Chapter 7: High-Risk Antepartum Nursing Care

A patient at 30 weeks gestation is exhibiting signs of preterm labor and delivery. The health care provider (HCP) informs the patient that nothing can be done to disrupt this process. The patient is in distress and states, "Why can't something be done to save my baby?" The nurse understands the HCP's decision is likely based on which finding?

A fetal heartbeat could not be obtained.

When a patient is diagnosed with preeclampsia, one sign that the fetus is at risk for hypoxia is a change in amniotic fluid called ____________________.

oligohydramnios

When performing a physical assessment on a patient during the initial prenatal visit, the nurse notes spongy gums prone to bleeding during the oral exam. Which comment by the nurse is appropriate?

"Oral bleeding can contribute to anemia."

The nurse is assessing a patient at 26 weeks gestation. The patient has chronic hypertension and exhibited hypertension and proteinuria prior to 20 weeks gestation. Previous blood pressure (BP) readings have been in the range of 130 to 140/88 to 90 mm Hg. Due to superimposed preeclampsia, for which additional manifestations will the nurse immediately contact the health care provider? Select all that apply.

Current blood pressure reading of 162/102 mm Hg Evident pulmonary edema noted with auscultation. Subjective report of severe headache and photophobia Lack of response to verbal and tactile stimulation

A patient with pregestational diabetes mellitus delivers a neonate who is diagnosed with macrosomia. The nurse is aware that the neonate is at risk for additional long-term conditions related to maternal diabetes mellitus. Which long-term effects may occur? Select all that apply.

Development of metabolic syndrome Impaired intellectual development Changes in genetic expression Increased risk for chronic illnesses

The nursing staff in a labor and delivery unit has noticed an increase in the number of patients experiencing placental abruption. The nurses begin to review demographics for the patients involved. Which risk factors will the nurses expect? Select all that apply.

Hypertensive disorders Uterine fibroids Cigarette smoking Methamphetamine use Abdominal trauma

A patient at 36 weeks gestation reports a constant dull backache, regular frequent contractions that are painless, and lower abdominal pressure. Physical examination reveals intact membranes and cervical dilation of 3 cm. Which order by the health care provider is unexpected by the nurse?

Obtain fetal fibronectin levels

The nurse educator is preparing a presentation on preterm labor (PTL) and birth (PTB). Which information does the nurse recognize as being inaccurate?

PTL is defined as regular uterine contractions resulting in cervical changes before 40 weeks gestation.

A patient who is in the third trimester of pregnancy is informed that she will need a cesarean hysterectomy and bladder reconstruction due to a placenta defect. Which medical condition does the nurse explain to the patient?

Placenta percreta

A patient just learns that her unborn fetus has a life-threatening condition and is not expected to survive long term. Which does the nurse include in a plan of care to meet psychological needs of the patient and her partner? Select all that apply.

Provide time for the patient to talk about her feelings. Facilitate referrals related to the fetal condition. Ascertain if the patient and partner have previous crisis skills.

The nurse in a prenatal clinic is assessing a patient who is at 37 weeks gestation for twins. The patient reports increased discomfort and increased lower pelvic pressure. Which action does the nurse take with this patient?

Sends the patient to the hospital to be checked for possible signs of labor

The nurse is providing care to a postpartum patient after an emergency cesarean due to eclampsia. The patient received spinal anesthesia prior to delivery. Magnesium sulfate is infusing 2 g/hr in 100 mL of IV fluid. Which assessment finding will cause the nurse to administer calcium gluconate to the patient via IV push?

Serum magnesium level is 10 mg/dL.

A patient at 35 weeks gestation arrives at the prenatal clinic in physical distress. Assessment reveals hypotension, thready pulse, shallow respirations, pallor, cold and clammy skin, and anxiety. The nurse does not find evidence of vaginal bleeding but suspects placental abruption. For which reason does the nurse call for emergency transport to the hospital? Select all that apply.

The patient has all the symptoms of hypovolemia. The absence of blood can indicate a concealed hemorrhage. The patient and fetus are at risk of death from hypovolemic shock. The patient states a sudden onset of severe symptoms.

The nurse in a prenatal clinic is reviewing the files of four patients scheduled for visits. Which patient does the nurse identify as having the highest-risk pregnancy?

The patient who is 37 years of age, obese, and experiencing pregnancy-induced hypertension

The nurse is interviewing a new patient who is in the first trimester of her second pregnancy. The patient shares that her first child was born at 36 weeks gestation. Which information does the patient share that places the patient at risk for a second premature birth?

The premature labor and birth was unexpected and followed a normal pregnancy.

A patient undergoes chorionic villa sampling to rule out the presence of a genetic disorder. Following the procedure, the patient experiences iatrogenic PPROM. Which explanation does the nurse provide to promote patient understanding?

The premature rupture of the membranes is a known risk to the test.

The nurse is conducting a staff education session about preeclampsia and eclampsia complications. Which statements by the nurse are accurate about HELLP syndrome? Select all that apply.

This syndrome destroys red blood cells. This syndrome impacts the amount of platelets. This syndrome increases liver enzymes.

A patient is threatening spontaneous abortion at 18 weeks gestation. The patient's two previous pregnancies aborted in the same time frame. The patient states, "They want to sew my cervix shut." The nurse shares the terminology for surgical treatment of incompetent cervix, which is ____________________.

cerclage

Premature rupture of membranes is defined as rupture of the ____________________ membranes before the onset of labor but at term.

chorioamniotic

The nurse in a prenatal unit is providing care for a patient who experienced PPROM at 32 weeks gestation. Which assessment does the nurse consider unnecessary?

heck for cervical dilation