconate because it acts as an antidote to magnesium toxicity. Nifedipine (Adalat) and labetalol hydrochloride (Normodyne) are antihypertensive medications, which are prescribed for gestational hypertension or severe preeclampsia. Hydralazine (Apresoline) is also an antihypertensive medication used for treating hypertension intrapartum.

The nurse is caring for a pregnant patient with gestational diabetes. What does the nurse teach the patient about diet during pregnancy? 1 Eat three meals a day with two or three snacks. 2 Avoid meals or snacks just before bedtime. 3 Use artificial sweeteners instead of sugar. 4 Avoid foods that are high in dietary fiber

1 The nurse should teach the patient to distribute her daily required calories into three meals with two or three snacks. In order to prevent hypoglycemia, the patient should eat meals on time and never skip meals. The patient should consume a bedtime snack of at least 25 g of complex carbohydrate with some protein or fat to prevent hypoglycemia and starvation ketosis during the night. The nurse should teach the patient to avoid the use of sweeteners that are nonnutritive and foods high in refined sugar. The patient should eat foods that are high in dietary fiber.

Upon reviewing the health history of a pregnant patient, the nurse finds that the patient has chronic glomerulonephritis. Which complication could occur if the patient and fetus are not managed effectively? 1 Retardation of fetal lung maturity 2 Retardation of fetal brain maturity 3 Retardation of immune system maturity 4 Retardation of fetal tubular heart maturity

1 The presence of pulmonary surfactants is used to determine the degree of fetal lung maturity. When a patient with a history of gestational diabetes or chronic glomerulonephritis becomes pregnant, this can slow down the development of the lungs of the fetus. Retardation of fetal brain maturity can cause motor, sensory, or cognitive disorders in the fetus after birth. Retardation of immune system maturity makes the fetus more susceptible to infections. Retardation of the fetal tubular heart maturity causes congenital heart diseases in the fetus after birth.

A nurse is caring for a woman with mitral stenosis who is in the active stage. Which action should the nurse take to promote cardiac function? 1 Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics. 2 Prepare the woman for delivery by cesarean section because this is the recommended delivery method to sustain hemodynamics. 3 Encourage the woman to avoid the use of narcotics or epidural regional analgesia because this alters cardiac function. 4 Promote the use of the Valsalva maneuver during pushing in the second stage to improve diastolic ventricular filling.

1 The side-lying position with the head and shoulders elevated helps facilitate hemodynamics during labor. A vaginal delivery is the preferred method for a woman with cardiac disease because it sustains hemodynamics better than a cesarean section. The use of supportive care, medication, and narcotics or epidural regional analgesia is not contraindicated with a woman with heart disease. Using the Valsalva maneuver during pushing in the second stage should be avoided because it reduces diastolic ventricular filling and obstructs left ventricular outflow.

The nurse is educating a patient who has experienced a hemorrhagic complication early in her pregnancy. What foods does the nurse encourage the patient to eat in order to increase hemoglobin (Hgb) and hematocrit (Hct) levels? Select all that apply. 1 Liver 2 Dried fruits 3 Milk and cheese 4 Strawberries 5 Green peppers 6 Dark-green, leafy vegetables

1,2 6 To increase Hgb and Hct values, the patient should eat foods that are high in iron. These include liver, dried fruits, and dark-green, leafy vegetables. Milk and cheese are not high in iron. Strawberries and green peppers are high in vitamin C, which helps prevent infection but does not address low levels of iron.

The nurse is using White's classification of diabetes in pregnancy. What are the features of White's classification? Select all that apply. 1 It considers the duration of diabetes in the patient. 2 It is based on the age at which diabetes was diagnosed. 3 It is based on the involvement of the eye and the kidneys. 4 It classified as type 1, type 2, others, and gestational diabetes. 5 It considers two groups with and without vascular complications.

1,2,3 The White's classification system considers the duration of diabetes in the patient. It is based on the age at which the illness was diagnosed. It also considers the involvement of the end-organs, which are the eye and the kidneys. The American Diabetes Association (ADA) classifies diabetes into four mutually exclusive categories. They are type 1, type 2, others, and gestational diabetes. In this classification method, type 1 and type 2 diabetes are further classified into two groups. One group includes those with vascular complications and the other group includes those without vascular complications.

The home care nurse is preparing to visit a pregnant patient with diabetes. What previsit preparation work does the nurse need to undertake? Select all that apply. 1 Contact the family to confirm address and route. 2 Ask the patient about the most convenient time to visit. 3 Review and clarify patient data with the provider. 4 Avoid carrying large bags and heavy equipment. 5 Bring along detailed written care instructions for the patient.

1,2,3 The nurse should contact the family before visiting the patient to confirm the address and route. The nurse also must schedule the visit at a convenient time for the patient. The nurse should review and clarify previous patient data with the primary care physician to understand the patient's condition. The nurse should bring along any equipment that is required for the assessment and proper care of the patient, even if that equipment is large or heavy. The nurse may provide written care instructions after assessing the patient, as per the patient's condition and issues, and may not have enough information before assessment to bring the instructions along.

While reviewing the reports of a pregnant patient, the nurse finds that the patient is severely anemic. Which supplements does the nurse recommend for the patient? Select all that apply. 1 Iron 2 Zinc 3 Copper 4 Sodium 5 Calcium

1,2,3 The patient is severely anemic. Therefore, the pregnant patient needs to take iron supplements in large amounts. Consumption of large amounts of iron supplements inhibits the absorption of zinc and copper. Copper and zinc are important in a pregnant woman to prevent central nervous system malformation in the fetus. During pregnancy, sodium or calcium supplements are not required. The recommended daily intake is sufficient to meet the pregnancy needs.

The nurse is caring for a patient who is in the 9th month of pregnancy and is experiencing dehydration. What risk is increased in the patient due to dehydration? Select all that apply. 1 Cramping 2 Contractions 3 Preterm labor 4 Fetal neurotoxicity 5 Physiologic anemia

1,2,3 Water is the main substance of cells, blood, lymph, amniotic fluid, and other vital body fluids. It is essential during the exchange of nutrients and waste products across cell membranes. The recommended daily intake is eight to ten glasses (2.3 L) of fluid. Dehydration may increase the risk for cramping, contractions, and preterm labor. Fetal neurotoxicity may occur due to consumption of fish with high levels of mercury. Physiologic anemia may occur due to iron deficiency.

The nurse is caring for a pregnant patient who is diagnosed with a urinary tract infection (UTI). Which symptoms of a UTI does the nurse expect to find in the patient? Select all that apply. 1 Dysuria 2 Dribbling 3 Hematuria 4 Urinary frequency 5 Odor of vaginal discharge

1,2,3,4 Lower urinary tract infections occur because of physiologic changes during pregnancy. Dysuria, or painful urination, may be caused by acidic pH of the urine due to infection. Urine may dribble because the infection may cause impaired function of the urethral sphincter. The urine may contain red blood cells, leading to hematuria. Impaired urethral sphincter and irritation of the bladder mucosa may lead to increased urinary frequency. A vaginal infection would produce a foul odor in vaginal discharge.

The nurse is caring for a pregnant patient admitted with vaginal bleeding. When taking the patient's history, the nurse is using open-ended questions. What are some additional ways to encourage this patient to share her information? Select all that apply. 1 Facilitation 2 Reflection 3 Clarification 4 Interruption 5 Confrontation 6 Empathic responses

1,2,3,5,6 Some additional ways to encourage this patient to share her information include facilitation, reflection, clarification, interpretation (not interruption), confrontation, and empathic responses.

Which hypertensive disorders can occur during pregnancy? Select all that apply. 1 Chronic hypertension 2 Preeclampsia-eclampsia 3 Hyperemesis gravidarum 4 Gestational hypertension 5 Gestational trophoblastic disease

1,2,4 Chronic hypertension refers to hypertension that developed in the pregnant patient before 20 weeks of gestation. Preeclampsia refers to hypertension and proteinuria that develops 20 weeks after gestation. Eclampsia is the onset of seizure activity in a pregnant patient with preeclampsia. Gestational hypertension is the onset of hypertension after 20 weeks of gestation. Gestational trophoblastic disease and hyperemesis gravidarum are not hypertensive disorders. Gestational trophoblastic disease refers to a disorder without a viable fetus that is caused by abnormal fertilization. Hyperemesis gravidarum is excessive vomiting during pregnancy that may result in weight loss and electrolyte imbalance.

