Unit 1 Exam

A client, 34 weeks pregnant, arrives at the ER with SEVERE abdominal pain, uterine tenderness and an increased uterine tone. The client denies vaginal bleeding. The external fetal monitor shows fetal distress with severe, variable decels. The client most likely has which of the following? 1. Abruptio Plantae 2. Placenta Previa 3. Molar Pregnancy 4. Ectopic Pregnancy

1. Abruptio placentae a client w/ severe abruptio placentae will often have SEVERE abdominal pain. The uterus will have increased tone w/ little to no return to resting tone btw/ contractions. The fetus will start to show signs of distress, with decels in the HR or even fetal death w/ large placental separation.Placenta previa usually involves PAINLESS vaginal bleeding w/out UCs. A molar preg. generally would be detected before 34 weeks gestation. An ecoptic preg. which usually occurs in the FALLOPIAN TUBES, would rupture well before 34 weeks gestation

a 21 y.o. client, 6 weeks pregnant, is diagnosed with hyperemesis gravidum. This excessive vomiting during pregnancy will often result in which of the following? 1. bowel perforation 2. electrolyte imbalance 3. miscarriage 4. PIH

2. ELECTROLYTE IMBALANCE Excessive vomiting in clients with hyperemesis grav often causes weight loss / fluid and electrolyte, acid base imbalance. PIH and bowel perforation arent r/t hyper gravthe effects of hyper grav on the fetus depend on the severity of the disorder. clients w/ severe hyper grav may have low birth weight infant, but the disorder isnt life threatening to the fetus.

17 y.o. primpigravida with severe preeclampsia has been receiving mag sulfate IV for 3 hours. The latest assessment reveals DTR of +1, BP 150/100 , pulse 92 bpm, respiratory rate 10bpm and urine output 20ml/hr. Which of the following actions would be most appropriate? 1. Continue monitoring per standards of care 2. Stop the mag sulfate infusion 3. Increase infusion by 5gtt/min 4. Decrease infusion by 5gtt/min

2. Stop the mag sulfate infusion Mag sulfate should be withheld if the clients resp rate or urine output falls or if reflexes are diminished / absent. The client also shows other signs of impending toxicity such as flushing / feeling warm. Inaction won't resolve the clients suppressed DTRs and low RR / urine output. The client is already showing CNS depression bc of excessive magnesium sulfate so increasing the infusion is wrong. Impending toxicity indicates that the infusion should be stopped rather than just slowed down.

After reviewing the client's maternal history of magnesium sulfate during labor, which condition would the nurse anticipate as a potential problem in the neonate? 1. hypoglycemia 2. jitteriness 3. respiratory depression 4. tachycardia

3. resp depression mag sulfate crosses the placenta and adverse neonatal effects are: resp depression hypotonia bradycardia the serum blood sugar isn't affected by mag sulfate the neonate would be floppy, not jittery

A client, diagnosed with DIC (disseminated intravascular coagulation), has delivered at 38 weeks gestation. Which is the priority nursing intervention for the nurse providing postpartum care to this client? A.Elevate the affected extremity B.Assess for post-partum hemorrhage C.Replace fluid lost from the massive diaphoresis D.Continue teaching the client how to give her own heparin injections

A.Assess for post-partum hemorrhage

The nurse identifies the following assessment findings on a client with preeclampsia: BP 158/100; urinary output 50 mL/hour; lungs clear to auscultation; urine protein 1+ on dipstick; and edema of the hands, ankles and feet. On the next hourly assessment, which new assessment finding indicates that the preeclampsia is worsening? A.blood pressure 158/104 B.urinary output 20 mL/hour C.reflexes 2+ D.platelet count 150,000

A.urinary output 20 mL/hour

Which of the following would the nurse have readily available for a client who is receiving magnesium sulfate to treat severe preeclampsia?A) Calcium gluconate B) Potassium chloride C) Ferrous sulfate D) Calcium carbonate

Ans: A The antidote for magnesium sulfate is calcium gluconate, and this should be readily available in case the woman has signs and symptoms of magnesium toxicity.

