High risk antepartum Nursing Care
6. 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? 1. Ruptured membranes caused an infection. 2. The patient is unstable due to hemorrhage. 3. Fetal age is incompatible with survival. 4. A fetal heartbeat could not be obtained.
ANS: 4 This is correct. The inability to obtain a fetal heart beat is indicative of fetal demise, which does not support measures to stop preterm labor and delivery.
18. Premature rupture of membranes is defined as rupture of the ____________________ membranes before the onset of labor but at term
ANS: chorioamniotic Premature rupture of membranes (PROM) is rupture of membranes before the onset of labor. Preterm PROM (PPROM) is when membranes rupture before labor and before 37 weeks of gestation. PROM may also refer to prolonged rupture of membranes, which is greater than 24 hours.
8. 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? 1. Check for cervical dilation 2. Monitor for signs of infection 3. Assess for vaginal bleeding 4. Watch for fetal compromise
ANS: 1 1 This is correct. PPROM places the mother and fetus at risk for infection from migration of bacteria from the vagina and/or introduced from the environment. The nurse will not check the patient for cervical dilation.
4. 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? 1. "Oral bleeding can contribute to anemia." 2. "Dental problems can interfere with nutrition." 3. "Periodontal disease is a risk factor for preterm labor" 4. "You need dental care because pregnancy causes dental problems."
ANS: 1 1 This is incorrect. Oral bleeding would need to be consistent and significant to be a contributing factor to anemia.
10. 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? 1. Serum magnesium level is 10 mg/dL. 2. Patella reflexes are rated at zero. 3. Respiratory rate is 18 breaths/min. 4. Urinary output remains at 30 mL/hr.
ANS: 1 This is correct. The therapeutic serum level of magnesium sulfate is 5 to 7 mg/dL, and the patient's laboratory result is 10 mg/dL. The nurse will give the antidote of calcium gluconate (5 to 10 mEq) by IV over a period of 5 to 10 minutes
16. 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. 1. Hypertensive disorders 2. Uterine fibroids 3. Cigarette smoking 4. Methamphetamine use 5. Abdominal trauma
ANS: 1, 2, 3, 4, 5 1 This is correct. Hypertensive disorders put women at risk for placental abruption during pregnancy. 2 This is correct. Uterine fibroids put women at risk for placental abruption during pregnancy. 3 This is correct. Cigarette smoking puts women at risk for placental abruption during pregnancy. 4 This is correct. Methamphetamine use puts women at risk for placental abruption during pregnancy. 5 This is correct. Abdominal trauma puts women at risk for placental abruption during pregnancy
15. 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. 1. This syndrome destroys red blood cells. 2. This syndrome impacts the amount of platelets. 3. This syndrome decreases a patient's white blood cell (WBC) count. 4. This syndrome decreases a patient's blood urea nitrogen (BUN). 5. This syndrome increases liver enzymes.
ANS: 1, 2, 5 1 This is correct. Hemolysis is part of HELLP syndrome. 2 This is correct. Low platelets are part of HELLP syndrome 5 This is correct. Elevated liver enzymes are part of HELLP syndrome.
17. 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. 1. The patient has all the symptoms of hypovolemia. 2. The patient reports a recent bout with nausea and vomiting. 3. The absence of blood can indicate a concealed hemorrhage. 4. The patient and fetus are at risk of death from hypovolemic shock. 5. The patient states a sudden onset of severe symptoms
ANS: 1, 3, 4, 5 1 This is correct. The presenting manifestations are classic for hypovolemia; the only cardinal symptom missing is the presence of bleeding. 2 This is incorrect. Placental abruption can be accompanied by nausea and vomiting; however, these manifestations alone do not indicate a need for emergency transport. 3 This is correct. In a pregnant patient, the lack of bleeding as evidence to placental abruption is indicative of concealed hemorrhage. 4 This is correct. Hypovolemic shock places both the patient and fetus at risk for death. 5 This is correct. During pregnancy, signs of shock are usually not until 25% to 30% of maternal blood loss has occurred. The patient may be unaware of life-threatening bleeding because of the concealed hemorrhage.
12. 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. 1. Provide time for the patient to talk about her feelings. 2. Encourage the patient's partner to be emotionally strong. 3. Facilitate referrals related to the fetal condition. 4. Monitor patient's condition and adjust visitors accordingly. 5. Ascertain if the patient and partner have previous crisis skills
ANS: 1, 3, 5 1 This is correct. In a time of crisis, a patient needs to be able to express and discuss their feelings in order to meet psychological needs. Providing for adequate time is planning and implementation actions in developing a nursing plan of care. 2 This is incorrect. The patient's partner is expected to be feeling emotionally distressed. Encouraging the partner to be emotionally strong does not fulfill either the patient's or partner's needs. 3 This is correct. Facilitating referrals related to the fetus condition is an implementation action that is appropriate for the patient's plan of care. The patient and partner need reliable sources of information and support. 4 This is incorrect. Monitoring the patient's condition and adjusting visitors accordingly may isolate the patient from her family/support sources. Visitation needs to have flexible guidelines to minimize the patient's isolation from family/support sources. 5 This is correct. Formulation of a solid plan of care always involves assessment. The nurse needs to ascertain if the patient and partner have experienced previous crisis events. The knowledge will guide the nurse to either implement coping strategies or evaluate and implement previous skills.
5. 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? 1. Administer antenatal steroids 2. Obtain fetal fibronectin levels 3. Beta-adrenergic agonist therapy 4. Monitor blood glucose levels
ANS: 2 2 This is correct. Fetal fibronectin is a previously used test, which has a low positive predictive value but a high negative predictive value, thereby making it a useful test to predict those women who will not deliver preterm. The test is considered to be unsuitable for wide-spread testing; the nurse would not expect the health care provider to prescribe this test.
