OB Maternity
Select the statement by the pregnant woman that indicates the need for more teaching about preeclampsia. a) "If I have changes in my vision, I will lie down and rest." b) "I will count my baby's movements twice a day." c) "If I have a slight headache I'll take Tylenol and call if unrelieved." d) "I will weigh myself every morning after voiding before breakfast."
"If I have changes in my vision, I will lie down and rest." Explanation: Changes in the visual field may indicate the patient has moved from preeclampsia to severe preeclampisa and is at risk for developing a seizure due to changes in cerebral blood flow. The patient would require immediate assessment and intervention. Options B, C, and D would not indicate that more teaching about preeclampsia is indicated.
A postpartum mother has the following lab data recorded: RH negative and rubella titer is positive. What is the appropriate nursing intervention? a) Administer RhoGam within 72 hours. b) Assess the RH of the baby. c) Administer rubella vaccine before discharge. d) Assess the rubella of the baby
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A pregnant client in her 35th week of gestation arrives at the clinic with complaints of abdominal pain and spotting. The ultrasound indicates that the placenta is partially covering the dilated internal os. The nurse interprets this as which type of placenta previa? a) Type III b) Type IV c) Type II d) Type I
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A pregnant woman is admitted to the hospital with a diagnosis of placenta previa. Which of the following would be the priority for this woman on admission? a) Helping the woman remain ambulatory to reduce bleeding b) Assessing uterine contractions by an internal pressure gauge c) Performing a vaginal examination to assess the extent of bleeding d) Assessing fetal heart tones by use of an external monitor
Assessing fetal heart tones by use of an external monitor Correct Explanation: Not disrupting the placenta is a prime responsibility. An internal monitor, a vaginal examination, and remaining ambulatory could all do this and thus are contraindicated
A woman has been diagnosed as having pregnancy-induced hypertension. Which of the following is the most typical symptom of this? a) Blood pressure elevation b) Weight loss c) Susceptibility to infection d) Increased perspiration
Blood pressure elevation
Which of the following changes in B/P assessment findings during the second trimester indicate the highest risk for preeclampsia. a) Initial BP 140/85, current BP 130/80. b) Initial BP 110/60, current BP 112/86. c) Initial BP 120/80, current BP 130/88. d) Initial BP 100/70, current BP 140/90.
Initial BP 100/70, current BP 140/90. Explanation: A rise in blood pressure to above 140/90 is a concern the patient may be developing preeclampsia. The B/Ps noted in options A, C, and D are not indicative of developing preeclampsia, so these are incorrect responses.
A pregnant woman with preeclampsia is to receive magnesium sulfate IV. Which of the following assessments would be most important prior to administering a new dose? a) Blood pressure b) Anxiety level c) Pulse rate d) Patellar reflex
Patellar reflex Correct Explanation: A symptom of magnesium sulfate toxicity is loss of deep tendon reflexes. Assessing for one of these before administration is assurance the drug administration will be safe
A young mother delivers twin boys who shared the same placenta. What serious complication are they at risk for? a) ABO incompatability b) Twin-to-twin transfusion syndrome (TTTS) c) TORCH syndrome d) HELLP syndrome
Twin-to-twin transfusion syndrome (TTTS) Explanation: When twins share a placenta, a serious condition called twin-to-twin transfusion syndrome (TTTS) can occur.
You are the post-partum nurse caring for a woman who delivered four hours ago. During delivery this patient had placental abruption. She is now at risk for postpartum hemorrhage because of what? a) Blood incompatabilities b) Retained products of conception c) Uterine atony d) Renal failure
Uterine atony Correct Explanation: After delivery, the woman who has had abruption placentae requires close monitoring for postpartum hemorrhage because she is at risk for uterine atony. (
A woman you care for has an Rh-negative blood type. Following the birth of her infant, you administer her RhIG (D immune globulin). The purpose of this is to a) prevent maternal D antibody formation. b) promote maternal D antibody formation. c) stimulate maternal D immune antigens. d) prevent fetal Rh blood formation.
prevent maternal D antibody formation. Explanation: Because RhIG contains passive antibodies, the solution will prevent the woman from forming long-lasting antibodies.
