OB 21

A pregnant patient is diagnosed with placenta previa. Which action should the nurse implement immediately for this patient? A) Assess fetal heart sounds with an external monitor. B) Help the patient remain ambulatory to reduce bleeding. C) Assess uterine contractions by an internal pressure gauge. D) Prepare for a vaginal examination to assess the extent of bleeding.

A) Assess fetal heart sounds with an external monitor. For placenta previa, the nurse should attach external monitoring equipment to record fetal heart sounds and uterine contractions. Internal pressure gauges to measure uterine contractions are contraindicated. A pelvic or rectal examination should never be done with painless bleeding late in pregnancy because any agitation of the cervix when there is a placenta previa might tear the placenta further and initiate massive hemorrhage, which could be fatal to both mother and child. To ensure an adequate blood supply to the patient and fetus, the patient should be placed immediately on bed rest in a side-lying position.

The nurse is preparing discharge instructions for a pregnant patient experiencing preterm rupture of membranes. What should the nurse include in this teaching? (Select all that apply.) A) Avoid douching. B) Resume regular coitus. C) Take a tub bath at least once per day. D) Expect malodorous vaginal discharge. E) Measure oral temperature twice a day

A) Avoid douching. E) Measure oral temperature twice a day The patient with premature rupture of membranes is at risk for developing an infection. The nurse should instruct the patient to avoid douching and measure oral temperature twice a day. Coitus and tub baths should be avoided because these could introduce an infection into the uterus. A malodorous vaginal discharge could indicate infection and should be reported to the health care provider.

A pregnant patient is diagnosed with preterm labor. What should the nurse teach the patient to help prevent the reoccurrence of preterm labor? (Select all that apply.) A) Drink 8 to 10 glasses of fluid each day. B) Report any signs of ruptured membranes. C) Remain on bed rest except to use the bathroom. D) Lie flat on the back should uterine contractions occur. E) Engage in mild activities of daily living with frequent rest periods.

A) Drink 8 to 10 glasses of fluid each day. B) Report any signs of ruptured membranes. C) Remain on bed rest except to use the bathroom. To reduce the onset of preterm labor, the nurse should instruct the patient to drink 8 to 10 glasses of fluid each day to remain hydrated. The patient should also report any signs of ruptured membranes and remain on bed rest unless using the bathroom. Should uterine contractions begin, the patient should be instructed to lie on either the right or left side to increase blood return to the uterus. The patient should not engage in any activity other than bed rest with bathroom privileges.

The nurse is preparing an education session on the 2020 National Health Goals to prevent complications of pregnancy. What should the nurse include as the best preventive measure to eliminate complications of pregnancy? A) Encourage all pregnant patients to have prenatal care. B) Suggest all pregnant patients keep weight gain to a minimum. C) Recommend all pregnant patients engage in exercise most days of the week. D) Counsel all pregnant patients to select low-fat dairy products rich in calcium.

A) Encourage all pregnant patients to have prenatal care. Encouraging all women to come for prenatal care is the best preventive measure for eliminating complications of pregnancy. Weight gain, exercise, and calcium intake are not identified as specific measures to prevent complications of pregnancy.

A patient is admitted with a diagnosis of ectopic pregnancy. For what should the nurse anticipate preparing the patient? A) Immediate surgery B) Internal uterine monitoring C) Bed rest for the next 4 weeks D) Intravenous administration of a tocolytic

A) Immediate surgery An ectopic pregnancy is one in which implantation occurred outside the uterine cavity, usually within the fallopian tube. As the embryo grows, the fallopian tube can rupture. The therapy for ruptured ectopic pregnancy is laparoscopy to ligate the bleeding vessels and to remove or repair the damaged fallopian tube. There is no reason to begin uterine monitoring. The patient does not need to be on bed rest for 4 weeks. A tocolytic is not needed because the patient is not in labor.