A woman is receiving magnesium sulfate as part of her treatment for severe preeclampsia. The nurse is monitoring the woman's serum magnesium levels. Which level would the nurse identify as therapeutic? A) 3.3 mEq/L B) 6.1 mEq/L C) 8.4 mEq/L D) 10.8 mEq/L

Ans: B Although exact levels may vary among agencies, serum magnesium levels ranging from 4 to 8 mEq/L are considered therapeutic, whereas levels more than 8 mEq/dL are generally considered toxic.

The nurse is developing a plan of care for a woman who is pregnant with twins. The nurse includes interventions focusing on which of the following because of the woman's increased risk? A) Oligohydramnios B) Preeclampsia C) Post-term labor D) Chorioamnionitis

Ans: B Women with multiple gestations are at high risk for preeclampsia, preterm labor, hydramnios, hyperemesis gravidarum, anemia, and antepartal hemorrhage. There is no association between multiple gestations and the development of chorioamnionitis.

A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. Which finding would the nurse interpret as indicating a therapeutic level of medication? A) Urinary output of 20 mL per hour B) Respiratory rate of 10 breaths/minute C) Deep tendons reflexes 2+ D) Difficulty in arousing

Ans: C With magnesium sulfate, deep tendon reflexes of 2+ would be considered normal and therefore a therapeutic level of the drug. Urinary output of less than 30 mL, a respiratory rate of less than 12 breaths/minute, and a diminished level of consciousness would indicate magnesium toxicity.

The nurse is reviewing the laboratory test results of a pregnant client. Which one of the following findings would alert the nurse to the development of HELLP syndrome? A) Hyperglycemia B) Elevated platelet count C) Leukocytosis D) Elevated liver enzymes

Ans: D HELLP is an acronym for hemolysis, elevated liver enzymes, and low platelets. Hyperglycemia or leukocytosis is not a part of this syndrome.

A nurse is assessing a pregnant woman with gestational hypertension. Which of the following would lead the nurse to suspect that the client has developed severe preeclampsia? A) Urine protein 300 mg/24 hours B) Blood pressure 150/96 mm Hg C) Mild facial edema D) Hyperreflexia

Ans: D Severe preeclampsia is characterized by blood pressure over 160/110 mm Hg, urine protein levels greater than 500 mg/24 hours and hyperreflexia. Mild facial edema is associated with mild preeclampsia.

A woman with gestational hypertension experiences a seizure. Which of the following would be the priority? A) Fluid replacement B) Oxygenation C) Control of hypertension D) Delivery of the fetus

Ans:B As with any seizure, the priority is to clear the airway and maintain adequate oxygenation both to the mother and the fetus. Fluids and control of hypertension are addressed once the airway and oxygenation are maintained. Delivery of fetus is determined once the seizures are controlled and the woman is stable.

The doctor suspects that the client has an ectopic pregnancy. Which symptom is consistent with a diagnosis of ectopic pregnancy? a. Painless vaginal bleeding b. Abdominal cramping c. Throbbing pain in the upper quadrant d. Sudden, stabbing pain in the lower quadrant

Answer D The signs of an ectopic pregnancy are vague until the fallopian tube ruptures. The client will complain of sudden, stabbing pain in the lower quadrant that radiates down the leg or up into the chest. Painless vaginal bleeding is a sign of placenta previa, abdominal cramping is a sign of labor, and throbbing pain in the upper quadrant is not a sign of an ectopic pregnancy, making answers A, B, and C incorrect.

Which action does the nurse take to determine whether the carbohydrate intake is inadequate in a pregnant patient with diabetes? 1. Monitor for urine ketones. 2. Evaluate the nonstress test results. 3. Determine the degree of glycosuria. 4. Schedule a baseline fetal sonogram.