What does the nurse assess to detect the presence of a hypertensive disorder in a pregnant patient? Select all that apply. 1 Proteinuria 2 Epigastric pain 3 Placenta previa 4 Presence of edema 5 Blood pressure (BP)

1,2,4,5 Proteinuria indicates hypertension in a pregnant patient. Proteinuria is concentration ≥300 mg/24 hours in a 24-hour urine collection. The nurse needs to assess the patient for epigastric pain because it indicates severe preeclampsia. Hypertension is likely to cause edema or swollen ankles due to greater hydrostatic pressure in the lower parts of the body. Therefore the nurse needs to assess the patient for the presence of edema. Accurate measurement of BP will help detect the presence of any hypertensive disorder. A systolic BP >140 mm Hg or a diastolic BP >90 mm Hg will indicate hypertension. Placenta previa is a condition wherein the placenta is implanted in the lower uterine segment covering the cervix, which causes bleeding when the cervix dilates.

An 8-month-pregnant patient presents with preeclampsia. Which clinical findings in the patient indicate that the disease has progressed to HELLP syndrome? Select all that apply. 1 Hepatic dysfunction 2 Elevated liver enzymes 3 Vaginal bleeding 4 Low platelet count 5 Chronic hypertension

1,24 Hepatic dysfunction in a patient with preeclampsia indicates that the disease has progressed to HELLP syndrome. It can result in both endothelial damage and fibrin deposits in the liver. Hepatic tissue damage results in elevated liver enzymes. Narrowed blood vessels damage the red blood cells (RBCs), and they become hemolyzed, resulting in a decreased RBC and platelet count. Vaginal bleeding is sometimes seen in patients with severe gestational hypertension or those who are at risk for miscarriage. Chronic hypertension is a condition in which patients develop hypertension before the pregnancy. It is not related to HELLP syndrome.

Which medication should be administered to manage excessive bleeding in a woman after a miscarriage? Select all that apply. 1 Oxytocin (Pictoin) 2 Ampicillin (Amcill) 3 Ergonovine (Methergine) 4 Magnesium sulfate (Sulfamag) 5 Misoprostol (Cytotec)

1,3 Ergonovine (Methergine) is used to promote uterine contractions (UCs), which, in turn, prevent excessive bleeding following a miscarriage. Oxytocin (Pitocin) is used to prevent uterine hemorrhage. Ampicillin (Amcill) is an antibiotic used to treat infection, but it does not prevent bleeding. Magnesium sulfate (Sulfamag) is used to suppress UCs. Misoprostol (Cytotec) is a prostaglandin medication that can be used to manage the miscarriage, but only if there is no bleeding and infection.

What are the manifestations associated with hypoglycemia? Select all that apply. 1 Dizziness 2 Fruity breath 3 Blurred vision 4 Excessive hunger 5 Presence of acetone in urine

1,3,4 Hypoglycemia refers to decreased blood sugar levels. Decreased availability of glucose impairs brain function, which results in dizziness and blurred vision. Decreased glucose levels stimulate the satiety center of the brain, which results in excessive hunger. Fruity breath and the presence of acetone in urine result from increased ketone levels in the blood. This complication may occur when the blood glucose increases over 300 mg/dL in the nonpregnant patient and 200 mg/dL in the pregnant patient.

A patient is administered magnesium sulfate (Epsom salts) as a part of tocolytic therapy. Which signs and symptoms should the nurse monitor in the patient? Select all that apply. 1 Diplopia 2 Tremors 3 Hot flushes 4 Drowsiness 5 Tachycardia

1,3,4 Magnesium sulfate (Epsom salt) is a tocolytic agent that relaxes smooth muscles, including those of the uterus during preterm labor. Diplopia, hot flushes, and drowsiness are maternal adverse effects of magnesium sulfate (Epsom salt). Tremors and tachycardia are not associated with magnesium sulfate (Epsom salt).

Which of the following findings is not likely to be seen in a pregnant patient who has hypothyroidism? 1 Miscarriage 2 Macrosomia 3 Gestational hypertension 4 Placental abruption

2 Infants born to mothers with hypothyroidism are more likely to be of low birth weight or preterm. These outcomes can be improved with early diagnosis and treatment. Hypothyroidism is often associated with both infertility and an increased risk of miscarriage. Pregnant women with hypothyroidism are more likely to experience both preeclampsia and gestational hypertension. Placental abruption and stillbirth are risks associated with hypothyroidism.

The nurse administers magnesium sulfate (Epsom salts) to stop labor in a pregnant patient. Which symptoms should the nurse monitor to ensure the patient's safety? 1 Swollen legs 2 Respiratory rate 3 Eating patterns 4 Maternal chills

2 Magnesium sulfate (Epsom salts) is administered to a pregnant patient to stop labor. Magnesium sulfate (Epsom salts) causes respiratory depression as a toxic effect. Therefore, the nurse should monitor the respiratory rate of the patient. Swollen legs or edema is a common observation during labor, which is caused by increased abdominal contents. Edema is unrelated to magnesium sulfate. Magnesium sulfate (Epsom salts) does not alter a patient's eating habits. Maternal chills are observed in patients with membrane rupture and are unrelated to magnesium sulfate (Epsom salts).

The nurse is caring for a patient with severe preeclampsia who is on an intravenous infusion of magnesium sulfate (Sulfamag). What assessment parameter indicates that the treatment is a success? 1 Edema is reduced 2 Seizures do not occur 3 Blood pressure is reduced 4 Respiratory rate is reduced

2 Magnesium sulfate (Sulfamag) is administered to a patient with preeclampsia to prevent seizures. The treatment is evaluated as successful if the seizures cease. A decrease in edema and blood pressure indicates reduced severity of preeclampsia in the patient but is not caused by the magnesium sulfate (Sulfamag). A decreased respiratory rate in the patient is considered an adverse effect of magnesium sulfate (Sulfamag) and requires the primary health care provider to attend to the patient immediately.

A woman with severe preeclampsia is being treated with an intravenous infusion of magnesium sulfate. This treatment is considered successful if what happens? 1 Blood pressure is reduced to prepregnant baseline. 2 Seizures do not occur. 3 Deep tendon reflexes become hypotonic. 4 Diuresis reduces fluid retention.

2 Magnesium sulfate is a central nervous system depressant given primarily to prevent seizures. A temporary decrease in blood pressure can occur; however, this is not the purpose of administering this medication. Hypotonia is a sign of an excessive serum level of magnesium. It is critical that calcium gluconate be on hand to counteract the depressant effects of magnesium toxicity. Diuresis is not an expected outcome of magnesium sulfate administration.

Which form of heart disease in women of childbearing years usually has a benign effect on pregnancy? 1 Cardiomyopathy 2 Mitral valve prolapse 3 Rheumatic heart disease 4 Congenital heart disease

2 Mitral valve prolapse is a benign condition that is usually asymptomatic. Cardiomyopathy produces congestive heart failure during pregnancy. Rheumatic heart disease can lead to heart failure during pregnancy. Some congenital heart diseases will produce pulmonary hypertension or endocarditis during pregnancy.

A pregnant patient experienced preterm labor at 30 weeks of gestation. Upon assessing the patient, the nurse finds that the newborn is at risk of having cerebral palsy. Which medication administration should the nurse perform to prevent cerebral palsy in the newborn? 1 Calcium gluconate 2 Magnesium sulfate 3 Glucocorticoid drugs 4 Antibiotic medications

2 Newborns who are born before 32 weeks' gestation may be at risk of cerebral palsy. Administering magnesium sulfate to the patient can prevent this risk, because it would delay delivery. Calcium gluconate is administered when the preterm child has magnesium toxicity. This intervention would not help to prevent cerebral palsy. Also, the newborn would not have a fully developed respiratory system. Therefore, administering glucocorticoids to the pregnant patient would help to prevent risk of respiratory depression in the baby. However, it does not help in preventing cerebral palsy. Administering antibiotics during labor would help prevent neonatal group B streptococci infection.

The nurse explains to the nursing student that the most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is what? 1 Bleeding 2 Intense abdominal pain 3 Uterine activity 4 Cramping

2 Pain is absent with placenta previa and may be agonizing with abruptio placentae. Bleeding may be present in varying degrees for both placental conditions. Uterine activity may be present with both placental conditions. Cramping is a form of uterine activity that may be present in both placental conditions.