3. The nurse educator is preparing a presentation on preterm labor (PTL) and birth (PTB). Which information does the nurse recognize as being inaccurate? 1. PTB is the leading cause of neonatal mortality and for antenatal hospitalization. 2. PTL is defined as regular uterine contractions resulting in cervical changes before 40 weeks gestation. 3. PTBs result in increased numbers of neonatal and infant deaths and long-term neurological impairment. 4. Average costs for premature/low birthweight infants are more than 10 times as high than for other newborns.
ANS: 2 This is correct. This is the information the nurse needs to recognize as being inaccurate. PTL is defined as regular contractions of the?9?uterus?9?resulting in changes in the?9?cervix before 37 weeks gestation, not before 40 weeks gestation. After 37 weeks, the fetus is no longer considered premature.
13. 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. 1. Shoulder injury related to birth size 2. Development of metabolic syndrome 3. Impaired intellectual development 4. Changes in genetic expression 5. Increased risk for chronic illnesses
ANS: 2, 3, 4, 5 2 This is correct. Long-term risks for a newborn whose mother has pregestational diabetes is for the development of metabolic syndrome. 3 This is correct. Long-term risks for a newborn whose mother has pregestational diabetes is for impaired intellectual development. There can also be an impairment of psychomotor development. 4 This is correct. Long-term risks for a newborn whose mother has pregestational diabetes is for changes in genetic expression related to exposure to hyperglycemia in utero. 5 This is correct. Long-term risks for a newborn whose mother has pregestational diabetes is for an increase in chronic illnesses in later life. This change is related to the previously listed changes in genetic expression.
14. 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. 1. Laboratory report that shows an elevation of liver enzymes 2. Current blood pressure reading of 162/102 mm Hg 3. Evident pulmonary edema noted with auscultation. 4. Subjective report of severe headache and photophobia 5. Lack of response to verbal and tactile stimulation
ANS: 2, 3, 4, 5 2 This is correct. The patient has significant increase in blood pressure; due to a risk for stroke, the nurse is prompted to immediately contact the health care provider. 3 This is correct. Pulmonary edema can be a symptom of organ failure (cardiac, renal, hepatic). This manifestation will prompt the nurse to contact the health care provider. 4 This is correct. If the client is expressing the presence of a severe headache and photophobia, the nurse needs to be aware of worsening preeclampsia symptoms. The nurse will be prompted to notify the health care provider of these manifestations. 5 This is correct. When the nurse notices a lack of response from the patient to verbal and tactile stimulation, the nurse needs to recognize the possibility of seizure activity. The HCP needs to be notified immediately.
7. 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? 1. The rupture of the membranes is from a bacterial infection. 2. The membranes ruptured because the test caused fetal death. 3. The premature rupture of the membranes is a known risk to the test. 4. The membranes ruptured due to the presence of a genetic disorder.
ANS: 3 This is correct. Iatrogenic PPROM is associated with a medical intervention such as the patient's procedure, chorionic villus sampling. The preterm rupture of membranes is a known risk and unpreventable complication related to invasive testing
11. 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? 1. Placenta accreta 2. Placenta increta 3. Placenta percreta 4. Placenta previa
ANS: 3 This is correct. Placenta percreta is when invasion of the trophoblast extends into the uterine musculature and can adhere to other pelvic organs (5% of cases)
1. 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? 1. The patient who is 16 years of age just diagnosed with gestational diabetes 2. The patient with preexisting hypertension who is currently pregnant with twins 3. The patient who is 37 years of age, obese, and experiencing pregnancy-induced hypertension 4. The patient who is 28 years of age who delivered a premature neonate 3 years prior
ANS: 3 This is correct. The patient who is 37 years of age, obese, and experiencing pregnancy-induced hypertension has three risk factors: age over 35 years, excessive weight, and a pregnancy-related complication. This is the patient with the highest-risk pregnancy.
2. 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? 1. The first labor was induced due to unresponsive management of hypertension. 2. The health care provider induced labor at the patient's request to avoid holiday interruptions. 3. Labor was induced when the fetus moved from a posterior to an anterior position. 4. The premature labor and birth was unexpected and followed a normal pregnancy.
ANS: 4 This is correct. When premature labor and birth occurs spontaneously, as this one did, there is a good chance the second pregnancy will end in the same manner. A history of delivering preterm is one of the strongest predictors for subsequent preterm births.
9. 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? 1. After examination, assures the patient of the absence of contractions 2. Explains to the patient that increased discomfort is expected with twins 3. Performs a digital cervical examination to determine if dilation is occurring 4. Sends the patient to the hospital to be checked for possible signs of labor
ANS: 4 This is correct. With so many variables related to multiple gestation, the nurse needs to send the patient to the hospital to be checked for possible signs of labor.
19. 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 ____________________.
ANS: cerclage Surgical treatment of incompetent cervix is cerclage, a type of purse-string suture placed cervically to reinforce a weak cervix. The standard transvaginal cerclage methods currently used include modifications of the McDonald and Shirodkar techniques.
20. When a patient is diagnosed with preeclampsia, one sign that the fetus is at risk for hypoxia is a change in amniotic fluid called ____________________.
ANS: oligohydramnios During preeclampsia, the fetus is at risk for hypoxia. Since amniotic fluid is comprised mostly of fetal urine, low amniotic fluid volume indicates a lack of renal perfusion. When blood is shunted away from the kidneys to other vital organs, low kidney perfusion results in a decrease of urine. The resulting amniotic fluid decrease is oligohydramnios