Answer- 1 If a patient with diabetes does not take in enough carbohydrates, the body resorts to breaking down fats for energy. The by-product of fat metabolism is ketones. Therefore the nurse monitors the urine for ketones. The amount of ketones in the urine helps detect inadequate carbohydrate intake. Nonstress tests will help assess the well-being of the fetus. Glycosuria does not accurately reflect the blood glucose levels because of a lowered renal threshold for glucose during pregnancy. The nurse obtains a baseline sonogram to assess gestational age in the first trimester.

Which medication does the primary health care provider ask the nurse to administer to a patient during labor in a vaginal delivery, who has a history of a myocardial infarction (MI)? 1. Oxytocin 2. Diuretics 3. Anticoagulant 4. Epidural analgesia

Answer- 4 Epidural analgesia is administered during labor to a patient with MI to prevent pain, which can result in tachycardia and increased cardiac demands. Oxytocin is administered to a patient after birth to prevent hemorrhage. Diuretics are administered to prevent fluid retention in a pregnant patient with a heart disease. Anticoagulant therapy is administered for recurrent venous thrombosis in pregnancy.

§A pregnant client is admitted to the hospital with preeclampsia. Her blood pressure is 148/100, her urine protein is 2+, and she has pitting ankle edema. The physician orders MgSO4 intravenously. Which of the following medications would be the most important for the nurse to have available at the bedside? A. Epinephrine B. Naloxone (Narcan) C. Calcium gluconate D. Diazepam (Valium)

Answer- C A. Epinephrine = stimulant B. Naloxone (Narcan) = antagonist for opioids C. Calcium gluconate = antidote for MgSO4 D. Diazepam (Valium) = anxiolytic

Four 38-week-gestation gravidas have just delivered. Which of the babies should be monitored closely by the nurse for respiratory distress? 1.The baby whose mother has diabetes mellitus. 2.The baby whose mother has lung cancer. 3.The baby whose mother has hypothyroidism. 4.The baby whose mother has asthma.

Answer-1 1.The lung maturation of infants of diabetic mothers is often delayed. These babies must be monitored at birth for respiratory distress. 2.A maternal diagnosis of lung cancer will not affect her neonate's pulmonary function. 3.A maternal diagnosis of hypothyroidism does not put the baby at high risk for respiratory distress. 4.A maternal diagnosis of asthma does not put the baby at high risk for respiratory distress.

A Type I diabetic is being seen for preconception counseling. The nurse should emphasize that during the first trimester the woman may experience which of the following? 1.Need for less insulin than she normally injects. 2.An increased risk for hyperglycemic episodes. 3.Signs and symptoms of hydramnios. A need to be hospitalized for fetal testing.

Answer-1 1.Type 1 diabetic often need less insulin during the first trimester than they did preconception. 2.The client will be at high risk for hypoglycemic episodes. 3.Hydramnios does not develop until the 2nd or 3rd trimester. 4.The client will likely be hospitalized during the 2nd and/or 3rd trimesters for fetal testing.

A client has a history of insulin dependent diabetes. The client is 10 weeks pregnant and has had persistent nausea and vomiting. The client states that her blood glucose has been 60-80 mg/dl. Based on the client's history, what is the nurse's priority concern? 1.Hypoglycemia 2.Hyperglycemia 3.Glucogenesis 4.Glucosuria

Answer-1 In early pregnancy, blood sugar is low because the liver decreases glucose production.

A nurse is providing instructions to a pregnant client with HIV infection regarding care to the newborn infant after delivery. The client asks the nurse about the feeding options that are available. The best response by the nurse is: 1."You will need to bottle-feed the newborn infant." 2."You will need to feed the newborn infant by NG tube." 3."You will be able to breast-feed for 6 months and then will need to switch to bottle-feeding." 4."You will be able to breast-feed for 9 months and then will need to switch to bottle feeding."

