Chapter 8 Nursing Care of Women with Complications During Labor and Birth

What would be the physiologic basis for a placenta previa?

low placental implantation

The nurse is teaching a prenatal class on potential problems during pregnancy to a group of expectant parents. The risk factors for placental abruption are discussed. What comment validates accurate learning by the parents?

"Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain."

A woman at 10 weeks gestation comes to the clinic for an evaluation. Which assessment finding should the nurse prioritize?

fundal height measurement of 18 cm

Upon entering the room of a client who has had a spontaneous abortion, the nurse observes the client crying. Which response by the nurse would be most appropriate?

"I'm sorry you lost your baby."

A 32-year-old gravida 3 para 2 at 36 weeks' gestation comes to the obstetric department reporting abdominal pain. Her blood pressure is 164/90 mm/Hg, her pulse is 100 beats per minute, and her respirations are 24 per minute. She is restless and slightly diaphoretic with a small amount of dark red vaginal bleeding. What assessment should the nurse make next?

Palpate the fundus, and check fetal heart rate.

A pregnant patient with a history of premature cervical dilatation undergoes cervical cerclage. Which outcome indicates that this procedure has been successful?

The client delivers a full-term fetus at 39 weeks' gestation.

The nurse is caring for a multigravid who experienced a placental abruption 4 hours ago. For which potential situation will the nurse prioritize assessment?

Uterine atony

What is the drug methylergonovine maleate used for?

Uterine contraction

A pregnant client at 20 weeks' gestation arrives at the health care facility reporting excessive vaginal bleeding and no fetal movements. Which assessment finding would the nurse anticipate in this situation?

cervical incompetence

A pregnant client with multiple gestation arrives at the maternity clinic for a regular antenatal check up. The nurse would be aware that client is at risk for which perinatal complication?

congenital anomalies

A pregnant client has been admitted with reports of brownish vaginal bleeding. On examination there is an elevated hCG level, absent fetal heart sounds, and a discrepancy between the uterine size and the gestational age. The nurse interprets these findings to suggest which condition?

gestational trophoblastic disease

Which medication would the nurse prepare to administer if prescribed as treatment for an unruptured ectopic pregnancy?

methotrexate

A pregnant woman is admitted to the hospital with a diagnosis of placenta previa. Which action would be the priority for this woman on admission?

assessing fetal heart tones by use of an external monitor

A pregnant client is admitted to a health care unit with disseminated intravascular coagulation (DIC). Which prescription is the nurse most likely to receive regarding the therapy for such a client?

Administer cryoprecipitate and platelets.

A 17-year-old G2 P0010 patient develops hypertension at 32 weeks and is required to limit her intake of sodium and increase her protein intake. The patient is out of work and does not attend school. Her time is spent primarily at the local shopping mall with friends. The best dietary suggestion that the home visiting nurse can make to this patient is:

Bring water and a lunch from home rather than eating at the food court

A nurse is caring for a young woman who is in her 10th week of gestation. She comes into the clinic reporting vaginal bleeding. Which assessment finding best correlates with a diagnosis of hydatidiform mole?

Dark red, "clumpy" vaginal discharge

When assessing a pregnant woman with vaginal bleeding, the nurse would suspect a threatened abortion based on which finding?

slight vaginal bleeding

A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. Which finding would the nurse interpret as indicating a therapeutic level of medication?

deep tendons reflexes 2+

A student nurse asks the instructor what percentage of clinically recognized pregnancies end in miscarriages during the first trimester. Which response from the nurse is the most accurate?

15% to 20%

A woman in labor has sharp fundal pain accompanied by slight vaginal bleeding. What would be the most likely cause of these symptoms?

premature separation of the placenta

A client is 11 weeks pregnant after many years trying to conceive. After arriving home from a normal prenatal visit, she experiences mild cramping and has a gush of bright red vaginal bleeding. She calls the nurse and reports having soaked a pad with fresh blood in fewer than 30 minutes. The uterine cramping is worsening. What is the most appropriate response from the nurse?

"You need to seek immediate attention from the primary care provider."

After teaching a woman who has had an evacuation for gestational trophoblastic disease (hydatidiform mole or molar pregnancy) about her condition, which statement indicates that the nurse's teaching was successful?

"I will be sure to avoid getting pregnant for at least 1 year."

After a regular prenatal visit, a pregnant client asks the nurse to describe the differences between abruptio placentae and placenta previa. Which statement should the nurse include in the teaching?

"Placenta previa causes painless, bright red bleeding during pregnancy due to an abnormally implanted placenta that is too close to or covers the cervix; abruptio placentae is associated with dark red painful bleeding caused by premature separation of the placenta from the wall of the uterus before the end of labor."

