Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications

A woman at 28 weeks' gestation has been hospitalized with moderate bleeding that is now stabilizing. The nurse performs a routine assessment and notes the client sleeping, lying on the back, and electronic fetal heart rate (FHR) monitor showing gradually increasing baseline with late decelerations. Which action will the nurse perform first? Administer oxygen to the client. Notify the health care provider. Reposition the client to left side. Increase the rate of IV fluids.

Reposition the client to left side.

A nurse is describing the use of Rho(D) immune globulin as the therapy of choice for isoimmunization in Rh-negative women and for other conditions to a group of nurses working at the women's health clinic. The nurse determines that additional teaching is needed when the group identifies which situation as an indication for Rho(D) immune globulin? maternal trauma amniocentesis STIs molar pregnancy

STIs

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 vomited. The client has a white vaginal discharge. The client has rhinitis and epistaxis. The client has pink vaginal discharge and pelvic pressure.

The client has pink vaginal discharge and pelvic pressure.

A client in her 20th week of gestation develops HELLP syndrome. What are features of HELLP syndrome? Select all that apply. leukocytosis hemolysis hyperthermia elevated liver enzymes low platelet count

hemolysis elevated liver enzymes low platelet count

A nurse is providing care to a client who has been diagnosed with a common benign form of gestational trophoblastic disease. The nurse identifies this as: ectopic pregnancy. hydramnios. hydatidiform mole. placenta accrete.

hydatidiform mole.

The nurse is preparing the plan of care for a woman hospitalized for hyperemesis gravidarum. Which interventions would the nurse most likely include? Select all that apply. monitoring intake and output obtaining baseline blood electrolyte levels administering antiemetic agents maintaining NPO status for the first day or two preparing the woman for insertion of a feeding tube

maintaining NPO status for the first day or two administering antiemetic agents obtaining baseline blood electrolyte levels monitoring intake and output

The nurse is admitting a G3 P2 client at 38 weeks' gestation who arrived reporting painless bleeding from the vagina leading to the diagnosis of placenta previa. When questioned by the client as to what caused this, which most likely factor should the nurse point out in her answer? previous cesarean birth morbidly obese maternal age more than 30 years living in coastal areas

previous cesarean birth

A woman in week 16 of her pregnancy calls her primary care provider's office to report that she has experienced abdominal cramping, vaginal spotting, and the passing of tissue. The nurse instructs the client to bring the passed tissue to the hospital with her. What is the correct rationale for this instruction? to determine whether infection is present to determine whether the fetus is viable to determine the stage of development of the fetus to determine whether gestational trophoblastic disease is present

to determine whether gestational trophoblastic disease is present

A nurse is providing discharge teaching for a pregnant client with preeclampsia who will be managed at home on bedrest. The nurse determines that the teaching was successful based on which client statement? "I need to drink about 8 glasses of water a day." "I should lie on my back as much as I can." "I will check how often my baby kicks once per week." "I should check my blood pressure about 3 times per week."

"I need to drink about 8 glasses of water a day."

The nurse is teaching a client who is diagnosed with preeclampsia how to monitor her condition. The nurse determines the client needs more instruction after making which statement? "If I have a severe headache, I'll call the clinic." "I will weigh myself every morning after voiding before breakfast." "I will count my baby's movements after each meal." "If I have changes in my vision, I will lie down and rest."

"If I have changes in my vision, I will lie down and rest."

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 (D&C). The client looks frightened and confused and states that she does not believe in induced abortion (medical 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." "The choice is up to you but the health care provider is recommending an induced abortion (medical abortion). "I know that it is sad but the pregnancy must be terminated to save your life." "You have experienced an incomplete abortion (miscarriage) and must have the placenta and any other tissues cleaned out."

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

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? Obtain a surgical consent from the client. Assess the client's vital signs. Administer oxygen to the client. Provide emotional support to the client and significant other.

Assess the client's vital signs.

A woman in her 20s has experienced a spontaneous abortion (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 miscarriage in the first trimester is related to which factor? Chromosomal defects in the fetus Exposure to chemicals or radiation Advanced maternal age Faulty implantation

Chromosomal defects in the fetus

A woman was diagnosed as having experienced a missed abortion at 10 weeks' gestation. When reviewing the client's medical records, which finding would most likely be noted? Gradually increasing uterine contractions. Feeling diminished signs of pregnancy such as breast tenderness and nausea. Bright red vaginal bleeding consistently over the past 2 weeks. Excessive nausea and vomiting. Passage of small amounts of tissue from the vagina.

Feeling diminished signs of pregnancy such as breast tenderness and nausea.