A woman of 16 weeks' gestation telephones you because she has passed some "berry-like" blood clots and now has continued dark brown vaginal bleeding. Which of the following would you instruct the woman to do? a) "Maintain bed rest and count the number of perineal pads used." b) "Come to the health care facility if uterine contractions begin." c) "Continue normal activity, but take your pulse every hour." d) "Come to the health facility with any vaginal material passed."
"Come to the health facility with any vaginal material passed." Correct Explanation: This is a typical time in pregnancy for gestational trophoblastic disease to present. Asking the woman to bring any material passed vaginally would be important so it can be assessed for this.
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? a) Obtain a voided urine specimen and determine blood type. b) Check deep tendon reflexes. c) Palpate the fundus and check fetal heart rate. d) Measure fundal height.
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A client experiences a threatened abortion. She is concerned about losing the pregnancy and asks what activity level she should maintain. What is the most appropriate response from the nurse? a) "There is no research evidence that I can recommend to you." b) "Carry on with the activity you engaged in before this happened." c) "Strict bedrest is necessary so as not to jeopardize this pregnancy." d) "Restrict your physical activity to moderate bedrest.
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A client in her first trimester arrives at the emergency room with reports of severe cramping and vaginal spotting. On examination, the physician informs her that no fetal heart sounds are evident and the fetus is no longer viable. He says that he must perform a dilatation and curettage to ensure that all of the products of conception are removed. The client looks frightened and confused and says that she does not believe in abortion. Which of the following should the nurse say to the client? a) "The pregnancy is already lost; the procedure is simply to clean out the uterus to prevent further complications." b) "The pregnancy must be terminated to protect your health and life." c) "You have experienced an incomplete miscarriage. This procedure is simply to remove the membranes and placenta that are retained in the uterus." d) "The choice is up to you, but the physician is recommending an abortion."
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A woman in week 35 of her pregnancy with severe hydramnios is admitted to the hospital. The nurse recognizes that which of the following is the biggest concern regarding this client? a) Development of eclampsia b) Development of gestational trophoblastic disease c) Hemorrhaging d) Preterm rupture of membranes followed by preterm birth
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A woman you care for has an Rh-negative blood type. Following the birth of her infant, you administer her Rho(D) (D immune globulin). The purpose of this is to a) Prevent fetal RH blood formation. b) Stimulate maternal D immune antigens. c) Promote maternal D antibody formation. d) Prevent maternal D antibody formation.
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The nurse through assessment can best differentiate between placenta previa and abruptio placentae by which of the following signs and or symptoms. a) Bleeding amount and consistency. b) Shape of the abdomen. c) Low back pain. d) Uterine tone and contractions of the uterus.
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Rhogam (Rh immune globulin) will be ordered for an RH - mother undergoing which of the following tests? a) Biophysical profile b) Contraction test c) Non-stress test d) Amniocentesis
Amniocentesis Correct Explanation: Amniocentesis is a procedure requiring a needle to enter into the amniotic sac. There is a risk of mixing of the fetal and maternal blood which could result in blood incompatibility. A contraction test, a non-stress test, and biophysical profile are not invasive, so there would be no indication for Rhogam to be administered.
A woman has been diagnosed as having pregnancy-induced hypertension. Which of the following is the most typical symptom of this? a) Susceptibility to infection b) Blood pressure elevation c) Weight loss d) Increased perspiration
Blood pressure elevation Explanation: The symptom of hypertension of pregnancy is blood pressure elevation
When administering magnesium sulfate to a woman with severe preeclampsia, which finding would alert the nurse to the development of magnesium toxicity? a) Seizures b) Serum magnesium level of 6.5 mEq/L c) Diminished reflexes d) Elevated liver enzymes
Diminished reflexes Correct Explanation: Diminished or absent reflexes occur when a client develops magnesium toxicity. Elevated liver enzymes are unrelated to magnesium toxicity and may indicate the development of HELLP syndrome. The onset of seizure activity indicates eclampsia. A serum magnesium level of 6.5 mEq/L would fall within the therapeutic range of 4 to 7 mEq/L.