Which finding in a urine specimen of a pregnant patient indicates the patient has proteinuria? 1 Value of greater than or equal to 0.5+ protein in a dipstick testing 2 Protein concentration that is greater than 300 mg/24 hours 3 Concentration of greater than or equal to 1 g protein in a 24-hour urine collection 4 Protein concentration at 10 mg/dL in random urine specimen

2 Proteinuria is determined from dipstick testing on a clean-catch or catheterized urine specimen or evaluation of a 24-hour urine collection. Protein concentration that is greater than 300 mg/24 hours in a 24-hour urine specimen indicates proteinuria. A concentration of greater than or equal to 5 g protein in a 24-hour urine collection will indicate severe preeclampsia. Protein concentration greater than 30 mg/dL in at least two random urine specimens collected at least 6 hours apart will indicate proteinuria. Value of greater than or equal to 1+ on dipstick measurement indicates proteinuria.

The nurse is caring for a patient with rheumatic heart disease (RHD). Which medication would the primary health care provider prescribe to prevent pulmonary edema? 1 Verapamil (Isoptin) 2 Furosemide (Lasix) 3 Atenolol (Tenormin) 4 Warfarin (Coumadin)

2 RHD causes pulmonary edema, atrial fibrillation, right-sided heart failure, infective endocarditis, pulmonary embolism, and massive hemoptysis. Diuretics, such as furosemide (Lasix), are used to prevent pulmonary edema. Calcium channel blockers, such as verapamil (Isoptin), are used to prevent atrial fibrillation and control the patient's heart rate. Beta-blockers, such as atenolol (Tenormin), prevent tachycardia. Anticoagulant therapy involving warfarin (Coumadin) is needed to prevent pulmonary embolism.

The nurse observes that an Rh-negative patient gave birth to an Rh-positive infant. What dosage of RhO(D) immunoglobulin should the nurse prepare to administer? 1 50 mcg 2 300 mcg 3 400 mcg 4 500 mcg

2 RhoGAM (WinGAM) is an RhO(D) immunoglobulin used to prevent sensitization in an Rh-negative mother whose fetus is Rh positive; 300 mcg RhoGAM (WinGAM) is injected intramuscularly to the Rh-negative mother within 72 hours of the birth. 50 mcg RhoGAM (WinGAM) is administered after chorionic villus sampling, ectopic pregnancy, miscarriage, or abortion before 13 weeks of gestation; 400 mcg and 500 mcg (more than 300 mcg) RhoGAM (WinGAM) are used in cases of large transplacental hemorrhage and mismatched blood transfusion.

A pregnant patient has a systolic blood pressure (BP) that exceeds 160 mm Hg. Which action should the nurse take for this patient? 1 Monitor uterine contractions (UCs). 2 Obtain a prescription for antihypertensive medications. 3 Restrict intravenous and oral fluids to 125 mL per hour. 4 Monitor fetal heart rate (FHR).

2 Systolic BP exceeding 160 mm Hg indicates severe hypertension in the patient. The nurse should alert the health care provider and obtain a prescription for antihypertensive medications, such as nifedipine (Adalat) and labetalol hydrochloride (Normodyne). Oral and intravenous fluids are restricted when the patient is at risk for pulmonary edema. Monitoring FHR and UCs is a priority when the patient experiences a trauma, so that any complications can be addressed immediately.

A patient who is planning for a pregnancy and has type 1 diabetes mellitus is seeking preconception care. On which aspect does the nurse primarily focus while planning preconception care for the patient? 1 Prevention of miscarriage 2 Prevention of maternal hypertension 3 Prevention of fetal malformations 4 Prevention of unintended pregnancy

2 The offspring of women with type 1 diabetes mellitus have a higher chance of fetal malformations than the offspring of women who do not have diabetes mellitus. Therefore, preconception care should be mainly focused on the prevention of fetal malformations. The prevention of miscarriage should be a focus of preconception care for patients with histories of miscarriage or preterm labor. Maintenance of normal glucose levels is more relevant than maintenance of blood pressure for women with type 1 diabetes mellitus. Prevention of unintended pregnancy is not relevant for the patient who is planning a pregnancy.

The nurse is assessing a 28-year-old female patient who has come to the clinic because of abdominal pain and vaginal "spotting." The patient's period is late. Upon further questioning, the nurse learns that the patient has a history of chlamydia and has had two abortions. What does the nurse suspect? 1 Placenta previa 2 Ectopic pregnancy 3 Hydatidiform mole 4 Hypovolemic shock

2 The patient is exhibiting classic signs of an ectopic pregnancy. These include a missed period, a positive pregnancy test, abdominal pain, and vaginal spotting. History of sexually transmitted diseases and multiple abortions are among the risk factors. A missed period, history of sexually transmitted diseases, and multiple abortions are not risk factors for the other complications listed. Placenta previa is a hemorrhagic condition of late pregnancy in which the placenta is implanted in the lower uterus. Hydatidiform mole involves vaginal bleeding, but the greatest risk is at both far ends of a woman's reproductive life. It would also be suspected later, once a pregnancy is further along. Hypovolemic shock is associated with hemorrhagic conditions of late pregnancy.

The nurse is caring for a pregnant patient who reports fatigue due to anemia. Which nursing intervention helps manage anemia in the patient? 1 Advise the patient to rest as needed. 2 Advise the patient to eat a well-balanced diet. 3 Discuss the use of support systems with the patient. 4 Reassure the patient of the transitory nature of fatigue.

2 The pregnant patient may feel fatigued during the first trimester due to hormonal changes. The nurse should advise the patient to eat a well-balanced diet to meet the increased metabolic demands and avoid anemia. Advising the patient to rest and use support systems, and emphasizing the transitory nature of fatigue, reduces fatigue in the patient but has no effect in treating anemia.

A woman in labor at 34 weeks of gestation is hospitalized and treated with intravenous magnesium sulfate for 18 to 20 hours. When the magnesium sulfate is discontinued, which oral drug will be prescribed for continuation of the tocolytic effect? 1 Buccal oxytocin (Pitocin) 2 Terbutaline sulfate (Brethine) 3 Calcium gluconate (Calgonate) 4 Magnesium sulfate (Magnesium sulfate)

2 The woman receiving decreasing doses of magnesium sulfate often is switched to oral terbutaline to maintain tocolysis. Buccal oxytocin increases the strength of contractions and is used to augment or stimulate labor. Buccal oxytocin dosing is uncontrollable. Calcium gluconate reverses magnesium sulfate toxicity. The drug should be available for complications of magnesium sulfate therapy. Magnesium sulfate usually is given intravenously or intramuscularly. The patient must be hospitalized for magnesium therapy because of the serious side effects of this drug.

With regard to preeclampsia and eclampsia, nurses should be aware of what information? 1 Preeclampsia is a condition of the first trimester; eclampsia is a condition of the second and third trimesters. 2 Preeclampsia results in decreased function in such organs as the placenta, kidneys, liver, and brain. 3 The causes of preeclampsia and eclampsia are well documented. 4 Severe preeclampsia is defined as preeclampsia plus proteinuria.

2 Vasospasms diminish the diameter of blood vessels; this impedes blood flow to all organs. Preeclampsia occurs after week 20 of gestation and can run for the duration of the pregnancy. The causes of preeclampsia and eclampsia are unknown, although several have been suggested. Preeclampsia includes proteinuria; severe cases are characterized by greater proteinuria or any of nine other conditions.

The nurse is informing a diabetic pregnant patient about the dietary changes, need for exercise, and possible risks to the fetus. Which fetal risks does the nurse need to inform the patient about? Select all that apply. 1 Fetal microsomia 2 Hypoglycemia 3 Respiratory distress syndrome 4 Galactosemia 5 Phenylketonuria

2,3 Hypoglycemia is seen in infants of diabetic women at birth, because the infant's glucose supply is removed abruptly at the time of birth. Fetal macrosomia (not microsomia) is seen in some infants born to diabetic women due to maternal hyperlipidemia and increased lipid transfer to the fetus. Hyperinsulinemia and hyperglycemia reduce fetal surfactant synthesis and cause respiratory distress syndrome in the infant of a diabetic woman. Galactosemia is an autosomal recessive disorder that results from various gene mutations. Phenylketonuria is an inborn error of metabolism.