The nurse is caring for a pregnant client with severe preeclampsia. Which nursing intervention should a nurse perform to institute and maintain seizure precautions in this client? Keep head of bed slightly elevated. Provide a well-lit room. Place the client in a supine position. Keep the suction equipment readily available.

Keep the suction equipment readily available.

A client at 25 weeks' gestation presents with a blood pressure of 152/99 mm Hg, pulse 78 beats/min, no edema, and urine negative for protein. What would the nurse do next? Document the client's blood pressure Notify the health care provider Provide health education Assess the client for ketonuria

Notify the health care provider

A client at 27 weeks' gestation is admitted to the obstetric unit after reporting headaches and edema of her hands. Review of the prenatal notes reveals blood pressure consistently above 136/90 mm Hg. The nurse anticipates the health care provider will prescribe magnesium sulfate to accomplish which primary goal? Decrease blood pressure Reverse edema Decrease protein in urine Prevent maternal seizures

Prevent maternal seizures

A 24-year-old client is brought to the emergency department complaining of severe abdominal pain, vaginal bleeding, and fatigue. On assessment, the nurse notes cool, clammy skin; confusion; and vital signs as the following: HR 130, RR 28, and BP 98/60 mm Hg. Which action should the nurse prioritize? Establish IV access. Rule out pregnancy. Rule out shock. Attach EFM.

Rule out shock.

The nurse is required to assess a pregnant client who is reporting vaginal bleeding. Which nursing action is the priority? determining the amount of funneling monitoring uterine contractility assessing signs of shock assessing the amount and color of the bleeding

assessing the amount and color of the bleeding

A pregnant woman is diagnosed with placental abruption (abruptio placentae). When reviewing the woman's physical assessment in her medical record, which finding would the nurse expect? gradual onset of symptoms firm, rigid uterus on palpation absence of pain fetal heart rate within normal range

firm, rigid uterus on palpation

A woman at 10 weeks' gestation comes to the clinic for an evaluation. Which assessment finding should the nurse prioritize? report of frequent mild nausea fundal height measurement of 18 cm history of bright red spotting 6 weeks ago blood pressure of 120/84 mm Hg

fundal height measurement of 18 cm

A 28-year-old primigravida client with type 2 diabetes comes to the health care clinic for a routine first trimester visit reporting frequent episodes of fasting blood glucose levels being lower than normal, but glucose levels after meals being higher than normal. What should the nurse point out that these episodes are most likely related to? tissue sensitivity to insulin increases insulin resistance is starting to decrease using too much insulin at this stage of the pregnancy normal response to the pregnancy

normal response to the pregnancy

During a routine prenatal visit, a client is found to have 1+ proteinuria and a blood pressure rise to 140/90 mm Hg with mild facial edema. The nurse recognizes that the client has which condition? eclampsia preeclampsia without severe features gestational hypertension preeclampsia with severe features

preeclampsia without severe features

A woman at 35 weeks' gestation with severe polyhydramnios is admitted to the hospital. The nurse recognizes that which concern is greatest regarding this client? hemorrhaging development of gestational trophoblastic disease development of eclampsia preterm rupture of membranes followed by preterm birth

preterm rupture of membranes followed by preterm birth

A nurse is providing care to a pregnant client hospitalized with preeclampsia. The nurse immediately notifies the health care provider that the client has developed eclampsia based on which finding? proteinuria seizure activity blood pressure greater than 160/100 mm Hg hyperreflexia

seizure activity

A nurse is reviewing the medical record of a pregnant client. The physical exam reveals that the placenta is implanted near the internal os but does not reach it. The nurse interprets this as which condition? placenta increta low-lying placenta placenta percreta placenta accreta

low-lying placenta

The nurse is assisting a client who has just undergone an amniocentesis. Blood results indicate the mother has type O blood and the fetus has type AB blood. The nurse should point out the mother and fetus are at an increased risk for which situation related to this procedure? Preterm birth Baby developing postbirth jaundice Placental abruption (abruptio placentae) Baby developing hemolytic anemia

Baby developing postbirth jaundice

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? Check deep tendon reflexes. Palpate the fundus and check fetal heart rate. Obtain a voided urine specimen and determine blood type. Measure fundal height.

Palpate the fundus and check fetal heart rate.