Answer-1 Perinatal transmission of HIV can occur during the antepartal period, during labor and birth, or in the postpartum period if the mother is breast-feeding. Clients who have HIV are advised not to breast-feed. There is no physiological reason why the newborn needs to be fed by NG tube.

A postpartum client, who admits to heavy alcohol use, asks the nurse about breastfeeding her baby. The nurse teaches the client that excessive alcohol consumption, while breastfeeding, may have which result? 1.Increase need for pain medication for the mother. 2.Decreased maternal milk letdown reflex. 3.Excessive weight loss for the mother. 4.Seizure disorders in the newborn.

Answer-2

A nurse implements a teaching plan for a pregnant client who is newly diagnosed with GDM. Which statement made by the client indicates a need for further teaching? 1."I should stay on the diabetic diet." 2."I should perform glucose monitoring at home." 3."I should avoid exercise because of the negative effects on insulin production." 4."I should be aware of any infections and report signs of infection immediately to my health care provider."

Answer-3 Exercise is safe for a client with GDM and is helpful in lowering the blood glucose level. Dietary modifications are the mainstay of treatment, and the client is placed on a standard diabetic diet. Many clients are taught to perform blood glucose monitoring. If the client is not performing the blood glucose monitoring at home, it is performed at the clinic or health care provider's office. Signs of infection need to be reported the health care provider.

A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to: a. Stimulate fetal surfactant production. b. Reduce maternal and fetal tachycardia associated with ritodrine administration. c. Suppress uterine contractions. d. Maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy.

Answer-A Antenatal glucocorticoids given as intramuscular injections to the mother accelerate fetal lung maturity. Inderal would be given to reduce the effects of ritodrine administration. Betamethasone has no effect on uterine contractions. Calcium gluconate would be given to reverse the respiratory depressive effects of magnesium sulfate therapy.

A 17 yr old nullipara reports to the clinic in the 24th week of gestation. Which of the following findings would indicate the need for further assessment by the nurse? A. edema of the lower extremities at the end of the day B. presence of clear thin vaginal mucous C. blurred vision reported by the patient D. low back ache

Answer-C A. normal in pregnancy B. normal in pregnancy C. could indicate PIH D. normal in pregnancy

A 32 yr old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on which of the following? A. A D&C will be performed to remove the products of conception B. Bedrest and analgesics are the recommended treatment C. She will be unable to conceive in the future. D. The patient is at high risk for hemorrhage

Answer-D A. cannot remove ectopic pregnancy with a D&C B. Must remove the pregnancy C. She would still have at least one tube D. from rupture of the tube.

A client is admitted to the postpartum unit with a MgSO4 continuous IV drip for pregnancy-induced hypertension. She delivers a viable neonate by C/S. which of the following immediate post op orders would the nurse most likely question? A. Anzimet 12.5mg IM now for nausea B. Demerol 50mg IM every 4 hours PRN pain C. MgSO4 level 4 hours post delivery D. Discontinue MgSO4 drip

Answer-D A. safe to give B. safe to give C. follows protocol D. should continue for 24 hours

13) During the first antepartal visit, a client who is at 10 weeks' gestation learns of being HIV positive. Which client statement indicates an understanding of the plan of care both during the pregnancy and postpartally? 1. "I should not breastfeed my baby." 2. "When my baby is 2 months old, he or she will be tested for HIV." 3. "If I have a cesarean section, there is an increased risk that my HIV will be passed to my baby." 4. "I am supposed to take highly active antiretroviral therapy (HAART), but only during the first trimester."

Answer: 1 Explanation: 1. HIV transmission can occur during pregnancy and through breast milk; however, it is believed that the majority of all infections occur during labor and birth. 2. Following birth, HIV infection in infants should be diagnosed using HIV virologic assays as soon as possible, with initiation of infant antiretroviral prophylaxis immediately if the test is positive. 3. Cesarean section reduces the transmission of HIV from mother to infant. 4. Longer duration therapy is preferable to shorter duration approaches, and it is best to start prophylaxis after the first trimester and no later than 28 weeks' gestation in women who do not require immediate therapy for their own health.