The blood group of a patient who is 36 weeks pregnant is A negative. The patient's first child's blood group is A positive and the fetus is B positive. The ultrasonography reports of the patient indicate accumulation of fluid and swelling in the abdominal area of the fetus. Which treatment strategy will be beneficial to prevent intrauterine death? Select all that apply. 1 Monitoring the fetal bilirubin levels regularly 2 Administering medications to cause early labor 3 Transfusing O negative blood to the umbilical vein 4 Administering intravenous diuretics to the patient 5 Monitoring the patient's blood glucose levels regularly

2,3 When the mother is Rh negative and the fetus is Rh positive, it may result in Rh incompatibility or isoimmunization. Severe Rh incompatibility can cause hydrops fetalis, resulting in fetal death due to destruction of red blood cells. Intrauterine transfusion of O-negative blood by umbilical vein helps to prevent anemia and fetal death. Early birth of the fetus prevents contact with maternal blood and intrauterine death. Therefore, the primary health care provider would prescribe medications to induce early labor. Monitoring fetal bilirubin levels may help detect jaundice but may not be helpful in preventing intrauterine death because of Rh incompatibility. Intravenous diuretics help to reduce edema and swelling in the patient, but they do not prevent Rh incompatibility or fetal death. Rh incompatibility is not associated with an increase in blood glucose levels.

In reviewing the history of a woman who wants to become pregnant, which medication profile would indicate a potential concern relative to toxic exposure? Select all that apply. 1 Tylenol OTC occasionally for a headache twice last week 2 Anticonvulsant for seizure disorder 3 Patient being treated for bipolar disorder with lithium 4 Patient has been treated with Coumadin for A Fib 5 Taking multivitamins once a day

2,3,4 A patient being treated with an anticonvulsant is at risk for toxic effects during pregnancy. A patient who is being treated with lithium is at risk for toxic effects during pregnancy. Coumadin can place a patient at risk during pregnancy. Although Tylenol can have toxic effects on the liver, the reported frequency is not a concern at this time. Taking multivitamins is a healthy recommended option.

What are the manifestations of HELLP syndrome? Select all that apply. 1 Hemolysis 2 Tachycardia 3 Hyperventilation 4 Low platelet count 5 Elevated liver enzymes

2,4,5 HELLP syndrome is a serious condition that may develop during pregnancy in a patient with preeclampsia. It is characterized by hemolysis due to the breakdown of red blood cells. The patient may have a low platelet count, increasing the risk of bleeding and elevated liver enzymes due to impaired functioning of the liver. HELLP is not associated with an increase in heart rate and may not result in tachycardia. The pulmonary functioning is not impaired in the patient with HELLP syndrome. Therefore, hyperventilation is not a manifestation of HELLP syndrome.

The nurse is caring for a pregnant patient who is administered magnesium sulfate to prevent preterm labor. Which parameters should the nurse assess in the patient to determine drug toxicity? Select all that apply. 1 Fluid intake 2 Respiratory status 3 Body temperature 4 Level of consciousness 5 Deep tendon reflexes

2,4,5 Magnesium sulfate, when used as a tocolytic agent, depresses the central nervous system (CNS). The CNS depressive effect would be enhanced if the drug reaches toxic levels. CNS activity can be determined by assessing the respiratory status, level of consciousness, and deep tendon reflexes. A low respiratory rate, decreased level of consciousness, and slow reflexes indicate magnesium sulfate toxicity. Fluid intake and body temperature are not affected by CNS depression.

The nurse is caring for a pregnant patient with a body mass index (BMI) of 32 kg/m2. The patient gives birth at 40 weeks of gestation by cesarean. Which postpartum intervention does the nurse plan to implement after childbirth? Select all that apply. 1 Avoid ambulation until the patient's BMI improves. 2 Provide sequential compression device (SCD) boots. 3 Provide the sufficient nutrition to the preterm neonate. 4 Administer glucose therapy to the patient. 5 Implement strategies to prevent infection in the patient.

2,5 A BMI of 32 kg/m2 indicates that the patient is obese. Obesity increases the risk of thromboembolism following the delivery. SCD boots are used postoperatively to decrease the risk of clot formation. A cesarean delivery may increase the risk of infection in patients who are obese due to concurrent morbidities. Therefore, infection control measures should be taken. The patient should be encouraged to ambulate early on to prevent pulmonary and vascular complications. The neonate born after 40 weeks of gestation is considered postterm; a preterm neonate is born before 37 weeks of gestation. Aggressive glucose is appropriate for a pregnant woman who is in labor to prevent hypoglycemia, but a postoperative patient may not need glucose therapy.

The nurse is assessing a patient with hyperemesis gravidarum during the early stages of pregnancy. Which nonpharmacologic measure is appropriate to alleviate the discomforts associated with nausea and vomiting? 1 Having the patient cook her favorite foods 2 Allowing frequent visits from friends 3 Providing environment that is free from odors 4 Having the patient eat warm, low-fat, soupy foods

3 The patient must be allowed to rest in an environment that is free from odors. This helps to alleviate the discomforts associated with hyperemesis gravidarum. Most patients find exposure to cooking odors nauseating; it is better to have other family members cook for the patient. It is important for the patient to have limited periods of visitation and receive adequate rest, because sleep disturbances accompany hyperemesis. The patient is able to tolerate dry, cold foods better than warm, soupy foods.

A woman presents to the emergency department complaining of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary health care provider finds that the cervix is closed. The anticipated plan of care for this woman is based on a probable diagnosis of which type of spontaneous abortion? 1 Incomplete 2 Inevitable 3 Threatened 4 Septic

3 A woman with a threatened abortion presents with spotting, mild cramps, and no cervical dilation. A woman with an incomplete abortion presents with heavy bleeding, mild to severe cramping, and cervical dilation. An inevitable abortion presents with the same symptomatology as an incomplete abortion: heavy bleeding, mild to severe cramping, and cervical dilation. A woman with a septic abortion presents with malodorous bleeding and typically a dilated cervix.

An Rh-negative woman has a miscarriage during the 8th week of pregnancy and a dilation and curettage is required. Which priority intervention would be required in the recovery period following the surgical procedure? 1 Type and screen for two units of blood. 2 Maintain hydration level by increasing fluids by mouth. 3 Administer Rhogam. 4 Fundal massage.

3 Administering Rhogam would be a priority intervention, because the patient is Rh negative and there is no way to determine the Rh status of the fetus. Type and screen would not be indicated as if the patient were to require a blood transfusion; this would not reflect holding blood. Although it would be important to maintain the patient's hydration level, this could be done if needed via the parenteral route. Fundal massage would not be indicated at 8 weeks' gestation.

A woman's cousin gave birth to an infant with a congenital heart anomaly. The woman asks the nurse when such anomalies occur during development. Which response by the nurse is most accurate? 1 "We don't really know when such defects occur." 2 "It depends on what caused the defect." 3 "They occur between the 3rd and 5th weeks of development." 4 "They usually occur in the first 2 weeks of development."

3 Blood vessel and blood formation begin in the 3rd week, and the heart is developmentally complete in the 5th week. Stating that it is not known when the defects occur is inaccurate. Regardless of the cause, the heart is vulnerable during its period of development, the 3rd to 5th weeks. The cardiovascular system is the first organ system to function in the developing human.

The home care nurse finds that a pregnant patient with diabetes is prescribed multiple medications for the management of her pregnancy. The patient is also a single parent to two other children. What action does the nurse take to ensure the safety of the patient and the family? 1 Ask the client to refrigerate all medications. 2 Inform the children that their mother is unwell. 3 Look for a safe place to store medications. 4 Tell the patient to keep used syringes near the bed

3 During the home visit the nurse ensures there is a safe place to store medications so that they are out of the children's reach. With a few exceptions, medications should be stored in a cool, dry place and not in the refrigerator, where children are more likely to see them and want to handle them. Informing the children that their parent is unwell, without parental involvement or permission, is unprofessional. The nurse should advise the patient to dispose of the used syringes properly and not keep them near the bed, because this is not out of the children's reach and may increase the chance of infection.

