Kelly PP questions

A women comes to the prenatal clinic suspecting that she is pregnant, and the assessment reveals probable signs of pregnancy. Which finding would the nurse most likely assess? (Select all that apply) A. positive pregnancy B. Ultrasound visualization of the fetus C. Auscultation of a fetal heart beat D. ballottement E. absence of menstruation F. softening of the cervix

A- positive pregnancy test D- Ballottement F- softening of the cervix

A nurse's patient has had recurrent variable decelerations for the last 2 hours. For which intervention should the nurse plan? A. Continuous electronic fetal monitoring B. Maternal position changes C. Amnioinfusion D. Cesarean delivery

C. Amnioinfusion

Danger Sign Decreased fetal movement

Compromised fetal well-being

The nurse is assessing a 37-year-old woman who has presented in active labor and notes the client has an increased risk for abruptio placentae. Which assessment finding should the nurse prioritize? Painless vaginal bleeding and decreased blood pressure Sharp fundal pain and discomfort between contractions Pain in a lower quadrant and increased pulse rate Hypertension and oliguria

Correct response: Sharp fundal pain and discomfort between contractions Explanation: An abruptio placentae refers to premature separation of the placenta from the uterus. As the placenta loosens, it causes sharp pain. Labor begins with a continuing nagging sensation. Painless vaginal bleeding and a fall in blood pressure are indicative of placenta previa. Pain in a lower quadrant and increased pulse rate are indicative of an ectopic pregnancy. Hypertension and oliguria are indicative of preeclampsia

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?

Correct response: ensures passage of all the products of conception Explanation: Misoprostol is used to stimulate uterine contractions and evacuate the uterus after an abortion to ensure passage of all the products of conception. Rho(D) immune globulin is used to suppress the immune response and prevent isoimmunization.

The nurse is required to assess a client for HELLP syndrome. Which are the signs and symptoms of this condition? Select all that apply.

Correct response: epigastric pain upper right quadrant pain hyperbilirubinemia Explanation: The signs and symptoms of HELLP syndrome are nausea, malaise, epigastric pain, upper right quadrant pain, demonstrable edema, and hyperbilirubinemia. Blood pressure higher than 160/110 mm Hg and oliguria are the symptoms of severe preeclampsia rather than HELLP syndrome.

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? ectopic pregnancy gestational trophoblastic disease placenta previa abruption of placenta

Correct response: gestational trophoblastic disease Explanation: The client is most likely experiencing gestational trophoblastic disease or a molar pregnancy. In gestational trophoblastic disease or molar pregnancy, there is an abnormal proliferation and eventual degeneration of the trophoblastic villi. The signs and symptoms of molar pregnancy include brownish vaginal bleeding, elevated hCG levels, discrepancy between the uterine size and the gestational age, and absent fetal heart sounds. Abruption of placenta is characterized by premature separation of the placenta. Ectopic pregnancy is a condition where there is implantation of the blastocyst outside the uterus. In placenta previa the placental attachment is at the lower uterine segment.

Danger Sign Persistent vomiting

Hyperemesis gravidarum

Danger Sign Generalized edema

Hypertension, preeclampsia

Danger Sign Severe headache

Hypertension, preeclampsia

Danger Sign Visual disturbances

Hypertension, preeclampsia

Danger Sign Temperature > 101.0 F

Infection

Magnesium sulfate toxicity signs Serum levels of toxicity Antidote?

Loss of DTRs, slurred speech, difficulty arousing 8 or higher Calcium gluconate

Danger Sign Vaginal bleeding

Placenta abruption, previa, bloody show

Danger Sign Epigastric pain

Preeclampsia, HELLP

Danger Sign Abdominal pain

Premature labor, placenta abruption

Danger Sign Gush of fluid from vagina

Rupture of membranes

Danger Sign Dysuria

Urinary tract infection

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

You Selected: Check for vaginal bleeding every 15 minutes. Correct response: Confine the client to bed rest in a darkened room. Explanation: With severe preeclampsia, most women are hospitalized so that bed rest can be enforced and a woman can be observed more closely than she can be on home care. The nurse should darken the room if possible because a bright light can also trigger seizures. The other interventions listed pertain to a client who has experienced a seizure and has thus progressed to eclampsia.

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?

You Selected: Faulty implantation Correct response: Chromosomal defects in the fetus Explanation: Fetal factors are the most common cause of early miscarriages, with chromosomal abnormalities in the fetus being the most common reason. This client fits the criteria for early miscarriage since she was only 10 weeks pregnant and early miscarriage occurs before 12 weeks.

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

You Selected: Maternal blood loss Correct response: Uterine atony Explanation: An abruptio placentae or placental abruption may occur any time before and during the labor process. After delivery, the woman who has had an abruption requires close monitoring for postpartum hemorrhage because of the risk for uterine atony. This does not cause increased blood pressure or blood incompatabilities.