A client in her first trimester arrives at the emergency room with reports of severe cramping and vaginal spotting. On examination, the health care provider informs her that no fetal heart sounds are evident and orders a dilatation and curettage. The client looks frightened and confused and states that she does not believe in abortion. Which statement by the nurse is best?

"Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications."

A pregnant patient is diagnosed with placenta previa. Which action should the nurse implement immediately for this patient?

Assess fetal heart sounds with an external monitor.

A nurse in the maternity triage unit is caring for a client with a suspected ectopic pregnancy. Which nursing intervention should the nurse perform first?

Assess the client's vital signs.

A woman in her 20s has experienced a miscarriage at 10 weeks' gestation and asks the nurse at the hospital what went wrong. She is concerned that she did something that caused her to lose her baby. The nurse can reassure the woman by explaining that the most common cause of spontaneous miscarriage in the first trimester is related to which factor?

Chromosomal defects in the fetus

A woman at 37 weeks gestation presents to the labor and delivery area with symptoms of abruptio placentae. Which action should the nurse prioritize?

Ensure large bore IV access is obtained

A 25-week-gestation client presents with a blood pressure of 152/99, pulse 78, no edema, and urine negative for protein. What would the nurse do next?

Notify the health care provider

A client with a multiple gestation has come to a health care facility for a regular antenatal check-up. When educating the client on pregnancy, about which complication should the nurse inform the client?

Placental dysfunction

A patient who is 16 weeks pregnant is passing pieces of body tissue along with blood clots and dark red blood from the vagina. What should the nurse direct the patient to do at this time?

Seek immediate medical attention and bring the expressed vaginal material.

The nurse is caring for a client who has a multifetal pregnancy. What topic should the nurse prioritize during health education?

Signs of preterm labor

A 25-year-old pregnant client has just been diagnosed with hyperemesis gravidarum. Which instruction should the nurse prioritize during a teaching session?

Take your anti-nausea medicine around the clock.

A client is 20 weeks pregnant. At a prenatal visit, the nurse begins the prenatal assessment. Which finding would necessitate calling the primary care provider to assess the client?

The client has pink vaginal discharge and pelvic pressure.

Vaginal bleeding during pregnancy is always a deviation from the normal.

True

A young mother gives birth to twin boys who shared the same placenta. What serious complication are they at risk for?

Twin-to-twin transfusion syndrome (TTTS)

The nurse is transcribing messages from the answering service. Which phone message should the nurse return first?

a 35-year-old, 21-week G3P2 client with blood pressure of 160/110 mm Hg, blurred vision, and whose last blood pressure was 143/99 mm Hg and urine dipstick showed a +2 proteinuria

A nurse is caring for a client who just experienced a miscarriage in her first trimester. When asked by the client why this happened, which is the best response from the nurse?

abnormal fetal development

Which compound would the nurse have readily available for a client who is receiving magnesium sulfate to treat severe preeclampsia?

calcium gluconate

A nurse suspects that a client is developing HELLP syndrome. The nurse notifies the health care provider based on which finding?

elevated liver enzymes

The nurse is developing a plan of care for a woman who is pregnant with twins. The nurse includes interventions focusing on which area because of the woman's increased risk?

preeclampsia

Which information on a client's health history would the nurse identify as contributing to the client's risk for an ectopic pregnancy?

recurrent pelvic infections

A pregnant client is being admitted for severe preeclampsia. When assigning room placement, which area would be most appropriate?

At the end of the hallway

It is determined that a client's blood Rh is negative and her partner's is positive. To help prevent Rh isoimmunization, the nurse would expect to administer Rho(D) immune globulin at which time?

at 28 weeks' gestation and again within 72 hours after birth

A woman with severe preeclampsia is receiving magnesium sulfate. The woman's serum magnesium level is 9.0 mEq/L. Which finding would the nurse most likely note?

diminished reflexes

A woman with an incomplete abortion is to receive misoprostol. The woman asks the nurse, "Why am I getting this drug?" The nurse responds to the client, integrating understanding that this drug achieves which effect?

ensures passage of all the products of conception

A novice nurse asks to be assigned to the least complex antepartum client. Which condition would necessitate the least complex care requirements?

gestational hypertension

A nurse is taking a history of a client at 5 weeks' gestation in the prenatal clinic; however, the client is reporting dark brown vaginal discharge, nausea, and vomiting. Which diagnosis should the nurse suspect?

gestational trophoblastic disease

During a routine prenatal visit, a client is found to have proteinuria and a blood pressure rise to 140/90 mm Hg. The nurse recognizes that the client has which condition?