22) A pregnant client is diagnosed with a cardiac problem. What should the nurse prepare to instruct this client to do, to ensure a safe pregnancy? Select all that apply. 1. Restrict activities. 2. Follow a diet high in iron and protein. 3. Restrict the intake of sodium. 4. Obtain 8 to 10 hours of sleep. 5. Obtain pneumococcal vaccination.

Answer: 1, 2, 3, 4 Explanation: 1. To help preserve her cardiac reserves, the woman may need to restrict her activities. 2. For the pregnant client with cardiac problems, the client should be instructed in the importance of a diet high in iron and protein. 3. For the pregnant client with cardiac problems, the client should be instructed in the importance of a diet low in sodium. 4. For the pregnant client with cardiac problems, 8 to 10 hours of sleep are essential.5. Because upper respiratory infections may tax the heart and lead to decompensation, the woman must avoid contact with sources of infection. A pneumococcal vaccination is not indicated.

6) A newly diagnosed type 1, insulin-dependent diabetic with good blood sugar control at 20 weeks' gestation asks how the diabetes will affect the baby. How should the nurse respond? 1. "Your baby may be smaller than average at birth." 2. "Your baby will probably be larger than average at birth." 3 "Your baby might have high blood sugar for several days." 4. "As long as you control your blood sugar, your baby will not be affected at all."

Answer: 2 Explanation: 1. Poorly controlled type 1 diabetics who have developed vascular problems will have infants who are small-for-gestational-age (SGA) due to placental insufficiency. 2. The infant of a diabetic mother produces excessive amounts of insulin in response to the high blood sugar. This hyperinsulinism stimulates growth (or macrosomia) in the infant because the infant utilizes the glucose in the bloodstream. 3. Within minutes of delivery, the baby of an insulin-dependent diabetic can begin to develop low blood sugar. 4. The demands of pregnancy will make it difficult for the best of clients to control blood sugar on a regular basis.

10) A woman at 30 weeks' gestation and a history of sickle cell anemia is experiencing fever, chills, and diarrhea for 3 days. What are the most serious potential complications that this client faces? 1. Severe lethargy 2. Sickle cell crisis 3. Electrolyte imbalance 4. Fetal neural tube defects

Answer: 2 Explanation: 1. While the client may develop severe lethargy, her greatest risk concerns development of sickle cell crisis. 2. Dehydration and fever can trigger sickling and crisis; for this reason, maternal infections are treated promptly. 3. While the client may experience electrolyte imbalance, sickle cell crisis is the most serious potential complication of dehydration and fever. 4. Fever, chills, and dehydration in the client with sickle cell anemia are not associated with an increased incidence of neural tube defects.

17) The nurse is caring for the newborn of a client who received magnesium sulfate for preterm labor. Which fetal effects should the nurse attribute to the client's medication treatment? Select all that apply. 1. Flushing 2. Lethargy 3. Hypotonia 4. Poor sucking reflex 5. Respiratory depression

Answer: 2, 3, 5 Explanation: 1. Flushing is a maternal adverse effect of magnesium sulfate. 2. Fetal side effects of magnesium sulfate may include lethargy that persists for 1 or 2 days following birth. 3. Fetal side effects of magnesium sulfate may include hypotonia that persists for 1 or 2 days following birth. 4. Poor sucking reflex is not an adverse effect of magnesium sulfate.5. Respiratory depression in the newborn can also occur after maternal magnesium sulfate.