The nurse is caring for a client with preeclampsia and understands the need to auscultate this client's lung sounds every 2 hours to detect which condition? pulmonary edema pulmonary hypertension pulmonary emboli pulmonary atelectasis

pulmonary edema

A nurse is caring for a pregnant client admitted with mild preeclampsia. Which assessment finding should the nurse prioritize? 1+ ankle edema urine output of less than 15 ml/hr mild hand edema proteinuria of 200 mg/24 hours

urine output of less than 15 ml/hr

A client reporting she recently had a positive pregnancy test has reported to the emergency department stating one-sided lower abdominal pain. The health care provider has prescribed a series of tests. Which test will provide the most definitive confirmation of an ectopic pregnancy? Abdominal ultrasound Quantitative human chorionic gonadotropin (hCG) test Pelvic examination Qualitative human chorionic gonadotropin (hCG) test

Abdominal ultrasound

A 24-year-old woman presents with vague abdominal pains, nausea, and vomiting. An urine hCG is positive after the client mentioned that her last menstrual period was 2 months ago. The nurse should prepare the client for which intervention if the transvaginal ultrasound indicates a gestation sac is found in the right lower quadrant? Bed rest for the next 4 weeks Intravenous administration of a tocolytic Immediate surgery Internal uterine monitoring

Immediate surgery

A nurse is providing care to a pregnant woman with preterm prelabor rupture of membranes (PPROM). On admission, the client's baseline information was as follows: temperature, 97.6°F (36.5°C); pulse, 76 beats/minute; fetal heart rate, 136 beats/minute; white blood cell count, 7 x 103cells/mm3 (7.0 x 109/L). Now, 8 hours later, assessment reveals the following: temperature, 99.6°F (37.7°C); pulse, 82 beats/minute; fetal heart rate, 180 beats/minute; white blood cell count, 8.5 x 103 cells/mm3 (8.5 X 109/L). The nurse suspects a possible infection based on the change in which parameter? pulse rate white blood cell count temperature fetal heart rate

fetal heart rate

A novice nurse asks to be assigned to the least complex antepartum client. Which condition would necessitate the least complex care requirements? placental abruption (abruptio placentae) preeclampsia placenta previa gestational hypertension

gestational hypertension

A woman at 8 weeks' gestation is admitted for ectopic pregnancy. She is asking why this has occurred. The nurse knows that which factor is a known risk factor for ectopic pregnancy? high number of pregnancies history of endometriosis multiple gestation pregnancy use of oral contraceptives

history of endometriosis

The nurse is teaching a prenatal class on potential problems during pregnancy to a group of expectant parents. The risk factors for placental abruption (abruptio placentae) are discussed. Which comment validates accurate learning by the parents? "I need a cesarean section if I develop this problem." "If I develop this complication, I will have bright red vaginal bleeding," "Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain." "Since I am over 30, I run a much higher risk of developing this problem."

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

A woman who is 10 weeks' pregnant calls the physician's office reporting "morning sickness" but, when asked about it, tells the nurse that she is nauseated and vomiting all the time and has lost 5 pounds. What interventions would the nurse anticipate for this client? The nurse will encourage the woman to lie down and rest whenever she feels ill. Since morning sickness is a common problem for pregnant women, the nurse will suggest the woman drink more fluids and eat crackers. Lab work will be drawn to rule out acid-base imbalances. An ultrasound will be done to reassess the correctness of gestational dates.

Lab work will be drawn to rule out acid-base imbalances.

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? maternal hypotension fetal nonimmune hydrops congenital anomalies postterm birth

congenital anomalies

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? "It is hard to know why a woman bleeds during early pregnancy." "I can understand your need to find an answer to what caused this. Let's talk about this further." "Your spontaneous bleeding is not work-related." "Something was wrong with the fetus."

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

A pregnant women calls the clinic to report a small amount of painless vaginal bleeding. What response by the nurse is best? "Bleeding during pregnancy happens for many reasons, some serious and some harmless." "If the bleeding lasts more than 24 hours, call us for an appointment." "Lie on your left side and drink lots of water and monitor the bleeding." "Please come in now for an evaluation by your health care provider."

"Please come in now for an evaluation by your health care provider."