mild preeclampsia

A client with hyperemesis gravidarum is admitted to the facility after being cared for at home without success. What would the nurse expect to include in the client's plan of care?

nothing by mouth

A pregnant client with severe preeclampsia has developed HELLP syndrome. In addition to the observations necessary for preeclampsia, what other nursing intervention is critical for this client?

observation for bleeding

A pregnant woman with preeclampsia is to receive magnesium sulfate IV. Which assessment should the nurse prioritize before administering a new dose?

patellar reflex

A 44-year-old client has lost several pregnancies over the last 10 years. For the past 3 months, she has had fatigue, nausea, and vomiting. She visits the clinic and takes a pregnancy test; the results are positive. Physical examination confirms a uterus enlarged to 13 weeks' gestation; fetal heart tones are heard. Ultrasound reveals that the client is experiencing some bleeding. Considering the client's prenatal history and age, what does the nurse recognize as the greatest risk for the client at this time?

pregnancy loss

A pregnant client has an Rh-negative blood type. Following the birth of the client's infant, the nurse administers her Rho(D) immune globulin. The purpose of this is to:

prevent maternal D antibody formation.

The nurse is orientating in the Labor and Delivery unit and asks her preceptor how to differentiate a client with preeclampsia from one with eclampsia. Which symptoms would the preceptor describe to the new nurse as indicative of severe preeclampsia? Select all that apply.

Hyperactive deep tendon reflexes Nondependent edema Blood pressure above 160/110 mm Hg

The nurse is monitoring a pregnant patient who is receiving intravenous magnesium sulfate for eclampsia. During the last assessment, the nurse was unable to elicit a patellar reflex. What should the nurse do?

Stop the current infusion.

The nurse is caring for a woman at 32 weeks gestation with severe preeclampsia. Which assessment finding should the nurse prioritize after the administration of hydralazine to this client?

Tachycardia

A woman who is Rh negative asks the nurse how many children she will be able to have before Rh incompatibility causes them to die in utero. The nurse's best response would be that:

as long as she receives RhoGAM, there is no limit.

A client in her 20th week of gestation develops HELLP syndrome. What are features of HELLP syndrome? Select all that apply.

hemolysis elevated liver enzymes low platelet count

A client at 11 weeks' gestation experiences pregnancy loss. The client asks the nurse if the bleeding and cramping that occurred during the miscarriage were caused by working long hours in a stressful environment. What is the most appropriate response from the nurse?

"I can understand your need to find an answer to what caused this. Let's talk about this further."

A client with a history of cervical insufficiency is seen for reports of pink-tinged discharge and pelvic pressure. The primary care provider decides to perform a cervical cerclage. The nurse teaches the client about the procedure. Which client response indicates that the teaching has been effective?

"Purse-string sutures are placed in the cervix to prevent it from dilating."

A client has been admitted to the hospital with a diagnosis of severe preeclampsia. Which nursing intervention is the priority?

Confine the client to bed rest in a darkened room.

The nurse is caring for a client with an ectopic pregnancy. Which symptom is a sign that the tube has ruptured?

Hypovolemic shock

A patient is admitted with a diagnosis of ectopic pregnancy. For what should the nurse anticipate preparing the patient?

Immediate surgery

The nurse is identifying nursing diagnoses for a patient with gestational hypertension. Which diagnosis would be the most appropriate for this patient?

Ineffective tissue perfusion related to vasoconstriction of blood vessels

A patient recovering from an uneventful vaginal delivery is prescribed Rho(D) immune globulin (RhIG). What should the nurse explain to the patient regarding the purpose of this medication?

It prevents maternal D antibody formation.

The nurse understands the need to be aware of the potential of bleeding disorders in her pregnant clients. Which disorder should she be aware of that occurs in the second trimester?

Placenta previa

A pregnant patient is developing HELLP syndrome. During labor, which order should the nurse question?

Prepare for epidural anesthesia.

The nurse is caring for a client with preeclampsia and understands the need to auscultate this client's lung sounds every 2 hours. Why would the nurse do this?

Pulmonary edema

A nurse is conducting a presentation for a group of pregnant women about conditions that can occur during pregnancy and that place the woman at high-risk. When discussing blood incompatibilities, which measure would the nurse explain as most effective in preventing isoimmunization during pregnancy?

Rho(D) immune globulin administration to Rh-negative women

The nurse is concerned that a pregnant patient is experiencing abruptio placentae. What did the nurse assess in this patient?

Sharp fundal pain and discomfort between contractions

The obstetric nurse is caring for a pregnant client who has been diagnosed with hydatidiform mole. What assessment should the nurse prioritize?

Vaginal bleeding