The nurse is concerned that a pregnant patient is developing hydramnios. What did the nurse assess in this patient? (Select all that apply.) A) Tense uterus B) Sudden weight loss C) Extreme shortness of breath D) Difficulty hearing fetal heart rate E) Uterus larger than expected for gestation week

A) Tense uterus C) Extreme shortness of breath D) Difficulty hearing fetal heart rate E) Uterus larger than expected for gestation week Hydramnios is an excessive amount of amniotic fluid. The first sign of this disorder may be a rapid enlargement of the uterus. The uterus becomes tense, and the patient experiences shortness of breath because of the uterus pressing on the diaphragm. Auscultating the fetal heart rate can be difficult because of depth of the increased amount of fluid surrounding the fetus. The uterus will be larger than expected for the patient's gestational week.

A pregnant patient with a history of premature cervical dilatation undergoes cervical cerclage. Which outcome indicates that this procedure has been successful? A) The client delivers a full-term fetus at 39 weeks' gestation. B) The client's membranes spontaneously rupture at week 30 of gestation. C) The client experiences minimal vaginal bleeding throughout the pregnancy. D) The client has reduced shortness of breath and abdominal pain during the pregnancy.

A) The client delivers a full-term fetus at 39 weeks' gestation. Premature cervical dilatation is when the cervix dilates prematurely and cannot retain a fetus until term. After the loss of one child because of premature cervical dilatation, a surgical operation termed cervical cerclage can be performed to prevent this from happening in a second pregnancy. This procedure is the use of purse-string sutures placed in the cervix to strengthen the cervix and prevent it from dilating until the end of pregnancy. Evidence that this procedure is effective would be the client delivering a full-term fetus at 39 weeks' gestation. Spontaneous rupture of the membranes could indicate that the procedure was not successful. Vaginal bleeding could indicate another health problem or that the procedure was not successful. This procedure does not impact the patient's respirations or amount of abdominal pain while pregnant. These manifestations could indicate another health problem with the pregnancy.

The nurse is evaluating care provided to a patient in the third trimester of pregnancy who has been diagnosed with gestational hypertension. Which finding indicates that treatment has been successful for this patient? A) Urine protein 0 B) Increased perspiration C) Weight gain of 1 lb/week D) Diastolic blood pressure 20 mmHg over normal level

A) Urine protein 0 Manifestations of gestational hypertension include elevated blood pressure, edema, and proteinuria. Absence of protein in the urine indicates that treatment has been successful. Increased perspiration is not a manifestation of gestational hypertension. A weight gain of 1 lb/week in the patient who is in the third trimester of pregnancy is an indication of ongoing edema. A diastolic blood pressure that is 20 mmHg over normal level is an indication of ongoing hypertension.

A pregnant patient is developing HELLP syndrome. During labor, which order should the nurse question? A) Assess urine output every hour. B) Prepare for epidural anesthesia. C) Position on the left side during labor. D) Assess blood pressure every 15 minutes.

B) Prepare for epidural anesthesia. In the HELLP syndrome, patients develop low platelet counts. With a low platelet count, injections such as epidural anesthesia are contraindicated. This is the order that the nurse should question. The patient's urine output should be assessed every hour because renal failure is a complication of this syndrome. Positioning on the left side during labor will help blood flow to the uterus. Assessing blood pressure every 15 minutes is appropriate for the patient with this syndrome.

The nurse is reviewing the plan of care for a pregnant patient experiencing a threatened miscarriage. Which outcome would be appropriate for this patient? A) Bed rest is maintained until all bleeding stops. B) Less than one perineal pad is saturated per hour. C) Bleeding spontaneously stops within 24 to 48 hours. D) Normal coitus is resumed 1 week after the episode.

C) Bleeding spontaneously stops within 24 to 48 hours. For a threatened miscarriage, an outcome for care would be that all bleeding would spontaneously stop within 24 to 48 hours. Bed rest is not recommended for a threatened miscarriage because blood will pool in the vagina. Vaginal bleeding that saturates a perineal pad in 1 hour is an emergency and could indicate an incomplete or complete miscarriage. Normal coitus should be withheld for 2 weeks after a threatened miscarriage.