12) A client at 9 weeks' gestation learns about being HIV positive. Which client statement indicates teaching about the effects on the baby has been effective? 1. "The pregnancy will increase the progression of my disease and will reduce my CD4 counts." 2. "The HIV will not affect my baby, and I will have a low-risk pregnancy without additional testing." 3. "My baby will probably be born with anti-HIV antibodies, but that does not mean the baby is infected." 4. "I cannot take the medications that control HIV during my pregnancy because they will harm the baby."

Answer: 3 Explanation: 1. There is no evidence to indicate that pregnancy increases the progression of HIV/AIDS. 2. Pregnancy affected by HIV/AIDS is considered complicated, and the fetus is monitored closely. Fetal assessments include weekly non-stress tests beginning at 32 weeks. 3. Babies of HIV-positive women or women with AIDS are born with maternal anti-HIV antibodies. HIV infection in infants should be diagnosed using HIV virologic assays as soon as possible, with initiation of infant antiretroviral prophylaxis immediately if the test is positive. 4. Most of the medications that control HIV progression are safe to take during pregnancy. Antiretroviral medications are recommended during pregnancy to prevent perinatal transmission.

1) A pregnant client who uses cocaine and ecstasy on a regular basis asks why ecstasy should not be used during pregnancy. What should the nurse explain about this drug? 1. "It produces intrauterine growth restriction and meconium aspiration." 2. "It leads to deficiencies of thiamine and folic acid, which help the baby develop." 3. "It produces babies with small heads and short bodies with brain function alterations." 4. "It can cause a high fever in you if high doses are taken and therefore cause the baby harm."

Answer: 4 Explanation: 1. Heroin causes these fetal effects, not ecstasy. 2. Alcohol, not ecstasy, causes deficiencies of thiamine and folic acid. Folic acid helps prevent neural tube defects. 3. Cocaine causes these fetal effects, not ecstasy. 4. High body temperature is a side effect of MDMA (methylenedioxymethamphetamine: ecstasy). Increased body temperature increases fetal oxygen needs, which can lead to hypoxia and subsequent brain and major organ damage.

15) For which reason should the nurse suspect hydramnios in a pregnant client?1. The client is pregnant with twins. 2. The quadruple screen comes back positive. 3. There is less amniotic fluid than normal for gestation. 4. The fundal height increases disproportionately to the gestation.

Answer: 4 Explanation: 1. Hydramnios is not suspected simply by virtue of a twin gestation. 2. A quadruple screen is not used to determine hydramnios. 3. Hydramnios occurs when there is more amniotic fluid than normal for gestation. 4. The increased amount of amniotic fluid will increase the fundal height disproportionately to the gestation.

11) A client who is at 18 weeks' gestation has been newly diagnosed with megaloblastic anemia. Which client statement indicates teaching has been effective? 1. "My body makes red blood cells that are smaller than they should be." 2. "Megaloblastic anemia is not known to cause any serious risks to my baby." 3. "Whenever possible, I should boil my vegetables in at least 2 quarts of water." 4. "I should include fresh leafy green vegetables, red meat, fish, poultry, and legumes in my diet."

Answer: 4 Explanation: 1. In megaloblastic anemia, red blood cells become enlarged and are fewer in number. 2. Maternal folic acid deficiency has been associated with an increased risk of neural tube defects (NTDs) such as spina bifida, meningomyelocele, and anencephaly in the newborn. 3. Folic acid, which is crucial for inclusion in the diet of clients with megaloblastic anemia, is easily destroyed by overcooking or cooking with large quantities of water. 4. Folic acid, which is used to treat megaloblastic anemia, is readily available in foods such as fresh leafy green vegetables, red meat, fish, poultry, and legumes.