A 28-year-old woman presents in the emergency room with severe abdominal pain. She has not had a normal period for 2 months but she reports that that is not abnormal for her. She has a history of endometriosis. What might the nurse suggest to the physician as a possible cause of the patient's abdominal pain? a) Healthy pregnancy b) Ectopic pregnancy c) Molar pregnancy d) Placenta previa
Ectopic pregnancy Correct Explanation: Ectopic pregnancy can present with severe unilateral abdominal pain. Given the history of the client , the amount of pain, the possibility of ectopic pregnancy needs to be considered. A healthy pregnancy would not present with severe abdominal pain unless the patient were term and she was in labor. With a molar pregnancy the woman typically presents between 8 to 16 weeks' gestation with complaints of painless (usually) brown to bright red vaginal bleeding. Placenta previa typically presents with painless, bright red bleeding that begins with no warning.
A woman with an incomplete abortion is to receive misoprostol. The nurse understands that the rationale for administering this drug is to: a) Halt the progression of the abortion b) Suppress the immune response to prevent isoimmunization c) Ensure passage of all the products of conception d) Alleviate strong uterine cramping
Ensure passage of all the products of conception Correct Explanation: Misoprostol is used to stimulate uterine contractions and evacuate the uterus after an abortion to ensure passage of all the products of conception. Rh (D) immunoglobulin is used to suppress the immune response and prevent isoimmunization.
In returning to the hospital floor after a weekend off, the nurse takes over care of a pregnant patient who is resting in a darkened room. The patient is receiving betamethasone and magnesium sulfate. What could the nurse deduce from those findings? a) The patient is suffering from hypertension and the care team is trying to lower her blood pressure so that she may return home until the baby is full term. b) The patient is suffering from severe preeclampsia and the care team is attempting to prevent advancement of the disorder to eclampsia; they are attempting to help the baby's lungs mature quickly so that they can deliver as soon as possible. c) The patient is suffering from eclampsia and the care team is attempting to prevent stroke and induce labor. d) The patient is suffering from mild preeclampsia and the care team is attempting to stabilize her and the baby before discharging her to home.
Explanation: The administration of magnesium sulfate is to relax the skeletal muscles and raise the threshold for a seizure. The administration of the betamethasone is to try and hasten the maturity of the fetus' lungs for delivery. This woman is in advanced preeclampsia and must be monitored for progression to eclampsia. The scenario described does not indicate a patient with hypertension who may be discharged home once the condition is under control. A woman in eclampsia would either be seizing or comatose, not resting in a quiet room. Symptoms of mild preeclampsia are limited to slightly elevated blood pressure and small amounts of protein in the urine. Betamethasone may be indicated at this time. (less) Reference: Ricci, S. S. Essentials of Maternity, Newborn, and Women's Health Nursing, 3rd ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013, Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications,
A novice nurse asks to be assigned to the least complex antepartum patient. Which of the following conditions would necessitate the least complex care requirements? a) Abruptio placenta. b) Placenta previa. c) Gestational hypertension. d) Pre-ecalmpsia.
Gestational hypertension. Correct Explanation: Hypertensive disorders represent the most common complication of pregnancy. Gestational hypertension is elevated blood pressure without proteinuria, other signs of pre-eclampsia, or pre-existing hypertension. Abruptio placenta (separation of the placenta from the uterine wall), placenta previa (placenta covering the cervical os), and pre-eclampsia are high-risk, potentially life-threatening conditions for the fetus and mother during labor and birth.
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? a) "It is hard to know why a woman bleeds during early pregnancy." b) "I can understand your need to find an answer to what caused this. Let's talk about this further." c) "Your spontaneous bleeding is not work-related." d) "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." Correct Explanation: Talking with the client may assist her to explore her feelings. She and her family may search for a cause for a spontaneous early bleeding so they can plan for future pregnancies. Even with modern technology and medical advances, however, a direct cause cannot usually be determined.
A woman is admitted with a diagnosis of ectopic pregnancy. For which of the following would you anticipate beginning preparation? a) Bed rest for the next 4 weeks. b) Intravenous administration of a tocolytic. c) Immediate surgery. d) Internal uterine monitoring.