A pregnant patient is being admitted for severe preeclampsia. In which room location should the nurse place this patient? A) Near the nursery B) Next to the elevator C) In the back private room D) Across from the nurse's station

C) In the back private room With severe preeclampsia, hospitalization is required so that bed rest can be enforced and the patient can be observed more closely. A patient with severe preeclampsia is admitted to a private room so that rest is undisturbed. Noises such as a baby crying, elevator doors opening and closing, and conversation from the nurse's station is sufficient to trigger a seizure. A private room will help reduce the likelihood of seizure development.

A patient recovering from an uneventful vaginal delivery is prescribed Rh (D) immune globulin (RhIG). What should the nurse explain to the patient regarding the purpose of this medication? A) It prevents fetal Rh blood formation. B) It stimulates maternal D immune antigens. C) It prevents maternal D antibody formation. D) It promotes maternal D antibody formation.

C) It prevents maternal D antibody formation. Rh (D) immune globulin (RhIG) is given to Rh-negative pregnant patients to prevent the formation of maternal antibodies to the Rh-positive blood type of the developing fetus. This medication does not prevent fetal Rh blood formation, stimulate maternal immune antigens, or promote maternal antibody formation.

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? A) Check fetal heart rate. B) Measure blood pressure. C) Stop the current infusion. D) Increase the infusion rate.

C) Stop the current infusion. When infusing magnesium sulfate, the nurse should stop the infusion if deep tendon reflexes are absent. Checking the fetal heart rate and measuring blood pressure could waste time and provide the patient with more magnesium sulfate. The infusion rate should not be increased because this could lead to cardiac dysrhythmias and respiratory depression.

The nurse is identifying nursing diagnoses for a patient with gestational hypertension. Which diagnosis would be the most appropriate for this patient? A) Risk for injury related to fetal distress B) Imbalanced nutrition related to decreased sodium levels C) Ineffective tissue perfusion related to poor heart contraction D) Ineffective tissue perfusion related to vasoconstriction of blood vessels

D) Ineffective tissue perfusion related to vasoconstriction of blood vessels In gestational hypertension, vasospasm occurs in both small and large arteries during pregnancy. This can lead to ineffective tissue perfusion. There is no evidence to suggest that the fetus is in distress. There is no enough information to support imbalanced nutrition. Gestational hypertension does not affect heart contractions.

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? A) Begin immediate bed rest. B) Count the number of perineal pads that are saturated with blood. C) Continue with normal daily activity and monitor pulse rate every hour. D) Seek immediate medical attention and bring the expressed vaginal material.

D) Seek immediate medical attention and bring the expressed vaginal material. Gestational trophoblastic disease is abnormal proliferation and then degeneration of the trophoblastic villi. The embryo fails to develop beyond a primitive start. At approximately week 16 of pregnancy, vaginal bleeding will begin as spotting of dark-brown blood accompanied by discharge of the clear fluid-filled vesicles. The pregnant patient who begins to miscarry at home needs to bring any clots or tissue passed to the hospital because the presence of clear fluid-filled cysts identifies gestational trophoblastic disease. The patient needs to seek immediate medical attention and not stay at home on bed rest, count perineal pads, or continue with normal activity and count pulse rates every hour.

The nurse is concerned that a pregnant patient is experiencing abruptio placentae. What did the nurse assess in this patient? A) Increased blood pressure and oliguria B) Pain in a lower quadrant and increased pulse rate C) Painless vaginal bleeding and a fall in blood pressure D) Sharp fundal pain and discomfort between contractions

D) Sharp fundal pain and discomfort between contractions Abruptio placentae is characterized by a sharp, stabbing pain high in the uterine fundus as the initial separation occurs. Manifestations of abruptio placentae do not include increased blood pressure, oliguria, pain in the lower quadrant, increased pule rate, painless vaginal bleeding, or a fall in blood pressure.