Which condition is characterized by implantation of fertilized ovum outside the uterine cavity? 1 Placenta previa 2 Molar pregnancy 3 Ectopic pregnancy 4 Cervical insufficiency

3 Ectopic pregnancy is a condition in which the fertilized ovum is implanted outside the uterine cavity. Placenta previa is a condition in which the placenta is implanted in the lower uterine segment. Molar pregnancy is a benign proliferative growth of the placental trophoblast. In this condition, the chorionic villi develop into cystic and avascular transparent vesicles that hang in a grapelike cluster. Cervical insufficiency is characterized by passive and painless dilation of the cervix. It may lead to recurrent preterm birth during the second trimester in the absence of other causes.

Which statement by the nursing student about the management of molar pregnancy indicates effective learning? 1 "Methotrexate therapy is prescribed to abort molar pregnancy." 2 "Expectant management is initiated as per the amount of bleeding." 3 "Suction curettage is the safest way of terminating molar pregnancy." 4 "Induction of labor with oxytocic agents is one of the treatment options."

3 In molar pregnancy the avascular transparent vesicles in the uterus may cause uterine distention. Therefore suction curettage is used for rapid and effective evacuation of the hydatidiform mole. Methotrexate therapy is prescribed to dissolve an ectopic pregnancy. Expectant management is initiated in case of a normal fetus, not in the case of a molar pregnancy. Induction of labor with oxytocic agents is not a safe method, because it has a risk of embolization of trophoblastic tissue.

The primary health care provider prescribes magnesium sulfate (Epsom salts) for a patient to prevent preterm labor. Following administration, the nurse observes that the patient has a respiratory rate of 10 breaths/minute and deep tendon reflexes. Based on these findings, what interventions would help to prevent complications in the patient? 1 Give an oral dose of 10 mg nifedipine (Adalat). 2 Administer propranolol (Inderal) intravenously. 3 Infuse 500 mg of calcium chloride intravenously for 30 minutes. 4 Administer 6 mg of dexamethasone (Decadron) intramuscularly.

3 Magnesium sulfate is a tocolytic that is administered to the patient at 24 to 32 weeks of gestation to prevent the risk of preterm birth. A respiratory rate of 10 breaths/minute (below 12 breaths/minute) and deep tendon reflexes are intolerable adverse effects of the drug. Therefore, 500 mg of calcium chloride is infused intravenously for 30 minutes to reverse the magnesium sulfate (Epsom salt) toxicity. Nifedipine (Adalat) is a calcium channel blocker that should not be administered concurrently with magnesium sulfate (Epsom salt), because it results in skeletal muscle blockade. Propranolol (Inderal) is used to reverse the intolerable cardiovascular effects of terbutaline (Brethine). Dexamethasone (Decadron) is an antenatal glucocorticoid that is used to prevent the risk of respiratory distress syndrome in the fetus.

A nurse is monitoring a patient's reflexes (DTRs) while receiving magnesium sulfate therapy for treatment of preeclampsia. Which assessment finding indicates a cause for concern? 1 Bilateral DTRs noted at 2+. 2 DTR response has been noted at 1+ since onset of therapy. 3 Positive clonus response elicited unilaterally. 4 Patient reports no pain upon examination of DTRs by nurse.

3 Positive clonus response elicited unilaterally is a cause for concern because it suggests a hyperactive response. Bilateral DTRs noted at 2+ would indicate a normal finding. Even though this finding indicates a sluggish or decreased response, this is unchanged since the initiation of therapy. The nurse would continue to monitor. Typically, there is no pain associated with determination of DTRs, so this finding would be considered normal.

The nurse is caring for a pregnant patient who has a history of miscarriage. What teaching does the nurse include in the patient's prenatal care plan? 1 Suggest that the patient avoid exercise. 2 Suggest that the patient avoid vaccinations. 3 Suggest that the patient eat a healthy diet including folic acid. 4 Suggest that the patient limit alcohol while trying to conceive.

3 Prenatal care is important for women who had a problem with a previous pregnancy. The nurse should promote nutrition in the patient by suggesting a healthy diet, including folic acid. The incidence of neural tube defects such as spina bifida and anencephaly decreases with sufficient intake of folic acid. The nurse should instruct the patient to avoid substance abuse (tobacco, alcohol, and recreational drugs) to reduce complications in the fetus. This is true while patients are trying to conceive, because they may not immediately know when they are pregnant. Patients should be assessed for vaccine-preventable diseases, and vaccination before conception is not contraindicated

Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. What is an appropriate management approach? 1 Prepare the woman for a dilation and curettage (D&C). 2 Place the woman on bed rest for at least 1 week and reevaluate. 3 Prepare the woman for an ultrasound and blood work. 4 Comfort the woman by telling her that if she loses this baby, she may attempt to get pregnant again in 1 month.

3 Repetitive transvaginal ultrasounds and measurement of human chorionic gonadotropin and progesterone levels may be performed to determine if the fetus is alive and within the uterus. If the pregnancy is lost, the woman should be guided through the grieving process. D&C is not considered until signs of the progress to an inevitable abortion are noted or the contents are expelled and incomplete. Bed rest is recommended for 48 hours initially. Telling the woman that she can get pregnant again soon is not a therapeutic response because it discounts the importance of this pregnancy.

After assessing the blood reports of a mother and her infant, the nurse receives orders to administer RhoGAM (WinGAM) to the mother. Which finding would require this intervention? 1 Both the mother and the infant were found to be Rh positive. 2 Both the mother and the infant were found to be Rh negative. 3 The mother was Rh negative and the infant was Rh positive. 4 The mother was Rh positive and the infant was Rh negative.

3 RhoGAM (WinGAM) is Rho(D) immunoglobulin, administered within 72 hours of delivery to prevent sensitization in Rh-negative mothers who gave birth to Rh-positive infants. Therefore, the nurse was instructed to administer RhoGAM because the mother is Rh negative and the infant is Rh positive. RhoGAM is not given when both mother and infant are Rh positive or Rh negative, or if the mother is Rh positive and the infant is Rh negative.

The nurse is assessing a pregnant patient with a cardiac disorder. After the assessment, the nurse informs the primary health care provider that the patient is symptomatic, with marked limitation of activity. Which class of cardiac disorder does the patient have according to the New York Heart Association (NYHA)? 1 Class I 2 Class II 3 Class III 4 Class IV

3 The New York Heart Association's (NYHA) functional classification of organic heart disease is based on the degree of disability due to cardiac disease in the patient. The cardiac diseases that are symptomatic with marked limitation of activity are grouped under class III cardiac diseases. Cardiac diseases grouped under class I are characterized as being asymptomatic without limitation of physical activity. Class II cardiac diseases include symptomatic diseases with slight limitation of activity. Cardiac diseases grouped under class IV are symptomatic and cause an inability to carry out physical activity without discomfort.

Nurses should be aware of what about HELLP syndrome? 1 It is a mild form of preeclampsia. 2 It can be diagnosed by a nurse alert to its symptoms. 3 It is characterized by hemolysis, elevated liver enzymes, and low platelets. 4 It is associated with preterm labor but not perinatal mortality.

3 The acronym HELLP stands for hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). HELLP syndrome is a variant of severe preeclampsia. HELLP syndrome is difficult to identify because the symptoms often are not obvious. It must be diagnosed in the laboratory. Preterm labor is greatly increased and so is perinatal mortality.

What clinical significance does a maternal blood Coombs test with a titer of 1:8 and increasing indicate? 1 Fetal lung maturity 2 Significant Rh compatibility 3 Significant Rh incompatibility 4 Fetus with trisomy 13, 18, or 21

3 The clinical significance of a maternal blood Coombs test with a titer of 1:8 and increasing indicates significant Rh incompatibility. Fetal lung maturity and fetus with trisomy 13, 18, or 21 are not clinically significant of a Coombs test with a titer of 1:8.

A patient in the 8th week of gestation reports abdominal cramps and pain. Lab reports show an abnormally slow increase in the patient's levels of human chorionic gonadotropin (hCG). What risk does this finding indicate? 1 Multiple fetuses 2 Down syndrome 3 Ectopic pregnancy 4 Gestational trophoblastic disease

3 The earliest biomarker of pregnancy is hCG. A woman's hCG levels peak after 60 to 70 days of pregnancy and decline to the lowest level at 100 to 130 days of pregnancy. An abnormally slow rise in hCG levels accompanied by abdominal pain and cramping indicates the risk of ectopic pregnancy or miscarriage. hCG levels higher than the normal range indicate the risk for multiple fetuses, Down syndrome, or gestational trophoblastic disease.