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

You Selected: fundal height measurement of 18 cm Correct response: fundal height measurement of 18 cm Explanation: A fundal height of 18 cm is larger than expected and should be further investigated for gestational trophoblastic disease (hydatidiform mole). One of the presenting signs is the uterus being larger than expected for date. Mild nausea would be a normal finding at 10 weeks' gestation. Blood pressure of 120/84 would not be associated with hydatidiform mole and depending on the woman's baseline blood pressure may be within acceptable parameters for her. Bright red spotting might suggest a spontaneous abortion.

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?

You Selected: maintaining a patent airway Correct response: observation for bleeding Explanation: Because of the low platelet count associated with this condition, women with HELLP syndrome need extremely close observation for bleeding, in addition to the observations necessary for preeclampsia. Maintaining a patent airway is a critical intervention needed for a client with eclampsia while she is having a seizure. Administration of a tocolytic would be appropriate for halting labor. Monitoring for infection is not a priority intervention in this situation.

A client has come to the office for a prenatal visit during her 22nd week of gestation. On examination, it is noted that her blood pressure has increased to 138/90 mm Hg. Her urine is negative for proteinuria. The nurse recognizes which factor as the potential cause?

You Selected: preeclampsia Correct response: gestational hypertension Explanation: Gestational hypertension is characterized by hypertension without proteinuria after 20 weeks of gestation resolving by 12 weeks postpartum. It is defined as systolic blood pressure of greater than 140 mm Hg and/or diastolic of greater than 90 mm Hg on at least two occasions at least 6 hours apart after the 20th week of gestation, in women known to be normotensive prior to this time and prior to pregnancy. HELLP is an acronym that refers to hemolysis, elevated liver enzymes, and low platelets. Preeclampsia may result if hypertension is not controlled or advances to a more severe state.

Mild Preeclampsia S/S

○ B/P > 140/90 ○ Protein ■ Trace to 2+ or 300 mg/24 hours ○ Mild edema ○ No hyperreflexia

Severe preeclampsia S/S

○ B/P > 160/110 ○ Protein ■ 3-4+ or > 500 mg/24 hours ○ Headaches ○ Visual changes (patients will sometimes say they see spots before their eyes) ○ Increased liver enzymes ○ Oliguria ○ Decreased uteroplacental perfusion

Secondary symptoms of HELLP

○ Jaundice ○ GI bleed ○ Bleeding gums ○ Epigastric pain

What to know: Magnesium sulfate Dose? Side effects?

○ Loading dose of 4-6 grams in 100 mL of fluid, IV given over 20-30 minutes ○ Followed by 1-2 grams IV maintenance dose ○ This is a critical drip therefore always on a pump ○ Side effects: ■ Flushing ■ "Wet noodle" feeling N/V

Second Stage of Labor

● Cervix is now fully dilated (complete) ● Only then can the mother begin pushing ● Pushing time can vary from one push to 3 hours depending on many variables ● It's exhausting! Mother may fall asleep in between contractions ● Baby is delivered!

Third Stage of Labor

● Cord is clamped; delivery of placenta ● Vagina, cervix, and perineum inspected and repaired if needed ● Assess fundal height, firmness ● Massage fundus (manually contracts the uterus) ● Give oxytocin (chemically contracts the uterus) ○ Standing order ● Promote skin to skin/breastfeeding

Hyperemesis Gravidarum: Client Teaching

● Eat small amounts every 2-3 hours ● Eat low protein food ● Avoid greasy or fried foods ● Sit upright after meals to reduce reflux ● Snack before going to bed ● Eat dry crackers before rising ● Get out of bed slowly and avoid sudden movement ● Avoid brushing teeth immediately after eating ● These patients should have a little bit of food in their stomachs at all times; keeps stomach acid production to a minimum

Fourth Stage of Labor

● First hour is CRITICAL for monitoring mother ● HEMORRHAGE is the major complication ● Assessments q 15 minutes x 4; then 30 minutes x 2 (or as per agency protocol); if the mother is bleeding you would check her vitals more frequently. This is just for a typical postpartum mother ● Kangaroo care and family bonding continues to be a priority once safety of mom and baby is established; prompt breastfeeding encouraged as this decreases bleeding by facilitating uterine contractions

HELLP stands for:

● Hemolysis ● Elevated liver enzymes ● Low platelets: < 100,000

Hyperemesis Gravidarum: Interventions:

● NPO for 24-48 hours ● Antiemetics (ondansetron, promethazine, prochlorperazine) ● Iv therapy to hydrate (LR or NS typically used in L&D); correct electrolyte imbalances ● Nutritional supplements ● Diet as tolerated

Hyperemesis Gravidarum: Signs and Symptoms

● Persistent, uncontrollable vomiting ● Decreased urinary output ● Rapid pulse ● Low-grade fever ● Weight loss; 5-10% of body weight ● Electrolyte imbalances; dehydration

Hyperemesis Gravidarum: Pharmacologic Management

● Sedatives ● Antiemetics ● Correction of fluid and electrolytes balances ● Vitamin B-6 and ginger also very effective