Immediate surgery. Correct Explanation: Ectopic pregnancy means an embryo has implanted outside the uterus, usually in the fallopian tube. Surgery is usually necessary to remove the growing structure before the tube ruptures or repair the tube if rupture has already occurred. Bed rest will not correct the problem of an ectopic pregnancy. Administering a tocolytic is not indicated, nor is internal uterine monitoring. This makes options A, B, and D incorrect. (less)
Which of the following would the nurse most likely include when planning the care for a woman requiring hospitalization for hyperemesis gravidarum? Select all that apply. a) Preparing the woman for insertion of a feeding tube b) Obtaining baseline blood electrolyte levels c) Administering antiemetic agents d) Monitoring intake and output e) Maintaining NPO status for the first day or two
Maintaining NPO status for the first day or two • Administering antiemetic agents • Obtaining baseline blood electrolyte levels • Monitoring intake and output Explanation: When hospitalization is necessary, oral food and fluids are withheld to allow the gut to rest. Antiemetic agents are ordered to help control nausea and vomiting. The woman is likely to be dehydrated, so the nurse would obtain baseline blood electrolyte levels and administer intravenous fluid and electrolyte replacement therapy as indicated. Once the nausea and vomiting subside, oral food and fluids are gradually reintroduced. Total parenteral nutrition or a feeding tube is used to prevent malnutrition only if the client does not improve with these interventions.
Which of the following would the nurse prepare to administer if ordered as treatment for an unruptured ectopic pregnancy? a) Promethazine b) Ondansetron c) Oxytocin d) Methotrexate
Methotrexate Correct Explanation: Methotrexate, a folic acid antagonist that inhibits cell division in the developing embryo, is most commonly used to treat ectopic pregnancy. Oxytocin is used to stimulate uterine contractions and would be inappropriate for use with an ectopic pregnancy. Promethazine and ondansetron are antiemetics that may be used to treat hyperemesis gravidarum
A pregnant client has been admitted with complaints 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 of the following? a) Ectopic pregnancy b) Placenta previa c) Molar pregnancy d) Abruption of placenta
Molar pregnancy Correct Explanation: The client is most likely experiencing molar pregnancy. In 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.
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? a) Palpate the fundus and check fetal heart rate. b) Obtain a voided urine specimen and determine blood type. c) Measure fundal height. d) Check deep tendon reflexes.
Palpate the fundus and check fetal heart rate. Explanation: The classic signs of abruption placentea are pain, dark red vaginal bleeding, a rigid, board-like abdomen, hypertonic labor, and fetal distres
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? a) Measure fundal height. b) Check deep tendon reflexes. c) Palpate the fundus and check fetal heart rate. d) Obtain a voided urine specimen and determine blood type.
Palpate the fundus and check fetal heart rate. Explanation: The classic signs of abruption placentea are pain, dark red vaginal bleeding, a rigid, board-like abdomen, hypertonic labor, and fetal distress.
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? a) Hypertension. b) Pregnancy loss. c) Premature birth. d) Preterm labor.
Pregnancy loss. Correct Explanation: The client's advanced maternal age (pregnancy in a woman 35 years or older) increases her risk for pregnancy loss. Hypertension, preterm labor, and prematurity are risks as this pregnancy continues. Her greatest risk at 13 weeks' gestation is losing this pregnancy
A woman in labor has sharp fundal pain accompanied by slight vaginal bleeding. Which of the following would be the most likely cause of these symptoms? a) Placenta previa obstructing the cervix b) Possible fetal death or injury c) Preterm labor that was undiagnosed d) Premature separation of the placenta
Premature separation of the placenta Correct Explanation: Premature separation of the placenta begins with sharp fundal pain, usually followed by vaginal bleeding. Placenta previa usually produces painless bleeding; labor contractions are more often described as cramping
A woman in labor has sharp fundal pain accompanied by slight vaginal bleeding. Which of the following would be the most likely cause of these symptoms? a) Preterm labor that was undiagnosed. b) Premature separation of the placenta. c) Placenta previa obstructing the cervix. d) Possible fetal death or injury.
Premature separation of the placenta. Explanation: Premature separation of the placenta begins with sharp fundal pain, usually followed by vaginal bleeding. Placenta previa usually produces painless bleeding; Preterm labor contractions are more often described as cramping. Possible fetal death or injury does not present with sharp fundal pain. It is usually painless.
A woman develops HELLP syndrome. During labor, which of the following orders would you question? a) Assess her blood pressure every 15 minutes. b) Prepare her for epidural anesthesia. c) Assess the urine output every hour. d) Urge her to lie on her left side during labor.
Prepare her for epidural anesthesia. Explanation: A consequence of the HELLP syndrome is poor blood coagulation. Epidural anesthesia is not recommended when blood coagulation is in doubt.