In terms of Rh incompatibility, which situations would cause a potential problem? 1 Rh-negative baby with two Rh-negative parents 2 Rh-negative mother having an Rh-negative baby 3 The infant of an Rh-negative mother with an Rh-positive father who is homozygous for the trait 4 Rh-positive baby born to an Rh-positive mother

3 The infant of an Rh-negative mother with an Rh-positive father who is homozygous for the trait The infant of an Rh-negative mother with an Rh-positive father who is homozygous for the trait would have a potential problem, because the infant would be Rh positive. An Rh-negative mother having an Rh-positive baby is the classic presentation for isoimmunization or Rh incompatibility. An Rh-negative mother having an Rh-negative baby would not cause a problem. An Rh-positive baby born to an Rh-positive mother would not cause a problem

A cesarean birth is planned for a diabetic patient with fetal macrosomia. Which intervention by the nurse is appropriate when preparing the patient for surgery? 1 Instruct the patient to avoid insulin the night before the surgery. 2 Administer a full dose of insulin on the morning of the surgery. 3 Ensure the patient has nothing by mouth on the morning of the surgery. 4 Infuse intravenous 5% dextrose if the patient's glucose level is below 100 mg/dL.

3 The nurse must ensure the patient is not given anything by mouth on the morning of the surgery. The patient must take a full dose of insulin at bedtime the night before surgery. The patient is fasting; therefore insulin is not administered on the morning of the surgery. The patient is given intravenous 5% dextrose if her glucose levels fall below 70 mg/dL during active labor.

After reviewing the urinalysis reports of a pregnant patient, the nurse finds that the patient has preeclampsia. What did the nurse find in the patient's urinalysis report? 1 Nitrites 2 Ketones 3 Proteins 4 Leukocytes

3 Urinalysis of the patient during pregnancy helps assess the patient's health. The presence of proteins in the urine indicates that the patient may have complications, such as preeclampsia. The presence of ketones in the urine sample indicates that the patient has improper nutrition. The presence of leukocytes and nitrates in the urine indicates that the patient has infection.

The nurse is assessing a pregnant patient who is primigravida. Upon reviewing the laboratory reports, the nurse finds that the patient's blood group is O negative and the fetal blood group is B negative. What does the nurse infer from these findings? 1 The newborn is at risk for leukocytosis. 2 The newborn is at risk for hydrops fetalis. 3 The newborn is at risk for hyperbilirubinemia. 4 The newborn is at risk for Rh incompatibility.

3 When the maternal blood type is O and the fetal blood type is B, the antibodies present in the maternal blood interact with the fetal blood and cause ABO incompatibility. ABO incompatibility causes the destruction of red blood cells and increases the serum bilirubin levels, resulting in hyperbilirubinemia. ABO incompatibility does not increase the number of white blood cells and does not result in leukocytosis. Because the mother and fetus are Rh negative, the newborn will not have risk of hydrops fetalis and Rh incompatibility.

What are maternal and neonatal risks associated with gestational diabetes mellitus? 1 Maternal premature rupture of membranes and neonatal sepsis 2 Maternal hyperemesis and neonatal low birth weight 3 Maternal preeclampsia and fetal macrosomia 4 Maternal placenta previa and fetal prematurity

3 Women with gestational diabetes have twice the risk of developing hypertensive disorders such as preeclampsia, and the baby usually has macrosomia. Premature rupture of membranes and neonatal sepsis are not risks associated with gestational diabetes. Hyperemesis is not seen with gestational diabetes, nor is there an association with low birth weight of the infant. Placental previa and subsequent prematurity of the neonate are not risks associated with gestational diabetes.

A patient is diagnosed with ectopic pregnancy. Which signs associated with ectopic pregnancy can be found in the patient? Select all that apply. 1 Bradycardia 2 Hypertension 3 Abdominal pain 4 Delayed menses 5 Abnormal vaginal bleeding

3,4,5 Ectopic pregnancy is a condition in which the fertilized ovum is implanted outside the uterine cavity. A patient with ectopic pregnancy would have colicky pain due to the stretching of the fallopian tube because of the growth of the embryo. Ectopic pregnancy delays menses and can produce abnormal vaginal bleeding. Mild to moderate dark red or brown intermittent vaginal bleeding is observed in ectopic pregnancy. Ectopic pregnancy may cause tubal rupture and result in internal bleeding. This type of pregnancy affects the heart rate and causes tachycardia. Bradycardia is not observed in ectopic pregnancy. The internal bleeding causes hypotension. Hypertension is not observed in ectopic pregnancy.

If a pregnant patient suspects signs and symptoms of preterm labor, which conditions would lead the patient to go to hospital immediately? Select all that apply. 1 Nausea and vomiting 2 Upper back pain 3 Fluid leakage from the vagina 4 Presence of vaginal bleeding 5 Contractions every 10 minutes

3,4,5 Fluid leakage from the vagina indicates rupture of the amniotic membranes. The patient should seek immediate medical attention because ruptured amniotic membranes can compromise fetal health. Presence of vaginal bleeding may indicate onset of labor or placental hemorrhage, which may compromise fetal perfusion. Therefore the patient should go to the hospital immediately. Uterine contractions after every 10 minutes indicate active labor and that the patient should go to the hospital immediately. Nausea and vomiting and upper back pain do not indicate labor. The patient need not seek immediate medical attention for these conditions.

A pregnant patient was found to have higher-than-normal levels of human chorionic gonadotropin (hCG). The patient also reports excessive vomiting and mild vaginal bleeding. What risk does the nurse suspect in the patient? 1 Miscarriage 2 Ectopic pregnancy 3 Intrauterine growth restriction 4 Gestational trophoblastic disease

4 A pregnant patient was found to have higher-than-normal levels of human chorionic gonadotropin (hCG). The patient also reports excessive vomiting and mild vaginal bleeding. What risk does the nurse suspect in the patient? 1 Miscarriage 2 Ectopic pregnancy 3 Intrauterine growth restriction 4 Gestational trophoblastic disease

With regard to hemolytic diseases of the newborn, nurses should be aware of what information? 1 Rh incompatibility matters only when an Rh-negative offspring is born to an Rh-positive mother. 2 ABO incompatibility is more likely than Rh incompatibility to precipitate significant anemia. 3 Exchange transfusions frequently are required in the treatment of hemolytic disorders. 4 The indirect Coombs' test is performed on the mother before birth; the direct Coombs' test is performed on the cord blood after birth.

4 An indirect Coombs' test may be performed on the mother a few times during pregnancy. Only the Rh-positive offspring of an Rh-negative mother is at risk. ABO incompatibility is more common than Rh incompatibility but causes less severe problems; significant anemia, for instance, is rare with ABO. Exchange transfers are needed infrequently because of the decrease in the incidence of severe hemolytic disease in newborns from Rh incompatibility.

A pregnant patient arrives at the clinic complaining of dull lower back pain. She says she thinks she has experienced frequent low-intensity contractions since getting up that morning. There is evidence of blood in the vagina, and the patient's abdomen feels firm to the touch. What complication of pregnancy does the nurse suspect? 1 Placenta previa 2 Ectopic pregnancy 3 Hydatidiform mole 4 Placental abruption

4 Clinical manifestations of placental abruption include abdominal or lower back pain that may be described as aching or dull, uterine irritability with frequent low-intensity contractions and poor relaxation between contractions, bleeding, and a "board-like" abdomen. Placental previa does not involve pain; its classic sign is sudden onset of painless uterine bleeding. Ectopic pregnancy is the implantation of a fertilized ovum in an area outside the uterine cavity. Ectopic pregnancies are not continued past diagnosis and treatment. One of the signs of hydatidiform mole is vaginal bleeding, but the patient is not exhibiting nausea or vomiting and is exhibiting classic signs of placental abruption.

What does the nurse administer to a patient if there is excessive bleeding after suction curettage? 1 Nifedipine (Procardia) 2 Methyldopa (Aldomet) 3 Hydralazine (Apresoline) 4 Ergonovine (Methergine)

4 Ergonovine (Methergine) is an ergot product, which is administered to contract the uterus when there is excessive bleeding after suction curettage. Nifedipine (Procardia) is prescribed for gestational hypertension or severe preeclampsia. Methyldopa (Aldomet) is an antihypertensive medication indicated for pregnant patients with hypertension. Hydralazine (Apresoline) is also an antihypertensive medication used for treating hypertension intrapartum.