A nurse has been assigned to assess a pregnant client for placental abruption (abruptio placentae). For which classic manifestation of this condition should the nurse assess? "knife-like" abdominal pain with vaginal bleeding painless bright red vaginal bleeding increased fetal movement generalized vasospasm

"knife-like" abdominal pain with vaginal bleeding

A primipara at 36 weeks' gestation is being monitored in the prenatal clinic for risk of preeclampsia. Which sign or symptom should the nurse prioritize? A dipstick value of 2+ for protein Pedal edema A systolic blood pressure increase of 10 mm Hg Weight gain of 1.2 lb (0.54 kg) during the past 1 week

A dipstick value of 2+ for protein

A primigravida 28-year-old client is noted to have Rh negative blood and her husband is noted to be Rh positive. The nurse should prepare to administer RhoGAM after which diagnostic procedure? Contraction test Amniocentesis Nonstress test Biophysical profile

Amniocentesis

A 28-year-old client and her current partner present for the first prenatal appointment with the ob/gyn. The client has no children but does question a possible miscarriage 2 years ago; however, she never sought medical attention because she felt fine. Labs reveal both client and partner are Rh negative. Which action should the nurse prioritize? Continue with routine procedures and tasks. Assess client for anti-D antibodies. Perform direct Coombs test. Arrange for an amniocentesis.

Assess client for anti-D antibodies.

A 28-year-old client with a history of endometriosis presents to the emergency department with severe abdominal pain and nausea and vomiting. The client also reports her periods are irregular with the last one being 2 months ago. The nurse prepares to assess for which possible cause for this client's complaints? Healthy pregnancy Molar pregnancy Ectopic pregnancy Placenta previa

Ectopic pregnancy

After a regular prenatal visit, a pregnant client asks the nurse to describe the differences between placental abruption (abruptio placentae) and placenta previa. Which statement will the nurse include in the teaching? Placenta previa is an abnormally implanted placenta that is too close to the cervix. Placental abruption requires "watchful waiting" during labor and birth. Placenta previa causes painful, dark red vaginal bleeding during pregnancy. Placental abruption results in painless, bright red vaginal bleeding during labor.

Placenta previa is an abnormally implanted placenta that is too close to the cervix.

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

Sharp fundal pain and discomfort between contractions

A nurse is monitoring a client with PROM who is in labor and observes meconium in the amniotic fluid. What does the observation of meconium indicate? infection cord compression central nervous system (CNS) involvement fetal distress related to hypoxia

fetal distress related to hypoxia

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? placenta previa pregnancy-induced depression hyperemesis gravidarum gestational trophoblastic disease

gestational trophoblastic disease

A pregnant client diagnosed with hyperemesis gravidarum is prescribed intravenous fluids for rehydration. When preparing to administer this therapy, which solution would the nurse anticipate being prescribed initially? albumin 0.45% sodium chloride dextrose 5% and water normal saline

normal saline

A 24-year-old client presents in labor. The nurse notes there is an order to administer Rho(D) immune globulin after the birth of her infant. When asked by the client the reason for this injection, which reason should the nurse point out? promote maternal D antibody formation. prevent fetal Rh blood formation. prevent maternal D antibody formation. stimulate maternal D immune antigens.

prevent maternal D antibody formation.

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? "Staples are put in the cervix to prevent it from dilating." "The cervix is glued shut so no amniotic fluid can escape." "A cervical cap is placed so no amniotic fluid can escape." "Purse-string sutures are placed in the cervix to prevent it from dilating."

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

An 18-year-old pregnant client is hospitalized as she recovers from hyperemesis gravidarum. The client reveals she wanted to have an abortion (elective termination of pregnancy) but her cultural background forbids it. She is very unhappy about being pregnant and even expresses a wish for a miscarriage. Which action by the nurse is most appropriate? Continue to monitor the client's hyperemesis gravidarum. Share the information with the client's family. Contact the health care provider to report the client's feelings. Encourage the client to be positive about the situation.

Contact the health care provider to report the client's feelings.

A pregnant woman at 12 weeks' gestation comes to the office reporting she has begun minimal fresh vaginal spotting. She is distressed because her primary care provider indicates after examining her that they will "wait and see." Which response would be most appropriate from the nurse in answering this client's concerns? Tell her that medication to prolong a 12-week pregnancy usually is not advised. Advise her to ask for a second care provider opinion. Explain that "wait and see" means that her care provider wants her to maintain strict bed rest. Suggest she take an over-the-counter tocolytic just to feel secure.

Tell her that medication to prolong a 12-week pregnancy usually is not advised.

The following hourly assessments are obtained by the nurse on a client with preeclampsia receiving magnesium sulfate: 97.3oF (36.2oC), HR 88, RR 12 breaths/min, BP 148/110 mm Hg. What other priority physical assessments by the nurse should be implemented to assess for potential toxicity? oxygen saturation lung sounds magnesium sulfate level reflexes

reflexes

A pregnant woman has arrived to the office reporting vaginal bleeding. Which finding during the assessment would lead the nurse to suspect an inevitable spontaneous abortion (miscarriage)? closed cervical os slight vaginal bleeding strong abdominal cramping no passage of fetal tissue

strong abdominal cramping