A patient is admitted to labor and delivery for management of severe preeclampsia. An IV infusion of magnesium sulfate is started. What is the primary goal for magnesium sulfate therapy? a) Decrease blood pressure b) Prevent maternal seizures c) Reverse edema d) Decrease protein in urine
Prevent maternal seizures Correct Explanation: The primary therapy goal for any preeclamptic patient is to prevent maternal seizures. Use of magnesium sulfate is the drug therapy of choice for severe preeclampsia and is only used to manage and attempt to prevent progression to eclampsia. Magnesium sulfate therapy does not have as its primary goal a decrease in blood pressure, a decrease in protein in the urine, nor the reversal of edema
A patient is admitted to labor and delivery for management of severe preeclampsia. An IV infusion of magnesium sulfate is started. What is the primary goal for magnesium sulfate therapy? a) Reverse edema b) Decrease protein in urine c) Decrease blood pressure d) Prevent maternal seizures
Prevent maternal seizures Explanation: The primary therapy goal for any preeclamptic patient is to prevent maternal seizures. Use of magnesium sulfate is the drug therapy of choice for severe preeclampsia and is only used to manage and attempt to prevent progression to eclampsia. Magnesium sulfate therapy does not have as its primary goal a decrease in blood pressure, a decrease in protein in the urine, nor the reversal of edema.
What makes the diagnosis of gestational hypertension different from the diagnosis of preeclampsia? a) Severity of hypertension b) Proteinuria c) Ketonuria d) The hypertension of gestation disappears after delivery. The hypertension of preeclampsia does not.
Proteinuria Explanation: Gestational hypertension is the current term used to describe elevated blood pressure (greater than or equal to 140/90 mm/Hg) that develops for the first time during pregnancy without the presence of protein in the urine.
You are caring for a patient with preeclampsia. You know that you need to auscultate this patient's lung sounds every two hours. Why would you do this? a) Pulmonary atelectasis b) Pulmonary emboli c) Pulmonary hypertension d) Pulmonary edema
Pulmonary edema Correct Explanation: In the hospital, monitor blood pressure at least every four hours for mild preeclampsia and more frequently for severe disease. In addition, it is important to auscultate the lungs every two hours. Adventitious sounds may indicate, developing pulmonary edema
The following hourly assessments are obtained by the nurse on a patient with preeclampsia receiving Magnesium Sulfate: 97.3, P88, R10, blood pressure 148/110. What other priority physical assessment by the nurse should be implemented to assess for potential toxicity? a) Lung sounds b) Magnesium sulfate level c) Reflexes d) Oxygen saturation
Reflexes Correct Explanation: Reflex assessment is part of the standard assessment for patients on magnesium sulfate. The first change when developing magnesium toxicity may be a decrease in reflex activity. The health care provider needs to be notified immediately. A change in lung sounds and oxygen saturation are not indicative of magnesium sulfate toxicity. Hourly blood draws to gain information on the magnesium sulfate level are not indicated.
A patient with preeclampsia is receiving magnesium sulfate. Which of the following nursing assessments should be ongoing while the medication is being administered? a) Respiratory rate. b) Ability to sleep. c) Hemoglobin. d) Urine protein.
Respiratory rate. Explanation: The level of magnesium in therapeutic range is 4 to 8 mg/dL. If magnesium toxicity occurs, one sign in the patient will be a decrease in the respiratory rate and a potential respiratory arrest. Respiratory rate will be monitored when on this medication. The patient's hemoglobin and ability to sleep are not factors for on-going assessments for the patient on magnesium sulfate. Urinary output is measured hourly on the preeclamptic patient receiving magnesium sulfate, but urine protein is not an ongoing assessment. (less)
Which measure would be most effective in preventing isoimmunization during pregnancy? a) RhoGAM administration to Rh-negative women b) Amniocentesis c) Cerclage d) Blood typing of mothers with type A or B blood
RhoGAM administration to Rh-negative women Correct Explanation: Rh incompatibility can be prevented with the use of RhoGAM. Hemolysis associated with ABO incompatibility is limited to mothers with type O blood and their fetuses with type A or B blood. Amniocentesis would be appropriate for treatment of polyhydramnios, not isoimmunization. Cerclage is a treatment for cervical insufficiency
A woman in labor is at risk for abruptio placentae. Which of the following assessments would most likely lead you to suspect that this has happened? a) Pain in a lower quadrant and increased pulse rate. b) An increased blood pressure and oliguria. c) Sharp fundal pain and discomfort between contractions. d) Painless vaginal bleeding and a fall in blood pressure.