2) The nurse is doing preconception counseling with a 28-year-old woman with no prior pregnancies. Which client statement indicates that teaching has been effective? 1. "A beer once a week will not damage the fetus." 2. "I can continue to drink alcohol until I am diagnosed as being pregnant." 3. "I can drink alcohol while breastfeeding since it does not pass into breast milk." 4. "I need to stop drinking alcohol completely when I start trying to get pregnant

Answer: 4 Explanation: 1. It is not known how much alcohol will cause fetal damage; therefore, alcohol during pregnancy is contraindicated. 2. Women should discontinue drinking alcohol when they start to attempt pregnancy. 3. Breastfeeding generally is not contraindicated, although alcohol is excreted in breast milk. Excessive alcohol consumption may intoxicate the infant and inhibit the maternal letdown reflex. 4. Because birth defects that are related to fetal alcohol exposure can occur in the first 3 to 8 weeks' gestation, often before the woman even knows she is pregnant, women should discontinue drinking alcohol when they start to attempt pregnancy.

5) The client with insulin-dependent type 2 diabetes and an HbA1c of 5% is planning to become pregnant soon. What anticipatory guidance should the nurse provide this client? 1. Vascular disease that accompanies diabetes slows progression. 2. The risk of ketoacidosis decreases during the length of the pregnancy. 3. The baby is likely to have a congenital abnormality because of the diabetes. 4. Insulin needs decrease in the first trimester and increase during the third trimester.

Answer: 4 Explanation: 1. Vascular disease progresses more rapidly during pregnancy, especially if blood sugar control is not good. Problems such as nephropathy and retinopathy can result. 2. The risk of ketoacidosis increases during pregnancy. 3. Infants of diabetic mothers have a 5% to 10% greater risk of having a congenital abnormality. This risk increases to 20% to 25% if the HbA1c is over 10%. 4. In addition, insulin requirements drop suddenly after delivery of the placenta.

5) The nurse is planning an educational program about disseminated intravascular coagulation (DIC) in pregnancy. What risk factors should the nurse include about this health problem? Select all that apply. 1. Multiparity 2. Preterm labor 3. Diabetes mellitus 4. Abruptio placentae 5. Prolonged retention of a fetus after demise

Answer: 4, 5 Explanation: 1. Multiparity does not cause the same release of thromboplastin that triggers DIC. 2. Preterm labor does not cause the same release of thromboplastin that triggers DIC. 3. Diabetes does not cause the same release of thromboplastin that triggers DIC. 4. Abruptio placentae leaves intrauterine arteries open and bleeding. This results in release of thromboplastin into the maternal blood supply and triggers the development of DIC. 5. In prolonged retention of the fetus after demise, thromboplastin is released from the degenerating fetal tissues into the maternal bloodstream, which activates the extrinsic clotting system. This triggers the formation of multiple tiny clots, which deplete the fibrinogen and factors V and VII, and result in DIC.

Maternal and neonatal risks associated with gestational diabetes mellitus are: A. maternal premature rupture of membranes and neonatal sepsis. B. maternal hyperemesis and neonatal low birth weight. C. Maternal preeclampsia and fetal macrosomia. D. maternal placenta previa and fetal prematurity.

C. Maternal preeclampsia and fetal macrosomnia Premature rupture of membranes and neonatal sepsis are not risks associated with gestational diabetes. Hyperemesis is not seen with gestational diabetes, nor is there an association with low birth weight of the infant. Women with gestational diabetes have twice the risk of developing hypertensive disorders such as preeclampsia, and the baby usually has macrosomia. Placental previa and subsequent prematurity of the neonate are not risks associated with gestational diabetes.

During a physical assessment of an at-risk client, the nurse notes generalized edema, crackles at the base of the lungs, and some pulse irregularity. These are most likely signs of: A. euglycemia. B. rheumatic fever. C. pneumonia. D. cardiac decompensation.

D. cardiac decompensation Euglycemia is a condition of normal glucose levels. These symptoms indicate cardiac decompensation. Rheumatic fever can cause heart problems, but it does not present with these symptoms, which indicate cardiac decompensation. Pneumonia is an inflammation of the lungs and would not likely generate these symptoms, which indicate cardiac decompensation. Symptoms of cardiac decompensation may appear abruptly or gradually.