What is gestational diabetes? 1 Diabetes that accompanies hypertension 2 Diabetes that begins abruptly at a young age 3 Diabetes caused by absolute insulin deficiency 4 Diabetes that is diagnosed during pregnancy

4 Gestational diabetes is a type of diabetes that did not exist before it was diagnosed during pregnancy. Hypertension is a risk factor for type 2 diabetes. Type 1 diabetes usually begins abruptly at a young age. People with type 1 diabetes have absolute insulin deficiency resulting from the destruction of beta cells in the pancreas.

The nurse is working in an obstetric ward. Which patient in the ward is at the highest risk of developing hydatidiform mole? 1 A patient with hypothyroidism 2 A patient with diabetes mellitus 3 A patient with lupus erythematosus 4 A patient with prior molar pregnancy

4 Hydatidiform mole is a benign proliferative growth of the placental trophoblast. In this condition the chorionic villi develop into edematous or avascular transparent vesicles, which hang in a grapelike cluster. A patient with prior molar pregnancy is at a higher risk of developing hydatidiform mole. The presence of growing tissue in a molar pregnancy increases the risk of hydatidiform mole. Patients with hypothyroidism, diabetes mellitus, and lupus erythematosus are not at a higher risk of developing hydatidiform mole.

The nurse is caring for a pregnant patient with preeclampsia. The patient reports severe and persistent epigastric pain. The primary health care provider orders a blood test. What result may indicate a worsening liver function? 1 Increased red blood cell levels 2 Decreased serum creatinine levels 3 Decreased platelet count 4 Increased liver transaminase levels

4 If a pregnant patient with preeclampsia reports severe and persistent epigastric pain, it often indicates impaired liver function. An increase in liver transaminases to twice the normal levels in the blood confirms liver damage. Preeclampsia is characterized by a decrease in red blood cells. An increase in serum creatinine levels indicates renal insufficiency and is not related to liver damage. A decreased platelet count does occur in preeclampsia, but this does not cause severe persistent epigastric pain. Epigastric pain is pathognomonic of liver damage.

Which drug prevents the risk of cerebral palsy in the fetus? 1 Nifedipine (Adalat) 2 Propranolol (Inderal) 3 Dexamethasone (Decadron) 4 Magnesium sulfate (Epsom salts)

4 Magnesium sulfate (Epsom salts) is a tocolytic agent used for preventing or reducing the risk of cerebral palsy in the fetus if preterm birth appears inevitable. Nifedipine (Adalat) is a calcium channel blocker used in the tocolytic therapy for preterm labor. Propranolol (Inderal) is used to reverse the intolerable cardiovascular effects of terbutaline (Brethine). Dexamethasone (Decadron) is an antenatal glucocorticoid that is used to prevent the risk of respiratory distress syndrome in the fetus.

A pregnant patient after 20 weeks of gestation reports painless bright-red vaginal bleeding. Upon assessment the nurse finds that the patient's vital signs are normal. Which condition does the nurse suspect in the patient? 1 Eclampsia 2 Preeclampsia 3 Pyelonephritis 4 Placenta previa

4 Placenta previa is indicated by painless bright red vaginal bleeding during the second or third trimester of pregnancy. The patient's vital signs may be normal even after blood loss, because a pregnant patient can lose up to 40% of the blood volume without any signs of shock. Eclampsia is the onset of seizure activity in a patient with preeclampsia. Preeclampsia is indicated by hypertension and proteinuria after 20 weeks of gestation. Pyelonephritis, which is identified by fever, shaking chills, and aching in the lumbar area of the back, is an infection caused by the E. coli organism.

A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes. Of what should the nurse be aware regarding this? 1 Oral hypoglycemic agents can be used if the woman is reluctant to give herself insulin. 2 Dietary modifications and insulin are both required for adequate treatment. 3 Glucose levels are monitored by testing urine four times a day and at bedtime. 4 Dietary management involves distributing nutrient requirements over three meals and two or three snacks.

4 Small frequent meals over a 24-hour period help decrease the risk for hypoglycemia and ketoacidosis. Oral hypoglycemic agents can be harmful to the fetus and less effective than insulin in achieving tight glucose control. In some women gestational diabetes can be controlled with dietary modifications alone. Blood, not urine, glucose levels are monitored several times a day. Urine is tested for ketone content; results should be negative.

A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes. The nurse caring for this woman understands what? 1 Oral hypoglycemic agents can be used if the woman is reluctant to give herself insulin. 2 Dietary modifications and insulin are both required for adequate treatment. 3 Glucose levels are monitored by testing urine four times a day and at bedtime. 4 Dietary management involves distributing nutrient requirements over three meals and two or three snacks.

4 Small, frequent meals over a 24-hour period help decrease the risk for hypoglycemia and ketoacidosis. Oral hypoglycemic agents can be harmful to the fetus and less effective than insulin in achieving tight glucose control. In some women gestational diabetes can be controlled with dietary modifications alone. Blood, not urine, glucose levels are monitored several times a day. Urine is tested for ketone content; results should be negative.

After reviewing the obstetric reports of a pregnant patient, the nurse finds that the patient's fundal height has not changed in the last 4 weeks. What condition does the nurse potentially interpret from this finding? 1 Polyhydramnios 2 Multifetal gestation 3 Maternal malnourishment 4 Intrauterine growth restriction

4 Stable or decreasing fundal height indicates that fetal growth does not correspond to the mother's gestational age. This indicates intrauterine growth restriction of the fetus. Polyhydramnios is a condition in which the amniotic fluid volume is greater than normal. In this condition, fundal height is greater than normal. Multifetal gestation is the presence of more than one child. Maternal malnourishment may affect the growth of the fetus but is not directly associated with fundal height.

The nurse is caring for a patient with insulin-dependent diabetes mellitus in the first trimester of pregnancy. The patient feels dizzy and lethargic and her blood glucose level is 50 mg/dL. What should the nurse do first in this situation? 1 Ask the dietician to recommend a sugar free diet to the patient. 2 Assess the patient for symptoms of retinopathy and nephropathy. 3 Assess the serum progesterone and estrogen levels in the patient. 4 Provide the patient a dose of glucose gel or a few glucose tablets.

4 Symptoms such as dizziness and lethargy, as well as a blood glucose level of 50 mg/dL, indicate that the patient may have hypoglycemia or be in insulin shock. Pregnant patients with insulin-dependent diabetes mellitus are extremely prone to hypoglycemia during the first trimester because estrogen and progesterone stimulate the release of insulin. In this situation, the nurse should give the patient fast glucose in the form of a gel or tablets to quickly stabilize the patient. If the patient is hypoglycemic, the nurse should not ask the dietician to prescribe a completely sugar-free diet. The signs and symptoms of the patient do not indicate that the patient may have retinopathy and nephropathy. The progesterone and estrogen levels are high in a pregnant patient. In this situation, it is not important to assess the levels of these hormones.

Which statement by the nursing student about the management of reduced cervical competence (premature dilation of the cervix) in a pregnant patient indicates effective learning? 1 "Progesterone supplementation is the only effective treatment." 2 "An abdominal cerclage is performed at the first week of gestation." 3 "Surgical treatment is ineffective in patients with extremely short cervix." 4 "A prophylactic cerclage is used to constrict the internal os of the cervix."

4 The best treatment option for premature dilation of the cervix is to surgically place a prophylactic cerclage to constrict the internal os of the cervix. It is usually placed at 11 to 15 weeks of gestation. Progesterone supplementation may not be effective in constricting the cervix and surgical intervention may be necessary. An abdominal cerclage is necessary in case of a failed vaginal cerclage and is usually placed at 11 to 13 weeks of gestation in patients by means of a laparotomy. In patients with an extremely short cervix, an abdominal cerclage is used, which is followed by a cesarean birth.

The home care nurse is providing care for a pregnant patient who lives in a rural area and is at risk for preterm labor, and so has been put on bedrest by her obstetrician-gynecologist. The patient needs intermittent assessment by specialists. What is the priority nursing intervention in this case? 1 Remind the patient to get enough rest. 2 Inform the family to provide care. 3 Inform the patient of potential risks. 4 Assess the patient's access to telehealth.