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.
When assessing a pregnant woman with vaginal bleeding, which finding would lead the nurse to suspect an inevitable abortion? a) Closed cervical os b) No passage of fetal tissue c) Strong abdominal cramping d) Slight vaginal bleeding
Strong abdominal cramping Correct Explanation: Strong abdominal cramping is associated with an inevitable abortion. Slight vaginal bleeding early in pregnancy and a closed cervical os are associated with a threatened abortion. With an inevitable abortion, passage of the products of conception may occur. No fetal tissue is passed with a threatened abortion
A pregnant woman at 12 weeks' gestation calls you because she has begun minimal fresh vaginal spotting. She is distressed because her physician says she is not going to do anything for her but "wait and see." Which of the following would you suggest? a) Suggest she take an over-the-counter tocolytic just to feel secure. b) Explain that her doctor meant for her to maintain strict bed rest by "wait and see." c) Tell her that medication to prolong a 12-week pregnancy usually is not advised. d) Advise her to ask for a second physician opinion.
Tell her that medication to prolong a 12-week pregnancy usually is not advised. Explanation: Because many early pregnancy losses occur as the result of chromosome abnormalities, an aggressive approach to prolong these is not usually recommended
A woman at 8 weeks' gestation is admitted for ectopic pregnancy. She is asking why this has occurred. The nurse knows that which of the following is a known risk factor for ectopic pregnancy? a) Use of IUD for contraception b) High number of pregnancies c) Use of oral contraceptives d) Multiple gestation pregnancy
Use of IUD for contraception Correct Explanation: Use of an IUD with progesterone has a known increased risk for development of ectopic pregnancies. The nurse needs to complete a full history of the patient to determine if she had any other risk factors for an ectopic pregnancy. Adhesions, scarring, and narrowing of the tubal lumen may block the zygote's progress to the uterus. Any condition or surgical procedure that can injure a fallopian tube increases the risk. Examples include salpingitis, infection of the fallopian tube, endometriosis, history of prior ectopic pregnancy, any type of tubal surgery, congenital malformation of the tube, and multiple elective abortions. Conditions that inhibit peristalsis of the tube can result in tubal pregnancy. Hormonal factors may play a role because tubal pregnancy occurs more frequently in women who take fertility drugs or who use progesterone intrauterine contraceptive devices (IUDs). A high number of pregnancies, multiple gestation pregnancy, and the use of oral contraceptives are not known risk factors for ectopic pregnancy
A woman who is Rh negative asks you how many children she will be able to have before Rh incompatibility causes them to die in utero. Your best response would be that a) no more than three children is recommended. b) she will have to ask her physician. c) only her next child will be affected. d) as long as she receives RhIG, there is no limit.
as long as she receives RhIG, there is no limit. Correct Explanation: Because RhIG supplies passive antibodies, it prevents the woman from forming antibodies. Without antibodies that could affect the fetus, the woman could have as many children as she wants.
A patient is admitted at 22 weeks gestation with advanced cervical dilatation to 5 centimeters, cervical insufficiency, and a visible amniotic sac at the cervical opening. What is the primary goal for this patient at this point? a) Notification of social support for loss of pregnancy b) Education on causes of cervical insufficiency for the future c) Bed rest to maintain pregnancy as long as possible d) Deliver vaginally
ed rest to maintain pregnancy as long as possible Correct Explanation: At 22 weeks gestation, the fetus is not viable. The woman would be placed on bed rest, total, with every attempt made to halt any further progression of dilatation as long as possible. You would not want to deliver this fetus vaginally at this stage of gestation. It is not your responsibility to notify the patient's social support of a possible loss of the pregnancy. It is not appropriate at this time to educate the mother on causes of cervical insufficiency for future pregnancies.
Which of the following would be the physiologic basis for a placenta previa? a) A loose placental implantation b) Low placental implantation c) A uterus with a midseptum d) A placenta with multiple lobes
ow placental implantation Correct Explanation: The cause of placenta previa is usually unknown, but for some reason the placenta is implanted low instead of high on the uterus.