4 The home care nurse is providing care for a pregnant patient who lives in a rural area and is at risk for preterm labor, and so has been put on bedrest by her obstetrician-gynecologist. The patient needs intermittent assessment by specialists. What is the priority nursing intervention in this case? 1 Remind the patient to get enough rest. 2 Inform the family to provide care. 3 Inform the patient of potential risks. 4 Assess the patient's access to telehealth.

The nurse is caring for a 32-year-old pregnant patient who had an onset of labor at 40 weeks' gestation. After the labor, the nurse finds that the newborn has a low birth weight (LBW). What explanation will the nurse give to the patient as to the etiology of the newborn's LBW? 1 Preterm labor 2 Maternal age 3 Diabetic condition of the patient 4 Intrauterine growth restriction (IUGR)

4 The low birth weight of the newborn is due to IUGR, a condition of inadequate fetal growth. It may be caused due to various conditions, such as gestational hypertension that interferes with uteroplacental perfusion. Interference with uteroplacental perfusion limits the flow of nutrients into the fetus and causes the low birth weight. The onset of labor is at 40 weeks' gestation. Therefore, it is not a preterm labor. The patient's age is normal for pregnancy. Therefore, the patient's age is not a reason for the low birth weight of the child. Infants born to patients with diabetes would have a high birth weight, not a low one.

The nurse is assessing a patient for gestational diabetes mellitus (GDM) using the oral glucose tolerance test. What intervention by the nurse is appropriate while caring for this patient? 1 Teach the patient to eat an unrestricted diet the day before the test. 2 Instruct the patient to avoid caffeine for 6 hours before the test. 3 Draw blood for a fasting blood glucose level just before the test. 4 Obtain the plasma glucose level an hour after a 50-g oral glucose load.

4 The nurse must draw blood for a fasting blood glucose level just before the test begins. This is the first sample, after which blood is drawn 1, 2, and 3 hours after providing the glucose load. The nurse must teach the patient to eat an unrestricted diet that includes at least 150 g of carbohydrates for at least 3 days before the test. The patient must be instructed to avoid caffeine for 12 hours before the test because it increases glucose levels. The patient is given a 100 g oral glucose load, and then the patient's blood glucose levels are determined every hour for up to 3 hours. The plasma glucose level is obtained after a 50-g oral glucose load in the first step of screening for GDM.

The nurse is caring for a pregnant patient with preeclampsia. What intervention will the nurse use to help prevent seizures in this patient? 1 Keeping the patient's door open in order to more easily monitor her for signs of seizure 2 Encouraging the patient to have as many visitors as she would like during any time of day 3 Only doing one or two assessments at a time to avoid stimulating the patient for too much time 4 Asking visitors to silence their phones and electronic devices before entering the patient's room

4 The nurse should keep lights low and noise to a minimum. Asking visitors to silence their phones and electronic devices before entering the patient's room will help with this goal. The patient's door should be closed to reduce stimuli. Visitors should be restricted. Assessments and care practices should be grouped so that the patient may have longer periods of undisturbed rest.

A patient is diagnosed with type 1 diabetes during pregnancy. The primary health care provider (PHP) finds that the offspring of the patient were born without any malformations. What is the possible reason for the absence of congenital anomaly in the offspring? 1 The patient took vitamin supplements during pregnancy. 2 The patient took calcium supplements during pregnancy. 3 The patient maintained a stable blood pressure during pregnancy. 4 The patient maintained a euglycemic condition during pregnancy.

4 The rate of malformations is reduced if the patient with insulin-dependent diabetes maintains euglycemia (normal blood sugar level) during pregnancy. The euglycemic condition should be maintained until the 56th day of pregnancy because it is the period of organ development of the fetus. Vitamin supplements are given to pregnant patients to maintain a healthy, nutritional diet. Calcium supplements are prescribed to pregnant patients to prevent problems such as osteoporosis in the fetus. Maintaining a stable blood pressure will help prevent miscarriage during pregnancy.

A pregnant patient reports an inflamed red tongue. On assessment, the nurse finds that the patient also has megaloblastic anemia. Which reason does the nurse suspect is the cause of the patient's condition? 1 Sodium deficiency 2 Vitamin D deficiency 3 Vitamin A deficiency 4 Vitamin B12 deficiency

4 Vitamin B12 deficiency can result in megaloblastic anemia, glossitis (inflamed red tongue), and neurologic deficits such as decreased sensation and inability to walk. These patients should be given adequate vitamin B12 supplements. The infants born to affected patients are likely to have megaloblastic anemia and exhibit neurodevelopmental delays. Sodium deficiency may lead to hypotension. Vitamin D deficiency may lead to tetany and hypocalcemia. Vitamin A deficiency in a pregnant patient can lead to impairment of cell development, tooth bud formation, and bone growth in the fetus.

The nurse examines a patient at 30 weeks of gestation for cervical dilation. The nurse understands that the infant may be at risk of cerebral palsy if it is born preterm. Which intervention would help to prevent cerebral palsy? 1 Shifting the patient to an obstetric facility 2 Administering antibiotic medications to the patient 3 Administering antenatal glucocorticoids to the patient 4 Administering magnesium sulfate (Epsom salts) to the patient

4 When preterm birth appears inevitable, magnesium sulfate (Epsom salts) is administered to the patient at 24 to 32 weeks of gestation to prevent the risk of cerebral palsy. Patients in preterm labor should be shifted to a healthcare facility that is well-equipped to handle emergencies and take care of preterm infants. Antibiotics are administered to prevent infections. Antenatal glucocorticoids are administered to pregnant patients to prevent the risk of respiratory depression in the fetus, caused by structurally and functionally immature lungs.

The nurse is caring for a hypertensive pregnant patient who is on magnesium sulfate therapy. The nurse finds that the patient has drowsiness, slurred speech, and depressed respiration. What medication would help in treating magnesium toxicity? 1 Intravenous diazepam (Valium) 2 Intravenous nifedipine (Adalat) 3 Intravenous hydralazine (Apresoline) 4 Intravenous calcium gluconate (Kalcinate)

4 When treating a hypertensive pregnant patient with magnesium sulfate therapy, the nurse should be alert for possible magnesium toxicity. Manifestations of magnesium toxicity include drowsiness, lethargy, slurred speech, depressed respiration, loss of deep tendon reflexes, and in severe cases cardiac arrest. The effects of magnesium toxicity can be reversed by administering calcium gluconate (Kalcinate) intravenously. Diazepam (Valium) is an anticonvulsant drug; it is not used to reverse the effects of magnesium toxicity. Nifedipine (Adalat) is an antihypertensive drug; if used along with magnesium sulfate, it leads to muscle blockade. Hydralazine (Apresoline) is an antihypertensive drug; it does not reverse the symptoms of magnesium toxicity.

A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark-red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of what? 1 Eclamptic seizure 2 Rupture of the uterus 3 Placenta previa 4 Abruptio placentae

4 Women with hypertension are at increased risk for an abruption. Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture presents as hypotonic uterine activity, signs of hypovolemia, and in many cases the absence of pain. Placenta previa presents with bright-red, painless vaginal bleeding. Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption).

During the first prenatal visit, a pregnant patient shows a titer value of 1:16 for the indirect Coombs' test. Following amniocentesis, the fetus is found to have increased serum bilirubin levels. What treatment does the nurse expect from the primary health care provider? 1 Carefully place a ventriculoperitoneal shunt in the patient. 2 Infuse 50 mcg of intravenous RhoGAM (WinGAM) into the patient. 3 Administer synthetic T4 (L-thyroxine) to the patient. 4 Prescribe intrauterine transfusion of Rh-negative, type O blood.

4 a titer value of 1:16 for an indirect Coombs' test indicates a positive result. The indirect Coombs' test is performed in an Rh-negative woman who may give birth to an Rh-positive fetus. Amniocentesis is performed in a patient with a titer value of 1:16. Raised bilirubin levels (hyperbilirubinemia) indicate the need for an intrauterine transfusion of Rh-negative, type O blood. Thus, intrauterine transfusion helps manage the fetal anemia that might occur due to maternal sensitization. Hydrocephalus, a condition of excess cerebrospinal fluid, is treated by placing a ventriculoperitoneal shunt. An intramuscular injection of Rho(D) immunoglobulin is given to a patient who tests negative to an indirect Coombs' test at 28 weeks of gestation. Synthetic T4 (L-thyroxine) is given to treat patients who have congenital hypothyroidism; it is not useful in treating fetal anemia.